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1دورية أكاديمية
المؤلفون: Mariana Murea, Jochen G. Raimann, Jasmin Divers, Harvey Maute, Cassandra Kovach, Emaad M. Abdel-Rahman, Alaa S. Awad, Jennifer E. Flythe, Samir C. Gautam, Vandana D. Niyyar, Glenda V. Roberts, Nichole M. Jefferson, Islam Shahidul, Ucheoma Nwaozuru, Kristie L. Foley, Erica J. Trembath, Merlo L. Rosales, Alison J. Fletcher, Sheikh I. Hiba, Anne Huml, Daphne H. Knicely, Irtiza Hasan, Bhaktidevi Makadia, Raman Gaurav, Janice Lea, Paul T. Conway, John T. Daugirdas, Peter Kotanko, on behalf of the Two Plus Research Consortium
المصدر: Trials, Vol 25, Iss 1, Pp 1-29 (2024)
مصطلحات موضوعية: End-stage kidney disease, Hemodialysis, Incremental, Randomized controlled trial, Medicine (General), R5-920
الوصف: Abstract Background Most patients starting chronic in-center hemodialysis (HD) receive conventional hemodialysis (CHD) with three sessions per week targeting specific biochemical clearance. Observational studies suggest that patients with residual kidney function can safely be treated with incremental prescriptions of HD, starting with less frequent sessions and later adjusting to thrice-weekly HD. This trial aims to show objectively that clinically matched incremental HD (CMIHD) is non-inferior to CHD in eligible patients. Methods An unblinded, parallel-group, randomized controlled trial will be conducted across diverse healthcare systems and dialysis organizations in the USA. Adult patients initiating chronic hemodialysis (HD) at participating centers will be screened. Eligibility criteria include receipt of fewer than 18 treatments of HD and residual kidney function defined as kidney urea clearance ≥3.5 mL/min/1.73 m2 and urine output ≥500 mL/24 h. The 1:1 randomization, stratified by site and dialysis vascular access type, assigns patients to either CMIHD (intervention group) or CHD (control group). The CMIHD group will be treated with twice-weekly HD and adjuvant pharmacologic therapy (i.e., oral loop diuretics, sodium bicarbonate, and potassium binders). The CHD group will receive thrice-weekly HD according to usual care. Throughout the study, patients undergo timed urine collection and fill out questionnaires. CMIHD will progress to thrice-weekly HD based on clinical manifestations or changes in residual kidney function. Caregivers of enrolled patients are invited to complete semi-annual questionnaires. The primary outcome is a composite of patients’ all-cause death, hospitalizations, or emergency department visits at 2 years. Secondary outcomes include patient- and caregiver-reported outcomes. We aim to enroll 350 patients, which provides ≥85% power to detect an incidence rate ratio (IRR) of 0.9 between CMIHD and CHD with an IRR non-inferiority of 1.20 (α = 0.025, one-tailed test, 20% dropout rate, average of 2.06 years of HD per patient participant), and 150 caregiver participants (of enrolled patients). Discussion Our proposal challenges the status quo of HD care delivery. Our overarching hypothesis posits that CMIHD is non-inferior to CHD. If successful, the results will positively impact one of the highest-burdened patient populations and their caregivers. Trial registration Clinicaltrials.gov NCT05828823. Registered on 25 April 2023.
وصف الملف: electronic resource
العلاقة: https://doaj.org/toc/1745-6215Test
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2دورية أكاديمية
المؤلفون: Irtiza Hasan, Tasnuva Rashid, Vishal Jaikaransingh, Charles Heilig, Emaad M. Abdel-Rahman, Alaa S. Awad
المصدر: Journal of Clinical & Translational Endocrinology, Vol 35, Iss , Pp 100335- (2024)
مصطلحات موضوعية: SGLT2, Chronic kidney disease, Cardiovascular disease, IgA nephropathy, Metabolism, Systematic review, Diseases of the endocrine glands. Clinical endocrinology, RC648-665
الوصف: Multiple randomized controlled trials have extensively examined the therapeutic effectiveness of sodium-glucose cotransporter 2 (SGLT2) inhibitors, ushering in a transformative approach to treating individuals with type 2 diabetes mellitus (DM). Notably, emerging reports have drawn attention to the potential positive impacts of SGLT2 inhibitors in nondiabetic patients. In an effort to delve into this phenomenon, a comprehensive systematic literature review spanning PubMed (NLM), Medline (Ovid), and Cochrane Library, covering publications from 2000 to 2024 was undertaken. This systematic review encompassed twenty-six randomized control trials (RCTs) involving 35,317 participants. The findings unveiled a multifaceted role for SGLT2 inhibitors, showcasing their ability to enhance metabolic control and yield cardioprotective effects through a reduction in cardiovascular death (CVD) and hospitalization related to heart failure (HF). Additionally, a renalprotective effect was observed, evidenced by a slowdown in chronic kidney disease (CKD) progression and a decrease in albuminuria. Importantly, these benefits were coupled with an acceptable safety profile. The literature also points to various biological plausibility and underlying mechanistic pathways, offering insights into the association between SGLT2 inhibitors and these positive outcomes in nondiabetic individuals. Current research trends indicate a continual exploration of additional role for SGLT2 inhibitors in. Nevertheless, further research is imperative to fully elucidate the mechanisms and long-term outcomes associated with the nondiabetic use of SGLT2 inhibitors.
