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Jasuja S, Jha V, Gallieni M, Rana DS, Vachharajani T, Sagar G, Bahl A, Tawakley S, Gaur M. Variation in performing kidney biopsy amongst nephrologists in the Asia-Pacific region: A multinational survey. Clin Nephrol 2024; 101:132-137. [PMID: 38156781 DOI: 10.5414/cn111203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 01/03/2024] Open
Abstract
AIM Kidney biopsy (KB) is the gold standard procedure for diagnosing kidney diseases. Globally, nephrologists are trained to perform KB. However, the past few decades have witnessed a transition where interventional radiologists (IRs) are now preferentially performing the procedure. Our survey-based cross-sectional study aimed to investigate the current trends of KB operators in the Asia-Pacific region (APR) in practicing interventional nephrologists. MATERIAL AND METHODS The Association of Vascular Access and intervenTionAl Renal Physicians (AVATAR) Foundation from India conducted a multinational online survey among interventional nephrologists from the APR to investigate who does KB, if the nephrology training curriculum includes KB, and whether nephrologists have access to ultrasound. RESULTS Out of 21 countries from the APR that participated in our survey, 10 countries (47.4%) reported that more than 70% of their nephrologists performed KB, whereas in 11 countries (57.6%), KB was most likely done by an IR. The frequency of nephrologists performing KB ranged from 0% in Afghanistan to 100% in countries such as Pakistan, Singapore, and Thailand. Formal training for KB and access to ultrasound was available to nephrologists in 80% of the responding countries. CONCLUSION Our study shows that despite the availability of training and access to USG, a significant number of nephrologists are not performing KB in the APR. Similar to the trends observed in Western countries, the observed pattern in the APR could be due to lack of time, less incentive, hospital policy, or interest of nephrologists in other aspects of intervention nephrology.
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Ghimire A, Shah S, Okpechi IG, Ye F, Tungsanga S, Vachharajani T, Levin A, Johnson D, Ravani P, Tonelli M, Thompson S, Jha V, Luyckx V, Jindal K, Shah N, Caskey FJ, Kazancioglu R, Bello AK. Global variability of vascular and peritoneal access for chronic dialysis. Nephrology (Carlton) 2024; 29:135-142. [PMID: 38018697 DOI: 10.1111/nep.14259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/03/2023] [Accepted: 11/17/2023] [Indexed: 11/30/2023]
Abstract
AIM Vascular and peritoneal access are essential elements for sustainability of chronic dialysis programs. Data on availability, patterns of use, funding models, and workforce for vascular and peritoneal accesses for dialysis at a global scale is limited. METHODS An electronic survey of national leaders of nephrology societies, consumer representative organizations, and policymakers was conducted from July to September 2018. Questions focused on types of accesses used to initiate dialysis, funding for services, and availability of providers for access creation. RESULTS Data from 167 countries were available. In 31 countries (25% of surveyed countries), >75% of patients initiated haemodialysis (HD) with a temporary catheter. Seven countries (5% of surveyed countries) had >75% of patients initiating HD with arteriovenous fistulas or grafts. Seven countries (5% of surveyed countries) had >75% of their patients starting HD with tunnelled dialysis catheters. 57% of low-income countries (LICs) had >75% of their patients initiating HD with a temporary catheter compared to 5% of high-income countries (HICs). Shortages of surgeons to create vascular access were reported in 91% of LIC compared to 46% in HIC. Approximately 95% of participating countries in the LIC category reported shortages of surgeons for peritoneal dialysis (PD) access compared to 26% in HIC. Public funding was available for central venous catheters, fistula/graft creation, and PD catheter surgery in 57%, 54% and 54% of countries, respectively. CONCLUSION There is a substantial variation in the availability, funding, workforce, and utilization of vascular and peritoneal access for dialysis across countries regions, with major gaps in low-income countries.
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Affiliation(s)
- Anukul Ghimire
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Samveg Shah
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Ikechi G Okpechi
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Somkanya Tungsanga
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Tushar Vachharajani
- School of Medicine, Wayne State University, Detroit, Michigan, United States
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Pietro Ravani
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stephanie Thompson
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Vivekananda Jha
- George Institute of Global Health, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Valerie Luyckx
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Kailash Jindal
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Nikhil Shah
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Fergus J Caskey
- Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Rumeyza Kazancioglu
- School of Medicine, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Aminu K Bello
- Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
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Jasuja S, Gallieni M, Jha V, Vachharajani T, Bhalla AK, Tan J, Tan CS, Basnet NB, Herath N, An HPH, Kim YS, Kim Y, SampathKumar K, Sahay M, Ramachandran R, Alexander S, Bhargava V, Balasubramaniam J, Voss D, Ogbac FE, Gunawan A, Goh BL, Lin CC, Khan J, Shiham I, Ayub H, Hein MA, Iqbal S, Srisawat N, Gao B, Sajiv C, Wilkinson C, Pichthida T, Rana DS, Sagar G, Bahl A, Tawakley S, Gaur M. Practice of dialysis access interventional nephrology procedures in the Asia-Pacific region: Getting lay of the land. Nephrology (Carlton) 2023; 28:672-681. [PMID: 37697492 PMCID: PMC7615839 DOI: 10.1111/nep.14236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/23/2023] [Accepted: 08/12/2023] [Indexed: 09/13/2023]
Abstract
AIM This cross-sectional survey aimed to determine the prevalence of Interventional Nephrology (IN) practice amongst nephrologists in the Asia-Pacific Region (APR), specifically related to dialysis access (DA). METHODS The Association of VA and intervenTionAl Renal physicians (AVATAR) Foundation from India conducted a multinational online survey amongst nephrologists from the Asia-Pacific to determine the practice of IN in the planning, creation, and management of dialysis access. The treatment modalities, manpower and equipment availability, monthly cost of treatment, specifics of dialysis access interventions, and challenges in the training and practice of IN by nephrologists were included in the survey. RESULTS Twenty-one countries from the APR participated in the survey. Nephrologists from 18 (85.7%) countries reported performing at least one of the basic dialysis access-related IN procedures, primarily the placement of non-tunnelled central catheters (n-TCC; 71.5%). Only 10 countries (47.6%) reported having an average of <4% of nephrologists performing any of the advanced IN access procedures, the most common being the placement of a peritoneal dialysis (PD) catheter (20%). Lack of formal training (57.14%), time (42.8%), incentive (38%), institutional support (38%), medico-legal protection (28.6%), and prohibitive cost (23.8%) were the main challenges to practice IN. The primary obstacles to implementing the IN training were a lack of funding and skilled personnel. CONCLUSION The practice of dialysis access-related IN in APR is inadequate, mostly due to a lack of training, backup support, and economic constraints, whereas training in access-related IN is constrained by a lack of a skilled workforce and finances.
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Affiliation(s)
| | - Maurizio Gallieni
- DIBIC “L. Sacco”, Università degli Studi di Milano, Milano, Italy
- The Journal of VA, USA
| | | | - Tushar Vachharajani
- John D. Dingell Veterans Affair Medical Center, Detroit, Michigan, USA
- Wayne State University, Detroit, Michigan, USA
| | | | - Jackson Tan
- Rimba Dialysis Center, Simpang, Brunei Darussalam
- Univeristy of Brunei Darussalam, Bandar Seri Begawan, Brunei
- RIPAS Hospital, Bandar Seri Begawan, Brunei
| | | | | | | | | | - Yong Soo Kim
- College of Medicine, St. Mary’s Hospital, Catholic University of Korea, Seoul, South Korea
| | - Yaeni Kim
- College of Medicine, St. Mary’s Hospital, Catholic University of Korea, Seoul, South Korea
| | | | | | | | | | | | | | - David Voss
- Middlemore Hospital, Auckland, New Zealand
| | | | - Atma Gunawan
- St Luke’s Medical Center, Quezon City, Philippines
- Dr Saiful Anwar General Hospital, Malang, Indonesia
| | | | | | | | | | | | - Min Aung Hein
- Defence Services Medical Academy (DSMA), Yangon, Myanmar
| | - Sarwar Iqbal
- BIRDEM General Hospital, Dhaka, Bangladesh
- Ibrahim Medical College, Dhaka, Bangladesh
| | | | - Bihu Gao
- Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Cherian Sajiv
- Alice Springs Hospital, The Gap, Northern Territory, Australia
| | - Catherine Wilkinson
- Cairns and Hinterland Hospital and Health Service, Cairns North, Queensland, Australia
| | - Thim Pichthida
- School of Medicine, International University, Phnom Penh, Cambodia
- Angkor Hospital for Children, Siem Reap, Cambodia
| | - D. S. Rana
- Sir Ganga Ram Hospital, New Delhi, Delhi, India
| | | | - Anupam Bahl
- Indraprastha Apollo Hospital, New Delhi, India
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Montane B, Abraham A, Bustamante S, Vachharajani T, Ayad S, Devarajan J, Thompson D, Lee R, Rampersad P, Gage B, Reznicek E, Luo C, Wardrop R. Implementing an Interdisciplinary Procedure Curriculum. Cureus 2023; 15:e44851. [PMID: 37809158 PMCID: PMC10559997 DOI: 10.7759/cureus.44851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
INTRODUCTION This curriculum was designed to improve access to procedures for our internal medicine residents. METHODS We created an interdisciplinary procedure course (IDPC) composed of two simulation sessions and a one-week procedural rotation supervised by multiple specialties including nephrology, cardiology, cardiothoracic anesthesiology, general anesthesiology, and interventional radiology. After the course, residents completed two surveys documenting the number of procedures and their level of confidence on a Likert scale (1 = very unconfident to 5 = very confident) prior to and after completing the curriculum. RESULTS Sixteen residents participated in the course from September 2021 to June 2022. The collective number of procedures performed by these 16 residents increased from 176 to 343 after a one-week rotation. For arterial lines, the proportion of residents that reported an improvement in confidence scores was 0.44 (95% confidence interval 0.23 to 1, p-value of 0.60). The proportion of residents that had an increase in their confidence performing central lines was 0.63 (95% confidence interval 0.39 to 1, p-value of 0.23). For intubations, the proportion of residents that reported an improvement in confidence was 0.94 (95% confidence interval 0.72 to 1, p-value of 0.0006). CONCLUSION By collaborating with multiple specialties, residents almost doubled the number of procedures performed during training and reported an increased level of confidence in procedural performance for airway intubation. We learned residents want to improve their access to procedures and described a curriculum that was easily implemented.
