Chronic Kidney Disease (CKD) is emerging as a major public health priority worldwide. It is a chronic condition influenced by lifestyle and behavior. The risk factors for CKD are highly prevalent among the Indian population, and the number of Indians at risk is increasing. Preventive measures focusing on reducing the prevalence of CKD by limiting exposure to risk factors could be cost effective in a country like India. Kidney diseases disproportionally affect disadvantaged populations and reduce the number of productive years of life. Furthermore, the prospect of financial burden discourages many patients from undergoing treatment, thereby leading to preventable morbidity and death. The management of patients with CKD is focused on early detection or prevention, treatment of the underlying cause (if possible) to curb progression and attention to secondary processes that contribute to ongoing nephron loss. Blood pressure control, inhibition of the renin-angiotensin system and disease-specific interventions are the cornerstones of therapy. Health literacy and self-management are critical to improving the outcomes of chronic conditions such as chronic kidney disease. Primary Care and Family physicians act as a bridge between the nephrologist specialist and the CKD patients; which will help in improving the quality of life, reduce physical and psychologic limitations and complications associated with CRF, and help patients return to their families, jobs, and social lives
Introduction: Acute cholangitis is a serious and life-threatening illness that results from sepsis and obstruction. Patients with acute cholangitis are susceptible to exposure to acute kidney injury(AKI) due to sepsis, which can lead to a poor prognosis. We aim to investigate the association of acute cholangitis and AKI with clinical outcomes. Methods: We retrospectively evaluated the medical records of patients who were diagnosed with acute cholangitis from January 2011 to December 2016 in our institution. We compared laboratory finding between patient's baseline and at the time of hospitalization to assess AKI. We divided groups into AKI group and normal renal function group, The primary endpoints was incidence of AKI, and secondary endpoints were all cause of death and risk factors. Patients were classified according to AKI criteria according to Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Patients were excluded if they were chronic kidney disease stage 5, only visited the emergency room, or could not confirm the baseline blood test. Results: A total of 1683 patients were evaluated, a mean age was 69.52AE13.675 years old. 211 patients(12.5%) developed AKI and the average estimated glomerular filtration rate(eGFR) of AKI group was 50.85AE31.60(ml/min/1.73m2) wereas non-AKI group was 99.14AE31.08(ml/min/1.73m2). There was a statistically significant increase in all cause of death in the AKI group(24.5%, 10.0% p<0.001). In AKI group, Systemic Inflammatory Response Syndrome(SIRS)(34.8% vs 8.7% p<0.001), blood urea nitrogen to albumin ratio(11.7 vs 4.1 p<0.001), which were related to death, were significantly higher than non-AKI group. The presence of CBD stone (50.7%, 52.8%, p¼0.561) and obstruction (11.5%, 10.7%, p¼0.726) were not significantly different between the two groups. Conclusions: Acute cholangitis can be accompanied by AKI due to sepsis, which leads to poor prognosis. All cause of death increases due to AKI, and prognosis can be assessed through SIRS score and blood urea nitrogen to albumin ratio.
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