scholarly journals P0192RELATIONSHIP BETWEEN SERUM HEPCIDIN AND THE PROGRESSION OF CHRONIC KIDNEY DISEASE: KOREAN COHORT STUDY FOR OUTCOME IN PATIENTS WITH CHRONIC KIDNEY DISEASE (KNOW-CKD)

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Su Ah Sung ◽  
Kum Hyun Han ◽  
Jien Lee ◽  
Taehee Lee
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Large Scale ◽  
Hemoglobin Level ◽  
Renal Diseases ◽  
Hepcidin Level ◽  
Replacement Treatment ◽  
Serum Hepcidin ◽  
The Relationship

Abstract Background and Aims Hepcidin plays a central role in iron metabolism. However, few studies have evaluated the relationship between serum hepcidin and the progression of chronic kidney disease (CKD). This study aimed to determine the relationship between serum hepcidin levels and the progression of renal diseases in patients with CKD. Method We reviewed data of 2,016 patients from a large-scale multicenter, prospective study enrolled between 2011 and 2016, who had data regarding the serum hepcidin level, hemoglobin level, iron indices, usage of erythopoiesis-stimulating agents (ESA) or iron, and follow-up of renal events. Renal events were defined as a >50% decrease in kidney function from the baseline values, doubling of the serum creatinine level, or initiation of renal-replacement treatment. Results During a mean 3.6 years, 556 patients developed renal events (27.6%). In multivariate Cox proportional hazard regression analysis adjusted for confounders including kidney function, the hemoglobin level, conventional iron indices, usage of ESA or iron, and other chronic diseases, the hazard of serum hepcidin for renal events was evident in the comparison between only the first and fourth quartiles (hazard ratio 1.603, 95% confidence interval, 1.187-2.163, P = 0.002). In the multivariate penalized spline curve analysis, the relationship between serum hepcidin and renal events was J-shaped, and the renal hazard was particularly evident at a serum hepcidin level ≥60 ng/ml. Conclusion Increased serum hepcidin levels independently predict the progression of CKD in non-dialysis patients with CKD. The potential direct renal hazard of serum hepcidin needs to be confirmed in future randomized controlled trials.

scholarly journals Polypharmacy and the Progression of Chronic Kidney Disease: Korean Cohort Study for Outcome in Patients with Chronic Kidney Disease

2021 ◽  
pp. 1-9
Author(s):  
Hyang Ki Min ◽  
Su Ah Sung ◽  
Wookyung Chung ◽  
Yeong Hoon Kim ◽  
Dong-Wan Chae ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Large Scale ◽  
Statistical Significance ◽  
Replacement Treatment ◽  
Korean Study ◽  
The Mean ◽  
Cox Proportional Hazard Regression ◽  
Stage 1

<b><i>Introduction:</i></b> The renal hazard of polypharmacy has never been evaluated in predialysis chronic kidney disease (CKD) patients. <b><i>Objective:</i></b> We aimed to analyze the renal hazard of polypharmacy in predialysis CKD patients with stage 1–5. <b><i>Method:</i></b> The data of 2,238 patients from a large-scale multicenter prospective Korean study (2011–2016), excluding 325 patients with various missing data, were reviewed. Polypharmacy was defined as taking 6 or more medications at the time of enrollment; renal events were defined as a ≥50% decrease in kidney function from baseline values, doubling of the serum creatinine levels, or initiation of renal replacement treatment. Hazard ratio (HR) and 95% confidence interval (CI) were calculated using Cox proportional-hazard regression analysis. <b><i>Results:</i></b> Of the 1,913 patients, the mean estimated glomerular filtration rate was 53.6 mL/min/1.73 m<sup>2</sup>. The mean medication count was 4.1, and the prevalence of polypharmacy was 27.1%. During the average period of 3.6 years, 520 patients developed renal events (27.2%). Although increased medication counts were associated with increased renal hazard with HR (95% CI) of 1.056 (1.007–1.107, <i>p</i> = 0.025), even after adjusting for various confounders, adding comorbidity score and kidney function nullified the statistical significance. In mediation analysis, 55.6% (<i>p</i> = 0.016) of renal hazard in increased medication counts was mediated by the kidney function, and there was no direct effect of medication counts on renal event development. In subgroup analysis, the renal hazard of the medication counts was evident only in stage 1–3 of CKD patients (<i>p</i> for interaction = 0.014). <b><i>Conclusions:</i></b> We cannot identify the direct renal hazard of multiple medications, and most of the potential renal hazard was derived from intimate relationship with disease burden and kidney function.

