scholarly journals Nutrition care for chronic kidney disease during pregnancy: an updated review

2020 ◽  
Vol 74 (7) ◽  
pp. 983-990 ◽  
Author(s):  
María Angélica Reyes-López ◽  
Giorgina B Piccoli ◽  
Filomena Leone ◽  
Alejandra Orozco-Guillén ◽  
Otilia Perichart-Perera
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Pregnant Women ◽  
Intrauterine Growth Restriction ◽  
Gestational Hypertension ◽  
Perinatal Outcomes ◽  
Adverse Outcomes ◽  
Nutrition Care ◽  
Increased Risk ◽  
Care Practices

AbstractCases of chronic kidney disease (CKD), including CKD in pregnant women, have increased globally in recent years. CKD during pregnancy is associated with a higher risk of adverse outcomes, including gestational hypertension, preeclampsia, intrauterine growth restriction, and preterm birth, among others. Nutrition plays a significant role in many metabolic and physiological changes during pregnancy. Women with CKD are at increased risk of nutrition deficiencies and metabolic issues than women without CKD. Currently, we lack evidence regarding metabolic and nutritional adaptations during pregnancy in women with CKD and how these adaptations relate to perinatal outcomes. In this review, dietary and supplementation recommendations for CKD in adults and pregnant women are summarized from current clinical guidelines. We present the main nutrition care practices that have been studied in CKD pregnancies. This review will be helpful to health professionals as a preliminary reference for nutrition assessment and therapy in pregnant women with CKD.

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

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.

scholarly journals Maternal and fetal outcomes of pregnancy in chronic kidney disease: diagnostic challenges, surveillance and treatment throughout the spectrum of kidney disease

2021 ◽  
Author(s):  
Inês Filipe Gouveia ◽  
Joana Raquel Silva ◽  
Clara Santos ◽  
Claudina Carvalho
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Gestational Hypertension ◽  
Normal Pregnancy ◽  
Adverse Outcomes ◽  
Physiological Adaptations ◽  
Fetal Complications ◽  
Recent Developments ◽  
Progression Of Renal Disease ◽  
Harmful Effects

Abstract Pregnancy requires several physiological adaptations from the maternal organism, including modifications in the glomerular filtration rate and renal excretion of several products. Chronic kidney disease (CKD) can negatively affect these modifications and consequently is associated with several adverse maternal and fetal adverse outcomes (gestational hypertension, progression of renal disease, pre-eclampsia, fetal growth restriction, and preterm delivery). A multidisciplinary vigilance of these pregnancies is essential in order to avoid and/or control the harmful effects associated with this pathology. Dialysis and transplantation can decrease the risks of maternal and fetal complications, nonetheless, the rates of complications remain high comparing with a normal pregnancy. Several recent developments in this area have improved quality and efficacy of treatment of pregnant women with CKD. This article summarizes the most recent literature about CKD and pregnancy.

scholarly journals Renin–angiotensin system blocker discontinuation and adverse outcomes in chronic kidney disease

2020 ◽  
Author(s):  
Carl P Walther ◽  
Wolfgang C Winkelmayer ◽  
Peter A Richardson ◽  
Salim S Virani ◽  
Sankar D Navaneethan
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renin Angiotensin System ◽  
Cox Proportional Hazards ◽  
Adverse Outcomes ◽  
Converting Enzyme Inhibitors ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
Risk Of Death ◽  
Increased Risk

