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 · Jul 2008
Comparative analysis of azathioprine versus cyclosporine-based therapy in primary haplo-identical live-donor kidney transplantation: a 20-year experience.
Chronic allograft nephropathy (CAN) remains a major cause of graft failure over the long term, second only to patient mortality. The main adverse effects of cyclosporine A (CsA) include nephrotoxicity, hypertension, symptomatic hyperuricemia, hirsutism, and gum hyperplasia. Available studies among live related donor renal transplants lack adequate information regarding the long-term efficacy and safety of primary CsA-based immunosuppressive regimens. ⋯ Our study suggests that the long-term results of treatment with steroids and azathioprine are satisfactory in live related donor kidney transplant recipients. Chronic rejection was significantly higher in patients in group III, possibly due to the risk of CsA nephrotoxicity. Groups with CsA-based protocols experienced many adverse reactions of CsA such as hypertension, diabetes mellitus, and chronic rejection.
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Saudi J Kidney Dis Transpl · Jul 2008
EditorialRenal replacement therapy in acute kidney injury: which method to use in the intensive care unit?
Over the last three decades the treatment options for patients with acute kidney injury (AKI) requiring renal replacement therapy (RRT) have expanded from basic acute peritoneal dialysis and intermittent hemodialysis (IHD), to now include a variety of continuous modalities (CRRT), ranging from hemofiltration, dialysis and/or hemodiafiltration, and a variety of hybrid therapies, variously described as extended daily dialysis and/or hemodiafiltration, with the possibility of additional adjunct therapies encompassing plasma separation and adsorption techniques. Current evidence does not support that one modality is superior to any other in terms of patients' survival in the intensive care unit, or at discharge. There have been two prospective audits, which have reported improved renal recovery in the survivors who were treated by CRRT rather than IHD, but this has not been confirmed in randomized controlled trials. Thus the choice of RRT modality should be guided by the individual patients' clinical status, the medical and nursing expertise in the local intensive care unit, and the availability of RRT modality.
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Saudi J Kidney Dis Transpl · May 2008
Microalbuminuria in patients with essential hypertension and its relationship to target organ damage: an Indian experience.
Persistent microalbuminuria (MA) is the earliest indicator of chronic kidney disease (CKD) in patients with diabetes mellitus and hypertension. Patients with MA have high risk for target organ damage (TOD) resulting in stroke, retinopathy and adverse cardiovascular events. Though the prevalence of hypertension is high in India, the relationship between MA and TOD in hypertension is not well studied. ⋯ Stroke (OR=3.8), echocardiography-proven LVH (OR=9.42) and hypertensive retinopathy (OR=9.7) were significantly higher in those with MA. In conclusion, the prevalence of MA in essential hypertension is high and patients with MA have high odds for developing TOD like stroke, LVH and hypertensive retinopathy. Early screening of hypertensives for MA and prompt treatment of positive cases might reduce the burden of CKD and cardiovascular disease in the community.
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Saudi J Kidney Dis Transpl · Nov 2007
The course and outcome of renal transplant recipients admitted to the intensive care unit at a tertiary hospital in Saudi Arabia.
Renal transplantation is the treatment of choice for most patients with end-stage renal disease (ESRD). This procedure provides a survival benefit compared to hemodialysis and is also cost effective. The aim of this study is to identify the types and incidence rates of complications that affect renal transplant recipients admitted to the intensive care unit (ICU) during long-term follow-up and, to examine the impact of these complications on the length of hospital stay as well as mortality, in a tertiary closed ICU in Saudi Arabia. ⋯ We found only the need for hemodialysis during the ICU as an independent risk factor for mortality (P < 0.02). We found in this study that the main reason for ICU admissions among renal transplant recipients was infections. Mortality rates for this particular population are relatively high and are primarily linked to need for dialysis.
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Saudi J Kidney Dis Transpl · Sep 2007
Randomized Controlled TrialGabapentin: a promising drug for the treatment of uremic pruritus.
Despite advances made in treatment, uremic pruritus remains a common and distressing symptom in patients on hemodialysis (HD). Gabapentin is an effective drug in the management of neuropathic pain. Considering that neuropathic pain and pruritus share similar pathogenic mechanisms, we conducted this study to evaluate the efficacy of gabapentin in controlling uremic itch. ⋯ After four weeks of treatment, the mean decrease in pruritus score in gabapentin and placebo groups was 6.7 +/- 2.6 and 1.5 +/- 1.8, respectively (p< 0.001). None of the patients was forced to drop out of the study due to side effects of the treatment. Our study suggests that gabapentin is a safe and effective treatment for uremic itch.