Pusat Pengajian Sains Perubatan - Tesis

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Browsing Pusat Pengajian Sains Perubatan - Tesis by Subject "acute kidney injury"

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    A study on patients requiring emergency hemodialysis in Hospital Universiti Sains Malaysia
    (2020)
    Rosedee, Noor Aida
    Objective: It is currently unknown whether there are differences in patients' characteristics and hemodialysis (HD) outcomes between patients who undergo emergent HD in the emergency department (ED) and non-ED setting (i.e. ward, intensive care unit (ICU) or HD unit). Therefore, this study aims to compare the clinical and non-clinical characteristics and HD outcomes between patients who underwent emergent HD at ED (“ED group”) and non-ED (“non-ED group”) settings. Methods: This is a retrospective observational study among patients admitted through the ED of a tertiary teaching hospital in Malaysia and underwent acute HD within 24 hours of admission between January 2016 till December 2017. Results: A total of 177 patients were included in the study. The bivariable analysis found that the ED group had a significantly higher proportion of new cases (i.e. no known history of HD), fluid overload cases, and refractory fluid overload indication as compared to the non-ED group. It was also found that the ED group had a higher proportion of those requiring mechanical ventilation and 60-day mortality. Hierarchical regression found that HD locations play a significant role in determining HD outcomes in terms of 60-days mortality and ICU stays. Those who underwent HD at non-ED have 0.263 (95%CI=0.096, 0.723) times lower odds of 60-day mortality but 2.946 (95%CI=1.051, 8.258) times higher odds of staying in ICU. Conclusion: There were significant differences in patients’ characteristics and HD outcomes between patients underwent HD in ED and non-ED settings. Emergent HD location may influence 60-day mortality and ICU stays. As the current study is insufficient to confidently justify the use of HD in ED settings as compared to the non-ED setting, a randomized controlled trial is needed.
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    Clinical predictors of acute kidney injury in children with acute post- streptococcal glomerulonephritis: A tertiary centre experience
    (2021)
    Yusof, Wan Adlina Wan
    Acute post-streptococcal glomerulonephritis (APSGN) in paediatric population remains the major health burden to the health care system in developing countries. Acute kidney injury (AKI) is not an uncommon complication of APSGN. This study aimed to look at the prevalence and predictors of AKI, and the median time of AKI resolution among APSGN children. Methods: An 11-year retrospective review of medical records of patients with APSGN aged between 12 months to 18 years old admitted at Hospital Universiti Sains Malaysia (Hospital USM) was performed. Multiple logistic regression analysis was used to identify predictors for AKI (age, gender, race, hypertension, gross haematuria and ASOT titre). Kaplan-Meier survival analysis was applied to study the median time of resolution of AKI among paediatric patients with APSGN. Results: Four hundred children were included in the study with predominantly males (n = 262 (65.5%). The prevalence of AKI in the cohort was 21.7% (n = 86) (95% CI: 17.6- 25.7). Children older than 5 years old and gross haematuria had been identified as significant predictors for AKI in APSGN (p = 0.004) and (p = 0.002), respectively. The median time of AKI resolution in APSGN patients is 18.9 (95% CI 15.3-20.7) days. Conclusion: Children older than 5 years old and the presence of gross haematuria had been demonstrated to be significant risk factors towards the development of AKI in children with APSGN