Abstract Background Treatment with renin–angiotensin system inhibitors (RASIs), angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) is the standard of care for those with chronic kidney disease (CKD) and albuminuria. However, ACEI/ARB treatment is often discontinued for various reasons. We investigated the association of ACEI/ARB discontinuation with outcomes among US veterans with non-dialysis-dependent CKD. Methods We performed a retrospective cohort study of patients in the Veterans Affairs healthcare system with non-dialysis-dependent CKD who subsequently were started on ACEI/ARB therapy (new user design). Discontinuation events were defined as a gap in ACEI/ARB therapy of ≥14 days and were classified further based on duration (14–30, 31–60, 61–90, 91–180 and >180 days). This was treated as a time-varying risk factor in adjusted Cox proportional hazards models for the outcomes of death and incident end-stage kidney disease (ESKD), which also adjusted for relevant confounders. Results We identified 141 252 people with CKD and incident ACEI/ARB use who met the inclusion criteria; these were followed for a mean 4.87 years. There were 135 356 discontinuation events, 68 699 deaths and 6152 incident ESKD events. Discontinuation of ACEI/ARB was associated with a higher risk of death [hazard ratio (HR) 2.3, 2.0, 1.99, 1.92 and 1.74 for those discontinued for 14–30, 31–60, 61–90, 91–180 and >180 days, respectively]. Similar associations were noted between ACEI and ARB discontinuation and ESKD (HR 1.64, 1.47, 1.54, 1.65 and 1.59 for those discontinued for 14–30, 31–60, 61–90, 91–180 and >180 days, respectively). Conclusions In a cohort of predominantly male veterans with CKD Stages 3 and 4, ACEI/ARB discontinuation was independently associated with an increased risk of subsequent death and ESKD. This may be due to the severity of illness factors that drive the decision to discontinue therapy. Further investigations to determine the causes of discontinuations and to provide an evidence base for discontinuation decisions are needed.

scholarly journals Association between serum phosphorus levels and adverse outcomes in chronic kidney disease: an observational cohort study

2021 ◽  
Author(s):  
Akira Oda ◽  
Kenichi Tanaka ◽  
Hirotaka Saito ◽  
Tsuyoshi Iwasaki ◽  
Shuhei Watanabe ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Cardiovascular Events ◽  
Cox Regression ◽  
Hazard Ratio ◽  
Adverse Outcomes ◽  
Serum Phosphorus ◽  
Increased Risk ◽  
Phosphorus Levels

Abstract Background Although an association between serum phosphorus levels and poor prognosis has been noted in dialysis patients, these associations have been insufficiently reported in non-dialysis dependent chronic kidney disease (NDD-CKD) patients. This study attempted to determine the association between serum phosphorus levels and adverse outcomes in Japanese NDD-CKD patients. Methods We investigated the relationships between serum phosphorus levels and adverse outcomes such as kidney events, cardiovascular events, and all-cause death in Japanese NDD-CKD patients, using the longitudinal data of the Fukushima CKD Cohort Study. The study evaluated 822 patients with NDD-CKD enrolled between June 2012 and July 2014. A kidney event was defined as a combination of doubling of the baseline serum creatinine or end-stage renal disease. Cox regression was performed to analyze the relationships of the quartile of the serum phosphorus with kidney events, cardiovascular events, and all-cause death. Results Over a median follow-up period of 2.8 years, 46 patients died, there were 50 cardiovascular events, and 102 kidney events occurred. Increased risk of kidney events was observed in patients with higher serum phosphorus, with the lowest risk shown to be a second quartile of serum phosphorus level of 2.9–3.2 mg/dL. Multivariable Cox regression analysis showed an increased risk of kidney events for the highest quartile of the serum phosphorus levels (≥ 3.7 mg/dL) versus the second quartile (2.9–3.2 mg/dL, hazard ratio, 3.62; 95% confidence interval, 1.65–7.94; P = 0.001). A 1 mg/dL increase of the serum phosphorus was associated with an adjusted hazard ratio of 1.66 (95% CI; 1.24–2.20) for the kidney events. There were no significant associations between the serum phosphorus levels at baseline and the risk of cardiovascular events and all-cause death. Conclusions Serum phosphorus levels were associated with an increased risk of CKD progression in Japanese NDD-CKD patients.

