This study aims to determine the effectiveness of a phosphate mobile app (PMA), MyKidneyDiet-Phosphate Tracker ©2019, on hemodialysis (HD) patients with hyperphosphatemia. A multicenter, open-label, randomized controlled trial design allowed randomization of patients with hyperphosphatemia to either the usual care group (UG; receiving a single dietitian-led session with an education booklet) or the PMA group (PG). Thirty-three patients in each intervention group completed the 12-week study. Post-intervention, serum phosphorus levels were reduced in both groups (PG: −0.25 ± 0.42 mmol/L, p = 0.001; UG: −0.23 ± 0.33 mmol/L, p < 0.001) without any treatment difference (p > 0.05). Patients in both groups increased their phosphate knowledge (PG: 2.18 ± 3.40, p = 0.001; UG: 2.50 ± 4.50, p = 0.003), without any treatment difference (p > 0.05). Dietary phosphorus intake of both groups was reduced (PG: −188.1 ± 161.3 mg/d, p < 0.001; UG: −266.0 ± 193.3 mg/d, p < 0.001), without any treatment difference (p > 0.05). The serum calcium levels of patients in the UG group increased significantly (0.09 ± 0.20 mmol/L, p = 0.013) but not for the PG group (−0.03 ± 0.13 mmol/L, p = 0.386), and the treatment difference was significant (p = 0.007). As per phosphate binder adherence, both groups reported a significant increase in Morisky Medication Adherence Scale scores (PG: 1.1 ± 1.2, p < 0.001; UGa: 0.8 ± 1.5, p = 0.007), without any treatment difference (p > 0.05). HD patients with hyperphosphatemia using the PMA achieved reductions in serum phosphorus levels and dietary phosphorus intakes along with improved phosphate knowledge and phosphate binder adherence that were not significantly different from a one-off dietitian intervention. However, binder dose adjustment with meal phosphate content facilitated by the PMA allowed stability of corrected calcium levels, which was not attained by UC patients whose binder dose was fixed.

Background Carbapenem-induced neurotoxicity is an unusual side effect, with seizure being the most commonly reported symptom. Among the carbapenems, imipenem-cilastin is classically associated with the most severe neurotoxicity side effects. Carbapenem is mainly excreted by the kidney and its half-life is significantly increased in patients with chronic kidney disease (CKD). Therefore, dose adjustment is necessary in such patients. Ertapenem-associated neurotoxicity is increasingly being reported in CKD patients, but rarely seen in patients with recommended dose adjustment. Case presentation We report a case of a 56-year-old male patient with chronic kidney disease 5 on dialysis(CKD 5D). The patient presented with a history of fever, chills and rigours during a session of haemodialysis (HD). He was diagnosed with Enterobacter cloacae catheter-related blood stream infection and was started on ertapenem. After 13 days of ertapenem, he experienced an acute confusional state and progressed to having auditory and visual hallucinations. His blood investigations and imaging results revealed no other alternative diagnosis. Hence a diagnosis of ertapenem-induced neurotoxicity was made. He had complete resolution of symptoms after 10 days’ discontinuation of ertapenem. Conclusion Our case draws attention to the risk of potentially serious toxicity of the central nervous system in HD patients who receive the current recommended dose of ertapenem. It also highlights that renal dosing in CKD 5D patients’ needs to be clinically studied to ensure antibiotic safety.

Introduction: Epidemiological data on AKI from an urban district is very limited. There is even less attention paid on the prevalence of community acquired AKI (CA-AKI) versus hospital acquired AKI (HA-AKI). Early detection and management of AKI will improve patients' outcomes and reduce the burden of disease. Objective: To study the incidence and short term outcomes of patient with CA-AKI versus HA-AKI in a district hospital. Method: A retrospective cohort study of general medical admissions to Hospital Kajang between 1st November 2016 to 31st December 2016 was conducted. Case notes of all patients were reviewed. Based on Kidney Disease: Improving Global Outcome (KDIGO) classification for AKI, the patients with serum creatinine increased 26mmol/L or more than the baseline during admission identified into CA-AKI group whereas HA-AKI was defined as the development of AKI at any time after 48 hours of hospitalization. The treatment outcomes were recorded on discharge day. Data was statistically analyzed. Result: A total of 1319 adult were admitted to general medical wards. There were 105 (56.5%) male and 81 (43.5%) female having AKI, giving a total of 186 patients. The incidence of AKI was 14.1%. Mean age of the AKI patients was 55.6 years old. In this study, 135 (72.6%) patients developed AKI in the community, whereas 51 (27.4%) patients had AKI during hospital stay. Average length of stay for CA-AKI versus HA-AKI patients was 6.8 days and 9.1 days respectively; P¼0.06. Patients with CA-AKI had lower inpatient mortality (15.6% versus 47.1% in HA-AKI group; P<0.001). Among CA-AKI patients, 76 (66%) had recovery of renal function compared to 10 (37%) patients in HA-AKI group; (P<0.01). Meanwhile, HA-AKI patient is more likely to be labeled as having de novo CKD as compared to patients with CA-AKI (63% versus 34%; P<0.005). Renal replacement therapy was done to 11 (5.9%) patients and only 19 (13%) patients had renal follow up after discharge. Conclusion: CA-AKI carries better implication in terms of development of progressive renal disease and inpatient mortality.

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