Clinical Focus

  • Fellow

Professional Education

  • Residency, NYC Health + Hospitals - Lincoln Medical Center, Internal Medicine (2026)
  • MD, St. Luke's Medical Center College of Medicine - William H. Quasha Memorial (2021)
  • BS, University of the Philippines - Manila, Biology (2016)

All Publications

  • Peritoneal dialysis results in similar outcomes to extracorporeal dialysis in acute kidney injury: A systematic review and meta-analysis. Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis Menghrajani, R. H., Almanzar, M. C., Matabang, M. A., Faroog, S., Placino, S., Sinha, A., Aparece, J. P., Shah, A. D. 2026: 8968608261448781

    Abstract

    BackgroundThe choice of kidney replacement therapy (KRT) modality for treatment of dialysis requiring acute kidney injury (AKI-D) is underappreciated as a modifiable factor that can impact outcomes. Peritoneal dialysis (PD) and extracorporeal dialysis are both established modalities for treatment of kidney failure; their comparative effectiveness in AKI remains controversial. We conducted a systematic review and meta-analysis to compare clinical outcomes between PD and extracorporeal dialysis in patients with AKI.MethodsWe systematically searched Medline, Embase, and Cochrane Central Register of Controlled Trials from inception through November 2024 for randomized controlled trials comparing PD with extracorporeal dialysis in adult patients with AKI requiring KRT. The primary outcome was mortality. Secondary outcomes included kidney function recovery, time to kidney function recovery, and infectious complications. We conducted meta-analyses using random-effects models and assessed risk of bias using the Cochrane Risk of Bias tool 2.0.ResultsAbout 358 records were identified, of which 7 were included in quantitative meta-analysis. We found no significant difference in mortality between PD and extracorporeal dialysis (odds ratio [OR] 1.05; 95% confidence interval [CI], 0.62-1.76; p = 0.87). Event rates were similar between groups (PD: 56.1%, extracorporeal: 56.5%). Kidney function recovery rates were comparable (OR 1.26; 95% CI, 0.81-1.95; p = 0.30), though time to kidney function recovery was significantly shorter with PD (mean difference -3.34 days, 95% CI -3.95 to -2.73, p < 0.00001). Infection rates were similar between modalities (OR 1.02, 95% CI 0.47-2.22, p = 0.96).ConclusionThis meta-analysis demonstrates comparable clinical outcomes between PD and extracorporeal dialysis for AKI management across key metrics including mortality, kidney function recovery, and infectious complications. PD was associated with faster time to kidney function recovery. These findings support the use of PD as an equally effective treatment for AKI-D. Further research is needed to evaluate patient-reported outcomes and patient modality preference.

    View details for DOI 10.1177/08968608261448781

    View details for PubMedID 42101465

  • Technological Solutions to Improve Inpatient Handover in the Era of Artificial Intelligence: Scoping Review. Journal of medical Internet research Agha-Mir-Salim, L., Alberto, I. R., Alberto, N. R., Celi, L. A., Alfonso, P. G., Hicklen, R., Legaspi, K., Menghrajani, R. H., Ng, F. Y., Pile, P. T., Sauer, C. M. 2025; 27: e70358

    Abstract

    Clinical care globally faces increasing strain due to escalating documentation demands. Simultaneously, technological solutions for clinical workflows, particularly inpatient handovers, are being developed to alleviate workforce stress. However, the maturity, adoption scale, and impact of these technologies on clinical practice remain unclear.To address this gap, we conducted a scoping review to summarize current advancements in technological solutions for inpatient handovers.This study was prospectively registered on Open Science Framework. Publications from January 1, 2010, to January 1, 2024, were retrieved from MEDLINE, Embase, Cochrane Library, and Scopus. To be included in this review, studies were required to focus on (1) the implementation, assessment, or enhancement of health care provider handover workflows; (2) inpatient setting; and (3) the proposal or implementation of one or more technological solutions. Abstract and full-text screenings were conducted independently by 2 reviewers, with conflicts resolved by a third reviewer. Data extraction and synthesis were performed by multiple authors and cross-reviewed for accuracy.The search identified 779 publications, of which 53 met the inclusion criteria. Analysis revealed a predominance of low-complexity technologies, such as electronic checklists, with limited exploration of advanced solutions like natural language processing. Most studies were in the pilot stage (33/53, 62%), while some described documented implementations (11/53, 21%). Reported outcomes included improvements in the completeness, accuracy, and consistency of critical information during patient transfers (20/53, 38%). Challenges included scalability, inconsistent adoption, and difficulties integrating advanced technologies into existing workflows.Low-complexity technological solutions show potential for enhancing inpatient handovers but face barriers to scalability and sustained adoption. While artificial intelligence (AI) has the potential to bring transformative benefits, a limitation of this review is that none of the included studies reported successful clinical implementations of AI solutions aimed at improving handover processes.