scholarly journals Fractures and their sequelae in non-dialysis-dependent chronic kidney disease: the Stockholm CREAtinine Measurement project

2019 ◽  
Vol 35 (11) ◽  
pp. 1908-1915 ◽  
Author(s):  
Björn Runesson ◽  
Marco Trevisan ◽  
Ken Iseri ◽  
Abdul Rashid Qureshi ◽  
Bengt Lindholm ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Hip Fractures ◽  
Cox Regression ◽  
Adverse Outcomes ◽  
Care Utilization ◽  
Cardiac Events ◽  
Increased Risk ◽  
Ckd Stage ◽  
Creatinine Measurement

Abstract Introduction People undergoing maintenance dialysis are at high risk for fractures, but less is known about fracture incidence and associated outcomes in earlier stages of chronic kidney disease (CKD). Methods We conducted an observational analysis from the Stockholm Creatinine Measurement project, a Swedish health care utilization cohort during 2006–11. We identified all adults with confirmed CKD Stages 3–5 and no documented history of fractures and extracted information on comorbid history, ongoing medication, cardiovascular events and death. We studied incidence rates of fractures (overall and by location), with the estimated glomerular filtration rate (eGFR) as time-dependent exposure. We then studied hazard ratios [HRs and 95% confidence intervals (CIs)] for the events of death and major adverse cardiac events (MACE) using Cox regression with fracture as time-varying exposure. Results We identified 68 764 individuals with confirmed CKD (mean age 79 years, 56% women). During a median follow-up of 2.7 years, 9219 fractures occurred, of which 3105 were hip fractures. A more severe CKD stage was associated with a higher risk of fractures, particularly hip fractures: compared with CKD Stage 3a, the adjusted HR was 1.10 (95% CI 1.02–1.19), 1.32 (1.17–1.49) and 2.47 (1.94–3.15) for CKD Stage 3b, 4 and 5, respectively. Spline curves suggested a linear association with fracture risk with an eGFR <30 mL/min/1.73 m2. Compared with non-fracture periods, incident fracture was associated with a 4-fold increased mortality within 90 days [HR 4.21 (95% CI 3.95–4.49)]. The risk remained elevated beyond 90 days [HR 1.47 (95% CI 1.40–1.54)] and was stronger after hip fractures. Post-fracture MACE risk was also highest in the first 90 days [HR 4.02 (95% CI 3.73–4.33)], particularly after hip fractures, and persisted beyond 90 days [HR 1.20 (95% CI 1.10–1.30)]. Conclusion Our findings highlight the commonness of fractures and the increased risk for subsequent adverse outcomes in CKD patients. These results may inform clinical decisions regarding post-fracture clinical surveillance and fracture prevention strategies.

scholarly journals Management of Kidney Failure in Patients with Diabetes Mellitus: What Are the Best Options?

2021 ◽  
Vol 10 (13) ◽  
pp. 2943
Author(s):  
Juan M. Buades ◽  
Lourdes Craver ◽  
Maria Dolores Del Pino ◽  
Mario Prieto-Velasco ◽  
Juan C. Ruiz ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Failure ◽  
Incidence Rates ◽  
Adverse Outcomes ◽  
Multidisciplinary Teams ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
At Home

Diabetic kidney disease (DKD) is the most frequent cause of kidney failure (KF). There are large variations in the incidence rates of kidney replacement therapy (KRT). Late referral to nephrology services has been associated with an increased risk of adverse outcomes. In many countries, when patients reach severely reduced glomerular filtration rate (GFR), they are managed by multidisciplinary teams led by nephrologists. In these clinics, efforts will continue to halt chronic kidney disease (CKD) progression and to prevent cardiovascular mortality and morbidity. In patients with diabetes and severely reduced GFR and KF, treating hyperglycemia is a challenge, since some drugs are contraindicated and most of them require dose adjustments. Even more, a decision-making process will help in deciding whether the patient would prefer comprehensive conservative care or KRT. On many occasions, this decision will be conditioned by diabetes mellitus itself. Effective education should cover the necessary information for the patient and family to answer these questions: 1. Should I go for KRT or not? 2. If the answer is KRT, dialysis and/or transplantation? 3. Dialysis at home or in center? 4. If dialysis at home, peritoneal dialysis or home hemodialysis? 5. If transplantation is desired, discuss the options of whether the donation would be from a living or deceased donor. This review addresses the determinant factors with an impact on DKD, aiming to shed light on the specific needs that arise in the management and recommendations on how to achieve a comprehensive approach to the diabetic patient with chronic kidney disease.

