International Journal of Nephrology

Introduction. Chronic kidney disease prevention programs must identify patients at risk of early progression to provide better treatment and prolong kidney replacement therapy-free survival. Risk equations have been developed and validated in cohorts outside of Colombia, so this study aims to evaluate the discrimination and calibration of the four-variable kidney failure risk equation in a Colombian population where it has yet to be validated. Methods. External validation study of a kidney failure risk equation using a historical cohort of patients with CKD stages 3, 4, and 5, adults without a history of dialysis or kidney transplantation with a two-year follow-up, belonging to the Baxter Renal Care Services Colombia network. The discriminatory capacity of the model was evaluated by the concordance index using Harrell’s C statistic, and the time-dependent area under the receiver operating characteristic (ROC) curve was estimated using the nearest neighbor method, as well as the optimal cut-off point for sensitivity and specificity. Calibration was determined by the degree of agreement between the observed outcome and the probabilities predicted by the model using the Hosmer–Lemeshow statistic. Results. A total of 5,477 patients were included, with a mean age of 72 years, 36.4% diabetic, and a mean baseline eGFR of 36 ml/min/1.73 m². The rate of dialysis initiation was three events per 100 patient-years, 95% CI (2.9–3.6). The optimal cutoff for sensitivity was 0.94, for specificity, 0.76, and the area under the ROC curve was 0.92. Harrell’s C-statistic was 0.88 for the total population, 0.88 for diabetic patients, and 0.93 for those 65 years or older. The validation of the model showed good calibration. Conclusions. In this Colombian cohort, the four-variable KFRE with a two-year prediction horizon has excellent calibration and discrimination, and its use in the care of CKD Colombian patients is recommended.

Introduction. Central venous catheters for hemodialysis (HD) can be nontunneled catheters (NTC) or tunneled catheters (TC). Bacteremia and dysfunction are complications that can impact morbidity and mortality. We decided to compare the rates of bacteremia and dysfunction between NTC and TC and patient survival 90 days after catheter insertion. Methods. Retrospective cohort to evaluate catheters inserted between January 2011 and December 2020 in a tertiary hospital. Catheters in patients with end-stage chronic kidney disease were included. Patients with acute kidney injury, catheters that lasted less than three HD sessions, and patients who died within one week after insertion were excluded. Bacteremia and dysfunction rates, bacteremia-free survival, and dysfunction-free survival were investigated. Multivariable analysis was performed using a Cox proportional hazards regression model for patient survival at 90 days. Results. 670 catheters were analyzed in 287 patients, 422 NTC (63%), and 248 TC (37%). The rates of confirmed bacteremia per 1,000 catheter-days were 1.19 for NTC and 0.20 for TC (). The confirmed or possible bacteremia rates were 2.27 and 0.37 per 1,000 catheter-days for NTC and TC, respectively (). The dysfunction rates were 3.96 and 0.86 for NTC and TC, respectively (). Patient survival at 90 days was higher in the TC group than the NTC group (96.8% vs. 89.1%; ). Conclusion. We found lower rates of bacteremia and dysfunction for TC and demonstrated that using NTC affects patient mortality.

Background. Hyperkalemia is a life-threatening condition in outpatient and emergency departments. Hyperkalemia is associated with more events of major adverse cardiovascular diseases, hospitalization, and death. The aim of this study is to study and assess the prevalence and risk factors for developing hyperkalemia within the Thai population. Method. A cross-sectional observational study of 3,299 unique adult patients (≥18 years) in one calendar year (2021) with at least 1 valid serum potassium (SK) test was conducted in the outpatient department of medicine. Hyperkalemia was determined as SK ≥5.8 mmol/L without hemolysis or technical error. Clinical data and laboratory tests were collected for analysis of risk factors. Result. 2,971 patients (131 hyperkalemia and 2,840 control) were eligible. The annual prevalence of hyperkalemia was 4.41%. The mean ages of patients were 66.5 years in the hyperkalemia group and 55.9 years in the control group. Increasing age had a positive association (r = 0.220, ) to risk of hyperkalemia, whereas the estimated glomerular filtration rate (eGFR) had an inverse association with SK level (r = −0.398, ). The risk factors for hyperkalemia were patients with age ≥65 years (odds ratio, 2.106; 95% CI, 1.399, 3.171; ), presence of diabetes mellitus (DM, odds ratio, 1.541; 95% CI, 1.030, 2.306; ), chronic kidney disease (CKD) stage ≥3 (odds ratio, 14.885; 95% CI, 8.112, 27.313; ), hemodialysis treatment (odds ratio, 10.170; 95% CI, 5.858, 17.657; ), and usage of renin-angiotensin-aldosterone system inhibitors (RAASi, odds ratio, 2.256; 95% CI, 1.440, 3.536; ). Conclusion. The risk factors contributing to hyperkalemia were patients with older age, DM, CKD, hemodialysis treatment, and usage of RAASi. Although the usage of RAASi is proven to be a cardiovascular advantage in the elderly, DM, and CKD patients, careful monitoring of SK is strongly advised to optimize patient care.