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Affiliation(s)
- Bryce Montane
- Internal Medicine, Washington University School of Medicine, St. Louis, USA
| | - Abey Abraham
- Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, USA
| | | | - Tushar Vachharajani
- Nephrology, John D. Dingell Department of Veterans Affairs Medical Center, Detroit, USA
| | - Sabry Ayad
- Outcomes Research, Cleveland Clinic, Cleveland, USA
- Anesthesiology, Cleveland Clinic, Cleveland, USA
| | | | | | - Ran Lee
- Cardiovascular Medicine, Cleveland Clinic, Cleveland, USA
| | | | - Brian Gage
- Internal Medicine, Washington University School of Medicine, St. Louis, USA
| | | | - Chongliang Luo
- Surgery, Washington University School of Medicine, St. Louis, USA
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Yuo TH, Kim CY, Rajan DK, Niyyar VD, Murea M, Dillavou ED, Bream PR, Dinwiddie LC, Hohmann SE, Woo K, Vachharajani T, Roberts C, Gooden C, Wright GW, Hogan AJ, Ferko NC, Kahle E, Clynes D, Lok CE. Hemodialysis Arteriovenous Access Cosmesis Scale (AVACS): A new measure for vascular access. J Vasc Access 2022:11297298221141499. [PMID: 36517942 DOI: 10.1177/11297298221141499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RATIONALE AND OBJECTIVE This study aimed to develop a cosmesis scale to evaluate the cosmetic appearance of hemodialysis (HD) arteriovenous (AV) accesses from the perspective of the patient and clinician, which could be incorporated into clinical trials. STUDY DESIGN Using a modified Delphi process, two AV access cosmesis scale (AVACS) components were developed in a four-round Delphi panel consisting of two surveys and two consensus meetings with two rounds of patient consultation. SETTING AND PARTICIPANTS The Delphi panel consisted of 15 voting members including five interventional or general nephrologists, five vascular surgeons, three interventional radiologists, and two vascular access nurse coordinators. Four patients experienced with vascular access were involved in patient question development. ANALYTICAL APPROACH For a component to be included in the AVACS, it had to meet the prespecified panel consensus agreement of ⩾70%. RESULTS The clinician component of the AVACS includes nine questions on the following AV access features: scarring, skin discoloration, aneurysm/pseudoaneurysms and megafistula appearance. The patient component includes six questions about future vascular access decisions, interference with work or leisure activities, clothing choices, self-consciousness or attractiveness, emotional impact, and overall appearance. LIMITATIONS Delphi panel methods are subjective by design, but with expert clinical opinion are used to develop classification systems and outcome measures. The developed scale requires further validation testing but is available for clinical trial use. CONCLUSIONS While safety and efficacy are the primary concerns when evaluating AV access for HD, cosmesis is an important component of the ESKD patient experience. The AVACS has been designed to assess this important domain; it can be used to facilitate patient care and education about vascular access choice and maintenance. AVACS can also be used to inform future research on developing new techniques for AV access creation and maintenance, particularly as relates to AV access cosmesis.
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Affiliation(s)
- Theodore H Yuo
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Charles Y Kim
- Division of Interventional Radiology, Duke University Medical Center, Durham, NC, USA
| | - Dheeraj K Rajan
- Division of Vascular & Interventional Radiology, Department of Medical Imaging, University of Toronto, University Health Network, Toronto, ON, Canada
| | - Vandana D Niyyar
- Division of Nephrology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Marianna Murea
- Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Peter R Bream
- Vascular and Interventional Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Karen Woo
- Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA, USA
| | - Tushar Vachharajani
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Cynthia Roberts
- Renal Research Institute, University of North Carolina at Chapel Hill Nephrology and Hypertension Division, Chapel Hill, NC, USA
| | - Christie Gooden
- North Texas Dialysis Access Clinic, Medical City Dallas, TX, USA
| | | | | | | | - Erin Kahle
- American Association of Kidney Patients, Tampa, FL, USA
| | - Diana Clynes
- American Association of Kidney Patients, Tampa, FL, USA
| | - Charmaine E Lok
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Nephrology, Department of Medicine, University Health Network-Toronto General Hospital, Toronto, ON, Canada
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Ramachandran R, Bhargava V, Jasuja S, Gallieni M, Jha V, Sahay M, Alexender S, Mostafi M, Pisharam JK, Wai TSC, Jacob C, Gunawan A, Leong GB, Thwin KT, Agrawal RK, Vareesangthip K, Tanchanco R, Choong L, Herath C, Lin CC, Cuong NT, Akhtar SF, Alsahow A, Rana DS, Kher V, Rajapurkar MM, Jeyaseelan L, Puri S, Sagar G, Bahl A, Verma S, Sethi A, Vachharajani T. Interventional nephrology and vascular access practice: A perspective from South and Southeast Asia. J Vasc Access 2022; 23:849-860. [PMID: 33934667 PMCID: PMC7615897 DOI: 10.1177/11297298211011375] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
South and Southeast Asia is the most populated, heterogeneous part of the world. The Association of Vascular Access and InTerventionAl Renal physicians (AVATAR Foundation), India, gathered trends on epidemiology and Interventional Nephrology (IN) for this region. The countries were divided as upper-middle- and higher-income countries as Group-1 and lower and lower-middle-income countries as Group-2. Forty-three percent and 70% patients in the Group 1 and 2 countries had unplanned hemodialysis (HD) initiation. Among the incident HD patients, the dominant Vascular Access (VA) was non-tunneled central catheter (non-TCC) in 70% of Group 2 and tunneled central catheter (TCC) in 32.5% in Group 1 countries. Arterio-Venous Fistula (AVF) in the incident HD patients was observed in 24.5% and 35% of patients in Group-2 and Group-1, respectively. Eight percent and 68.7% of the prevalent HD patients in Group-2 and Group-1 received HD through an AVF respectively. Nephrologists performing any IN procedure were 90% and 60% in Group-2 and Group 1, respectively. The common procedures performed by nephrologists include renal biopsy (93.3%), peritoneal dialysis (PD) catheter insertion (80%), TCC (66.7%) and non-TCC (100%). Constraints for IN include lack of time (73.3%), lack of back-up (40%), lack of training (73.3%), economic issues (33.3%), medico-legal problems (46.6%), no incentive (20%), other interests (46.6%) and institution not supportive (26%). Routine VA surveillance is performed in 12.5% and 83.3% of Group-2 and Group-1, respectively. To conclude, non-TCC and TCC are the most common vascular access in incident HD patients in Group-2 and Group-1, respectively. Lack of training, back-up support and economic constraints were main constraints for IN growth in Group-2 countries.
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Affiliation(s)
| | | | | | | | - Vivekanand Jha
- Executive Director, George Institute of Global Health, India
| | | | | | - Mamun Mostafi
- Department of Nephrology, Armed Forces Medical College, Bangladesh
| | | | | | | | | | | | | | | | | | | | | | | | | | - Nguyen The Cuong
- Department of Kidney diseases and Dialysis, Viet Duc University Hospital, Vietnam
| | | | | | | | | | | | | | - Sonika Puri
- Rutgers Robert Wood Johnson Medical School, USA
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Bhargava V, Jasuja S, Wai TSC, Bhalla AK, Sagar G, Jha V, Ramachandran R, Sahay M, Alexander S, Vachharajani T, Lydia A, Mostafi M, Pisharam JK, Jacob C, Gunawan A, Leong GB, Thwin KT, Agrawal RK, Vareesangthip K, Tanchanco R, Choong L, Herath C, Lin CC, Akhtar SF, Alsahow A, Rana DS, Rajapurkar MM, Kher V, Verma S, Krishnaswamy S, Gupta A, Bahl A, Gupta A, Khanna UB, Varughese S, Gallieni M. Peritoneal dialysis: Status report in South and South East Asia. Nephrology (Carlton) 2021; 26:898-906. [PMID: 34313370 PMCID: PMC7615904 DOI: 10.1111/nep.13949] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/05/2021] [Accepted: 07/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Peritoneal dialysis (PD) as a modality of kidney replacement therapy (KRT) is largely underutilized globally. We analyzed PD utilization, impact of economic status, projected growth and impact of state policy(s) on PD growth in South Asia and Southeast Asia (SA&SEA) region. METHODS The National Nephrology Societies of the region responded to a questionnaire on KRT practices. The responses were based on the latest registry data, acceptable community-based studies and societal perceptions. The representative countries were divided into high income and higher-middle income (HI & HMI) and low income and lower-middle income (LI & LMI) groups. RESULTS Data provided by 15 countries showed almost similar percentage of GDP as health expenditure (4%-7%). But there was a significant difference in per capita income (HI & HMI -US$ 28 129 vs. LI & LMI - US$ 1710.2) between the groups. Even after having no significant difference in monthly cost of haemodialysis (HD) and PD in LI & LMI countries, they have poorer PD utilization as compared to HI & HMI countries (3.4% vs. 10.1%); the reason being lack of formal training/incentives and time constraints for the nephrologist while lack of reimbursement and poor general awareness of modalities has been a snag for the patients. The region expects ≥10% PD growth in the near future. Hong Kong and Thailand with 'PD first' policy have the highest PD utilization. CONCLUSION Important deterrents to PD underutilization were lack of PD centric policies, lackadaisical patient/physician's attitude, lack of structured patient awareness programs, formal training programs and affordability.
