scholarly journals [68 Ga]Ga-FAPI uptake correlates with the state of chronic kidney disease

2022 ◽  
Author(s):  
Patrick Conen ◽  
Francesca Pennetta ◽  
Katharina Dendl ◽  
Fabian Hertel ◽  
Andreas Vogg ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Negative Correlation ◽  
Background Activity ◽  
Renal Parenchyma ◽  
Diagnostic Tools ◽  
Kidney Fibrosis ◽  
Radiotracer Uptake ◽  
Ckd Stage

Abstract Purpose Kidney fibrosis leads to a progressive reduction in kidney function ultimately resulting in kidney failure. Diagnostic tools to detect kidney fibrosis are all invasive in nature requiring kidney biopsies with subsequent histological validation. In this retrospective study, the diagnostic value of three different radiotracers for the noninvasive prediction of kidney fibrosis was analyzed, taking into account the glomerular filtration rate (GFR) and the intra-renal parenchymal radiotracer uptake. Methods In 81 patients receiving either one of the following molecular imaging probes, [68 Ga]Ga-FAPI, [68 Ga]Ga-PSMA, or [68 Ga]Ga-DOTATOC, kidney function parameters were correlated with SUVmax and SUVmean of the renal parenchyma and background activity measured in lung parenchyma, myocardium, gluteal muscle, and the abdominal aorta. Patients were clustered according to their grade of chronic kidney disease (CKD), and a regression analysis and one-way ANOVA were conducted in this retrospective analysis. Results We found a negative correlation between GFR and [68 Ga]Ga-FAPI uptake for both SUVmax and SUVmean values, whereas background activity showed no correlation with GFR. [68 Ga]Ga-DOTATOC and [68 Ga]Ga-PSMA did not correlate between CKD stage and intra-renal parenchymal radiotracer uptake. Only [68 Ga]Ga-PSMA background activity exhibited a positive correlation with GFR suggesting an unspecific binding/retention potentially due to longer circulation times. Conclusion There is a significant negative correlation between renal parenchymal [68 Ga]Ga-FAPI uptake and GFR, which was not the case for [68 Ga]Ga-DOTATOC and [68 Ga]Ga-PSMA. This correlation suggests a specific binding of FAPI rather than a potential unspecific retention in the renal parenchyma, underlining the potential value of [68 Ga]Ga-FAPI for the noninvasive quantitative evaluation of kidney fibrosis.

scholarly journals Enteropeptidase inhibitor SCO-792 effectively prevents kidney function decline and fibrosis in a rat model of chronic kidney disease

2020 ◽  
Author(s):  
Yuko Katayama ◽  
Jun Sugama ◽  
Tomohisa Suzuki ◽  
Yoshimasa Ishimura ◽  
Akihiro Kobayashi ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Therapeutic Potential ◽  
Renal Plasma Flow ◽  
Production Capacity ◽  
Therapeutic Effects ◽  
Kidney Fibrosis ◽  
Obesity And Diabetes ◽  
Gfr Decline

Abstract Background Inhibiting enteropeptidase, a gut serine protease regulating protein digestion, suppresses food intake and ameliorates obesity and diabetes in mice. However, the effects of enteropeptidase inhibition on the kidney parameters are largely unknown. Here, we evaluated the chronic effects of an enteropeptidase inhibitor, SCO-792, on kidney function, albuminuria, and kidney pathology in spontaneously hypercholesterolaemic (SHC) rats, a rat chronic kidney disease (CKD) model. Methods SCO-792, an orally available enteropeptidase inhibitor, was administered (0.03% and 0.06% (w/w) in the diet) for five weeks to 20-week-old SHC rats showing albuminuria and progressive decline in glomerular filtration rate (GFR). The effects of SCO-792 and the contribution of amino acids to these effects were evaluated. Results SCO-792 increased the faecal protein content, indicating that SCO-792 inhibited enteropeptidase in SHC rats. Chronic treatment with SCO-792 prevented GFR decline and suppressed albuminuria. Moreover, SCO-792 improved glomerulosclerosis and kidney fibrosis. Pair feeding with SCO-792 (0.06%) was less effective in preventing GFR decline, albuminuria, and renal histological damage than SCO-792 treatment, indicating the enteropeptidase-inhibition-dependent therapeutic effects of SCO-792. SCO-792 did not affect the renal plasma flow, suggesting that its effect on GFR was mediated by an improvement in filtration fraction. Moreover, SCO-792 increased hydrogen sulphide production capacity, which has a role in tissue protection. Finally, methionine and cysteine supplementation to the diet abrogated SCO-792-induced therapeutic effects on albuminuria. Conclusions SCO-792-mediated inhibition of enteropeptidase potently prevented GFR decline, albuminuria, and kidney fibrosis; hence, it may have therapeutic potential against CKD.

