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Effect Of Vaccination On The Case Fatality Rate For Coronavirus Disease (Covid-19) Injections, Glen H. Murata, Allison E. Murata, Douglas J. Perkins, Heather M. Campbell, Jenny T. Mao, Brent Wagner, Benjamin H. Mcmahon, Curt H. Hagedorn 2022 New Mexico Veterans Affairs Health Care System

Effect Of Vaccination On The Case Fatality Rate For Coronavirus Disease (Covid-19) Injections, Glen H. Murata, Allison E. Murata, Douglas J. Perkins, Heather M. Campbell, Jenny T. Mao, Brent Wagner, Benjamin H. Mcmahon, Curt H. Hagedorn

The Kidney Institute of New Mexico

Objectives:

To evaluate the benefits of vaccination on the case fatality rate (CFR) for COVID-19 infections.

Design, setting, and participants:

The United States Department of Veterans Affairs has one hundred and thirty medical centers. We created multivariate models from these data -339,772 patients with coronaviral disease (COVID-19)-as of September 30, 2021.

Outcome measures:

The primary outcome for all models was death within 60 days of the diagnosis. Logistic regression derived adjusted odds ratios (OR) for vaccination and infection with delta versus earlier variants. Models were adjusted for demographic traits, standard comorbidity indices, and three novel parameters representing all ...


Free Silicone-Induced Granulomatosis And Hypercalcemia In A Transgender Female, Brian L. Pando, Benjamin Goldsmith, Adam Lane Webb, Komal Kinger, Brian Helmly 2022 Memorial Health University Medical Center

Free Silicone-Induced Granulomatosis And Hypercalcemia In A Transgender Female, Brian L. Pando, Benjamin Goldsmith, Adam Lane Webb, Komal Kinger, Brian Helmly

HCA Healthcare Journal of Medicine

Introduction

Vitamin D derangements are a rare but important cause of hypercalcemia. Granulomatous disease is a primary cause of vitamin D derangements and is frequently associated with sarcoidosis, tuberculosis, and in the present case, foreign body granulomatosis. Liquid or injectable silicone is used as a filler for cosmetic body contouring. Transgender patients may seek silicone injections as part of gender affirmation surgeries. Granuloma formation is a rare but well-described complication of injectable silicone.

Case Description

A 40-year-old, assigned male at birth (AMAB) transgender female patient, with a history of HIV and chronic kidney disease (CKD) stage 3b, was admitted to ...


Perceived Barriers To Peritoneal Dialysis Among Kenyan Nephrologists: A Cross-Sectional Descriptive Study, Saleem Abdul Karim Sokwala, John Otieno Odhiambo, Ahmed Sokwala 2022 Aga Khan University

Perceived Barriers To Peritoneal Dialysis Among Kenyan Nephrologists: A Cross-Sectional Descriptive Study, Saleem Abdul Karim Sokwala, John Otieno Odhiambo, Ahmed Sokwala

Internal Medicine, East Africa

Background: Peritoneal dialysis (PD) is a well-recognized technique of renal replacement therapy (RRT), with similar efficacy as well as survival outcomes as hemodialysis (HD). Despite its advantages including prolonged preservation of residual renal function, potentially lower cost and advances with automated techniques, and commercialization of more biocompatible solutions, the overall prevalence of patients treated with PD is still very low in developed countries and even more so in Africa and low-middle income countries like Kenya. According to our knowledge, no local studies have been done on prevalence of peritoneal dialysis or on potential barriers to utilization of PD as an ...


Reno-Protective And Immune Effects Of Growth Differentiation Factor 15 In Obesity-Related Kidney Disease, Jessie T. Sullivan 2022 University of South Dakota

Reno-Protective And Immune Effects Of Growth Differentiation Factor 15 In Obesity-Related Kidney Disease, Jessie T. Sullivan

Honors Thesis

According to the World Health Organization, worldwide obesity has tripled since 1975 and is still on the rise, putting people at a higher risk of some cardiovascular diseases and kidney disease. Growth differentiation factor 15 (GDF15) is a stress-responsive cytokine that has been studied recently for its role in multiple biological processes and diseases. The member of the transforming growth factor beta (TGF-b) family has been investigated as a therapeutic agent and biomarker for obesity and associated cardiovascular diseases, stroke, diabetes, osteoarthritis, cancer, and kidney disease. Studies have shown the anti-inflammation, anti-obesity, and anti-diabetic effects of GDF15, but few have ...