scholarly journals Evaluation of potential drug–drug interactions among patients with chronic kidney disease in northeastern Nigeria

2019 ◽  
Vol 22 (1) ◽  
pp. 77-81
Author(s):  
Roland N. Okoro
Keyword(s):  
Chronic Kidney Disease ◽  
Calcium Carbonate ◽  
Kidney Disease ◽  
Drug Interactions ◽  
Ferrous Sulphate ◽  
Laboratory Data ◽  
Adverse Outcomes ◽  
Potential Drug ◽  
Cross Sectional ◽  
Increased Risk

Background: Potential drug–drug interactions (pDDIs) may not manifest clinically in patients who are treated with multiple pharmaceutical agents, but when they do they can produce adverse outcomes. In patients with chronic kidney disease (CKD), the frequent use of multiple agents to manage this condition and its complications puts these patients at increased risk for DDIs. We determined the prevalence of pDDIs in CKD patients in two Nigerian hospitals and investigated possible predictors of pDDIs. Methods: This cross-sectional study involved patients with CKD who attended the nephrology unit of the University of Maiduguri Teaching Hospital and the medical outpatients clinic of the State Specialist Hospital in Maiduguri, Nigeria. We collected prescriptions, clinical data and laboratory data from the medical files of patients seen between January 2013 and December 2017. Descriptive and inferential statistics were used to analyse the data. Results: The study included 201 patients. A total of 273 pDDIs were identified in 166 patients (83%). These pDDIs included 30 unique drug interactions, the most common being between ferrous sulphate and calcium carbonate (seen in 46% of patients with pDDIs), followed by lisinopril and furosemide (8%). The proportion of clinically significant interactions was only 2%. There was a positive association between pDDIs and the total number of drugs prescribed (P < 0.001).Conclusions: A high prevalence of pDDIs was documented among Nigerian patients with CKD. The bulk of the interactions were related to the co-prescription of ferrous sulphate and calcium carbonate. The total number of drugs prescribed was a significant predictor of pDDIs. We recommend routine screening of prescriptions of CKD patients for potential pDDIs.

Meta-analysis of Clinical Outcomes of Electrical Cardioversion and Catheter Ablation in Patients with Atrial Fibrillation and Chronic Kidney Disease

2018 ◽  
Vol 24 (24) ◽  
pp. 2794-2801 ◽  
Author(s):  
Igor Diemberger ◽  
Simonetta Genovesi ◽  
Giulia Massaro ◽  
Maria Letizia Bacchi Reggiani ◽  
Jessica Frisoni ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Catheter Ablation ◽  
Kidney Disease ◽  
Meta Analysis ◽  
Adverse Outcomes ◽  
Electrical Cardioversion ◽  
Cochrane Central Register ◽  
Pharmacological Management ◽  
Increased Risk

