Purpose of Review: This article reviews the evidence on optimal medical therapy (OMT) versus coronary revascularization in patients with stable ischemic heart disease (SIHD) and advanced chronic kidney disease (CKD). Recent Findings: A post hoc analysis of the COURAGE trial in patients with SIHD and CKD showed no difference in freedom from angina, death, and nonfatal myocardial infarction (MI) between OMT and percutaneous intervention plus OMT compared with patients without CKD. The ISCHEMIA-CKD trial of 777 patients with advanced CKD revealed no difference in cumulative incidence of death or nonfatal MI at 3 years between OMT and revascularization but the composite of death or new dialysis was higher in the invasive arm. Additionally, there were no significant or sustained benefits in related to angina-related health status in invasive versus conservative strategy. Summary: An initial revascularization strategy does not reduce mortality or MI or relieve angina symptoms in patients with SIHD and advanced CKD.

Thesis (M. A. (PHARM.) -- University of Limpopo, 2019 / Introduction Multidisciplinary team (MDT) approach has emerged as one solution to improving chronic kidney disease (CKD) care. The MDT may include a nephrologist, physicians, nurses, dietitians, pharmacists, and social workers, all working together to deliver effective care to patients with CKD. Participation of pharmacists within the renal MDT at Polokwane hospital seems to be limited. The perceived barriers to pharmacists providing renal care services to CKD patients at Polokwane hospital could inform future strategy development, to enhance their participation. The aim of this study was to explore the role of pharmacists in renal care and develop strategies to maximise their participation in the renal multidisciplinary health care team, based on their participation at Polokwane hospital, Limpopo province. Method A qualitative study using semi-structured interviews was conducted with a purposeful sample of 8 members of the renal MDT and 9 pharmacists. The audiotaped interviews were transcribed exactly as said and analysed using thematic content analysis. Results Four themes emerged from the analysis: ‘pharmacist’s current scope of practice within the renal MDT’, ‘potential future roles of pharmacists’, ‘perceived barriers to participation of pharmacists within the renal MDT’ and ‘recommendation/Strategies to incorporate pharmacists into the MDT’. Results have shown that pharmacists have an absent role within the renal MDT. Their role is limited to just dispensing and managing stock, with no role in direct patient care. Both pharmacists and MDT members showed preference to working together during renal care. Pharmacy services suggested include medication reviews, provision of patient education and counselling, patient adherence improvement, dosage workouts, patient monitoring and education on contraindicated drugs and drug interactions. Shortage of staff, pharmacists lack of clinical skills, lack of communication and attitude of pharmacists were perceived as the major barriers to participation of pharmacists within the renal xii MDT. To overcome these barriers, it was recommended that the department of health (DoH) provide more pharmacy staff and educational opportunities in the form of workshops, to equip pharmacists clinically and broaden competency and knowledge on effective communication and coordination. In addition, it was recommended that the clinical curriculum at Universities be revised, to build solid foundation on MDT care and pharmacology and that the MDT programme be standardized through standard treatment guidelines (SOP’s), policies and drawing of job descriptions. Conclusion The role of pharmacists at Polokwane hospital is confined to just stock management and dispensing. There are promising avenues for future development of their role during patient care, which can be achieved by addressing the barriers highlighted Recommendations The expansion of the role of pharmacists within the renal MDT will require improved partnership between health care professionals, resources, legislations and guidance from formal SOPs. Having a national framework for pharmacy practice from Ministry of Health, supported by educational opportunities and a pro-active professional association would be key to incorporating pharmacists within the renal MDT.

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(1) Background: Patients with severe chronic kidney disease (CKD G4–G5) often have chronically elevated high-sensitivity cardiac troponin T (hs-cTnT) values above the 99th percentile of the upper reference limit. In these patients, optimal cutoff levels for diagnosing non-ST-elevation acute coronary syndrome (NSTE-ACS) requiring revascularization remain undefined. (2) Methods: Of 11,912 patients undergoing coronary angiography from 2012 to 2017 for suspected NSTE-ACS, 325 (3%) had severe CKD. Of these, 290 with available serial hs-cTnT measurements were included, and 300 matched patients with normal renal function were selected as a control cohort. (3) Results: In the CKD cohort, 222 patients (76%) had NSTE-ACS with indication for coronary revascularization. Diagnostic performance was high at presentation and similar to that of the control population (AUC, 95% CI: 0.81, 0.75–0.87 versus 0.85, 0.80–0.89, p = 0.68), and the ROC-derived cutoff value was 4 times higher compared to the conventional 99th percentile. Combining the ROC-derived cutoff levels for hs-cTnT at presentation and absolute 3 h changes, sensitivity increased to 98%, and PPV and NPV improved up to 93% and 86%, respectively. (4) Conclusions: In patients with severe CKD and suspected ACS, the diagnostic accuracy of hs-cTnT for the diagnosis of NSTE-ACS requiring revascularization is improved by using higher assay-specific cutoff levels combined with early absolute changes.

Feline morbilliviruses (FeMV) are fairly newly discovered paramyxoviruses found in cats. The first description indicated an association with widely distributed chronic kidney disease (CKD) in the host species. In various studies, a global prevalence and a further genotype, designated FeMV-2, and the involvement of other organ systems in infected individuals were shown. Using an immunofluorescence assay, we detected an overall seroprevalence of FeMV in almost half of the cats investigated (n = 380), with a significantly increased proportion in younger animals. In comparison to European Shorthair cats, the rate of seropositivity is higher in pedigree cats. Regardless of the breed, FeMV infection was associated with increased blood creatinine concentrations, suggesting an association with CKD. Further analysis indicated that this association was the strongest in animals having high IFA titers against FeMV-2. In addition, a significant association between FeMV-positive status and the prevalence of feline lower urinary tract disease (FLUTD, or idiopathic cystitis) was detected. This association was dominated by cats having antibodies against FeMV-1 only. To further evaluate the positive correlation between FeMV seroprevalence and CKD as well as FLUTD, consideration of additional clinical characteristics and laboratory parameters is warranted, and controlled infection studies with both FeMV genotypes are necessary. Clinicians should, however, be aware of a possible link between renal and lower urinary tract disease and FeMV infections.

