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Dive into the research topics where Arif Khwaja is active.

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Featured researches published by Arif Khwaja.


Nephron Clinical Practice | 2012

KDIGO clinical practice guidelines for acute kidney injury.

Arif Khwaja

tion’, implying that most patients ‘should’ receive a particular action. In contrast, level 2 guidelines are essentially ‘suggestions’ and are deemed to be ‘weak’ or discretionary, recognising that management decisions may vary in different clinical contexts. Each recommendation was further graded from A to D by the quality of evidence underpinning them, with grade A referring to a high quality of evidence whilst grade D recognised a ‘very low’ evidence base. The overall strength and quality of the supporting evidence is summarised in table 1 . The guidelines focused on 4 key domains: (1) AKI definition, (2) prevention and treatment of AKI, (3) contrastinduced AKI (CI-AKI) and (4) dialysis interventions for the treatment of AKI. The full summary of clinical practice statements is available at www.kdigo.org, but a few key recommendation statements will be highlighted here.


QJM: An International Journal of Medicine | 2009

Conservatively managed patients with stage 5 chronic kidney disease—outcomes from a single center experience

T. Ellam; M. El-Kossi; K.C. Prasanth; M. El-Nahas; Arif Khwaja

BACKGROUND Limited survival data are available on chronic kidney disease stage 5 (CKD 5) patients who opt for conservative management rather than dialysis. AIM To measure survival in such patients and investigate potential factors predicting survival. DESIGN Retrospective survival analysis of a cohort of conservatively managed CKD 5 patients from a single center. METHODS Survival was measured in 69 conservatively managed patients from the time they were first known to have CKD 5. Comorbidities, residual renal function and other laboratory parameters (calcium, phosphate, parathyroid hormone, albumin and hemoglobin) and blood pressure were recorded. RESULTS Overall median patient survival from the time of first known CKD 5 was 21 months. Patients known to a nephrologist before reaching CKD 5 survived longer (median 32 months) than those presenting with CKD 5 (15 months, P = 0.025). Serum albumin >35 g/l was associated with greater survival, but other biochemical parameters, comorbidity grade and age did not predict survival. CONCLUSION These survival data provide useful information for nephrologists counseling CKD 5 patients considering whether to pursue dialysis or conservative management. Risk factors that correlate with survival in the dialysis population may not predict survival in conservatively managed CKD 5 patients.


American Journal of Kidney Diseases | 2014

Fragility Fractures and Osteoporosis in CKD: Pathophysiology and Diagnostic Methods

Syazrah Salam; Richard Eastell; Arif Khwaja

Both chronic kidney disease (CKD) and osteoporosis are major public health problems associated with an aging population. Osteoporosis is characterized by reduced bone mineral density, while CKD results in qualitative changes in bone structure; both conditions increase the predisposition to fragility fractures. There is a significant coprevalence of osteoporotic fractures and CKD, particularly in the elderly population. Not only is the risk of fracture higher in the CKD population, but clinical outcomes are significantly worse, with substantial health care costs. Management of osteoporosis in the CKD population is particularly complex given the impact of renal osteodystrophy on bone quality and the limited safety and hard outcome data for current therapy in patients with severe CKD or on dialysis therapy. In this review, we discuss the pathophysiology of osteoporosis, the impact of CKD on bone strength, and the role of novel imaging techniques and biomarkers in predicting underlying renal osteodystrophy on bone histomorphometry in the context of CKD.


Nephrology Dialysis Transplantation | 2015

Multicentre randomized controlled trial of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker withdrawal in advanced renal disease: the STOP-ACEi trial

Sunil Bhandari; Natalie Ives; Elizabeth A. Brettell; Marie Valente; Paul Cockwell; Peter Topham; John G.F. Cleland; Arif Khwaja; Meguid El Nahas

Background Blood pressure (BP) control and reduction of urinary protein excretion using agents that block the renin–angiotensin aldosterone system are the mainstay of therapy for chronic kidney disease (CKD). Research has confirmed the benefits in mild CKD, but data on angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) use in advanced CKD are lacking. In the STOP-ACEi trial, we aim to confirm preliminary findings which suggest that withdrawal of ACEi/ARB treatment can stabilize or even improve renal function in patients with advanced progressive CKD. Methods The STOP-ACEi trial (trial registration: current controlled trials, ISRCTN62869767) is an investigator-led multicentre open-label, randomized controlled clinical trial of 410 participants with advanced (Stage 4 or 5) progressive CKD receiving ACEi, ARBs or both. Patients will be randomized in a 1:1 ratio to either discontinue ACEi, ARB or combination of both (experimental arm) or continue ACEi, ARB or combination of both (control arm). Patients will be followed up at 3 monthly intervals for 3 years. The primary outcome measure is eGFR at 3 years. Secondary outcome measures include the number of renal events, participant quality of life and physical functioning, hospitalization rates, BP and laboratory measures, including serum cystatin-C. Safety will be assessed to ensure that withdrawal of these treatments does not cause excess harm or increase mortality or cardiovascular events such as heart failure, myocardial infarction or stroke. Results The rationale and trial design are presented here. The results of this trial will show whether discontinuation of ACEi/ARBs can improve or stabilize renal function in patients with advanced progressive CKD. It will show whether this simple intervention can improve laboratory and clinical outcomes, including progression to end-stage renal disease, without causing an increase in cardiovascular events.


