Background: Limited comparative data are available on the symptom severity and burden of dialyzed versus nondialyzed end-stage renal disease (ESRD) patients and their association with negative emotional states. Objective: To investigate the prevalence of symptom burden and severity of ESRD patients and correlate the findings with their psychological status. Methods: This was a cross-sectional study of dialyzed (N = 87) and nondialyzed (N = 100) patients. The symptom burden and severity were determined using the Dialysis Symptom Index (DSI) and the psychological assessment using Depression Anxiety Stress Scale 21 (DASS-21). Results: Symptom severity evaluated using the DSI was comparable in both groups with fatigue as the most common symptom (n = 141, 75.4%), followed by sleep-related, sexual dysfunction, and dry skin problems. The symptom burden for worrying, dry skin and mouth, decreased appetite, numbness, and leg swelling were significant in not dialyzed group (p < 0.05).The DASS-21 scores revealed that 11% of patients were depressed, 21.8% were stressed, and 15.6% were anxious (p < 0.030). The prevalence of psychological disturbances was associated with high symptom burden regardless of their treatment options (p < 0.005). Dialyzed patients showed a positive psychological status trend on DASS-21 assessment. The not dialyzed group consisted of 34% from comprehensive conservative group, 26% of choice-restricted conservative care, and 40% with no definitive future plan. Conclusions: There was no difference in the prevalence of symptom burden and severity, irrespective of the type of treatment. Psychological disturbances were associated with higher symptom burden and severity and, therefore, should be screened thoroughly to achieve optimal ESRD management.

Although there is a large volume of literature regarding the definition and epidemiology of. Type 2 diabetes nephropathy (T2DN). There has been a paucity of data focused on the rate of transition of T2 DN. Based on our personal observation a certain percentage of our incident end stage renal disease (ESRD) patients from T2DN experienced a rapid decline of renal function. Their rapid decline nature of glomerular filtration rate (GFR) of 46 to 60 mL/min per 1.73m2 per year have far exceeded the KDIGO definitions of acute kidney injury (abrupt decrease in kidney function occurring over 7 days or less), acute kidney disease (acute or subacute damage and/or loss of kidney function for a duration of between 7 and 90 days after exposure to an acute kidney injury initiating event (Chawla et al Nat Rev Nephrol 241–57 2017) or even rapid decliner (eGFR declines > 5 mL/min per 1.73m2 per year) (Chawla et al Nat Rev Nephrol 241–57 2017; Andrassy Kidney Int 622–623 2013). We describe here three cases of type 2 diabetic patients that have rapid renal deterioration with rate of decline 46 - 60 mL/min per 1.73m2 per year. All the patients are heavily nephrotic. All of the renal biopsies done showed the classical diabetic changes, hypertensive changes, diffuse tubulointerstitial damage, and interstitial nephritis. All of the patients admitted to taking various form of traditional medications in hope of curing their renal disease. We wish to highlight that type 2 diabetics with massive nephrotic range proteinuria have enhanced risk of rapid renal function deterioration. The patients should be educated about the risks of rapid renal function deterioration when there is presence of heavy proteinuria. High grade proteinuria is likely to inflict the diffuse tubulointerstitial inflammation. The interstitial nephritis could be further worsened by traditional supplements consumption. Timely health education and advice must be undertaken to retard this unwanted rapid renal disease progression.

Category: Epidemiology and Outcomes from AKI Presenter: Dr WAN ZUL HAIKAL HAFIZ WAN ZUKIMAN Keywords: dengue, aki, crrt, acute kidney injury, DSS, DHF, severe dengue, Introduction Dengue fever imposed a major health problem with significant morbidity and mortality. Acute kidney injury (AKI) is a well-known factor associated with the poorer outcome of the patients. We audited 2-monthdengue fever admissions in Serdang Hospitalin 2016. Objective We hope to determine the prevalence of AKI in dengue cases and their incidence, characteristic, risk factors and clinical outcome. Methodology A total of 266 patients was treated as dengue fever in March and April 2016. Increment of 1.5 fold in creatinine following the AKIN criteriawas used to differentiate AKI versus non-AKI group.We analyzed data of the AKI group using appropriate statistical methods. Result Hundred fifty-two among 266 patients (57%) were serology positive for dengue. Only 29 patients(18.9%) developedAKI, categorized into AKIN-I (82.1%), AKIN-II (7.2%), and AKIN-III (10.7%) respectively. The mean age of AKI group was 24.5±12.1 years old. The mean pulse pressure for the AKI group was 50.9 ± 11.3 mmHg. Significantly, the presentation as severe dengue denote a strong relationship with AKI (p=0.009);as we noticed strong association on fluid loss into third space and hemoconcentration with AKI (p < 0.05).The AKI risk increased by 4.7 fold in the presence of hemoconcentration and the mortality was noted as high as 6.9%, mostly in the AKIN-III group of patients. We did not see any significant association between the age of the patients, pulse pressure, hemoglobin level, platelet count, bilirubin level, and coagulation profile with the risk of developing AKI in this cohort. However, we saw a near significant association between transaminitis and the risk of developing AKI. Conclusion View Large Image Figure Viewer Download Hi-res image Download (PPT)