Patients suffering from Chronic KidneyFailure (CKF) are usually involved in haemodialysis (HD) treatment. Being compliant with the Integrated Care Process for HD patients defined by our regional health authorities , this process encompasses HD sessions, medical treatments, and follow-up sessions making use of lab tests.
The aging of the general popu- lation means that older people now account for a much greater proportion of patients with or at risk for kidney disease and kidneyfailure. The tremendous clinical heterogeneity within this population indicates the need for more discerning mana- gement. Chronological age alone will not be sufficient as the ba- sis for clinical decisions, and a more nuanced approach is re- quired - based on the comorbidi- ties, functional status, quality of life and preferences of each individual patient. Clinicians can be reassured that dialysis and kidney transplantation can increase life expectancy – and will allow reasonable quality of life in selected older people with kidneyfailure. Perhaps more importantly, clinicians, pa- tients and their families can be comforted by the knowledge that timely specialist evalua- tion can help to improve outco- mes and reduce symptoms in older people with advanced kid- ney disease – whether they have selected conservative ma- nagement or dialysis as their treatment plan.
this can be as high as 7% in the DM population. Acute perioperative kidneyfailure is associated with an increased risk for acute mortality of 40% to 90%. A prospective study of 109 patients with a baseline GFR of 82 ml/kg/min that underwent BS, found that the rate of AKI (defined as a rise in serum creatinine more than 25% above baseline or 0.5 mg/dl) was 6.4%. The majority of these cases had primary cardiopulmonary complication such as myocardial infarction, stroke, heart failure, or venous thromboembolism. The risks of AKI in patients with more advanced CKD undergoing BS are unknown. 5
We recommend studying the renal function in every patient with thyroid dysfunction. Having excluded other causes of kidneyfailure, an improvement in GFR can be expected in patients with subclinical hypothyroidism after levothyroxine treatment. Rev Argent Endocrinol Metab 49:115-118, 2012.
During the study period, the difference between the health burden caused by kidneyfailure and the burden associated with the rest of the complications increased. However, YLL and YLD show different trends during this period (the disaggregation of DALYs in YLL and YLD is available upon request). On the one hand, the difference between kidneyfailure YLL and the second cause of YLL, diabetic foot, rose 161% with this gap broadening in the last three years due to a continuous increase in kidneyfailure YLL and a stable trend in diabetic foot YLL. On the other hand, the difference between kidneyfailure YLD and the second cause of
kidney disease—from preventive efforts to curb development of acute kidney injury (AKI) or chronic kidney disease (CKD), to screening for kidney disease among persons at high risk, to access to subspecialty care and treatment of kidneyfailure with renal replacement therapy (RRT). World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and current state of global capacity for prevention and management. In this editorial, we highlight these disparities and emphasize the role of public policies and organizational structures in addressing them. We outline opportunities to improve our understanding of disparities in kidney disease, the best ways for them to be addressed, and how to streamline efforts toward achieving kidney health equity across the globe.
7) Schiavelli R. Estudio multicéntrico y retrospectivo de incidencia de retardo de la función renal. IX Congreso Argentino de Trasplante, II Congreso Argentino de En- fermería en Trasplante. Nov 2007; Santa Fe (Argentina). 8) Helfer MS, Vicari AR, Spuldaro F, Gonçalves LF, Manfro RC. Incidence, risk factors, and outcomes of delayed graft function in deceased donor kidney transplantation in a Brazilian center. Transplant Proc. 2014;46(6):1727-9.
Despite elegant demonstrations for the role of sex hormones in vascular health and immuno- regulation, the striking predominance in females of SLE, RA, and SS remains unexplained rela- tive to other systemic diseases such as ANCA vasculitis and hemolytic-uremic syndrome. Note that thrombotic thrombocytopenic purpura has a higher incidence in women, though this is likely due to the association with other condi- tions more common in women. The incidence of kidney involvement in SLE during pregnancy and similarities/differences in those with PE have not been well studied. The role of different medications and responses to medications for autoimmune diseases relative to sex has also not been well studied.
