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Asinobi AO, Ademola AD, Alao MA. Haemodialysis for paediatric acute kidney injury in a low resource setting: experience from a tertiary hospital in South West Nigeria. Clin Kidney J 2015; 9:63-8. [PMID: 26798463 PMCID: PMC4720192 DOI: 10.1093/ckj/sfv112] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 10/08/2015] [Indexed: 01/12/2023] Open
Abstract
Background Acute kidney injury (AKI) is an important cause of preventable mortality among children. Management of AKI may require renal replacement therapy (RRT) but access to RRT for children in low resource settings is limited. Our study explored the role of haemodialysis in the management of children with AKI in a low resource setting in terms of aetiology and outcomes. Methods A review of patients managed in the Paediatric Nephrology Unit, University College Hospital Ibadan, South-West Nigeria, who underwent haemodialysis for AKI from January 2006 to December 2014. Results Sixty-eight patients (55.9% males), aged 3–16 (mean ± standard deviation, 9.0 ± 3.4) years were studied. The causes of AKI were sepsis (22.1%), malaria (17.6%) and glomerulonephritis (17.6%), intravascular haemolysis—cause unknown (16.2%), G6PDH deficiency (7.4%), malignancy (8.8%) and haemoglobinopathy (5.9%). The number of sessions of haemodialysis ranged from 1 to 10 (mode = 2 sessions) over a period of 1–55 days. Mortality was 27.9% (n = 19) and was related to the aetiology of AKI (P = 0.000): no deaths among patients with intravascular haemolysis or malaria, six deaths among patients with sepsis (40%), six (50%) among the patients with glomerulonephritis, while all the patients with malignancies died. Conclusions The outcome of haemodialysis for AKI in Nigeria is relatively good and is related to the underlying aetiology of AKI. In addition to peritoneal dialysis, intermittent haemodialysis may have a role in the management of paediatric AKI in low resource settings and should be supported.
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Affiliation(s)
- Adanze O Asinobi
- Department of Paediatrics, College of Medicine, University of Ibadan, Oyo State, Nigeria; Department of Paediatrics, University College Hospital, Ibadan, Oyo State, Nigeria
| | - Adebowale D Ademola
- Department of Paediatrics, College of Medicine, University of Ibadan, Oyo State, Nigeria; Department of Paediatrics, University College Hospital, Ibadan, Oyo State, Nigeria
| | - Michael A Alao
- Department of Paediatrics , Bowen University Teaching Hospital , Ogbomoso, Oyo State , Nigeria
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Pun PH, Abdalla S, Block GA, Chertow GM, Correa-Rotter R, Dehmel B, Drüeke TB, Floege J, Goodman WG, Herzog CA, London GM, Mahaffey KW, Moe SM, Parfrey PS, Wheeler DC, Middleton JP. Cinacalcet, dialysate calcium concentration, and cardiovascular events in the EVOLVE trial. Hemodial Int 2015; 20:421-31. [PMID: 26564024 DOI: 10.1111/hdi.12382] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Among patients receiving hemodialysis, abnormalities in calcium regulation have been linked to an increased risk of cardiovascular events. Cinacalcet lowers serum calcium concentrations through its effect on parathyroid hormone secretion and has been hypothesized to reduce the risk of cardiovascular events. In observational cohort studies, prescriptions of low dialysate calcium concentration and larger observed serum-dialysate calcium gradients have been associated with higher risks of in-dialysis facility or peri-dialytic sudden cardiac arrest. We performed this study to examine the risks associated with dialysate calcium and serum-dialysate gradients among participants in the Evaluation of Cinacalcet Hydrochloride Therapy to Lower Cardiovascular Events (EVOLVE) trial. In EVOLVE, 3883 hemodialysis patients were randomized 1:1 to cinacalcet or placebo. Dialysate calcium was administered at the discretion of treating physicians. We examined whether baseline dialysate calcium concentration or the serum-dialysate calcium gradient modified the effect of cinacalcet on the following adjudicated endpoints: (1) primary composite endpoint (death or first non-fatal myocardial infarction, hospitalization for unstable angina, heart failure, or peripheral vascular event); (2) cardiovascular death; and (3) sudden death. In EVOLVE, use of higher dialysate calcium concentrations was more prevalent in Europe and Latin America compared with North America. There was a significant fall in serum calcium concentration in the cinacalcet group; dialysate calcium concentrations were changed infrequently in both groups. There was no association between baseline dialysate calcium concentration or serum-dialysate calcium gradient and the endpoints examined. Neither the baseline dialysate calcium nor the serum-dialysate calcium gradient significantly modified the effects of cinacalcet on the outcomes examined. The effects of cinacalcet on cardiovascular death and major cardiovascular events are not altered by the dialysate calcium prescription and serum-dialysate calcium gradient.
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Affiliation(s)
- Patrick H Pun
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Safa Abdalla
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | | | - Glenn M Chertow
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ricardo Correa-Rotter
- Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, District Federal, Mexico
| | | | - Tilman B Drüeke
- Inserm Unit 1088, UFR Médecine/Pharmacie, Université de Picardie, Amiens, France
| | - Jürgen Floege
- Department of Nephrology, Universitätsklinikum der RWTH Aachen, Aachen, Germany
| | | | | | - Gerard M London
- Hôpital Manhès, Paris, France.,Indiana University School of Medicine and Roudebush Veterans Administration Medical Center, Indianapolis, Indiana, USA
| | - Kenneth W Mahaffey
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Sharon M Moe
- Hôpital Manhès, Paris, France.,Indiana University School of Medicine and Roudebush Veterans Administration Medical Center, Indianapolis, Indiana, USA
| | | | | | - John P Middleton
- Department of Medicine, Duke University, Durham, North Carolina, USA
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