Validity and reliability of the Arabic-translated kidney disease quality of life survey among long-term dialysis patients in Saudi Arabia.

One of the tools used to measure the quality of life in hemodialysis (HD) patients is the Kidney Disease Quality of Life (KDQOL) survey. The KDQOL has been through several developmental processes, with the most recent one being the KDQOL-36™. Our study evaluated the validity and reliability of the Arabic-translated KDQOL-36™ survey in Saudi chronic dialysis patients. This cross-sectional study was conducted at four HD centers in Saudi Arabia. The KDQOL-36™ survey was translated into Arabic according to the RAND Corporation's basic guidelines for translating surveys. The validation process was achieved by assessing reliability and validity. The reliability of the translated survey was established by Cronbach's alpha to measure internal consistency and the intra-class correlation coefficient (ICC) to measure the test-retest reliability. The validity of the translated survey was established based on content validity and convergent validity. The study included 184 patients (36-65 years; 60.9% of men). Regarding reliability, Cronbach's alpha for the subscales ranged from 0.63 to 0.89, and ICCs ranged from 0.60 to 0.88. For content validity, an expert panel reviewed the questions in depth. In addition, we found a positive relationship between all sub- and overall health-rated scores (P <0.01). The Arabic-translated version of the KDQOL-36™ survey is reliable and valid for evaluating the quality of life in Saudi chronic dialysis patients.

A study of quality of life among hemodialysis patients and its associated factors using kidney disease quality of life instrument-SF36 in Riyadh, Saudi Arabia.

We aimed in this study to assess the quality of life for kidney-ill patients using Kidney Disease Quality of Life Instrument-SF36 (KDQOL-SF36) and the impact of other demographic, clinical, and social factors on patients' QOL. The quality of life was assessed using an Arabic version of KDQOL-36. The KDQOL-36 subscales Physical Component Summary (PCS), Mental Component Summary (MCS), Burden of Kidney Disease, and Effects of Kidney Disease were calculated. The effect of sex, diabetic status, diabetes mellitus, marital and status employment status, etc. on these subscales was evaluated. Reliability was determined by calculating Cronbach's alpha. A total of 254 patients were enrolled. The mean age was 58.2 (standard deviation 18.2) years; 61% were male, 56.7% diabetic and 20.1% were employed. The mean domain scores on the PCS, MCS, burden of kidney disease, and effects of kidney disease subscales were 49.4, 38.7, 52.6, and 37.2, respectively. Afternoon shift patients score highest among all shifts in MCS and PCS (P = 0.0001). The MCS score (38.7 ± 28.7) was significantly lower than PCS (49.4 ± 16.5) (P = 0.0001). The "effect of kidney disease" subscale was higher in males (P = 0.02), employed patients (P = 0.02), in the afternoon dialysis shift (0.0001). For PCS higher scores were seen in males (P = 0.0001), in non-diabetics (compared to diabetics) (P = 0,006), in the employed patients (P = 0.02). The highest score was seen in the "burden of kidney disease" subscale and the lowest in the "effects of kidney disease" subscale. Higher scores were seen in males, in nondiabetics, in the employed patients.

Effect of Fasting the Whole Month of Ramadan on Renal Function Among Muslim Patients With Kidney Transplant: A Meta-Analysis.

OBJECTIVES: Muslim renal transplant patients often ask whether fasting during Ramadan would be harmful to their kidneys. We performed a meta-analysis on relevant studies to answer this question. MATERIALS AND METHODS: We searched 4 databases using comprehensive search terms with predefined eligibility criteria. Two reviewers (FH and RA) independently assessed the relevance of studies obtained during the search. If disagreement occurred, a consensus would be sought; if disagreement persisted, the arbitration would be left to a third author (AAS). RESULTS: Eight studies (549 patients) were identified as eligible; these studies measured renal function before and after Ramadan with patients acting as their own controls in 5 studies. Our pooled analyses showed no significant changes after fasting with regard to estimated glomerular filtration rate (70.1 ± 9.1 vs 68.5 ± 7.5 mL/min, respectively; P = .6) or in serum creatinine levels (105.3 ± 8.8 and 106.1 ± 6.0 µmol/L, respectively; P = .47). In 4 self-controlled studies (148 patients) that had analyzed changes in systolic and diastolic blood pressure before versus after fasting, no significant differences were shown. However, in 3 studies that assessed changes in glomerular filtration rate in fasting (n = 358) versus nonfasting patients (n = 355), there was a significant difference in change in glomerular filtration rate following Ramadan fasting (-0.13 ± 1.2 mL/min in those who fasted versus 4.2 ± 4.6 mL/min in those who did not fast; P = .039); however, these results were associated with significant publication bias (systematic heterogeneity). CONCLUSIONS: Fasting during Ramadan did not result in significant changes in kidney function or blood pressure in posttransplant patients with good baseline kidney function when patients acted as their own controls.

