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The demand for dialysis treatment has exceeded supply over the last decade in Saudi Arabia in line with other countries in the region and hence the Ministry of Health (MOH) to outsource dialysis care on a fee-for-service basis. The main objective of this review article is to examine and understand the challenges and strategies devised for the successful implementation, the good operation, and the guaranteed efficiency of outsourcing dialysis program in order to achieve the set clinical performance indicators and quality standards. The outsourcing program has largely helped the MOH in Saudi Arabia to improve the adequacy of dialysis care and the quality of life of dialysis patients and might be cost-effective.

Erectile dysfunction (ED) is a common problem seen among patients on hemodialysis (HD), but it is still a taboo subject in our country. The attention given to this sexual problem remained low, and the prevalence of ED among these patients has not been well characterized. We carried out this study in order to determine the prevalence and severity of ED in HD patients. We conducted a descriptive cross-sectional study in our HD unit in March 2013. ED was evaluated using the International Index Erection Function. Thirty patients with a mean age of 49.1 years were eligible for this study. The main causes of chronic kidney disease were hypertension (62.5%) and diabetes (41.6 %). The prevalence of ED was 80 %, including 33.3 % severe ED. Plasma levels of gonadotropins: luteinizing hormone (LH), follicule-stimulating hormone were in the standards except for one patient who had an elevated level of LH. Prolactin was elevated in four cases. ED was present in 8.4 % of patients before the discovery of renal failure and in 91.6 % of patients at the beginning of dialysis. For 19 patients (79.1%), the ED had increased during the dialysis sessions. A significant number of our HD patients presented with ED of varying degrees. Nephrologists should pay attention to the problem of ED in order to improve the quality of their life.

Autosomal recessive polycystic kidney disease (ARPKD) is the most common childhood-onset ciliopathy. Intracranial aneurysms (ICA) are a serious complication of autosomal dominant polycystic kidney disease (ADPKD). However, there are only three reports about ICA in an adult patient with ARPKD. We describe a rare case of a 29-year-old man with ARPKD presenting with subarachnoid hemorrhage secondary to a ruptured intracranial aneurysm. The diagnosis of ARPKD was at the age of eight years based on typical ultrasonography findings with polycystic kidneys and liver disease. Magnetic resonance cholangiography showed a nonobstructive dilatation of intrahepatic bile ducts. Liver biopsy showed hepatic fibrosis. None of the family members was affected. At the age of 15 years, he had progressed to end-stage kidney disease, and hemodialysis was started. The patient had always a severe arterial hypertension. At the age of 29 years, he complained of headaches with an uncontrolled hypertension and disturbance of consciousness, computed tomography angiography showed subarachnoid hemorrhage and multiple cerebral aneurysms. Early neurologic screening of intracranial aneurysm should be recommended in ARPKD like in ADPKD patients.

Hypertension is a common early finding in autosomal dominant polycystic kidney disease (ADPKD). Improvements in screening and diagnosis of ADPKD have allowed earlier diagnosis, later onset of end-stage renal disease, and better survival. However, the main and most effective therapy remains control of hypertension. Hypertension is the most important modifiable risk factor in ADPKD. Therefore, early management of hypertension reduces the incidence of cardiovascular events in ADPKD patients. Stimulation of the renin–angiotensin–aldosterone system (RAAS) plays a central role in the pathogenesis of hypertension in ADPKD. Therapies that block the RAAS have improved patient management, blood pressure control, and ADPKD patient survival. This review highlights the current understanding of the epidemiology, potential pathogenetic mechanisms and proposes a strategy for the treatment and management of hypertension in ADPKD.