    View details for DOI 10.2196/70358

    View details for PubMedID 40743446

    View details for PubMedCentralID PMC12312997

  • Torsemide vs. furosemide in congestive heart failure: a systematic-review and meta-analysis on mortality and rehospitalization. Acta cardiologica Gudushauri, N., Polintan, E. T., Lemonjava, I., Menghrajani, R. H., Alfonso, P. G., Shah, S., Azmaiparashvili, Z., Lo, K. B., Rangaswami, J. 2025; 80 (4): 351-357

    Abstract

    Current guidelines suggest the use of loop diuretics as the preferred agent for decongestion in patients with heart failure. However, there is no clear evidence as to superiority of one loop diuretic over the other. The understanding of pharmacokinetic and pharmacodynamic superiority of torsemide over furosemide has generated the hypothesis that these features could result in better clinical outcomes.To determine whether the use of torsemide is associated with reduced risk for mortality and rehospitalizations in comparison to furosemide among patients with heart failure.The study involves a comprehensive search of literature from PubMed, Cochrane CENTRAL, and ClinicalTrials.gov of clinical trials addressing the use of torsemide vs. furosemide in patients with heart failure. Pooled risk ratios (RR) were used to measure association for all outcomes with inverse-variance weighting and random effects model.The literature search included 188 studies that were screened individually. A total of 24 studies were identified out of which 12 were excluded. The pooled risk ratio (RR) revealed all-cause mortality of 0.98 [0.87 to 1.10] with 0% heterogeneity, all cause rehospitalization of 0.95 [0.88 to 1.02] with 5% heterogeneity, and heart failure rehospitalization of 0.85 [0.52 to 1.38] with 55% heterogeneity.Considering the evidence from pooled randomised trials, the use of torsemide compared to furosemide did not result in statistically significant differences in all-cause mortality or rehospitalization rates.

    View details for DOI 10.1080/00015385.2025.2460406

    View details for PubMedID 39910952

  • PERITONEAL DIALYSIS VS EXTRACORPOREAL DIALYSIS IN ACUTE KIDNEY INJURY: A SYSTEMATIC REVIEW AND META-ANALYSIS Menghrajani, R., Almanzar, M., Matabang, M., Faroog, S., Placino, S., Aparece, J., Shah, A. W B SAUNDERS CO-ELSEVIER INC. 2025

    View details for Web of Science ID 001454442000165

  • Post-Duodenal Polypectomy Pancreatitis: An Uncommon Iatrogenic Trigger Mosquera, D., Menghrajani, R., Kilani, Y., Banks, M. A. LIPPINCOTT WILLIAMS & WILKINS. 2024: S1713

    View details for DOI 10.14309/01.ajg.0001038980.79833.90

    View details for Web of Science ID 001359315600029

  • To Be or Not to Be: Elevated Troponin and the Role of Secondary Prevention of Atherosclerotic Cardiovascular Disease in ESKD Yip, L., Vohra, A., Lim, C., Johan, K., Soe, M., Almanzar, M., Gutierrez, J., Patel, P., Ortega, M., Menghrajani, R., Park, J., Chijioke, C., Menon, V. AMER SOC NEPHROLOGY. 2024