Attendees' feedback on king abdulaziz medical city pilot chronic kidney disease education class.

Despite similar or better patient outcomes, peritoneal dialysis and pre-emptive kidney transplantation are underutilized in Saudi Arabia. Moreover, most patients with end-stage renal disease begin dialysis in unplanned fashion necessitating the commencement of dialysis using central venous catheter access. We aimed to investigate if early patient education can help in overcoming these barriers. The study is a survey-based study at King Abdulaziz Medical City, Riyadh Dialysis Center. In January 2017, we started a monthly Chronic Kidney Disease Education Class in our center. Since then, 14 classes have taken place attended by 54 patients referred from outpatient nephrology clinics with chronic kidney disease (CKD) stages IV and V. The mean age was 51.6 years (16-85); 32 of the attendees were male and 22 were female. The class consisted of a slide informative presentation, a display of educational materials, and interactions with a multidisciplinary team from dialysis, transplantation, vascular access, and dietician services. A feedback survey was given to attendees at the conclusion of the class covering three domains; speakers, the program, and their personal reflections. Feedback options were laid out as "excellent, very good, good, fair, and poor." All class attendees responded to the questionnaire (100% response rate). The overall class evaluation was positive with the majority of attendees giving "excellent" rating for the speakers and the educational materials covered. Most thought that the class made them understand CKD nature better and helped them choose the right modality of renal replacement therapy. This initiative proves the feasibility of a sustained and attendee-gratifying education class to inform patients with advanced CKD about different options of renal replacement therapy and the need for timely preparation. To objectively measure the class's effect, the next phase of this review will define the ultimate outcome of each of its attendees.

Nonadherence to dialysis among saudi patients - Its prevalence, causes, and consequences.

Dialysis nonadherence among Saudi hemodialysis (HD) patients has not been studied previously. We study its prevalence, causes, and consequences. All chronic HD patients at our center were enrolled. Their demographics as well as levels of hemoglobin (Hb), Kt/v, potassium, and phosphate; dialysis type; dialysis vintage; duration; and shift were recorded. Nonadherence, defined as missed dialysis session or patient-derived shortening of the dialysis session by >10 min at least once over a month's period, was recorded. We analyzed the relationship of nonadherence to emergency room visits, hospitalizations, interdialytic weight gain (IDWG), intradialytic symptoms, home-to-hospital distance, and smoking habits. Two hundred and sixty-five patients were included; their mean age was 61.8 ± 18.2 years, 47.3% were male, dialysis vintage was 3.8 ± 3.3 years, 5.9% were on HD, and 34.1% were on hemodiafiltration. During the study period, the nonadherence rate was 25% for missed dialysis sessions and 72% for shortened dialysis on at least one occasion. Nonadherence was more likely to occur in males than females (75% and 66%, respectively, P = 0.05), in smokers (57.1% vs. 21.7%, P = 0.0003), and in night shifts rather than day shifts (33.6% vs. 20.6%, P = 0.042). Nonadherent patients had lower Kt/V than adherent patients (1.22 ± 0.2 and 1.31 ± 0.2, respectively P = 0.01), had higher mean IDWG (2.7 ± 1.0 and 2.4 ± 1.0 kg, respectively, P = 0.02), and are more likely to be hospitalized (50% vs. 32%, P = 0.01). On the other hand, no differences were observed in serum phosphate, potassium, or Hb levels; intradialytic symptoms; education; employment; the distance between the dialysis unit and home; type of dialysis; Charlson Comorbidity Index; or the dialysis vintage. The prevalence of nonadherence in our group was comparable to that of other reports and is more likely to occur in male patients, smokers, and those in night shifts. It is associated with lower dialysis adequacy, higher mean IDWG, and higher hospitalization rate.