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Affiliation(s)
- Vinant Bhargava
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Sanjiv Jasuja
- Department of Nephrology, Indraprastha Apollo Hospital, New Delhi, India
| | - Tang Sydeny Chi Wai
- Department of Nephrology, Hong Kong Society of Nephrology, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Anil K. Bhalla
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Gaurav Sagar
- Department of Nephrology, Indraprastha Apollo Hospital, New Delhi, India
| | - Vivekanand Jha
- Chair of global Kidney Health, George Institute of Global Health, New Delhi, India
| | | | - Manisha Sahay
- Department of Nephrology, Osmania General Hospital, Hyderabad, India
| | | | | | - Aida Lydia
- Department of Nephrology&Hypertension, Universitas Indonesia, Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Mamun Mostafi
- Department of Nephrology, Armed Forces Medical College, Dhaka, Bangladesh
| | | | - Chakko Jacob
- Department of Nephrology, Bangalore Baptist Hospital, Bangalore, India
| | - Atma Gunawan
- Department of Nephrology, Brawijaya University, Malang city, Indonesia
| | - Goh Bak Leong
- Department of Nephrology, Serdang Hospital, Kajang, Malaysia
| | - Khin Thida Thwin
- Department of Nephrology, University Of Medicine, Yangon, Myanmar
| | | | | | | | - Lina Choong
- Department of Nephrology, Singapore General Hospital, Singapore, Singapore
| | - Chula Herath
- Department of Nephrology, Sri Jayewardenepura General Hospital, Kotte, Sri Lanka
| | - Chih-Ching Lin
- Department of Nephrology, Taipei Veterans General Hospital, Teipei city, Taiwan
| | - Syed Fazal Akhtar
- Department of Nephrology, Sindh Institute of Urology and Transplantation, karachi, Pakistan
| | - Ali Alsahow
- Department of Nephrology, Jahra Hospital, Al-Jahra, Kuwait
| | | | - Mohan M. Rajapurkar
- Department of Nephrology, Muljibhai Patel Urological Hospital, Gujrat, India
| | - Vijay Kher
- Department of Nephrology, Medanta Hospital, Gurugram, Haryana, India
| | - Shalini Verma
- Clinical Research, AVATAR foundation, New Delhi, India
| | | | - Amit Gupta
- Department of Nephrology, Apollo Medics Hospital, Kanpur–Lucknow, Uttar Pradesh, India
| | - Anupam Bahl
- Department of Nephrology, Indraprastha Apollo Hospital, New Delhi, India
| | - Ashwani Gupta
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Umesh B. Khanna
- Department of Nephrology, Lancelot Kidney and GI Centre, Mumbai, India
| | | | - Maurizio Gallieni
- ’L. Sacco’ Department of Biomedical and Clinical Sciences, University of Milano, Milano, Italy
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Vachharajani T, Jasuja S, AlSahow A, G Alghamdi SM, Al-Aradi AH, Al Salmi I, Bernieh B, Bahbahani Y, Alali F, Ramachandran R, Alexander S, Mandal SK, Malhotra RK, Sahay M, Bhargava V, Jha V, Rana DS, Sagar G, Bahl A, Kher V, Prasad N, Kumar KS, Alrukhaimi M, Ashuntantang GE, Verma S, Gallieni M. Current Status and Future of End-Stage Kidney Disease in Gulf Cooperation Council Countries: Challenges and Opportunities. Saudi J Kidney Dis Transpl 2021; 32:1073-1088. [PMID: 35229807 DOI: 10.4103/1319-2442.338281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
There is a paucity of data on epidemiology along with an incomplete registry of end-stage kidney disease (ESKD), nephrologist workforce, and variability among the countries of Gulf Cooperation Council (GCC). The study is an observation, descriptive study which aimed to describe current ESKD burden, nephrologist density, and kidney care infrastructure in GCC. Responses to a questionnaire-based survey obtained from representatives of the Nephrology Societies of GCC countries were analyzed. The categorical variables were compared using Chi-square test. A P = 5% was considered as significant. The mean prevalence of ESKD per million populations (pmp) was 551, highest in Oman (1000/pmp), least in Qatar (347/pmp). Predominant etiology in GCC was diabetes mellitus (DM) and hypertension (HTN) (100%, each), followed by chronic glomerulonephritis (66.7%). A transplant registry was maintained by all GCC countries. Hemodialysis (HD) (67.2%) was the most opted modality of kidney replacement therapy (KRT), followed by kidney transplantation (22%) and peritoneal dialysis (9.6%); 1.0% of patients opted for conservative management. Unplanned initiation of HD was three times more common. The access distribution among incident and prevalent HD patients respectively was (i) nontunneled central catheter (nTCC) (58.7 ± 36.6 vs. 1.5 ± 1.5), (ii) tunneled central catheter (23.5 ± 29.9 vs. 33.6 ± 10.0), and (iii) arteriovenous fistula (17.3± 14.4 vs. 57.8 ± 11.86). Death and transplantation were the reasons for dropout from HD. GCC has adequate kidney care infrastructure. There are 1686 nephrologists [range: Bahrain 9, Kingdom of Saudi Arabia (KSA) 1279]. Qatar, KSA, and Kuwait provide training in kidney biopsy; all countries except Bahrain have formal training programs for nTCC placement. ESKD prevalence is high, DM, HTN; glome-rulonephritis (GN) is the most common causes. The need for KRT is expected to rise in GCC. HD is the predominant KRT modality with a high prevalence of dialysis catheters as vascular access.
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Affiliation(s)
- Tushar Vachharajani
- Cleveland Clinic Lerner College of Medicine of CWRU Cleveland Clinic, Ohio, USA
| | - Sanjiv Jasuja
- Department of Nephrology, Indraprastha Apollo Hospital, New Delhi, India
| | - Ali AlSahow
- Department of Nephrology, Jahra Hospital, Jahra, Kuwait
| | - Saeed M G Alghamdi
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ali H Al-Aradi
- Department of Nephrology, Salmaniya Medical Complex, Manama, Bahrain
| | - Issa Al Salmi
- The Renal Medicine Department, The Royal Hospital, Muscat, Oman
| | - Bassam Bernieh
- Department of Nephrology, Mediclinic Hospital, Al Ain, United Arab Emirates
| | - Yousif Bahbahani
- Department of Nephrology, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Fadwa Alali
- Department of Nephrology, Hamad Medical Corporation, Doha, Qatar
| | - Raja Ramachandran
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Sandeep K Mandal
- Department of Nephrology, Columbia Asia Hospital, Gurugram, Haryana, India
| | - Rajeev K Malhotra
- Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital; Department of Biomedical Statistics, All India Institute of Medical Sciences, New Delhi, India
| | - Manisha Sahay
- Department of Nephrology, Osmania Medical College and General Hospital, Telangana, India
| | - Vinant Bhargava
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Vivekanand Jha
- Department of Nephrology, George Institute for Global Health, New Delhi, India
| | | | - Gaurav Sagar
- Department of Nephrology, Indraprastha Apollo Hospital, New Delhi, India
| | - Anupam Bahl
- Department of Nephrology, Indraprastha Apollo Hospital, New Delhi, India
| | - Vijay Kher
- Department of Nephrology, Medanta Hospital, The Medicity, Gurugram, Haryana, India
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical science, Lucknow, India
| | - Krishnaswamy S Kumar
- Department of Nephrology, Meenakshi Mission Hospital, Madurai, Tamil Nadu, India
| | | | - Gloria E Ashuntantang
- Faculty of Medicine and Biomedical Sciences, Yaounde General Hospital, Yaounde, Cameroon
| | | | - Maurizio Gallieni
- Nephrology and Dialysis Unit, Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
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9
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Riaz P, Caskey F, McIsaac M, Davids R, Htay H, Jha V, Jindal K, Jun M, Khan M, Levin A, Lunney M, Okpechi I, Pecoits-Filho R, Osman MA, Vachharajani T, Ye F, Harris D, Tonelli M, Johnson D, Bello A. Workforce capacity for the care of patients with kidney failure across world countries and regions. BMJ Glob Health 2021; 6:bmjgh-2020-004014. [PMID: 33461978 PMCID: PMC7816926 DOI: 10.1136/bmjgh-2020-004014] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/19/2020] [Accepted: 12/23/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION An effective workforce is essential for optimal care of all forms of chronic diseases. The objective of this study was to assess workforce capacity for kidney failure (KF) care across world countries and regions. METHODS Data were collected from published online sources and a survey was administered online to key stakeholders. All country-level data were analysed by International Society of Nephrology region and World Bank income classification. RESULTS The general healthcare workforce varies by income level: high-income countries have more healthcare workers per 10 000 population (physicians: 30.3; nursing personnel: 79.2; pharmacists: 7.2; surgeons: 3.5) than low-income countries (physicians: 0.9; nursing personnel: 5.0; pharmacists: 0.1; surgeons: 0.03). A total of 160 countries responded to survey questions pertaining to the workforce for the management of patients with KF. The physicians primarily responsible for providing care to patients with KF are nephrologists in 92% of countries. Global nephrologist density is 10.0 per million population (pmp) and nephrology trainee density is 1.4 pmp. High-income countries reported the highest densities of nephrologists and nephrology trainees (23.2 pmp and 3.8 pmp, respectively), whereas low-income countries reported the lowest densities (0.2 pmp and 0.1 pmp, respectively). Low-income countries were most likely to report shortages of all types of healthcare providers, including nephrologists, surgeons, radiologists and nurses. CONCLUSIONS Results from this global survey demonstrate critical shortages in workforce capacity to care for patients with KF across world countries and regions. National and international policies will be required to build a workforce capacity that can effectively address the growing burden of KF and deliver optimal care.
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Affiliation(s)
- Parnian Riaz
- Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Fergus Caskey
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Mark McIsaac
- Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Razeen Davids
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Htay Htay
- Medicine, Singapore General Hospital, Singapore
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India
| | - Kailash Jindal
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Min Jun
- The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Maryam Khan
- Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
| | - Adera Levin
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meaghan Lunney
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Ikechi Okpechi
- Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada.,Medicine, University of Cape Town, Cape Town, South Africa
| | | | | | - Tushar Vachharajani
- Department of Nephrology and Hypertension, Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, Ohio, USA
| | - Feng Ye
- Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - David Harris
- University of Sydney at Westmead Hospital, Westmead, New South Wales, Australia
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David Johnson
- Department of Nephrology, Metro South and Ipswich Nephrology and Transplant Services (MINTS), Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Aminu Bello
- Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
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10
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SOHAIL M, Lane J, Hanane T, Vachharajani T. POS-211 SAFETY AND EFFICACY OF BEDSIDE PLACEMENT OF TUNNELED HEMODIALYSIS CATHETERS IN PATIENTS WITH COVID-19 IN THE INTENSIVE CARE UNIT. Kidney Int Rep 2021. [PMCID: PMC8049705 DOI: 10.1016/j.ekir.2021.03.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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11
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SHARMA M, Vachharajani T. POS-615 Reusing an existing tunnel and venotomy site following accidental loss of a tunneled dialysis catheter. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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12
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Hossain MA, Ahmed N, Gupta V, Bajwa R, Alidoost M, Asif A, Vachharajani T. Post-traumatic thrombotic microangiopathy: What trauma surgeons need to know? Chin J Traumatol 2021; 24:69-74. [PMID: 33518399 PMCID: PMC8071723 DOI: 10.1016/j.cjtee.2021.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 12/10/2020] [Accepted: 12/29/2020] [Indexed: 02/04/2023] Open
Abstract
Thrombotic microangiopathy (TMA) is characterized by systemic microvascular thrombosis, target organ injury, anemia and thrombocytopenia. Thrombotic thrombocytopenic purpura, atypical hemolytic uremic syndrome and Shiga toxin E-coli-related hemolytic uremic syndrome are the three common forms of TMAs. Traditionally, TMA is encountered during pregnancy/postpartum period, malignant hypertension, systemic infections, malignancies, autoimmune disorders, etc. Recently, the patients presenting with trauma have been reported to suffer from TMA. TMA carries a high morbidity and mortality, and demands a prompt recognition and early intervention to limit the target organ injury. Because trauma surgeons are the first line of defense for patients presenting with trauma, the prompt recognition of TMA for these experts is critically important. Early treatment of post-traumatic TMA can help improve the patient outcomes, if the diagnosis is made early. The treatment of TMA is also different from acute blood loss anemia namely in that plasmapheresis is recommended rather than platelet transfusion. This article familiarizes trauma surgeons with TMA encountered in the context of trauma. Besides, it provides a simplified approach to establishing the diagnosis of TMA. Because trauma patients can require multiple transfusions, the development of disseminated intravascular coagulation must be considered. Therefore, the article also provides different features of disseminated intravascular coagulation and TMA. Finally, the article suggests practical points that can be readily applied to the management of these patients.
