Keyword: Diabetes

ABSTRACT: Background: Intradialytic hypotension (IDH) is one of the most common complications of hemodialysis and may manifest as weakness, dizziness, syncope, and poor tolerance of treatment. The risk is increased in elderly patients and those with diabetes mellitus or cardiovascular disease. A key mechanism is an imbalance between ultrafiltration rate and plasma refilling of the intravascular compartment. We present a case of recurrent IDH in a high-risk patient with stage 5 chronic kidney disease (CKD), type 2 diabetes mellitus, and hypertensive heart and kidney disease.Case Presentation
A female patient, born in 1952, had stage 5 CKD (N18.5), extracorporeal dialysis (Z49.1), anemia in chronic disease (D63.8), type 2 diabetes mellitus (E11), and hypertensive heart and kidney disease (I13). Diabetes mellitus had been diagnosed in 2010, with longstanding arterial hypertension.
On December 15, 2022, following a fall and osteosynthesis of the right femur, serum creatinine was 481 μmol/L and blood urea 29.1 mmol/L. Repeat testing showed creatinine 505 μmol/L and urea 32 mmol/L. A double-lumen catheter was placed and renal replacement therapy initiated. On February 27, 2023, an arteriovenous fistula was created. The patient subsequently continued maintenance hemodialysis at Fresenius Medical Care Kazakhstan LLP, Talgar.
Baseline blood pressure was 160/90 mmHg. During every hemodialysis session, approximately 30 minutes after initiation, blood pressure decreased to 80/50 mmHg without adjustment of dialysis parameters.
Management included individualized dialysis prescription. Dry weight was assessed by bioimpedance spectroscopy (BCM), with adjustment of ultrafiltration volume and rate. Dialysate temperature was reduced to 35.5–36.5°C. Dialysate sodium, potassium, and calcium concentrations were 138, 3, and 1.5 mmol/L, respectively. Ultrafiltration profiling was used when fluid overload exceeded 3% of body weight. During hypotensive episodes, the patient was placed in the Trendelenburg position with elevated lower extremities, and ultrafiltration and dialysis parameters were adjusted. AF81 dialysate was used.
Following optimization, intradialytic blood pressure remained approximately 100/60–120/70 mmHg without significant hypotensive episodes. Post-dialysis blood pressure was 130/80 mmHg. Treatment tolerance improved, with clinical observations indicating improved quality of life.
Conclusion: Individualized hemodialysis prescription, including accurate dry-weight assessment, optimized ultrafiltration, reduced dialysate temperature, appropriate dialysate composition, ultrafiltration profiling, timely Trendelenburg positioning, and regular blood pressure monitoring, contributed to improved hemodynamic stability and reduced IDH severity in this high-risk patient.

ABSTRACT: Background: Patients with type 2 diabetes mellitus (T2DM) on maintenance hemodialysis represent one of the highest-risk populations in nephrology practice. End-stage kidney disease (ESKD) and T2DM create a state of profound immunosuppression that predisposes patients to life-threatening infections.
Central venous catheters (CVCs), frequently required for hemodialysis access, are a well-recognized gateway for bacteremia. When bacteremia is complicated by coagulopathy, the clinical course can rapidly evolve toward disseminated intravascular coagulation (DIC).
Case Presentation: A 58-year-old woman was admitted with a 3-day history of nausea, vomiting, and body pain. Examination revealed anasarca, lower-extremity purpura, and petechial rash, with concern for coagulopathy. T2DM diagnosed in 2007 and ESKD on maintenance hemodialysis since October 2025 (three 4-hour sessions weekly). Vascular access was a right internal jugular CVC.
On admission, hemoglobin 62 g/L, RBC 2.02 ×10¹²/L, platelets 93 ×10⁹/L, WBC 11.18 ×10⁹/L, glucose 24.28 mmol/L, total protein 63 g/L, D-dimer 2,680 ng/mL, procalcitonin (PCT) 14.8 ng/mL, creatinine 405 μmol/L, urea 13.9 mmol/L, INR 1.46, Prothrombin Index 66%, fibrinogen 4.0 g/L, APTT 28.2 sec. Antibiotics had been started at home without improvement. In hospital, broad-spectrum therapy was escalated to a carbapenem plus a fluoroquinolone, with packed red blood cell and fresh frozen plasma transfusions. Hemoglobin increased to 87 g/L, PCT decreased to 1.78 ng/mL, and D-dimer to 1,178 ng/mL; thrombocytopenia persisted. After treatment, creatinine 592 μmol/L, urea 20.7 mmol/L, glucose 16.55 mmol/L, albumin 26 g/L, total protein 53 g/L, INR 1.39, Prothrombin Index 69%, fibrinogen 7.55 g/L, APTT 25.4 sec.
On days 5–6, livedo reticularis, worsening dyspnea, and persistent coagulopathy prompted chest MSCT. It revealed bilateral peribronchial foci with formed cavities, consistent with abscessing (necrotizing) pneumonia. The bilateral cavitary pattern suggested hematogenous dissemination, likely from the indwelling CVC. Patient transferred to the ICU with sepsis-associated DIC.
Linezolid 600 mg IV twice a day was added to provide coverage for possible methicillin-resistant Staphylococcus aureus and other gram-positive organisms. Following treatment escalation, hemoglobin reached 118 g/L, PCT decreased to 0.9 ng/mL, INR normalized to 0.92, and Prothrombin Index increased to 117%.
Conclusion: CVC-related bacteremia should be considered early in hemodialysis patients with unexplained coagulopathy or bilateral pulmonary infiltrates. Purpura followed by livedo reticularis may indicate DIC progression and should prompt urgent reassessment. Cavitation despite antibiotics signals treatment failure and need to reassess pathogen coverage, including biofilm-forming gram-positive organisms. T2DM and ESKD create a multiplicative immunocompromised state, requiring multimodal management and glycemic control.