Improvement in dialysis-related adverse events with use of body composition monitoring.

This study aims to utilize body composition monitor (BCM) device to achieve euvolemic status in problematic dialysis patients and to evaluate its clinical outcome. One hundred and five hemodialysis (HD) patients were enrolled based on difficulty in achieving dry weight. The reasons for enrollment in the study were (a) recurrent intradialytic hypotension, (b) intradialytic hypertension, (c) intradialytic muscle cramps, or (d) the presence of comorbid conditions that make clinical assessment of dry weight difficult (e.g., cirrhosis of liver, heart failure, severe malnutrition, or morbid obesity). Following initial assessment of hydration status using BCM device, dry weight for each patient was adjusted accordingly (upward, downward, or unchanged). The patients were, thereafter, monitored over a 15-week period for possible resultant change in the clinical and hemodynamic parameters. Forty-two patients were monitored due to hypertension, 18 due to hypotension, 10 due to hypotension and cramps, and 35 due to comorbid conditions that make clinical assessment of dry weight difficult. At the conclusion of study period, there was improvement in the monitored parameters. Hypertension improved in 79% of the patient with hypertension, hypotension in 90%, and hypotension with cramps in 90%. In the comorbid group, BCM monitoring provided better insight to clinical problem management in 80% cases. Overall quality of BCM assessments was 96.1%. In the hypertension group, mean blood pressure decreased by 10.9 mm Hg in the whole group (P = 0.0006), the drop was 3 mm Hg in the patients dialyzing with HD (P = 0.0006) and 8.6 mm Hg in those on hemodiafiltration (HDF) (P = 0.08). In the comorbid conditions group, the mean blood pressure rose by 22.5 mm Hg in the whole group (P 0.00001), 21.5 mm Hg in the patients dialyzing with HD (P = 0.00001) and 21.5 mm Hg in those on HDF (P = 0.0004). BCM monitoring together with clinical assessment is a useful tool which when appropriately applied reduces the incidence of dialysis-related complications.

Awareness of acute kidney injury risk factors and perspectives on its practice guidelines.

OBJECTIVES: Identifying and assessing risk factors for acute kidney injury (AKI) are crucial for its early detection and possible intervention to prevent AKI and associated adverse outcomes. This study aimed to investigate AKI risk factor awareness and risk assessment by healthcare professionals and to evaluate perspectives on the Kidney Disease Improving Global Outcomes AKI guidelines. METHODS: This cross-sectional survey-based study was conducted among healthcare professionals (physicians and pharmacists) at XXX from December 2016 to February 2017. RESULTS: Among the respondents (117 physicians and 135 pharmacists), 78% were aged ≤38 years, 57% were men, and 70% had <9 years of experience. Respondents varied in their knowledge of the 25 risk factors for AKI and 15 nephrotoxic drugs: 96% were aware of nephrotoxic medication, whereas 20% acknowledged female sex as an AKI risk factor, and 92% agreed with aminoglycoside, while 47% agreed with ciprofloxacin as nephrotoxic drugs. A significantly higher percentage of physicians identified individual AKI risk factors than pharmacists; however, a significantly higher percentage of pharmacists identified individual AKI-causing drugs than physicians. Although 77% of respondents encountered AKI cases in their practice, only half of them performed AKI risk assessment, and 42% stratified patients' AKI risk according to their presenting risk factors or documented AKI in previous medical history. Seventy-one percent of respondents agreed that practice guidelines improve patient outcome, and 69% thought these guidelines help standardize care and ensure that patients are treated in consistently. CONCLUSION: While the majority of the respondents had a positive perspective toward AKI guidelines, a large variation in their knowledge of AKI risk factors, risk assessment, and nephrotoxic drugs was found. Educational efforts are needed to raise awareness and thereby reduce this variation.

Shifting paradigm: From "No Code" and "Do-Not-Resuscitate" to "Goals of Care" policies.

