Accuracy and feasibility of portable blood pressure monitoring in the detection of atrial fibrillation in hemodialysis patients.

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in clinical practice and is a common comorbidity in hemodialysis patients. AF contributes to cardiovascular complications; therefore, it is recommended to screen for AF in high-risk patients to prevent serious complications. As we currently lack a handy AF screening tool, the aim of this study was to assess the accuracy of a modified BP monitor (Omron M6), in detecting AF in hemodialysis patients. In a cross-sectional analysis conducted from October 2018 to February 2019, we enrolled all the hemodialysis patients, older than 18 years and maintained on hemodialysis for at least 3 months in four hemodialysis centers in Jordan. Logistic regression was used to predict the accuracy, while the R package (epiR) was used to determine the sensitivity and specificity of the Omron M6 in screening AF. A total of 227 patients participated in the study, with a median age of 57 years (42.8-67.3); among these, 44.5% were female. Of all the participants, 18 were detected with AF, which was confirmed by a 12-lead ECG. The prevalence of AF in our study was 7.9%, while the sensitivity, specificity and accuracy of the Omron M6 in detecting AF were calculated as 83.0% (95% CI, 59.0-96.0), 94.0% (95% CI, 90.0-97.0) and 93.4% (95% CI, 88.0-95.0) respectively. We concluded that Omron M6 has high sensitivity, specificity, and accuracy in screening AF among hemodialysis patients. However, further studies are required to ascertain and firmly establish this preliminary finding.

Mini mental status examination (MMSE) in stable chronic renal failure patients on hemodialysis: The effects of hemodialysis on the MMSE score. A prospective study.

Cognitive impairment is common in hemodialysis (HD) patients. The mini mental status examination is a simple screening test for dementia. The objectives of this study were to (1) study and compare the predialysis and postdialysis mini mental status examination score and 2 subscores and compare them with those of a control group and (2) determine the factors affecting these scores. This was a prospective study of 54 HD patients, which involved calculation of their predialysis (PrHDSc) and (2-4 weeks later) postdialysis (PoHDSc) scores and comparison of these with the control scores (CoSc). The mean scores for PreHDSc and PoHDSc were 26.5+/-2.7 and 26.4+/-3.3, respectively. Both were significantly lower than CoSc, 28.4+/-1.6 (95% CI for score difference 0.99-2.97, P<0.001). The subscores for orientation, registration, and recall (ORR) and attention (ATT) before and after HD were 14.2+/-1.3, 14.3+/-1.8, and 3.5+/-1.7, 3.2+/-1.8, respectively. Both were significantly lower than the CoSc, 15.2+/-1.2 and 4.2+/-1.1 (P=0.001 and 0.004, respectively). There were no significant differences between the PrHDSc and PoHDSc (P values of 0.87, 0.63, and 0.45, respectively). Patients' PrHDSc correlated positively with PoHDSc and dialysis efficiency measured by the urea reduction ratio and Kt/V (r=0.58, 0.4, and 0.34, respectively). Education level correlated positively with PrHDSc r=0.41 but not PoHDSc. Hemodialysis duration correlated negatively with PrHDSc r=-0.3. There was no correlation among age, chronic renal failure duration, HD frequency, weight loss, systolic or diastolic blood pressure drop, and PrHDSc or PoHDSc. Hemodialysis patients scored significantly less than the control patients. Their score was not affected by HD. This may reflect the stable cognitive function/dysfunction or the mild sensitivity of the test.

Spot urine protein-to-creatinine ratio compared with 24-hour urinary protein in patients with kidney transplant.

OBJECTIVES: This study sought to determine the correlation between protein-to-creatinine ratio and 24-hour urinary protein excretion, to examine agreement between the 2 methods, and to determine the discriminant value for protein-to-creatinine ratio that reliably determines significant threshold levels of proteinuria. MATERIALS AND METHODS: Proteinuria was assessed by 24-hour urine protein excretion and protein-to-creatinine ratio. Correlation and limits of agreement between the 2 methods were evaluated. The discriminant cutoff values for spot urine protein-to-creatinine ratio in predicting 24-hour urine protein excretion were determined using receiver operating characteristic curves. RESULTS: A positive correlation (r=0.7459, P < .0001) was found between spot urine protein-to-creatinine ratio and 24-hour urine protein excretion. A Bland-Altman plot shows that the 2 tests have reasonable limits of agreement at a low level of protein excretion, but the limits become wider as protein excretion increases. The area under the receiver operating characteristic curve for urine protein-to-creatinine ratio at various cutoffs was 0.967 (95% confidence interval: 0.880-0.996; P < .0001). The cutoff level of 0.433 had a sensitivity and specificity of 100% and 90%. CONCLUSIONS: We conclude that the protein-to-creatinine ratio in spot urine specimens in patients undergoing a kidney transplant is a convenient and reliable method of estimating protein excretion in urine.

Comparison of creatinine clearance estimates with routine measured clearance in adult Jordanians with a kidney transplant.

