Dose adjustment of rheumatology and allergy/immunology medications in chronic kidney disease: awareness and knowledge among internal medicine housestaff.

Background: Patients with chronic kidney disease (CKD) are at increased risk for adverse drug events due to medication dosing errors. We studied the awareness and knowledge among internal medicine housestaff (IMHS) of proper dose adjustment of commonly used rheumatology and allergy/immunology medications for patients with CKD. Methods: We surveyed 353 IMHS to evaluate their awareness of the need for medication dose adjustments for patients with CKD and knowledge for medication adjustment by level of glomerular filtration rate for common rheumatology and allergy/immunology medications. Results: There was lack of awareness and knowledge for both rheumatology and allergy/immunology medications. Incorrect awareness and knowledge were as follows: allopurinol, 21.2%, 73.4%; colchicine, 19.0%, 75.9%; diphenhydramine, 34.0%, 34.0%; loratadine, 82.2%, 93.2%; and montelukast, 34.0%, 34.0%, respectively. Exploratory logistic regression analyses showed that PGY1 residents had higher odds for lack of awareness for allopurinol (odds ratio [OR] 24.57, 95% CI [confidence interval] 4.69, 99.13, P < 0.001), colchicine (OR 3.98, 95% CI 1.50, 10.51, P < 0.01), diphenhydramine (OR 2.24, 95% CI 1.10, 4.54, P < 0.04), and montelukast (OR 2.45, 95% CI 1.20, 5.00, P < 0.05) than PGY3 residents. A nephrology rotation in medical school was associated with lower odds for incorrect knowledge for allopurinol (OR 0.46, 95% CI 0.25, 0.87, P < 0.05) and montelukast (OR 0.50, 95% CI 0.27, 0.92, P < 0.05). Conclusion: Overall, awareness and knowledge were poor among IMHS for dose adjustments of rheumatology and allergy/immunology medications in patients with CKD. Proper education and exposure to nephrology during training may improve quality and safety of care for patients with CKD.

Renal Manifestations and their Association with Mortality and Length of Stay in COVID-19 Patients at a Safety-net Hospital.

Background: Renal involvement in COVID-19 leads to severe disease and higher mortality. We study renal parameters in COVID-19 patients and their association with mortality and length of stay in hospital. Methods: A retrospective study (n=340) of confirmed COVID-19 patients with renal involvement determined by the presence of acute kidney injury. Multivariate analyses of logistic regression for mortality and linear regression for length of stay (LOS) adjusted for relevant demographic, comorbidity, disease severity, and treatment covariates. Results: Mortality was 54.4% and mean LOS was 12.9 days. For mortality, creatinine peak (OR:35.27, 95% CI:2.81, 442.06, p<0.01) and persistent renal involvement at discharge (OR:4.47, 95% CI:1.99,10.06, p<0.001) were each significantly associated with increased odds for mortality. Increased blood urea nitrogen peak (OR:0.98, 95%CI:0.97,0.996, p<0.05) was significantly associated with decreased odds for mortality. For LOS, increased blood urea nitrogen peak (B:0.001, SE:<0.001, p<0.01), renal replacement therapy (B:0.19, SE:0.06, p<0.01), and increased days to acute kidney injury (B:0.19, SE:0.05, p<0.001) were each significantly associated with increased length of stay. Conclusion: Our study emphasizes the importance in identifying renal involvement parameters in COVID-19 patients. These parameters are associated with LOS and mortality, and may assist clinicians to prognosticate COVID-19 patients with renal involvement.

Respiratory involvement parameters in hospitalized COVID-19 patients and their association with mortality and length of stay.

