Our objective is to study the outcomes and complications of peritoneal dialysis (PD) including comparison of self-care PD with home-care assisted PD during a five-year period. A retrospective study of PD data at King Saud University-affiliated hospital in Riyadh from January 1, 2009, to December 31, 2013. One hundred and eleven patients were included (female 55%). The average age was 47.4 (1-83) years. Twenty-one (18.91%) patients were on continuous ambulatory PD and 90 (81.08%) on automated PD. The mean time on PD was 23.5 (3-60) months. At the end of five years, 47 (42.34%) patients were continuing on PD, 12 (10.81%) had renal transplant, 33 (29.73%) patients were transferred to hemodialysis, and two (1.8%) patients were transferred to other centers. Seventeen patients died during this period giving a mortality rate of 7.13 deaths/100 patient-year during the five-year period. Six patients died due to cardiovascular causes, while five had sepsis. There was one death each due to prostate cancer, hyperoxaluria, and toxic epidermal necrolysis. Three patients died suddenly at home. Peritonitis rate was one episode/35.28 patient/month or one episode/2.94 patient/year. We compared the results for patients doing the dialysis themselves [56 (50.45%)] "self-care PD" to 55 (49.5%) patients assisted by a family member or other caregivers "assisted PD." We found no significant difference in the incidence of complications, technical outcome, mortality, and peritonitis episodes. However, we found a high prevalence of diabetes mellitus and significant increase in exit site infection in assisted PD. Our study suggests that PD patients in Saudi Arabia have a good overall outcome. Furthermore, assisted PD showed good patient and technique outcome.
Climate change is one of the greatest threats to human health in the 21st century. The human health impacts of climate change contribute to approximately 1 in 4 deaths worldwide. Health care itself is responsible for approximately 5% of annual global greenhouse gas (GHG) emissions. Canada is a recent signatory of the 26th United Nations Climate Change Conference (COP26) health agreement that is committed to developing low carbon and climate resilient health systems. Kidney care services have a substantial environmental impact and there is opportunity for the kidney care community to climate align clinical care. We introduce a framework of redesigned kidney care and describe examples of low carbon kidney disease management strategies to expand our duty of care to the environment which completes the triple bottom line of optimal patient outcomes and cost effectiveness in the Anthropocene.
In this issue of the Journal, Sharoni E. et al. from Rabin Medical Center evaluate the impact of female gender on postoperative morbidity and mortality after coronary artery bypass grafting (CABG) surgery. The authors retrospectively analyzed 1 758 isolated first-time CABG patients operated from 2003 to 2005 and found that women had distinctly different pre-and intraoperative profiles compared with men, and also a significantly higher postoperative mortality. On propensity scoring of 359 matched pairs, and validation with the bootstrap technique, female gender was not found to be an independent risk factor of death after CABG in their study. This data is based on a single center experience and seems to contradict some of the earlier studies demonstrating that female gender is in itself an independent risk factor for mortality. Previously published data have shown that women are less likely to undergo percutaneous intervention (PCI) or CABG procedures and there is a question whether this is secondary to the perception that women have a less favorable outcome. Over the years, it appeared that women had a higher morbidity and mortality after PCI or CABG and lower success rates for CABG but they shared similar long-term outcomes to men once periprocedural risk factors and characteristics were accounted for. To date, the controversy still exists about whether differences in clinical outcomes can be attributed to female gender itself or to other associated unfavorable characteristics or factors. In the majority of the previously published studies women who underwent CABG needed more urgent or emergent operations and had a higher incidence of perioperative myocardial infarction (MI), congestive heart failure (CHF) and anemia. Women undergoing CABG were also older, had a lower body surface area (BSA), and a higher incidence of diabetes, obesity, and hypertension. These associated comorbidities are known to contribute to a significantly higher perioperative mortality following CABG. From the studies that looked at the rate of perioperative MI following CABG, it appears that the higher incidence of emergent CABG in women is secondary to more acute and unstable disease. This is supported by more recent studies suggesting that, once women present with an acute MI or once they undergo cardiac catheterization, their revascularization rate is not any different from that of their male counterparts. Furthermore, their left ventricular ejection fraction is not adversely affected by the increased urgency at presentation. Other studies have concluded that lower BSA by itself is an independent risk factor for increased mortality regardless of gender. Women generally receive fewer arterial grafts and less extensive revascularization and this has been demonstrated by many single center series in which bias in decision-making was eliminated or accounted for. This was also reproduced through database analysis and was partly explained by the difference in age between the two sexes and the greater need for emergent CABG among women. It is ...
Background. The clock drawing test (CDT) is frequently used to detect changes in cognition. Multiple scales of varying length have been published to assess performance. The aim of this study is to compare the CDT performance measured by three scales among a sample of nondemented patients on renal dialysis and identify the variables that affect performance. Methodology. This is a cross-sectional study performed at the dialysis unit at King Saud University Medical City. Eighty-nine dialysis patients performed the CDT. The CDT was scored by the methods of Rouleau et al. (RCS 10-point), Babins et al. (BCS 18-point), and the MoCA (MCS 3-point). Regression models were used to determine influencing demographic and dialysis variables. Scores were then correlated, and a combined factor analysis of scale components was done. Results. Females represented 44.6%, the mean (SD) age was 49.99 (15.49) years, and education duration was 10.29 (5.5) years. Dialysis vintage was 55.81 (62.91) months. The scores for the MCS, RCS, and BCS were 2.18 (1.08), 6.67 (3.07), and 11.8 (5.5), respectively, with significant correlation (P<0.0001). In all scales, increasing age was associated with a lower score (each P<0.0001). The scores increased with increasing education (each P<0.0001). Diabetics had a lower score on both the BCS and MCS by 2.56 (SE 1.2) (P=0.035) and 0.71 (P=0.003) points, respectively. However, only age and years of education were significant in the multivariable analysis. In factor analysis, two shared factors appeared between the three scales: hand and number placement and the clock face. Conclusion. Age and education influence the performance on the CDT, and factors diverged into executive and visuospatial components. The MCS is likely to yield useful information but should be interpreted as part of the MoCA.
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