Chronic kidney disease (CKD) refers to a range of various pathophysiological processes correlated with abnormal renal function and a progressive loss in GFR. Just as dysbiosis and altered pathology of the gut are accompanied with hypertension, which is a significant CKD risk factor. Gut dysbiosis in CKD patients is associated with an elevated levels of uremic toxins, which in turn increases the CKD progression. According to research results, the gut-kidney axis has a role in the formation of kidney stones, also in IgAN. A number of researchers have categorized the gut microbiota as enterotypes, and others, skeptical of theory of enterotypes, have suggested biomarkers to describe taxa that related to lifestyle, nutrition, and disease status. Metabolome-microbiome studies have been used to investigate the interactions of host-gut microbiota in terms of the involvement of metabolites in these interactions and are yielded promising results. The correlation between gut microbiota and CKD requires further multi-omic researches. Also, with regard to systems biology, studies on the communication network of proteins and transporters such as SLC and ABC, can help us achieve a deeper understanding of the gut-liver-kidney axis communication and can thus provide promising new horizons in the treatment of CKD patients. Probiotic-based treatment is an approach to reduce uremic poisoning, which is accomplished by swallowing microbes those can catalyze URS in the gut. If further comprehensive studies are carried out, we will know about the probiotics impact in slowing the renal failure progression and reducing inflammatory markers. 

Chronic kidney disease and gut microbiota

Public-private partnerships (PPP) is used to advance health service access and quality. PPP implementation in hospitals is vital to shorten the service and quality gap. Hospitals are the most significant health budget spender, and this study aimed to identify the PPP effect on hospital performance indicators and its implementation challenges. Thirty-three inclusive articles were filtered and collected from Pubmed, ScienceDirect, Medline, and Sage Publication databases. Results showed that various articles succeeded in implementing PPP and improving the access and quality of health services. Several hospital performance indicators such as diagnosis, therapy, service waiting time, length of stay, referral rate, mortality rate, and patient satisfaction were reported to show better results. However, there was insufficient evidence to say the same on related financial indicators. Policy, resource, communication and trust, risk, and evaluation monitoring were considered challenges in PPP implementation. Its success was not only influenced by major factors such as governance model, finance, politics, and social but also was influenced by the medical practice model applied within the organization. This study contributed to whether PPP affects the hospital performance indicators.

Hospital services under public-private partnerships, outcomes and, challenges: A literature review

Hypertension is highly prevalent and poorly controlled among hemodialysis patients. However, published information regarding the management and control of hypertension among Pakistani hemodialysis patients is scarce. Our objective was to evaluate the pharmacotherapeutic management and control of hypertension and associated factors in hemodialysis patients at a tertiary-care hospital. Eligible hypertensive hemodialysis patients enrolled at the Balochistan Institute of Nephrology-Urology Quetta, Pakistan, between 1 July 2017 and 30 November 2019 were retrospectively followed for 6 months after the baseline hemodialysis session. Collected data were analyzed using SPSS version 20, and odds ratios (ORs) were calculated. Patients with mean pre-dialysis blood pressure (BP) < 140/90 and post-dialysis BP < 130/80 mmHg in the final month of study were classified as being at target BP. A total of 237 hypertensive hemodialysis patients were included in the analysis. The mean age of patients was 42.8 ± 13.2 years, and most (78.9%) had at least one comorbidity. In the final month of the study, only 68 patients (28.7%) were at target BP. Patients were treated with a median of two antihypertensive drugs (range 1–5). Calcium-channel blockers (CCBs) were the most commonly prescribed antihypertensive (54.4%), followed by angiotensin-receptor blockers (53.2%) and diuretics (42.2%). In multivariate binary logistic regression analysis, the use of diuretics (OR 0.50; 95% CI 0.27–0.95), CCBs (OR 2.90; 95% CI 1.35–6.20), β-blockers (OR 2.9; 95% CI 1.30–6.73), and α/β-blockers (OR 2.75; 95% CI 1.26–5.98) was significantly associated with hypertension control. Hypertension control was suboptimal at the study site. A notable proportion of patients were receiving diuretics despite guidelines discouraging their use. The use of β-blockers, α-β-blockers, and CCBs was associated with hypertension control.

Evaluation of management and factors associated with hypertension control in hemodialysis patients at a tertiary-care hospital in Pakistan