وصف الملف: electronic resource
العلاقة: http://www.sciencedirect.com/science/article/pii/S2214623724000061Test; https://doaj.org/toc/2214-6237Test
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3دورية أكاديمية
المصدر: Biomedicines, Vol 12, Iss 4, p 906 (2024)
مصطلحات موضوعية: anti-glomerular basement membrane, anti-neutrophil cytoplasmic antibodies, crescentic glomerulonephritis, nephrotic range proteinuria, rituximab, Biology (General), QH301-705.5
الوصف: Nephrotic range proteinuria in the setting of dual-positive anti-glomerular basement membrane (AGBM) and anti-neutrophil cytoplasmic antibodies (ANCAs) is rare. Furthermore, using rituximab as a primary immunosuppressant along with steroids and plasmapheresis has not been widely studied. We present a case of dual AGBM and ANCA with nephrotic range proteinuria in a young female, where rituximab was used as a primary immunosuppressant with partial recovery.
وصف الملف: electronic resource
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4دورية أكاديمية
المؤلفون: Aly M. Abdelrahman, Alaa S. Awad, Emaad M. Abdel-Rahman
المصدر: Journal of Clinical Medicine, Vol 13, Iss 4, p 956 (2024)
مصطلحات موضوعية: SGLT2i, non-diabetics, CKD, blood pressure, IgAN, FSGS, Medicine
الوصف: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are currently available for the management of type 2 diabetes mellitus. SGLT2i acts by inhibiting renal SGLT2, thereby increasing glucosuria and lowering serum glucose. Recent trials are emerging supporting a role for SGLT2i irrespective of the diabetic status pointing towards that SGLT2i have other mechanisms of actions beyond blood sugar control. In this review, we will shed light on the role of this group of medications that act as SGLT2i in non-diabetics focusing on pre-clinical and clinical data highlighting the mechanism of renoprotection and effects of SGLT2i in the non-diabetic kidneys.
وصف الملف: electronic resource
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5دورية أكاديمية
المؤلفون: Alaa S. Awad, Emaad M. Abdel-Rahman
المصدر: Journal of Clinical Medicine, Vol 12, Iss 5, p 1873 (2023)
الوصف: Kidney failure poses an enormous burden on patients, caregivers, healthcare providers, and society as a whole [...]
وصف الملف: electronic resource
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6دورية أكاديمية
المؤلفون: Maureen Metzger, Emaad M. Abdel-Rahman, Heather Boykin, Mi-Kyung Song
المصدر: Kidney International Reports, Vol 6, Iss 4, Pp 894-904 (2021)
مصطلحات موضوعية: chronic kidney disease, dialysis, palliative care, quality of life, symptom management, symptoms, Diseases of the genitourinary system. Urology, RC870-923
الوصف: Patients with advanced chronic kidney disease (CKD) experience multiple bothersome symptoms, undermining their quality of life (QOL). With growing attention to the importance of symptom management in advanced CKD, the evidence regarding symptoms is increasing. In this review, we briefly summarize the current evidence of effective pharmacologic and nonpharmacologic interventions to improve symptoms and QOL in patients with advanced CKD, including those on dialysis. We focused on symptoms that are commonly experienced by patients, such as pain, fatigue, sleep disturbances, itching, nausea and vomiting, cognitive impairment, and anxiety and depression. We noted that research in symptom science focused on improving symptom management in CKD is still very limited. In addition to the lack of clinical practice guidelines to address those common symptoms, the major gaps in the current literature include the evidence regarding mechanistic pathways to inform the development of effective symptom management for CKD populations, the evidence to confirm effective pharmacologic interventions in other populations for CKD populations, and research on how to incorporate effective symptom management approaches into clinical care. Although improving mortality remains as an important area in the kidney community, there is an urgent need to focus on improving symptom management to improve QOL in advanced CKD.