    View details for DOI 10.1681/ASN.2024jdcqqt56

    View details for Web of Science ID 001405917801239

  • Pharmacologic and Nonpharmacologic Management of Intradialytic Hypotension in ESKD: A Systematic Review and Meta-Analysis Menghrajani, R., Almanzar, M., Matabang, M., Gumabon, K., Shah, A., Lerma, E. V. AMER SOC NEPHROLOGY. 2024

    View details for DOI 10.1681/ASN.2024ws1v4wv9

    View details for Web of Science ID 001405917805079

  • Long-Term Efficacy of Renal Denervation in Patients with Resistant Hypertension: A MetaAnalysis of Randomized Controlled Trials Menghrajani, R., Almanzar, M., Matabang, M., Aparece, J. B., Lerma, E. AMER SOC NEPHROLOGY. 2024

    View details for DOI 10.1681/ASN.2024j02bb3hn

    View details for Web of Science ID 001405917805016

  • Outcomes of Patients with Critical Limb Ischemia and Chronic Kidney Disease: A National Perspective. Cardiorenal medicine Rivera, F. B., Aparece, J. P., Marie Ruyeras, J. M., Menghrajani, R. H., Ybañez, M. J., Candida Honorio, E. G., Albert Ramirez Damayo, J. I., Li, G., Dwivedi, A., Puentespina, R. A., Talili, P. J., Cu, J. P., Alfonso Marañon Joson, J. J., Baoy Bantayan, N. R., Lerma, E. V., Collado, F. M., Ong, K., Vijayaraghavan, K., Kazory, A. 2024; 14 (1): 533-542

    Abstract

    Studies exploring the relationship between peripheral arterial disease (PAD), critical limb ischemia (CLI), and chronic kidney disease (CKD) and its effect on in-hospital outcomes are limited. We aimed to analyze the outcomes of patients with CKD and PAD who are admitted for CLI.We utilized the National Inpatient Sample (NIS) to capture hospitalizations for CLI from 2012 to 2020 and then identified cases with concomitant CKD. The primary outcome was mortality, and secondary outcomes were cerebrovascular accident, major bleeding, vasopressor requirement, percutaneous coronary intervention, cardiac arrest, acute respiratory failure, transfusion, length of stay, and total hospital charges. Multivariable logistic regression was performed to adjust for covariates.A total of 441,245 patients with CLI were identified, of which 122,370 (27.7%) reported concomitant CKD. Patients with CKD had higher in-patient mortality (odds ratio [OR] 1.68, 95% confidence interval [CI], 1.17-1.68, p < 0.001), vascular complications (OR 1.31, 95% CI, 1.17-1.48, p < 0.001), acute kidney injury requiring hemodialysis (OR 3.17, 95% CI, 2.64-3.80, p < 0.001), and major bleeding (OR 1.12, 95% CI, 1.05-1.19, p < 0.001). Patients with CKD underwent minimally invasive endovascular therapy (31.08% vs. 36.73%, p < 0.0001) and invasive procedures (14.73% vs. 23.55%, p < 0.0001) less often. PAD-CLI with CKD was associated with major (20.54% vs. 16.17%, OR 1.04; p < 0.0001) and minor (26.87% vs. 19.53%, OR 1.2, p < 0.0001) amputations more often.Patients admitted for PAD-CLI with concomitant CKD have significantly higher in-hospital mortality as compared to patients without CKD. Moreover, patients with CKD and PAD-CLI are less likely to receive revascularization and more likely to undergo amputation.

    View details for DOI 10.1159/000541146

    View details for PubMedID 39222616

  • CARDIOVASCULAR DISEASE IN PATIENTS WITH HIV: A NATIONWIDE STUDY Aparece, J. B., Salva, W., Cha, S., Menghrajani, R., Rivera, F. B., Brockman, M. ELSEVIER SCIENCE INC. 2024: 1857

    View details for Web of Science ID 001324901501889

  • HIV-Associated Nephropathy in 2022. Glomerular diseases Rivera, F. B., Ansay, M. F., Golbin, J. M., Alfonso, P. G., Mangubat, G. F., Menghrajani, R. H., Placino, S., Taliño, M. K., De Luna, D. V., Cabrera, N., Trinidad, C. N., Kazory, A. 2023; 3 (1): 1-11