Background and Aim: The number of patients on hemodialysis (HD) increases continuously. The HD population is usually divided into early and late HD patients according to the duration of HD, that are known as incident and prevalent groups. Still, there is a debate about the exact definition of both the incident and prevalent groups. Furthermore, predictors of death of both of these groups are not yet identified, especially in Egyptian HD patients. We aimed to compare between the incident and prevalent HD patients as well as to define predictors of mortality among each of these groups. Study Design and Methodology: This prospective multicenter study was started in June 2016, comprising 2123 HD patients recruited from twenty-five Egyptian HD centers. Patients were classified according to HD duration into two groups: Incident group including patients with HD Original Research Article Megahed et al.; AJMAH, 18(11): 42-54, 2020; Article no.AJMAH.63317 43 duration equals to or less than 6 months, and a prevalent group including patients who had been maintained on HD for more than 6 months. All patients were observed for one and half years and their demographic data, laboratory findings and mortality events were recorded. Results: In comparison to the prevalent group, the incident HD patients showed significantly lower hemoglobin, serum albumin, urea reduction ratio, serum phosphorus, and serum ferritin but higher average erythropoiesis stimulating agents (ESA) dose. There was significantly a higher number of patients with hypertension in the incident group, while there was no significant difference in diabetes mellitus or ischemic heart disease in both groups. There were a higher number of patients with positive hepatitis C virus antibodies and hyperparathyroidism in the prevalent group. By the end of the study, the mortality frequency was found to be significantly higher in the incident than the prevalent groups. Older age and corrected serum calcium were significant predictors of mortality in the total studied group as well as the prevalent group. However, no significant predictors of mortality could be detected among the incident group. Conclusion: The incident HD group tends to show higher frequency of hypertension, laboratory findings suggestive of malnutrition as well as higher frequency of mortality with different pattern of mortality predictors compared to the prevalent group.

/pdf/differences-between-the-incident-and-prevalent-hemodialysis-4gx2n6rmpi.pdf

Differences between the Incident and Prevalent Hemodialysis Patients in Egypt

Devletlerin uygulamış olduğu siyasi ve ekonomik politikalardaki değişimler, devletlerin iş yapma modellerini farklılaştırmıştır. Bu bağlamda günümüzde tartışılan modellerden birisi, kamu özel ortaklığıdır. Kamu özel ortaklığı modeli, öncelikli olarak hizmete odaklanan projelerin tasarımı, yapımı, işletimi ve finansmanıyla ilgili olarak belirli proje risklerinin özel ortağa aktarılmasına dayalı uzun vadeli sözleşmeleri ön plana çıkarmaktadır. Bu çalışmanın amacı, Avrupa Birliği ülkelerinin kamu özel ortaklıkları uygulamalarının sektörel dağılımlarını ve sağlık sistemlerindeki uygulamaları betimlemek ve bu modelin sağlık sektöründeki rolünün önemini tartışmaktır. Çalışmanın yöntemi, sistematik analizdir. Bu doğrultuda başlıca Avrupa Birliği ülkelerinin 1959-2020 yılları arasında Avrupa Yatırım Bankası’na bağlı Avrupa Kamu-Özel Ortaklığı Uzmanlık Merkezi (European PPP Expertise Centre – EPEC) tarafından finanse edilen projelerinin verileri incelenmiştir. Çalışmanın sonucunda, bu ülkelerin siyasi yapılanması, çağa uyum sağlama, ekonomik nedenler, küreselleşme gibi unsurların etkisiyle sağlık hizmetlerinde kamu özel ortaklığı uygulamalarının gittikçe daha çok önem kazandığı görülmüştür. 

/pdf/avrupa-birligi-ulkelerinin-saglik-sistemlerinde-kamu-ozel-2zmz04if.pdf

Avrupa birliği ülkelerinin sağlık sistemlerinde kamu özel ortaklığı uygulamaları

Innovative care models such as public-private partnerships (PPPs) may help meet the challenge of providing cost-effective high-quality care for the steadily growing and complex chronic kidney disease population since they combine the expertise and efficiency of a specialized dialysis provider with the population care approach of a public entity. We report the five-years main clinical outcomes of a population of patients treated on hemodialysis within a PPP-care model in Italy. This descriptive retrospective cohort study consisted of all consecutive hemodialysis patients treated in the NephroCare-operated Nephrology and Dialysis unit of the Seriate Hospital in 2012–2016, which exercises a PPP-care model. Clinical and treatment information was obtained from the European Clinical Database. Hospitalization outcomes and cumulative all-cause mortality incidences that accounted for competing risks were calculated. We included 401 hemodialysis patients (197 prevalent and 204 incident patients) in our study. The mean cohort age and age-adjusted Charlson Comorbidity Index were 67.0 years and 6.7, respectively. Patients were treated with online high-volume hemodiafiltration or high-flux hemodialysis. Parameters of treatment efficiency were above the recommended targets throughout the study period. Patients in the PPP experienced benefits in terms of hospitalization (average number of hospital admissions/patient-year: 0.79 and 1.13 for prevalent and incident patients, respectively; average length of hospitalization: 8.9 days for both groups) and had low cumulative all-cause mortality rates (12 months: 10.6 and 7.8%, 5 years: 42.0 and 35.9%, for prevalent and incident patients, respectively). Results of our descriptive study suggest that hemodialysis patients treated within a PPP-care model framework received care complying with recommended treatment targets and may benefit in terms of hospitalization and mortality outcomes.

/pdf/clinical-outcomes-of-hemodialysis-patients-in-a-public-2qwjo0xtsd.pdf

Clinical outcomes of hemodialysis patients in a public-private partnership care framework in Italy: a retrospective cohort study

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Clinical outcomes of hemodialysis patients in a public-private partnership care framework in Italy: a retrospective cohort study