Acute coronary syndromes in chronic kidney disease patients: the good, the bad or the ugly?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Saleiro ◽  
D De Campos ◽  
J Lopes ◽  
R Teixeira ◽  
J.P Sousa ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Systolic Function ◽  
Lv Function ◽  
Angiotensin Ii Antagonist ◽  
All Cause Mortality ◽  
Group A ◽  
Lv Ejection Fraction ◽  
Group B ◽  
Lv Systolic Function

Abstract Background Patients with chronic kidney disease (CKD) are at increased risk of composite cardiovascular (CV) events and all-cause mortality. However, current aggressiveness of therapeutic strategies may minimize the course of the disease. Aim To assess the prognostic impact of optimized medical treatment in a CKD population with acute coronary syndrome (ACS). Methods 355 ACS patients admitted to a single coronary care with CKD who were discharged from hospital were included. Those with end-stage renal disease were excluded. Three groups were created based on the KDIGO classification: Group A (Stage 3A, eGFR [estimated glomerular filtration rate] 45–59mL/min/1.73 m2) N=190; Group B (Stage 3B, eGFR 30–44mL/min/1.73 m2) N=113; and Group C (Stage 3B, eGFR 15–29mL/min/1.73 m2) N=52. The primary endpoint was long-term all-cause mortality. Kaplan-Meyer survival curves and Cox regression were done. The median of follow-up was 32 (IQ 15–70) months. Results Groups were similar regarding demographics, CV risk factors, ACS type, heart failure diagnosis, left ventricular (LV) systolic function, peak troponin, multivessel disease, treatment option (PCI, CABG or OMT) and medical therapy at discharge. More advance renal failure patients had a higher prevalence of diabetes mellitus (DM), a lower haemoglobin, a higher NT-proBNP and were less likely to receive ACE inhibitors/angiotensin II antagonist at discharge. 170 patients met the primary outcome. Kaplan-Meyer curves showed decreased survival with worse renal function (Group A 68% vs Group B 57% vs Group C 37%, Log Rank P=0.006 – Figure 1). After adjustment for age, DM, haemoglobin, NT-proBNP, LV systolic function and ACE inhibitors/angiotensin II antagonist at discharge, eGFR was not associated with increased death (HR 1.00, 95% CI 0.98–1.01). In this model, only age (HR 1.04, 95% CI 1.01–1.07), haemoglobin (HR 0.86, 95% CI 0.979–0.94), Nt-proBNP (HR 1.00, 95% CI 1.00–1.00) and impaired LV function (LV ejection fraction 40–49%: HR 2.95, 95% CI 1.89–4.81; LV ejection fraction <40%: HR 2.15, 95% CI 1.44–3.21) remained associated with the outcome. Conclusion The worse outcome attributed to CKD after an ACS seems to be related not the eGFR itself but to associated comorbidities such as age, anaemia, fluid overload and impaired LV function. The fact that some of these comorbidities may be altered by intensive therapy indicates that CKD patients should also be candidates to optimized medical treatment. Funding Acknowledgement Type of funding source: None

P6242Left ventricular global longitudinal strain to predict pulmonary edema in chronic kidney disease patients on haemodialysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Meenakshi ◽  
R Rameshwar
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Ejection Fraction ◽  
Pulmonary Edema ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Lv Function ◽  
Group A ◽  
Group B

