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Type 2 diabetes mellitus (T2DM) and hypertension are common chronic diseases mainly associated with the development and progression of end-stage renal disease (ESRD) leading to morbidity and mortality. Gene polymorphisms linked to the renin–angiotensin (AGT)–aldosterone system (RAAS) were broadly inspected in patients with diabetic nephropathy (DN) and hypertension. This study aimed to investigate the association of AGT gene polymorphisms (rs699 and rs4762) with ESRD in T2DM hypertensive Egyptian patients. Genotyping of rs699 and rs4762 was conducted using the tetra-primers amplification refractory mutation system (ARMS-PCR). The allelic distribution analysis was performed on 103 healthy control subjects, 97 non-ESRD patients, and 104 patients with ESRD. The allelic frequencies of AGT gene polymorphisms (rs4762 and rs699) in all study participants were assessed. For the non-ESRD group, the frequencies of the alleles of AGT-rs4762 (χ2 = 31.88, p < 0.001, OR = 5.17, CI 95%: 2.81–9.51) and AGT-rs699 (χ2 = 4.85, p = 0.027, OR = 1.56, CI 95%: 1.05–2.33) were significantly associated with the non-ESRD group. However, for the ESRD group, the T allele was significantly higher than that in the controls (χ2 = 24.97, p < 0.001, odds ratio (OR) = 4.35, CI 95%: 2.36–8.02). Moreover, AGT (rs699) genotypes showed no significant difference between the ESRD group and controls. In conclusion, AGT gene polymorphisms rs699 and rs4762 were associated with non-ESRD versus controls, without any significant risk observed in all patient groups. However, the AGT (rs4762) variant showed a significant risk in the ESRD group in comparison to controls in Egyptians.

ABC of Kidney Disease ABC of Kidney Disease, Second Edition The ABC of Kidney Disease, Second Edition is a practical guide to the most common renal diseases to help healthcare professionals screen, identify, treat and refer renal patients appropriately and to provide the best possible care. Covering the common renal presentations in primary care, this highly illustrated guide provides guidance on symptoms, signs and treatments, which tests to use, measures to prevent progression, and when and how to refer. Fully revised in accordance with current guidelines, it also includes organizational aspects of renal disease management, dialysis and transplantation. The appendices contain an explanatory glossary of renal terms, guidance on anaemia management and information on drug prescribing and interactions. The ABC of Kidney Disease, Second Edition is an ideal practical reference for GPs, GP registrars, junior doctors, medical students and for anyone working with patients with renal-related conditions. About the ABC series The new ABC series has been thoroughly updated, offering a fresh look, layout and features throughout, helping you to access information and deliver the best patient care. The newly designed books remain an essential reference tool for GPs, GP registrars, junior doctors and those in primary care, designed to address the concerns of general practitioners and provide effective study aids for doctors in training. Now offering over 70 titles, this extensive series provides you with a quick and dependable reference on a range of topics in all the major specialities. Each book in the new series now offers links to further information and articles, and a new dedicated website provides you with even more support. The ABC series is the essential and dependable source of up-to-date information for all practitioners and students in general practice. To receive automatic updates on books and journals in your specialty, join our email list. Sign up today at www.wiley.com/email

In Dialysis Without Fear, psychiatrist and dialysis patient Dr. Daniel Offer joins with his wife, Marjorie Kaiz Offer, and daughter, Susan Offer Szafir, to reveal how life can be lived, and lived well, on dialysis. Drawing on his long medical career and more than seven years of personal experience with dialysis, Dr. Offer dispels many misconceptions surrounding this treatment, explaining how you can adapt to the new diet, travel, work and continue to partake in life's joys and celebrations. But the fears and hardships can be quite real, and Dr. Offer brings his years as a psychiatrist to bear as he provides practical advice on how patients can overcome them. Walking through each step of dialysis, he explains different types of treatment, examines the pros and cons of a transplant, and discusses side effects. Since dialysis affects the entire family, Dr. Offer and his co-authors also provide realistic insights into how relatives can cope and thrive together, sharing the humour, courage, and triumphs of real families who have successfully faced the challenges of dialysis. The result is an inspiring, practical guide that will help patients and their families learn to overcome the difficulties of dialysis, live without fear, and enjoy every day.

Since 1972, many victims of endstage renal disease (ESRD) have received treatment under a unique Medicare entitlement. This book presents a comprehensive analysis of the federal ESRD program: who uses it, how well it functions, and what improvements are needed.The book includes recommendations on patient eligibility, reimbursement, quality assessment, medical ethics, and research needs.Kidney Failure and the Federal Government offers a wealth of information on these and other topics:The ESRD patient population.Dialysis and transplantation providers.Issues of patient access and availability of treatment.Ethical issues related to treatment initiation and termination.Payment policies and their relationship to quality of care.This book will have a major impact on the future of the ESRD program and will be of interest to health policymakers, nephrologists and other individual providers, treatment site administrators, and researchers.