Policies addressing limitations of medical therapy in patients with advanced medical conditions are typically referred to as Code Status (No Code) policies or Do-Not-Resuscitate (DNR) status polices. Inconsistencies in implementation, understanding, decision-making, communication and management of No Code or DNR orders have led to delivery of poorer care to some patients. Several experts have called for a change in the current approach. The new approach, Goals of Care paradigm, aims to contextualize the decisions about resuscitation and advanced life support within the overall plan of care, focusing on choices of treatments to be given rather than specifically on treatments not to be given. Adopting "Goals of Care" paradigm is a big step forward on the journey for optimizing the care for patients with advanced medical conditions; a journey that requires collaborative approach and is of high importance for patients, community and healthcare systems.

Atypical antiglomerular basement membranes disease with nephrotic-range proteinuria, mesangial proliferation, and membranoproliferative glomerulonephritis pattern of injury.

Antiglomerular basement membrane (anti-GBM) disease is an uncommon autoimmune disease characterized by the presence of IgG autoantibodies targeting the alpha-3 chain of type IV collagen. Some of the atypical forms of the disease have been described. Herein, we describe a case of atypical anti-GBM in a 27-year-old Saudi male who presented with lower limb edema, gross hematuria, elevated serum creatinine concentration, and nephrotic-range proteinuria. All serology tests were negative, except for anti-GBM which was weakly positive. Renal biopsy showed proliferative glomerulonephritis (GN) with nodular transformation of the glomerular tufts, mesangial hypercellularity (mesangial cell proliferation), segmental endocapillary hypercellularity and three incomplete cellular crescents, and recapitulating membranoproliferative GN pattern of glomerular injury. Direct immunofluorescence microscopy demonstrated diffuse, intense linear positivity for IgG and Kappa and Lambda light chains, and compatible with anti-GBM disease. The patient was treated with cyclophosphamide and corticosteroids in addition to therapeutic plasma exchange which resulted in mild improvement in renal function over a period of six weeks. We emphasize the importance of recognition of atypical pathological and serological patterns of anti-GBM disease, which is crucial for proper and early diagnosis and possibly improved clinical outcome and we highlight the importance of clinicopathological correlation in cases with atypical clinical and pathological presentations.

Multinational observational study on clinical practices and therapeutic management of mineral and bone disorders in patients with chronic kidney disease stages 4, 5, and 5D: The OCEANOS study.

Our aim is to assess the current clinical practices in monitoring and treatment patterns of chronic kidney disease (CKD)-mineral bone disorder and the degree to which these practices met the kidney disease improving global outcome (KDIGO) guidelines. This was an international, multi-center, cross-sectional, observational study in adult patients diagnosed with CKD Stages 4, 5, and 5D. Patients were enrolled from Middle East, South Asia, Eurasia, and Africa; patients with estimated glomerular filtration rate ≥30 mL/min/1.73 m(2) or with any medical/surgical conditions precluding their participation were excluded. Frequency of measurements, levels of serum calcium (Ca), phosphorus and parathormone (parathyroid hormone [PTH], and presence vascular/valvular calcification were recorded. Of the 2250 patients enrolled, data on 2247 patients were evaluated. Overall, only a small percentage of patients met all three target KDIGO ranges of serum Ca, phosphorus, and PTH (13.7% [95% confidence interval: 12.0; 15.4], with a higher proportion among CKD Stage 5D patients (14.8%) than CKD Stage 4 and 5 (5.6%) patients. Majority (84.3%) of the patients received treatment with phosphorous binders, of whom 85.5% received Ca-based phosphate binders. Overall, 57.0% of patients received Vitamin D treatment with a similar frequency among patients with CKD Stages 4, 5, and 5D. Over half (65.7%) of the patients were screened for vascular/valvular calcification; of these, 58.8% had ≥1 calcification. Diabetes status, P, PTH, and low density lipoprotein-cholesterol had significant impact on the prescription pattern of phosphorous binders. The current practices for the management of bone and mineral metabolism in CKD patients in the study region fall far short of meeting the KDIGO target range.

Erythrocyte sedimentation rate in stable patients on chronic hemodiaysis.