Abstract The left ventricular (LV) function remains preserved in the majority patients with chronic kidney disease (CKD). Despite this, Pulmonary edema can still occur in CKD patients with preserved ejection fraction during or after haemodialysis. The aim of our study was to determine whether assessment of Left ventricular global longitudinal strain (LV GLS) in CKD patients, could be used to detect sub clinical LV dysfunction and hence the propensity to develop pulmonary edema during or post hemodialysis. Our study cohort consisted of 105 CKD patients with normal Ejection fraction by transthoracic Echocardiography (TTE) and undergoing haemodialysis. There were 38 females and 67 males, ages ranging from 23 to 63yrs. They underwent detailed evaluation and assessment of risk factor profile, particularly the presence of hypertension and Diabetes. The Ejection fraction, presence of left ventricular hypertrophy (LVH), Left ventricular diastolic dysfunction (LVDD) and the LV GLS were assessed by TTE. Based on the findings, the male and female patients were divided into 3 groups. Group A with a GLS <−15, Group with a GLS between −15 and −18 and group C with GLS >−18. In group A, 81.1% of the males and 86.7% of the females developed pulmonary edema in contrast to 13% and 21.1% and 14.3% and 0% in groups B and C respectively. When LVDD was compared to the LV GLS it was found that in Group A, 80% of the males, and 88.2% of the females with LVDD developed pulmonary edema in contrast to 7% and 20% in group B and 0% and 0% in Group c respectively who had LVDD and developed pulmonary edema. In spite of having a normal LV diastolic function 100% of the males in group A developed pulmonary edema. Further, 92.8% of the males and 80% of the females in group B did not develop pulmonary edema despite having LVDD. So from our study, a cut of LV GLS value of −15 could predict pulmonary edema in CKD patients undergoing hemodialysis and although the majority were associated with LVDD, it could occur even in the absence of diastolic dysfunction. Further at LV GLS values >−15, the incidence of pulmonary edema was statistically significantly less despite having LVDD. Conclusion Left ventricular GLS appears to be a more reliable method than LVDD for predicting the occurrence of pulmonary edema during or post haemodialysis in CKD patients with normal LV Function, A LV GLS <15 would indicate the necessity for the implementation of appropriate precautions to prevent the occurrence of the same during dialysis. It can also be used in the long term follow up of patients.

scholarly journals Effect of Dietary Supplements in Reducing Probability of Death for Uremic Crises in Dogs Affected by Chronic Kidney Disease (Masked RCCT)

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Andrea Zatelli ◽  
Marco Pierantozzi ◽  
Paola D'Ippolito ◽  
Mauro Bigliati ◽  
Eric Zini
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Mortality Rate ◽  
Dietary Supplements ◽  
Dietary Supplementation ◽  
Phosphate Binders ◽  
Group A ◽  
Probability Of Death ◽  
Group B ◽  
To Receive

Chitosan and alkalinizing agents can decrease morbidity and mortality in humans with chronic kidney disease (CKD). Whether this holds true in dog is not known. Objective of the study was to determine whether a commercial dietary supplement containing chitosan, phosphate binders, and alkalinizing agents (Renal), compared to placebo, reduces mortality rate due to uremic crises in dogs with spontaneous CKD, fed a renal diet (RD). A masked RCCT was performed including 31 azotemic dogs with spontaneous CKD. Dogs enrolled in the study were randomly allocated to receive RD plus placebo (group A; 15 dogs) or RD plus Renal (group B; 16 dogs). During a first 4-week period, all dogs were fed an RD and then randomized and clinically evaluated up to 44 weeks. The effects of dietary supplements on mortality rate due to uremic crises were assessed. At 44 weeks, compared to group A, dogs in group B had approximately 50% lower mortality rate due to uremic crises (P=0.015). Dietary supplementation with chitosan, phosphate binders, and alkalinizing agents, along with an RD, is beneficial in reducing mortality rate in dogs with spontaneous CKD.

scholarly journals A comparison between Chinese finger trap and Roman sandals suturein peritoneal dialysis catheters for chronic kidney disease appliedin veterinary medicine

2020 ◽  
Vol 71 (01) ◽  
pp. 8-11
Author(s):  
BOGDAN ALEXANDRU VIȚĂLARU ◽  
MĂDĂLIN ION RUSU ◽  
CARMEN MIHAI ◽  
ALEXANDRU CHIOTOROIU
Keyword(s):  
Chronic Kidney Disease ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Chronic Treatment ◽  
Chronic Peritoneal Dialysis ◽  
Peritoneal Catheter ◽  
Catheter Migration ◽  
Group A ◽  
Initial Placement ◽  
Group B

