SUN-255 Calcium phosphate product predicts adverse outcomes in chronic kidney disease: novel insight using trajectory analysis

Introduction: The prevalence of bone mineral disorder is best known in end-stage renal disease (ESRD) patients, but less data is available for the earlier stages. Objectives: We aimed to compare the prevalence of bone metabolic disorder at all stages of chronic kidney disease (CKD) and assess its contribution to CKD progression and patients’ outcome. Patients and Methods: In a retrospective cohort study, CKD patients who were under treatment for three years were selected from a nephrology clinic in Tehran, Iran. Patients’ demographic and laboratory data, as well as the outcome of their treatment were gathered and analyzed. Results: In 473 patients with an average age of 61.5, 60.1% were at stage III, 35.8% were at stage IV, and 4.1% were at stage V of CKD. There was a significant relationship between CKD stage and serum phosphate, calcium-phosphate product, and systolic blood pressure (SBP). Furthermore, the patients’ outcome was significantly related to advanced stages of CKD, higher first phosphate level, diabetes mellitus in medical history, and higher stages of SBP. By multiple Cox regression analysis, after adjustment for glomerular filtration rate (GFR), the first serum phosphate level, and the calcium-phosphate product did not contribute to the undesirable outcome. Conclusion: Although bone metabolic disorder is more frequently seen in advanced stages of chronic kidney disease, these changes can be seen even in earlier stages of the disease. The influence of phosphate abnormality in the patients’ outcome should be studied more in earlier stages for better control.

Download Full-text

Prevalence of Cardiovascular Risk Factors among Chronic Kidney Disease Patients Undergoing Hemodialysis in a Tertiary Care Center, Kathmandu, Nepal

Nepal Medical College Journal ◽

10.3126/nmcj.v21i4.27629 ◽

2019 ◽

Vol 21 (4) ◽

pp. 313-318

Author(s):

A Pokhrel ◽

P. Gyawali ◽

BR Pokhrel ◽

M P Khanal ◽

D N Manandhar ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Cardiovascular Risk ◽

Calcium Phosphate ◽

Kidney Disease ◽

Care Center ◽

Tertiary Care ◽

Maintenance Hemodialysis ◽

Tertiary Care Center ◽

Phosphate Product

The risk of cardiovascular disease is higher in chronic kidney disease patients compared to the general population and its impact is higher in developing countries compared to the developed countries. With this background in mind, we aimed to evaluate the prevalence of different cardiovascular risk factors in patients on maintenance hemodialysis in a tertiary care center. Chronic kidney disease patients aged 18 years and above who were under maintenance hemodialysis in the hemodialysis unit of Nepal Medical College were included in the study. Pre-dialysis venous blood samples from the participants were collected and analyzed for serum calcium, phosphorus, total protein, albumin and hemoglobin. Calcium phosphate product was calculated. Out of 100 study participants, 52% were male and 48% were female. Age-wise distribution showed 38% of the participants were below 40 years. The mean age of the participants was 45.86 ± 14.4 years. Ninety-three percent had hypertension and 29% had diabetes mellitus. Hypocalcemia was present in 80%, hyperphosphatemia was seen among 81% and high calcium phosphate product was present in 33% of the participants. Low hemoglobin (< 10gm/dL) was found in 86%. The cardiovascular risk trend in the Nepalese chronic kidney disease population is fairly different compared to the western population. Participants were younger. Prevalence of hypertension and diabetes was high. The high prevalence of anemia might be due to unaffordability of the participants for regular erythropoietin therapy. Inadequately managed hyperphosphatemia despite the widespread use of phosphorus binders, is still a major clinical challenge in patients on hemodialysis.

Download Full-text

Fibroblast growth factor-23 and calcium phosphate product in young chronic kidney disease patients: a cross-sectional study

BMC Nephrology ◽

10.1186/1471-2369-14-39 ◽

2013 ◽

Vol 14 (1) ◽

Cited By ~ 16

Author(s):

Abeer Yasin ◽

Daisy Liu ◽

Luan Chau ◽

Joaquín Madrenas ◽

Guido Filler

Keyword(s):

Chronic Kidney Disease ◽

Growth Factor ◽

Calcium Phosphate ◽

Kidney Disease ◽

Fibroblast Growth Factor 23 ◽

Cross Sectional Study ◽

Fibroblast Growth ◽

Sectional Study ◽

Cross Sectional ◽

Phosphate Product

Download Full-text

Postoperative acute kidney injury in adult non-cardiac surgery: joint consensus report of the Acute Disease Quality Initiative and PeriOperative Quality Initiative

Nature Reviews Nephrology ◽

10.1038/s41581-021-00418-2 ◽

2021 ◽

Author(s):

John R. Prowle ◽

Lui G. Forni ◽

Max Bell ◽

Michelle S. Chew ◽

Mark Edwards ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Cardiac Surgery ◽