Background: Chronic kidney disease (CKD) is associated with adverse outcomes in presence of atrial fibrillation (AF). However, the literature shows limited data on non-pharmacological management of AF in CKD patients. Aim: summarizing the available data on outcomes associated with electrical cardioversion (ECV) and AF catheter ablation (CA) in CKD patients. Methods: We searched MEDLINE and the Cochrane Central Register of Controlled Trials and performed a metaanalysis. The primary outcome was recurrence of AF. The secondary outcomes were occurrence of thromboembolic events (TEs) and estimated glomerular filtration rate (eGFR) modification. Results: Literature search yielded 26 eligible papers: 22 on CA and 4 concerning ECV. CKD patients presented more AF recurrences 30 days after ECV (OR 2.62, 95%CI 1.28-5.34; p <0.001). Patients with eGFR<60-68 ml/min and on dialysis presented a higher incidence of AF recurrences after CA, median follow up 26.0 and 29.9 months (HR 1.75, 95%CI 1.46-2.09, p <0.001; and HR 1.69, 95%CI 1.22-2.33, p <0.001; respectively). Periprocedural TEs were rare and not associated with CKD or dialysis. However, patients with CKD were at increased risk for delayed TEs after CA (HR 2.61, 95%CI 1.04-6.54; p <0.001). No significant modification of eGFR was associated with ECV or CA in the overall population. Conclusion: ECV and CA for sinus rhythm restoration/maintenance in AF patients, albeit theoretically promising, seem to be associated with lower efficacy at medium to long-term in patients with CKD. Further studies are needed to better define the role of ECV and CA in CKD.

scholarly journals Prevalence, correlates and outcomes of absolute and functional iron deficiency anemia in nondialysis-dependent chronic kidney disease

2019 ◽  
Vol 36 (1) ◽  
pp. 129-136 ◽  
Author(s):  
Ahmed A Awan ◽  
Carl P Walther ◽  
Peter A Richardson ◽  
Maulin Shah ◽  
Wolfgang C Winkelmayer ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Large Population ◽  
Adverse Outcomes ◽  
Deficiency Anemia ◽  
Functional Iron Deficiency ◽  
Risk Of Mortality ◽  
Increased Risk

Abstract Background Anemia is associated with adverse outcomes in those with chronic kidney disease (CKD). We examined the association of absolute and functional iron deficiency anemia (IDA) with adverse outcomes (cardiovascular hospitalization, dialysis and mortality) in those with nondialysis-dependent CKD. Methods Nondialysis-dependent CKD patients followed in the US Veterans Administration with hemoglobin level measured within 90 days of the date of the second estimated glomerular filtration rate &lt;60 mL/min/1.73 m2 were included. Logistic regression, multivariate Cox proportional hazards and Poisson regression models adjusted for demographics and comorbidities were used to assess the prevalence and correlates of absolute [transferrin saturation (TSAT) ≤20%, ferritin &lt;100 ng/mL] and functional (TSA T≤20%, ferritin &gt;100–500 ng/mL) IDA and the associations of absolute and functional IDA with mortality, dialysis and cardiovascular hospitalization. Results Of 933 463 patients with CKD, 20.6% had anemia. Among those with anemia, 23.6% of patients had both TSAT and ferritin level measured, of whom 30% had absolute IDA and 19% had functional IDA. Absolute IDA in CKD was not associated with an increased risk of mortality or dialysis but was associated with a higher risk of 1-year {risk ratio [RR] 1.20 [95% confidence interval (CI) 1.12–1.28]} and 2-year cardiovascular hospitalization [RR 1.11 (95% CI 1.05–1.17)]. CKD patients with functional IDA had a higher risk of mortality [hazard ratio (HR) 1.11 (95% CI 1.07–1.14)] along with a higher risk of 1-year [RR 1.21 (95% CI 1.1–1.30)] and 2-year cardiovascular hospitalization [RR 1.13 (95% CI 1.07–1.21)]. Ferritin &gt;500 ng/mL (treated as a separate category) was only associated with an increased risk of mortality [HR 1.38 (95% CI 1.26–1.51)]. Conclusions In a large population of CKD patients with anemia, absolute and functional IDA were associated with various clinical covariates. Functional IDA was associated with an increased risk of mortality and cardiovascular hospitalization, but absolute IDA was associated only with a higher risk of hospitalization.

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