Catheters designed for chronic peritoneal dialysis have Dacron cuffs meant to protect the patient against bacterialinfection and catheter migration that may lead to a high peritonitis rate in case of extensive use. Peritoneal catheter isfixed by suturing the skin with a non-absorbable monofilament thread ranging from 4/0 to 2/0. The two types of suturesmost commonly used are Roman sandal and Chinese fingertrap. In this study we selected 44 dogs, both males andfemales with CKD (Chronic Kidney Disease) undergoing peritoneal dialysis. We have created two groups: first group(A) of 22 patients were treated using a peritoneal catheter for chronic treatment, with Roman sandal suture and thesecond group of 22 patients (B) were treated using a peritoneal catheter for chronic treatment, with Chinese fingertrapsuture. All patients from group A kept the catheters until the end of the treatment (22 out of 22, 100%). Eight out of14 patients (36.36%) from group B needed secondary suture. Four out of the eight patients (18.18%) form the group Bneeded secondary suturing because of the suture weakening. Three out of the eight patients (13.63%) form the groupB needed secondary suturing of the catheter because of the skin rupture at the initial placement spot of the suture. Oneof the eight patients (4.54%) form the group B needed secondary suturing of the catheter because of the catheterreplacement, due to the weakening of the suture and its lack of resistance to the aggression manifested by the patients

scholarly journals The Dose per Fraction May be correlated with Late Kidney Toxicity after Total Body Irradiation: a Single Institution Experience

2019 ◽  
Vol 2 (1) ◽  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Total Body Irradiation ◽  
Group A ◽  
The Common ◽  
Total Body ◽  
Group B ◽  
Chronic Kidney Disease Group ◽  
Dose Per Fraction

Background: The purpose of the present study was to retrospectively evaluate the subacute or late toxicities in the kidney, lung, and liver after two total body irradiation regimens, 12 Gy in 6 fractions (group A) and 12 Gy in 4 fractions (group B). Methods: Forty-two patients who underwent total body irradiation (group A, n=32; group B, n=10) between June 1997 and June 2013 were included in the present study. The median follow up period was 60 months (range: 3–219 months) for the patients in group A and 143 months (range: 5–220 months) for the patients in group B. We evaluated the renal, pulmonary, and hepatic toxicities using the Common Terminology Criteria for Adverse Events version 4.0. Results: There were 4 cases of chronic kidney disease (group A, n=1; group B, n=3). Although the cumulative incidence of chronic kidney disease differed significantly between the two total body irradiation regimens (p=0.014), the pulmonary and hepatic toxicities did not differ to a statistically significant extent. Conclusion: The present study suggests that a higher dose per fraction caused a higher incidence of chronic kidney disease.

scholarly journals Histology and Immunohistochemistry of Radial Arteries Are Suggestive of an Interaction between Calcification and Early Atherosclerotic Lesions in Chronic Kidney Disease

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1156
Author(s):  
Aikaterini Lysitska ◽  
Nikiforos Galanis ◽  
Ioannis Skandalos ◽  
Christina Nikolaidou ◽  
Sophia Briza ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Vascular Calcification ◽  
Morphometric Analysis ◽  
Intima Media Thickness ◽  
Inflammatory Cells ◽  
Vascular Wall ◽  
Control Group ◽  
Group A ◽  
Group B

Background and Objectives: recent studies suggest an implication of immune mechanisms in atherosclerotic disease. In this paper, the interaction between inflammation, calcification, and atherosclerosis on the vessel walls of patients with chronic kidney disease (CKD) is described and evaluated. Materials and Methods: patients with stage V CKD, either on pre-dialysis (group A) or on hemodialysis (HD) for at least 2 years (group B), in whom a radiocephalic arteriovenous fistula (RCAVF) was created, were included in the study. The control group included healthy volunteers who received radial artery surgery after an accident. The expressions of inflammatory cells, myofibroblasts, and vascular calcification regulators on the vascular wall were estimated, and, moreover, morphometric analysis was performed. Results: the expressions of CD68(+) cells, matrix carboxyglutamic acid proteins (MGPs), the receptor activator of nuclear factor-kB (RANK) and RANK ligand (RANKL), and osteoprotegerin (OPG), were significantly increased in CKD patients compared to the controls p = 0.02; p = 0.006; p = 0.01; and p = 0.006, respectively. In morphometric analysis, the I/M and L/I ratios had significant differences between CKD patients and the controls 0.3534 ± 0.20 vs. 0.1520 ± 0.865, p = 0.003, and 2.1709 ± 1.568 vs. 4.9958 ± 3.2975, p = 0.03, respectively. The independent variables correlated with the degree of vascular calcification were the intensity of CD34(+), aSMA(+) cells, and OPG, R2 = 0.76, p < 0.0001, and, with intima-media thickness (IMT), the severity of RANKL expression R2 = 0.3, p < 0.0001. Conclusion: atherosclerosis and vascular calcification in CKD seem to be strongly regulated by an immunological and inflammatory activation on the vascular wall.

