Abdullah Al Sayyari

Increased Risk of Hypertension, Proteinuria and Preeclampsia in Pregnant Saudi Females with IgA Nephropathy

Background. IgA nephropathy is fairly prevalent in Saudi Arabia. In this paper we examine the natural history of pregnancies and their impact on renal function in Saudi females affected by this condition. Methods. We followed a series of 12 patients, documented to have IgA nephritis by kidney biopsy, during their gestation. We monitored their blood pressure, serum creatinine, creatinine clearance, 24-hour protein before conception and at the third trimester of pregnancy. We also documented any maternal or fetal complications. Results. All patients had well-controlled blood pressure, normal renal function, and proteinuria of less than one gram per day prior to conception. During pregnancy, all patients (100%) developed hypertension-requiring treatment and three of them (25%) developed preeclampsia. One patient (8.3%) had hemolysis, elevated liver enzymes, and, low platelets syndrome. All patients had worsening of their proteinuria during pregnancy from 535.2 (101.4) to 2179.2 (636.6) mg/24 h (p < 0.01) with a decrease in creatinine clearance from 88.6 (7.6) mls/min to 77.4 (5.9) mls/min (p < 0.05). No fetal complications were observed. Conclusion. We conclude that pregnancies in patients, even with mild IgA nephritis, require close observation as there is an increased incidence of worsening hypertension and preeclampsia.

Comparison of the tuberculin skin test and Quanti-FERON-TB Gold In-Tube (QFT-G) test for the diagnosis of latent tuberculosis infection in dialysis patients

Dialysis patients are more likely than the general population to develop active tuberculosis (TB). In these patients, the availability of a highly sensitive and specific test to diagnose latent TB will ensure earlier treatment and decreased progression to active disease. In the current study, the Quanti-FERON-TB Gold In-Tube (QFT-G) test was compared with the tuberculin skin test (TST) for the diagnosis of latent tuberculosis infection (LTBI) among 200 hemodialysis patients and 15 confirmed TB disease cases in a tertiary care center in Saudi Arabia. Among the LTBI cases, 26 (13%) were TST positive, and 65 (32.5%) were positive by the QTF-G test, with an overall agreement between the 2 tests of 75.5% (k=0.34) being observed. Among the confirmed tuberculosis disease cases, none were positive by TST, and 10 (66.7%) were positive by the QTF-G test, resulting in an overall agreement of 33.3% (k=0). A comparison between the TST and the QTF-G test was performed based on the sensitivity, specificity, and area under the curve (AUC) obtained for the tests. The QTF-G test was more sensitive and less specific than the TST in predicting the confirmed TB disease cases. When we tested the correspondence of the AUC values between the 2 diagnostic modalities, the obtained p-value was 0.0003. In conclusion, the AUCs of the examined diagnostic modalities are significantly different in predicting LTBI and tuberculosis.

Higher access-associated bacteremia but less hospitalization among Saudi compared with US hemodialysis outpatients.

Comparison of Saudi patients with chronic hemodialysis to an international benchmark was not performed before. We conducted a prospective surveillance study for all end‐stage kidney disease patients served by the hemodialysis unit at King Abdulaziz Medical City (KAMC) in Riyadh, SA, between May 2008 and December 2009. US National Healthcare Safety Network (NHSN) definitions were used for comparison. Among 227 patients with adverse events, 55% were women and their age was 60.2 ± 20.2 years. Events recorded included 339 all‐cause hospitalizations, 302 outpatient start of intravenous antimicrobials, and 174 access‐associated bacteremias. In comparison with NHSN, hospitalization rate per 100 patient‐months was lower (8.6 vs. 10.7, p < 0.001), rates of both antimicrobial start (7.6 vs. 3.5, p < 0.001) and access‐associated bacteremia (4.4 vs. 1.3, p < 0.001) were higher, and blood cultures were more likely to grow gram‐negative rods (47.9% vs. 21.3%, p < 0.001). Similar to NHSN, permanent catheter was associated with highest, while arterio‐venous fistula was associated with lowest event rates, irrespective of event type. KAMC had 2–4 times higher rates of access‐associated bacteremia and antimicrobial start as well as a higher catheter prevalence (42% vs. 31%). The lower hospitalization may indicate good control of comorbidities at outpatient level or underutilization of inpatient services.

