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Umbar Ghaffar

Bio: Umbar Ghaffar is an academic researcher. The author has contributed to research in topics: Retrospective cohort study & Cohort study. The author has an hindex of 2, co-authored 2 publications receiving 13 citations.

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Journal Article
TL;DR: It is found that up to 40% of patients experienced an improvement in their blood pressure profile over the period of the study, suggesting that simple changes to dialysis prescription can result in a significant reduction in the incidence of intradialytic hypotension.
Abstract: Intradialytic hypotension is defined as a decrease in systolic blood pressure by ≥ 20 mm Hg or a decrease in mean arterial pressure by 10 mm Hg, and is associated with symptoms that include abdominal discomfort, yawning, sighing, nausea, vomiting, muscle cramps, restlessness, dizziness or fainting, and anxiety. The incidence of a symptomatic reduction in blood pressure during (or immediately following) dialysis ranges from 15-50% of dialysis sessions. It is a major cause for morbidity in elderly hemodialysis patients and those with cardiovascular compromise. It impairs patient well-being, limits ultrafiltration, and increases the risk for coronary and cerebral ischemic events as well as vascular access thrombosis. Several studies have shown a poorer survival in dialysis patients who experience frequent hypotensive episodes on dialysis as opposed to those who do not. In our outpatient dialysis unit, we identified that 9% of our dialysis patients experienced a decrease in their systolic blood pressure to below 80 during dialysis. The purpose of this quality improvement project was to study the factors associated with intradialytic hypotension in these patients and institute appropriate measures to mitigate this issue. Another aim was to educate the dialysis staff on how to manage these patients. Patients were selected using data from weekly rounding reports and orders were written for interventions including ultrafiltration profiling, cool (36 degrees C) dialysate, weight-based ultrafiltration, etc. Outcomes were studied over a period of 3 months. We found that up to 40% of patients experienced an improvement in their blood pressure profile over the period of the study, suggesting that simple changes to dialysis prescription can result in a significant reduction in the incidence of intradialytic hypotension.

10 citations

Journal Article
TL;DR: It is concluded that each episode of acute kidney injury, related to contrast or other nephrotoxins, increases the risk for CKD progression and eGFR decline in the elderly.
Abstract: We wanted to examine the predictors of annual estimated glomerular filtration rate (eGFR) decline during a five-year follow-up in elderly individuals with pre-existing chronic kidney disease (CKD) stage 3 or greater (defined as baseline eGFR of less than 60 ml/min per 1.73 m2 or a urinary albumin-to-creatinine ratio > 30 mg/g), and to examine the difference in risk factors when compared to a co-hort without CKD. Our research team identified 599 patients who were 65 years of age or older with and without CKD stage 3 or greater at baseline. Data regarding various predictors such as age, sex, race, proteinuria, medication use, contrast exposure, acute kidney injury episodes, coronary artery disease, congestive heart failure, dyslipidemia, gout etc. were obtained. Semi-partial correlations were used to determine the fac-tors providing the largest unique contribution to the overall variability in eGFR. Semi-partial correlations identified age, proteinuria, and intravenous contrast ex-posure as the most significant predictors of eGFR decline in this population. Overall, patients in the pre-existing CKD cohort were more likely to be older, Af-rican American and with co-morbidities like diabetes, hypertension, etc. In this group, the unadjusted rate of decline in eGFR varied from 0.5% to 8.3% per year. This study identifies important risk factors for eGFR decline in the population aged > 65 years. It also concludes that each episode of acute kidney injury, wheth-er related to contrast or other nephrotoxins, increases the risk for CKD progression and eGFR decline in the elderly.

4 citations


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Journal ArticleDOI
TL;DR: A meta-analysis suggests that the prevalence of Intradialytic hypotension is lower than 12% for both the EBPG and the Nadir <90 definition which is much lower than stated in most reviews.
Abstract: Background: Intradialytic hypotension (IDH) is considered to be a frequent complication of hemodialysis (HD) and is associated with symptom burden, increased incidence of access failure, cardiovascular events, and higher mortality. This systematic literature review aims to analyse studies that investigated the prevalence of IDH. A complicating factor herein is that many different definitions of IDH are used in literature. Methods: A systematic literature search from databases, Medline, Cinahl, EMBASE, and the Cochrane library to identify studies reporting on the actual prevalence of IDH was conducted. Studies were categorized by the type of definition used for the prevalence of IDH. A meta-analysis of the prevalence of IDH was performed. Results: In a meta-analysis comprising 4 studies including 1,694 patients and 4 studies including 13,189 patients, the prevalence of HD sessions complicated by IDH was 10.1 and 11.6% for the European Best Practice Guideline (EBPG) definition and the Nadir <90 definition, respectively. The proportion of patients with frequent IDH could not reliably be established because of the wide range in cutoff values that were used to identify patients with frequent IDH. There was a large variety in the prevalence of symptoms and interventions. Major risk factors associated with IDH across studies were diabetes, a higher interdialytic weight gain, female gender, and lower body weight. Conclusion: Our meta-analysis suggests that the prevalence of IDH is lower than 12% for both the EBPG and the Nadir <90 definition which is much lower than stated in most reviews.