ABSTRACT: Background: To evaluate diabetic kidney disease (DKD) knowledge, attitudes, and practices (KAP) among adults with type 2 diabetes (T2D) in southern Kyrgyzstan.
Methods: A cross-sectional survey assessed DKD KAP among adults with T2D recruited from public healthcare facilities in Osh, Kyrgyzstan. We used a structured questionnaire guided by the Health Belief Model and the Health Locus of Control. We used multiple linear regression models to examine factors associated with KAP scores.
Results: A total of 207 adults participated (mean age 61.0 ± 10.7 years; 61.4% female). Although 91.3% identified healthcare workers as their most trusted information source, only 49.3% reported receiving DKD-related information from a healthcare provider. Only 13.5% recognized that early kidney damage does not cause pain. Despite generally positive attitudes towards kidney protective behaviors, 72.9% of participants reported low personal control over their health outcomes. In adjusted models, prior receipt of provider DKD information was the sole factor consistently associated with higher knowledge (β = 1.25, 95% CI 0.43–2.08, p = 0.003), attitudes (β = 3.11, 95% CI 1.61–4.61, p < 0.001), and practices (β = 3.99, 95% CI 2.26–5.71, p < 0.001).
Conclusion: Adults with T2D in southern Kyrgyzstan experience significant knowledge gaps and misconceptions regarding kidney protection, despite high trust and willingness to learn from healthcare providers. Prior provider-delivered information was associated with better practices, highlighting the need for structured DKD counseling that explicitly addresses misconceptions and aligns health messages with local beliefs to strengthen self-efficacy.

ABSTRACT: Background: Chronic kidney disease (CKD) is an increasing global health concern and a major contributor to cardiovascular morbidity and mortality. Although its global prevalence is estimated at about 13%, data from Central Asia are limited.
Objective: To assess the prevalence, structure, and key determinants of CKD among adults in the Kyrgyz Republic.
Methods: A population-based cross-sectional study was conducted among adults aged ≥18 years across different regions. CKD was defined according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m² and/or a urinary albumin-to-creatinine ratio (UACR) ≥30 mg/g. Disease severity was staged by eGFR and albuminuria categories. Logistic regression identified independent predictors of CKD.
Results: The overall CKD prevalence was 10.8%, comparable to global estimates. Prevalence increased with age, reaching 25.0% among participants ≥70 years, of whom 64.3% had reduced kidney function. CKD was more common in women than in men (p<0.001). Major etiologic factors included diabetes mellitus (29%), chronic glomerulonephritis (23%), chronic pyelonephritis (17%), and hypertension (10%). In multivariable analysis, diabetes, hypertension, dyslipidemia, obesity (BMI ≥30), and rural residence were independent predictors of CKD (p<0.05).
Conclusion: CKD is highly prevalent among adults in the Kyrgyz Republic. Risk factors align with international data, but regional patterns show higher rates of chronic glomerulonephritis and pyelonephritis. Strengthening early detection, integrating CKD screening into national health programs, and focusing on high-risk groups—older adults, women, and rural populations—are crucial to reducing the CKD burden in Kyrgyzstan.

ABSTRACT: Diabetic kidney disease (DKD) is a major complication of diabetes mellitus and the leading cause of end-stage renal disease (ESRD) worldwide. Despite considerable research efforts, the pathogenesis of DKD remains incompletely understood, largely due to its multifactorial etiology and pronounced phenotypic heterogeneity. Genome-wide association studies (GWAS) have identified over 40 loci associated with DKD; however, these common variants collectively explain only a small fraction of the disease’s heritability. Rare and low-frequency variants, often undetected by GWAS, are increasingly recognized as important contributors, and next-generation sequencing (NGS) technologies offer valuable tools for their identification. Kazakhstan, characterized by a unique genetic landscape and substantial ethnic admixture, remains underrepresented in DKD genomics research. Expanding integrative, high-resolution genomic studies in such settings is essential for identifying population-specific risk variants, improving diagnostic accuracy, and advancing precision medicine approaches to DKD prevention and management.