MO777HISTOLOGICAL AND IMMUNOPHENOTYPICAL VESSEL CHANGES IN CHRONIC KIDNEY DISEASE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Aikaterini Lysitska ◽  
Nikiforos Galanis ◽  
Ioannis Skandalos ◽  
Eustathios Mitsopoulos ◽  
Nikolaos Antoniadis ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Internal Carotid ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Atherosclerotic Lesions ◽  
Ckd Stage ◽  
Group A ◽  
The Common ◽  
Group B

Abstract Background and Aims Recent studies suggest thw possibility of activating immune mechanism in the onset and progression of atherosclerotic disease. The aim of the present study was to evaluate the role of immune mechanisms in the vessel of patients with Chronic Kidney Disease (CKD) and the association with clinical and laboratory indicators of atherosclerosis. Method Patients with CKD stage V, in whom a radiocephalic arteriovenous fistula (RC-AVF) was created, were included in the study. Patients were divided in two groups, group A was consisted of patients who were on stage V, pre-dialysis, and being prepared to start on hemodialysis (HD), and those who had already been on HD for at least 3 years, and were having a new RC-AVF formation, due to previous failure, group B. Inclusion criteria were: age 25-80 years, gradual deterioration of renal function up to stage V or under dialysis for more than 3 years. All patients should have been under close follow up for at least 3 years prior to enrolment, with adequate control of diabetes, hypertension, dyslipidemia, secondary hyperparathyroidism and anemia. The control group included healthy volunteers of similar age, sex and ethnicity, who agreed to have a radial artery biopsy during an orthopedic procedure because of a fracture. All patients were informed and signed the consent form. Patients’ history, primary disease and comorbid conditions, medication and clinical examination were recorded based on hospital outpatients’ files. Prior to the scheduled day of RC-AVF creation, all patients underwent laboratory examination, included hematological and serum biochemical analyses. The histological characteristics, inflammatory activation and immunophenotypic alterations of the radial artery wall were estimated and their association with the severity of calcification and atherosclerosis were studied. Presence and severity of atherosclerotic lesions in CKD patients was assessed based on the measurement of common carotid intima – media thickness (IMT) of the common and internal carotid on both sides. Results Significant correlation was fount between inflammatory infiltration [expression of CD3(+), CD20(+), CD68(+) cells], cellular activation [CD34(+), a-SMA(+) cells] and calcification regulators (MPG, RANKL, OPG) with the degree of vascular calcification, as this was estimated and classified based on Verhoff’s Elastic and von Kossa staining Forty five patients with chronic kidney disease (CKD), stage V, either pre-dialysis (p=25) (group A) or on hemodialysis (HD) (p=20) (group B) were included in the study. There were no significant differences in age, sex, race, and also in the frequency of hypertension, diabetes mellitus or smoking habits between patients and controls. Presence and severity of atherosclerotic lesions in CKD patients was assessed based on the measurement of common carotid intima – media thickness (IMT) of the common and internal carotid on both sides. Conclusion Atherosclerotic disease in Chronic KidnEy Disease and its clinical effects appear to be directly related to inflammatory ifiltration of blood vessels by T, B lymphocytes, macrophages and myofibrolasts, as well as factors that affect calcification.

