2017 Kidney Disease: Improving Global Outcomes (KDIGO) Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD) Guideline Update Implementation: Asia Summit Conference Report

Abstract

The Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) 2009 provided recommendations on the detection, evaluation, and treatment of CKD-MBD in patients CKD who are and are not undergoing dialysis. Because of the accumulation of evidence since this initial publication, the CKD-MBD Guideline underwent a selective update in 2017. In April 2018, KDIGO convened a CKD-MBD Guideline Implementation Summit in Japan with the key objective to discuss various barriers to the uptake and implementation of the CKD-MBD Guideline in 8 Asian countries/regions. These countries/regions were comparable according to their high-to-middle economic ranking assigned by the World Bank. The discussion took into account the availability of CKD-MBD medication therapies and government health policies that may influence reimbursement and practice patterns in the region. Most importantly, Summit participants developed a framework of multifaceted strategies aimed at overcoming barriers to guideline implementation. The Summit attendees suggested a shared decision-making approach between clinicians and patients in CKD-MBD management, as well as individualized care based on the treatment risk-benefit ratio. The Summit participants also discussed how KDIGO, as a guideline development organization, may work in partnership with local and national nephrology societies to provide education and facilitate implementation of the guideline by clinicians. The conclusions drawn from this Summit in Asia may serve as an important guide for other regions to follow.

Reverse takotsubo cardiomyopathy in fulminant COVID-19 associated with cytokine release syndrome and resolution following therapeutic plasma exchange: a case-report

“…A dose of 1.5 plasma volumes was used for the first dose then one plasma volume daily for a total of five doses (4 hours each day). Spectra Optia™ Apheresis System employs an acid-citrate dextrose anticoagulant as per Kidney Disease Improving Global Outcomes 2019 guidelines [ 54 ]. Intravenous hydrocortisone 100 mg and chlorpheniramine 10 mg were administered as adjunctive treatment during TPE to reduce any potential side-effects.…”

Life-threatening COVID-19 presenting as stroke with antiphospholipid antibodies and low ADAMTS-13 activity, and the role of therapeutic plasma exchange: A case series

“…1 Most patients with COVID-19 are asymptomatic; however, a minority of cases can present with life-threatening diseases, which are characterized by acute respiratory distress syndrome (ARDS), sepsis, multi-system organ failure (MSOF), cytokine release syndrome (CRS), neurological manifestations, and thromboembolic disease. [2][3][4] Recently, severe COVID- 19 was associated with devastating central nervous system (CNS) pathology, including stroke, and acute disseminated encephalomyelitis. 5 Moreover, severe thromboembolic phenomena were observed in mechanically ventilated critically ill patients Life-threatening COVID-19 presenting as stroke with antiphospholipid antibodies and low ADAMTS-13 activity, and the role of therapeutic plasma exchange: A case series with COVID-19.…”

Predictors of Acute Kidney Injury Following Surgical Valve Replacement

“…Several efforts have been evolved to address this issue and several definitions of AKI have been adopted over the years, namely the RIFLE (Risk, Injury, failure, Loss of renal function and End stage renal disease), the modified RIFLE, the acute kidney injury network (AKIN) criteria, 3,4 and most recently the Kidney Disease Improving Global Outcomes (KDIGO). 5 Previous studies have identified among others, emergency surgery, old age, low ejection fraction, patients with preoperative kidney impairment, and postoperative blood transfusion as predictors of AKI. 1,2 Cardiac surgery-associated AKI is caused by a variety of factors including exogenous and endogenous toxins, metabolic abnormalities, ischemia-reperfusion injury, neurohormonal activation, inflammation, and oxidative stress.…”