A recent paper, also from the University of Minnesota but from different authors, evaluated the impact of transplan- tation on QOL in diabetic patients with ESRD . Spe- cifically, the authors addressed the interesting question whether simultaneous kidney/pancreas transplantation (KPT) confers a better QOL than kidney transplantation alone with subcutaneous insulin therapy. Most QOL read- ings improved after transplantation in both groups. After adjustment for co-morbidities, the authors found higher SF-36 scores in KPT in the domains of physical function- ing, bodily pain, general health and the physical compo- nent. The better physical scores could be attributed to the perceived benefits of reduced secondary diabetes compli- cations, the higher mental scores remained unexplained. Johnson and colleagues published the first study that eval- uated changes in QOL in the first year after renal trans- plantation split by gender and race . The authors used three questionnaires to assess HRQL, the Sickness Impact Profile, Ferrans and Powers' Quality of life index, and the adult self image scales. African-American patients observed less QOL improvement compared to Caucasian patients, and women scored consistently lower than men. This study demonstrates nicely the although all partici- pants improved their QOL, considerable racial and gender differences exist and these differences may affect care requirements.
In conclusion, LKT is an effective therapeutic op- tion in patients with end-stage liver and kidney disease. Late complications as well as medium-term survival are comparable to those obtained with iso- lated LT and although two organs are used in the same recipient, the good results should not dis- courage this practice in patients in need of both or- gans. The difficulty in clinical practice remains in when to decide in each patient when she/he actually needs a simultaneous LKT.
Background: Patients with chronic kidney disease (CKD) have a high symptoms burden that is related to a poor health-related quality of life (HRQoL) and high costs of care. Validated instruments may be useful for assessing the symptoms and monitoring outcomes in these patients. The Palliative care Outcome Scale-Symptoms Renal (POS-S Renal) is a patient-reported outcome measure for assessing symptoms in CKD stage 4 – 5. This study is the first cross-cultural adaptation and psychometric analysis of this clinical tool. The purpose of this study is to carry out a cross-cultural adaptation of the POS-S Renal for Spanish-speaking patients, and to perform an analysis of the psychometric properties of this questionnaire.
21. Pan CQ, Zhang JX. Natural history and clinical consequenc- es of hepatitis B Virus infection. Int J Med Sci 2005; 2: 36-40. 22. Xu Z, Ren X, Liu Y, Li X, Bai S, Zhong Y, Wang L, et al. As- sociation of hepatitis B virus mutations in basal core promot- er and precore regions with severity of liver disease: an investigation of 793 Chinese patients with mild and severe chronic hepatitis B and acute-on-chronic liver failure. J Gas- troenterol 2011; 46: 391-400.
home is simply the intermittent or continuous use of a ventilation system administered through a nasal or facial interface or a mouthpiece in non- invasive ventilation. The aim of this treatment in chronic respiratory failure due to the cause or in patients who are carrying a terminal illness is to reduce the work of the respiratory muscles and to correct hypoxemia and/or respiratory acidosis, through increased alveolar ventilation, thus improving the gaseous exchange. Non invasive mechanical ventilation (NIMV) at home is a well- established treatment of chronic respiratory failure in patients with ventilatory failure. It improves the survival of patients with neuromuscular and thoracic cage diseases 1,2 and
MoviLog is a mobile agent platform that implements a new form of mobility called Reactive Mo- bility by Failure which aims at reducing the effort of developing mobile agents by automating some decisions about mobility. RMF is based on the assumption that mobility is orthogonal to the rest of attributes that an agent may possess (intelligence, agency, etc) . Under this assumption it is pos- sible to think of a separation between these concerns at the implementation level . RFM exploits this separation by allowing the programmer to focus his efforts on the stationary functionality, and delegating mobility issues on a distributed MAS that is part of MoviLog.
