Browsing by Author "Al-Makki, Akram"

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    Conservative Kidney Management in the Middle East and North Africa: Attitudes, Practices, and Implementation Barriers
    (Elsevier, 2025-01-16) Koubar, Sahar H.; Hatab, Taha; Razzak, Farah Abdul; Helal, Imed; Ali, Ala; Shebani, Abdulhafid; Kaysi, Saleh; Gunderman, David; Al-Makki, Akram; Davison, Sara N.; Medicine, School of Medicine
    Introduction: Conservative kidney management (CKM) is poorly developed and not easily accessible globally, especially in middle- and low-income countries. This study aimed to understand the perspectives of nephrologists on CKM and the barriers to its implementation in the Middle East and North Africa (MENA) region. Methods: We conducted an online survey. Nephrologists were contacted through their local nephrology societies. Responses were divided into the following 3 groups as per the country's income classification by the World Bank: high-, middle-, and low-income. Results: A total of 336 surveys were analyzed (response rate: 34.28%). The mean age of participants was 43.3 ± 9.8 years; 50% were male, 91% practiced in urban settings, and 18% were affiliated with academic centers. Of the participants, 76% were from middle-income countries. Nearly 80% of the participants were aware of CKM, and 65% accepted CKM as a treatment modality for kidney failure. However, only 20% consistently offered CKM to their patients and only 16% had a formal CKM program at their institution. Among these, 12% had a multidisciplinary team and only 6% had formal CKM training. The major perceived barriers to CKM implementation were financial and resource constraints (37.7% and 32.7%, respectively). Cultural and religious barriers constituted 18.3% and 8.6%, respectively, and were similar among the 3 income groups. Conclusion: Despite the significant awareness of CKM in the MENA region, its implementation remains poor. Key barriers include financial limitations, resource shortages, and a lack of training. Regional and national research is required to address these challenges and guide policies to improve CKM accessibility and implementation.
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    Hypertension Pharmacological Treatment in Adults: A World Health Organization Guideline Executive Summary
    (Wolters Kluwer, 2022) Al-Makki, Akram; DiPette, Donald; Whelton, Paul K.; Murad, M. Hassan; Mustafa, Reem A.; Acharya, Shrish; Beheiry, Hind Mamoun; Champagne, Beatriz; Connell, Kenneth; Cooney, Marie Therese; Ezeigwe, Nnenna; Gaziano, Thomas Andrew; Gidio, Agaba; Lopez-Jaramillo, Patricio; Khan, Unab I.; Kumarapeli, Vindya; Moran, Andrew E.; Silwimba, Margaret Mswema; Rayner, Brian; Sukonthasan, Apichard; Yu, Jing; Saraffzadegan, Nizal; Reddy, K. Srinath; Khan, Taskeen; Medicine, School of Medicine
    Hypertension is a major cause of cardiovascular disease and deaths worldwide especially in low- and middle-income countries. Despite the availability of safe, well-tolerated, and cost-effective blood pressure (BP)-lowering therapies, <14% of adults with hypertension have BP controlled to a systolic/diastolic BP <140/90 mm Hg. We report new hypertension treatment guidelines, developed in accordance with the World Health Organization Handbook for Guideline Development. Overviews of reviews of the evidence were conducted and summary tables were developed according to the Grading of Recommendations, Assessment, Development, and Evaluations approach. In these guidelines, the World Health Organization provides the most current and relevant evidence-based guidance for the pharmacological treatment of nonpregnant adults with hypertension. The recommendations pertain to adults with an accurate diagnosis of hypertension who have already received lifestyle modification counseling. The guidelines recommend BP threshold to initiate pharmacological therapy, BP treatment targets, intervals for follow-up visits, and best use of health care workers in the management of hypertension. The guidelines provide guidance for choice of monotherapy or dual therapy, treatment with single pill combination medications, and use of treatment algorithms for hypertension management. Strength of the recommendations was guided by the quality of the underlying evidence; the tradeoffs between desirable and undesirable effects; patient’s values, resource considerations and cost-effectiveness; health equity; acceptability, and feasibility consideration of different treatment options. The goal of the guideline is to facilitate standard approaches to pharmacological treatment and management of hypertension which, if widely implemented, will increase the hypertension control rate world-wide.
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    Neutropenic fever in COVID-19 in kidney transplant patient
    (Wiley, 2021-01) Al-Makki, Akram; Taber, Tim; Medicine, School of Medicine