21 research outputs found
Factors Affecting Inpatient Mortality in Elderly People with Acute Kidney Injury
Get PDFBackground. Acute Kidney Injury (AKI) is common in elderly people (EP). There is paucity of data on predictor of mortality in EP with AKI. Objective. This study was done to know more about factors associated with inpatient mortality in EP with AKI. Methods. We retrospectively reviewed medical records of patients aged 65 years or above hospitalized with a diagnosis of AKI at Aga Khan University Hospital, Karachi, between January 2005 and December 2010. Binary logistic regression models were constructed to identify factors associated with mortality in EP with AKI. Results. 431 patients had AKI, with 341 (79.1%) having stage I AKI, 56 (13%) having stage II AKI, and 34 (7.9%) having stage III AKI. Out of 431 patients, 142 (32.9%) died. Mortality increased with increasing severity of AKI. Mortality was 50% (17/34) in AKI stage III, 44.6% (25/56) in AKI stage II, and 29.3% (100/341) in AKI stage I. Factors associated with increased inpatients mortality were presence of stage III AKI (OR: 3.20, P=0.04, 95% CI: 1.05–9.72), presence of oliguria (OR: 3.42, P=0.006, 95% CI: 1.42–8.22), and need for vasopressors (OR: 6.90, P<0.001, 95% CI: 2.42–19.65). Median bicarbonate 18 versus 17 between those who survived and those who died was associated with less mortality (OR: 0.94, P=0.02, 95% CI: 0.89–0.99). History of hypertension (OR: 0.49, P=0.03, 95% CI: 0.25–0.95) and high admission creatinine (OR: 0.68, P=0.01, 95% CI: 0.50–0.91) were also associated with less mortality. Conclusion. Mortality in EP increases with increasing severity of AKI. Presence of stage III AKI, oliguria, and hemodynamic instability needing vasopressor are associated with increased mortality. Increased median bicarbonate, presence of hypertension, and high admission creatinine were various factors associated with decreased inpatient mortality. Increasing age and need for dialysis did not increase mortality in elderly population
Improving kidney transplant care through the application of continuous glucose monitoring - a narrative review
Get PDFContinuous glucose monitoring (CGM) is used more frequently among patients with chronic kidney disease (CKD), including those undergoing haemodialysis and peritoneal dialysis. However, there is a lack of information and evidence regarding CGM use in kidney transplantation (KT). Dysglycaemia is commonly observed in the transplant setting; often complicated by impaired kidney function with fluctuating glomerular filtration rates and competing influences of diabetogenic immunosuppressants, perioperative surgical stress and transplant-related complications. This narrative review, the first of its kind, examines the utility, accuracy, efficacy and clinical outcomes of CGM in KT patients. It also addresses specific transplant-related issues that may necessitate future CGM usage and highlights knowledge gaps to inform future research directions
Drug-Induced Hematological Cytopenia in Kidney Transplantation and the Challenges It Poses for Kidney Transplant Physicians
No full textDrug-induced hematological cytopenia is common in kidney transplantation. Various cytopenia including leucopenia (neutropenia), thrombocytopenia, and anemia can occur in kidney transplant recipients. Persistent severe leucopenia or neutropenia can lead to opportunistic infections of various etiologies. On the contrary, reducing or stopping immunosuppressive medications in these events can provoke a rejection. Transplant clinicians are often faced with the delicate dilemma of balancing cytopenia and rejection from adjustments of immunosuppressive regimen. Differentials of drug-induced cytopenia are wide. Identification of culprit medication and subsequent modification is also challenging. In this review, we will discuss individual drug implicated in causing cytopenia and correlate it with corresponding literature evidence
Cigarette Smoking and Its Hazards in Kidney Transplantation
