Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia
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Saudi J Kidney Dis Transpl · May 2010
Multicenter StudyFactors associated with decision-making about end-of-life care by hemodialysis patients.
The current cross sectional study is based on a questionnaire database on patients with end-stage renal disease (ESRD) to determine their preferences about end-of-life care and differences of certainty regarding the application of cardiopulmonary resuscitation and life sustaining measures in case of cardiac arrest. The study was performed on 100 patients on hemodialysis for at least 2 years and not on the transplant list in two tertiary hospitals in Saudi Arabia; King Fahad National Guard in Riyadh and King Faisal Specialist Hospital in Jeddah in March 2007. ⋯ Factors such as self-perception or disease curability, previous admissions to hospital or intensive care units, prior knowledge of mechanical ventilation, or cardiopulmonary resuscitation did not have any influence on making certain decisions on end-of-life care. There was a significant lack of knowledge in our study patients of cardiopulmonary resuscitation, mechanical ventilation, and disease outcome.
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Saudi J Kidney Dis Transpl · May 2010
The effect of low serum bicarbonate values on the onset of action of local anesthesia with vertical infraclavicular brachial plexus block in patients with end-stage renal failure.
Vertical infraclavicular brachial plexus block is utilized in patients with chronic renal failure at the time of creation of an arterio-venous fistula (AVF). The aim of this study is to test the effect of impaired renal function, with the resulting deranged serum electrolytes and blood gases, on the success rate and the onset of action of the local anesthetics used. In this prospective clinical study, we investigated the effect of the serum levels of sodium, potassium, urea, creatinine, pH, and bicarbonate on the onset of action of a mixture of lidocaine and bupivacaine administered to create infraclavicular brachial plexus block. ⋯ There was no significant association with serum sodium, potassium, urea, creatinine or the blood pH level (P > 0.05). The bivariate correlation between serum bicarbonate level and the partial and complete sensory loss was -0.714 and -0.433 respectively, with significant correlation (P = 0.00, 0.019). Our study suggests that infraclavicular block in patients with chronic renal failure carries a high success rate; the onset of the block is delayed in patients with low serum bicarbonate levels.
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Saudi J Kidney Dis Transpl · May 2010
Comparative StudyComparative study of anticoagulation versus saline flushes in continuous renal replacement therapy.
Systemic heparinization during continuous renal replacement therapy (CRRT) is associated with disadvantage of risk of bleeding. This study analyses the efficacy of frequent saline flushes compared with heparin anticoagulation to maintain filter life. From January 2004 to November 2007, 65 critically ill patients with acute renal failure underwent CRRT. ⋯ Patients receiving heparin had 16 bleeding episodes (0.45/patient) while only four bleeding episodes occurred in heparin free group (0.13/patient, P < 0.05). Mortality was 71% in heparin group and 67% in heparin free group. Frequent saline flushes is an effective mode of maintainance of extracorporeal circuit in CRRT when aPTT is already on the higher side, with significantly decreased bleeding episodes.
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Saudi J Kidney Dis Transpl · May 2010
Comparative StudyThe role of B-mode ultrasonography in the detection of urolithiasis in patients with acute renal colic.
This study was conducted to assess the diagnostic yield of B-Mode Ultrasonography compared to unenhanced helical CT scan in detecting urinary stones in patients with acute renal colic. This retrospective study comprised of 156 patients who underwent unenhanced urinary tract CT scan and ultrasonography for suspicion of urolithiasis. Both techniques were used to determine the presence or absence, site, size, and number of urinary stones, as well as presence of any other intra-abdominal pathology. ⋯ The overall sensitivity, specificity, positive and negative predictive values, and accuracy of ultrasonography in the diagnosis of renal stone disease were 58%, 91%, 79%, 78%, and 78%, respectively. Our study suggests that, despite its limited value in detecting urinary stones, ultrasonography should be performed as an initial assessment in patients with acute flank pain. Unenhanced helical CT should be reserved for patients in whom ultrasonography is inconclusive.
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Saudi J Kidney Dis Transpl · May 2010
Case ReportsCongenital vitamin D deficiency: a rare etiology of an acute life threatening event in early infancy.
Infants born to mothers with deficiency of vitamin D and/or calcium due to cultural modifications in their diets, life style and clothing habits, are at risk of developing early and fatal sequelae of hypocalcemic vitamin D deficiency. We present a 44-day-old infant with hypocalcemia secondary to congenital vitamin D deficiency, who presented as a recurrent Acute Life Threatening Event (ALTE) resulting in an unexpectedly prolonged intensive care course. This report suggests that evaluation of vitamin D status should be included as part of the workup of ALTE and we describe evidence-based preventive measures for both mothers and infants who are at risk for vitamin D deficiency.