Sleep disorders and chronic kidney disease

Sleep disorders have a profound and well-documented impact on overall health and quality of life in the general population. In patients with chronic disease, sleep disorders are more prevalent, with an additional morbidity and mortality burden. The complex and dynamic relationship between sleep disorders and chronic kidney disease(CKD) remain relatively little investigated. This article presents an overview of sleep disorders in patients with CKD, with emphasis on relevant pathophysiologic underpinnings and clinical presentations. Evidence-based interventions will be discussed, in the context of individual sleep disorders, namely sleep apnea, insomnia, restless leg syndrome and excessive daytime sleepiness. Limitations of the current knowledge as well as future research directions will be highlighted, with a final discussion of different conceptual frameworks of the relationship between sleep disorders and CKD.

Cutaneous Abnormalities in Chronic Kidney Disease Patients with and without Dialysis

Background: Chronic kidney disease (CKD) is increasingly prevalent worldwide. CKD may present with different cutaneous manifestations. Objectives: To evaluate the dermatological manifestations and compare these manifestations between patients with maintenance hemodialysis (MHD) and non-dialysis groups. Methods: It was a cross sectional study conducted in the Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from April 2013 to March 2014. A total of 150 hospital admitted CKD patients were evaluated for dermatological manifestations. Age, gender, haemoglobin level, 24-hours urinary total protein (UTP), serum creatinine, serum fasting lipid profile, estimated glomerular filtration rate (e-GFR) and dermatological manifestations of the study subjects were recorded accordingly. Inter-group comparisons were made between patients with and those without cutaneous abnormality. Results: Out of 150 study subjects, 99 (66%) were male and 51 (34%) were female, 69 (46%) patients were on MHD and 81 (54%) patients were without dialysis, their mean (±SD) age was 44.6 ± 12.3 year. A Total of 126 (84%) patients had cutaneous abnormalities;among them 69 (54.76%) were pre-dialytic and 57 (45.24%) were on MHD group. The mean (±SD) serum creatinine was relatively higher but haemoglobin level was significantly lower (p = 0.021), while UTP was significantly higher (p = 0.038) among patients with cutaneous abnormality. There was no relationship between lipid profile with cutaneous abnormality. Among 126 (84%) patients with cutaneous abnormality;pallor was the most common cutaneous abnormality (72%) followed by xerosis (68.66%), pruritus (65.33%), half and half nails (38.66%), pigmentation (33.33%), purpura/ecchymosis (16.66%), fungal infection (16%), ulcerative stomatitis (10.66%) and bacterial infection (10%). Pigmentation (52.6%), purpura (35.1%), ulcerative stomatitis (21.1%) and bacterial infection (19.3%) were significantly higher in MHD group. Among 69 (54.76%) predialytic patients;11 (15.94%), 20 (28.98%) and 38 (55.07%) of them were on CKD stage-III, IV and V respectively. Conclusions: The dermatological disorders are frequent among CKD patients. Pallor, pruritus, xerosis, pigmentation and purpura are predominant changes. Pigmentation, purpura, ulcerative stomatitis and bacterial infection are significantly higher in MHD patients. Cutaneous abnormalities are more frequent in advance stages of CKD.

Approach to Acute Kidney Injury: Diagnosis and Management

Acute kidney injury is a critical but commonly occurring medical condition that presents with a sudden decline in kidney function. This comprehensive review article provides an in-depth examination of the risk elements, etiology, diagnosis, management, and preventive approach of AKI. The causes that contribute to the development of AKI include prerenal, intrinsic renal, and postrenal. The diagnostic approach to AKI includes clinical, laboratory, and imaging studies to evaluate the root cause analysis and to find out the severity of kidney injury. Timely and accurate diagnosis is crucial for initiating appropriate management strategies. The treatment strategies may include fluid and electrolyte management, medication adjustments, nutritional support, and renal replacement therapy. The prospect of recovery diverges as it relies on the individual factors, reasons, and gravity of the condition. This review highlights the importance of raising awareness among healthcare professionals and the public about AKI, early recognition of risk factors, and prompt management. Further research is needed to explore novel therapeutic approaches and refine existing management guidelines for this critical condition.

维持性血液透析患者病因变化的分析

目的分析维持性血液透析患者病因的变化。方法对首都医科大学附属北京友谊医院血液透析中心2001年1月至2010年12月收治的918例慢性肾功能不全维持性血液透析(MHD)的患者进行病因构成分析,分别对2005年前后5年间、不同性别间、不同年龄段之间MHD的病因构成进行对比。结果 2000～2010年918例MHD患者的病因中,慢性肾小球肾炎(CGN)占首位,270例(29.4%),其次是糖尿病肾病(DN)122例(13.2%),高血压(HT)第3位,68例(7%),2005年后CGN所占比率呈下降趋势(34.6%vs.25.1%,P<0.001),而DN(5.9%vs.19.8%,P<0.001)和HT(5.9%vs.8.9%,P=0.061)所占比率明显上升。男性MHD患者高血压肾损害的比率明显高于女性(10.9%vs.2.9%,P<0.001)。随着年龄增长,DN在MHD中所占的比率显著增高,20～39岁6.2%,40～59岁14.9%,60～79岁20.1%(P<0.001)。而HT在40～60岁MHD患者中所占比率显著高于其他年龄段,20～39岁3.7%,40～59岁11.0%,60～79岁6.4%(P<0.001)。结论近年MHD的病因构成发生了变化,有必要重视代谢性疾病的早期防治。

维持性血液透析患者原发病变化分析

目的探讨维持性血液透析（maintenance hemodialysis，MHD）患者原发病变化。方法收集1990-1999年和2005—2014年2个时间段收治的MHD患者的资料并对原发病进行回顾性分析，分析不同性别、不同年龄组（16-岁、36～岁、60～岁组）患者MHD的原发病变化。结果MHD患者的前3位原发病依次是慢性肾小球。肾炎、糖尿病肾病以及高血压。同1990—1999年相比，2005—2014年慢性肾小球肾炎（chronic chronic glomerulonephritis，CGN）所占比例由70．18％下降至21．30％；糖尿病肾病（diabetic kidney disease，DKD）以及高血压肾损害（hypertension，HT）所占比例则分别从7．80％和1．38％上升至13．33％和8．33％。按不同性别分组，可发现与1990—1999年相比，2005—2014年无论男性还是女性群体中CGN所占比例均有所下降，而仅有男性患者DKD和HT在原发病中所占比例从6．9％和0．86％上升至16．35％和10．06％。在不同年龄组，前、后10年的CGN所占比例均有明显下降；而DKD与HT在36～岁组中所占比例由6．00％、2．00％上升至14．24％、11．00％。结论近年来维持性血液透析患者的病因构成与早年相比发生了明显变化，应加强对高血压以及糖尿病的早期防治。