scholarly journals Calcium - Phosphate Index: Considerable Indicator in Different Stages of Chronic Kidney Disease

2012 ◽  
Vol 19 (Number 2) ◽  
pp. 3-6
Author(s):  
N Y Mili ◽  
Md. E Hoque ◽  
S Akhter ◽  
N S Lovely
Keyword(s):  
Chronic Kidney Disease ◽  
Calcium Phosphate ◽  
Kidney Disease ◽  
Serum Calcium ◽  
Phosphate Level ◽  
Ckd Stage ◽  
P Index ◽  
Group A ◽  
Group B ◽  
Serum Inorganic Phosphate

Since the early 1970s. calcium phosphate (Ca-P) index has been regarded as a risk factor for extra skeletal calcification. tumoral calcinosis and increased cardiovascular event and death. The general consensus was not to exceed 70 ing2h1Lt (5.6 unno1/1,2) in chronic kidney disease. The present study was done to find out the Ca - P index in different stages of (CKB) patients to assess the risks of the patients which can be understood and be negotiated. In this study 100 of previously diagnosed chronic kidney disease patients of different stages as CKD stage Ill. IV and stage V were included. Subjects were divided into three groups according to staging of chronic kidney disease : group A (stage 111) were 34 patients, group 8 (Stage IV) were 36 and group C (Stage V) were 30 patients. Mean serum inorganic phosphate level was in group A .5.41 + 2.49. group 8 8.17 + 3.63 and in group C 10.50 + 3.06. Mean serum Calcium level in three groups were in group-A 8.36± 0.74. group- B 8.10± 0.75 and in group- C was 7.43± 1.27 ). Ca - P index was calculated by multiplying the serum calcium and phosphate level. Mean Ca-P index was in group-A 49.39+ 22.95. group B-67.93+ 31.2 and in group-C 90.76+ 24.82. Statistical analysis was done betWeen these groups and it was signifimuly higher in group B than group A ( p< 0.06. group A is group 8). in group C than group A ( p< 0.00. group A vs group C) and in ,group C than group ft ( p< .002. group B vs group C). It was found that as the renal function deteriorates gradually the Ca P index increases and it is highly significantly higher in CKD — V patient than other stages.