Pulmonary calcification can develop as a complication of end‐stage renal failure. Most patients are asymptomatic, with characteristic parenchymal changes incidentally detected on computed tomography (CT) imaging and a clinical course that is usually benign. In this report, we describe a 64‐year‐old female with a history of inadequate peritoneal dialysis who presented with severe chronic cough, a symptom that persisted despite treatment for respiratory tract infection. On follow‐up bronchoscopic examination, white nodular tracheobronchial mucosal changes persisted. The presence of calcium deposits within these nodules was histologically confirmed, although CT imaging had not suggested the presence of calcific tracheobronchial changes. We believe that the bronchoscopic findings represent a highly unusual presentation of metastatic pulmonary calcification and an uncommon cause of chronic cough amongst patients with end‐stage renal failure. In this report, we describe a 64‐year‐old female with a history of inadequate peritoneal dialysis who presented with severe and persistent chronic cough. Extensive white nodular tracheobronchial mucosal changes were identified on bronchoscopy despite the absence of corresponding abnormalities on CT imaging. We believe that the bronchoscopic findings represent a highly unusual presentation of metastatic pulmonary calcification and an unusual cause of chronic cough amongst patients with end‐stage renal failure.

Introduction Chronic kidney disease is a common, progressive illness that is becoming a global public health problem. In patients with kidney dysfunction, the renal excretion of parent drug and/or its metabolites will be impaired, leading to their excessive accumulation in the body. In addition, the plasma protein binding of drugs may be significantly reduced, which in turn could influence the pharmacokinetic processes of distribution and elimination. The activity of several drug-metabolizing enzymes and drug transporters has been shown to be impaired in chronic renal failure. In patients with end-stage renal disease, dialysis techniques such as hemodialysis and continuous ambulatory peritoneal dialysis may remove drugs from the body, necessitating dosage adjustment. Methods Inappropriate dosing in patients with renal dysfunction can cause toxicity or ineffective therapy. Therefore, the normal dosage regimen of a drug may have to be adjusted in a patient with renal dysfunction. Dosage adjustment is based on the remaining kidney function, most often estimated on the basis of the patient's glomerular filtration rate (GFR) estimated by the Cockroft-Gault formula. Net renal excretion of drug is a combination of three processes: glomerular filtration, tubular secretion and tubular reabsorption. Therefore, dosage adjustment based on GFR may not always be appropriate and a re-evaluation of markers of renal function may be required. Discussion According to EMEA and FDA guidelines, a pharmacokinetic study should be carried out during the development phase of a new drug that is likely to be used in patients with renal dysfunction and whose pharmacokinetics are likely to be significantly altered in these patients. This study should be carried out in carefully selected subjects with varying degrees of renal dysfunction. In addition to this two-stage pharmacokinetic approach, a population PK/PD study in patients participating in phase II/phase III clinical trials can also be used to assess the impact of renal dysfunction on the drug's pharmacokinetics and pharmacodynamics. Conclusion In conclusion, renal dysfunction affects more that just the renal handling of drugs and/or active drug metabolites. Even when the dosage adjustment recommended for patients with renal dysfunction are carefully followed, adverse drug reactions remain common.

Background: There are limited data on the outcomes of elderly patients with chronic kidney disease undergoing renal replacement therapy or conservative management. Aims: We aimed to compare survival, hospital admissions and palliative care access of patients aged over 70 years with chronic kidney disease stage 5 according to whether they chose renal replacement therapy or conservative management. Design: Retrospective observational study. Setting/participants: Patients aged over 70 years attending pre-dialysis clinic. Results: In total, 172 patients chose conservative management and 269 chose renal replacement therapy. The renal replacement therapy group survived for longer when survival was taken from the time estimated glomerular filtration rate <20 mL/min (p < 0.0001), <15 mL/min (p < 0.0001) and <12 mL/min (p = 0.002). When factors influencing survival were stratified for both groups independently, renal replacement therapy failed to show a survival advantage over conservative management, in patients older than 80 years or with a World Health Organization performance score of 3 or more. There was also a significant reduction in the effect of renal replacement therapy on survival in patients with high Charlson’s Comorbidity Index scores. The relative risk of an acute hospital admission (renal replacement therapy vs conservative management) was 1.6 (p < 0.05; 95% confidence interval = 1.14–2.13). A total of 47% of conservative management patients died in hospital, compared to 69% undergoing renal replacement therapy (Renal Registry data). Seventy-six percent of the conservative management group accessed community palliative care services compared to 0% of renal replacement therapy patients. Conclusions: For patients aged over 80 years, with a poor performance status or high co-morbidity scores, the survival advantage of renal replacement therapy over conservative management was lost at all levels of disease severity. Those accessing a conservative management pathway had greater access to palliative care services and were less likely to be admitted to or die in hospital.

