Chronic kidney disease

Patients with advanced chronic kidney disease (CKD) have a high burden of physical and psychosocial symptoms, poor outcomes, and high costs of care. Current paradigms of care for this highly vulnerable population are variable, prognostic and assessment tools are limited, and quality of care, particularly regarding conservative and palliative care, is suboptimal. The KDIGO Controversies Conference on Supportive Care in CKD reviewed the current state of knowledge in order to define a roadmap to guide clinical and research activities focused on improving the outcomes of people living with advanced CKD, including those on dialysis. An international group of multidisciplinary experts in CKD, palliative care, methodology, economics, and education identified the key issues related to palliative care in this population. The conference led to a working plan to address outstanding issues in this arena, and this executive summary serves as an output to guide future work, including the development of globally applicable guidelines. Patients with advanced chronic kidney disease (CKD) have a high burden of physical and psychosocial symptoms, poor outcomes, and high costs of care. Annual mortality of patients on dialysis exceeds 20%. Withdrawal from dialysis is a common cause of death for dialysis patients worldwide, reflecting their poor health-related quality of life (HRQL), although this may be owing to nonmedical reasons in low-income and lower-middle-income countries. The high level of disability and symptom burden in some patients with advanced CKD is not necessarily improved by dialysis. To improve the quality of care, it is now recognized that palliative care principles need to be integrated into the routine care of these patients. Despite great need, palliative care is under-utilized among patients with advanced CKD compared with other chronic disease populations, even in countries where such care is available. 1,2 Rates of hospitalization, intensive care unit admissions, and other intensive treatments are higher for CKD patients in the last month of life compared with other severe chronic illnesses, including chronic obstructive lung disease, congestive heart failure, and advanced liver disease. 3 Current evidence suggests that end-of-life care practices are not consistent with preferences of patients with advanced CKD (i.e., GFR categories G4 and G5). 4 The majority of dialysis patients die in acute care facilities, receiving high-intensity care that may be unwanted. 1 Health systems and policies that integrate palliative care are urgently required to optimize the care of CKD patients. To achieve international, multidisciplinary, transparent, and unbiased analysis, Kidney http://www.kidney-international.org m e e t i n g r e p o r t

Context: Chronic kidney disease (CKD) patients are at high risk of drug-drug interactions (DDIs) that may require dose adjustments or the avoidance of drug combinations.
Aim: To evaluate DDIs among chronic kidney disease patients of
nephrology unit in the University of Nigeria Teaching Hospital (UNTH), Enugu in South-East Nigeria. Settings and Design: This study was a retrospective review of CKD patients who received treatment at the nephrology unit of UNTH between January 2004 and December 2014. Methods and Materials: The drug-drug interactions (DDIs) of the prescribed drugs were classified using the Medscape drug interaction checker. Statistical Analysis used the data were analyzed using the Statistical Package for Social Sciences (SPSS) for Windows version 16.0 (SPSS Inc, Version 16.0, Chicago, USA). The predictors of the DDIs were explored through linear regression with number of DDIs as the dependent variable. Results: A total of 898 DDIs were identified from the
folders of the 169 CKD patients that were eligible. Majority were above 50 years old and in renal disease stage 4 or 5. Furosemide, lisinopril and amlodipine were the most frequently prescribed drugs and had the greatest likelihood for nephrotoxicity. The number of medications and hypertension (as co-morbidity) were the independent predictors of DDIs among the patients. Majority of the DDIs (64.14%) were significant. The most common interactions were between lisinopril and furosemide; furosemide and calcium carbonate; lisinopril and calcium carbonate. Conclusion: The prevalence of significant DDIs was high among the renal patients. The major determinants of the DDIs were the number
of medications and the presence of hypertension as co-morbidity.