Editorial
Stemming the tide of chronic kidney disease: A focus on primary care prevention
The prevalence of chronic kidney disease (CKD) among Singapore residents aged 18 to 74 years rose significantly from 8.8% in 2019–2020 to 13.8% in 2021–2022.1,2 Singapore ranks third globally for treated end-stage kidney disease (ESKD), with a median survival of 6 years post-dialysis.3 Diabetic nephropathy was the leading cause...
Original Article
Five-year outcomes of a holistic programme for managing early chronic kidney disease in primary care
Singapore has the third highest incidence and sixth highest prevalence of end-stage kidney disease (ESKD) in the world.1 Globally, chronic kidney disease (CKD) is estimated to affect over 850 million people, with a prevalence of 13.4% among adults worldwide.2 Diabetes is the main cause of ESKD in new patients...
Letter to the Editor
Evaluating the role of technology in disseminating education to patients with chronic kidney disease
Dear Editor,
The optimal management of chronic kidney disease (CKD) requires lifestyle changes and adherence to long-term medications. Knowledge is a component of health literacy and is needed for self-management. Limited health literacy can lead to negative outcomes, such as adverse clinical events and mortality.1
Using technology to improve patients’ knowledge...
Original Article
Trends in fluid overload-related hospitalisations among patients with diabetes mellitus: The impact of chronic kidney disease
Diabetes mellitus (DM) is a major global health problem, contributing to significant clinical disease burden, healthcare expenditure and societal costs.1 In Singapore, DM accounts for 2.9% of disability-adjusted life years and 4.3% of years lived with disability.2,3 By 2030, it is projected to cost approximately USD 1.89 billion in...
Editorial
Fluid management in renal transplantation: Is it time to move towards goal-directed directed therapy?
Achieving optimal fluid balance for a patient undergoing major surgery, especially transplant surgery, has always been the lofty goal of peri-operative care,1 which often proves to be an elusive target. While keeping the patient well hydrated improves organ perfusion, being too generous with fluids can result in morbidity, such...
Letter to the Editor
Outcomes of COVID-19 infection in patients on dialysis and kidney transplant recipients: A single-centre audit
Dear Editor,
Patients with end-stage kidney disease (ESKD) are at increased risk of adverse outcomes following COVID-19 infection. Their vulnerability stems from multiple factors including kidney failure, comorbid illnesses, close contact in the haemodialysis centre, and transplant immunosuppression. European registry data in the pre-vaccination era report a COVID-19 mortality rate...
Commentary
Value the patient as a person: Answering the call for a person-centred model of care
There has been a change in patients’ attitudes towards healthcare professionals in recent decades, coupled with an increasingly evident shift in the care paradigm. In 2015, the World Health Organization released a framework of care that recommends healthcare professionals consciously consider the perspectives of individuals, carers, families and communities....
Original Article
Thiazide and thiazide-like diuretics associated with improved cardiovascular and renal outcomes for chronic kidney disease patients
Chronic kidney disease (CKD) is an increasingly pressing global health issue due to its strong link to serious complications such as end stage renal disease (ESRD), cardiovascular disease (CVD) and mortality.1 Over the last few decades, its impact has become more severe, moving from 27th to 18th on the...
Editorial
Thiazide diuretics in chronic kidney disease: Is there still a role?
“The young physician starts life with 20 drugs for each disease, and the old physician ends life with one drug for 20 diseases.” — William Osler
Hypertension is both a cause and consequence of chronic kidney disease (CKD). As such, the prevalence of hypertension is high among CKD patients and...
Original Article
Plasma selenium and zinc alter associations between nephrotoxic metals and chronic kidney disease: Results from NHANES database 2011–2018
Chronic kidney disease (CKD) is a clinical condition comprising persistent changes in kidney function or structure, or both. It is characterised by irreversible and progressive evolution, increasing the risk of complications and mortality. As the 16th leading cause of mortality worldwide, CKD affects 8–16% of the global population.1,2 Clinically,...
Original Article
Association of anticoagulation use during continuous kidney replacement therapy and 90-day outcomes: A multicentre study
Acute kidney injury (AKI) affects 21.6% of critically ill adult patients,1 with 5–7% requiring kidney replacement therapy (KRT).2 AKI carries significant prognostic and socioeconomic implications—chronic kidney disease (CKD) progression over 1 year has been described in 21%, 30%, and 79% of initial survivors with septic AKI reversal, recovery and...