Potassium Status In Pediatric Chronic Kidney Disease, Katherine L. Kurzinski 2022 Children's Mercy Hospital

Potassium Status In Pediatric Chronic Kidney Disease, Katherine L. Kurzinski

Research Days

Watch recording of live presentation.

Background: Potassium trends are well described in adult chronic kidney disease (CKD) and hyperkalemia is known to be associated with increased disease progression, morbidity, and mortality. Large scale studies assessing potassium trends and the prevalence of hyperkalemia in pediatric CKD have not been performed.

Objectives/Goal: We aimed to characterize median serum potassium levels and the prevalence of hyperkalemia for each CKD stage using the CKiD cohort. The relationship of serum potassium and hyperkalemia with patient demographics, CKD etiology (glomerular or non-glomerular), presence of acidosis, and degree of proteinuria was also evaluated.

Methods/Design: Median ...


Wilms Tumor Presenting With Spontaneous Necrosis And Clostridium Perfringens Co-Infection, Ronald Palmen, Abbey Elsbernd, Kristin Palmen 2022 Children's Mercy Hospital

Wilms Tumor Presenting With Spontaneous Necrosis And Clostridium Perfringens Co-Infection, Ronald Palmen, Abbey Elsbernd, Kristin Palmen

Research Days

Background: Wilm’s Tumor (WT) is the most common renal malignancy of childhood. The initial presentation of WT may mimic infection or other malignancies with nonspecific symptoms including fever, abdominal/flank pain, or hematuria. This poses a diagnostic challenge for providers, particularly when both infection and malignancy are observed. We describe a case of WT with spontaneous necrosis initially obscured by overlying Clostridium perfringens infection, making diagnosis of the cancer difficult.

Case Description: A previously healthy 5-year-old girl presented to the emergency department with a two-day history of left flank pain and fevers. In the emergency department, she was tachycardic ...


A Hidden Cause For Electrolyte Derangement In The Ed: Gitelman Syndrome, Alexis Dunn, James Espinosa, Alan Lucerna, Kevin Dwyer 2022 Rowan University

A Hidden Cause For Electrolyte Derangement In The Ed: Gitelman Syndrome, Alexis Dunn, James Espinosa, Alan Lucerna, Kevin Dwyer

Stratford Campus Research Day

Electrolyte derangements are a common finding in the emergency department, whether incidental or the cause for presenting symptoms. Gitelman syndrome (GS) can be the cause for recurrent hypokalemia and hypomagnesemia. While often diagnosed when the patient is young, a clinician should keep this on the differential when seeing repeated visits with electrolyte deficiencies and treating them. Here we discuss a case of how Gitelman syndrome has presented in the ED and what to learn from it.


Incidental Finding Of Unusually Large Renal Cyst During Point Of Care Ultrasound, David Ho, Jeffrey Gardecki 2022 Rowan University

Incidental Finding Of Unusually Large Renal Cyst During Point Of Care Ultrasound, David Ho, Jeffrey Gardecki

Stratford Campus Research Day

Renal cysts are common, and their frequency and size increase as patients age. Renal cysts are derived primarily from tubules and can occur anywhere between Bowman’s capsule to the renal papilla. The cysts are composed of abnormally differentiated epithelial cells encapsulating a cavity of fluid. These abnormally differentiated cells are due to defects in the structure and function of cilia, the structures responsible for detecting urine flow as well as the epithelial composition of the epithelial architecture and repair. According to Campbell Urology, there are three processes in which renal cysts increase in their size – proliferation of epithelial cells ...