Role of hepcidin as a biomarker for iron status and its effect on anemia management in patients with chronic kidney disease (stage II-Iv) after HCV treatment

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Magdy M El Sharkawy ◽  
Lina E Khedr ◽  
Ashraf H Abdelmbdy ◽  
Mohamed T Mohamed
Keyword(s):  
Chronic Kidney Disease ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Kidney Disease ◽  
Iron Status ◽  
Disease Stage ◽  
Hepcidin Level ◽  
Stage 4 ◽  
Ckd Stage ◽  
Serum Hepcidin

Abstract Background Anemia is a severe complication of chronic kidney disease (CKD) that is seen in more than 80% of patients with impaired renal function. Although there are many mechanisms involved in the pathogenesis of anemia of renal disease, the primary cause is the inadequate production of erythropoietin by the damaged kidneys. Aim of the work to assess hepcidin level in non dialysis patients (CKD stage 4 &5) treated from Hepatitis C virus and its relation to iron parameters. Patients and Methods This study was conducted on 20 CKD patients (stage 4 and 5) treated from hepatitis C virus. All candidates included in this study subjected to careful history taking, full clinical examination and investigations (including complete blood count, renal chemistry, HCVAb, serum iron, total iron binding capacity, TSAT%, ferritin and hsCRP. Serum hepcidin was analyzed by ELISA technique. Results Serum hepcidin was 26.35±7.26; 40% in stage III, 37.8% in stage IV and 22.2% in stage V. There was statistically significant difference between GFR stages according to Hb., Drug intake ACE inhibitor/ARB, Plt., Creatinine, BUN, Iron, TIBC, Ferritin, T SAT%, CRP and Serum Hepcidin. We showed significant correlations between serum hepcidin and TIC, Iron, TIBC, Ferritin and TSAT%. Conclusion Median hepcidin value is elevated in nondialysis CKD patients due to increased inflammation and decreased clearance of hepcidin. Furthermore, iron status modifies serum hepcidin level and its association with Hb. Increased hepcidin level leads to iron-restricted erythropoiesis and recombinant human EPO (rhEPO) resistance by inhibiting iron absorption from gut and iron recycling from macrophages. Hence, elevated hepcidin can predict need for parenteral iron to overcome hepcidin-mediated iron-restricted erythropoiesis and need for relatively higher rhEPO doses to suppress hepcidin.

scholarly journals Impacts of Indoxyl Sulfate and p-Cresol Sulfate on Chronic Kidney Disease and Mitigating Effects of AST-120

Toxins ◽  
2018 ◽  
Vol 10 (9) ◽  
pp. 367 ◽  
Author(s):  
Wen-Chih Liu ◽  
Yasuhiko Tomino ◽  
Kuo-Cheng Lu
Keyword(s):  
Oxidative Stress ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Large Scale ◽  
Interstitial Fibrosis ◽  
Uremic Toxins ◽  
Indoxyl Sulfate ◽  
Renal Diseases ◽  
Glomerular Sclerosis ◽  
Inflammatory Reactions

Uremic toxins, such as indoxyl sulfate (IS) and p-cresol, or p-cresyl sulfate (PCS), are markedly accumulated in the organs of chronic kidney disease (CKD) patients. These toxins can induce inflammatory reactions and enhance oxidative stress, prompting glomerular sclerosis and interstitial fibrosis, to aggravate the decline of renal function. Consequently, uremic toxins play an important role in the worsening of renal and cardiovascular functions. Furthermore, they destroy the quantity and quality of bone. Oral sorbent AST-120 reduces serum levels of uremic toxins in CKD patients by adsorbing the precursors of IS and PCS generated by amino acid metabolism in the intestine. Accordingly, AST-120 decreases the serum IS levels and reduces the production of reactive oxygen species by endothelial cells, to impede the subsequent oxidative stress. This slows the progression of cardiovascular and renal diseases and improves bone metabolism in CKD patients. Although large-scale studies showed no obvious benefits from adding AST-120 to the standard therapy for CKD patients, subsequent sporadic studies may support its use. This article summarizes the mechanisms of the uremic toxins, IS, and PCS, and discusses the multiple effects of AST-120 in CKD patients.

scholarly journals Relationship between birth weight and chronic kidney disease: evidence from systematics review and two-sample Mendelian randomization analysis

2020 ◽  
Vol 29 (13) ◽  
pp. 2261-2274 ◽  
Author(s):  
Xinghao Yu ◽  
Zhongshang Yuan ◽  
Haojie Lu ◽  
Yixin Gao ◽  
Haimiao Chen ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Birth Weight ◽  
Kidney Disease ◽  
Low Birth Weight ◽  
Kidney Function ◽  
Large Scale ◽  
Mendelian Randomization ◽  
Negative Relationship ◽  
Sensitivity Analyses ◽  
Inverse Association