OBJECTIVES: There are conflicting data on using the Cockroft-Gault formula and the Modification of Diet in Renal Disease formula to assess graft function in kidney transplants. This study uses a cohort of Jordanian kidney transplant patients to assess performance of the Cockroft-Gault formula and the Modification of Diet in Renal Disease equations by using the criterion standard of measured creatinine clearance. MATERIALS AND METHODS: Creatinine clearance measured by 24-hour urine creatinine in patients with a kidney transplant was compared with the estimated clearance using the Cockroft-Gault formula and the Modification of Diet in Renal Disease equations. Correlation, limits of agreement, and concordance analyses were used. RESULTS: There was a positive correlation between both the Cockcroft-Gault (r=0.878; P < .001) and the Modification of Diet in Renal Disease (r=0.732; P < .001) equations with creatinine clearance. The former was statistically superior (P = .0416). Using Bland-Altman plots, the limits of agreement were wide for both methods. After log transformation, the limits of agreement were -0.06 to +0.27 for the Cockcroft-Gault formula, and -0.21 to + 0.26 for the Modification of Diet in Renal Disease. Concordance analyses showed a correlation coefficient of 0.7384 (95% CI: 0.6134 to 0.8273) when the Cockcroft-Gault formula was used, and 0.7257 (95% CI: 0.5622 to 0.8345) for the Modification of Diet in Renal Disease. Pearson P coefficient (precision) and bias correction factor Cb (accuracy) for the Cockcroft-Gault formula and for the Modification of Diet in Renal Disease were 0.8762, 0.8427, 0.7324, and 0.9908. CONCLUSIONS: In Jordanian patients with a renal transplant, although the Cockcroft-Gault formula performed slightly better than the Modification of Diet in Renal Disease equation in estimating creatinine clearance, neither of these equations can accurately predict renal graft function.

Achievements of kidney disease outcomes quality initiative goals in hemodialysis patients at Jordan University Hospital.

This study was conducted to assess the current practice patterns of care for hemodialysis (HD) patients at the Jordan University Hospital Dialysis Center using Dialysis Outcomes Quality Initiative Guidelines as the reference. In a cross-sectional study, we assessed 61 patients on HD. The Kt/V was calculated, and data on serum levels of hemoglobin, iron, ferritin, transferrin saturation, calcium, phosphate, and intact parathormone (PTH) were collected. The values were compared with the dialysis outcomes quality initiative (K/DOQI) recommended target values. Forty-one patients (67.2%) had an arteriovenous fistula as the primary access. The mean hemoglobin level was 10.8 ± 1.4 g/dL, 9.8% of patients had mean serum ferritin < 100 ng/dL and 14.7% had transferrin saturation < 20%. The mean serum calcium level was 9.1 ± 0.9 mg/dL and serum calcium level between 8.5 and 10.5 mg/dL was found in 82% of HD patients. The mean serum phosphorus was 3.9 ± 1.1 mg/dL and 59% of patients had serum phosphorus between 3.5 and 5.5 mg/dL. The mean serum PTH was 364 ± 315 and 14 patients (23%) had serum PTH between 150 and 300 pg/mL. The achieved standard of HD among our study patients was acceptable and, in many aspects, comparable with the NKF-KDOQI guidelines. However, there is still need to improve the management of anemia and control of hyperparathyroidism.

Comparison of 24-hour urinary protein and protein-to-creatinine ratio in the assessment of proteinuria.

To determine the correlation between protein-to-creatinine ratio (PCR) and 24-hour urinary protein (UP), we measured proteinuria in 68 patients attending the nephrology clinic at Jordan University Hospital by 24-hour urine protein excretion and protein-to-creatinine ratio. The cutoff values for spot urine protein-to-creatinine ratio in predicting 24-hour protein "threshold" excretion of 0.5, 1.0 and 3.5 g/day were determined using receiver operating characteristic curves. A very good correlation (r= 0.832, P< 0.0001) was found between spot urine protein-to-creatinine ratio and 24-hour urine protein excretion. Bland-Altman plot showed the two tests had reasonable limits of agreement at low level of protein excretion but the limits became wider as the protein excretion increased. For protein excretion < 2.0 g/day, the limits of agreement of spot urine (PCR) and (UP) were +1.48 and -1.2 g/day. The spot urine protein-to-creatinine ratios of 0.72 (sensitivity 0.97; specificity 1.0), 1.2 (0.97; 0.89) and 3.23 (1.0; 0.86) mg/mg reliably predicted 24-hour urine total protein equivalent "thresholds" of 0.5, 1.0 and 3.5 g/day, respectively. We conclude that the protein-to-creatinine ratio in spot urine specimens is an accurate, convenient, and reliable method to estimate the protein excretion in urine. However, the protein-to-creatinine ratio will likely be within clinically acceptable limits only when proteinuria is at reasonably low levels.

Spectrum of glomerulonephritis in adult Jordanians at Jordan university hospital.

We retrospectively reviewed the records and histopathological findings of 64 adequate native kidney biopsies performed at the Jordan University Hospital from January 2002 through December 2006. The nephrotic syndrome (NS) was the main reason for biopsy in 51.6% of the cases and deterioration of kidney function in 31%. Primary glomerulonephritis (GN) was diagnosed in 59.4% of the biopsies, and focal segmental glomerulosclerosis (FSGS) was the most common pathology detected (17.2%). Systemic lupus erythematosis was found in 17 patients (26.6%), and it was the commonest secondary GN pathology.