The objective of this study was to assess the value and determinants of erythrocyte sedimentation rate (ESR) in stable patients on regular hemodialysis (HD). Pre-dialysis and post-dialysis ESR was measured in a group of stable adult patients on regular HD and the results were compared. The results were also correlated with the patients' demographic and laboratory data. Only stable patents were included in the study. Patients with evidence of current infection, active inflammatory processor malignancy and severe anemia were excluded. We recruited 161 patients in the study of whom 44.1% were males, 53.4% had diabetes mellitus and 40.4% had an episode of sepsis previously. Only 15.5% of the patients had less than one year of dialysis and 54.3% were over the age of 60 years. The mean post-dialysis ESR was significantly higher than the pre-dialysis ESR (55.6 ± 30.4 and 49.8 ± 28.5, respectively; P = 0.003). Pre-dialysis, 79.5% of the patients had raised ESR. ESR was significantly correlated with C-reactive protein, serum ferritin, plasma albumin and fibrinogen (P <0.05). Patient factors (age, gender, duration of dialysis, previous renal transplantation, type of dialysis access and sepsis or thrombosis of dialysis access site) and blood laboratory parameters (hemoglobin, serum creatinine and serum parathormone) had no statistically significant correlation with ESR ( P ≥ 0.05). Post-dialysis the ESR was raised in most of the stable patients on regular HD and was significantly higher than the pre-dialysis ESR (by, on average, 5.8 mm/h). ESR had variable correlation with different blood factors.

Stroke-free status and depression scores among Saudi dialysis patients.

BACKGROUND: To assess the prevalence of stroke symptoms and depression among Saudi dialysis patients and related factors. METHODS: This is a cross-sectional multicentre study of Saudi dialysis patients. Demographics, clinical and laboratory's data were collected. Freedom from stroke symptoms was assessed using the Questionnaire for Verifying Stroke-Free Status and depression using the Geriatric Depression Scale. RESULTS: Five-hundred and forty-nine patients (77.3% response rate); 94.6% were receiving hemodialysis and 5.4% peritoneal dialysis were included in the study. Freedom from stroke was reported in 76.6% of patients, was higher in females (p = 0.07), and was not affected by the presence of diabetes mellitus coronary artery disease or peripheral vascular disease. However, it was significantly lower in hypertensive patients (p = 0.035) and was not affected by age, dialysis duration, Kt/V, albumin or hemoglobin levels. It was, however, more prevalent in the non-depressed patients compared to depressed patients (p = 0.036). Mild and major depression scores were noted in 45.2% and 6.1%, respectively; the depression score being significantly higher in HD than in PD patients (6.3 ± 3.4 vs. 5.0 ± 3.2 p = 0.049) but was not related to sex, employment, vascular access type, age, dialysis duration, Kt/V or serum albumin or hemoglobin levels. CONCLUSION: A quarter of the patients were not stroke symptom-free and these were more likely the depressed patients, in females, but significantly less in hypertensive patients. Almost half of the patients were depressed with 6.1% having major depression. The depression score was significantly higher in HD than in PD patients.

Posterior reversible encephalopathy syndrome with tactile hallucinations secondary to dialysis disequilibrium syndrome.

We report what we believe is the first case of posterior reversible encephalopathy syndrome (PRES) secondary to dialysis disequilibrium syndrome (DDS) in patients in whom all other possible causes of PRES were excluded and in whom a transient episode of tactile hallucination also occurred. We believe that this case of DDS was particularly severe, leading to PRES because of the late institution of dialysis therapy and the concomitant severe degree of metabolic acidosis on presentation.

Prevalence of vitamin D deficiency in Saudi adults.

OBJECTIVE: To determine the prevalence of vitamin D deficiency in healthy Saudi adults. METHODS: A cross-sectional study carried out as part of the screening and early evaluation of kidney disease project. Vitamin D was measured in subjects recruited at 2 screening camps in Riyadh, Saudi Arabia, between March to May 2008. Subjects from the 2 large commercial centers in Riyadh aged ≥18 years and Saudi nationals were invited. RESULTS: The study sample comprised of 488 subjects. The mean age of the subjects was 37.43 (11.32) years, of which 50.2% (n=245) were males. Twenty-nine percent of subjects were in the vitamin D deficiency group, 22.7% were in the relative insufficiency group, and 47.5% had normal levels of 25-hydroxy vitamin D. We observed that female gender was an independent predictor of vitamin D deficiency or insufficiency (odds ratio [OR]: 2.992; 95% confidence intervals [CI] 2.069-4.327). Anemia was also a predictor for vitamin D deficiency or insufficiency (OR: 3.16; 95% CI 2.02-4.92). Age was positively correlated with vitamin D levels (Pearson correlation=0.183, p<0.000). CONCLUSION: Vitamin D deficiency is common in healthy Saudi adults. This is more pronounced in females and in the younger age groups. Wearing of traditional clothes, deliberate avoidance of the sun, and inadequate dietary intake are likely to be the principal causes of low vitamin D levels.