Introduction/Background: Patients with Coronavirus Disease 2019 (COVID-19) present with a spectrum of respiratory symptoms. There are no studies describing respiratory system involvement adjusted for other organ systems, oxygen saturation nadir, hospitalization days until respiratory involvement, proportion of days of respiratory system involvement, and persistent respiratory involvement at discharge in COVID-19 patients. We studied these parameters in COVID-19 patients that received respiratory therapy interventions and their association with mortality and length of stay (LOS). Methods: A single-center cross-sectional retrospective study of 738 COVID-19 patients with respiratory involvement at a hospital in the New York metropolitan area. Results: COVID-19 patients with respiratory involvement had increased mortality with oxygen requirement of FiO2 >55% (OR:39.02, 95% CI:1.59-960.51, P < 0.05) and mechanical ventilation (OR:236.64, 95% CI:8.24-6798.93, P < 0.01). Respiratory system involvement adjusted for other organ system involvement was associated with increased mortality (OR:1.60, 95% CI:1.20, 2.14, P < 0.01) and LOS (B = 0.02, SE = 0.01, P < 0.01). Oxygen saturation nadir of 70%-89% was significantly associated with increased LOS (B = 0.07, SE = 0.03, P < 0.05), whereas oxygen saturation nadir of <70% was associated with increased mortality (OR:12.95, 95% CI:2.72-61.61, P < 0.01). An increased proportion of days in hospital with respiratory system involvement was associated with decreased mortality (OR:0.004, 95% CI:<0.001-0.06, P < 0.001) and increased LOS (B = 0.90, SE = 0.07, P < 0.001). Respiratory involvement on days 4-7 was associated with decreased mortality (OR:0.02, 95% CI:<0.003-0.17, P < 0.001), and respiratory involvement on day >1 was associated with increased LOS. Respiratory involvement persistent at discharge was associated with increased mortality (OR:56.82, 95%CI:18.51-174.43, P < 0.001). Conclusions: Among all respiratory parameters, high oxygen requirements and low oxygen saturation nadir are the most predictive of COVID-19 prognosis.

Glucose dysregulation and its association with COVID-19 mortality and hospital length of stay.

BACKGROUND AND AIMS: We investigate the impact of blood glucose on mortality and hospital length of stay (HLOS) among COVID-19 patients. METHODS: Retrospective study of 456 patients with confirmed COVID-19 and glycemic dysregulation in the New York City area. RESULTS: We found that impaired glucose adjusted for other organs systems involved (OR:1.87; 95% CI:1.36-2.57, p < 0.001), increased glucose nadir (OR:34.28; 95% CI:3.97-296.05, p < 0.01) and abnormal blood glucose levels at discharge (OR:5.07; 95% CI:2.31-11.14, p < 0.001) were each significantly associated with increased odds for mortality. New or higher from baseline insulin requirement during hospitalization (OR:0.34; 95% CI:0.15-0.78; p < 0.05) was significantly associated with decreased odds for mortality. Increased glucose peak (B = 0.001, SE=<0.001, p < 0.001), new or higher from baseline insulin requirement during hospitalization (B = 0.11, SE = 0.03, p < 0.001), and increased days to dysglycemia (B = 0.15, SE = 0.04, p < 0.001) were each significantly associated with increased HLOS. Increased glucose nadir (B = -0.67, SE = 0.07, p < 0.001), insulin intravenous drip (B = -0.10, SE = 0.05, p < 0.05), and increased proportion days endocrine system involved (B = -0.25, SE = 0.06, p < 0.001) were each significantly associated with decreased HLOS. CONCLUSION: Glucose dysregulation adversely affects mortality and HLOS in COVID-19. These data can help clinicians to guide patient treatment and management in COVID-19 patients.

Hematologic Involvement as a Predictor of Mortality in COVID-19 Patients in a Safety Net Hospital.

