The disease burden of chronic kidney disease (CKD) and its impact on healthcare systems has been poorly studied in Asia, a socioeconomically diverse region with wide variations in availability, access, and quality of CKD care. The high CKD burden in this region is predominantly driven by an increased prevalence of risk factors including diabetes mellitus, hypertension, obesity, and use of traditional medicines and is further aggravated by challenges associated with effective implementation of population-based screening and surveillance systems in early detection and intervention of CKD. The Asian continent mostly comprised of low- and middle-income countries with resource restraints lacks robust population-based CKD registries resulting in a paucity of data on CKD incidence and prevalence, various treatment modalities, uptake of current guidelines, and the overall impact of implementation of developmental programs. There is an urgent need for a collaborative action plan between the healthcare community and governments in this region to detect CKD in its early stages and prevent its complications including kidney failure, cardiovascular disease, and death. Research- based evidence on the impact of early detection, sustainable treatment options, quality of life, delay or avoidance of dialysis, and related cost analysis is the need of the hour. We highlight successful implementation of strategic and policy-sharing programs adopted in a few countries; also, consolidate available region-specific data, quantify estimates of CKD burden and propose strategies with a multidisciplinary approach involving patients, the healthcare community and governmental bodies to combat CKD and its complications.

Introduction: This is a prospective, post marketing surveillance study that aims to determine the efficacy and safety of sevelamer carbonate in hyperphosphatemic chronic kidney disease (CKD) patients in the Philippines. Methods: Adult CKD patients with serum phosphorous levels >1.78 mmol/L and whose physician had decided to treat with sevelamer carbonate 800 mg were enrolled in the study and followed-up for a minimum of three visits from baseline within a six-month period. The primary endpoint was the change in serum phosphorous levels from baseline to the sixth month. Adverse events were noted and recorded during the treatment period. Results: There were 233 patients included in the study from five centers in Metro Manila from 2010 to 2013. Of the 233 patients, 199 were on chronic dialysis, 33 were not on dialysis, and 1 had no data. There was a statistically significant (P-value <0.0001) reduction in serum phosphorous levels from baseline after treatment with sevelamer carbonate. There were 16 patients reported to have adverse drug reactions, 13 of whom had serious adverse events (SAE) and three were non-serious. Of the 13 patients with SAEs, only one was possibly/probably related to sevelamer carbonate and all three non-SAEs were possibly/definitely related to sevelamer carbonate. Conclusion The results showed sevelamer carbonate to be effective in lowering serum phosphorous levels and the most common adverse events were related to the gastrointestinal tract (1.4%). There were sixteen patients with adverse events, three of which were non-serious, while 13 were reported to be serious adverse events. Only one was probably related to the drug.
Renal Insufficiency, Chronic ; Hyperphosphatemia ; Sevelamer

OBJECTIVE: This study aimed to assess the safety and effectiveness of subcutaneous (SC) Epoetin alfa in the treatment of Filipino patients with anemia associated with chronic renal failure.
METHODS: This is a prospective, observational, multicenter study on chronic renal failure patients with anemia for whom Epoetin alfa SC is indicated. Each patient was followed-up according to the frequency deemed appropriate by the physician for a period of 6 months. Data were collected using a case-report form which is filled-up by the investigator based on available data in the patient records. Patient characteristics were analyzed descriptively. The frequency and description of adverse events were obtained. Baseline and endstudy hemoglobin and hematocrit levels were compared inferentially. Monitoring for antibody-mediated pure red cell aplasia (PRCA) was given special focus.
RESULTS: A total of 458 patients were enrolled in the study with an average age 52.8 ± 16.9 years and a slight male predominance (57.8% male). Among patients with primary renal diseases, the most common diagnosis was chronic glumerulonephritis (31.0%), followed by diabetic nephropathy (14.4%) and hypertension (10.0%). Around two-thirds (66.2%) of the patients were on dialysis, while the rest were in the pre-dialysis stage. Most patients had concomitant disease conditions with hypertension (57.9%) and diabetes mellitus (27.1%) being the most common. Most patients also had multiple concomitant medications. Significant improvements inhemoglobin (mean increase 0.8 ± 2.3 mg/dL from 9.66 at baseline; p value at < 0.0001) and hematocrit (mean increase 2.4 ± 6.9% from 28.91% at baseline; p value at <0.0001) levels were observed. A total of 16.6% of the patients experienced non-serious adverse events, with fatigue being the most common, and all of these were resolved during the study. Less than 5% of the patients had serious adverse events leading to mortality, which were all assessed by the investigators as not related to Epoetin alfa. There was no reported suspected loss ofeffect among the subjects indicating no incident PRCA.
CONCLUSION: Subcutaneously administered Epoetin alfa was effective in significantly increasing hemoglobin and hematocrit in chronic kidney disease patients with anemia. The drug is also safe and well tolerated, with no new safety issue identified, and no incident case of PRCA.