Efficacy and safety of treatment of hepatitis C virus infection in renal transplant recipients.

AIM: To assess the efficacy and safety of combined pegylated interferon and ribavirin therapy in hepatitis C virus (HCV) infection in renal transplant recipients. METHODS: This is a retrospective chart review of post renal transplant patients who were positive for anti-HCV and HCV-RNA, and who have received treatment with combination of pegylated interferon and ribavirin between October 2003 and December 2008. Only patients with stable graft function and absence of evidence of cirrhosis and who received the therapy for continuous 48 wk were included. Nineteen patients (13 male and 6 female) were identified and included. The patient's complete blood count, liver and kidney profile, and calculated glomerular filtration rate (GFR) were monitored every 6-8 wk while on treatment. HCV-RNA was tested at 12 wk for early virological response, at 48 wk for end of treatment response (ETR), and then retested at 24, and 48 wk after completion of therapy for sustained virological response (SVR). Liver biopsies were obtained before treatment from all patients and graft kidney biopsies were performed as required. RESULTS: Of the entire cohort, 9 patients (47.4%) showed an ETR and 8 had SVR (42.1%). Of the 8 patients with abnormal alanine aminotransferase (ALT) levels at baseline, 78.9% had their ALT normalized (including the virological non responders). ALT was normal in all responders at the end of therapy and at 24 wk post therapy (100%). Only one patient (5.3%) developed an increase in creatinine and decline in GFR from baseline towards the end of treatment. This patient's kidney biopsy revealed borderline rejection. There was no impact on response by HCV-genotype, initial HCV RNA load, age or sex of the patient or duration post transplant before commencement of therapy. All patients tolerated treatment in the same way as non-transplant with no unusual or increased occurrence of side effects. CONCLUSION: The combination of pegylated interferon and ribavirin is effective in suppressing HCV-RNA, with a low risk of graft rejection or failure in HCV infected renal transplant recipients.

Inpatients' care experience and satisfaction study.

OBJECTIVE AND BACKGROUND: Measures to promote patient satisfaction are important components of the assessment of outcome and strategies for the delivery of health care. In this article, we assess satisfaction among inpatients and the impact of demographics on satisfaction levels. MATERIALS AND METHODS: This cross-sectional survey adapted from previously used survey tools and validated in our patient group included questions on demographics, communication skills, hospital environment, and the patients' overall evaluation of the hospital. Inpatients from acute wards of five different specialties who stayed for at least 2 days were enrolled. RESULTS: There were 988 respondents with a mean age of 39.1 years (25.9%) and the mean length of stay (LOS) of 10.0 days (24.1%). Illiteracy rate was 42.4%, and 43.1% were male. The overall satisfaction scores-out of five-were 4.3 (0.6%) for communication with nurses, 4.4 (0.4%) for communication with doctors, and 4.1 (0.3%) for hospital environment; 98.9% of the patients would recommend the hospital to their family and friends. The lowest score was for the "room environment" (3.99, 0.8%) and the highest for overall services of the hospital (4.7, 0.5%). Satisfaction levels drop significantly with LOS of more than 4 days (P < 0.006). The satisfaction was higher in females than males across all the three domains of care assessed (P < 0.005). The highest satisfaction seen in the obstetrics service could be explained by the nature of the condition normally seen in this department and the normally good outcome. There was higher satisfaction in the medical than surgical services but this reached a significant level for the overall center score domain only (4.1, 0.3% versus 4.0, 0.3%; P < 0.0001). CONCLUSION: The factors with positive impact on satisfaction were the female gender and shorter LOS. There was higher satisfaction in the medical than surgical services for all three domains reaching significant levels for center score only.

End stage chronic kidney disease in Saudi Arabia. A rapidly changing scene.

There have been a marked rise in the prevalence and incidence of end stage chronic kidney disease (CKD) in Saudi Arabia over the last 3 decades. This rise exceeds those reported from many countries. The enormous and rapid changes in lifestyle, high population growth, and fast increase in life expectancy, and massive urbanization that has occurred over the last 3 decades combined to make the current CKD status different to what it was. The 2 major factors that influence the CKD status are the very high rate of diabetic nephropathy and shift in age demographics.