INTRODUCTION: COVID-19 affects the hematologic system. This article evaluated the impact of hematologic involvement of different blood cell line parameters of white blood cells including absolute neutrophil count (ANC), hemoglobin, and platelets in COVID-19 patients and their association with hospital mortality and length of stay (LOS). METHODS: This was a retrospective study of 475 patients with confirmed positive COVID-19 infection and hematologic abnormalities in the metropolitan New York City area. RESULTS: Elevated absolute neutrophil count (OR: 1.20; 95% CI: 1.02-1.42; p < 0.05) increased days of hematologic involvement (OR: 4.44; 95% CI: 1.42-13.90; p < 0.05), and persistence of hematologic involvement at discharge (OR: 2.87; 95% CI: 1.20-6.90; p < 0.05) was associated with higher mortality. Higher hemoglobin at admission (OR: 0.77; 95% CI:0.60-0.98; p < 0.001) and platelets peak (OR: 0.995; 95% CI: 0.992-0.997; p < 0.001) were associated with decreased mortality. Patients with higher white blood cell peak (B = 0.46; SE = 0.07; p < 0.001) and higher hemoglobin at admission (B = 0.05; SE = 0.01; p < 0.001) were associated with higher LOS. Those with higher hemoglobin nadir (B = -0.06; SE = 0.01; p < 0.001), higher platelets nadir (B = -0.001; SE = < 0.001; p < 0.001), and hematologic involvement at discharge or death (B = -0.06; SE = 0.03; p < 0.05) were associated with lower LOS. CONCLUSIONS: These findings can be used by clinicians to better risk-stratify patients with hematologic involvement in COVID-19 and tailor therapies potentially to improve patient outcomes.

MELD-Na score, Acute Physiologic and Chronic Health Evaluation II score, and SOFA score and their association with mortality in critically ill COVID-19 patients with liver injury: A retrospective single-center study.

Background: The Acute Physiologic and Chronic Health Evaluation II (APACHE-II), Sequential Organ Failure Assessment (SOFA), and Model for End-Stage Liver Disease modified for Sodium concentration (MELD-Na) scores are validated to predict disease mortality. We studied the prognostic utility of these scoring systems in critically ill coronavirus disease 2019 (COVID-19) patients with liver injury. Methods: This was a retrospective study of 291 confirmed COVID-19 and liver injury patients requiring intensive care unit level of care. These patients required supplemental oxygen requirement with fraction of inspired oxygen >55% and/or the use of vasopressor. MELD-Na, SOFA, and APACHE-II scores were adjusted. Outcomes were mortality and length of stay (LOS). Results: SOFA (odds ratio: 0.78, 95% confidence interval: 0.63-0.98, P < 0.05) was associated with decreased odds for mortality. APACHE-II and MELD-Na were not associated with mortality or LOS. Conclusions: We suggest that the novel nature of COVID-19 necessitates new scoring systems to predict outcomes in critically ill COVID-19 patients with liver injury.

Awareness and Knowledge Among Internal Medicine House-Staff for Dose Adjustment of Cardiovascular Drugs in Chronic Kidney Disease.

INTRODUCTION: Patients with chronic kidney disease (CKD) are vulnerable to adverse-drug events from cardiovascular drugs. AIM: To evaluate awareness and knowledge for appropriate dose adjustment of cardiovascular drugs in CKD patients among Internal Medicine house-staff (IMHS). METHODS: Cross-sectional convenience sample survey in Fall 2015 among 341 IMHS from multiple academic institutions in the suburban New York City metropolitan area. Awareness was whether drug dose adjustment was needed. Knowledge was correct GFR level for drug dose adjustment. Multivariate logistic regression was conducted. RESULTS: We found overall high percentages and high odds for all cardiovascular drugs for incorrect awareness and knowledge. Postgraduate year (PGY)-1 had greater odds than PGY-3 for Carvedilol (OR: 5.56, 95% CI: 2.19-14.12, p < 0.001) and Digoxin (OR: 3.87, 95% CI: 1.37-10.95, p < 0.05), and lesser odds than PGY3 for Atenolol (OR: 0.31, 95% CI: 0.10-0.91, p < 0.05). Nephrology exposure during medical school rotation, renal clinic, or family history had lesser odds for Carvedilol (OR: 0.45, 95% CI: 0.21-0.97, p < 0.05), Simvastatin (OR: 0.40, 95% CI: 0.16-0.97, p < 0.05), and Hydralazine (OR: 0.31, 95% CI: 0.12-0.81, p < 0.05). Nephrology exposure during residency (OR: 1.96, 95% CI: 1.10-3.50, p < 0.05) and US osteopathic graduates (OR: 2.40, 95% CI: 1.04-5.50, p < 0.05) each had greater odds for Enalapril (OR: 2.40, 95% CI: 1.04-5.50, p < 0.05). International medical graduates had lesser odds than US graduates for Amlodipine (OR: 0.30, 95% CI: 0.11-0.82, p < 0.05). CONCLUSIONS: IMHS had overall poor awareness and knowledge for dose adjustment for common cardiovascular drugs in patients with CKD. As the majority of CKD patients are managed by their primary care providers, training programs should ensure that IMHS have adequate education in Nephrology during their residency training.