Glomerular hyperfiltration occurs as a physiological response during pregnancy and after consumption of high-protein meals, but an elevation in glomerular filtration rate is also associated with various disease states. In this Review, the authors discuss the definitions of glomerular hyperfiltration as well as the underlying mechanisms and hemodynamic changes that can adversely affect kidney function. They also describe potential approaches to treat glomerular hyperfiltration. Glomerular hyperfiltration is a phenomenon that can occur in various clinical conditions including kidney disease. No single definition of glomerular hyperfiltration has been agreed upon, and the pathophysiological mechanisms, which are likely to vary with the underlying disease, are not well explored. Glomerular hyperfiltration can be caused by afferent arteriolar vasodilation as seen in patients with diabetes or after a high-protein meal, and/or by efferent arteriolar vasoconstriction owing to activation of the renin–angiotensin–aldosterone system, thus leading to glomerular hypertension. Glomerular hypertrophy and increased glomerular pressure might be both a cause and a consequence of renal injury; understanding the renal adaptations to injury is therefore important to prevent further damage. In this Review, we discuss the current concepts of glomerular hyperfiltration and the renal hemodynamic changes associated with this condition. A physiological state of glomerular hyperfiltration occurs during pregnancy and after consumption of high-protein meals. The various diseases that have been associated with glomerular hyperfiltration, either per nephron or per total kidney, include diabetes mellitus, polycystic kidney disease, secondary focal segmental glomerulosclerosis caused by a reduction in renal mass, sickle cell anemia, high altitude renal syndrome and obesity. A better understanding of the mechanisms involved in glomerular hyperfiltration could enable the development of new strategies to prevent progression of kidney disease. Key Points Glomerular hyperfiltration has been variably defined either as an abnormally high whole-kidney glomerular filtration rate (GFR), increased filtration fraction, or as increased filtration per nephron An increased GFR occurs physiologically after consuming a high-protein meal and during pregnancy Increased GFR can occur as an early manifestation of disease, for example in diabetes mellitus, but it remains to be proven whether glomerular hyperfiltration is a precursor of chronic kidney disease Increased filtration per nephron occurs as an adaptive response to nephron loss, and leads to glomerular hypertension and subsequent glomerulosclerosis with progressive renal function decline The mechanisms of glomerular hyperfiltration in disease conditions are variable and not entirely clear, although the renin–angiotensin–aldosterone system has been implicated as a contributing pathway Longitudinal studies are needed to examine whether treatment of glomerular hyperfiltration will slow the progression of chronic kidney disease; this research requires uniform, pathophysiologically based definitions of glomerular hyperfiltration

A phosphate binder combining calcium and magnesium offers an interesting therapeutic option to control hyperphosphatemia in dialysis patients. We investigated the effectiveness and tolerance of calcium acetate-magnesium carbonate (Ca-Mg). This is a 16-week prospective study including 16 dialysis patients. After an initial two-week washout period, serum phosphorus (sPho) ≥1.8 mmol/L, serum calcium (sCa) ≤2.6 mmol/L, and serum magnesium ≤1.5 mmol/L were the main inclusion criteria. The initial dose of Ca-Mg depended on sPho level and was titrated for every two weeks to have a sPho ≤ 1.8 mmol/L. A second two-week washout period followed the 12 weeks of treatment. Ca-Mg significantly reduced the mean sPho levels from 2.14 to 1.75 mmol/L by the end of the 12-week treatment period (P <0.006). Two weeks after the completion of the Ca-Mg study, the mean sPho levels increased to 2.2 mmol/L. The mean sCa levels did not significantly change during the Ca-Mg trial. The mean serum intact parathyroid hormone declined significantly from 446 pg/mL at the beginning of the study to 367 pg/mL at the end of the 12-week treatment period (P = 0.0002). Digestive tolerance was good in all patients which allowed good compliance. There were no episodes of hypercalcemia. However, six patients had a moderate hypermagnesemia (21 episodes) requiring adjustment of treatment dose. The Ca-Mg proved to be effective in the control of hyperphosphatemia in dialysis patients with good clinical and biological tolerance. Thus, in patients with hypercalcemia or poor tolerance to calcium carbonate, Ca-Mg might be a good alternative.

