Hospital Practices and Research

Abstract Background: Acute kidney injury appears to be both the cause and the result of developing chronic kidney disease. "Acute on chronic kidney disease" refers to acute kidney injury that develops in the presence of pre-existing chronic kidney disease.
Objectives: This study aimed to gain a better understanding of the disease's incidence and outcomes in a rural area.
Methods: A retrospective analysis was conducted to identify individuals with acute or chronic kidney disease who had acute dialysis at Sakon Nakhon Hospital in Thailand between January 2021 and December 2022. The patient's demographics, clinical symptoms, laboratory values, and outcomes were documented.
Results: There were 82 patients with acute kidney injury requiring dialysis, of which 35 (42.7%) had acute on chronic kidney disease. The mean age was 61.6 ± 13.46 years, with 48.6% being male. Diabetes was the most frequent primary cause and comorbid condition (60%). The majority of indication for acute dialysis (57.1%) was volume overload. Sepsis (37.1%), and urinary tract obstruction (25.7%) were the leading causes of acute renal function decline. There was a significant difference in risk variables between non-survivors and survivors, including shock (P <0.00001), mechanical ventilation use (P = 0.0017), and Intensive Care Unit (ICU) admission (P = 0.0005). Significant mortality-related risk factors identified by logistic regression analysis were shock [OR 159.00, 95%CI 6.86-3683.71; P = 0.002], mechanical ventilation usage [OR 30.79, 95%CI 1.59-597.71; P = 0.024], and ICU admission [OR 43.00, 95%CI 2.18-847.42; P = 0.013].
Conclusion: Acute on chronic kidney disease increased not just in-hospital mortality and morbidity, but also the risk of chronic kidney disease onset and progression.

Abstract Background: As the rate of renal transplantation increases, more immunosuppressive drugs such as cyclosporine A (CsA) are consumed, particularly during the early months following transplantation, leading to post-transplant diabetes mellitus (PTDM) which can cause death.
Objective: The present study examined the role of CsA in causing PTDM and other effective factors among patients with chronic kidney disease (CKD) who had undergone renal replacement therapy.
Methods: The present investigation was a quantitative case-control study carried out on 30 CKD patients who had undergone renal transplantation and 30 healthy individuals. A questionnaire was utilized to gather their demographic information, and direct interviews were conducted with the subjects. To examine random blood sugar (RBS), white blood cell (WBC) count, creatinine level, and blood urea nitrogen (BUN), blood samples were obtained from the subjects. The mentioned parameters were analyzed using SPSS 22.0.
Results: According to the results, the groups were homogenous in age, body mass index (BMI), and male-to-female ratio. However, there were significant differences between the two groups in RBS (P = 0.011), WBC count (P = 0.031), creatinine level (P = 0.001), and BUN (P = 0.001).
Conclusion: Failure of allograft survival of renal transplantation was found to be a leading cause of death, which has been reportedly been treated by the consumption of immunosuppressive drugs such as CsA. However, this drug can increase the patient’s chances of developing PTDM. PTDM development can be reduced by applying a dosage of 10 mg/kg/d during the first week and 8-9 mg/kg/day during weeks 2-5 following transplantation.

Abstract Background: In sub-Saharan Africa (SSA), the trend in the number of patients admitted for maintenance hemodialysis is on the rise. The identification of risk factors for chronic kidney disease (CKD) ensures adequate primary and secondary preventive measures geared at reducing the burden of CKD in low-resource settings. A family history of CKD is an established risk factor for CKD in high-income countries. However, data on family predisposition to CKD is scarce in the literature on SSA.
Objective: The current study aimed to determine the prevalence and risk factors of CKD in family relatives of a Cameroonian population of hemodialysis patients (HDP) followed-up in a major hemodialysis referral center in Cameroon.
Methods: The current cross-sectional study was conducted over four months on a consecutive sample of first-degree family relatives of end-stage renal disease patients undergoing maintenance hemodialysis at the hemodialysis unit of the General Hospital of Yaoundé. For each participating family relative, socio-demographic characteristics, clinical data, and biological data including fasting blood glucose, proteinuria, and serum creatinine were collected.
Results: A total of 82 first-degree family relatives of HDP were recruited. The prevalence of CKD among the participants was 15.8%. The main identified risk factors for CKD were age (P=0.0015), female gender (P=0.0357), hypertension (P=0.0004), regular intake of herbal remedies (P=0.0214), and diabetes mellitus (P=0.0019).
Conclusion: Overall, the current findings suggest an urgent need for population education, routine screening of CKD, and the identification of risk factors in first-degree family relatives of HDP in Cameroon.