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Affiliation(s)
- Mohammad A. Hossain
- Department of Medicine, Hackensack Meridian Health Jersey Shore University Medical Center, Neptune, NJ, 07753, USA
| | - Nasim Ahmed
- Department of Surgery, Division of Trauma Surgery, Hackensack Meridian Health Jersey Shore University Medical Center, Neptune, NJ, 07753, USA,Corresponding author.
| | - Varsha Gupta
- Department of Medicine, Hackensack Meridian Health Jersey Shore University Medical Center, Neptune, NJ, 07753, USA
| | - Ravneet Bajwa
- Department of Medicine, Hackensack Meridian Health Jersey Shore University Medical Center, Neptune, NJ, 07753, USA
| | - Marjan Alidoost
- Department of Medicine, Hackensack Meridian Health Jersey Shore University Medical Center, Neptune, NJ, 07753, USA
| | - Arif Asif
- Department of Medicine, Hackensack Meridian Health Jersey Shore University Medical Center, Neptune, NJ, 07753, USA
| | - Tushar Vachharajani
- Global Nephrology, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, 44103, USA
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13
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Sahay M, Jasuja S, Wai TSC, Alexander S, Jha V, Vachharajani T, Mostafi M, Pisharam JK, Jacob C, Gunawan A, Leong GB, Thwin KT, Agrawal RK, Vareesangthip K, Tanchanco R, Choong L, Herath C, Lin CC, Cuong NT, Haian HP, Akhtar SF, Alsahow A, Rana DS, Rajapurkar MM, Kher V, Verma S, Ramachandran R, Bhargava V, Puri S, Sagar G, Bahl A, Mandal S, Gupta A, Gallieni M. Aetiology, practice patterns and burden of end-stage kidney disease in South Asia and South-East Asia: A questionnaire-based survey. Nephrology (Carlton) 2021; 26:142-152. [PMID: 33169890 PMCID: PMC7615902 DOI: 10.1111/nep.13825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/11/2020] [Accepted: 10/16/2020] [Indexed: 11/28/2022]
Abstract
AIM There is paucity of data on the epidemiology of end-stage kidney disease (ESKD) from South Asia and South-East Asia. The objective of this study was to assess the aetiology, practice patterns and disease burden and growth of ESKD in the region comparing the economies. METHODS The national nephrology societies of the region; responded to the questionnaire; based on latest registries, acceptable community-based studies and society perceptions. The countries in the region were classified into Group 1 (High|higher-middle-income) and Group 2 (lower|lowermiddle income). Student t-test, Mann-Whitney U test and Fisher's exact test were used for comparison. RESULTS Fifteen countries provided the data. The average incidence of ESKD was estimated at 226.7 per million population (pmp), (Group 1 vs. Group 2, 305.8 vs. 167.8 pmp) and average prevalence at 940.8 pmp (Group 1 vs. Group 2, 1306 vs. 321 pmp). Group 1 countries had a higher incidence and prevalence of ESKD. Diabetes, hypertension and chronic glomerulonephritis were most common causes. The mean age in Group 2 was lower by a decade (Group 1 vs. Group 2-59.45 vs 47.7 years). CONCLUSION Haemodialysis was the most common kidney replacement therapy in both groups and conservative management of ESKD was the second commonest available treatment option within Group 2. The disease burden was expected to grow >20% in 50% of Group 1 countries and 78% of Group 2 countries along with the parallel growth in haemodialysis and peritoneal dialysis.
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Affiliation(s)
- Manisha Sahay
- Department of Nephrology Osmania General Hospital, Hyderabad (+91) 9849097507
| | - Sanjiv Jasuja
- Department of Nephrology Indraprastha Apollo Hospital, Delhi (+91) 9711197981
| | - Tang Sydeny Chi Wai
- Department of Nephrology Queen Mary Hospital Hong Kong Society of Nephrology (+852) 92360037
| | | | - Vivekanand Jha
- Department of Nephrology George Institute of Global Health (+91) 85275 44733
| | - Tushar Vachharajani
- Department of Nephrology Cleveland Clinic, Ohio, United States (+1) 336 546 2713
| | - Mamun Mostafi
- Department of Nephrology Armed Forces Medical College, Bangladesh Representative from Bangladesh Renal Association (+880) 171 3035 346
| | - Jayakrishnan K Pisharam
- Department of Nephrology Ministry of Health, Brunei, Darussalam Medical Services, Brunei Representative from Brunei Society of Nephrology (+673) 817 8123
| | - Chakko Jacob
- Department of Nephrology Bangalore Baptist Hospital, India Representative from Indian Society of Nephrology (+91)9535236019
| | - Atma Gunawan
- Department of Nephrology Brawijaya University, Indonesia Representative from Society of Nephrology Indonesia (+62) 812 3300 543
| | - Goh Bak Leong
- Department of Nephrology Serdang Hospital, Malaysia Representative from Malaysian Nephrology Congress (+60) 1260 69119
| | - Khin Thida Thwin
- Department of Nephrology University Of Medicine, Myanmar Representative from Myanmar Nephro-Uro Society (+95) 95021764
| | - Rajendra Kumar Agrawal
- Department of Nephrology Bir Hospital, Nepal Nepal Society of Nephrology (+977)98 5102 3840
| | - Kriengsak Vareesangthip
- Department of Nephrology Siriraj Hospital, Mahidol University, Thailand Representative from Nephrology Society of Thailand (+66) 24198383
| | - Roberto Tanchanco
- Department of Nephrology The Medical City, Philippine Representative from Philippine Society of Nephrology (+63)9189173940
| | - Lina Choong
- Department of Nephrology Singapore General Hospital, Singapore Representative from Singapore Society of Nephrology (+65) 81253594
| | - Chula Herath
- Department of Nephrology Sri Jayewardenepura General Hospital, Srilanka Representative from Sri Lanka Society of Nephrology (+94) 773017025
| | - Chih-Ching Lin
- Department of Nephrology Taipei Veterans General Hospital, Taiwan Representative from Taiwan society of Nephrology (+886) 937024083
| | - Nguyen The Cuong
- Department of Nephrology Hochiminh City national University, Vietnam Representative from Society of Nephrology-Urology of Vietnam (+84) 912 323276
| | - Ha Phan Haian
- Department of Nephrology Viet Duc University Hospital, Vietnam Representative from- Society of Nephrology-Urology of Vietnam (+84) 913546992
| | - Syed Fazal Akhtar
- Department of Nephrology Sindh Institute of Urology and Transplantation, Pakistan Representative from Pakistan Society of Nephrology (+92)300 8249856
| | - Ali Alsahow
- Department of Nephrology Jahara Hospital, Kuwait Representative From Gulf Corporation Council (+96)599335599
| | - D S Rana
- Department of Nephrology Sir Gangaram Hospital, Delhi (+91)9811033984
| | - M M Rajapurkar
- Department of Nephrology Muljibhai Patel Urological Hospital, Gujrat (+91) 9824349500
| | - Vijay Kher
- Department of Nephrology Medanta Hospital Gurugram, Haryana (+91) 9811054118)
| | - Shalini Verma
- Clinical Research AVATAR foundation, New Delhi (+91)8586983027
| | | | - Vinant Bhargava
- Department of Nephrology Sir Ganga Ram Hospital, Delhi (+91) 9990610096
| | - Sonika Puri
- Department of Nephrology Rutgers Robert Wood Johnson Medical School, New Jersy United States +1 (732) 501 1737
| | - Gaurav Sagar
- Department of Nephrology Indraprastha Apollo Hospital, Delhi (+91) 9810995996
| | - Anupam Bahl
- Department of Nephrology Indraprastha Apollo Hospital, Delhi (+91) 9711311750
| | - Sandeep Mandal
- Department of Nephrology Columbia Asia Hospital, Gurugram (+91) 8130007368
| | - Ashwani Gupta
- Department of Nephrology Sir Ganga Ram Hospital, Delhi (+91) 9811049761
| | - Maurizio Gallieni
- Department of Nephrology ‘L. Sacco’ Department of Biomedical and Clinical Sciences University of Milano, Italy (+39) 347746 8832
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14
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Hassanein M, Radhakrishnan Y, Sedor J, Vachharajani T, Vachharajani VT, Augustine J, Demirjian S, Thomas G. COVID-19 and the kidney. Cleve Clin J Med 2020; 87:619-631. [PMID: 33004323 DOI: 10.3949/ccjm.87a.20072] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
COVID-19 is primarily considered a respiratory illness, but the kidney may be one of the targets of SARS-CoV-2 infection, since the virus enters cells through the angiotensin-converting enzyme 2 receptor, which is found in abundance in the kidney. Information on kidney involvement in COVID-19 is limited but is evolving rapidly. This article discusses the pathogenesis of acute kidney injury (AKI) in COVID-19, its optimal management, and the impact of COVID-19 on patients with chronic kidney disease, patients with end-stage kidney disease on dialysis, and kidney transplant recipients.
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Affiliation(s)
- Mohamed Hassanein
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic
| | | | - John Sedor
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic; Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Tushar Vachharajani
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic; Clinical Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Vidula T Vachharajani
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic; Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Joshua Augustine
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic; Associate Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Sevag Demirjian
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic; Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - George Thomas
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic; Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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15
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Azem R, Daou R, Bassil E, Anvari EM, Taliercio JJ, Arrigain S, Schold JD, Vachharajani T, Nally J, Nakhoul GN. Correction to: Serum magnesium, mortality and disease progression in chronic kidney disease. BMC Nephrol 2020; 21:139. [PMID: 32303197 PMCID: PMC7165400 DOI: 10.1186/s12882-020-01801-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Following publication of the original article [1], we have been notified that the name of one author was spelled incorrectly as Georges N. Na khoul, when the correct spelling is Georges N. Nakhoul.
