Successful pregnancy in a patient with high volume pre-dilution on-line haemodiafiltration. Is it the best dialysis option in women with chronic kidney disease?

Background Intracranial hemorrhage (ICH) is a rare but devastating complication of thoracoabdominal aortic aneurysm (TAAA) repair with fenestrated/branched endograft (f/bEVAR). The cerebrospinal fluid drainage (CSFD) is considered one of the leading causes; however, other possible concomitant factors have not been individualized yet. The aim of the present work was to evaluate the pattern of ICH events after f/bEVAR for TAAA and to identify possible associated factors. Materials and Methods All f/bEVAR procedures for TAAA performed in a single academic center from 2012 to 2020 were evaluated. ICH was assessed by cerebral computed tomography if neurological symptoms arose. Pre-, intra-, and postoperative characteristics were analyzed in order to identify possible factors associated. Results A total of 135 f/bEVAR were performed for 72 (53%) type I, II, III and 63 (47%) type IV TAAA; 74 (55%) were staged procedures, 101 (73%) required CSFD, and 24 (18%) were performed urgently. The overall 30-day mortality was 8% (5% in elective cases); spinal-cord ischemia occurred in 11(8%) and ICH in 8 (6%) patients. All ICH occurred in patients with CSFD. ICH occurred intraoperatively in 1 case, inter-stage in 4 and after F/BEVAR completion in 3, after a median of 6 days the completion stage. Three (38%) of 8 patients with ICH died at 30 days and ICH was associated with 30-day mortality: odds ratio (OR) 13.2, 95% confidence interval (CI): 2.3–76, p=0.01. The analysis of the perioperative characteristics identified platelet reduction >60% (OR 11, 95% CI 1.6–77, p=0.03), chronic kidney disease (16% vs 0%, p=0.002), and total volume of liquor drained >50 mL (OR 8.1, 95% CI 1.1–69, p=0.03) as associated with ICH. Conclusions Current findings may suggest that ICH is a potential lethal complication of the endovascular treatment for TAAAs and it mainly occurs in patients with CSFD. High-volume liquor drainage, platelet reduction, and chronic kidney disease seems increase significantly the risk of ICH and should be considered during the perioperative period and for further studies.

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Exceptional Fertility and Poor Fetal Outcome in a Female with 17-Year Hemodialysis: A Case Study and Mini-review

Asian Journal of Medicine and Health ◽

10.9734/ajmah/2020/v18i630216 ◽

2020 ◽

pp. 38-45

Author(s):

Abir Farouk Megahed ◽

Al Zahraa Ahmed Gamal Ammar ◽

Ehab Hussein Hashish ◽

Nagy Sayed- Ahmed

Keyword(s):

Chronic Kidney Disease ◽

Side Effects ◽

Kidney Disease ◽

Cerebral Hemorrhage ◽

Fetal Outcome ◽

Successful Pregnancy ◽

Self Image ◽

Patient Scenario ◽

Menstrual Pattern

Background: Chronic kidney disease can affect different aspects of female patient’s life including menstrual pattern, marital status and sexuality, fertility, pregnancy outcome, and recommended methods of contraception especially when initiated on HD. In Egypt, it has been noticed that it is infrequent for a hemodialysis (HD) female to start her marriage after initiation of HD; this may be attributed to a negative self-image experienced by the patient and perceived by the community. Moreover, it is also less common for an HD patient to marry another HD partner and it is odd for them to conceive during HD. Aim: To describe the possibility of starting family and plan for successful pregnancy during the course of HD therapy in patients with ESRD. Patient Scenario: Our case is a 36 years old Egyptian female who started HD in 1999 and continued on HD for 17 years. She married four times and conceived five times from three husbands. She got live birth only once from her second HD husband, but unfortunately, the baby died within a few days. The patient used Implanon - with its possible side effects- as a method of contraception during her last four years of life. After hectic 17 years under HD and unfortunate marital and fertility events, she decided to withdraw from her dialysis program, chose to live in isolation, and passed away within five days as a consequence of cerebral hemorrhage. Results and Conclusions: Fertility and successful pregnancies are believed to be possible in HD couples if they receive proper care.

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Towards cardiovascular risks in children with chronic kidney disease: a prospective cohort study

F1000Research ◽

10.12688/f1000research.15883.1 ◽

2018 ◽

Vol 7 ◽

pp. 1794

Author(s):

Taghreed Fadhil Al-Doori ◽

Abd El-Salam Dawood Al-Ethawi ◽

Jessar Saleem Hasan ◽

Ban Adil Al-Kaaby

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Prospective Cohort ◽

Growth Parameters ◽

Systolic Function ◽

High Volume ◽

Left Ventricular ◽

Cardiovascular Risks ◽

Valvular Calcification ◽

Tertiary Teaching

Background:Children with chronic kidney disease (CKD) are at substantially high risk of morbidity and mortality from cardiovascular disease (CVD). Although this issue has been extensively studied in adults, little is known whether similar associations exist in the paediatric population. We therefore aimed to evaluate the cardiac structure and function in children with CKD, and investigate the factors that contribute to the development of CVD.Methods:A prospective cohort was established following 40 children with CKD treated in the nephrology unit at a high-volume, tertiary, teaching hospital and compared to age- and gender-matched controls of the same number. We reviewed the patients’ medical records, assessed growth parameters, measured blood pressure, took blood samples, and performed echocardiography.Results:More than half of the CKD patients are hypertensive (N = 22; 55%) and were found to have a higher proportion of increased left ventricular mass index (LVMI) (75.5%; P = 0.001). In contrast, we did not find any significant association between CKD and both valvular calcification & left ventricular (LV) fractional shortening (FS) in children (P = 0.314). Furthermore, high LVMI is found to be correlated well with the following: anaemia, hypertension, CKD duration > one year, hyperparathyroidism, estimated glomerular filtration rate (eGFR) < 15ml/minute/1.73 m2and death (P < 0.05).Conclusions:Despite the fact that LV systolic function is preserved and valvular calcification is usually absent, left ventricular hypertrophy (LVH) is common in children with CKD. Hypertension, anaemia, hyperparathyroidism, as well as the severity and duration of renal impairment, are amongst the additional risk factors that predispose to LVH. We contribute this study to the growing information of the review articles regarding the association between CKD and CVD in paediatrics.

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