Bmc Nephrol
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Maximal conservative management (MCM) may be an appropriate alternative option for dialysis in some elderly patients with end-stage kidney disease (ESKD). Evidence about the impact of dialysis or MCM on quality of life (QoL) in older patients is sparse. In the GOLD (Geriatric assessment in OLder patients starting Dialysis) Study the trajectory of QoL was assessed in patients starting dialysis or MCM. ⋯ A small decline of QoL was found for conservative patients, while QoL did not change in dialysis patients. However, hospitalization rate was higher in patients starting dialysis. In patients over 80 years, no survival benefit was found.
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Multicenter Study
Sleep disturbance among Malaysian patients with end-stage renal disease with pruritus.
Chronic kidney disease-associated pruritus (CKD-aP) is a well-recognized, frequent and compromising complication among patients on hemodialysis. Despite advancement in basic medical sciences, CKD-aP is still a major complication and a challenge for both physicians and patients to manage. The aim of this study was to estimate the prevalence of CKD-aP among hemodialysis patients in Malaysia, to determine the impact of CKD-aP on sleep quality and any factors associated with CKD-aP. ⋯ In Malaysia, the prevalence of CKD-aP was 61.3%, of which the majority reported that their pruritus was mild. Patients with moderate to severe pruritus were found to be 5.47 times more likely to experience poor sleep quality as compared to patients with mild or no pruritus.
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Biography Historical Article
The pioneers of nephrology - Professor Natalia Tomilina: courage, passion and humanism in medicine.
Listening to the interview of Natalia Tomilina is an inspiring experience, and not one reserved purely for young physicians. Within these pages, one can discover Tomilina's determination and passion for learning that has been with her throughout her life, even during difficult and testing times. A great resolve that she developed through the teachings of her parents and her mentor, Prof. ⋯ These great attributes have ensured that Tomilina's contributions to the field of nephrology have been significant - her belief being that her discoveries in medicine belong to the patients and not to the physicians. Those who are older will find the stories of her trials and tribulations in old Russia fascinating, as you rediscover what life was like for a female scientific researcher behind the "Iron Curtain". I think that, regardless of age, the nephrology community would like to join us in paying homage to a great woman, whose life tells us that changing the world is possible."Prosperity is not the main point, and it is not prosperity that gives you satisfaction."The interview was recorded in Prague in June 2011.
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Hyperuricemia and gout have been linked to chronic kidney disease (CKD). Whether the increased risk of CKD in gout is due to shared risk factors such as hypertension, diabetes or heart disease, or due to gout itself is not known. Studies in older adults, who tend to have a high incidence of CKD, are limited. Our objective was to assess whether gout was associated with incident CKD in older adults. ⋯ Gout was associated with a 3-fold higher risk of CKD, confirmed in multiple sensitivity analyses. Future studies should provide insights into underlying mechanisms that are responsible for an increased CKD risk in gout.
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Observational Study
Evaluation of iron stores in hemodialysis patients on maintenance ferric Carboxymaltose dosing.
Iron is administered intravenously (IV) to many dialysis patients at regular intervals and iron stores are evaluated through periodic measurements of ferritin and transferrin saturation (TSAT). In patients without kidney diseases, large single doses of IV iron lead to a transient rise in serum ferritin that does not reflect iron stores. It is not known whether and to what extent smaller IV iron doses used to maintain adequate stores in hemodialysis patients lead to transient spurious elevations of ferritin and TSAT. ⋯ IV administration of FCM at doses of 100 or 200 mg in hemodialysis patients leads to dose-dependent transient ferritin elevations of extended duration. Temporal coordination of blood sampling for iron status evaluation with the maintenance IV iron dosing schedule is advisable.