P0839EVALUATION OF ECHOCARDIOGRAPHIC INDICES OF DIASTOLIC DYSFUNCTION IN PATIENTS WITH CHRONIC KIDNEY DISEASE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Alexandros Kourtinos ◽  
Kostas Pappas ◽  
Lazaros Belbasis ◽  
ANILA DUNI ◽  
Karolos Pavlos Rapsomanikis ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Diastolic Function ◽  
Negative Correlation ◽  
Sample Population ◽  
Cross Sectional ◽  
Lv Mass ◽  
Ckd Stage ◽  
Lv Diastolic Function

Abstract Background and Aims The structure and function of the left ventricle (LV) are affected since the early stages of chronic kidney disease (CKD). Our cross-sectional study aimed to estimate the echocardiographic indices of the LV diastolic function and the evaluation of their potential correlation with indices of kidney injury in patients with CKD, before initiation of renal replacement therapy. Method 99 patients with CKD (stage 2 CKD: 31 patients (27%), stage 3 CKD: 47 patients (40.9%) and stage 4 CKD: 37 patients (32.1%)) were enrolled in the study. Anthropometric data, indices of renal function (eGFR-CKD-EPI, urinary protein excretion in mg/24h), biochemical laboratory parameters, comorbidities [hypertension (HT), diabetes mellitus (DM), coronary heart disease (CAD)] and echocardiographic indices of LV diastolic function were recorded. In specific, left atrial (LA) dimensions were measured in M-Mode and were expressed both as absolute values in mm as well as indexed to body surface area ((BSA) and expressed as the LA index in mm/m2. The study sample, after taking into account patient gender, was further divided into separate groups according to the presence or not of LA dilation. Results The average patient age was 62 +/- 13 years and average eGFR (CKD-EPI) was 44.1+/-21.4 ml/min/1.73m2. With regard to comorbidities, 59.3% of the sample population had arterial hypertension, 24.3% had diabetes mellitus and 10.4% had known coronary artery disease. Regarding anti-hypertensive and hypolipidemic treatment, 22.6% of the patients were on ARB and 24% on ACEi, 51.3% on CCB, 29.6% on β-blockers, 37.4% on diuretics and 28.7% of the patients were receiving statin treatment. 28.2% of the patients had dilated LA in terms of absolute value and 13.8% had dilated LA following indexing to BSA (LA index). A positive correlation was observed between the LA size and age (p=0.001), BMI (p=0.041), uric acid levels (p=0.022), PTH (p=0.029), fibrinogen (p=0.035), LV mass (p=0.006) and LV mass/BSA (p=0.005), whereas a negative correlation was observed with serum LDL (p=0.027). Additionally, there was observed a negative correlation of LA index with eGFR (p=0.05), as well as an inverse relationship between LA index and PTH (p=0.012), age (p=0.004), BMI (p=0.037) and LV mass/BSA (p=0.005). No significant correlations between LA size and LA index with proteinuria or with co-morbidities (DM, HT, CAD) were observed. Conclusion In a population of patients with stage 2-4 CKD, LA size correlated to indices of CKD. Larger studies are required in order to further confirm these correlations.

scholarly journals Urine headspace analysis with field asymmetric ion mobility spectrometry for detection of chronic kidney disease

2020 ◽  
Vol 14 (8) ◽  
pp. 629-638
Author(s):  
Elina Jokiniitty ◽  
Lauri Hokkinen ◽  
Pekka Kumpulainen ◽  
Yrjö Leskinen ◽  
Terho Lehtimäki ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Ion Mobility Spectrometry ◽  
Ion Mobility ◽  
Headspace Analysis ◽  
Diagnostic Tools ◽  
Electronic Noses ◽  
Volatile Organic ◽  
Preliminary Study

