Retinal Neuronal Changes and Kidney Dysfunction in Diabetes Mellitus.

Background: Diabetic kidney disease (DKD) and diabetic retinopathy (DR) share common microvascular pathophysiology, yet the relationship between retinal neuronal alterations and kidney dysfunction remains unclear. This cross-sectional study examines the association between individual retinal layer thickness and kidney indicators to identify novel optical coherence tomography (OCT) biomarkers for DKD.

Methods: A total of 410 type 2 diabetes (T2D) patients (815 eyes) were recruited from the outpatient clinics of a tertiary eye centre in Singapore.

Impact of the 2021 Chronic Kidney Disease Epidemiology Collaboration glomerular filtration rate estimating equation on risk of healthcare utilization for hospitalizations for cardiovascular and kidney disease.

Aim Reduced kidney function is a known risk amplifier for atherosclerotic cardiovascular disease (ASCVD) and adverse kidney events. Accurate assessment of kidney function using estimated glomerular filtration rate (eGFR) is therefore essential for evaluating ASCVD risk and kidney prognosis. We aimed to compare the revised 2021 Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) [2021-eGFRcr(AS)] and European Kidney Function Consortium (EKFCcr) with the 2009 CKD-EPI [2009-eGFRcr(ASR)] equations in predicting the risk of hospitalizations for acute myocardial infarction (AMI), acute kidney disease (AKD) and chronic kidney disease (CKD) in a multi-ethnic Asian cohort.

Patient and Health Care Provider Perspectives of Cognitive Difficulties in Dialysis.

Introduction: Cognitive impairments (CIs) are common among patients on dialysis, compromising functional capacity, decision-making, and quality of life. Previous work is dominated by quantitative studies, leaving the everyday experience of these impairments and their practical implications poorly understood. This qualitative study explored patients' and providers' perspectives on the lived experience of cognitive difficulties, impacts on daily living and care delivery, and associated needs.

Hospital Readmissions for All-Causes and Fluid Overload in Severely Reduced Kidney Function Not Requiring Dialysis-A Retrospective Cohort Study.

Aim: Chronic kidney disease is associated with frequent readmissions for ambulatory-sensitive conditions such as fluid overload. There is a paucity of literature to identify individuals at high risk of fluid overload or all-cause readmissions.

Methods: We performed a single-centre retrospective cohort study involving 783 patients with an estimated glomerular filtration rate of 11-30 mL/min/1.

Inside CKD: Cost-Effectiveness of Multinational Screening for CKD.

Introduction: Early detection of chronic kidney disease (CKD) could slow its progression; however, most patients in earlier stages remain undiagnosed. Our study objective was to assess the cost-effectiveness of multinational CKD screening strategies from the payer perspective across general and higher-risk populations.

Methods: Using the published Inside CKD microsimulation, we projected virtual closed populations to assess CKD screening strategies in 31 countries or regions over a lifetime horizon.

Artificial intelligence in chronic kidney disease management: a scoping review.

Chronic kidney disease (CKD) is a major public health problem worldwide associated with cardiovascular disease, renal failure, and mortality. To effectively address this growing burden, innovative solutions to management are urgently required. We conducted a scoping review to identify key use cases in which artificial intelligence (AI) could be leveraged for improving management of CKD.

Development of a rapid screener through network analysis to identify central cognitive complaints in haemodialysis patients: a cross-sectional study.

Objectives: Cognitive impairments and cognitive complaints are commonly present in dialysis patients and can affect clinical, functional, occupational, and psychosocial well-being. It is important to screen for patients' cognitive status as it offers a gateway to specialty referral, prevention or rehabilitation programmes, and personalisation of clinical care. The Patient's Assessment of Own Functioning Inventory (PAOFI) is a comprehensive questionnaire that assesses patient-reported difficulties in memory, language, motor/sensory-perceptual skills and higher-level cognitive function.

The Cost and Outcomes of Using Multidisciplinary Care Program in the Care of Adult Patients with Advanced Chronic Kidney Disease.

Objective: The aim of the study was to compare the direct healthcare cost and outcomes of a multidisciplinary care (MDC) program versus usual care for patients with advanced chronic kidney disease (CKD) in Singapore.

Methods: A retrospective study of patients with an estimated glomerular filtration rate (eGFR) less than 20 mL/min/1.73 m2, attending the MDC program or the usual care clinic in a tertiary hospital from 2016 to 2019.

Clinical Implementation of Nephrologist-Led Genomic Testing for Glomerular Diseases in Singapore: Rationale and Protocol.

Introduction: The early diagnosis and appropriate treatment of monogenic glomerular diseases can reduce kidney failure, avoid unnecessary investigations such as kidney biopsies and ineffective treatment with immunosuppressants, guide transplant decisions, and inform the genetic risks of their family members. Yet, genetic testing for kidney disease is underutilized in Singapore. We aimed to implement a nephrologist-led genetic service and evaluate the acceptance, adoption, utility, and cost-effectiveness of genetic testing for monogenic glomerular disease in Singapore.