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Introducción: La enfermedad renal crónica es un problema de salud a nivel mundial. Se estima que muchos pacientes los cuales inician el tratamiento presentan un alto índice de mortalidad y de poca adherencia en los primeros días del tratamiento; sin embargo, son pocos los estudios que investigan sobre el nivel de adherencia presente en aquellos pacientes que llevan este tratamiento, lo cual conlleva a que no exista un estándar para medir el mismo. Objetivo: Identificar la frecuencia de los factores relacionados a la no adherencia al tratamiento de hemodiálisis presentes en pacientes con enfermedad renal crónica. Materiales y Métodos: Se realizó un estudio descriptivo y de corte transversal con un muestreo no probabilístico. Se definió como pacientes no adherentes aquellos que presentaran como mínimo 1 falta a sus sesiones o aquellos que disminuyeron la duración de la sesión por un tiempo mayor igual a 10 minutos. Resultados: Fueron 30 los pacientes catalogados como no adherentes, un 73% fue de sexo masculino, además, la etiología más reportada en estos pacientes fue la diabetes mellitus. Dentro de los factores de no adherencia, los más destacados fueron los familiares, así como los institucionales. Conclusiones: Se encontró que el porcentaje de pacientes no adherentes se encontraba dentro del rango reportado por otros estudios; asimismo tuvieron una edad media de 45 años siendo la mayoría de sexo masculino. / Introduction: Chronic kidney disease is a global health problem. It is estimated that patients that begin dialysis have a higher rate of mortality and low adherence in the first days of the treatment. Objective: Identify the frequency of the factors related to poor adherence to hemodialysis present in patients with chronic kidney disease. Materials and methods: A descriptive study with transversal cut and a non-probabilistic sampling. Patients were defined as non adherent if they had one or more skipped sessions during the month or if they shortened their sessions for a period of time of 10 or more minutes. Results: Patients defined as non adherent were 30, 73% were males, diabetes mellitus was the etiology most reported among these patients. Observing factors of no adherence, family and institutional factors were the most relevant in the evaluated patients Conclusions: We found the percentage of non adherent patients was in the range according to other researches made, also the mid range age was of 45 being the most males.

La presente revisión crítica titulada “Complicaciones clínicas más frecuentes en los pacientes durante el tratamiento de hemodiálisis” es una investigación secundaria que utilizó la metodología Enfermería Basada en Evidencia, tuvo como objetivo identificar las complicaciones clínicas más frecuentes que presentan los pacientes durante el tratamiento de hemodiálisis con Enfermedad Renal Crónica. Formulándose la pregunta clínica con esquema de PS: ¿Cuáles son las complicaciones clínicas más frecuentes en los pacientes durante el tratamiento de hemodiálisis? La búsqueda de estudios fué desde mayo hasta octubre 2017 en adelante, es decir con 5 años de antigüedad en diversos idiomas, inglés, portugués y se empleó base de datos (Redib.org, repositorio, Researghgate, Esprints repositorio, Pubmed, Scielo, Proquest.). Se seleccionó 11 investigaciones, sometidos a la lista de Guía de Validez y utilidad aparentes de Gálvez Toro, pasando solo una. Se usó las listas chequeo de Bobenrieth Astete, de acuerdo a la metodología del artículo, para valorar la calidad metodológica, se obtuvo nivel de evidencia III de recomendación A. Se encontró como respuesta ante la pregunta, que los pacientes sometidos a la terapia de hemodiálisis presentarán hipotensión arterial, siendo esta la complicación clínica más frecuente durante la sesión de hemodiálisis. Además, manifestaran otros síntomas como calambres, vómitos, dolor de cabeza, mareos, arritmia, náuseas, convulsiones, diarrea, sudoración, debilidad, dificultad para respirar, dolores corporales y temblores, las cuales deben ser observadas porque según su intensidad afectará la calidad de vida de los pacientes. / The present critical review entitled “Most frequent clinical complications in patients during hemodialysis treatment” is a secondary investigation that used the Evidence-Based Nursing methodology, its objective was to identify the most frequent clinical complications that patients present during hemodialysis treatment. with Chronic Kidney Disease. Formulating the clinical question with PS scheme: What are the most frequent clinical complications in patients during hemodialysis treatment? The search for studies was from May to October 2017 onwards, that is, 5 years old in various languages, English, Portuguese, and a database was used (Redib.org, repository, Researghgate, Esprints repository, Pubmed, Scielo, Proquest.)11 investigations were selected, submitted to the list of Gálvez Toro's Guide to Apparent Validity and Usefulness, passing only one. The Bobenrieth Astete checklists were used, according to the methodology of the article, to assess the methodological quality, level of evidence III of recommendation A was obtained. It was found in response to the question that patients undergoing hemodialysis therapy will present arterial hypotension, this being the most frequent clinical complication during the hemodialysis session. In addition, they will manifest other symptoms such as cramps, vomiting, headache, dizziness, arrhythmia, nausea, convulsions, diarrhea, sweating, weakness, difficulty breathing, body pains and tremors, which must be observed because depending on their intensity it will affect the quality of patients' lives.