Kidney Disease ◽

Kidney Injury ◽

Adverse Outcomes ◽

Baseline Risk ◽

Major Surgery ◽

Increased Risk

AbstractPostoperative acute kidney injury (PO-AKI) is a common complication of major surgery that is strongly associated with short-term surgical complications and long-term adverse outcomes, including increased risk of chronic kidney disease, cardiovascular events and death. Risk factors for PO-AKI include older age and comorbid diseases such as chronic kidney disease and diabetes mellitus. PO-AKI is best defined as AKI occurring within 7 days of an operative intervention using the Kidney Disease Improving Global Outcomes (KDIGO) definition of AKI; however, additional prognostic information may be gained from detailed clinical assessment and other diagnostic investigations in the form of a focused kidney health assessment (KHA). Prevention of PO-AKI is largely based on identification of high baseline risk, monitoring and reduction of nephrotoxic insults, whereas treatment involves the application of a bundle of interventions to avoid secondary kidney injury and mitigate the severity of AKI. As PO-AKI is strongly associated with long-term adverse outcomes, some form of follow-up KHA is essential; however, the form and location of this will be dictated by the nature and severity of the AKI. In this Consensus Statement, we provide graded recommendations for AKI after non-cardiac surgery and highlight priorities for future research.

Download Full-text

A phosphate and calcium-enriched diet promotes progression of 5/6-nephrectomy-induced chronic kidney disease in C57BL/6 mice

Scientific Reports ◽

10.1038/s41598-021-94264-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

J. Radloff ◽

N. Latic ◽

U. Pfeiffenberger ◽

C. Schüler ◽

S. Tangermann ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Calcium Phosphate ◽

Kidney Disease ◽

Renal Fibrosis ◽

Time Course ◽

Bone Mineralization ◽

Fibroblast Growth Factor 23 ◽

Functional Decline ◽

Left Ventricular ◽

Normal Diet

AbstractC57BL/6 mice are known to be rather resistant to the induction of experimental chronic kidney disease (CKD) by 5/6-nephrectomy (5/6-Nx). Here, we sought to characterize the development of CKD and its cardiac and skeletal sequelae during the first three months after 5/6-Nx in C57BL/6 mice fed a calcium- and phosphate enriched diet (CPD) with a balanced calcium/phosphate ratio. 5/6-NX mice on CPD showed increased renal fibrosis and a more pronounced decrease in glomerular filtration rate when compared to 5/6-Nx mice on normal diet (ND). Interestingly, despite comparable levels of serum calcium, phosphate, and parathyroid hormone (PTH), circulating intact fibroblast growth factor-23 (FGF23) was 5 times higher in 5/6-Nx mice on CPD, relative to 5/6-Nx mice on ND. A time course experiment revealed that 5/6-Nx mice on CPD developed progressive renal functional decline, renal fibrosis, cortical bone loss, impaired bone mineralization as well as hypertension, but not left ventricular hypertrophy. Collectively, our data show that the resistance of C57BL/6 mice to 5/6-Nx can be partially overcome by feeding the CPD, and that the CPD induces a profound, PTH-independent increase in FGF23 in 5/6-Nx mice, making it an interesting tool to assess the pathophysiological significance of FGF23 in CKD.

Download Full-text

Association between serum potassium levels and adverse outcomes in chronic kidney disease: the Fukushima CKD cohort study

Clinical and Experimental Nephrology ◽

10.1007/s10157-020-02010-7 ◽

2021 ◽

Author(s):

Kenichi Tanaka ◽

Hirotaka Saito ◽

Tsuyoshi Iwasaki ◽

Akira Oda ◽

Shuhei Watanabe ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Serum Potassium ◽

Adverse Outcomes

Download Full-text

Optimal blood pressure for patients with chronic kidney disease: a nationwide population-based cohort study

Scientific Reports ◽

10.1038/s41598-021-81328-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

You-Bin Lee ◽

Ji Sung Lee ◽

So-hyeon Hong ◽

Jung A. Kim ◽

Eun Roh ◽

...

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Cardiovascular Events ◽

Antihypertensive Treatment ◽

Antihypertensive Agents ◽

Population Based ◽

Adverse Outcomes ◽

Optimal Blood Pressure ◽

Stage Renal Disease

AbstractThe effect of blood pressure (BP) on the incident cardiovascular events, progression to end-stage renal disease (ESRD) and mortality were evaluated among chronic kidney disease (CKD) patients with and without antihypertensive treatment. This nationwide study used the Korean National Health Insurance Service-Health Screening Cohort data. The hazards of outcomes were analysed according to the systolic BP (SBP) or diastolic BP (DBP) among adults (aged ≥ 40 years) with CKD and without previous cardiovascular disease or ESRD (n = 22,278). The SBP and DBP were ≥ 130 mmHg and ≥ 80 mmHg in 10,809 (48.52%) and 11,583 (51.99%) participants, respectively. During a median 6.2 years, 1271 cardiovascular events, 201 ESRD incidents, and 1061 deaths were noted. Individuals with SBP ≥ 130 mmHg and DBP ≥ 80 mmHg had higher hazards of hypertension-related adverse outcomes compared to the references (SBP 120–129 mmHg and DBP 70–79 mmHg). SBP < 100 mmHg was associated with hazards of all-cause death, and composite of ESRD and all-cause death during follow-up only among the antihypertensive medication users suggesting that the BP should be < 130/80 mmHg and the SBP should not be < 100 mmHg with antihypertensive agents to prevent the adverse outcome risk of insufficient and excessive antihypertensive treatment in CKD patients.

Download Full-text