Screening for cognitive symptoms in dialysis patients with an extended version of Kidney Disease Quality of Life Cognitive Function subscale (KDQOL-CF): a validation study.

Background: Cognitive impairment and cognitive complaints are highly prevalent in haemodialysis patients and are associated with adverse health outcomes. Currently, there is no established guideline on cognitive screening in this population. Although neuropsychological tests are the gold standard measure of cognition, they are time-consuming and require trained personnel.

Structural equation modelling of the role of cognition in functional interference and treatment nonadherence among haemodialysis patients.

Background And Objectives: Cognitive impairment is common in haemodialysis patients and associated with adverse health outcomes. This may be due to cognitive impairments interfering with daily functioning and self-care, but evidence is limited. This cross-sectional study aims to explore the interrelationships between cognition and functional outcomes in haemodialysis patients.

AL amyloidosis: Singapore Myeloma Study Group consensus guidelines on diagnosis, treatment and management.

AL amyloidosis is the most common form of systemic amyloidosis. However, the non-specific nature of presenting symptoms requires the need for a heightened clinical suspicion to detect unexplained manifestations in the appropriate clinical setting. Early detection and treatment are crucial as the degree of cardiac involvement emerges as a primary prognostic predictor of survival in a patient with AL amyloidosis.

Exploring the Cognitive Profiles of Haemodialysis Patients using Objective and Subjective Indicators: A Cross-sectional Observational Study.

Background: Cognitive impairment is common in haemodialysis patients and associated with adverse health outcomes. Previous work focused primarily on neuropsychological tests, the gold standard measure of cognition. However, these tests reflect performance under optimal conditions rather than performance in everyday life.

Patient education interventions for haemodialysis and peritoneal dialysis catheter care: An integrative review.

Background: Inadequate training on how to care for haemodialysis and peritoneal dialysis catheters can lead to mechanical issues with the catheters and infectious complications (such as peritonitis) that could endanger patient safety, reduce the effectiveness of the dialysis treatment, and have a negative impact on patient morbidity and mortality. Such incidents can be prevented as they are mostly dependant on controllable factors - proper dialysis catheter care, which can be addressed through effective patient education. Effective patient education is crucial in ensuring that patients are equipped with the knowledge and skills necessary for both peritoneal and haemodialysis catheter care.

Rapid point-of-care test for diagnosis of peritonitis in peritoneal dialysis patients.

Background: Periplex is a rapid point-of-care test based on the detection of interleukin-6 (IL-6) or matrix metalloproteinase-8 (MMP-8) to diagnose peritonitis in peritoneal dialysis (PD) patients.

Methods: This single-centre study was conducted in Singapore General Hospital from 2019 to 2022. The study recruited PD patients suspected of having peritonitis.

Results from a cross-specialty consensus on optimal management of patients with chronic kidney disease (CKD): from screening to complications.

Background: Chronic kidney disease (CKD) affects around 10% of the global population and has been estimated to affect around 50% of individuals with type 2 diabetes and 50% of those with heart failure. The guideline-recommended approach is to manage with disease-modifying therapies, but real-world data suggest that prescribing rates do not reflect this in practice.

Objective: To develop a cross-specialty consensus on optimal management of the patient with CKD using a modified Delphi method.

Cost-effectiveness of sodium zirconium cyclosilicate for advanced chronic kidney patients in Singapore.

Introduction: Hyperkalaemia (HK) is prevalent among patients with chronic kidney disease (CKD) and chronic heart failure, especially if they are treated with renin-angiotensin-aldosterone system inhibitors (RAASi). This study evaluated the cost-effectiveness of a newly developed anti-HK therapy, sodium zirconium cyclosilicate (SZC), to the current standard of care for treating HK in advanced CKD patients from the Singapore health system perspective.

Methods: We adapted a global microsimulation model to simulate individual patients' potassium level trajectories with baseline potassium ≥5.

Assessing caregiver burden in advanced kidney disease: protocol for a systematic review of the measurement properties of instruments and tools.

Introduction: Caregiver burden is a significant issue in the care of patients with advanced kidney disease. Its assessment is crucial for evaluating the needs of caregivers and for the development of interventions to support them. Several instruments have been developed to measure caregiver burden in these patients.

Comparative effectiveness of first-line antihypertensive drug classes on the maintenance of estimated glomerular filtration rate (eGFR) in real world primary care.

Renin-angiotensin system inhibitors (RASi), particularly angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), are commonly used in the treatment of hypertension and are recommended for kidney protection. Uncertainty remains about the effectiveness of RASi being used as first-line antihypertensive therapy on eGFR maintenance compared to its alternatives, especially for those with no or early-stage chronic kidney disease (CKD). We conducted a retrospective cohort study of 19,499 individuals (mean age 64.

Readability, Understandability, and Actionability of Online Cardiovascular Risk Assessment Tools and Patient Educational Material: A Systematic Review.

Introduction: Individuals with kidney diseases have increased risk of cardiovascular disease and death. Online cardiovascular risk assessment tools can educate patients on risks and modifiable factors. Since patients have variable health literacy, we evaluated the readability, understandability, and actionability of publicly available online cardiovascular risk assessment tools.