Digoxin Toxicity And Acute Renal Failure In A 75 Year-Old Female, Daniel Zaayenga, Andrew Caravello, Nicholas Tomasello 2022 Rowan University

Digoxin Toxicity And Acute Renal Failure In A 75 Year-Old Female, Daniel Zaayenga, Andrew Caravello, Nicholas Tomasello

Stratford Campus Research Day

Digoxin toxicity can present with varying manifestations. While pathognomonic symptoms such as xanthopsia (object appearing yellow) are a board favorite it is not a required finding and is in fact not seen with most patients. Rather digoxin toxicity presents with more non-specific symptoms such as GI distress (anorexia, N/V) neurological distress (lethargy, fatigue, delirium, confusion, disorientation, weakness. EKG findings are varied and include premature ventricular contractions, bradycardia, atrial tachyarrhythmias with AV block, ventricular bigeminy, junctional rhythms, various degrees of AV nodal blockade, ventricular tachycardia, and ventricular fibrillation. Although rarely seen, digoxin is one of the only causes of bidirectional ...


Case Study Of Metformin-Induced Lactic Acidosis, Kajel Patel, Kishan Patel 2022 Rowan University

Case Study Of Metformin-Induced Lactic Acidosis, Kajel Patel, Kishan Patel

Stratford Campus Research Day

Metformin induced lactic acidosis is when high levels of metformin cause dangerously high levels of lactic acid. Here is a case report of a 72-year-old female who came in for nausea, vomiting, and diarrhea found to have a high suspicion for metformin induced lactic acidosis. She stabilized in the emergency department, nephrology and ICU was contacted, and she went for emergent dialysis. For many patients the prognosis of metformin induced lactic acidosis is poor. This patient was made comfort care by her family.


Burnout In Pediatric Nephrology Fellows And Faculty: Lessons From The Sustainable Pediatric Nephrology Workforce Project (Superpower)., Susan M. Halbach, Kartik Pillutla, Patricia Seo-Mayer, Alan Schwartz, Darcy K. Weidemann, John D. Mahan 2022 Children's Mercy Kansas City

Burnout In Pediatric Nephrology Fellows And Faculty: Lessons From The Sustainable Pediatric Nephrology Workforce Project (Superpower)., Susan M. Halbach, Kartik Pillutla, Patricia Seo-Mayer, Alan Schwartz, Darcy K. Weidemann, John D. Mahan

Manuscripts, Articles, Book Chapters and Other Papers

Physician well-being is an important contributor to both job satisfaction and patient outcomes. Rates of burnout among physicians vary by specialty, ranging from 35 to 70%. Among pediatric residents, longitudinal data demonstrates consistent rates of burnout around 50-60%, although little is known about burnout among pediatric subspecialty fellows. Specifically, the degree of burnout among pediatric nephrologists remains unknown, as does the impact faculty burnout may have on trainee burnout. We sought to evaluate prevalence and predictors of burnout among US pediatric nephrology fellows and faculty, and assess for interactions between groups. In this multi-center pilot survey of all United States ...


The Burden Of Mental Health Conditions In Children With Ckd., Katherine L. Kurzinski, Darcy K. Weidemann 2022 Children's Mercy Hospital

The Burden Of Mental Health Conditions In Children With Ckd., Katherine L. Kurzinski, Darcy K. Weidemann

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.


Implementing A Patient Reported Outcome Measure For Patient With Anemia Of Chronic Kidney Disease (Ckd) In The Outpatient Setting, Marissa Finger 2022 Sacred Heart University

Implementing A Patient Reported Outcome Measure For Patient With Anemia Of Chronic Kidney Disease (Ckd) In The Outpatient Setting, Marissa Finger

DNP Projects

Introduction: Chronic kidney disease (CKD) is a growing public health concern in the United States. People with CKD suffer from many symptoms that cause distress and low quality of life (QoL). Research has found an association between symptom burden in patients with CKD and the disease's worsening progression. There is little data on ways to monitor and address CKD symptoms routinely.

