scholarly journals Infection in advanced chronic kidney disease leads to increased risk of cardiovascular events, end-stage kidney disease and mortality

2016 ◽  
Vol 90 (4) ◽  
pp. 897-904 ◽  
Author(s):  
Hicham I. Cheikh Hassan ◽  
Mila Tang ◽  
Ognjenka Djurdjev ◽  
David Langsford ◽  
Manish M. Sood ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cardiovascular Events ◽  
End Stage Kidney Disease ◽  
Advanced Chronic Kidney Disease ◽  
Increased Risk ◽  
End Stage

Types of erythropoiesis-stimulating agents and risk of end-stage kidney disease and death in patients with non-dialysis chronic kidney disease

2020 ◽  
Author(s):  
Roberto Minutolo ◽  
Carlo Garofalo ◽  
Paolo Chiodini ◽  
Filippo Aucella ◽  
Lucia Del Vecchio ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Primary Endpoint ◽  
End Stage Kidney Disease ◽  
Short Acting ◽  
Erythropoiesis Stimulating Agents ◽  
Increased Risk ◽  
Significant Difference ◽  
Long Acting ◽  
End Stage

Abstract Background Despite the widespread use of erythropoiesis-stimulating agents (ESAs) to treat anaemia, the risk of adverse outcomes associated with the use of different types of ESAs in non-dialysis chronic kidney disease (CKD) is poorly investigated. Methods From a pooled cohort of four observational studies, we selected CKD patients receiving short-acting (epoetin α/β; n = 299) or long-acting ESAs (darbepoetin and methoxy polyethylene glycol-epoetin β; n = 403). The primary composite endpoint was end-stage kidney disease (ESKD; dialysis or transplantation) or all-cause death. Multivariable Cox models were used to estimate the relative risk of the primary endpoint between short- and long-acting ESA users. Results During follow-up [median 3.6 years (interquartile range 2.1–6.3)], the primary endpoint was registered in 401 patients [166 (72%) in the short-acting ESA group and 235 (58%) in the long-acting ESA group]. In the highest tertile of short-acting ESA dose, the adjusted risk of primary endpoint was 2-fold higher {hazard ratio [HR] 2.07 [95% confidence interval (CI) 1.37–3.12]} than in the lowest tertile, whereas it did not change across tertiles of dose for long-acting ESA patients. Furthermore, the comparison of ESA type in each tertile of ESA dose disclosed a significant difference only in the highest tertile, where the risk of the primary endpoint was significantly higher in patients receiving short-acting ESAs [HR 1.56 (95% CI 1.09–2.24); P = 0.016]. Results were confirmed when ESA dose was analysed as continuous variable with a significant difference in the primary endpoint between short- and long-acting ESAs for doses >105 IU/kg/week. Conclusions Among non-dialysis CKD patients, the use of a short-acting ESA may be associated with an increased risk of ESKD or death versus long-acting ESAs when higher ESA doses are prescribed.

scholarly journals P0205SYMPTOM BURDEN IN AUSTRALIAN PATIENTS WITH ADVANCED CHRONIC KIDNEY DISEASE AND END-STAGE KIDNEY DISEASE RECEIVING RENAL SUPPORTIVE CARE: A SINGLE CENTRE COHORT STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Jenny Chen ◽  
Narelle Ilic ◽  
Holly Mitchell
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Supportive Care ◽  
Symptom Management ◽  
Symptom Improvement ◽  
End Stage Kidney Disease ◽  
Karnofsky Score ◽  
Advanced Chronic Kidney Disease ◽  
Asymptomatic Patients ◽  
End Stage

Abstract Background and Aims Renal supportive care (RSC) is a novel multidisciplinary patient-centred model of care that focuses on symptom management and quality of life improvement in patients with advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD), including conservative care. Despite an increased interest in embedding RSC into routine nephrology practice, there is limited literature on the effects of symptom improvement in patients attending RSC services. We aimed to examine symptom improvement and symptom progression in patients receiving renal supportive care. Method Using Integrated Palliative care Outcome Scale Renal (IPOS-renal) scores collected during routine RSC clinics, we analysed the changes in individual IPOS-renal items and summative scores for symptoms associated with chronic kidney disease, stratified by time from the initial clinic visit (0-6 months, 6-12 months, and >12 months), in all patients attending our RSC service in a tertiary hospital between November 2015 and July 2019. Results Of 245 patients referred to our RSC service, 61 patients completed two or more IPOS-renal surveys. At initial visit, majority of the patients were reviewed at hospital outpatient clinic (n=42, 71%), followed by dialysis (n=8, 13%), home visit (n=6, 10%), and inpatient ward (n=4, 7%). The median (IQR) eGFR was 13 (7-16) ml/min/1.73m2 and median Karnofsky score was 70 (60-80). Weakness (n=59, 97%) and poor mobility (n=52, 85%) were the most common initial complaints. For all reported symptoms, dyspnea improved the most for all three time periods (summative IPOS score changes of 28, 17, and 8 points for 0-6, 6-12, >12 months, respectively). Poor mobility was the only symptom that continued to deteriorate between 0-6 months despite attending renal supportive care (without a physiotherapist). For asymptomatic patients, more than half of the symptoms remained quiescent after attending RSC service for more than 12 months. Among newly developed symptoms, nausea, dyspnea, and drowsiness were most common between 0-6 months. In contrast, pruritus, dry mouth, and constipation were the most common complaints after 12 months. Conclusion RSC interventions provided symptom improvement in patients with advanced CKD and ESKD, but poor mobility remained a concern in this population. Incorporating physiotherapy to RSC may further improve symptom management.