Electronic noses (eNoses) are an emerging class of experimental diagnostic tools. They are based on the detection of volatile organic compounds. Urine is used as sample medium in several publications but neither the effect of chronic kidney disease (CKD) on the analysis nor the potential to detect CKD has been explored. Materials & methods: We utilized an eNose based on field asymmetric ion mobility spectrometry (FAIMS) technology to classify urine samples from CKD patients and controls. Results: We were able to differentiate extremes of kidney function with an accuracy of 81.4%. Conclusion: In this preliminary study, applying eNose technology we were able to distinguish the patients with impaired kidney function from those with normal kidney function.

P0624INCREASED URINARY BIOMARKERS OF KIDNEY INJURY IN PATIENTS AFTER ALLOGENETICHEMATOPOETIC STEM CELL TRANSPLANTATION REFLECT KIDNEY DAMAGE EVEN IN NORMALN KIDNEY FUNCTION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Malgorzata Kepska ◽  
Inga Chomicka ◽  
Ewa Karakulska-Prystypiuk ◽  
Agnieszka Tomaszewska ◽  
Grzegorz Basak ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Stem Cell ◽  
Kidney Disease ◽  
Healthy Volunteers ◽  
Kidney Function ◽  
Kidney Injury ◽  
Allogeneic Hsct ◽  
Ckd Stage ◽  
Nephrotoxic Drugs

Abstract Background and Aims Chronic kidney disease (CKD) and acute kidney injury (AKI) are common complications of hematopoietic stem cell transplantation (HSCT) associated with increased morbidity and mortality. On the other hand, presence of CKD is often used as an exclusion criterion when selecting patients who undergo HSCT, especially when fludarabine in conditioning or GVHD prophylaxis with a calcineurin inhibitor is contemplated. There is also no threshold (CKD stage, level of serum creatinine etc) below which patients should not undergo allogeneic HSCT. Kidney function in patients undergoing HSCT is frequently worsened by previous chemotherapy and exposure to a variety of nephrotoxic drugs. Several biomarkers were widely investigated for early diagnosis of acute kidney injury, including neutrophil gelatinase associated lipocalin (NGAL), urinary liver-type fatty acid-binding protein (uL-FABP) and others, however, in patients undergoing HSCT, the published literature is exceptionally scarce. A few studies with inconclusive results stress the knowledge gap and need for further research. The aim of the study was to assess biomarkers of kidney injury in patients at least 3 months after HSCT (to avoid the effect of calcineurin inhibitors) under ambulatory care of Hematology, Oncology and Internal Medicine Department, University Teaching Hospital. Method We studied 80 prevalent patients after allogeneic HSCT and 32 healthy volunteers to obtained normal ranges for biomarkers. In this cross-sectional study following biomarkers of kidney injury in urine were evaluated: IGFBP-7/TIMP2 (insulin growth factor binding protein-7/, tissue inhibitor of metalloproteinases-2), netrin-1, semaphorin A2 using commercially available assays. Results All the biomarkers studied were significantly higher in patients after HSCT when compared to healthy volunteers (all p<0.001). When we divided patients according to kidney function (below and over 60 ml./min/1.72m2), we found that only concentration of IGFBP-7 was significantly higher in 23 patients with CKD stage 3 (i.e. eGFR below 60ml.min/1.72m2) relative to patients with eGFR over 60 ml.min.1.72m2. All biomarkers in both subgroups of patients with eGFR below and over 60 ml./min/1.72m2 were significantly higher relative to healthy volunteers. In univariate correlations sempahorinA2 was related to netrin 1 (r=0.47, p<0.001), IGFBP7 (r=0.35, p<0.01), TIMP2 (r=0.32, p<0.01), whereas IGFBP7 was positively related to serum creatinine (r=0.38, p<0.001) and inversely to eGFR (r=-0.36, p<0.001). Conclusion Concluding, patients after allogeneic HSCT despite normal or near normal kidney function show evidence of kidney injury, which might be due to comorbidities, previous chemotherapy, conditioning regimen,complement activation, calcineurin therapy after HSCT, other possible nephrotoxic drugs etc. Nephroprotective strategies are to be considered as chronic kidney disease is a risk factor for increased morbidity and mortality in this vulnerable population.