Purpose: The purpose of this project was to identify symptoms related to advancing kidney disease using patient-reported outcome measures (PROMs) through IPOS-Renal survey and implement a nurse-driven protocol to manage patient reported symptoms.

Interventions/Setting: Over a three-month ...


Health And Dental Insurance And Health Care Utilization Among Children, Adolescents, And Young Adults With Ckd: Findings From The Ckid Cohort Study., Andrea R. Molino, Maria Lourdes G. Minnick, Judith Jerry-Fluker, Jacqueline Karita Muiru, Sara A. Boynton, Susan L. Furth, Bradley A. Warady, Derek K. Ng, Chronic Kidney Disease in Children Study 2022 Children's Mercy Hospital

Health And Dental Insurance And Health Care Utilization Among Children, Adolescents, And Young Adults With Ckd: Findings From The Ckid Cohort Study., Andrea R. Molino, Maria Lourdes G. Minnick, Judith Jerry-Fluker, Jacqueline Karita Muiru, Sara A. Boynton, Susan L. Furth, Bradley A. Warady, Derek K. Ng, Chronic Kidney Disease In Children Study

Manuscripts, Articles, Book Chapters and Other Papers

Rationale & Objective: To understand the association between health and dental insurance status and health and dental care utilization, and their relationship with disease severity in a population with childhood-onset chronic kidney disease (CKD).

Study Design: Observational cohort study.

Settings & Participants: Nine hundred fifty-three participants contributing 4,369 person-visits (unit of analysis) in the United States enrolled in the Chronic Kidney Disease in Children (CKiD) Study from 2005 to 2019.

Exposures: Health insurance (private vs public vs none) and dental insurance (presence vs absence) self-reported at annual visits.

Outcomes: Self-reported suboptimal health care utilization in the past year, defined separately as not visiting a private physician, visiting the emergency room, visiting the emergency room at least twice, being hospitalized, and self-reported suboptimal dental care utilization over the past year, defined as not receiving dental care.

Analytical Approach: Repeated measures Poisson regression models were fit to estimate and compare utilization by insurance type and disease severity at the prior visit. Additional unadjusted and adjusted models were fit, as well as models including interactions between insurance and Black race, maternal education, and income.

Results: Those with public health insurance were more likely to report suboptimal health care utilization across the CKD severity spectrum, and lack of dental insurance was strongly associated with lack of dental care. These relationships varied depending on strata of socioeconomic status and race but the effect measure modification was not significant.

Limitations: Details of insurance coverage were unavailable; reasons for emergency care or type of private physician visited were unknown.

Conclusions: Pediatric nephrology programs may consider interventions to help direct supportive resources to families with public insurance who are at higher risk for suboptimal utilization of care. Insurance providers should identify areas to expand access for families of children with CKD.


Renal Replacement Therapy May Be Initiated In Patients With Hepatorenal Syndrome Who Are Not Transplant Candidates, Laura Donohue 2022 Wayne State University

Renal Replacement Therapy May Be Initiated In Patients With Hepatorenal Syndrome Who Are Not Transplant Candidates, Laura Donohue

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using

Allegretti AS, Parada XV, Eneanya ND, et al. Prognosis of Patients with Cirrhosis and AKI Who Initiate RRT. Clin J Am Soc Nephrol. 2018;13(1):16-25. https://doi.org/10.2215/CJN.03610417

for a patient being considered for RRT who was not yet a candidate for liver transplant.


Quality Reporting On Dialysis Water Testing And Dialysis Machine Disinfection, Jennifer Boquiren Quitevis 2022 University of St. Augustine for Health Sciences

Quality Reporting On Dialysis Water Testing And Dialysis Machine Disinfection, Jennifer Boquiren Quitevis

Student Scholarly Projects

Practice Problem: Kidney failure affects 0.1% - 0.2% of the general population, yet the dialysis expenditure is 5%-7% of total healthcare budget spending. The increased incidence of chronic disease will result in more End Stage Renal Disease patients on dialysis along with more comorbidities. Thus, it is imperative for health organizations to have well established protocols and guidelines to manage the care of the dialysis patient.