Original Article
Association between lower phase angle and chronic kidney disease progression in type 2 diabetes patients
Chronic kidney disease (CKD) is a global public health problem with an estimated prevalence of 13.4%.1 One of the key drivers of the global increase in CKD is the rising prevalence of diabetes mellitus (DM).1 CKD affects about 25–40% of patients with type 2 diabetes mellitus (T2DM).2 A few...
Letter to the Editor
Association between self-care and chronic kidney disease in patients with type 2 diabetes mellitus
Dear Editor,
Chronic kidney disease (CKD) is one of the key complications occurring in 25–40% of patients with type 2 diabetes mellitus (T2DM).1 Our earlier study also showed that CKD was present in 53% of patients with T2DM recruited from a secondary care diabetes centre and primary care polyclinic...
Images in Medicine
White precipitate in a dialysis circuit
An 81-year-old man who had been fully vaccinated against COVID-19 was admitted to the medical intensive care unit on day 5 of his COVID-19-induced pneumonia for high flow nasal oxygen treatment. He had hypoxaemic respiratory failure secondary to acute respiratory distress syndrome (ARDS) from the COVID-19-induced pneumonia. He had...
Letter to the Editor
Palliative dialysis in hospice: A paradox or promising answer?
Dear Editor,
End-stage renal disease (ESRD) patients have higher mortality, hospital admissions and invasive procedures towards the end of life.1 However, many of them (82%) prioritise minimising suffering over life prolongation. Although twice as many patients prefer dying at home and inpatient hospice (65%) compared to hospital (27%), hospice utilisation...
Original Article
Comparison of planned-start, early-start and deferred-start strategies for peritoneal dialysis initiation in end-stage kidney disease
Peritoneal dialysis (PD) is a well-established long-term dialysis modality for patients with end-stage kidney disease (ESKD).1 It is recommended that a PD catheter should be placed at least 2 weeks prior to the anticipated need of long-term PD treatment for a planned-start PD.2 Despite wide-spread promotion of planned-start dialysis for...
Original Article
Identifying high-risk hospitalised chronic kidney disease patient using electronic health records for serious illness conversation
In-hospital cardiopulmonary resuscitation (CPR) for chronic kidney disease (CKD) patients is shown to have lower survival1 and a higher proportion of survivors on maintenance haemodialysis were discharged to skilled nursing facilities.2 Despite that, haemodialysis patients still preferred CPR during cardiac arrest3 and there are lower do-not-resuscitate orders for the...
Original Article
Death and cardiovascular outcomes in end-stage renal failure patients on different modalities of dialysis
End-stage renal failure (ESRF) is a major cause of morbidity and mortality worldwide, including Asia.1 In Singapore, incidence of chronic kidney disease (CKD) stage 5 has increased from 383.9 per million population (PMP) in 2010 to 414.8 PMP in 2015. Incidence of patients requiring dialysis has increased in tandem....
Editorial
Survival outcome of haemodialysis and peritoneal dialysis
End-stage renal disease (ESRD) is a challenging and growing health issue, with number of patients increasing globally. The use of dialysis has greatly improved the survival and life expectancy of ESRD patients. Haemodialysis (HD) and peritoneal dialysis (PD) are 2 broad dialysis modalities used for ESRD. Despite the advancement...
Letter to the Editor
Impact of COVID-19 infections among kidney transplant recipients
Dear Editor,
More than 2 years since the start of the COVID-19 pandemic, cases continue to climb despite global efforts at viral control. This is largely driven by the emergence of viral variants. In the later part of 2021, the Delta variant was the predominant variant circulating globally, and was...
Letter to the Editor
Paediatric living-donor liver and kidney transplantation during COVID-19
Dear Editor,
The coronavirus disease 2019 (COVID-19) pandemic has impacted global healthcare including paediatric solid organ transplantation (SOT). We report our experience of resuming paediatric living-donor SOT during COVID-19, which took into account safety considerations for living donors, paediatric recipients and the transplant healthcare team. The US Centers for Disease...