Dose adjustment of antidiabetic medications in chronic kidney disease.

PURPOSE: The purpose of this study is to identify whether Internal Medicine house-staff (IMHS) have awareness and knowledge about the correct dosage of antidiabetic medications for patients with chronic kidney disease (CKD), as dosing errors result in adverse patient outcomes for those with diabetes mellitus (DM) and CKD. METHODS: There were 353 IMHS surveyed to evaluate incorrect level of awareness of medication dose adjustment in patients with CKD (ILA) and incorrect level of knowledge of glomerular filtration rate level for medication adjustment (ILK-GFR) for Glipizide, Pioglitazone, and Sitagliptin. RESULTS: Lack of awareness and knowledge was high, with the highest for Pioglitazone at 72.8%. For ILA, the percentages were: Pioglitazone: 72.8%, Glipizide: 43.9%, and Sitagliptin: 42.8%. For ILK-GFR, the percentages were: Pioglitazone: 72.8%, Glipizide: 68.3%, and Sitagliptin: 65.4%. CONCLUSIONS: IMHS have poor awareness and knowledge for antidiabetic medication dose adjustment in patients with DM and CKD. Both Electronic Medical Rerecord best practice advisory and physician-pharmacist collaborative drug therapy management can enhance safe drug prescribing in patients with CKD. In addition, IMHS's practice for antidiabetic medication dose adjustment was better with Nephrology exposure. A formal didactic educational training during medical school and residency for antidiabetic medication dose adjustment in patients with DM and CKD is highly encouraged to prevent medication dosing errors and to more effectively and safely allow IMHS to manage complex treatment regimens.

Social Support, Caregivers, and Chronic Kidney Disease.

The morbidity and mortality associated with chronic kidney disease remains unacceptably high. Psychosocial issues in CKD patients are frequently overlooked yet are often modifiable risk factors for mortality. Addressing patient perception of social support can potentially improve patient outcomes.

Psychological and relational factors in ESRD hemodialysis treatment in an underserved community.

OBJECTIVE: The researchers investigated the association of depression with treatment adherence, and examined the possible moderating roles of social support and of the physician-patient working alliance (PPWA) on treatment adherence, satisfaction with treatment, and quality of life. METHODS: The current study sampled ninety-five patients with End Stage Renal Disease who were receiving outpatient hemodialysis (HD) treatment. RESULTS: Findings indicated that higher levels of depression were significantly associated with lower ratings of adherence, quality of life, and social support. In contrast, higher levels of social support and of the PPWA were significantly associated with higher ratings of adherence, satisfaction with treatment, and quality of life. Analyses of moderation showed no effect for PPWA between depression and adherence, satisfaction, or quality of life; however, there was a significant moderation effect for social support. CONCLUSION: There are mild but significant associations between PPWA and social support. Positive associations between the PPWA and social support on adherence, satisfaction, and quality of life indicate that each one, PPWA and social support, plays its own role on patients' experiences of and behavior in treatment. Affective social support significantly limits the negative influence of depression on adherence. PRACTICE IMPLICATIONS: Assessment of depression and social support is essential in hemodialysis treatment.