A Simple and Cheap Hospitalization Risk Assessment Tool for Use in Hemodialysis Patients

Objective: To develop a simple, objective, cheap scoring tool incorporating nutritional parameters and other variables to predict hospitalization and mortality among hemodialysis patients – a tool that could be utilized in low resource countries. Methods: The following variables were scored according to severity into 0, 1, 2 or 3: BMI, functional capacity, HD vintage in years, serum albumin, serum ferritin, and the number of comorbid conditions (diabetes mellitus, hypertension, ischemic heart disease, cerebrovascular disease). This tool was evaluated on our regular hemodialysis patients who were followed up for 24 months (June 2015 till July 2017). In our study population, the maximum score recorded was 12; accordingly, a score of 6 was used to differentiate between a low-risk group (score < 6) or a high-risk group (score ≥6). The 2 groups were compared (using the Chi square test) for possible differences in mortality and hospitalization rates during the follow-up period. Results: One hundred and forty adult hemodialysis patients were monitored over 2 years; 83 were males and 57 females; 59% of the patients had diabetes mellitus. Twenty-nine patients (30.7%) were found to be in the high-risk group and 111 (79.3%) in the low-risk group. The high-risk patients were almost one and a half times more likely to be hospitalized for vascular access issues than the low-risk group (p = 0.056) and 3 times more likely to be hospitalized for non-vascular access issues than the low-risk group (p = 0.0001). The mortality rate in the high-risk group was 3.1 times that in the low-risk group, but this was not statistically significant. Conclusion: Using a simple and cheap assessment tool in hemodialysis patients, we have identified patients at high risk for hospitalization rates and mortality. Video Journal Club “Cappuccino with Claudio Ronco” at http://www.karger.com/?doi=490544.

Barriers to Peritoneal Dialysis in Saudi Arabia: Nephrologists' Perspectives

In Saudi Arabia, only 9% of dialysis patients are on peritoneal dialysis (PD), and this has been the case for years. A number of centers around the world have sought to understand the underutilization of PD by asking nephrologists directly. In this study, we aimed to gather information that will answer the question “Why is PD underutilized in Saudi Arabia?” hoping that a roadmap may be developed to overcome the hurdles the study underscores, allowing for more patients to utilize this valuable modality.

The impact of introducing automated eGFR reporting on uncovering new cases of chronic kidney disease in a University Hospital in Saudi Arabia

Abstract Objective: To determine the impact of introducing eGFR automated reporting on uncovering new cases of Chronic Kidney Disease. Methods: All serum creatinine (SCr) in adult patients attending outpatient clinics over a two-month period were recorded and eGFR estimated. Cases with a SCr within normal limits but were in CKD stage 3 (<60 mL/min) or higher were recorded and their numbers, percentages and mean ages calculated. Stages 1 and 2 were excluded from analysis because urinary albumin and other urinary abnormalities were not checked. Results: A total of 26,422 SCr from different patients were included. The mean SCr was 92.5 ± 130.9 μmol/ and the mean eGFR was 99.8 ± 32.4 mL/min/1.73 m2. Of all the10,601 males with normal SCr, 0.84% were in CKD stage 3 and in all the 14,695 female, 19.24% were in stage 2 in stage. Of all the 14,695 females with serum creatinine in the normal range, 200 (1.36%) were in CKD stage 3. The patients in stages 2 and 3 were significantly older. Conclusion: If our findings are shown to be true for the rest of Saudi Arabia, one could extrapolate that for each 100,000 serum creatinine assayed for males, 840 new cases will be uncovered in CKD stage 3. The corresponding number for females would be 1360 cases.

Decreasing but differential trends of adverse events among dialysis outpatient following re-enforcement of infection control measures; 20-month surveillance study

We set to monitor adverse events among hemodialysis patientsfollowing re-enforcement of infection control measures.

Microorganisms associated with access-associated bacteremia in hemodialysis outpatients in Saudi Arabia

Results Out of 198 positive blood cultures recorded during the study, 174 (88%) were access-associated bacteremia. The majority (89%) of these bacteremias were cause by a single organism. Out of the 190 organism identified 51.6% gramnegatives, 39.5% gram-positives, 8.5% skin contaminants, and 0.5% fungi. There was no significant difference of the organism distribution between those with catheter and those with AV fistula or graft (p=0.973). Staphylococcus aureus (17.9%) and Enterococcus sp (16.8%) were the most common gram-positives. Klebsiella sp (13.2%), Enterobacter sp (11.6%), and Pseudomonas aeruginosa (6.8%) were the most common gram-negatives. Compared to NHSN centers, KAMC had significantly higher gram negative (47.9% vs 21.3%, p<0.001), lower skin contaminants (13.0% vs 43.1%, p<0.001), but similar gram-positives (39.7% vs 34.2%, p=0.171). Conclusion In KAMC hemodialysis patients known of their high rates of permanent catheter and access-associated bacteremia, gram negative rods were the most common organisms identified. The causes of such finding whether colonization pattern, catheter care, empirical antimicrobials, or patient cormorbidities need to be delineated in future studies.