Review Article
Retardation of Kidney Failure – Applying Principles to Practice
By 2010 there will be more than 2 million patients worldwide on maintenance dialysis, a 400% increase in 20 years.1 This increase, occurring predominantly in developing nations, is being driven especially by a worldwide increase in the incidence of diabetes, and is too great to be offset by increased...
Letter to the Editor
Nephrologists-led intervention increases utilisation of peritoneal dialysis in Singapore
Dear Editor,
Over the past decade, the utilisation of peritoneal dialysis (PD) among end-stage kidney disease (ESKD) patients in Singapore has been persistently low (<20%).1 Difficulty in accessing PD catheter insertion services is considered one of the main obstacles to the growth of the PD population.2
Traditionally, PD catheter insertion...
Review Article
Drug-induced Kidney Disease – Pathology and Current Concepts
Departing from the usual account of drug-induced renal disease according to the specific type of drug, we divide this discussion into 3 main areas - glomerular injury, vascular injury and tubulointerstitial changes. In doing so, more emphasis will be placed on morphological findings although functional toxicity (with little or...
Original Article
National Health Survey on the Prevalence of Urinary Abnormalities in the Population: then and now (1975 to 2012)
In the planning of a tuberculosis prevalence survey in Singapore in 1975, it was decided to include a urine examination of the respondents using Labstix (Ames Company, Elkhart, Indiana, USA). Respondents found to have proteinuria, haematuria or both in the examination centres were then referred to the Department of...
Original Article
Kidney Cancer and Diabetes Mellitus: A Population-Based Case-Control Study in Taiwan
Kidney cancer accounts for 3% to 4% of all cancers. In a systematic review by Mathew and et al,2 the incidence of kidney cancer was the highest in France (16.1 per 100,000
man-years) and the lowest in India (0.9 per 100,000 woman-years) during 1988 to 1992. A trend analysis in...
Letter to the Editor
Empagliflozin-induced severe osmotic nephrosis and acute renal injury in advanced chronic kidney disease
Diabetic kidney disease remains a significant disease burden globally and is associated with increased medical costs once chronic kidney disease (CKD) ensues. Therefore, optimisation of CKD management through glycaemic control and albuminuria reduction are key strategies for retarding renal deterioration. Sodium glucose cotransporter-2 (SGLT-2) inhibitors are a new class...
Original Article
Survival and Predictors of Mortality in Acute Kidney Injury Patients Treated with Sustained Low Efficiency Dialysis
Approximately one in ten patients admitted to an intensive care unit (ICU) develops acute kidney injury (AKI), an important complication of ICU patients, and requiring renal replacement therapy (RRT). It is well known that AKI contributes to mortality and chronic kidney diseases which result in health and economic burdens....
Original Article
Impact of Chronic Kidney Disease on Outcomes in Transcatheter Aortic Valve Implantation
With improvements in device technology as well as increasing experience, transcatheter aortic valve implantation (TAVI) has replaced open surgical aortic valve implantation as the treatment of choice in severe symptomatic aortic stenosis (AS) patients who have prohibitive and high surgical risks. TAVI has also gained increasing uptake in patients...
Review Article
Managing a Renal Transplant Programme During the COVID-19 Pandemic: Practical Experience from a Singapore Transplant Centre
As infrastructure and policies were being put in place to combat COVID-19, we recognised that specialty-specific policies and protocols had to be drawn up as well. Similarly, the Renal Medicine Unit at the Singapore General Hospital, an academic medical centre, acted quickly to modify our services to (1) protect...
Review Article
Metformin use in patients with type 2 diabetes mellitus and chronic kidney disease: An evidence-based review
Diabetes is a chronic disease characterised by elevated levels of blood glucose. The most common type of diabetes is type 2 diabetes mellitus (T2DM). This usually occurs in adults and arises through insulin resistance or an insufficiency of insulin production. Diabetes is one of the priority non-communicable diseases targeted...
Original Article
PLA2R1 and HLA-DQA1 gene variations in idiopathic membranous nephropathy in South China
Membranous nephropathy is an organ-specific autoimmune disease and is the most common cause of adult-onset nephrotic syndrome. The diagnosis of membranous nephropathy mainly depends on pathological characteristics observed through various techniques such as diffuse thickening of the glomerular basement membrane and spike formation by light microscopy, granular deposition of...