scholarly journals Serum Intact Parathyroid Hormone Level is Inversely Correlated with Glycated Haemoglobin in Diabetic Chronic Kidney Disease Stages 3-5 Predialysis Patients

2017 ◽  
Vol 7 (2) ◽  
pp. 110-113
Author(s):  
Wasim Md Mohosin Ul Haque ◽  
Muhammad Abdur Rahim ◽  
Palash Mitra ◽  
Tabassum Samad ◽  
Samira Humaira Habib ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Parathyroid Hormone ◽  
Kidney Disease ◽  
Negative Correlation ◽  
Glycated Haemoglobin ◽  
Diabetic Patients ◽  
Intact Parathyroid Hormone ◽  
Ipth Level ◽  
Ckd Stage ◽  
The Relationship

Introduction: Diabetes mellitus (DM) is one of the leading causes of chronic kidney disease (CKD). Management of chronic kidney disease-mineral and bone disorder (CKD-MBD) is an integral component of CKD management; serum intact parathyroid hormone (iPTH) level is the key target. This study was designed to evaluate the relationship between glycated haemoglobin (HbAlc) and iPTH in diabetic CKD stages 3-5 patients not yet on dialysis.Methods: This cross-sectional study was conducted in BIRDEM General Hospital, Dhaka, Bangladesh from January 2013 to December 2014. Diabetic patients suffering from CKD stages 3-5, who were not on dialysis, were consecutively and purposively included in this study. Along with base-line characteristics, clinical and laboratory data including HbAlc and iPTH levels were recorded for all patients. Data were analyzed by using SPSS version 20.0 and Pearson’s correlation test was applied to evaluate the relationship between HbAlc and iPTH.Results: Total patients were 306, including 166 (54.2%) males. Mean age was 56.5±11.3 years. Mean duration of DM and CKD were 12.8±7.6 and 2.9±1.7 years respectively. Among the study population, 49 (16.0%) were in CKD stage 3, 90 (29.4%) in CKD stage 4 and rest 167 (54.6%) in CKD stage 5. Mean HbAlc (%), serum creatinine (mg/dl), urea (mg/dl), calcium (mg/dl), phosphate (mg/dl), alkaline phosphatase (U/L) and iPTH (pg/ml) were 7.77±2.14, 6.8±3.0, 141.1±75.7, 8.1±1.2, 5.2±1.9,164.1±135.3 and 229.7±151.2 respectively. Mean HbAlc (%) and iPTH (pg/ml) in CKD stages 3, 4 and 5 were 8.36±1.59 and 171.7±127.9, 7.99±1.92 and 179.5±131.4, and 7.77±2.14 and 273.8±119.2 respectively. On correlation analysis, HbAlc had a significant negative correlation with iPTH (r=-0.002).Conclusion: The results of current study showed that most diabetic CKD stages 3-5 predialysis patients had poor glycaemic control and HbAlc had negative correlation with iPTH. As iPTH level is influenced by presence and control of DM, the targets of iPTH in CKD stages 3-5 in general, as recommended in existing guidelines, may not be appropriate in diabetic CKD patients and this issue merits further investigation.Birdem Med J 2017; 7(2): 110-113

scholarly journals Bardoxolone Methyl Improves Kidney Function in Patients with Chronic Kidney Disease Stage 4 and Type 2 Diabetes: Post-Hoc Analyses from Bardoxolone Methyl Evaluation in Patients with Chronic Kidney Disease and Type 2 Diabetes Study

2018 ◽  
Vol 47 (1) ◽  
pp. 40-47 ◽  
Author(s):  
Melanie P. Chin ◽  
George L. Bakris ◽  
Geoffrey A. Block ◽  
Glenn M. Chertow ◽  
Angie Goldsberry ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Chronic Kidney Disease Stage ◽  
Disease Stage ◽  
Stage 4 ◽  
Ckd Stage ◽  
Post Hoc

