Dietary management of haemodialysis patients with chronic kidney disease and malnourishment.

BACKGROUND AND OBJECTIVES: Dietary supplementation for haemodialyzed (HD) patients with chronic kidney disease (CKD) and its benefits for the anthropometric profiles remain contentious. This study analysed changes in the albumin levels and anthropometric profiles of HD patients within 3 months of nutritional therapy. METHODS AND STUDY DESIGN: Sixty-three malnourished HD patients (Subjective Global Assessment nutrition status B or C) were enrolled. Twenty patients received counselling, 17 patients received oral therapy, 26 patients received intradialytic parenteral nutrition (IDPN), and were evaluated at month 0, month 1, and month 3. Five patients withdrew before completing the trial. The patients' albumin levels and anthropometric profiles (biceps and triceps skinfold thickness, upper arm circumference, body weight, and body mass index) were analysed before and after treatment. We performed multivariate analysis to determine the effect of each treatment on serum albumin and anthropometric profiles. RESULTS: At months 1 and 3, nutritional therapy was associated with different mean serum albumin level among three nutritional intervention groups (p<0.05). Significant increases in serum albumin, upper arm circumference, and triceps and biceps skinfold thickness were identified in the counselling and IDPN groups. Multivariate linear regression revealed significant differences between oral and nonoral groups in albumin and biceps and triceps skinfold thickness at months 1 and 3. These variables were affected by age and duration of haemodialysis (p<0.05). CONCLUSIONS: Nutritional therapy for malnourished CKD patients receiving HD ameliorated serum albumin and their anthropometric profiles within 3 months.

Mesenchymal Stem Cell Senescence and Osteogenesis.

Mesenchymal stem cells (MSCs) are stem cells with the potential ability to differentiate into various cells and the ability to self-renew and resemble fibroblasts. These cells can adhere to plastic to facilitate the culture process. MSCs can be used in research into tissue biotechnology and rejuvenation medicine. MSCs are also beneficial in recipient tissue and differentiate as a breakthrough strategy through paracrine activity. Many databases have shown MSC-based treatment can be beneficial in the reduction of osteogenesis induced by senescence. In this article, we will discuss the potential effect of MSCs in senescence cells related to osteogenesis.

PREVALENCE AND RISK FACTORS OF HEPATITIS B AND C VIRUS INFECTIONS AMONG HEMODIALYSIS PATIENTS FROM PRIVATE HEMODIALYSIS UNITS IN SURABAYA, INDONESIA.

The aims of the present study were to profile seroprevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, and possible risk factors among hemodialysis (HD) patients in private hemodialysis units (HDU) in Surabaya, Indonesia. Sera were obtained from 180 HD patients in 4 different private HDUs and tested for hepatitis B surface antigen (HBsAg) and antibody to HCV (anti-HCV). Patients without HBsAg and anti-HCV at first sampling were followed serologically every 3 months for 9 months, while those with HBsAg or anti-HCV positive sera were subjected continually to PCR to detect HBV DNA and HCV RNA. The prevalence of hepatitis infections varied widely between the HDUs, from 0% to 8.1% of patients positive for HBsAg and 0% to 60.6% of those positive for anti-HCV, respectively. These values were markedly higher than those among the general population, but not as high as in governmental HDUs in Indonesia. New incidence of HBV was not detected in any HDU, whereas that of HCV was found in two HDUs, HCV-1b in one HDU and HCV-1a in the other. Inappropriate practices were observed, such as shortage of medical staff and malfunctions in infection-control committees. Prevalence of HBV and HCV infection among HD patients in private HDUs were high and varied among the HDUs. Isolation of both HBV- and HCV-infected patients and staff education should help to reduce the prevalence of hepatitis infections in HDUs.

Comparison of Asymmetric Dimethylarginine Levels Between Stages Three, Four, and Five Non-dialysis of Chronic Kidney Disease.