Introduction. Patients with chronic kidney disease (CKD) have a high prevalence of peripheral artery disease. How best to manage lower extremity peripheral artery disease remains unclear in this patient population. We therefore sought to compare the outcomes after endovascular versus surgical lower extremity revascularization among patients with CKD. Methods. We used data from Optum’s de-identifed Clinformatics® Data Mart Database, a nationwide database of commercially insured persons in the United States to study patients with CKD who underwent lower extremity endovascular or surgical revascularization. We used inverse probability of treatment weighting to balance covariates. We employed proportional hazard regression to study the primary outcome of major adverse limb events (MALE), defined as a repeat revascularization or amputation. We also studied each of these events separately and death from any cause. Results. In our cohort, 60,057 patients underwent endovascular revascularization and 9,338 patients underwent surgical revascularization. Endovascular revascularization compared with surgical revascularization was associated with a higher adjusted hazard of MALE (hazard ratio (HR) 1.52; 95% confidence interval (CI) 1.46–1.59). Endovascular revascularization was also associated with a higher adjusted hazard of repeat revascularization (HR 1.65; 95% CI 1.57–1.72) but a lower adjusted risk of amputation (HR 0.71; CI 0.73–0.89). Patients undergoing endovascular revascularization also had a lower adjusted hazard for death from any cause (0.85; CI 0.82–0.88). Conclusions. In this analysis of patients with CKD undergoing lower extremity revascularization, an endovascular approach was associated with a higher rate of repeated revascularization but a lower risk of subsequent amputation and death compared with surgical revascularization. Multiple factors must be considered when counseling patients with CKD, who have a high burden of comorbid conditions. Clinical trials should include more patients with kidney disease, who are often otherwise excluded from participation, to better understand the most effective treatment strategies for this vulnerable patient population.

The Islamic (lunar) calendar has 11 fewer days each year than the Gregorian (solar) calendar. Consequently, ambient temperatures during the month of Ramadan and the duration of the presunrise-to-sunset fast will change each year. At some point, individuals observing Ramadan will experience prolonged periods of fasting during the hot summer months. In this manuscript, findings published in the English-language medical literature that address the impact of prolonged fasting during the warmer summer months on patients with chronic kidney disease, including dialysis and transplantation patients, are reviewed. This is of particular concern given the accelerated pace of global warming. The limitations of the evidence that is currently available are also discussed, and an approach that might be used to standardize future evaluations of the impact of fasting on kidney health is suggested.

Introduction. High protein intake may accelerate progression of chronic kidney disease (CKD). Estimation of dietary protein intake (DPI) is indispensable for management of CKD, but to achieve optimum DPI is quite challenging in routine clinical practice. We recently studied a beneficial effect of utilizing integrated care on the management of CKD at the rural community level. In that study, we created a short protein food-recall questionnaire (S-PFRQ) as a working tool to estimate DPI of the CKD patients during home visit by community health personnel. Herein, we reported the initial evaluation of the reliability of S-PFRQ from our previous study. Objective. We compared the amount of DPI obtained from S-PFRQ with that obtained from protein-equivalent of total nitrogen appearance (PNA). Methods. In the previous ESCORT-2 study, 914 patients with CKD stage 3 or 4, who were living in the rural area of Thailand, were prospectively followed while receiving integrated care for 36 consecutive months. During home visits by community nurses from subdistrict health centers, dietary food recall was made, recorded in S-PFRQ, and DPI was obtained. Among these, sixty patients were randomly selected, and 24-h urine was collected for urinary urea-N and estimation of PNA. A correlation was made between DPI obtained from S-PFRQ and PNA. Results. The DPIs derived from S-PFRQ and PNA were 28.8 ± 14.8 and 39.26 ± 17.79 g/day, respectively. The mean difference and 95% CI between the 2 methods was −10.43 (−7.1 to −13.8) g/day, respectively ( < 0.001). Interclass correlation between these 2 methods was 0.24,  = 0.007. The difference between the 2 methods remained constant across different amounts of DPI. Conclusion. The DPI estimated from S-PFRQ significantly correlated to that from PNA. However, the S-PFRQ method yielded a DPI value which was about 10 g of protein or 25% less than the PNA method. Despite this amount of difference, this S-PFRQ is user-friendly and could be used during field work as an easy and simple tool for DPI estimation in resource-limiting condition.