Nephrology Dialysis Transplantation | 2012

Transplantation in the obese: separating myth from reality

Arif Khwaja; Meguid El-Nahas

The prevalence of obesity among patients requiring renal replacement therapy continues to increase inexorably. While observational data have suggested that obesity may be associated with better outcomes among patients on dialysis, many centres have been reluctant to transplant obese patients because of concerns over adverse outcomes in the short and long term. In this review, we evaluate data about the safety of weight loss on dialysis and critically review the impact of pre-transplant body mass index and sarcopenia on post-transplant outcomes. We also highlight comparative data on outcomes of obese patients on dialysis versus those undergoing kidney transplantation. We conclude that while obesity can increase the risk of complications such as wound infections or delayed graft function, selected obese patients can achieve good outcomes after transplantation with the risk being broadly comparable to other recipient co-morbidities such as diabetes mellitus.


Clinical Journal of The American Society of Nephrology | 2016

Bone Disease after Kidney Transplantation

Antoine Bouquegneau; Syrazah Salam; Pierre Delanaye; Richard Eastell; Arif Khwaja

Bone and mineral disorders occur frequently in kidney transplant recipients and are associated with a high risk of fracture, morbidity, and mortality. There is a broad spectrum of often overlapping bone diseases seen after transplantation, including osteoporosis as well as persisting high- or low-turnover bone disease. The pathophysiology underlying bone disorders after transplantation results from a complex interplay of factors, including preexisting renal osteodystrophy and bone loss related to a variety of causes, such as immunosuppression and alterations in the parathyroid hormone-vitamin D-fibroblast growth factor 23 axis as well as changes in mineral metabolism. Management is complex, because noninvasive tools, such as imaging and bone biomarkers, do not have sufficient sensitivity and specificity to detect these abnormalities in bone structure and function, whereas bone biopsy is not a widely available diagnostic tool. In this review, we focus on recent data that highlight improvements in our understanding of the prevalence, pathophysiology, and diagnostic and therapeutic strategies of mineral and bone disorders in kidney transplant recipients.


Nephron Clinical Practice | 2009

A Critique of the UK NICE Guidance for the Detection and Management of Individuals with Chronic Kidney Disease

Arif Khwaja; David Throssell

The increasing global prevalence of chronic kidney disease (CKD) and end-stage renal disease (ESRD) has significant public health and economic implications. The recently published UK National Institute for Health and Clinical Excellence (NICE) clinical guidelines for the early identification and management of CKD provide a framework of disease management for both primary and secondary care with the stated aim of reducing the progression of CKD and the associated risk of cardiovascular death. Identification of at-risk individuals with proteinuria and inhibition of the renin-angiotensin system are the cornerstones of this strategy. However, the vast majority of patients with CKD will not develop ESRD and it is far from clear whether the NICE recommendations will reduce either ESRD or cardiovascular death associated with CKD.


Nephron Clinical Practice | 2011

Stopping renin-angiotensin system inhibitors in chronic kidney disease: predictors of response.

Anderson Roman Gonçalves; Arif Khwaja; Aimune K. Ahmed; Mohsen El Kossi; Meguid El Nahas

Background/Aims: Renin-angiotensin system (RAS) inhibitors are considered first-line agents for hypertensive patients with progressive chronic kidney disease (CKD). In a previous study, we showed that stopping RAS inhibitors increased estimated glomerular filtration rate (eGFR) in a significant number of advanced CKD patients. The present study tries to address who would benefit and whether this benefit is predictable. Methods: Forty-three CKD stage 4 patients had RAS inhibitors stopped and were followed for at least 24 months. Compared outcome groups were ‘alive’, ‘renal replacement therapy (RRT)’ or ‘died’. Improvement in eGFR was used in a receiver-operating characteristic curve and finds the best predictor for surviving without RRT. Results: Patients who survived without RRT were all hypertensive and had a higher eGFR increment after stopping the drugs. Those with eGFR improvement ≧5 ml/min/1.73 m2 were the most likely to survive long term without RRT (log-rank test, p = 0.03). They had a significant increment in blood pressure that correlated with eGFR improvement (r = 0.403, p = 0.013). Conclusion: A significant increase in eGFR after stopping RAS inhibitors suggests that long-term survival without RRT is more likely. Our findings question the universal preemptive indication of RAS inhibitors in advanced CKD and suggest that they can be safely stopped, at least in some patients.


BMJ | 2016

Chronic kidney disease in elderly people: disease or disease label?

Timothy Ellam; Helen Twohig; Arif Khwaja

Timothy Ellam and colleagues argue for a focus on what diagnosis means for individual patients rather than population risks


Ndt Plus | 2012

Progressive chronic kidney disease secondary to tubulointerstitial nephritis in primary biliary cirrhosis

Tarun Bansal; Anna Takou; Arif Khwaja

Primary biliary cirrhosis (PBC) is an autoimmune disease characterized by the presence of anti-mitochondrial antibodies (AMA). Whilst asymptomatic distal tubular acidosis (DTA) is the commonest renal lesion reported in PBC, tubulointerstitial nephritis (TIN) has also been reported as a rare association. Although PBC could be a familial disorder, there have been no previous reports of familial chronic TIN in association with PBC. We report a case of progressive chronic kidney disease (CKD) due to TIN in a mother and daughter known to suffer from PBC and review the previously reported literature. Both showed good response to steroids.

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Mohsen El Kossi

Northern General Hospital

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Syazrah Salam

Northern General Hospital

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Tarun Bansal

Northern General Hospital

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Aimune K. Ahmed

Northern General Hospital

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Anna Takou

Northern General Hospital

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David Throssell

Northern General Hospital

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Helen Twohig

Northern General Hospital

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