A patient presented with a malfunctioning permanent hemodialysis catheter due to a kink. After a lateral X-ray revealed the problem, a new catheter was inserted under C-arm guidance. This approach is being adopted to prevent malposition and malfunction of HD catheters. Share your experience with using lateral X-rays for HD catheter placement!
Time for an Entresto trial in HFrEF and dialysis!
A recent systematic review in KI reports by Mariam Charkviani and colleagues examined Sacubitril/Valsartan's cardiovascular effects and safety in end-stage kidney disease (ESKD) patients on dialysis. The analysis of 12 observational studies involving 799 patients showed significant improvement in LVEF for HFrEF and HFmrEF patients, with no significant safety concerns. Limited ongoing trials in dialysis patients urge more research for this population.
December is the month of Chlorthalidone
In December 4th, 2023, JAMA published a secondary analysis of outcomes of the famous Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) study. The objective was to determine the long-term posttrial risk of primary and secondary outcomes among trial participants who were randomized to either a thiazide-type diuretic, calcium channel blocker (CCB), or … Continue reading December is the month of Chlorthalidone
Tumor Lysis syndrome, in a nut shell
Either spontaneously or post treatment. Risk factors: Older age, CKD, high tumor burden, use of nephrotoxic drugs Clinical: AKI, convulsions, arrythmia, sudden cardiac death (-3: +7 days of treatment) Labs: Urea, creatinine, uric acid, K, Calcium, phosphorus, LDH Definition: 2 or more electrolytes disturbance Prevention: Hydration with IV fluids, aim 100 ml/hour, monitor for volume … Continue reading Tumor Lysis syndrome, in a nut shell
Don’t have fluoroscopy? US can help!
At AlQabbary nephrology department, we had to insert a permanent external iliac HD catheter, for a patient with multiple access failure. We didn't have fluoroscopy at that day. Under US guidance, the external iliac vein was localized and punctured. The guide wire was inserted and the subcutaneous track was made, then the catheter was inserted … Continue reading Don’t have fluoroscopy? US can help!
Systemic sclerosis and scleroderma renal crisis (SRC), multiple questions!
I recently got a 68-years-old female with systemic sclerosis and SRC who is maintained and stable on Ramipril, steroids 5 mg, hydroxychloroquine with an ESR of 20 in the first hour. She also has T2DM, maintained and controlled on Metformin and insulin glargine, and controlled hypertension using Ramipril. She presented with dry cough, which doesn't … Continue reading Systemic sclerosis and scleroderma renal crisis (SRC), multiple questions!
HD catheter malfunction, an unexpected cause
The 55-year old lady, with ESKD on MHD recently had hip fracture, and was unable to measure her weight before and after HD. The UF was estimated using clinical examination, including measuring her blood pressure, chest auscultation and examining her lower extremities for the presence of edema. Her recently inserted permanent IJ HD catheter was … Continue reading HD catheter malfunction, an unexpected cause
Ketogenic diet in patients with ADPKD, a pilot study!
Each time ketogenic diet (KD) appear in discussions, there are lots of conflict regarding its safety and efficacy in CKD patients. However, in ADPKD it is some what different. Trials in animal models showed that the metabolic state of ketosis is important for inhibiting PKD progression. However, clinical trials in humans were lacking, many are … Continue reading Ketogenic diet in patients with ADPKD, a pilot study!
Piracetam for CKD patients
My stage 4 CKD patient recently suffered a cerebrovascular stroke, on discharge from ICU, he was prescribed Piracetam 1200 mg bid, and Aniracetam 750 mg bid. After discharge, he came to the OPC for a follow up visit. His eGFR was stable at 25 ml/min. When I saw his prescription, I revised the dose of … Continue reading Piracetam for CKD patients
A post to collect data about MCD in adults for a lecture
After a recent discussion about MCD in adults with nephrology fellows at AlQabbary hospital, we explored different subjects related to MCD from a simple pubmed search. Here are some important points to take into account when managing adults with MCD: 1. Females with MCD are at greater risk of thrombosis if they are taking oral … Continue reading A post to collect data about MCD in adults for a lecture
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