Background
Women of all ages and elderly patients of both genders comprise an increasing proportion of the haemodialysis population. Worldwide, significant differences in practice patterns and treatment results exist between genders and among younger versus older patients. Although efforts to mitigate sex-based differences have been attempted, significant disparities still exist.
Methods
This retrospective cohort study included all 1247 prevalent haemodialysis patients in DaVita units in Portugal (five dialysis centres, n = 730) and Poland (seven centres, n = 517). Demographic data, dialysis practice patterns, vascular access prevalence and the achievement of a variety of Kidney Disease: Improving Global Outcomes (KDIGO) treatment targets were evaluated in relation to gender and age groups.
Results
Body weight and the prescribed dialysis blood flow rate were lower in women (P < 0.001), whereas treated blood volume per kilogram per session was higher (P < 0.01), resulting in higher single-pool Kt/V in women than in men (P < 0.001). Haemoglobin was significantly higher in men (P = 0.01), but the proportion of patients within target range (10–12 g/dL) was similar. Men more often had an arteriovenous fistula than women (80% versus 73%; P < 0.01) with a similar percentage of central venous catheters. There were no gender-specific differences in terms of dialysis adequacy, anaemia parameters or mineral and bone disorder parameters, or in the attainment of KDIGO targets between women and men >80 years of age.
Conclusions
This large, multicentre real-world analysis indicates that haemodialysis practices and treatment targets are similar for women and men, including the most elderly, in DaVita haemodialysis clinics in Europe.
To evaluate the use of rituximab in the treatment of severe glomerulonephritis (GN) in order to prevent progression of kidney disease toward the end stage, we designed a multicenter, retrospective study in Saudi Arabia about the efficacy and safety of the use of "off label" rituximab in a variety of severe refractory GN to conventional treatment and the progression of kidney disease for at least one year of follow-up. All the patients had kidney biopsies before treatment with rituximab, and proteinuria and glomerular filtration rate (GFR) were followed-up for the period of the study. The immediate side-effect at the time of administration of rituximab included itching in three patients, hypotension in one patient and anaphylaxis in one patient (dropped out from the study). After the administration of rituximab in 42 patients and during the first six months of therapy, 16 (38%) patients had complete remission (CR), 13 (31%) patients had partial remission (PR) and 13 (31%) patients had no remission. The mean follow-up period for the patients was 19.0 ± 6.97 months (median 18.0 months). The long-term follow-up during the study period disclosed a good hospitalization record for almost all of the patients. Membranous GN (MGN) was the largest group in the cohort (58% of the patients), and we observed CR and PR in 40% and 28% of them, respectively, which was comparable with the previous experience with rituximab in MGN patients with more CR than PR in our cohort. We conclude that our study suggests the safety and efficacy of the use of rituximab in patients with refractory GN and that larger and long-term prospective studies are required to define the role of rituximab in the different categories of these diseases.
Introduction: Glomerular diseases in the elderly population are a challenging clinical dilemma, and kidney biopsy is of paramount importance to clarify the morphological changes. The aim of this study was to evaluate the prevalence of major glomerulopathies that affect older adults.Methods: This retrospective study included 70 adults aged >65 years and was performed at four tertiary centres in Saudi Arabia between January 2001 and December 2017.Results: There were 74 native kidney biopsies, which accounted for 7.2% of all native renal biopsies that were performed in the 16-year period. Furthermore, 64% of the native biopsied patients were men. The most common clinical presentations were nephrotic syndrome (40%) and acute kidney injury (20%).In older adults with primary glomerular diseases, IgA nephropathy was the most frequent pathological type (36.4%), whereas diabetes mellitus was the most frequent etiology (37.5%) for secondary glomerular diseases. Women were more likely to develop diabetic nephropathy.
Conclusion:The prevalence of IgA is progressively increasing and is currently the most frequent type of primary glomerular disease diagnosed in senior adult. Diabetes has become the leading cause of secondary glomerular disease. Renal biopsy is therefore of paramount importance because an accurate diagnosis will help clinicians establish the diagnosis and guide therapy for both younger and older adults.
Background: The concurrence of diabetes and nephritogenic infections may have a tremendous impact on the kidney. The approach to the two concurrent diseases is based on histological, immunofluorescence findings and most importantly on ultrastructural features. In this experiment our aim was to compare the pattern of injury seen in the kidney in animals with induced post-infectious glomerulonephritis with and without associated diabetes.
Background/purpose: The validity of the Oxford classification of immunoglobulin (Ig)A nephropathy has not been fully explored in the Arab population. The aim of this study was to assess the validity of this classification in a cohort of adult Saudi patients with histologically proven IgA nephropathy. Methods: A retrospective review of clinical and histological data of patients with biopsyproven IgA nephropathy diagnosed between May 1998 and May 2011 was undertaken. The study was conducted at two institutions in Riyadh, Saudi Arabia. A total of 70 patients (46% females) with primary IgA nephropathy were included, with a mean age of 32.2 AE 12.9 years. The median follow-up was 3.5 years. The primary endpoint was decreased renal function, which was defined as 50% decrease in estimated glomerular filtration rate from baseline at last follow up. Results: Higher mesangial score and later stage of segmental glomerulosclerosis showed trends towards correlations with a higher degree of proteinuria and lower estimated glomerular filtration rate at presentation and a higher rate of worsening of renal function, but these trends did not reach statistical significance (p > 0.05). However, endocapillary hypercellularity and tubular atrophy/interstitial fibrosis were significantly associated with reduced initial estimated glomerular filtration rate and higher initial proteinuria. In multivariate logistic regression, the worsening of renal function was not predicted by any histologic class. Conclusion: The Oxford classification system is a useful tool that reflects the severity of the initial clinical presentation in Arabs with IgA nephropathy. However, it did not predict longterm renal outcomes.
Objectives: To assess the prognostic value of IgG4 reactivity in biopsy-proven cases of idiopathic membranous nephropathy (iMN) and to outline its potential in guiding therapy.
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