The Effect of Hemodiafiltration on Inflammatory Biomarkers in Comparison to High Flux Dialyzers in Prevalent Hemodialysis Patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Gamal Elsayed Mady ◽  
Walid Ahmed Bichari ◽  
Mostafa Abdelnassier Abdelgawad ◽  
Lina Essam Khedr ◽  
Khaled Mohamed Rezk ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Uric Acid ◽  
Kidney Disease ◽  
Enzyme Linked Immunosorbent Assay ◽  
High Flux ◽  
Dialysis Unit ◽  
Statistical Significant Difference ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Introduction Inflammation in patients with ESRD undergoing HD is an increasing concern for physicians and has been related to increase the rates of morbidity and mortality. Interestingly, patients with ESRD in conventional HD have frequent infections and a suboptimal response to vaccines; this is probably related to an immune inflammatory disorder associated either with uremia and/or nutritional status. In addition to CRP, which seems to be the most important marker for the identification and control of inflammation in clinical practice, many other markers are also available for the evaluation of inflammatory state. Decreased renal clearance clearly accounts for higher levels of circulating cytokines, although increased production has also been described. Hemodiafiltration has been shown to improve cardio-protection and the immunologic system and reduces infection and mortality compared with conventional HD. A recent study showed that hemodiafiltration compared with conventional HD reduced the risk of mortality in ESRD patients. Analysis of pooled individual participant data from randomized controlled trials has shown survival benefits of high volume-HDF on all-cause mortality and especially cardiovascular mortality rate. The mechanisms that lead to improved outcomes are not clear, but it is thought that HDF may reduce the production of inflammatory mediators through the use of biocompatible dialysers and ultrapure dialysate and also improve clearance of larger molecular weight substances, many of which are associated with oxidative stress, inflammation and endothelial dysfunction. Objective The aim of this study is to detect, prospectively, the effect of 3 months dialysis with Hemodiafiltration on inflammatory and nutritional biomarkers in comparison to conventional dialysis with high flux dialyzer in stable HD patients. Patients and methods 30 adults aged 20-75 years who were selected from Dialysis Unit, Kobary El-Kobba Military Hospital. 30 male patients known to have chronic kidney disease and are on dialysis with high flux dialyzer more than 3 months were divided into 2 groups:15 Patients are shifted to be on dialysis with HDF and 15 Patients are continued to be on Regular Hemodialysis with high flux dialyzer. Full medical history and clinical examination. Anthropometric measurements and Laboratory investigations including Complete Blood Picture (WBCs, platelets, Hb), Coagulation profile PT, PTT&INR, Liver function tests (ALT, AST, T. Bilirubin and S. Albumin), Lipid profile (Triglycerides, total cholesterol, VLDL), S. creatinine, BUN, Na, K, Uric acid, Total Proteins, Serum Calcium, Serum Phosphorus, PTH, Serum ferritin, High sensitivity CRP (Enzyme- Linked Immunosorbent Assay (ELISA)) and IL6 (ELISA). Results The current study was conducted on 30 patients with chronic kidney disease on regular dialysis. The patients were divided into two groups A representing patients on hemodiafiltration (n = 15) and group B representing patients on dialysis with high flux dialyzer (n = 15). A high statistical significant difference (P &lt; 0.01) was found regarding K 4.3±0.6 meq/l in group A while it is 5.2±0.5 meq/l in group B, a high statistical significant difference (P &lt; 0.01) was found regarding phosphorus 4.6±1.0 mg/dl in group A while it is 6.1±0.9 mg/dl in group B and no statistical significant difference (P &gt; 0.05) was found as regard the uric acid. A statistical significant difference (P &lt; 0.05) was found regarding CRP 63.5±40.9 mg/dl in group A while it is 73.4±33.2 mg/dl in group B, a statistical significant difference (P &lt; 0.01) was found regarding IL6 85.3±37.6 mg/dl in group A while it is 156.7±151.9 mg/dl in group B after 3 months and no statistical significant difference (P &gt; 0.05) was found as regard those inflammatory markers before 3 months. A statistical significant difference (P &lt; 0.05) was found regarding CRP. A statistical significant difference (P &lt; 0.05) was found regarding IL6. Conclusion The present study revealed that there was no significant change in CRP and IL6 in patients on HDF compared to patients undergoing hemodialysis with high flux dialyzer before 3 months but there was a significant decrease in CRP and IL6 in patients on HDF compared to patients undergoing hemodialysis with high flux dialyzer after 3 months.

scholarly journals Oral supplementation with omega-3 fatty acids and inflammation markers in patients with chronic kidney disease in hemodialysis

2020 ◽  
Vol 45 (8) ◽  
pp. 805-811
Author(s):  
José A. Valle Flores ◽  
Juan E. Fariño Cortéz ◽  
Gabriel A. Mayner Tresol ◽  
Juan Perozo Romero ◽  
Miquel Blasco Carlos ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Fatty Acids ◽  
Kidney Disease ◽  
Omega 3 Fatty Acids ◽  
Omega 3 ◽  
Inflammation Markers ◽  
Oral Supplementation ◽  
Reactive Protein ◽  
Group A ◽  
Group B

Chronic kidney disease (CKD) is an increasingly common public health problem that increases the risk of death because of cardiovascular complications by 2–3 times compared with the general population. This research concerns a prospective, randomized, double-blind study in patients with CKD undergoing hemodialysis. The participants were assigned to 1 of 2 groups: the study group (group A; 46 patients) received 4 capsules (2.4 g) of omega-3 fatty acids daily during the 12-week intervention, while patients in the control group (group B; 47 patients) received 4 capsules of paraffin oil. The patients’ general characteristics, nutritional indicators, renal disease markers and inflammatory markers (C-reactive protein, interleukin (IL)-6, IL-10, and tumour necrosis factor alpha (TNF-α)) were evaluated. No differences were found between the general characteristics of the patients (P < 0.05), and no differences were shown in the nutritional indicators and markers of kidney disease (P < 0.05). Patients in group A showed significant decreases in levels of C-reactive protein, IL-6, TNF-α, and the IL-10/IL-6 ratio after 12 weeks of supplementation (P < 0.05). Patients in group B did not show any significant changes in concentrations of inflammatory markers during the intervention (P < 0.05). In conclusion, oral supplementation with omega-3 fatty acids produces a significant decrease in the concentrations of inflammation markers in patients with chronic kidney disease on hemodialysis. Novelty Oral supplementation with omega-3 fatty acids produced significant decreases in the concentrations of inflammation markers. This supplementation could be given to patients with uremic syndrome and coronary heart disease to reduce cardiovascular risk.