وصف الملف: electronic resource
العلاقة: http://www.sciencedirect.com/science/article/pii/S2468024921000711Test; https://doaj.org/toc/2468-0249Test
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7دورية أكاديمية
المؤلفون: Faruk Turgut, Alaa S. Awad, Emaad M. Abdel-Rahman
المصدر: Journal of Clinical Medicine, Vol 12, Iss 1, p 375 (2023)
مصطلحات موضوعية: acute kidney injury, prerenal AKI, acute tubular necrosis, acute interstitial nephritis, acute glomerulonephritis, postrenal AKI, Medicine
الوصف: Acute kidney injury (AKI) is a common clinical syndrome characterized by a sudden decline in or loss of kidney function. AKI is not only associated with substantial morbidity and mortality but also with increased risk of chronic kidney disease (CKD). AKI is classically defined and staged based on serum creatinine concentration and urine output rates. The etiology of AKI is conceptually classified into three general categories: prerenal, intrarenal, and postrenal. Although this classification may be useful for establishing a differential diagnosis, AKI has mostly multifactorial, and pathophysiologic features that can be divided into different categories. Acute tubular necrosis, caused by either ischemia or nephrotoxicity, is common in the setting of AKI. The timely and accurate identification of AKI and a better understanding of the pathophysiological mechanisms that cause kidney dysfunction are essential. In this review, we consider various medical causes of AKI and summarize the most recent updates in the pathogenesis of AKI.
وصف الملف: electronic resource
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8دورية أكاديمية
المؤلفون: Abdulrahman Alwagdani, Alaa S. Awad, Emaad M. Abdel-Rahman
المصدر: Journal of Clinical Medicine, Vol 11, Iss 21, p 6277 (2022)
مصطلحات موضوعية: AKI, AKI-D, management, renin−angiotensin system inhibitors, Medicine
الوصف: Acute kidney injury (AKI) is a serious problem, affecting multiple organs, and is associated with a high mortality. The severe consequences of AKI extend beyond hospital discharge to the outpatient setting. While a plethora of literature exists guiding the management of AKI in the hospital setting, currently, there are no guidelines for the best care of AKI patients post-hospital discharge. In this review, we address the burden of AKI on patients and the importance of optimal coordinated care of these patients post-hospital discharge. We review the care of patients with or without dialysis requirements at the time of discharge and thereafter.
وصف الملف: electronic resource
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9دورية أكاديمية
المؤلفون: Emaad M. Abdel-Rahman, Ernst Casimir, Genevieve R. Lyons, Jennie Z. Ma, Jitendra K. Gautam
المصدر: Journal of Clinical Medicine, Vol 11, Iss 11, p 3147 (2022)
مصطلحات موضوعية: acute kidney injury, end stage kidney disease, dialysis, mortality, Medicine
الوصف: Identifying modifiable predictors of outcomes for cases of acute kidney injury requiring hemodialysis (AKI-D) will allow better care of patients with AKI-D. All patients with AKI-D discharged to University of Virginia (UVA) outpatient HD units between 1 January 2017 to 31 December 2019 (n = 273) were followed- for up to six months. Dialysis-related parameters were measured during the first 4 weeks of outpatient HD to test the hypothesis that modifiable factors during dialysis are associated with AKI-D outcomes of recovery, End Stage Kidney Disease (ESKD), or death. Patients were 42% female, 67% Caucasian, with mean age 62.8 ± 15.4 years. Median number of dialysis sessions was 11 (6–15), lasting 3.6 ± 0.6 h. At 90 days after starting outpatient HD, 45% recovered, 45% were declared ESKD and 9.9% died, with no significant changes noted between three and six months. Patients who recovered, died or were declared ESKD experienced an average of 9, 10 and 16 intradialytic hypotensive (IDH) episodes, respectively. More frequent IDH episodes were associated with increased risk of ESKD (p = 0.01). A one liter increment in net ultrafiltration was associated with 54% increased ratio of ESKD (p = 0.048). Optimizing dialysis prescription to decrease frequency of IDH episodes and minimize UF, and close monitoring of outpatient dialysis for patients with AKI-D, are crucial and may improve outcomes for these patients.
وصف الملف: electronic resource
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10دورية أكاديمية
المصدر: Journal of Clinical Medicine, Vol 10, Iss 6, p 1175 (2021)
مصطلحات موضوعية: acute kidney injury, recovery, mortality, biomarkers, Medicine
الوصف: Acute kidney injury (AKI) is a common clinical syndrome characterized by rapid impairment of kidney function. The incidence of AKI and its severe form AKI requiring dialysis (AKI-D) has been increasing over the years. AKI etiology may be multifactorial and is substantially associated with increased morbidity and mortality. The outcome of AKI-D can vary from partial or complete recovery to transitioning to chronic kidney disease, end stage kidney disease, or even death. Predicting outcomes of patients with AKI is crucial as it may allow clinicians to guide policy regarding adequate management of this problem and offer the best long-term options to their patients in advance. In this manuscript, we will review the current evidence regarding the determinants of AKI outcomes, focusing on AKI-D.
وصف الملف: electronic resource
النص الكامل