El Campo de la Discapacidad Desde la Perspectiva de los Docentes Que Cursan la Especialización en Actividad Física Adaptada y Discapa cidad Del IUACJ / The Field of Disability from the Perspective of the Teachers Enrolled in the Adapted Physical Activity and Disability Specialization Course of the IUACJ

RESUMEN: La primera edición de la especialización en actividad física adaptada y discapacidad se constituye en un hito por ser el primer posgrado de estas características en Uruguay. Esto implica pensar la formación de los docentes a partir de escenarios y poblaciones diversos. Nos planteamos analizar la formación y trayectoria laboral en el campo de la discapacidad, así como las concepciones de inclusión y discapacidad de once estudiantes que cursan el posgrado. Los datos fueron recolectados a través de la entrevista semi-estructurada. Los resultados muestran que sólo cinco docentes tienen formación previa en el área de la discapacidad y seis de ellos experiencia en el trabajo con personas con discapacidad. Todos entienden la importancia de formarse para tener herramientas que les permitan intervenir de mejor manera es sus prácticas. Las concepciones de discapacidad e inclusión muchas veces transitan por el paradigma médico rehabilitador y de educación especial, pero a pesar de ello, presentan actitudes positivas ante el reto de trabajar con la diversidad del alumnado.

ABSTRACT: The first edition of the specialization in adapted physical activity and disability is a milestone as it is the first graduate program with these characteristics in Uruguay. This implies in thinking the teacher training from different scenarios and populations. We set out to analyze the training and career path in the field of disability, as well as the inclusion and disability conceptions of eleven students who attend the graduate course. The data was collected through the semi-structured interview. Results show that only five teachers had previous formation in the area of disability and six of them had experience of working with people with disabilities. Everyone understands the importance of training to have the tools that will allow them to intervene in a better way in their practices. Conceptions of disability and inclusion often go through the medical and special education paradigm of rehabilitation, but, despite this, they present positive attitudes in relation to the challenge of working with the diversity of the students.

Awareness and Knowledge Among Internal Medicine Resident Trainees for Dose Adjustment of Analgesics and Neuropsychotropic Medications in CKD.

OBJECTIVES: Errors in drug dosing lead to poor patient outcomes and are common in patients with chronic kidney disease (CKD). Because the majority of patients with CKD are being treated by physicians specializing in internal medicine, we studied the awareness and knowledge that internal medicine resident trainees (IMRTs) have regarding the correct dosage of commonly used analgesic and neuropsychotropic medications for patients with CKD. METHODS: We surveyed 353 IMRTs about their awareness of whether a medication needs dose adjustment in patients with CKD and knowledge for medication adjustment by level of glomerular filtration rate. RESULTS: There were high percentages for lack of awareness and knowledge. For analgesics, this lack of awareness/knowledge was highest for acetaminophen (awareness 83.0%, knowledge 90.9%). For neuropsychotropics, this was highest for paroxetine (awareness 74.5%, knowledge 91.5%). Analyses for postgraduate year (PGY) -1 trainees and PGY-2 trainees for analgesics showed higher odds for lack of awareness for tramadol (PGY-1 odds ratio [OR] 2.37, 95% confidence interval [CI] 1.2-4.62, P < 0.05; PGY-2 OR 2.34, 95% CI 1.16-4.72, P < 0.05) and for lack of knowledge for meperedine (PGY-1 OR 4.01, 95% CI 1.81-8.89, P < 0.05; PGY-2 OR 3.30, 95% CI 1.44-7.59, P < 0.05). Nephrology residency rotation for the neuropsychotropic medication of gabapentin showed lower odds for both lack of awareness (OR 0.56, 95% CI 0.32-0.97, P < 0.05) and knowledge (OR 0.52, 95% CI 0.27-0.997, P < 0.05). CONCLUSIONS: Awareness and knowledge are poor among IMRTs for dose adjustments of analgesics and neuropsychotropic medication classes in patients with CKD. There should be a renewed focus during IMRTs' residency on additional nephrology exposure and formal didactic educational training to help them better manage complex treatment regimens to prevent medication dosing errors.

Awareness and knowledge among internal medicine house-staff for dose adjustment of commonly used medications in patients with CKD.