    Abstract

    HIV-associated nephropathy (HIVAN) is a renal parenchymal disease that occurs exclusively in people living with HIV. It is a serious kidney condition that may possibly lead to end-stage kidney disease, particularly in the HIV-1 seropositive patients.The African-American population has increased susceptibility to this comorbidity due to a strong association found in the APOL1 gene, specifically two missense mutations in the G1 allele and a frameshift deletion in the G2 allele, although a "second-hit" event is postulated to have a role in the development of HIVAN. HIVAN presents with proteinuria, particularly in the nephrotic range, as with other kidney diseases. The diagnosis requires biopsy and typically presents with collapsing subtype focal segmental glomerulosclerosis and microcyst formation in the tubulointerstitial region. Gaps still exist in the definitive treatment of HIVAN - concurrent use of antiretroviral therapy and adjunctive management with like renal-angiotensin-aldosterone system inhibitors, steroids, or renal replacement therapy showed benefits.This study reviews the current understanding of HIVAN including its epidemiology, mechanism of disease, related genetic factors, clinical profile, and pathophysiologic effects of management options for patients.

    View details for DOI 10.1159/000526868

    View details for PubMedID 36816427

    View details for PubMedCentralID PMC9936764

  • LEFT-SIDED PORTAL HYPERTENSION DUE TO SPLENIC VEIN COMPRESSION BY ABDOMINAL ABSCESS IN THE SETTING OF DISSEMINATED TUBERCULOSIS Karstens, J., Mahbub, E., Riaz, M., Mohsin, S., Lachhar, G. G., Pavlica, M., Barber, N., Menghrajani, R., Melek, A., Brar, I., Badia, J., Sklarek, H. M. ELSEVIER. 2023: 2898A-2899A

    View details for DOI 10.1016/j.chest.2023.07.1902

    View details for Web of Science ID 001085062002462

  • Combination prophylactic amiodarone with beta-blockers versus beta-blockers in atrial fibrillation after cardiac surgery: A systematic-review and meta-analysis. Heart & lung : the journal of critical care Polintan, E. T., Monsalve, R., Menghrajani, R. H., Sirilan, K. Y., Nayak, S. S., Abdelmaseeh, P., Patarroyo-Aponte, G., Lo, K. B., Dani, S. S. 2023; 62: 256-263

    Abstract

    Guideline recommendations regarding the preferred preventive measures for postoperative atrial fibrillation (POAF) are unclear, nor have we found any review articles addressing the combination of amiodarone and beta-blockers for the prevention of POAF.To investigate the efficacy and safety of combination beta-blockers and amiodarone in the prevention of POAF while also comparing the use of amiodarone and beta-blockers individually.We used Pubmed as the primary resource. POAF incidence was the primary outcome of this study. The secondary outcomes were hospital length of stay (LOS), ICU LOS, treatment-related drug discontinuation (TRDD), and mortality. The random-effects model assessed all pooled outcomes with 95% confidence intervals. Statistical significance was set at p≤0.05.The amiodarone subgroup of POAF incidence saw a Risk Ratio (RR) of 0.81 [0.63, 1.06], p=0.12, while the combination subgroup resulted in a RR of 0.63 [0.49, 0.80], p <0.001. TRDD for the amiodarone subgroup resulted in a RR of 0.68 [0.25, 1.82], p=0.44, while the combination subgroup saw a RR of 0.84 [0.57, 1.23], p=0.36. For mortality, the amiodarone subgroup resulted in a RR of 0.97 [0.48, 1.98], p=0.93, while the combination subgroup resulted in a RR of 1.04 [0.27, 4.05], p=0.96. Both hospital and ICU LOS saw no significant difference between treatment arms for both the combination subgroup and amiodarone alone. Except for the incidence of postoperative atrial fibrillation (POAF) in the combination prophylaxis group, most of the measured outcomes did not meet the optimized information size (OIS) that was estimated.Combination prophylaxis with amiodarone and beta-blockers significantly lowered risks of POAF incidence in comparison to beta-blockers alone while also having comparative mortality and TRDD outcomes.

    View details for DOI 10.1016/j.hrtlng.2023.08.006

    View details for PubMedID 37619317