Get PDFCigarette smoking affects many organs. It causes vasoconstriction through activation of sympathetic nervous system which leads to elevation of blood pressure and reduction in glomerular filtration rate and filtration pressure. It also causes thickening of renal arterioles. Cigarette smoking increases the risk of microalbuminuria and accelerates progression of microalbuminuria to macroalbuminuria. Furthermore, it causes rapid loss of glomerular filtration rate in chronic kidney disease patients. After kidney donation, these factors may be injurious to the solitary kidney. Kidney donors with history of cigarette smoking are prone to develop perioperative complications, pneumonia, and wound infection. Postkidney transplantation various stressors including warm and cold ischemia time, delayed graft function, and exposure to calcineurin inhibitors may result in poor graft function. Continuation of cigarette smoking in kidney transplant recipients will add further risk. In this review, we will specifically discuss the effects of cigarette smoking on normal kidneys, live kidney donors, and kidney transplant recipients. This will include adverse effects of cigarette smoking on graft and patient survival, cardiovascular events, rejection, infections, and cancers in kidney transplant recipients. Lastly, the impact of kidney transplantation on behavior and smoking cessation will also be discussed.</jats:p
Dual Kidney Transplantation: A Review of Past and Prospect for Future
Get PDFKidney transplantation (KT) is one of the treatment options for patients with chronic kidney disease. The number of patients waiting for kidney transplantation is growing day by day. Various strategies have been put in place to expand the donor pool. Extended criteria donors are now accepted more frequently. Increasing number of elderly donors with age > 60 years, history of diabetes or hypertension, and clinical proteinuria are accepted as donor. Dual kidney transplantation (DKT) is also more frequently done and experience with this technique is slowly building up. DKT not only helps to reduce the number of patients on waiting list but also limits unnecessary discard of viable organs. Surgical complications of DKT are comparable to single kidney transplantation (SKT). Patient and graft survivals are also promising. This review article provides a summary of evidence available in the literature.</jats:p
Spontaneous Bacterial Peritonitis and Anasarca in a Female Patient with Ovarian Hyperstimulation Syndrome Complicated by Respiratory and Kidney Failure
No full textOvarian hyperstimulation syndrome (OHSS) was first described in 1960. It may occur as a complication of gonadotropin hormone therapy during assisted pregnancy or for primary infertility. A 26-year-old female patient with polycystic ovarian syndrome and primary infertility was treated to conceive. She received intravenous gonadotropin-releasing hormone (GnRH) along with follicle-stimulating hormone in an outside private clinic. She presented to the emergency department with abdominal and chest pain, loose stool, vomiting, shortness of breath and decreasing urine output. She was found to have edema, ascites, effusion and acute kidney injury (AKI). Considering the symptoms preceding the drug history and anasarca, a diagnosis of severe OHSS was made. Ascites was further complicated by spontaneous bacterial peritonitis (SBP), which had already been reported before. We speculate that low immunity due to decreased immunoglobulin in patients with OHSS makes them prone to SBP. In our case, septicemia secondary to SBP and fluid loss due to capillary leakage from OHSS resulted in AKI and respiratory failure. This critically ill patient was treated in a special care unit, and she fully recovered with supportive measures. Severe OHSS may present as anasarca including ascites which can develop SBP leading to sepsis and multiorgan failure
A Rare Case of Aeromonas Hydrophila Catheter Related Sepsis in a Patient with Chronic Kidney Disease Receiving Steroids and Dialysis: A Case Report and Review of Aeromonas Infections in Chronic Kidney Disease Patients
Get PDFAeromonas hydrophila (AH) is an aquatic bacterium. We present a case of fifty-five-year-old gentleman with chronic kidney disease (CKD) due to crescentic IgA nephropathy who presented to us with fever. He was recently pulsed with methyl prednisolone followed by oral prednisolone and discharged on maintenance dialysis through a double lumen dialysis catheter. Blood culture from peripheral vein and double lumen dialysis catheter grew AH. We speculate low immunity due to steroids and uremia along with touch contamination of dialysis catheter by the patient or dialysis nurse could have led to this rare infection. Dialysis catheter related infection by AH is rare. We present our case here and take the opportunity to give a brief review of AH infections in CKD patients
Recurrent Brachiocephalic Vein Stenosis as a Cause for Persistent Left-sided Transudative Pleural Effusion in a Hemodialysis Patient
No full textBackground: Effusion is common in dialysis patients. The most common causes include fluid overload due to renal failure and nonrenal causes like congestive heart failure and infection. We here report a case of left side transudative effusion due to brachiocephalic venous stenosis.