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Affiliation(s)
- Rami Azem
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue - Q7, Cleveland, OH, 44195, USA
| | - Remy Daou
- Department of Family Medicine, Saint Joseph University, Beirut, Lebanon
| | - Elias Bassil
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Eva Maria Anvari
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue - Q7, Cleveland, OH, 44195, USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Jonathan J Taliercio
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue - Q7, Cleveland, OH, 44195, USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Susana Arrigain
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Jesse D Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Tushar Vachharajani
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue - Q7, Cleveland, OH, 44195, USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Joseph Nally
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue - Q7, Cleveland, OH, 44195, USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Georges N Nakhoul
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue - Q7, Cleveland, OH, 44195, USA. .,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
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16
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McLennan G, Vachharajani T, Kirksey L. Abstract No. 442 Inpatient screening for endovascular arteriovenous fistula: the good, the bad, and the ugly. . . J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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17
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Bassil E, Azem R, Daou R, Anvari E, Taliercio J, Arrigain S, Schold J, Vachharajani T, Nally J, Nakhoul G. SAT-073 Serum Magnesium, mortality and disease progression in Chronic Kidney disease. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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18
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Swanepoel CR, McCulloch MI, Abraham G, Donner JA, Alrukhaimi MN, Blake PG, Bunnag S, Claus S, Dreyer G, Ghnaimat MA, Ibhais FM, Liew A, McKnight M, Mengistu YT, Naicker S, Niang A, Obrador GT, Perl J, Rashid HU, Tonelli M, Tungsanga K, Vachharajani T, Zakharova E, Zuniga C, Finkelstein FO. Challenges for sustainable end-stage kidney disease care in low-middle-income countries: the problem of the workforce. Kidney Int Suppl (2011) 2020; 10:e49-e54. [PMID: 32149008 DOI: 10.1016/j.kisu.2019.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/11/2019] [Accepted: 11/07/2019] [Indexed: 11/30/2022] Open
Abstract
Prevention and early detection of kidney diseases in adults and children should be a priority for any government health department. This is particularly pertinent in the low-middle-income countries, mostly in Asia, Africa, Latin America, and the Caribbean, where up to 7 million people die because of lack of end-stage kidney disease treatment. The nephrology workforce (nurses, technicians, and doctors) is limited in these countries and expanding the size and expertise of the workforce is essential to permit expansion of treatment for both chronic kidney disease and end-stage kidney disease. To achieve this will require sustained action and commitment from governments, academic medical centers, local nephrology societies, and the international nephrology community.
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Affiliation(s)
- Charles R Swanepoel
- Division of Nephrology and Hypertension, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Mignon I McCulloch
- Paediatric Intensive and Critical Unit, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Georgi Abraham
- Nephrology Division, Madras Medical Mission Hospital, Pondicherry Institute of Medical Sciences, Chennai, India
| | - Jo-Ann Donner
- International Society of Nephrology, Brussels, Belgium
| | - Mona N Alrukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Peter G Blake
- Ontario Renal Network, Toronto, Ontario, Canada.,Division of Nephrology, University of Western Ontario and London Health Sciences Centre, London, Ontario, Canada
| | - Sakarn Bunnag
- Division of Nephrology, Department of Internal Medicine, Rajavithi Hospital, Bangkok, Thailand
| | - Stefaan Claus
- Nephrology Division, Ghent University Hospital, Ghent, Belgium
| | - Gavin Dreyer
- Department of Nephrology, Barts Health National Health Service Trust, London, UK
| | - Mohammad A Ghnaimat
- Nephrology Division, Department of Internal Medicine, The Specialty Hospital, Amman, Jordan
| | | | - Adrian Liew
- Department of Renal Medicine, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Imperial College London-Nanyang Technological University, Singapore
| | - Marla McKnight
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Program in Global Noncommunicable Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Saraladevi Naicker
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Abdou Niang
- Department of Nephrology, Dalal Jamm Hospital, Cheikh Anta Diop University Teaching Hospital, Dakar, Senegal
| | - Gregorio T Obrador
- Faculty of Health Sciences, School of Medicine, Universidad Panamericana, Mexico City, Mexico
| | - Jeffrey Perl
- Division of Nephrology, St. Michael's Hospital and the Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Harun Ur Rashid
- Department of Nephrology, Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Pan-American Health Organization/World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Kriang Tungsanga
- Division of Nephrology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Bhumirajanagarindra Kidney Institute, Bangkok, Thailand
| | - Tushar Vachharajani
- Nephrology Section, Salisbury Veterans Affairs Health Care System, Salisbury, North Carolina, USA.,Division of Nephrology and Hypertension, Department of Medicine, School of Medicine, University of North Carolina Chapel Hill, North Carolina, USA
| | - Elena Zakharova
- Department of Nephrology, Moscow City Hospital named after S.P. Botkin, Moscow, Russian Federation.,Department of Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation.,Department of Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Carlos Zuniga
- School of Medicine, Catholic University of Santisima Concepción, Advanced Renal Care Unit - Las Higueras Hospital, Talcahuano, Chile
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19
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Luyckx VA, Martin DE, Moosa MR, Bello AK, Bellorin-Font E, Chan TM, Claure-Del Granado R, Douthat W, Eiam-Ong S, Eke FU, Goh BL, Jha V, Kendal E, Liew A, Mengistu YT, Muller E, Okpechi IG, Rondeau E, Sahay M, Trask M, Vachharajani T. Developing the ethical framework of end-stage kidney disease care: from practice to policy. Kidney Int Suppl (2011) 2020; 10:e72-e77. [PMID: 32149011 DOI: 10.1016/j.kisu.2019.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/11/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022] Open
Abstract
Ethical issues relating to end-stage kidney disease (ESKD) care are increasingly being discussed by clinicians and ethicists but are still infrequently considered at a policy level or in the education and training of health care professionals. In most lower-income countries, access to kidney replacement therapies such as dialysis is not universal, leading to overt or implicit rationing of resources and potential exclusion from care of those who are unable to sustain out-of-pocket payments. These circumstances create significant inequities in access to ESKD care within and between countries and impose emotional and moral burdens on patients, families, and health care workers involved in decision-making and provision of care. End-of-life decision-making in the context of ESKD care in all countries may also create ethical dilemmas for policy makers, professionals, patients, and their families. This review outlines several ethical implications of the complex challenges that arise in the management of ESKD care around the world. We argue that more work is required to develop the ethics of ESKD care, so as to provide ethical guidance in decision-making and education and training for professionals that will support ethical practice in delivery of ESKD care. We briefly review steps that may be required to accomplish this goal, discussing potential barriers and strategies for success.
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Affiliation(s)
- Valerie A Luyckx
- Institute of Biomedical Ethics and the History of Medicine, University of Zurich, Zurich, Switzerland.,Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Mohammed Rafique Moosa
- Division of Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Aminu K Bello
- Division of Nephrology and Immunity, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ezequiel Bellorin-Font
- Division of Nephrology and Hypertension, Department of Medicine, Saint Louis University, Saint Louis, Missouri, USA
| | - Tak Mao Chan
- Division of Nephrology, Department of Medicine, University of Hong Kong, Hong Kong
| | - Rolando Claure-Del Granado
- Division of Nephrology, Department of Medicine, Hospital Obrero 2-Caja Nacional de Salud, Universidad Mayor de San Simon School of Medicine, Cochabamba, Bolivia
| | - Walter Douthat
- Hospital Privado-Universitario de Cordoba and Instituto Universitario de Ciencias Biomédicas, Cordoba, Argentina
| | - Somchai Eiam-Ong
- Department of Medicine, Chulalongkorn Hospital, Bangkok, Thailand
| | - Felicia U Eke
- Department of Pediatrics, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Bak Leong Goh
- Department of Nephrology and Clinical Research Centre, Hospital Serdang, Jalan Puchong, Kajang, Selangor, Malaysia
| | - Vivekanand Jha
- George Institute for Global Health India, New Delhi, India.,Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Evie Kendal
- School of Medicine, Deakin University, Melbourne, Victoria, Australia
| | - Adrian Liew
- Department of Renal Medicine, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Imperial College London-Nanyang Technological University, Singapore
| | | | - Elmi Muller
- Transplant Unit, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Ikechi G Okpechi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.,Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Eric Rondeau
- Intensive Care Nephrology and Transplantation Department, Hopital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, Paris, France
| | - Manisha Sahay
- Department of Nephrology, Osmania Medical College and General Hospital, Hyderabad, Telangana, India
| | - Michele Trask
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada.,Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Tushar Vachharajani
- Nephrology Section, Salisbury Veterans Affairs Health Care System, Salisbury, North Carolina, USA.,Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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20
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Azem R, Daou R, Bassil E, Anvari EM, Taliercio JJ, Arrigain S, Schold JD, Vachharajani T, Nally J, Na Khoul GN. Serum magnesium, mortality and disease progression in chronic kidney disease. BMC Nephrol 2020; 21:49. [PMID: 32050924 PMCID: PMC7017617 DOI: 10.1186/s12882-020-1713-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 02/06/2020] [Indexed: 11/10/2022] Open
Abstract
Introduction Magnesium disorders are commonly encountered in chronic kidney disease (CKD) and are typically a consequence of decreased kidney function or frequently prescribed medications such as diuretics and proton pump inhibitors. While hypomagnesemia has been linked with increased mortality, the association between elevated magnesium levels and mortality is not clearly defined. Additionally, associations between magnesium disorders, type of death, and CKD progression have not been reported. Therefore, we studied the associations between magnesium levels, CKD progression, mortality, and cause specific deaths in patients with CKD. Methods Using the Cleveland Clinic CKD registry, we identified 10,568 patients with estimated Glomerular Filtration Rate (eGFR) between 15 and 59 ml/min/1.73 m2 in this range for a minimum of 3 months with a measured magnesium level. We categorized subjects into 3 groups based on these magnesium levels (≤ 1.7, 1.7–2.6 and > 2.6 mg/dl) and applied cox regression modeling and competing risk models to identify associations with overall and cause-specific mortality. We also evaluated the association between magnesium level and slope of eGFR using mixed models. Results During a median follow-up of 3.7 years, 4656 (44%) patients died. After adjusting for relevant covariates, a magnesium level < 1.7 mg/dl (vs. 1.7–2.6 mg/dl) was associated with higher overall mortality (HR = 1.14, 95% CI: 1.04, 1.24), and with higher sub-distribution hazards for non-cardiovascular non-malignancy mortality (HR = 1.29, 95% CI: 1.12, 1.49). Magnesium levels > 2.6 mg/dl (vs. 1.7–2.6 mg/dl) was associated with a higher risk of all-cause death only (HR = 1.23, 95% CI: 1.03, 1.48). We found similar results when evaluating magnesium as a continuous measure. There were no significant differences in the slope of eGFR across all three magnesium groups (p = 0.10). Conclusions In patients with CKD stage 3 and 4, hypomagnesemia was associated with higher all-cause and non-cardiovascular non-malignancy mortality. Hypermagnesemia was associated with higher all-cause mortality. Neither hypo nor hypermagnesemia were associated with an increased risk of CKD progression.