AIM: to determine the differences of ADMA level between stages 3, 4, and 5 non-dialysis of chronic kidney disease (CKD) patients at Outpatient Nephrology Clinic, Dr. Soetomo Hospital. METHODS: a cross-sectional study was conducted on stage 3, 4, and 5 non-dialysis CKD patients at Outpatient Nephrology Clinic, Dr. Soetomo Hospital, Surabaya from January to February 2015. Stages of CKD were determined based on GFR estimation according to 4-variable MDRD formula. Statistical analysis of differences in the levels of ADMA in three subject groups use one-way ANOVA test. RESULTS: seventy-five patients were included in the study. Each group consisted of 25 patients stage 3, 4, and, 5 non-dialysis patients. Mean age of stage 3, stage 4, and stage 5 non-dialysis CKD patients were respectively 57.12 years, 54.80 years and 53.68 years. The mean levels of ADMA in stage 3, stage 4, and 5 were 0.62 (0.11) IU/mL, 0.72 (0.16) IU/mL, and 0.73 (0.18) IU/mL respectively. Analysis of the differences between the groups showed significant differences in ADMA levels (p=0.04), with the highest difference between stage 3 and stage 5. CONCLUSION: comparison of ADMA levels showed significant differences between CKD stages and the level tends to be higher along with increase severity of CKD stages.

Autosomal dominant polycystic kidney disease (ADPKD) with multiple complications: Management challenges.

Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary polycystic kidney disease characterized by renal enlargement, resulting in renal failure. In Indonesia, the exact prevalence of ADPKD is unknown due to limited reports on the disease. The aim of this study was to report a case of a patient with ADPKD with multiple complications. A 54-year-old male presented to the emergency room of Dr. Soetomo Academic General Hospital, Surabaya, Indonesia, with a chief complaint of dark-red-colored urine for one week. There was a progressive abdominal enlargement over the past five years, which had become more tense and rigid for the past one month. The patient had a history of fatigue and hypertension with routine follow-up. Physical examination on admission showed normal vital signs, and the abdominal assessment revealed a palpable hard mass approximately 4 cm in size in the right upper abdomen. Laboratory test indicated anemia, leukocytosis, lymphopenia, proteinuria, hematuria, leukocyturia, and elevated serum creatinine and urea levels. Abdominal imaging using ultrasonography, computed tomography (CT) scan, and magnetic resonance imaging (MRI) revealed bilateral kidney and liver enlargement containing multiple cysts, suggesting polycystic kidney and liver disease. There was a ruptured cyst in the middle of the left kidney pole with minimal ascites found in the CT scan. The MRI exhibited the presence of multiple cysts in both kidneys, partially filled with blood. The patient was diagnosed with ADPKD, gross hematuria, acute or chronic kidney disease (CKD), urinary tract infection (UTI), normochromic-normocytic anemia, and metabolic acidosis. Dietary control with high-calorie, high-protein, and low-salt diet; fluid balance; and other symptomatic medications were initiated. It is critical to be aware of risk factors associated with the rapid progression of ADPKD in order to be able to provide a favorable impact on the disease prevention and management.

Risk Factors and Clinical Characteristics of Acute Kidney Injury in Patients with COVID-19: A Systematic Review and Meta-Analysis.

Acute kidney injury (AKI) is associated with a worse prognosis in coronavirus disease 2019 (COVID-19) patients. Identification of AKI, particularly in COVID-19 patients, is important for improving patients' management. The study aims to assess risk factors and comorbidities of AKI in COVID-19 patients. We systematically searched PubMed and DOAJ databases for relevant studies involving confirmed COVID-19 patients with data on risk factors and comorbidities of AKI. The risk factors and comorbidities were compared between AKI and non-AKI patients. A total of 30 studies involving 22385 confirmed COVID-19 patients were included. Male (OR: 1.74 (1.47, 2.05)), diabetes (OR: 1.65 (1.54, 1.76)), hypertension (OR: 1.82 (1.12, 2.95)), ischemic cardiac disease (OR: 1.70 (1.48, 1.95)), heart failure (OR: 2.29 (2.01, 2.59)), chronic kidney disease (CKD) (OR: 3.24 (2.20, 4.79)), chronic obstructive pulmonary disease (COPD) (OR: 1.86 (1.35, 2.57)), peripheral vascular disease (OR: 2.34 (1.20, 4.56)), and history of nonsteroidal anti-inflammatory drugs (NSAID) (OR: 1.59 (1.29, 1.98)) were independent risk factors associated with COVID-19 patients with AKI. Patients with AKI presented with proteinuria (OR: 3.31 (2.59, 4.23)), hematuria (OR: 3.25 (2.59, 4.08)), and invasive mechanical ventilation (OR: 13.88 (8.23, 23.40)). For COVID-19 patients, male gender, diabetes, hypertension, ischemic cardiac disease, heart failure, CKD, COPD, peripheral vascular disease, and history of use of NSAIDs are associated with a higher risk of AKI.