scholarly journals Bupi Yishen Formula Versus Losartan for Non-Diabetic Stage 4 Chronic Kidney Disease: A Randomized Controlled Trial

2021 ◽  
Vol 11 ◽  
Author(s):  
Wei Mao ◽  
Nizhi Yang ◽  
Lei Zhang ◽  
Chuang Li ◽  
Yifan Wu ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Randomized Controlled Trial ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Cardiovascular Events ◽  
Controlled Trial ◽  
Diabetic Patients ◽  
End Stage Kidney Disease ◽  
Randomized Controlled ◽  
End Stage

Chinese herbal medicine (CHM) might have benefits in patients with non-diabetic chronic kidney disease (CKD), but there is a lack of high-quality evidence, especially in CKD4. This study aimed to assess the efficacy and safety of Bupi Yishen Formula (BYF) vs. losartan in patients with non-diabetic CKD4. This trial was a multicenter, double-blind, double-dummy, randomized controlled trial that was carried out from 11-08-2011 to 07-20-2015. Patients were assigned (1:1) to receive either BYF or losartan for 48 weeks. The primary outcome was the change in the slope of the estimated glomerular filtration rate (eGFR) over 48 weeks. The secondary outcomes were the composite of end-stage kidney disease, death, doubling of serum creatinine, stroke, and cardiovascular events. A total of 567 patients were randomized to BYF (n = 283) or losartan (n = 284); of these, 549 (97%) patients were included in the final analysis. The BYF group had a slower renal function decline particularly prior to 12 weeks over the 48-week duration (between-group mean difference of eGFR slopes: −2.25 ml/min/1.73 m2/year, 95% confidence interval [CI]: −4.03,−0.47), and a lower risk of composite outcome of death from any cause, doubling of serum creatinine level, end-stage kidney disease (ESKD), stroke, or cardiovascular events (adjusted hazard ratio = 0.61, 95%CI: 0.44,0.85). No significant between-group differences were observed in the incidence of adverse events. We conclude that BYF might have renoprotective effects among non-diabetic patients with CKD4 in the first 12 weeks and over 48 weeks, but longer follow-up is required to evaluate the long-term effects.Clinical Trial Registration:http://www.chictr.org.cn, identifier ChiCTR-TRC-10001518.

scholarly journals Onco-nephrology highlights: Chronic kidney disease, end-stage kidney disease, and cancer patients

2020 ◽  
Vol 4 (1-2) ◽  
pp. 7-14
Author(s):  
Matthew R Lynch ◽  
Susie L Hu
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cancer Patients ◽  
End Of Life Care ◽  
Treatment Options ◽  
Kidney Injury ◽  
End Stage Kidney Disease ◽  
Patient Centered ◽  
Advanced Chronic Kidney Disease ◽  
End Stage

With increasing prevalence of both kidney disease and cancer, patients who have both are common. Toxicity from treatment or direct kidney injury by the cancer itself can lead to acute kidney injury or progression of pre-existing chronic kidney disease. Management of advanced chronic kidney disease or end-stage kidney disease among those with concomitant cancer is challenging; however, better understanding of complications in this population will allow for optimization of treatments. Strategies for medication dosing, judicious use of erythropoiesis-stimulating agents in anemia, and treatment options for mineral bone disorders will be reviewed. Among those who require dialysis, special consideration should be made surrounding medication dosing, and end-of-life care should be addressed as early as possible in a patient-centered manner.

scholarly journals Cardiovascular disease in chronic kidney disease – a review of risk factors

2020 ◽  
Vol 23 (1) ◽  
Author(s):  
Muzamil Olamide Hassan ◽  
Stephen Olawale Oguntola ◽  
Raquel Duarte ◽  
Saraladevi Naicker
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Evidence Based ◽  
End Stage Kidney Disease ◽  
Increased Risk ◽  
Risk Of Progression ◽  
Novel Biomarkers ◽  
End Stage

Patients with chronic kidney disease (CKD) are at increased risk of cardiovascular disease (CVD), such that the risk of cardiovascular mortality is greater than the risk of progression to end-stage kidney disease. Despite the increased prevalence of traditional and non-traditional cardiovascular risk factors, patients with kidney disease have been mostly under-represented in previous cardiovascular outcome studies, thereby resulting in a paucity of data on the evidence-based management of CVD in CKD. In this review, we explore the evidence on the burden of CVD and its risk factors in patients with CKD, highlight various inflammatory biomarkers for predicting CVD and provide an overview on novel biomarkers for CVD.