PICOT: The PICOT question that guided this project was: in patients receiving dialysis at an acute care dialysis unit (P), does utilizing a Standardized Policy for Quality Reporting on Dialysis Water Testing ...


Potassium Status In Pediatric Chronic Kidney Disease: A Preliminary Report From The Chronic Kidney Disease In Children (Ckid) Study, Katherine L. Kurzinski, Yunwen Xu, Derek NG, Susan Furth, George Schwartz, Bradley A. Warady 2022 Children's Mercy Hospital

Potassium Status In Pediatric Chronic Kidney Disease: A Preliminary Report From The Chronic Kidney Disease In Children (Ckid) Study, Katherine L. Kurzinski, Yunwen Xu, Derek Ng, Susan Furth, George Schwartz, Bradley A. Warady

Posters

No abstract provided.


Rare Variants In Renal Developmental Genes And The Risk Of Hypertension And Ckd: A Uk Biobank Study, Benjamin Spector, Byunggil Yoo, Neil Miller, Laurel K. Willig 2022 Children's Mercy Hospital

Rare Variants In Renal Developmental Genes And The Risk Of Hypertension And Ckd: A Uk Biobank Study, Benjamin Spector, Byunggil Yoo, Neil Miller, Laurel K. Willig

Posters

Background: Prior studies show chronic kidney disease (CKD) is heritable but only a few common variants have been associated with CKD and kidney dysfunction. Much of CKD heritability remains unknown and limited studies have explored the role of rare genetic variants in this missing heritability. Objectives: Identify rare genetic variants in renal developmental genes associated with hypertension and CKD. Methods: We examined the association between rare variants in 58 candidate genes from five renal developmental compartments and presence of CKD and elevated blood pressure (BP) in 49,989 individuals using whole exome sequencing and phenotypic data from the UK Biobank ...


Predictors Of Hyperkalemia And Outcomes Of Dyskalemia In Us Veterans With Advanced Chronic Kidney Disease Transitioning To Dialysis, Ankur Dashputre 2022 University of Tennessee Health Science Center

Predictors Of Hyperkalemia And Outcomes Of Dyskalemia In Us Veterans With Advanced Chronic Kidney Disease Transitioning To Dialysis, Ankur Dashputre

Theses and Dissertations (ETD)

Background: The kidneys play a crucial role in maintaining homeostasis of serum potassium levels (K+). Patients with advanced chronic kidney disease (CKD) are at a higher risk of experiencing dyskalemia events (i.e. hyper- and hypokalemia; especially the former) and thus future adverse outcomes. Currently, there is a dearth of literature on prediction models for hyperkalemia and the effects of dyskalemia on outcomes such as incidence of ischemic stroke and short-term hospital/emergency room (ER) utilization in an advanced CKD population transitioning to dialysis. Objectives: Using a nationally representative sample of US veterans with advanced CKD transitioning to dialysis, in ...


Moving The Needle Toward Fair Compensation In Pediatric Nephrology., Darcy K. Weidemann, I A Ashoor, D E Soranno, R Sheth, C Carter, P D Brophy 2022 Children's Mercy Hospital

Moving The Needle Toward Fair Compensation In Pediatric Nephrology., Darcy K. Weidemann, I A Ashoor, D E Soranno, R Sheth, C Carter, P D Brophy

Manuscripts, Articles, Book Chapters and Other Papers

Remuneration issues are a substantial threat to the long-term stability of the pediatric nephrology workforce. It is uncertain whether the pediatric nephrology workforce will meet the growing needs of children with kidney disease without a substantial overhaul of the current reimbursement policies. In contrast to adult nephrology, the majority of pediatric nephrologists practice in an academic setting affiliated with a university and/or children's hospital. The pediatric nephrology service line is crucial to maintaining the financial health and wellness of a comprehensive children's hospital. However, in the current fee-for-service system, the clinical care for children with kidney disease ...


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