Background: Increases in measured inulin clearance, measured creatinine clearance, and estimated glomerular filtration rate (eGFR) have been observed with bardoxolone methyl in 7 studies enrolling approximately 2,600 patients with type 2 diabetes (T2D) and chronic kidney disease (CKD). The largest of these studies was Bardoxolone Methyl Evaluation in Patients with Chronic Kidney Disease and Type 2 Diabetes (BEACON), a multinational, randomized, double-blind, placebo-controlled phase 3 trial which enrolled patients with T2D and CKD stage 4. The BEACON trial was terminated after preliminary analyses showed that patients randomized to bardoxolone methyl experienced significantly higher rates of heart failure events. We performed post-hoc analyses to characterize changes in kidney function induced by bardoxolone methyl. Methods: Patients in ­BEACON (n = 2,185) were randomized 1: 1 to receive once-daily bardoxolone methyl (20 mg) or placebo. We compared the effects of bardoxolone methyl and placebo on a post-hoc composite renal endpoint consisting of ≥30% decline from baseline in eGFR, eGFR <15 mL/min/1.73 m2, and end-stage renal disease (ESRD) events (provision of dialysis or kidney transplantation). Results: Consistent with prior studies, patients randomized to bardoxolone methyl experienced mean increases in eGFR that were sustained through study week 48. Moreover, increases in eGFR from baseline were sustained 4 weeks after cessation of treatment. Patients randomized to bardoxolone methyl were significantly less likely to experience the composite renal endpoint (hazards ratio 0.48 [95% CI 0.36–0.64]; p < 0.0001). Conclusions: Bardoxolone methyl preserves kidney function and may delay the onset of ESRD in patients with T2D and stage 4 CKD.

scholarly journals Breath Ammonia Is a Useful Biomarker Predicting Kidney Function in Chronic Kidney Disease Patients

Biomedicines ◽  
2020 ◽  
Vol 8 (11) ◽  
pp. 468
Author(s):  
Ming-Jen Chan ◽  
Yi-Jung Li ◽  
Chao-Ching Wu ◽  
Yu-Chen Lee ◽  
Hsiao-Wen Zan ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Characteristic Curve ◽  
Laboratory Data ◽  
Public Health Problem ◽  
Exhaled Breath ◽  
Ckd Stage ◽  
Significant Difference ◽  
Stage 1

Chronic kidney disease (CKD) is a public health problem and its prevalence has increased worldwide; patients are commonly unaware of the condition. The present study aimed to investigate whether exhaled breath ammonia via vertical-channel organic semiconductor (V-OSC) sensor measurement could be used for rapid CKD screening. We enrolled 121 CKD stage 1–5 patients, including 19 stage 1 patients, 26 stage 2 patients, 38 stage 3 patients, 21 stage 4 patients, and 17 stage 5 patients, from July 2019 to January 2020. Demographic and laboratory data were recorded. The exhaled ammonia was collected and rapidly measured by the V-OSC sensor to correlate with kidney function. Results showed no significant difference in age, sex, body weight, hemoglobin, albumin level, and comorbidities in different CKD stage patients. Correlation analysis demonstrated a good correlation between breath ammonia and blood urea nitrogen levels, serum creatinine levels, and estimated glomerular filtration rate (eGFR). Breath ammonia concentration was significantly elevated with increased CKD stage compared with the previous stage (CKD stage 1/2/3/4/5: 636 ± 94; 1020 ± 120; 1943 ± 326; 4421 ± 1042; 12781 ± 1807 ppb, p < 0.05). The receiver operating characteristic curve analysis showed an area under the curve (AUC) of 0.835 (p < 0.0001) for distinguishing CKD stage 1 from other CKD stages at 974 ppb (sensitivity, 69%; specificity, 95%). The AUC was 0.831 (p < 0.0001) for distinguishing between patients with/without eGFR < 60 mL/min/1.73 m2 (cutoff 1187 ppb: sensitivity, 71%; specificity, 78%). At 886 ppb, the sensitivity increased to 80% but the specificity decreased to 69%. This value is suitable for kidney function screening. Breath ammonia detection with V-OSC is a real time, inexpensive, and easy to administer measurement device for screening CKD with reliable diagnostic accuracy.