scholarly journals Serum Soluble Transferrin Receptor-Ferritin Indices in Diagnosing and Differentiating Iron Deficiency Anemia from Anemia of Chronic Disease among Patients with Chronic Kidney Disease

2019 ◽  
Vol 9 (2) ◽  
pp. 151-156
Author(s):  
Abdul Latif ◽  
Farhana Hoque ◽  
Muhammad Rafiqul Alam ◽  
Asia Khanam ◽  
Sarwar Iqbal ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Chronic Disease ◽  
Kidney Disease ◽  
Iron Deficiency ◽  
Transferrin Receptor ◽  
Deficiency Anemia ◽  
Soluble Transferrin Receptor ◽  
Anemia Of Chronic Disease ◽  
Group A ◽  
Group B

Background: Anemia is common in patients with chronic kidney disease (CKD) and this is generally anemia of chronic disease (ACD), but iron deficiency anemia (IDA) is also common. Soluble transferrin receptor (sTfR) is a useful marker for IDA. Present study was undertaken to assess the utility of sTfR as a marker of IDA and to differentiate ACD from IDA in selected group of Bangladeshi patients with CKD. Methods: This cross-sectional study was conducted in the Department of Nephrology, BSMMU, Dhaka, Bangladesh from January 2013 to December 2014. Patients with anemia admitted in Nephrology Department, whether on hemodialysis or not and Medicine Department of BSMMU were taken for study. The study population was further divided into two groups; Group A, patients (30) who were having IDA and Group B, patients (40) with ACD and a control group was also selected. Data were collected by face to face interview and laboratory investigations with a self-administered questionnaire. Results: The mean age of the patients in Group A and Group B were 38.40±13.23 and 34.85±10.52 years respectively and male-female ratio were 0.5:1 and 1:0.5. Mean sTfR level was higher (4.81± 1.64 μg/ml) in patients with IDA than (2.89±1.40 μg/ml) in patients with ACD (p <0.0001). Mean ferritin level was 599.59± 449.15μg/L in ACD patients whereas 101.23±119.42 in IDA patients (p<0.0001). Total iron binding capacity (TIBC) was more in ACD patients with sTfRe”3μg/ml as compared to ACD patients with sTfR<3μg/ml. Transferrin saturation (TSAT) level was significantly decreased in ACD patients with sTfRe”3μg/ml as compared to ACD patients with sTfR<3μg/ml. sTfR and ferritin indices between group A (IDA) and group B (ACD) shows mean sTfR:logSF level was significantly (P<0.001) high in group A (2.71±1.13) in comparison to group B (1.08±0.54). Mean log sTFR:SF was also significantly higher (P<0.05) in group A (0.001±0.0008) compared to group B (0.013±0.012). Conclusion: sTfR level has a comparable ability to serum ferritin in diagnosing IDA and ACD. However, sTfR and serum ferritin alone cannot definitely exclude coexisting iron deficiency in ACD. Log sTfR/ ferritin index has role in identifying development of iron deficiency in ACD whereas sTfR/ log SF ratio can differentiate pure IDA from ACD with or without iron deficiency. Thus, it is important to estimate both serum sTfR and sTfRferritin indices to be able to differentiate pure IDA, ACD and ACD with co-existing iron deficiency thus providing a non-invasive alternative to bone marrow iron. Birdem Med J 2019; 9(2): 151-156

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