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Affiliation(s)
- Rami Azem
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue - Q7, Cleveland, OH, 44195, USA
| | - Remy Daou
- Department of Family Medicine, Saint Joseph University, Beirut, Lebanon
| | - Elias Bassil
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Eva Maria Anvari
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue - Q7, Cleveland, OH, 44195, USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Jonathan J Taliercio
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue - Q7, Cleveland, OH, 44195, USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Susana Arrigain
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Jesse D Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Tushar Vachharajani
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue - Q7, Cleveland, OH, 44195, USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Joseph Nally
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue - Q7, Cleveland, OH, 44195, USA.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Georges N Na Khoul
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue - Q7, Cleveland, OH, 44195, USA. .,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
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21
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Abstract
BACKGROUND Conflicting data continue to surround the optimal dialysis access for the elderly. Many propose that catheters are the best option for this population; others emphasize the creation of an arteriovenous fistula. SUMMARY While an arteriovenous access is the best available access, it has a high early failure rate, particularly in the elderly. However, significant differences exist in forearm (men ≥65 years ~70%; women ≥65 years ~80%) versus upper arm (men ≥65 years ~40%; women ≥65 years ~38%) fistula failure rates in the elderly, with upper arm having much lower failure rates. Two percutaneous innovative techniques that successfully establish fistulas at the upper arm using proximal radial/ulnar -artery as the inflow have been recently introduced. These procedures have been successfully performed in the elderly. Importantly, these techniques bypass the open surgical exploration and as such avoid the surgical manipulation of the juxta-anastomotic region (a common cause for the development of juxta-anastomotic stenosis and early fistula failure). Key Message: This article discusses the arteriovenous fistula creation in the elderly, highlights the factors necessary for successful fistula creation, and describes the 2 innovative techniques that can be used to provide a robust platform for successful fistula creation in this population.
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Affiliation(s)
- Arif Asif
- Department of Medicine, Jersey Shore University Medical Center, Hackensack-Meridian School of Medicine at Seton Hall University, Neptune, New Jersey, USA,
| | - Mohamed M Bakr
- Department of Medicine, Jersey Shore University Medical Center, Hackensack-Meridian School of Medicine at Seton Hall University, Neptune, New Jersey, USA
| | - Michael Levitt
- Department of Medicine, Jersey Shore University Medical Center, Hackensack-Meridian School of Medicine at Seton Hall University, Neptune, New Jersey, USA
| | - Tushar Vachharajani
- Division of Nephrology, Salisbury VA Health System, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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22
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Hossain MA, Amin A, Paul A, Qaisar H, Akula M, Amirpour A, Gor S, Giglio S, Cheng J, Mathew R, Vachharajani T, Bakr M, Asif A. Recognizing Obesity in Adult Hospitalized Patients: A Retrospective Cohort Study Assessing Rates of Documentation and Prevalence of Obesity. J Clin Med 2018; 7:jcm7080203. [PMID: 30087233 PMCID: PMC6111619 DOI: 10.3390/jcm7080203] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 07/30/2018] [Accepted: 08/03/2018] [Indexed: 11/30/2022] Open
Abstract
Background: While obesity is a chronic condition that predisposes patients to other more serious disorders, the prevalence and the documentation of obesity as diagnosis has not been extensively studied in hospitalized patients. We conducted a retrospective chart review to investigate the prevalence and documentation of obesity as a diagnosis among patients admitted to our medical center. Method: IRB approval was obtained for this retrospective study. Body mass index (BMI) as per CDC, admission and discharge diagnosis of obesity and common comorbidities (hypertension, diabetes, hyperlipidemia, coronary artery disease, congestive heart disease, chronic kidney disease and chronic obstructive pulmonary disease) were recorded. The length of stay in the hospital was also calculated. We also investigated whether counselling was provided to the obese patients for weight loss. Results: A total of 540 consecutive patients were reviewed with a mean age was 66 ± 6 years. Out of 540 patients only 182 (34%) had normal weight, 188 (35%) of the patients were overweight and 170 (31%) patients were obese. Of the obese group, 55% were female and 45% were male.100 (59%) had class I obesity, 43 (25%) had class II obesity and 27 (16%) class III obesity. Of the obese patients 40/170 (23.5%) patients had obesity documented on the admission problem list and only 21 (12%) had obesity documented as a discharge diagnosis. Only 3 (2%) patients were given appropriate counseling and referral for obesity management during the hospitalization. Comorbidities and their prevalence included, hypertension (68%), diabetes mellitus (35%), hyperlipidemia (36%), coronary artery disease (18%), chronic kidney disease (17%), congestive heart failure (18%) and COPD (24%). The average length of stay in normal weight, overweight and obese patients was similar for all three groups (4.5 ± 0.5 days). Conclusion: A significant number of hospitalized patients were overweight and obese. An overwhelming percentage never had weight status documented. Hospitalization offers health care providers a window of opportunity to identify obesity, communicate risks, and initiate weight management interventions.
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Affiliation(s)
- Mohammad A Hossain
- Department of Medicine, Jersey Shore University Medical Center, 1945 State Route 33, Neptune, NJ 07753, USA.
- Hackensack-Meridian School of Medicine at Seton Hall University, Hackensack Meridian Health, NJ 07753, USA.
| | - Ami Amin
- Department of Medicine, Jersey Shore University Medical Center, 1945 State Route 33, Neptune, NJ 07753, USA.
| | - Anju Paul
- Department of Medicine, Jersey Shore University Medical Center, 1945 State Route 33, Neptune, NJ 07753, USA.
| | - Huzaif Qaisar
- Department of Medicine, Jersey Shore University Medical Center, 1945 State Route 33, Neptune, NJ 07753, USA.
| | - Monika Akula
- Department of Medicine, Jersey Shore University Medical Center, 1945 State Route 33, Neptune, NJ 07753, USA.
| | - Alireza Amirpour
- Department of Medicine, Jersey Shore University Medical Center, 1945 State Route 33, Neptune, NJ 07753, USA.
| | - Shreya Gor
- Department of Medicine, Jersey Shore University Medical Center, 1945 State Route 33, Neptune, NJ 07753, USA.
| | - Sofi Giglio
- Department of Medicine, Jersey Shore University Medical Center, 1945 State Route 33, Neptune, NJ 07753, USA.
| | - Jennifer Cheng
- Department of Medicine, Jersey Shore University Medical Center, 1945 State Route 33, Neptune, NJ 07753, USA.
| | - Roy Mathew
- Department of Medicine, WJB Dorn VA Medical Center, Columbia, SC 29208, USA.
| | - Tushar Vachharajani
- Division of Nephrology, Salisbury VA Health Care System and University of NC, Chapel Hill, NC 27599, USA.
| | - Mohamed Bakr
- Department of Medicine, Jersey Shore University Medical Center, 1945 State Route 33, Neptune, NJ 07753, USA.
- Hackensack-Meridian School of Medicine at Seton Hall University, Hackensack Meridian Health, NJ 07753, USA.
| | - Arif Asif
- Department of Medicine, Jersey Shore University Medical Center, 1945 State Route 33, Neptune, NJ 07753, USA.
- Hackensack-Meridian School of Medicine at Seton Hall University, Hackensack Meridian Health, NJ 07753, USA.
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23
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Zuckerman R, Asif A, Costanzo EJ, Vachharajani T. Complement activation in atypical hemolytic uremic syndrome and scleroderma renal crisis: a critical analysis of pathophysiology. ACTA ACUST UNITED AC 2018; 40:77-81. [PMID: 29796581 PMCID: PMC6533968 DOI: 10.1590/2175-8239-jbn-3807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 06/09/2017] [Indexed: 01/19/2023]
Abstract
Scleroderma is an autoimmune disease that affects multiple systems. While
pathophysiologic mechanisms governing the development of scleroderma are
relatively poorly understood, advances in our understanding of the complement
system are clarifying the role of complement pathways in the development of
atypical hemolytic uremic syndrome and scleroderma renal crisis. The abundant
similarities in their presentation as well as the clinical course are raising
the possibility of a common underlying pathogenesis. Recent reports are
emphasizing that complement pathways appear to be the unifying link. This
article reviews the role of complement system in the development of atypical
hemolytic uremic syndrome and scleroderma renal crisis, and calls for heightened
awareness to the development of thrombotic angiopathy in patients with
scleroderma.
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Affiliation(s)
- Roman Zuckerman
- Jersey Shore University Medical Center, Seton Hall-Hackensack-Meridian School of Medicine, Neptune, NJ, USA
| | - Arif Asif
- Jersey Shore University Medical Center, Seton Hall-Hackensack-Meridian School of Medicine, Neptune, NJ, USA
| | - Eric J Costanzo
- Jersey Shore University Medical Center, Seton Hall-Hackensack-Meridian School of Medicine, Neptune, NJ, USA
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24
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Viecelli AK, Tong A, O'Lone E, Ju A, Hanson CS, Sautenet B, Craig JC, Manns B, Howell M, Chemla E, Hooi LS, Johnson DW, Lee T, Lok CE, Polkinghorne KR, Quinn RR, Vachharajani T, Vanholder R, Zuo L, Hawley CM. Report of the Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) Consensus Workshop on Establishing a Core Outcome Measure for Hemodialysis Vascular Access. Am J Kidney Dis 2018; 71:690-700. [PMID: 29478866 DOI: 10.1053/j.ajkd.2017.12.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 12/07/2017] [Indexed: 02/08/2023]
Abstract
Vascular access outcomes in hemodialysis are critically important for patients and clinicians, but frequently are neither patient relevant nor measured consistently in randomized trials. A Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) consensus workshop was convened to discuss the development of a core outcome measure for vascular access. 13 patients/caregivers and 46 professionals (clinicians, policy makers, industry representatives, and researchers) attended. Participants advocated for vascular access function to be a core outcome based on the broad applicability of function regardless of access type, involvement of a multidisciplinary team in achieving a functioning access, and the impact of access function on quality of life, survival, and other access-related outcomes. A core outcome measure for vascular access required demonstrable feasibility for implementation across different clinical and trial settings. Participants advocated for a practical and flexible outcome measure with a simple actionable definition. Integrating patients' values and preferences was warranted to enhance the relevance of the measure. Proposed outcome measures for function included "uninterrupted use of the access without the need for interventions" and "ability to receive prescribed dialysis," but not "access blood flow," which was deemed too expensive and unreliable. These recommendations will inform the definition and implementation of a core outcome measure for vascular access function in hemodialysis trials.
