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Early application of a novel, intermittent pneumatic compression device may be successful in preparing forearm veins in Stage 4 CRF patients. The early study results of the FACT trial show statistical significance in vein size improvement, distensibility, and clinical effectiveness to reach predetermined size goals.

BACKGROUND: Chronic kidney disease (CKD) is a global health burden in the world. One of the complications of CKD is proteinuria. Candesartan is a drug that is often used in CKD patients to improve proteinuria. There are several studies that suggest that using a higher dose of candesartan can further improve its effectiveness in reducing proteinuria in CKD patient AIM: This paper is aimed to review the effectiveness and safety at a supramaximal dose of 64 mg to a dose of 16 mg of candesartan. METHODS: We performed a literature search using PubMed, SCOPUS, EuropePMC, ProQuest, and Cochrane Central Databases using these keywords: “candesartan” and “16 mg” and “64 mg” or “proteinuria renal disease” or “albuminuria” and “blood pressure” that were published within the year of 1980–2021. Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) protocol were used to conduct this meta-analysis. We included randomized controlled trials, prospective cohort, retrospective or clinical observational evaluating the effect of candesartan in 16 mg or 64 mg in proteinuria renal disease patients regardless of clinical status. Non-randomized, controlled trials reporting efficacy were included if these trials were in the scope of our topic. Duplicate studies were excluded. Dichotomous variables were analyzed with the Mantel-Haenszel statistical method using risk ratio as the summary statistic and reported with 95% confidence intervals (CIs). RESULTS: Forty-six studies were initially generated using our search keyword. After applying inclusion and exclusion criteria, we included two studies in our analysis. Our pooled analysis found that candesartan 16mg dosage administration, compared to 64mg, was not associated with proteinuria reduction (std mean diff: −10.92 [95% CI: −40.09–18.26], p = 0.46). CONCLUSION: Candesartan supramaximal dosage 64 mg did not differ significantly in proteinuria reduction and blood pressure reduction against candesartan 16 mg. More studies are needed to determine this efficacy and safety.

BACKGROUND: Malnutrition in chronic kidney disease (CKD) patients undergoing hemodialysis (HD) interferes with the natural and adaptive immune response, consequently, increasing the latent tuberculosis (TB) reactivation. AIM: This study therefore aims to determine the relationship between nutritional status and latent TB in routine HD, using interferon gamma release assays (IGRA), to screen for latent TB. METHODS AND STUDY DESIGN: This study has an analytical observation cross-sectional design, and was conducted on 120 CKD-HD patients aged 18 years and above, and has been undergoing HD twice weekly for over 3 months, without malignancy, human immunodeficiency virus/acquired immunodeficiency syndrome, history of TB, or radiological evidence at the HD Unit of the Dr. Hasan Sadikin Hospital, Bandung, Indonesia, between March and May 2020, and not currently receiving immunosuppressant or TB therapy. In addition, the age, gender, history of Bacille Calmette-Guerin vaccine, CKD etiology, length of HD, HD adequacy, TB contact history, number of family members, smoking status, body mass index, albumin, malnutrition inflammation score, triceps skinfold thickness (TST), biceps skinfold thickness, suprailiac skinfold thickness (SIST), mid-upper arm circumference (MAC), and normalized protein catabolic rate between positive and negative IGRA groups, of each patient, were determined. RESULTS: In this study, all the patients met the inclusion and exclusion criteria. Based on the IGRA test, 47 patients (39.17%) tested positive, and 68 (56.67%) tested negative, while the results for the remaining 5 (4.16%) were indeterminate. The malnutrition inflammation score (MIS) score with positive IGRA 23.3 (20.0–26.7) was discovered to differ insignificantly (p value of 0.252) from the negative counterpart 20.0 (16.7–28.4). Meanwhile, in the HD adequacy assessment based on urea reduction rate, a statistically significant difference (p = 0.042) occurred between the positive 70.45 (65.70–76.61) and negative 74.15 (70.71–77.33) IGRA groups. In the smoking status, the positive and negative IGRA were discovered to differ significantly (30 (63.8% vs. 28 (41.2% p = 0.017) OR 2.521 (1.172–5.425). However, in the history of contact with TB patients, the positive and negative IGRA did not differ significantly (4.3% vs. 11.8% p = 0.160). Furthermore, there was a significant difference in TST and MAC, between MIS >5 and MIS ≤5 (p < 0.05). CONCLUSION: The assessment of nutritional status level, TST, MAC, smoking status, and adequate HD is crucial for CKD patients with routine HD, as these factors present risks of latent TB.