There is ample evidence showing that acute kidney injury (AKI) increases the risk of developing chronic kidney disease (CKD). Although considerable efforts have been undertaken in recent years to elucidate the mechanisms responsible for the AKI to CKD transition, many questions remain to be answered. In this review, we address most of the latest studies elucidating the mechanisms involved in this transition. Based on recent studies, the consensus to date is that endothelial and proximal tubular epithelium injury along with the activation of inflammatory processes occurring after an AKI episode, not only establish a close interrelation but also trigger a series of signaling pathways that culminate in the generation of tubulointerstitial fibrosis and chronic hypoxia, which lead to the progressive deterioration of functional tissue. These events highlight that the tubular epi- thelium does not appear to be the same after cell damage occurs. In this review, we present the advances aimed at elucidating the mechanisms that lead to a maladaptive response and how sex hormones seem to be involved in a positive or negative adaptive response. Elucidating and characterizing the mechanisms responsible for the AKI to CKD transition are an indispensable preliminary step that will help to identify the most important actors in this process. (REV INVEST CLIN. 2018;70:261-8)
2 Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW & American College of Cardiology Foundation; American Heart Association . Focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation. Journal of the American College of Cardiology 2009 53 e1–e90. (doi:10.1016/ j.jacc.2008.11.013)
evaluation of the analytical consistency and description of the main sources of the variance. The initial princi- pal component analysis (PCA) modeling revealed a strong outlier - a MCK sample. Despite using probabilistic quotation normalization (PQN), abnormally low signal intensities were observed in this sample, indicating an analytical failure as a possible cause and consequently the sample was removed from further analysis. The score plot of the PCA model built after reprocessing the data without the outlier is presented in Fig. 2A. The model requires just three principal components to cover the first 50% of the variance, while the first two principal com- ponents covered 43% of the variance. The QC samples clustered together which indicates a proper analytical consistency and analytical variance within the limits expected for the CESI-MS method. It is worth mentioning that metabolic profiles for QC samples were not analyzed from multiple injections using the same injection vial, but were obtained from independent aliquots which had to be reconstituted in 2.5 µ L of water every day before the start of the acquisition sequence. Figure 2B shows the score plot of the PCA model built without QC samples, similar characteristics were observed when compared to Fig. 2A, with only three components 50% of the variance was covered, whereas the first two components covered 44% of the variance. The score plot clearly shows that the end-stage cystic kidney (ESCK) group, which forms a distinct cluster, strongly influences the model. Figure 2C shows the loadings plot of the model presented in Fig. 2B. The plot is colored according to the modelling power emphasizing the cluster of the variables relevant for the model. As a next step we built a multi-class PLS-DA model using the experimental groups as the class ID. Figure 3A,B show the score plot and cross-validated score plot of the resulting model, respectively. The model parameters (R 2 X 0.75, R 2 Y 0.94, Q 2 0.5) and CV-ANOVA
Results: patients were predominantly hypertensive, Caucasian and males with mortality rate of 2.9 %. The incidence of acute kidney injury (AKI) was 76.3 % and 80.7 % according to AKIN and RIFLE classifications, respectively. Both classifications showed similar power for AKI identification, using both creatinine and urinary output criteria. Body mass index and length of stay in ICU have been shown to be risk factors for AKI. Conclusion: The incidence of AKI remains high and the performance of RIFLE and AKIN classification for renal function assessment after cardiac surgery was similar.
Despite elegant demonstrations for the role of sex hormones in vascular health and immunoregulation, the striking predominance in females of SLE, RA, and SS remains unexplained relative to other systemic diseases such as ANCA vasculitis and hemolytic-uremic syndrome. Note that thrombotic thrombocytopenic purpura has a higher incidence in women, though this is likely due to the association with other conditions more common in women. The incidence of kidney involvement in SLE during pregnancy and similarities/differences in those with PE have not been well studied. The role of different medications and responses to medications for autoimmune diseases relative to sex has also not been well studied.