BACKGROUND: Drug dosing errors result in adverse patient outcomes and are more common in patients with chronic kidney disease (CKD). As internists treat the majority of patients with CKD, we study if Internal Medicine house-staff have awareness and knowledge about the correct dosage of commonly used medications for those with CKD. METHODS: A cross-sectional survey was performed and included 341 participants. The outcomes were the awareness of whether a medication needs dose adjustment in patients with CKD and whether there was knowledge for the level of glomerular filtration rate (GFR) a medication needs to be adjusted. RESULTS: The overall pattern for all post-graduate year (PGY) groups in all medication classes was a lack of awareness and knowledge. For awareness, there were statistically significant increased mean differences for PGY2 and PGY3 as compared to PGY1 for allergy, endocrine, gastrointestinal, and rheumatologic medication classes but not for analgesic, cardiovascular, and neuropsychotropic medication classes. For knowledge, there were statistically significant increased mean differences for PGY2 and PGY3 as compared to PGY1 for allergy, cardiovascular, endocrine, and gastrointestinal, medication classes but not for analgesic, neuropsychotropic, and rheumatologic medication classes. CONCLUSIONS: Internal Medicine house-staff across all levels of training demonstrated poor awareness and knowledge for many medication classes in CKD patients. Internal Medicine house-staff should receive more nephrology exposure and formal didactic educational training during residency to better manage complex treatment regimens and prevent medication dosing errors.

The Physician-Patient Working Alliance in Hemodialysis Treatment.

Over the past 20 years, the role of psychological and social factors, including the physician-patient working alliance, have emerged as integral components of medical care for patients with a myriad of health conditions. The current study examines a model comprised of psychological-interpersonal factors and the extent to which it explains patient satisfaction with and adherence to hemodialysis treatment. One hundred and seven adults with end-stage renal disease who were receiving regular outpatient hemodialysis participated in the study. Path analyses show that the physician-patient working alliance indirectly predicts patient adherence through patient satisfaction and patients' outcome expectations. The working alliance directly predicts patients' quality of life. It is concluded that consistent with previous research, the physician-patient working alliance is a significant factor in predicting key patient behaviors in medical care.

Icodextrin-induced acute pancreatitis in a peritoneal dialysis patient: a case report and literature review
.

The 7.5% icodextrin solution is widely used for long-dwell in peritoneal dialysis (PD) regimens as an alternative osmotic agent to glucose. It has been defined as a biocompatible agent because of its iso-osmolarity and is generally safe and well tolerated. Icodextrin and its hydrolyzed metabolites are found in systemic circulation. In serum, icodextrin interferes with amylase determination causing a significantly decreased plasma amylase level making it unreliable for the diagnosis of acute pancreatitis. Lipase measurement provides an alternative and accurate method for diagnosing acute pancreatitis (AP) in patients using icodextrin. Icodextrin-induced acute pancreatitis is not well described. The literature appears limited to two case reports. We describe a case of a man with end-stage renal disease (ESRD) on PD who developed acute pancreatitis following icodextrin use. We also provide a novel possible mechanism for understanding how icodextrin causes AP.
.

Facial disfigurement due to osteitis fibrosa cystica or brown tumor from secondary hyperparathyroidism in patients on dialysis: A systematic review and an illustrative case report.

Osteitis fibrosa cystica (OFC) is the most frequent type of osseous change in renal osteodystrophy affecting the majority of dialysis patients. Brown tumors are a severe form of OFC. The involvement of the craniofacial skeleton causing facial disfigurement in patients on dialysis appears to be limited to case reports. After searching PubMed, we performed a systematic review of 127 cases with a severe form of OFC resulting in a facial disfigurement to understand possible determinants for this condition. We found that since the first published case in 1974, and after a peak in 1996, there appears to be an increase in published reported cases. Only 27.6% of these cases were published in nephrology journals. The most common region for reported cases was North America. Mean age of these patients was 31.2 years with a mean dialysis duration of 7 years. Almost 67% were women, and almost all were on hemodialysis. The disease tended to most commonly localize to the maxilla (73.2%) and mandible (57.5%). As part of the treatment, 59% of patients had a parathyroidectomy. More than one-third (35.4%) had symptomatic improvement at follow-up. Mean follow-up was 1.6 years. Clinicians should be aware of this clinical presentation of a severe form of OFC and/or brown tumors. Timely diagnosis and intervention may help to prevent or decrease destructive bone changes and reduce negative psychological consequences of facial disfigurement.