Deep vein thrombosis after insertion of a central venous catheter: a case report.

A male patient aged 50 years, presented with a swelling in the right leg which had occurred five days before hospital admission. This was associated with pain in the swollen leg. The patient had a history of femoral double lumen catheter (DLC) insertion for hemodialysis. On physical examination, Wong Baker's scale was 3, Wells' score was 3, and the patient had edematous, red, and warm right lower extremity. Laboratory results showed anemia (Hb 11.4 g/dl), leukocytosis (27.99 x 103/ul), increased blood urea nitrogen (BUN) (60 mg/dl), increased serum creatinine (9.93 mg/dl), hyperkalemia (6 mmol/l), urine leukocytes +3; 15-20/hpf. Lower extremity ultrasound revealed diffuse deep vein thrombosis (DVT). After the diagnosis of DVT, the patient was treated with fondaparinux injection and warfarin as an anticoagulant for six days. Our results show that treatment was effective in reducing swelling and pain in the right leg, that disappeared after a three months´ treatment.

Osteoblastogenesis of adipose-derived mesenchymal stem cells in chronic kidney disease patient with regular hemodialysis.

Background: Chronic kidney disease (CKD) is a health problem associated with high morbidity and mortality. Mineral and bone disorders are complications of CKD with a risk of fractures and cardiovascular disease. Mesenchymal stem cells can differentiate into osteoblasts and regulate their regulation by a network of cytokines and transcription factors. Objective: Analyzing differences in osteoblastogenesis of adipose mesenchymal stem cells in CKD patients and healthy people. Methods: The study sample was adipose mesenchymal stem cells from CKD patient undergoing hemodialysis and healthy people. Osteoblastogenesis was assessed by measuring the concentrations of transforming growth factor-ß1 (TGF-ß1), bone morphogenetic protein-2 (BMP-2), and (DKK-1) in culture media. The Elisa method measured the concentration of these parameters on days 4, 7, 14, and 21. Data were analyzed using an independent t-test and post hoc test with p-value <0.05. Result: There was a significant difference in CKD patients with increasing TGF-ß1 on day 4 (t = 2.821; 95% CI = 30,498-199,727; p = 0.010) and decreased on day 14. In the BMP-2 parameter, there was an increase on day 7 (t = 4.291; 95% CI = 0.289-0.831; p <0.001). Similar conditions were also found in the DKK-1 parameter, increasing on the 7th day, but there was no significant difference (p = 0.583). Conclusion: Osteoblastogenesis in adipose mesenchymal stem cells in CKD patients differs from that in healthy individuals. Osteoblasts fail in maturation and cause failure in matrix mineralization.

Severe COVID-19 infection in a kidney transplant recipient treated with lopinavir/ritonavir, hydroxychloroquine and dexamethasone.

Severe COVID-19 infection management for a recipient of kidney transplant has debatable prognosis and treatment. We described the case of a COVID-19 infected 70 year old female, previously had renal transplantation in 2017. The patient took immunosuppressive agents as routine drugs for transplant recipient status and received lopinavir/ritonavir, hydroxychloroquine, and dexamethasone daily at the hospitalization. Specific question arises about renal transplant recipients being infected by COVID-19 - whether the infection will get worse compared to those without immunosuppresive agent. In this case, author decided to stop the immunosuppressive agent followed administration of combination lopinavir/ritonavir, hydroxychloroquine, and dexamethasone that gives a good clinical impact change to patient's condition after once getting worsened and mechanically ventilated. Nevertheless, the assessment of risk and benefit in continuing immunosuppressive drugs is concurrently essential due to the prevention of transplant rejection.