Cardiovascular risk factors in children on dialysis: an update

AbstractCardiovascular disease (CVD) is a life-limiting comorbidity in patients with chronic kidney disease (CKD). In childhood, imaging studies have demonstrated early phenotypic characteristics including increases in left ventricular mass, carotid artery intima-media thickness, and pulse wave velocity, which occur even in young children with early stages of CKD. Vascular calcifications are the signature of an advanced phenotype and are mainly found in adolescents and young adults treated with dialysis. Association studies have provided valuable information regarding the significance of a multitude of risk factors in promoting CVD in children with CKD by using intermediate endpoints of measurements of surrogate parameters of CVD. Dialysis aggravates pre-existing risk factors and accelerates the progression of CVD with additional dialysis-related risk factors. Coronary artery calcifications in children and young adults with CKD accumulate in a time-dependent manner on dialysis. Identification of risk factors has led to improved understanding of principal mechanisms of CKD-induced damage to the cardiovascular system. Treatment strategies include assessment and monitoring of individual risk factor load, optimization of treatment of modifiable risk factors, and intensified hemodialysis if early transplantation is not possible.
Source: Pediatric Nephrology - Category: Urology & Nephrology Source Type: research

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The objectives of the conservative treatment for chronic kidney disease are to slow down the progression of kidney dysfunction, treat complications (anemia, bone diseases, cardiovascular diseases), vaccination for hepatitis B, and preparation for kidney replacement therapy.
Source: Revista da Associacao Medica Brasileira - Category: General Medicine Source Type: research
Abstract In 2015, Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA), a policy intended to transition Medicare away from pure fee-for-service care to value-based care. MACRA does this by evaluating the cost and quality of providers, resulting in financial bonuses and penalties in Medicare reimbursement. MACRA offers two tracks for participation, the Merit-based Incentive Payment System and the Advanced Alternative Payment Models. Although the payment rules are different for each of the tracks, common to both is an emphasis on holding providers accountable for high-quality, cost-efficient care...
Source: Seminars in Dialysis - Category: Urology & Nephrology Authors: Tags: Semin Dial Source Type: research
AbstractBackgroundEnteral feeding by tube in chronic kidney disease (CKD) before 2 years of age improves growth. Whether it is effective after this age is unknown. We assessed whether height and weight SDS changed after tube feeding was started in children with CKD above 2 years of age.MethodsRetrospective study of pre-transplant, pre-pubertal children (
Source: Pediatric Nephrology - Category: Urology & Nephrology Source Type: research
ConclusionOur study showed excellent efficacy with the safety profile of this drug combination in end-stage renal disease patients. However, larger prospective studies and multicenter randomized controlled trials are needed for further confirmation.
Source: Journal of Clinical and Experimental Hepatology - Category: Gastroenterology Source Type: research
CONCLUSION: There is a high CKD burden in the ME countries. There needs to be emphasis on prevention of ESRD and provision of adequate care for the total ESRD patient population. National renal registries are needed to monitor the status of ESRD patients. Health expenditures should be increased to cover all aspects of RRT in ME Countries. PMID: 31793874 [PubMed - as supplied by publisher]
Source: Clinical Nephrology - Category: Urology & Nephrology Authors: Tags: Clin Nephrol Source Type: research
Publication date: Available online 30 November 2019Source: Clinica Chimica ActaAuthor(s): S. Boyer-Suavet, M. Cremoni, T. Dupeyrat, K. Zorzi, V. Brglez, S. Benzaken, V. Esnault, B. Seitz-PolskiAbstractBackgroundInfections remain the second most common cause of death in patients with end-stage kidney disease (ESKD). We aimed to evaluate non-specific cell-mediated immunity in an ESKD cohort using a functional assay applicable to routine use, QuantiFERON-Monitor (Qiagen), and assess whether it can predict infectious events.MethodsIn this prospective study, we performed the QuantiFERON-Monitor test in 80 subjects including 54 ...
Source: Clinica Chimica Acta - Category: Laboratory Medicine Source Type: research
Abstract BACKGROUND: Infections remain the second most common cause of death in patients with end-stage kidney disease (ESKD). We aimed to evaluate non-specific cell-mediated immunity in an ESKD cohort using a functional assay applicable to routine use, QuantiFERON-Monitor (Qiagen), and assess whether it can predict infectious events. METHODS: In this prospective study, we performed the QuantiFERON-Monitor test in 80 subjects including 54 patients with ESKD. QuantiFERON-Monitor is based on the measurement of plasma interferon-gamma (IFN-γ) after stimulation of NK-cells with a TLR-7 agonist, and T-cells ...
Source: International Journal of Clinical Chemistry - Category: Chemistry Authors: Tags: Clin Chim Acta Source Type: research
Abstract INTRODUCTION: Severe uncontrolled secondary hyperparathyroidism and kidney transplantation history are both risk factors for fractures in hemodialyzed patients. Moreover, patients who return to dialysis after transplant failure have more severe infections/anemia and higher mortality risk than transplant-naive patients starting dialysis with native kidneys. In this context, our aim was to test the hypothesis that transplant failure patients have more secondary hyperparathyroidism than transplant-naive patients. METHODS: We retrospectively compared 29 transplant failure patients to 58 transpl...
Source: Nephrologie and Therapeutique - Category: Urology & Nephrology Authors: Tags: Nephrol Ther Source Type: research
Conclusions: Despite the questionnaire results suggesting that transplantation does improve some aspects of QOL, there were no differences observed between kidney replacement therapies regarding the emotional repercussion of chronic kidney disease.RESUMO Objetivo: Investigar as repercuss ões emocionais e a qualidade de vida (QV) associadas à doença renal crônica em crianças e adolescentes submetidos à hemodiálise ou ao transplante renal. Métodos: Foram entrevistadas 48 crianças e adolescentes com doença renal crônica, metade dos quais submetidos ao ...
Source: Revista Paulista de Pediatria - Category: Pediatrics Source Type: research
Conclusion: We identified a higher proportion of patients with extra-pulmonary TB in our population compared to the national figure of 58.0% in all patients diagnosed with TB. Despite co-morbidity of patients with CKD on RRT, the treatment completion rates and mortality of these patients were similar to national rates for all patients with active TB.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Tuberculosis Source Type: research
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