Human ; Male ; Female ; Middle Aged ; Adult ; Anemia ; Kidney Failure, Chronic ; Diabetic Nephropathies ; Epoetin Alfa ; Hematocrit ; Hypertension ; Renal Dialysis ; Renal Insufficiency, Chronic ; Erythropoietin

INTRODUCTION: Fungal peritonitis is uncommon but important complication of continuous ambulatory peritoneal dialysis (CAPD). It accounts for 5 percent-15 percent of the total burden of peritonitis in most CAPD units. At the National Kidney and Transplant Institute (NKTI), the incidence increased from 11 percent in 1997 to 21 percent in 2000. Since this complication is associated with severe morbidity, CAPD drop-out and death, measures to decrease or prevent its occurrence are necessary.

OBJECTIVES: (l) To determine if nystatin is effective as prophylaxis for fungal peritonitis in patients with an ongoing CAPD-related bacterial peritonitis; and (2) to determine the predisposing factors for fungal peritonitis

DESIGN: Randomized single-blinded trial

SETTING: National Kidney and Transplant Institute, tertiary renal referral center in the Philippines

METHODS: From June 2001 to December 2004, newly diagnosed patients with end-stage renal disease (ESRD) on CAPD were randomized to receive nystatin as prophylaxis for fungal peritonitis during their first bacterial peritonitis episode and for all successive episodes within the next 6 months. Group 1 patients received nystatin concomitantly with the antibiotics for bacterial peritonitis while Group 2 received antibiotics alone. The incidence and the time to development of fungal peritonitis were measured. Intention-to-treat analysis was used.

RESULTS: There were 133 eligible patients, of whom 74 patients were randomized to Group 1 and 59 patients were randomized to Group 2. Eighty-three patients completed the study: 47 in Group 1 and 36 in Group 2. The cumulative incidence of developing fungal peritonitis was 10.8 percent. Group 1 had a slightly lower incidence of fungal peritonitis compared to Group 2 (10.6 percent vs 11.1 percent) but this was not statistically significant (p-1.0). Nystatin prophylaxis delayed the time to develop fungal peritonitis by 5 months but this was not statistically significant (p-0.94). Among the potential risk factors studied, only the presence of diabetes mellitus was associated with the development of fungal peritonitis.

CONCLUSION: There were no significant differences in clinical outcomes in the two treatment groups. However, there appeared to be a delay in the development of fungal peritonitis with the use of nystatin prophylaxis within the first 5 months of a bacterial peritonitis episode. (Author)

Fungal Peritonitis ; Nystatin ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis

OBJECTIVE: To demonstrate an important differential diagnosis of unilateral pleural effusion in a peritoneal dialysis patient and to review the therapeutic options for pleuroperitoneal leak to enable patients to remain on continuous ambulatory peritoneal dialysis (CAPD).

STUDY DESIGN: Case report

SETTING: National Kidney and Transplant Institute

CASE SUMMARY: This is the case of a 57-year old female with end-atage renal disease (ESRD) secondary to diabetic nephropathy, with a previous myocardial Infarction, who was started on CAPD with the onset of uremia. Although her symptoms improved after several dialysis exchanges, she later had chest pain and progressive dyspnea. She developed a right-sided transudative pleural effusion, which recurred on resumption of peritoneal dialysis (PD). Persistently poor PD fluid drainage was noted despite a change of the PD catheter. The diagnosis of hydrothorax probably due to a pleuroperitoneal leak was confirmed by peritoneal scintigraphy. With the patient's poor cardiovascular status, it was preferable that she remain on PD. Video-assisted thoracoscopic surgery (VATS) was performed, which revealed around 6 small fenestrations on the diaphragmatic surface, covered by a thin membrane 1 to 3 millimeters in diameter. Talc poudrage was done to promote adherence of the parietal and visceral pleurae, preventing fluid reaccumulation in the peural space. PD was discontinued for 4 weeks to allow adherence of the pleurae. It was resumed using gradually increasing PD fluid dwell volumes without further recurrence of hydrothorax. The patient successfully remained on ,PD.

CONCLUSION: This is the first reported case in the Philippines using VATS and talc poudrage as treatment for hydrothorax due to a pleuroperitoneal leak in a PD patient. It is an effective form of therapy with very little associated morbidity. The presence of a pleuroperitoneal leak no longer necessitates the switch provides an option for to hemodialysis (HD). It patients to remain on PD. (Author)

Human ; Middle Aged ; Thoracic Surgery, Video Assisted ; Hydrothorax ; Peritoneal Dialysis ; End-stage Renal Disease ; Peritoneal Dialysis, Continuous Ambulatory