scholarly journals Induction of AMPK activity corrects early pathophysiological alterations in the subtotal nephrectomy model of chronic kidney disease

2013 ◽  
Vol 305 (5) ◽  
pp. F727-F733 ◽  
Author(s):  
Joseph Satriano ◽  
Kumar Sharma ◽  
Roland C. Blantz ◽  
Aihua Deng
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Rat Kidney ◽  
Metabolic Efficiency ◽  
Loss Of Function ◽  
Kidney Fibrosis ◽  
Subtotal Nephrectomy ◽  
Progression Of Disease ◽  
Ampk Activity

The rat kidney ablation and infarction (A/I) model of subtotal or 5/6th nephrectomy is the most commonly studied model of nondiabetic chronic kidney disease (CKD). The A/I kidney at 1 wk exhibits reductions in kidney function, as determined by glomerular filtration rate, and diminished metabolic efficiency as determined by oxygen consumption per sodium transport (QO2/TNa). As renoprotective AMPK activity is affected by metabolic changes and cellular stress, we evaluated AMPK activity in this model system. We show that these early pathophysiological changes are accompanied by a paradoxical decrease in AMPK activity. Over time, these kidney parameters progressively worsen with extensive kidney structural, functional, metabolic, and fibrotic changes observed at 4 wk after A/I. We show that induction of AMPK activity with either metformin or 5-aminoimidazole-4-carboxamide ribonucleotide increases AMPK activity in this model and also corrects kidney metabolic inefficiency, improves kidney function, and ameliorates kidney fibrosis and structural alterations. We conclude that AMPK activity is reduced in the subtotal nephrectomy model of nondiabetic CKD, that altered regulation of AMPK is coincident with the progression of disease parameters, and that restoration of AMPK activity can suppress the progressive loss of function characteristic of this model. We propose that induction of AMPK activity may prove an effective therapeutic target for the treatment of nondiabetic CKD.

A Study of Sleep Disorders in Patients with Chronic Kidney Disease (CKD)

2017 ◽  
Vol 9 (5) ◽  
Author(s):  
Hussein A. ◽  
El–Hadidy A. ◽  
Gomaa N. ◽  
Amin Y. ◽  
El-Shabouny T.
Keyword(s):  
Chronic Kidney Disease ◽  
Sleep Apnea ◽  
Kidney Disease ◽  
Respiratory Distress ◽  
Oxygen Saturation ◽  
Kidney Function ◽  
Group Iii ◽  
Group I ◽  
Ckd Stage ◽  
Group Ii