Hypercalcemia and renal failure in a young man: lessons in diagnosis.

Hypercalcemia is a common clinical problem. Morbidity and mortality associated with hypercalcemia are directly related to its underlying cause, making identification of the correct underlying etiology vital. When hypercalcemia is combined with acute kidney injury it points towards very specific diagnoses. We present a case of a young man with hypercalcemia and acute kidney injury who had multiple unusual laboratory findings that lead to the establishment of a correct diagnosis.

Fulminant hepatic failure with virtually undetectable serum alkaline phosphatase.

Wilson's disease presenting as fulminant hepatic failure is a rare presentation that carries a high morbidity and mortality. We report a young patient who developed fulminant hepatic failure as the initial manifestation of Wilson's disease. Virtually undetectable serum alkaline phosphatase provided the first clue to the diagnosis. Our patient underwent a successful liver transplantation which is the only effective treatment in patients with Wilsonian fulminant hepatic failure. In this report, we discuss laboratory clues to the diagnosis of this form of Wilson's disease. Clinicians should have a high suspicion of Wilson's disease as any delay in diagnosis can be catastrophic.

Changes in osmol gap in chronic kidney disease: an exploratory study.

AIM: There is no data on osmol gap (OG) in chronic kidney disease (CKD) by stage and limited data on OG in adults on maintenance hemodialysis (HD). We aimed to examine the OG between different stages of CKD and to compare the OG pre- and post-HD in those on maintenance HD. METHODS: We conducted a cross-sectional study of 67 patients. The participants were divided into six groups: Group 1-reference group (normal renal function), Group 2-CKD stage 2; Group 3-CKD stage 3; Group 4-CKD stage 4; Group 5-CKD stage 5 and not on dialysis. Group 6 were subjects on maintenance HD. RESULTS: The means of OG ± standard deviation of Groups 1-6 were 15.25 ± 3.0, 20.73 ± 2.68, 22.85 ± 6.99, 24.11 ± 3.64, 25.15 ± 5.06, and 28.88 ± 3.45, respectively (p < 0.001). In the HD group, the difference between the pre-HD and post-HD OG was statistically significant (p < 0.001). CONCLUSION: There is a statistically significant upward trend for OG as CKD stage increases. The OG is elevated in patients on maintenance HD and is normalized by the HD. OG can be a valuable additional tool to suggest CKD stage and serve as a marker of dialysis adequacy.

Occupational risk and chronic kidney disease: a population-based study in the United States adult population.

OBJECTIVE: Previous studies on occupational risk for chronic kidney disease (CKD) have analyzed a limited range of occupations and focused on nephrotoxins. The primary purpose of this study was to examine the relative risk for the occurrence of CKD between different occupations in the US adult population. MATERIALS AND METHODS: This was a population-based survey study of 91,340 participants in the US, who completed the National Health Interview Survey, 2004 through 2008. The outcome variable, CKD, was defined as having weakening/failing kidneys in the past 12 months, as diagnosed by a physician. The predictor variable, occupation, was obtained using the census occupational codes, regrouped according to North American Industrial Classification System. RESULTS: After controlling for age, gender, hypertension, and education, and with the category Life, Physical, and Social Science Occupations as a reference group, the likelihood of developing CKD was 4.3 times higher in respondents working in Building, Grounds Cleaning and Maintenance Occupations, 4.4 times higher in Healthcare Practitioners and Technical Occupations, 4.7 times higher in Transportation and Material Moving Occupations and in Computer and Mathematical Occupations, 4.8 times higher in Production Occupations, 5.3 times higher in Food Preparation and Serving Related Occupations, and 6.1 times higher in Healthcare Support Occupations and in Legal Occupations. CONCLUSION: This study identified occupation groups in US adult population with increased risk for CKD. Alleviation of workplace stress is suggested as a goal for behavioral intervention in high-risk occupations.