Bone mineral density in Kuwaiti patients with end-stage renal disease

Mid-term cumulative patency of fistula and PTFE grafts among hemodialysis patients: A retrospective, single-center study from Palestine

BACKGROUND

Due to the long waiting time for kidney transplantation, most End-Stage renal disease patients are commenced on either hemodialysis or peritoneal dialysis. Reusable fistulas have the lowest risk for death, cardiovascular events, and infections among all vascular accesses. This study aims to report the outcomes of the arteriovenous fistulas and PTFE grafts and the related predictive clinical and demographic variables.

METHODS

This retrospective study reviewed the charts of all hemodialysis patients between January 2017 and January 2021 at the Dialysis Center of An-Najah National University Hospital, Nablus, Palestine. Our outcomes were a primary failure, primary and secondary patency, and the related factors. Survival analysis using the Kaplan-Meier method was conducted, and the log-rank test was used to compare patency rates. The Cox proportional hazards regression model tested factors relevant to primary and secondary patency rates in univariate and multivariate analyses.

RESULTS

A total of 312 procedures were performed during the study period. Primary failure was 7.1% for AVF, 13.9% for arterio-venous graft (AVG) procedures. Peripheral arterial disease and left-sided AVF were associated with more primary failure rates. AVF, primary patency rates at 1, 2, and 3 years were 82%, 69%, and 59%, respectively, while secondary patency rates at 1, 2, and 3 years were 85%, 72%, and 63%, respectively. Factors associated with increased AVF patency in a proportional hazard model were younger age and dual antiplatelet administration.

CONCLUSION

Our study adds further evidence that autogenous AVF has better results than prosthetic AVG in both primary and secondary patency rates as well as less primary failure rates. Therefore, we encourage further longitudinal studies that assess the benefits of using antiplatelet on AVF outcome versus risks of bleeding, especially with dual agents.

Bone mineral density in Palestinian patients with end-stage renal disease and the related clinical and biochemical factors: Cross-sectional study

Introduction

End-Stage Renal Disease (ESRD) is the ultimate result of chronic kidney disease (CKD). In Palestine, the prevalence of ESRD was 240.3 PMP which is comparable with the nearby countries. Accelerated bone loss among ESRD patients is attributed to abnormal bone turn over that leads to osteoporosis and osteopenia. The risk of fractures is increased four-fold in men and women on hemodialysis, which explains the importance of assessing the bone mineral density among these population. The goals of this study were to find the prevalence of osteoporosis in ESRD patients as determined by bone mineral density (BMD) at different sites and to determine whether BMD correlates with many other clinical parameters.

Methods

A cross-sectional study of 194 ESRD patients were recruited from the dialysis unit in An-Najah National University Hospital, Nablus, Palestine. The patients were on regular hemodialysis or peritoneal dialysis. BMD was measured at the lumbar spine and the hip using the dual-energy X-Ray absorptiometry (DEXA) and the value is expressed as T-score. The data were analyzed using SPSS, version 26. The relationship between BMD and the clinical and biochemical parameters among the ESRD patients was assessed.

Results

We found that 42.8% of ESRD patient had osteoporosis and 40.2% had osteopenia. There were significantly higher proportions of osteoporosis and osteopenia among patients >60 years of age (p<0.005). Patients with osteoporosis and osteopenia had significantly higher serum levels of PTH (792.9 and 469.7) (p<0.05). BMD decreases as the duration of dialysis (39.0 months Vs. 56.8 months), (p<0.05). We found no significant difference between patients on hemodialysis or peritoneal dialysis.

Conclusion

This study showed that Palestinian patients with ESRD have low BMD at the hip and spine. The observed high serum level of PTH was associated with low BMD. Those patients should be closely monitored especially those with more than one risk factor. Moreover, more attention should be paid for these category of patients to decrease the incidence of falling down and the resulting fractures that might lead to mortality and morbidity.

Association between renal function and bone mineral density in healthy postmenopausal Chinese women

BACKGROUND

The relationship between renal function and bone mineral density (BMD) is controversial. The aim of this study was to determine the relationship of renal function with BMD and osteoporosis risk in healthy postmenopausal Chinese women.

METHODS

A cross-sectional study was conducted in 776 healthy postmenopausal Chinese women. Dual-energy X-ray absorptiometry was used to measure BMDs. Clinical, demographic, and biochemical data were obtained at the time of image acquisition. Estimated glomerular filtration rate (eGFR) was calculated using a Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.