Rationale and objectiveThe Kidney Failure Risk Equation (KFRE) predicts the risk of end-stage kidney disease in patients with chronic kidney disease (CKD). This study aimed to evaluate the impact of the utility of KFRE in clinical practice.Study designSystematic review.Setting and study populationsAdult patients with CKD but not receiving renal replacement therapy enrolled in studies where KFRE was used in clinical care pathways.Selection criteria for studiesAll studies published from April 2011 to October 2021 identified from Medline, Cumulative Index to Nursing and Allied Health Literature, Embase and reference and citation searches of included studies.Data extractionRelevant data were extracted, and two reviewers independently assessed study quality using appropriate appraisal tools.Analytical approachFindings reported as a narrative synthesis due to heterogeneity of the included studies.ResultsOf 1635 studies identified, 440 duplicates were removed. The remaining 1195 titles and abstracts were screened. All five studies for full-text review were included in the analysis. Three uses of KFRE were assessed: (1) primary to specialty care interface; (2) general nephrology to multidisciplinary care transition; and (3) treatment planning. Evidence of impact on number of patient referrals into nephrology care was conflicting. However, wait times improved in one study. Although KFRE identified high-risk patients for increased multidisciplinary support, there was concern patients stepped down, no longer meeting eligibility criteria, may lack access to services.ConclusionsThis is the first systematic review of studies that have assessed the actual impact of KFRE in clinical practice with five studies of varying quality reported to date. Trials are in progress assessing the impact on clinical outcomes of using KFRE in clinical practice, and KFRE is being incorporated into guidelines for CKD management. Further studies are needed to assess the impact of KFRE on clinical care.Trial registration numberProtocol registered on PROSPERO before initiation of the study (Ref: CRD42020219926).

The aim of this study was to evaluate the site, early results, and postoperative complications of arteriovenous fistula (AVF) creation procedures for hemodialysis in our clinic. The hospital records of 384 patients who underwent 411 AVF creation procedures for hemodialysis by the same team at our clinic between February 2008 and January 2010 were included for retrospective analysis. All procedures were performed under local anesthesia with lidocaine. Vasospasm was treated by mechanical dilatation with a probe and topical papaverine. Of our 384 patients, 58.5% were male and 41.5% were female. Mean age was 46 (range 12-72) years. Of the 411 AVF procedures performed, 106 (25.8%) were created at the anatomical snuffbox, 264 (64.3%) were Brescia-Cimino procedures, and 41 (9.9%) were antecubital, brachiocephalic, or brachiobasilic procedures. Twenty-three patients (5.98%) were subjected to more than one surgical intervention due to early thrombosis or failure of AVF. Early patency was found in 94.0% of the AVF created. Twenty-three patients underwent more than one surgical intervention due to early AVF thrombosis or failure. Early AVF failure occurred more often in females (60.8%) than in males (39.2%). Complications were observed in a total of 11.4% patients. Mechanical dilatation of the artery and vein, before starting the anastomosis, as well as the use of vasodilatory agents, could decrease early thrombosis of the fistula, and this method has very high early patency.

ObjectivesThe purpose of this study was to synthesise data on the prevalence of post-dialysis fatigue (PDF) among haemodialysis (HD) patients.DesignSystematic review and meta-analysis.Data sourcesChina National Knowledge Infrastructure, Wanfang, Chinese Biological Medical Database, PubMed, EMBASE and Web of Science were searched from their inception to 1 April 2022.Eligibility criteriaWe selected patients who must receive HD treatment for at least 3 months. Cross-sectional or cohort studies published in Chinese or English were eligible for inclusion. The main search terms used in the abstract were: “renal dialysis”, “hemodialysis” and “post-dialysis”, in combination with the word “fatigue”.Data extraction and synthesisTwo investigators independently performed data extraction and quality assessment. Data were pooled to estimate the overall prevalence of PDF among HD patients using the random-effects model. Cochran’s Q and I2 statistics were adopted to evaluate heterogeneity.ResultA total of 12 studies were included, with 2152 HD patients, of which 1215 were defined as having PDF. The overall prevalence of PDF in HD patients was 61.0% (95% CI: 53.6% to 68.3%, p<0.001, I2=90.0%). Subgroup analysis failed to explain the source of heterogeneity, but univariable meta-regression showed that a mean age of ≥50 years might be the source of heterogeneity. Egger’s test revealed no publication bias among the studies (p=0.144).ConclusionsPDF is highly prevalent among HD patients.