scholarly journals The Burden Of Unrecognized Chronic Kidney Disease In Patients With Type 2 Diabetes At A County Hospital Clinic In Kenya: Implications To Care And Need For Screening

2019 ◽  
Author(s):  
Frederick C. F. Otieno ◽  
Elijah N Ogola ◽  
Mercy W Kimando ◽  
Ken K Mutai
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
High Risk ◽  
Kidney Disease ◽  
Cardiovascular Events ◽  
End Stage Kidney Disease ◽  
Long Duration ◽  
End Stage

Abstract Background : Chronic Kidney Disease (CKD) in patients with type 2 diabetes enhances the risk of cardiovascular events and a strong predictor of progression to end-stage kidney disease. Early diagnosis is encouraged for referral to specialist kidney care for active management that would optimize outcomes including forestalling progression to end-stage kidney disease. This study was conducted in a regional public health facility in Central Kenya with a high prevalence of type 2 diabetes. It was aimed at determining the burden of undiagnosed chronic kidney disease in their clinic of ambulatory patients with type 2 diabetes who dwell mainly in the rural area. Methods : A cross-sectional study was conducted at the out-patient of Nyeri County hospital. A total of 385 patients were enrolled over five months. Informed consent was obtained and clinical evaluation was done, a spot sample of urine obtained for albuminuria and venous blood drawn for HbA1c, Lipids and serum creatinine. Estimated GFR (eGFR) was calculated using the Cockroft-Gault equation. Chronic kidney disease (CKD) was classified on KDIGO scale. Albuminuria was reported as either positive or negative. Main outcomes measure: Estimated Glomerular filtration rate and albuminuria as markers of chronic kidney disease. Results : A total of 385 participants were included in the study, 252 (65.5%) were females. There were 39.0 % (95%CI 34.3-44.2) patients in CKD/KDIGO stages 3, 4 and 5 and 32.7% (95%CI, 27.8-37.4) had Albuminuria. The risk factors that were significantly associated with chronic kidney disease/KDIGO stages 3, 4 and 5 were: age >50years, long duration with diabetes >5years and hypertension. Employment and paradoxically, obesity reduced the odds of having CKD, probably as markers of better socio-economic status. Conclusion : Previously unrecognized CKD of KDIGO stages 3,4 and 5 occurred in over thirty percent of the study patients. They were at high risk of progression to end-stage kidney disease and cardiovascular events. The risk factors of hypertension, age above 50, long duration of diabetes should help identify those at high risk of developing CKD, for screening and linkage to care. The imperative of screening for chronic kidney disease is availing care in publicly-funded hospitals.

scholarly journals Cardiopulmonary exercise testing (CPET) in patients with end-stage kidney disease (ESKD): principles, methodology and clinical applications of the optimal tool for exercise tolerance evaluation

2021 ◽  
Author(s):  
Eva Pella ◽  
Afroditi Boutou ◽  
Aristi Boulmpou ◽  
Christodoulos E Papadopoulos ◽  
Aikaterini Papagianni ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Exercise Intolerance ◽  
End Stage Kidney Disease ◽  
Exercise Limitation ◽  
Cardiopulmonary Exercise ◽  
Functional Reserves ◽  
Increased Risk ◽  
End Stage

Abstract Chronic kidney disease (CKD), especially end-stage kidney disease (ESKD), is associated with increased risk for cardiovascular events and all-cause mortality. Exercise intolerance as well as reduced cardiovascular reserve are extremely common in patients with CKD. Cardiopulmonary exercise testing (CPET) is a non-invasive, dynamic technique that provides an integrative evaluation of cardiovascular, pulmonary, neuropsychological and metabolic function during maximal or submaximal exercise, allowing the evaluation of functional reserves of these systems. This assessment is based on the principle that system failure typically occurs when the system is under stress and, thus, CPET is currently considered to be the gold-standard for identifying exercise limitation and differentiating its causes. It has been widely used in several medical fields for risk stratification, clinical evaluation and other applications but its use in everyday practice for CKD patients is scarce. This article describes the basic principles and methodology of CPET and provides an overview of important studies that utilized CPET in patients with ESKD, in an effort to increase awareness of CPET capabilities among practicing nephrologists.

Chronic kidney disease, pregnancy and haemodialysis: Case reports from a single centre in Kenya and literature review

2021 ◽  
pp. 1753495X2098540
Author(s):  
Samuel K Kabinga ◽  
Jackline Otieno ◽  
John Ngige ◽  
Seth O Mcligeyo
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Case Reports ◽  
Tertiary Hospital ◽  
Reproductive Age ◽  
Review Of Literature ◽  
Single Centre ◽  
End Stage Kidney Disease ◽  
Women Of Reproductive Age ◽  
End Stage

Chronic kidney disease (CKD) and end stage kidney disease are prevalent even in women of reproductive age. These are known to reduce fertility and successful pregnancy. There are chances of conception even in advanced CKD, though laden with complications. We present two cases of women who conceived in advanced CKD and are on haemodialysis in a tertiary hospital in Kenya and review of literature.

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