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Affiliation(s)
- Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Australia.
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Emma O'Lone
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Angela Ju
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Camilla S Hanson
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Benedicte Sautenet
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia; University Francois Rabelais, Tours, France; Department of Nephrology and Clinical Immunology, Tours Hospital, Tours, France; INSERM, U1246, Tours, France
| | - Jonathan C Craig
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Braden Manns
- Departments of Medicine and Community Health Sciences, Libin Cardiovascular Institute and O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Martin Howell
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Eric Chemla
- St George's University NHS Foundation Trust, London, United Kingdom
| | - Lai-Seong Hooi
- Department of Medicine and Haemodialysis Unit, Hospital Sultanah Aminah, Johor Bahru, Malaysia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia
| | - Timmy Lee
- Division of Nephrology, Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL
| | - Charmaine E Lok
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kevan R Polkinghorne
- Department of Nephrology, Monash Medical Centre, Melbourne, Australia; Department of Medicine, Monash University, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Robert R Quinn
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Tushar Vachharajani
- Division of Nephrology, W.G. (Bill) Hefner Veterans Affairs Medical Center, Salisbury, NC
| | - Raymond Vanholder
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Li Zuo
- Peking University People's Hospital, Beijing, China
| | - Carmel M Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia
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25
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Asif A, Hossain M, Cheema A, Kalathil S, Bajwa R, Costanzo E, Cosentino J, Cheng J, Vachharajani T. Atypical hemolytic uremic syndrome: Laboratory characteristics, complement-amplifying conditions, renal biopsy, and genetic mutations. Saudi J Kidney Dis Transpl 2018; 29:276-283. [DOI: 10.4103/1319-2442.229287] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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26
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Viecelli AK, O'Lone E, Sautenet B, Craig JC, Tong A, Chemla E, Hooi LS, Lee T, Lok C, Polkinghorne KR, Quinn RR, Vachharajani T, Vanholder R, Zuo L, Irish AB, Mori TA, Pascoe EM, Johnson DW, Hawley CM. Vascular Access Outcomes Reported in Maintenance Hemodialysis Trials: A Systematic Review. Am J Kidney Dis 2017; 71:382-391. [PMID: 29203125 DOI: 10.1053/j.ajkd.2017.09.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 09/19/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Many randomized controlled trials have been performed with the goal of improving outcomes related to hemodialysis vascular access. If the reported outcomes are relevant and measured consistently to allow comparison of interventions across trials, such trials can inform decision making. This study aimed to assess the scope and consistency of vascular access outcomes reported in contemporary hemodialysis trials. STUDY DESIGN Systematic review. SETTING & POPULATION Adults requiring maintenance hemodialysis. SELECTION CRITERIA All randomized controlled trials and trial protocols reporting vascular access outcomes identified from ClinicalTrials.gov, Embase, MEDLINE, and the Cochrane Kidney and Transplant Specialized Register from January 2011 to June 2016. INTERVENTIONS Any hemodialysis-related intervention. OUTCOMES The frequency and characteristics of vascular access outcome measures were analyzed and classified. RESULTS From 168 relevant trials, 1,426 access-related outcome measures were extracted and classified into 23 different outcomes. The 3 most common outcomes were function (136 [81%] trials), infection (63 [38%]), and maturation (31 [18%]). Function was measured in 489 different ways, but most frequently reported as "mean access blood flow (mL/min)" (37 [27%] trials) and "number of thromboses" (30 [22%]). Infection was assessed in 136 different ways, with "number of access-related infections" being the most common measure. Maturation was assessed in 44 different ways at 15 different time points and most commonly characterized by vein diameter and blood flow. Patient-reported outcomes, including pain (19 [11%]) and quality of life (5 [3%]), were reported infrequently. Only a minority of trials used previously standardized outcome definitions. LIMITATIONS Restricted sampling frame for feasibility and focus on contemporary trials. CONCLUSIONS The reporting of access outcomes in hemodialysis trials is very heterogeneous, with limited patient-reported outcomes and infrequent use of standardized outcome measures. Efforts to standardize outcome reporting for vascular access are critical to optimizing the comparability, reliability, and value of trial evidence to improve outcomes for patients requiring hemodialysis.
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Affiliation(s)
- Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Australia.
| | - Emma O'Lone
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Benedicte Sautenet
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia; University Francois Rabelais, Tours, France; Department of Nephrology and Clinical Immunology, Tours Hospital, Tours, France
| | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Eric Chemla
- St George's University Hospitals Foundation Trust, London, United Kingdom
| | - Lai-Seong Hooi
- Department of Medicine and Haemodialysis Unit, Hospital Sultanah Aminah, Johor Bahru, Malaysia
| | - Timmy Lee
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Section of Nephrology, Veterans Affairs Medical Center, Birmingham, AL
| | - Charmaine Lok
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kevan R Polkinghorne
- Department of Nephrology, Monash Medical Centre, Melbourne, Australia; Department of Medicine, Monash University, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Robert R Quinn
- Department of Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Tushar Vachharajani
- Division of Nephrology, W.G. (Bill) Hefner Veterans Affairs Medical Center, Salisbury, NC
| | - Raymond Vanholder
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Li Zuo
- Peking University People's Hospital, Beijing, China
| | - Ashley B Irish
- Department of Nephrology, Fiona Stanley Hospital, Perth, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Trevor A Mori
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Elaine M Pascoe
- Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia
| | - Carmel M Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia
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Viecelli A, O'Lone E, Sautenet B, Craig J, Tong A, Chemla E, Hooi LS, Lee T, Lok C, Polkinghorne K, Quinn R, Vachharajani T, Vanholder R, Zuo L, Irish A, Mori T, Pascoe E, Johnson D, Hawley C. SP583VASCULAR ACCESS OUTCOMES REPORTED IN RANDOMISED TRIALS CONDUCTED IN PATIENTS REQUIRING HAEMODIALYSIS: A SYSTEMATIC REVIEW. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx153.sp583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Desai T, Ali S, Fang X, Thompson W, Jawa P, Vachharajani T. Equal work for unequal pay: the gender reimbursement gap for healthcare providers in the United States. Postgrad Med J 2016; 92:571-5. [PMID: 27528703 DOI: 10.1136/postgradmedj-2016-134094] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 06/07/2016] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Gender disparities in income continue to exist, and many studies have quantified the gap between male and female workers. These studies paint an incomplete picture of gender income disparity because of their reliance on notoriously inaccurate or incomplete surveys. We quantified gender reimbursement disparity between female and male healthcare providers using objective, non-self-reported data and attempted to adjust the disparity against commonly held beliefs as to why it exists. METHODS We analysed over three million publicly available Medicare reimbursement claims for calendar year 2012 and compared the reimbursements received by male and female healthcare providers in 13 medical specialties. We adjusted these reimbursement totals against how hard providers worked, how productive each provider was, and their level of experience. We calculated a reimbursement differential between male and female providers by primary medical specialty. RESULTS The overall adjusted reimbursement differential against female providers was -US$18 677.23 (95% CI -US$19 301.94 to -US$18 052.53). All 13 specialties displayed a negative reimbursement differential against female providers. Only two specialties had reimbursement differentials that were not statistically significant. CONCLUSIONS After adjustment for how hard a physician works, his/her years of experience and his/her productivity, female healthcare providers are still reimbursed less than male providers. Using objective, non-survey data will provide a more accurate understanding of this reimbursement inequity and perhaps lead the medical profession (as a whole) towards a solution that can reverse this decades-old injustice.
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Affiliation(s)
- Tejas Desai
- Division of Nephrology, WG (Bill) Hefner VA Medical Center, Salisbury, North Carolina, USA NOD Analytics, Charlotte, North Carolina, USA
| | - Sadeem Ali
- Division of Nephrology, East Carolina University-Brody School of Medicine, Greenville, North Carolina, USA
| | - Xiangming Fang
- Department of Biostatistics, East Carolina University-Brody School of Medicine, Greenville, North Carolina, USA
| | - Wanda Thompson
- Office of the Chief of Staff, WG (Bill) Hefner VA Medical Center, Salisbury, North Carolina, USA
| | - Pankaj Jawa
- Division of Nephrology, East Carolina University-Brody School of Medicine, Greenville, North Carolina, USA
| | - Tushar Vachharajani
- Division of Nephrology, WG (Bill) Hefner VA Medical Center, Salisbury, North Carolina, USA
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Asif A, Vachharajani T, Salman L, Nayer A. A Simplified Approach to the Diagnosis of Atypical HUS: Clinical Considerations and Practical Implications. ACTA ACUST UNITED AC 2014. [DOI: 10.2174/1874303x01407010091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Although rare, atypical hemolytic-uremic syndrome (aHUS) carries a high morbidity and mortality. Widespread microvascular thrombosis, thrombocytopenia and microangiopathic hemolytic anemia are the hallmark of aHUS. Virtually any organ (particularly the kidney) can be a target for the devastating effects of this syndrome. Uncontrolled activation of the alternative pathway of the complement system lies at the heart of the pathogenesis of aHUS. While significant advances have been made in our understanding of aHUS, establishing timely diagnosis of this syndrome has been challenging. This, in part, is due to the absence of a sensitive and specific diagnostic test and a relatively lack of our familiarity with the syndrome. With the recent success and approval of a humanized monoclonal antibody (eculizumab) in the treatment of aHUS, prompt and accurate diagnosis is of paramount importance to limit the target organ injury. This article presents a simplified approach to establishing the diagnosis of aHUS.