Autosomal-dominant polycystic kidney disease (ADPKD) is the most common single cause of end-stage renal disease after diabetes, hypertension and glomerulonephritis. The clinical course of ADPKD is highly variable. Even with optimal care and therapy monitoring, currently the progression of ADPKD is slowed but not stopped. Newer treatments will no doubt become available in the future, but their side effect profiles will always need to be considered. Therefore, markers to distinguish ADPKD patients with a poor versus a good prognosis will be helpful. Several risk factors influencing kidney disease progression in ADPKD have been identified in the current era. The present review will discuss the spectrum of early markers of ADPKD renal disease progression. Specifically, the volume of total kidney, hypertension, glomerular hyperfiltration, renal blood flow, microalbuminuria, uric acid, and urinary molecular markers will be discussed. On this background, implications for the prevention and treatment of kidney disease progression in ADPKD are also discussed.

Background: This study evaluates the prevalence of cardiovascular events in autosomal dominant polycystic kidney disease (ADPKD) patients. Methods: We distributed surveys to 1,439 subjects from our ADPKD research database. In total, 426 subjects completed and returned surveys; 7 of these were from children and were excluded from the study. Results: The patients who responded were female (63.2%), nonHispanic (88.1%) and white (93.6%). The mean age of the total group was 53.2 ± 13.7 years; 82.8% had a family history of ADPKD and 32.5% had reached end-stage renal disease (ESRD). With respect to cardiovascular risk factors, 86.6% were hypertensive with a mean age at diagnosis of 36.9 ± 12.9 years and hypertension was significantly more prevalent in males. In addition, 19.6% of the subjects were obese, 20.8% were smokers, 8.7% had diabetes, 45.7% had high cholesterol and 17.8% were sedentary. The most prevalent self-reported cardiovascular events were arrhythmias (25.9%), evidence of peripheral vascular disease (16.5%), heart valve problems (14.4%), cardiac enlargement (9.5%), stroke or cerebral bleeding (7.5%), myocardial infarction (6%) and brain aneurysm (5.0%). The most commonly used antihypertensive medications were renin-angiotensin inhibitors used by 75% of ADPKD patients. Older ADPKD patients and those at ESRD had a significantly higher incidence of cardiovascular events. Conclusion: These findings support the high prevalence of cardiovascular risk factors and events in ADPKD patients which contribute to a greater mortality risk. Due to the prevalence of cardiovascular risk factors in the ADPKD population, early diagnosis and clinical intervention are recommended.

The chemical composition of the volatile constituents from the flowering parts of Suaeda fructicosa and Limonium echioides were analysed by GC-FID and GC-MS. Sixty-five compounds were identified in L. echioides aerial parts. 48 out of 65 were found common to the aerial part of S. fructicosa. Palmitic acid was found as a predominant compound in both tested halophytic oils. Furthermore, the essential oil was tested against six bacteria and four fungi at different concentrations. Both oils, tested at 0.5 and 0.8 mg ml⁻¹, inhibited the visible growth of Staphylococcus aureus, Staphylococcus epidermidis, Micrococcus luteus, Escherichia coli and Salmonella typhimurium, but no antibacterial effect was detected against Pseudomonas aeruginosa. Additionally, both halophytic oils failed to show antifungal activity against all the test fungi when applied at 80, 200 and 500 μg/disc.

Antimicrobial activity of methanolic extracts obtained from the aerial parts of Evax pygmaea was tested against five bacteria and two strains of phytopathogenic fungi using the agar diffusion and broth microdilution methods. Antioxidant properties were evaluated through the ability of the different fractions to scavenge the stable ABTS (2,2'-azinobis-(3-ethylbenzothiazoline-6-sulfonic acid)) and DPPH (1,1-diphenyl-2-picrylhydrazyl) radicals. The TEAC (Trolox Equivalent Antioxidant Capacity) and IC₅₀ values of the fractions were calculated and compared. The experimental data indicated that all fractions exhibit moderate to appreciable antibacterial activities against all Gram-positive cocci and Gram-negative rods except Pseudomonas aeruginosa, but no antifungal activity was observed. Ethyl acetate and methanol fractions were found to cause significant free radical-scavenging effects in both assays. These results may suggest that E. pygmaea could be used as a natural preservative ingredient in the food and/or pharmaceutical industries.