RESULTS

Women with eGFR levels of at least 90 ml/min/1.73m² had a lower prevalence of osteoporosis compared with women with decreased eGFR levels (60 ml/min/1.73 m² ≤ eGFR < 90.0 ml/min/1.73 m²). BMDs at femoral neck and total hip were significantly lower in the lower eGFR class than the higher class (0.717 ± 0.106 vs 0.744 ± 0.125 g/cm², P < 0.01; 0.796 ± 0.116 vs 0.823 ± 0.129 g/cm², P < 0.01, respectively). eGFR was positively correlated with BMDs at femoral neck and total hip in unadjusted analysis (P < 0.05). After controlling for age, menopausal duration and body mass index (BMI), decreased eGFR was not associated with osteoporosis risk.

CONCLUSIONS

After adjustments for age, menopausal duration and BMI, the decline in renal function was not independently associated with osteoporosis risk in healthy postmenopausal Chinese women.

Predictors of Quality of Life among Peritoneal Dialysis Patients with End-Stage Renal Disease in Kuwait

Quality of life (QOL) is an important indicator of quality of healthcare. Measuring QOL and its correlates for peritoneal dialysis (PD) patients is important for public health policy, intervention, and clinical decision-making. Data from 62 patients treated at 6 dialysis centers were collected using short form (SF)-36. Multiple linear regression was used to assess the relationship between QOL and several covariates. Results indicated most patients were ≥ 60 years old (51.6%), retired (40.3%), diagnosed with end-stage renal disease (ESRD) > 1 year (82.3%), with diabetes as primary cause of ESRD (38.7%), and performing daily dialysis (77.4%). After adjustment of covariates, males (β = 19.03, p = 0.0001) scored on average 19.03 higher on QOL than females. Patients 41 - 60 years (β = 11.4, p = 0.018) scored on average 11.4 higher than those ≥ 60 years. Kuwaitis (β = -9.61, p = 0.057) scored on average 9.61 lower than non-Kuwaitis. Patients living with family/others (β = 13.02, p = 0.076) scored on average 13.02 higher than those living alone. Patients satisfied with their dialysis (β = 28.37, p = 0.001) scored on average 28.37 higher than non-satisfied patients. Performing dialysis at home (β = -15.52, p = 0.006) resulted in an average decrease of 15.52 in QOL compared with those in dialysis centers. Finally, patients with diabetes as the primary cause of ESRD (β = -9.8, p = 0.047) saw an average 9.8 decrease in QOL compared with patients with other ESRD causes. Gender, age, nationality, living status, satisfaction and place of dialysis, and causes of ESRD are independent predictors of QOL. Healthcare providers should pay more attention to females, those living alone, and those older than 60 years. Patients performing PD at home should have assistance from a nurse or health practitioner.

Association between Human Leukocyte Antigens (HLA-A, -B, and -DR) and end-stage renal disease in Kuwaiti patients awaiting transplantation

The number of patients with end stage renal disease (ESRD) is increasing considerably worldwide. Human Leukocyte Antigens (HLAs) are relevant for the expression of many immunological diseases and contribute to the development of different nephropathies. Therefore, we aimed from the present work to investigate the possible association between the frequency of HLA-A, -B, and -DR antigens and ESRD in Kuwaiti patients awaiting renal transplant. HLA-A, -B, and -DR typing was performed by complement-dependent cytotoxicity (CDC) method for 334 patients with ESRD awaiting renal transplantation and 191 healthy controls. The frequency of HLA-B8 antigen was significantly higher in ESRD patients (OR = 2.62, p = 0.001, pc = 0.038), and the frequency of HLA-A28, HLA-DR11 antigens was significantly higher in healthy controls (OR 0.42, p = 0.0001; pc = 0.0021, and OR = 0.44, p = 0.0007, pc = 0.01 respectively). While the HLA-B8 antigen may be a susceptibility risk factor for development of ESRD, the HLA-A28, and HLA-DR11 antigens may be protective against development of ESRD in Kuwaiti population.

Using the contralateral reverse less invasive plating system for subtrochanteric femur fractures in elderly patients

OBJECTIVE

In this retrospective study, we evaluated the efficacy of the reverse less invasive plating system (LISS) in the management of subtrochanteric fractures (STF) in elderly patients that are expected to be difficult to nail.

SUBJECTS AND METHODS

Fifty-five patients with STF were treated from April 2005 to December 2007. Of these, 26 (16 females and 10 males, age >65 years, average 79.8 ± 3) had nonpathologic fractures that were internally fixed with a LISS device. The average follow-up period was 24 months (range 15-30). The main outcome measures evaluated were pain, union, varus deformity and implant failure. Radiographic and clinical evidence of functional outcome and complications were also evaluated.

RESULTS

Mean perioperative blood loss was 120.5 ± 12 ml (range 65-285), and mean postoperative hospital stay was 7.8 ± 2 days (range 4-14). Using the reverse LISS plates led to complete union of STF in all of the 26 elderly patients without additional procedures.

CONCLUSION

Due to advantages like high union rate, early postoperative mobilization and short operation time, the reverse LISS device offers an alternative management of STF in elderly patients unsuitable for nailing procedures.