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- Department of Medicine, Division of Nephrology, Hamad Medical Corporation, Doha, Qatar. E-mail: [email protected]; ORCID: (0000-0003-4677-7686) [1]
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- Division of Nephrology, Department of Medicine, Hamad General Hospital, Doha, Qatar E-mail: [email protected] [1]
- Division of Nephrology, Department of Medicine, Hamad General Hospital, Doha, Qatar Email: [email protected] [1]
- Division of Nephrology, Department of Medicine, Hamad General Hospital, Doha, Qatar Email: [email protected] [1]
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar [1]
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- Weill Cornell Medicine, Doha, Qatar [1]
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Atypical Anti-Glomerular Basement Membrane Disease With Diffuse Crescentic Membranoproliferative Glomerulonephritis: Case Report and Review of Literature
Anti-glomerular basement membrane (anti-GBM) disease occurs in fewer than two cases per million population. Patients usually present with features of rapidly progressive glomerulonephritis (RPGN) with or without pulmonary involvement. Anti-GBM disease is classically diagnosed by both demonstrating GBM linear immunofluorescence staining on kidney biopsy and detecting anti-GBM antibodies in serum. More than 90% of patients with anti-GBM disease either become dialysis-dependent or die if left untreated.
Here we report a 37-year-old man who presented with bilateral lower limb edema hypertension acute kidney injury (creatinine of 212 μmol/L) microscopic hematuria and nephrotic range proteinuria (15 g/day). His kidney biopsy showed diffuse crescentic membranoproliferative glomerulonephritis and bright linear staining of GBM by immunoglobulin G consistent with anti-GBM disease; however serum anti-GBM antibodies were negative. The patient was diagnosed with atypical anti-GBM disease and treated aggressively with intravenous pulse steroids plasmapheresis oral cyclophosphamide and oral prednisolone with significant improvement in kidney function and proteinuria.
Atypical anti-GBM disease should be considered in patients presenting with RPGN even in the absence of serum anti-GBM antibodies. Early diagnosis and aggressive treatment in such cases are warranted to prevent irreversible kidney damage as the course of the disease might not be as benign as previously thought.
National response to the COVID-19 Omicron variant crisis in the ambulatory hemodialysis service in the State of Qatar
The coronavirus disease (COVID-19) pandemic has had a significant worldwide impact since its emergence in 2019. End-stage kidney disease patients have been among the most vulnerable population affected and have a higher risk of acquiring infection and developing more severe disease. We have encountered three major COVID-19 waves in Qatar and they have required different strategies to overcome. The most recent wave was due to the Omicron variant characterized by higher transmissibility. The monthly incidence of COVID-19 infection during the Omicron wave in patients with end-stage renal disease peaked at 256 patients compared to 35 and 39 patients during the first and second waves respectively. In addition more than one-third of our dialysis staff became infected during this wave. Unlike the previous two waves COVID-19 due to the Omicron variant was less severe with only 5% of hemodialysis patients requiring admission to the intensive care unit compared to 25% during the previous waves. The Omicron variant wave resulted in a crisis in our country due to the high number of non-hospitalized COVID-19 hemodialysis patients and the severe staff shortage. Several measures were taken to overcome the crisis such as designating one facility to dialyze all COVID-19 ambulatory patients reducing dialysis sessions to 3 hours and introducing a fourth dialysis shift.
This article describes the challenges we faced in the ambulatory hemodialysis service during the Omicron wave and the measures taken in the COVID-19 and non-COVID-19 designated facilities to combat the crisis.
Time-Series Forecasting of Hemodialysis Population in the State of Qatar by 2030
Background: There are few statistics on dialysis-dependent individuals with end-stage kidney disease (ESKD) in Qatar. Having access to this information can aid in better understanding the dialysis development model aiding higher-level services in future planning. In order to give data for creating preventive efforts we thus propose a time-series with a definitive endogenous model to predict ESKD patients requiring dialysis.
Methods: In this study we used four mathematical equations linear exponential logarithmic decimal and polynomial regression to make predictions using historical data from 2012 to 2021. These equations were evaluated based on time-series analysis and their prediction performance was assessed using the mean absolute percentage error (MAPE) coefficient of determination (R2) and mean absolute deviation (MAD). Because it remained largely steady for the population at risk of ESKD in this investigation we did not consider the population growth factor to be changeable. (FIFA World Cup 2022 preparation workforce associated growth was in healthy and young workers that did not influence ESKD prevalence).
Result: The polynomial has a high R2 of 0.99 and is consequently the best match for the prevalence dialysis data according to numerical findings. Thus the MAPE is 2.28 and the MAD is 9.87% revealing a small prediction error with good accuracy and variability. The polynomial algorithm is the simplest and best-calculated projection model according to these results. The number of dialysis patients in Qatar is anticipated to increase to 1037 (95% CI 974–1126) in 2022 1245 (95% CI 911–1518) in 2025 and 1611 (95% CI 1378–1954) in 2030 with a 5.67% average yearly percentage change between 2022 and 2030.
Conclusion: Our research offers straightforward and precise mathematical models for predicting the number of patients in Qatar who will require dialysis in the future. We discovered that the polynomial technique outperformed other methods. Future planning for the need for dialysis services can benefit from this forecasting.