Methods: A 34-year-old female who had chronic kidney disease V during transplant work-up was found to be having left arm swelling and left transudative effusion. Work-up for transudative effusion did not show any cardiac cause or liver problem. Her dialysis duration was optimized from 2 times a week to 3 times a week for 4hr and her dry weight was adjusted. Despite adequate dialysis for 1month, effusion on the left side persisted. She had a previous venoplasty for a stenosis in brachiocephalic vein but restenosis occurred again.
Results: Brachiocephalic vein stenting was performed which successfully lead to resolution of left arm swelling and left effusion. She was later on successfully transplanted.
CONCLUSIONS: Brachiocephalic stenosis can cause ipsilateral transudative effusion. Venoplasty and stenting of the brachiocephalic vein lead to complete resolution of effusion
Predictors of hospital stay and mortality in dengue virus infection-experience from Aga Khan University Hospital Pakistan
Get PDFBackground: Dengue virus infection (DVI) is very common infection. There is scarcity of data on factor associated with increased hospitalstay and mortality in dengue virus infection (DVI). This study was done to know about factors associated with increased hospital stay and mortality in patients admitted with DVI.
Results: Out of 532 patients, two third (72.6%) had stay ≤3 days while one third (27.4%) had stay greater than 3 days. The mean length of hospital stay was 3.46 ± 3.45 days. Factors associated with increased hospital stay (\u3e3 days) included AKI (acute kidney injury) (Odd ratio 2.98; 95% CI 1.66-5.34), prolonged prothrombin time (Odd ratio 2.03; 95% CI 1.07-3.84), prolonged activated partial thromboplastin time (aPTT) (Odd ratio 1.80; CI 95% 1.15-2.83) and increased age of \u3e 41.10 years (Odd ratio 1.03; CI 95% 1.01-1.04).Mortality was 1.5%. High mortality was found in those with AKI (P \u3c0.01), dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) (P \u3c0.001), respiratory failure (P0.01), prolong PT (P 0.001), prolong aPTT (P0.01) and increased hospital stay (P0.04).
Conclusion: Increasing age, coagulopathy and acute kidney injury in patients with DVI is associated with increased hospital stay. Morality was more in patients with AKI, DHF and DSS, respiratory failure, coagulopathy and these patients had more prolonged hospitalization
Outcomes of Renal Transplantation in Brunei Darussalam over a Twenty-Year Period (1993-2012)
No full textObjectives. Brunei Darussalam has a high prevalence and incidence of end stage renal disease (ESRD). Up until 2012, all renal transplantations were performed in overseas centres, either as government-sponsored (living-related transplantation) or as selfsponsored (commercialized transplantation) ones. We hypothesize that graft and patient survival of Brunei renal transplant patients are on a par with international standards. Materials and Methods. Data of all renal transplant patients in Brunei were analysed over a twenty-year period from registry records and case notes. Comparative survival data from other countries were obtained from PubMed-listed literature. Results. A total of 49 transplantation procedures were performed in foreign centres between 1993 and 2012. 29 were government-sponsored and 20 were self-sponsored transplantations. The 5-and 10-year overall patient survival rates were 93.3% and 90.1%, respectively. The 5-and 10-year overall graft survival rates were 91.1% and 81.2%. There is no difference in the survival outcomes of government-sponsored and self-sponsored patients. Living-related (government-sponsored) and commercialised (self-sponsored) grafts had equivalent survival to those reported in the literature. Conclusion. Our survival data was on par with those achieved in many countries. We hope to use this information to convince local stakeholders and patients to favour transplantation as the preferred modality of RRT