70 citations

Journal ArticleDOI
TL;DR: Management of older people on dialysis requires focus on the wider aspects of aging as well as dialysis, and understanding each individual's goals of care in the context of his or her life experience is particularly important in the elderly.

60 citations

Journal ArticleDOI
TL;DR: It is demonstrated that renal dysfunction (eGFR) is independently associated with the severity of PVH but not SDWMH in patients with acute ischemic stroke.
Abstract: Previous studies suggested the potential interactions between cerebrovascular diseases and impaired renal function. However, the relationship between renal function and white matter hyperintensity (WMH), marker of cerebral small vessel disease, in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) remains unknown. We consecutively enrolled 1632 subjects with AIS or TIA who underwent brain MRI for this analysis. The severity of WMH in both of periventricular (PVH) and deep subcortical white matter (SDWMH) was evaluated using Fazekas scale. Estimated glomerular filtration rate (eGFR) was calculated by the equation of the Modification Diet for Renal Disease. Multinomial logistic regression was performed to evaluate the association between the severity of WMH and eGFR. Advanced age and hypertension were independently associated with the severity of both PVH and SDWMH (all p < 0.001). There is a significantly inverse association between eGFR and PVH. Patients having each 30 ml/min/1.73 m2 increase in eGFR was associated with 75 % of risk of having degree 3 of WMH in periventricular areas compared with degree 0 (p = 0.04, OR = 0.75, 95 % CI 0.61–0.92). However this inverse association was not found between eGFR and SDWMH (P = 0.50, OR = 0.93, 95 % CI0.75–1.14). Our study demonstrates that renal dysfunction (eGFR) is independently associated with the severity of PVH but not SDWMH in patients with acute ischemic stroke. This results highlighted different pathological mechanism and risk factors of PVH and SDWMH.

18 citations

Journal ArticleDOI
TL;DR: The current body of evidence on the effectiveness of using low dialysate temperatures for prevention of IDH in ESRD patients is detailed, and areas where further research is needed are suggested.
Abstract: Abnormal decreases in blood pressure during hemodialysis are frequent in end stage renal disease (ESRD) patients treated with hemodialysis, and thought to be largely due to an inadequate cardiovascular response to the rapid blood volume decline. Intradialytic hypotension (IDH) and cardiac instability during dialysis can increase risks for negative health consequences and is possibly preventable though several types of interventions. One intervention that holds promise for prevention of IDH in hemodialysis patients is to reduce the temperature of the dialysate to or below the patient's core temperature. A considerable number of randomized studies have demonstrated a short term benefit of using a cooler dialysate temperature for the prevention of IDH and improved cardiac stability. Despite this, a key observational study was not able to show long term improvements with lower dialysate temperatures utilized in routine clinical practice, albeit possibly confounded by indication. It appears that cooling the dialysate may be reasonable to consider on an individual basis for patients who suffer from persistent IDH if they can tolerate the adjustment and it is effective. However, careful assessment of the etiology of IDH should be performed when considering treatment options. In this review, we detail the current body of evidence on the effectiveness of using low dialysate temperatures for prevention of IDH in ESRD patients, and suggest areas where further research is needed.

16 citations

Journal ArticleDOI
TL;DR: The high occurrence of hypotension-related events demonstrates that ultrafiltration treatment goals in satellite dialysis clinics are sometimes overestimated, resulting in regular significant symptomatic episodes for the patient.
Abstract: Aims and objectives To measure the prevalence of symptomatic (S-IDH) and asymptomatic intradialytic hypotension (A-IDH) or postdialysis overhydration in a satellite haemodialysis clinic in Western Australia. Background Intradialytic hypotension is one of the most common side effects of haemodialysis caused by ultrafiltration provoking a temporary volume depletion. The prevalence of asymptomatic hypotension during dialysis has been rarely reported, but is considered to have the same negative consequences as symptomatic hypotension on various end organs like the brain and the gastrointestinal tract. Design Observational study on a retrospective 3-month period of nursing recorded fluid-related adverse events. Methods Data collection on the occurrence of S-IDH and A-IDH during a total of 2,357 haemodialysis treatments in 64 patients. Body weight of patients at the time of cessation of treatment was recorded, and patients, whose weight exceeded their ideal body weight by at least 0.5 kg, were classified as overhydrated. Data analysis was performed using spss version 24 software. Results Symptomatic intradialytic hypotension was the most common adverse event measured in this cohort, and occurred during 221 (9.4%) of all treatments, whereas asymptomatic intradialytic hypotension occurred in 88 (3.7%) of all treatments. The total occurrence of intradialytic hypotension was 13.1%, and symptomatic was observed in 30 patients, implying that nearly every second patient had at least one symptomatic episode within 3 months. Overhydration occurred in a total of 103 (4.4%) of all treatments, and involved 17 patients. Conclusions Symptomatic and asymptomatic intradialytic hypotension were the most commonly observed adverse events in this cohort; overhydration occurrence was considerably less common. Relevance to clinical practice The high occurrence of hypotension-related events demonstrates that ultrafiltration treatment goals in satellite dialysis clinics are sometimes overestimated, resulting in regular significant symptomatic episodes for the patient. Raising the awareness of the prevalence of IDH amongst renal nurses could be an essential initial step before collectively preventative strategies in haemodialysis satellite units are implemented.

9 citations