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Asif A, Ghate K, Jube N, Haqqie SS, Mathew RO, Kumar V, Tietjen J, Rosenberger J, Pokharel S, Saeed SF, Yousefian S, Merrill D, Shahid R, Akmal MU, Nayer A, Mason D, Vachharajani T, Salman L. Hyponatremia Etiology and Tolvaptan: Are we Optimally Targeting the Mechanism? ACTA ACUST UNITED AC 2014. [DOI: 10.2174/1874303x01407010008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Asif A, Haqqie SS, Ghate K, Mathew RO, Vachharajani T, Nayer A. Continued Eculizumab Therapy for Persistent Atypical Hemolytic Uremic Syndrome. ACTA ACUST UNITED AC 2013. [DOI: 10.2174/1874303x01306010046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Atypical hemolytic uremic syndrome (atypical HUS) is characterized by endothelial injury and microvascular thrombosis resulting in microangiopathic hemolytic anemia, thrombocytopenia, and ischemic injury to organs, especially the kidney. Activation of complements is involved in the pathogenesis of atypical HUS. Eculizumab, a neutralizing monoclonal antibody directed against complement C5, has shown salutary effects in patients with atypical HUS. In this report, we present a 23-year-old man with atypical HUSwho was treated with eculizumab. During the first four weeks of treatment, eculizumab failed to achieve a remission. Microangiopathic hemolytic anemia and thrombocytopenia persisted, while renal function deteriorated necessitating initiation of hemodialysis. Continuation of eculizumab therapy, however, led to marked improvement in hemolytic anemia, thrombocytopenia, and renal function. After 10 weeks of eculizumab therapy, hemodialysis was discontinued. At 5-month follow-up, serum creatinine was 1.1 mg/dL with continued eculizumab therapy every other week. In addition, platelet count was normal, while there was no evidence of hemolysis. We conclude that in patients with persistent atypical HUS continued treatment with eculizumab can be helpful in achieving remission.
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Abstract
IntroductionMethemoglobinemia refers to the presence of increased levels of methemoglobin (Fe3+) in the blood. Methemoglobinemia can cause cyanosis, dyspnea, fatigue, seizure, arrhythmia, coma, and even death. Although methemoglobinemia is shown to cause acute kidney injury in experimental settings, human case reports are exceedingly rare. In addition, morphological features of methemoglobinemia-induced renal disease in humans remain undefined.Case PresentationA 76-year-old man with a history of chronic obstructive pulmonary disease underwent bronchoscopy following local anesthesia with a benzocaine spray. The patient developed benzocaine-induced methemoglobinemia and acute renal failure. Urinalysis disclosed numerous dysmorphic erythrocytes, erythrocyte casts, and granular casts. Urine protein excretion was approximately 1.1 g/day. Serologic tests were negative. Renal biopsy demonstrated minor glomerular abnormalities, severe acute tubular necrosis, and numerous erythrocyte casts in the tubules. Despite supportive care, renal function deteriorated necessitating hemodialysis. Four months later, the patient remained on hemodialysis. To exclude a superimposed pathology, renal biopsy was repeated and showed numerous erythrocyte casts in the tubules and severe tubular damage.ConclusionMethemoglobinemia can cause acute kidney injury in humans. Morphological features resemble those observed in methemoglobin-induced acute kidney injury in experimental settings. This case calls for a heightened awareness of potential adverse effects of methemoglobinemia on renal function.
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Asif A, Castro H, Waheed AA, Kumar V, Haqqie SS, Siskin G, Mathew RO, Mason D, Vachharajani T, Nayer A, Merrill D, Akmal MUT, Salman L. Blood pressure recordings during hemodialysis access interventions: implications for acute management. Semin Dial 2013; 26:E30-2. [PMID: 23551213 DOI: 10.1111/sdi.12083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A retrospective study evaluating the pattern of blood pressure and its related complications before, during, and after percutaneous hemodialysis interventions was performed in patients presenting with asymptomatic hypertension. Hemodialysis patients undergoing percutaneous interventions including tunneled hemodialysis catheter insertion, percutaneous balloon angioplasty and thrombectomy procedure, and stage II hypertension (systolic blood pressure ≥160 mmHg) were included in this analysis. Blood pressure medications were not used while midazolam and fentanyl were routinely administered. Patients were followed for up to 4 weeks to monitor any complications. The mean blood pressure before, during, and after the procedures were 185 ± 18/96 ± 14, 172 ± 22/92 ± 15, and 153 ± 25/87 ± 14, respectively. There was a statistically significant difference between the blood pressure readings before and after the procedure (before = 185 ± 18/96 ± 14, after = 153 ± 25/87 ± 14; p = 0.001). None of the patients had a stroke, myocardial infarction, or acute pulmonary edema before, during, or after the procedure or during the 4-week follow-up period. A significant reduction in blood pressure was observed after the procedure without the administration of any antihypertensive medication. These results suggest that the reduction in blood pressure observed after percutaneous dialysis access interventions (particularly in the presence of midazolam and fentanyl) may make it unnecessary to treat asymptomatic hypertension prior to these procedures.
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Affiliation(s)
- Arif Asif
- Albany Medical College and Veterans Affairs Medical Center, Albany, NY, USA.
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Abreo K, Allon M, Asif A, Atray N, Besarab A, Dember LM, Dixon BS, DeVita M, Kaufman J, Murray BM, Nguyen VD, Paulson WD, Ram SJ, Vachharajani T, Vesely TM, White JJ, Work J, Kennedy J. Which direction is right for vascular access surveillance? A debate. Nephrol News Issues 2010; 24:30-34. [PMID: 20617629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Kenneth Abreo
- Louisiana State University School of Medicine, Shreveport, LA, USA
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Vachharajani T. Medical alert bracelet: an effective way to preserve veins for future dialysis vascular access in patients with chronic kidney disease. Medscape J Med 2009; 11:1. [PMID: 19295922 PMCID: PMC2654680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Tushar Vachharajani
- Dialysis Access Group of WFU, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC Author's
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Vachharajani T, Vachharajani V. Vasopressin-receptor antagonist therapy in patients with hyponatraemia. Br J Hosp Med (Lond) 2007; 68:367-72. [PMID: 17663307 DOI: 10.12968/hmed.2007.68.7.23972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hyponatraemia often complicates the treatment of underlying conditions in patients who are seriously ill. Arginine vasopressin receptor antagonists block the action of arginine vasopressin and correct sodium and water imbalance in patients with euvolaemic or hypervolaemic hyponatraemia.
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Affiliation(s)
- Tushar Vachharajani
- Department of Internal Medicine/Nephrology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
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Pervez A, Zaman F, Aslam A, Petty S, Murphy S, Vachharajani T, Abreo K. American Society of Diagnostic and Interventional Nephrology Section Editor: Stephen Ash: Port Catheter Placement by Nephrologists in an Interventional Nephrology Training Program. Semin Dial 2004; 17:61-4. [PMID: 14717814 DOI: 10.1111/j.1525-139x.2004.17116.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We retrospectively reviewed all subcutaneous single- and double-lumen port catheters (PCs) inserted by interventional nephrologists at our institution to determine the success rate, immediate and late complications, and functional life. From January 2000 to August 2002, 187 PCs were placed in 187 patients (42% males, 51% Caucasians, mean age 50 +/- 14 years). There were no immediate complications related to the procedure such as hemorrhage, pulmonary embolism, or pneumothorax. There were a total of 35,078 catheter-days of follow-up. Sixteen catheters were removed during the observation period: three because of infection, seven after completion of chemotherapy, and six for other reasons. The remaining PCs are either functioning or the patients have died. The initial success rate was 100%. Kaplan-Meier analysis showed a 30-day survival of 97% and a 1-year survival of 92%. Interventional nephrologists, who have adequate training in central venous tunneled cuffed catheter placements, can successfully place PCs, with excellent success and minimal complications.
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Affiliation(s)
- Aslam Pervez
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana 71103, USa.
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Qadri M, Atray NK, Vachharajani T. 113 CELIAC SPRUE AND RENAL CELL CARCINOMA: A UNIQUE ASSOCIATION. J Investig Med 2004. [DOI: 10.1136/jim-52-suppl1-666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Vachharajani T, Atray N. 112 MODERN NEPHROLOGY: “ONE-STOP-SHOP” APPROACH. J Investig Med 2004. [DOI: 10.1136/jim-52-suppl1-665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
BACKGROUND The incidence of Mycobacterium tuberculosis in hemodialysis (HD) and renal transplant (RT) patients in developing countries is high. With the resurgence of tuberculosis in the US, insights gained in the diagnosis and treatment of this infection in HD and RT patients in developing countries should be valuable to physicians in the West. METHODS A retrospective study of 40 cases of tuberculosis, 24 in HD patients (24/177, 13.6%) and 16 in RT patients (16/109, 14.7%) diagnosed over a period of 21 months in one center. RESULTS The clinical features, diagnostic procedures, and management dilemmas of this group of patients are described in this report. Diabetes mellitus was the most common associated disease in both groups of patients. Fever, the most common presenting sign, was persistent low grade in 66.6% of HD patients and high intermittent in 56.2% of RT patients. Fever of unknown origin was only seen in RT patients. Pulmonary involvement was most common in both groups, presenting either as infiltrates or effusions. Tuberculous peritonitis was seen only in HD patients (33.3%). Eight HD patients were treated for tuberculosis for variable periods prior to transplantation, 4 of whom had less than 6 months of therapy. None had a recurrence of tuberculosis after transplantation. Because of the known cyclosporin-lowering effect of rifampicin resulting in an increased cost of immunosuppressive therapy, 13 patients were treated successfully with rifampicin-sparing therapy. CONCLUSION Tuberculosis should be included in the differential diagnosis of fever in HD and RT patients, especially if fever is of unknown origin in the RT patient. M. tuberculosis in the renal transplant patient can present with high intermittent fever. Partial treatment of tuberculosis is sufficient prior to renal transplantation but treatment should be continued to completion after transplantation. If the cost of immunosuppressive therapy is prohibitive because of rifampicin, rifampicin-sparing antituberculosis therapy can be successfully employed in RT patients.
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Affiliation(s)
- T Vachharajani
- Division of Renal Transplant, Bombay Hospital Institute of Medical Sciences, Mumbai, India.
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Kulkarni SG, Jagose JT, Vachharajani T, Kirpalani AL. Continuous arteriovenous haemofiltration & haemodialysis. J Assoc Physicians India 1994; 42:754. [PMID: 7883686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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