Epidemiology of chronic kidney disease in the Kingdom of Saudi Arabia (SEEK-Saudi investigators) - a pilot study.

There are no available data about the prevalence of chronic kidney disease (CKD) and its risk factors in the general population of the kingdom of Saudi Arabia. To estimate the prevalence of CKD and its associated risk factors in the Saudi population, we conducted a pilot community-based screening program in commercial centers in Riyadh, Saudi Arabia. Candidates were interviewed and blood and urine samples were collected. Participants were categorized to their CKD stage according to their estimated Modification of Diet in Renal Disease (MDRD3)-based, the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and the presence of albuminuria. The sample comprised 491 (49.9% were males) adult Saudi nationals. The mean age was 37.4 ± 11.3 years. The over-all prevalence of CKD was 5.7% and 5.3% using the MDRD-3 and CKD-EPI glomerular filtration equations, respectively. Gender, age, smoking status, body mass index, hypertension and diabetes mel-litus were not significant predictors of CKD in our cohort. However, CKD was significantly higher in the older age groups, higher serum glucose, waist/hip ratio and blood pressure. Only 7.1% of the CKD patients were aware of their CKD status, while 32.1% were told that they had protein or blood in their urine and 10.7% had known kidney stones in the past. We conclude that prevalence of CKD in the young Saudi population is around 5.7%. Our pilot study demonstrated the feasibility of screening for CKD. Screening of high-risk individuals is likely to be the most cost-effective strategy to detect CKD patients.

Culture-related service expectations: a comparative study using the Kano model.

OBJECTIVE: To compare service expectations between Arab and Austrian patients. METHODS: We used a Kano model-based questionnaire with 20 service attributes of relevance to the dialysis patient. We analyzed 530, 172, 60, and 68 responses from Saudi, Austrian, Syrian, and UAE patients, respectively. We compared the customer satisfaction coefficient and the frequencies of response categories ("must be," "attractive," "one-dimensional," and "indifferent") for each of the 20 service attributes and in each of the 3 national groups of patients. We also investigated whether any differences seen were related to sex, age, literacy rate, or duration on dialysis. RESULTS: We observed higher satisfaction coefficients and "one-directional" responses among Arab patients and higher dissatisfaction coefficients and "must be" and "attractive" responses among Austrian patients. These were not related to age or duration on dialysis but were related to literacy rate. CONCLUSION: We speculate that these discrepancies between Austrian and Arab patients might be related to underdeveloped sophistication in market competitive forces and to cultural influences.

Cystatin C-based formula is superior to MDRD, Cockcroft-Gault and Nankivell formulae in estimating the glomerular filtration rate in renal allografts.

OBJECTIVES: There are conflicting reports on the reliability of the various glomerular filtration rate formula in renal allografts, to assess the performance of various glomerular filtration rate formula in estimating renal function of renal allografts. MATERIALS AND METHODS: Glomerular filtration rate was measured using an isotope Tc99m DTPA in 97 renal transplant patients and estimated using modification of diet in renal disease, Cockroft-Gault formula, Nankivell, and a cystatin C-based formula. The overall performance of these formula was evaluated by calculating bias, accuracy and precision. RESULTS: Mean age was 39.8 years (-/+ 12.7), body mass index was 26.9 (-/+ 6.3) and serum creatinine was 114.5 micromol/L (-/+ 39.3). The mean measured glomerular filtration rate was 58.1 mL/min (-/+ 25.6). The bias with modification of diet in renal disease was 7.7 (P = .03), with Cockroft-Gault formula it was 3.2 (P = .3), with Nankivell it was 10.3 (P = .0002), and with cystatin C it was 0.31 (P = .9) The precisions (r) for modification of diet in renal disease, Cockroft-Gault formula, Nankivell, and cystatin C were 0.26 (P = .01), 0.26 (P = .01), 0.42 (P = .0001), and 0.60 (P < .0001), respectively. We also investigated the impact of sex, age, body mass index, and glomerular filtration rate on the performance of these 4 formula. CONCLUSION: The best correlation, highest precision, accuracy, and least bias were seen when using cystatin C. The largest bias was seen when using Nankivell and modification of diet in renal disease formula.