Sleep apnea is an important comorbidity in patients with chronic kidney disease (CKD). Although the increased prevalence of sleep apnea in patients with CKD is well established, few studies have examined the full spectrum of kidney function. We sought to determine the prevalence of sleep apnea and associated nocturnal hypoxia in patients with CKD. We hypothesized that the prevalence of sleep apnea would increase progressively as kidney function declines. 45 patients were recruited from outpatient nephrology clinics, nephrology department, and hemodialysis units. All patients completed an overnight inpatient polysomnograhy test to determine the prevalence of sleep apnea (AHI ≥ 5 events /h) and nocturnal hypoxia (oxygen saturation (SaO2) below 90% for ≥12% of the nocturnal monitoring time). Patients were stratified according to their estimated glomerular filtration rate (eGFR) at the time of the study visit into three groups as follows: CKD stage 2 (eGFR 60 to 89 mL/min/1.73 m2) (control group), CKD stages 3 and 4 (eGFR 15 to 59 mL/min/1.73 m2), and CKD stage 5 (eGFR less than 15 mL/min/1.73 m2). eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Out of the 45 patients included in our study with the full spectrum of kidney function, ranging from those with eGFR 60 to 89 ml/min./1.73m2 to patients with eGFR less than 15 ml/min./1.73m2, 15 (33.3%) had sleep apnea (Mean AHI; 8.71±5.86). Our study found that prevalence of sleep apnea increased as kidney function declined (Group (I), 20%; Group (II), 36.4%; Group (III), 37.5%). Furthermore, severity of sleep apnea increased as kidney function declined (Group (I), mean AHI: 5.75±0.35; Group (II), mean AHI: 6±1.38; Group (III), mean AHI: 10.6±7.04). We also found that prevalence of nocturnal hypoxia which is characteristically associated with sleep apnea was greater among groups (II) and (III) (27.3% and 16.7%, respectively) than in group (I) (10%). Severity of nocturnal hypoxia increased as kidney function declined (Group (I), 13%; Group (II), 13.6±1.22%; Group (III), 16.75±3.30%). Overall, 8 out of the 45 studied CKD patients (17.8%) had nocturnal hypoxia (Mean SaO2 below 90% for ≥12% of the nocturnal monitoring time; 15.1±2.87%). Our study revealed that as kidney function declined, Apnea/Hypopnea (AHI) indices increased, oxygen desaturation indices increased, minimal peripheral capillary oxygen saturation values decreased, peripheral capillary oxygen saturation time less than 90% increased, and snore indices increased. Also, respiratory distress index (RDI) was higher among groups (II) and (III) than in group (I). However, only differences between groups as regards respiratory distress events, respiratory distress indices, snore events, and snore indices were statistically significant. These results show that as kidney function declines, several respiratory parameters deteriorate during sleep. In addition, wake events and indices, and sleep stage 1 (%) increased as kidney function deteriorated. Sleep efficiency (%) was highest among group (I) patients and lower among groups (II) and (III), Light sleep (%) was lowest among group (I) patients and higher among groups (II) and (III), and deep sleep (%) was highest among group (I) patients and lower among groups (II) and (III). It is clear from the above results that as kidney function declines, sleep efficiency deteriorates, wake indices increase, light sleep (%) increases, and deep sleep (%) decreases. We concluded that prevalence and severity of sleep apnea in patients with CKD increase as kidney function declines. Almost 18% of patients with CKD experience nocturnal hypoxia, which may contribute to loss of kidney function.

Does chronic kidney disease affect implant survival after primary hip and knee arthroplasty?

2021 ◽  
Vol 103-B (4) ◽  
pp. 689-695
Author(s):  
Pyry Jämsä ◽  
Aleksi Reito ◽  
Niku Oksala ◽  
Antti Eskelinen ◽  
Esa Jämsen
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Knee Arthroplasty ◽  
Competing Risk ◽  
Normal Kidney ◽  
Normal Kidney Function ◽  
Risk Of Death ◽  
Stage 4 ◽  
Ckd Stage

Aims To investigate whether chronic kidney disease (CKD) is associated with the risk of all-cause revision or revision due to a periprosthetic joint infection (PJI) after primary hip or knee arthroplasty. Methods This retrospective cohort study comprised 18,979 consecutive hip and knee arthroplasties from a single high-volume academic hospital. At a median of 5.6 years (interquartile range (IQR) 3.5 to 8.1), all deaths and revisions were counted. To overcome the competing risk of death, competing risk analysis using the cumulative incidence function (CIF) was applied to analyze the association between different stages of CKD and revisions. Confounding factors such as diabetes and BMI were considered using either a stratified CIF or the Fine and Gray model. Results There were 2,111 deaths (11.1%) and 677 revisions (3.6%) during the follow-up period. PJI was the reason for revision in 162 cases (0.9%). For hip arthroplasty, 3.5% of patients with CKD stage 1 (i.e. normal kidney function, NKF), 3.8% with CKD stage 2, 4.2% with CKD stage 3, and 0% with CKD stage 4 to 5 had undergone revision within eight years. For knee arthroplasty, 4.7% with NKF, 2.7% with CKD stage 2, 2.4% with CKD stage 3, and 7% of CKD stage 4 to 5 had had undergone revision. With the exception of knee arthroplasty patients in whom normal kidney function was associated with a greater probability of all-cause revision, there were no major differences in the rates of all-cause revisions or revisions due to PJIs between different CKD stages. The results remained unchanged when diabetes and BMI were considered. Conclusion We found no strong evidence that CKD was associated with an increased risk of all-cause or PJI-related revision. Selection bias probably explains the increased amount of all-cause revision operations in knee arthroplasty patients with normal kidney function. The effect of stage 4 to 5 CKD was difficult to evaluate because of the small number of patients. Cite this article: Bone Joint J 2021;103-B(4):689–695.

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