Abstract Observational studies showed an inverse association between birth weight and chronic kidney disease (CKD) in adulthood existed. However, whether such an association is causal remains fully elusive. Moreover, none of prior studies distinguished the direct fetal effect from the indirect maternal effect. Herein, we aimed to investigate the causal relationship between birth weight and CKD and to understand the relative fetal and maternal contributions. Meta-analysis (n = ~22 million) showed that low birth weight led to ~83% (95% confidence interval [CI] 37–146%) higher risk of CKD in late life. With summary statistics from large scale GWASs (n = ~300 000 for birth weight and ~481 000 for CKD), linkage disequilibrium score regression demonstrated birth weight had a negative maternal, but not fetal, genetic correlation with CKD and several other kidney-function related phenotypes. Furthermore, with multiple instruments of birth weight, Mendelian randomization showed there existed a negative fetal casual association (OR = 1.10, 95% CI 1.01–1.16) between birth weight and CKD; a negative but non-significant maternal casual association (OR = 1.09, 95% CI 0.98–1.21) was also identified. Those associations were robust against various sensitivity analyses. However, no maternal/fetal casual effects of birth weight were significant for other kidney-function related phenotypes. Overall, our study confirmed the inverse association between birth weight and CKD observed in prior studies, and further revealed the shared maternal genetic foundation between low birth weight and CKD, and the direct fetal and indirect maternal causal effects of birth weight may commonly drive this negative relationship.

P0930SERUM LEVELS OF OSTEOPROTEGERIN ARE ASSOCIATED WITH OBESITY IN CHRONIC KIDNEY DISEASE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Yooju Nam ◽  
Seonyeong Lee ◽  
Hyung Woo Kim ◽  
Jae Hyun Chang ◽  
Tae-Hyun Yoo
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Large Scale ◽  
Multivariate Logistic Regression Model ◽  
Cox Models ◽  
Prevalence Of Obesity ◽  
The Mean ◽  
Artery Disease ◽  
The Relationship

Abstract Background and Aims Osteoprotegerin (OPG), which is an osteoclastic inhibitory factor, is associated with type 2 diabetes mellitus, severity of vascular calcification, coronary artery disease, and chronic kidney disease. Obesity is a risk factor for diabetes, and cardiovascular disease, however there are few studies about the relationship between OPG and obesity, especially in patients with CKD. This study aimed to investigate association between OPG level and obesity in a large-scale prospective cohort. Method Among 2,238 patients with non-dialysis CKD enrolled in the KoreaN cohort study for Outcome in patients With Chronic Kidney Disease (KNOW-CKD), 1,970 patients who measured body mass index (BMI), waist circumference (WC) and OPG level were included in the analysis. Obesity were defined as having a BMI &gt;25 kg/m2 and WC &gt; 90 cm in male, &gt; 85 cm in female. Results The mean age was 53.6 ± 12.2 years and 1,196 (60.7%) patients were males. At baseline, obesity by BMI, WC, and composite of BMI and WC were found in 814 (41.3%), 208 (26.9%) and 1,137 (57.7%) patients. A multivariate logistic regression model showed that log transformed OPG level was independently associated with the prevalence of obesity by BMI, WC, composite of BMI and WC (odds ratio [OR], 0.33; 95% confidence interval [CI], 0.16-0.65, P&lt;0.001 and OR, 0.37; 95% CI, 0.18-0.75, P=0.006, and OR, 0.33, 95% CI, 0.16-0.69, P=0.003, respectively). Among patients without baseline obesity, 207 (19.3%) patients developed obesity by BMI, 202 (21.7%) by WC, and 194 (23.3%) by composite of BMI and WC. In the fully adjusted multivariable Cox models, risks of developing obesity by BMI, WC and composite of BMI and WC were significantly higher with increased level of OPG (hazard ratio [HR], 0.59; 95% CI, 0.38-0.92; P=0.019, HR, 0.63; 95% CI, 0.41-0.98; P=0.001). Conclusion We showed that serum OPG levels are associated with obesity in patients with non-dialysis CKD.

scholarly journals Immunochemical and Mass-Spectrometry–Based Serum Hepcidin Assays for Iron Metabolism Disorders

2010 ◽  
Vol 56 (10) ◽  
pp. 1570-1579 ◽  
Author(s):  
Joyce JC Kroot ◽  
Coby MM Laarakkers ◽  
Anneke J Geurts-Moespot ◽  
Nicolaï Grebenchtchikov ◽  
Peter Pickkers ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Iron Metabolism ◽  
Large Scale ◽  
Limit Of Detection ◽  
Deficiency Anemia ◽  
Anemia Of Chronic Disease ◽  
Serum Hepcidin ◽  
Tof Ms

BACKGROUND Hepcidin is an iron-regulatory peptide hormone that consists of 3 isoforms: bioactive hepcidin-25, and inactive hepcidin-22 and hepcidin-20. Hepcidin is instrumental in the diagnosis and monitoring of iron metabolism disorders, but reliable methods for its quantification in serum are sparse, as is knowledge of their relative analytical strengths and clinical utility. METHODS We developed a competitive (c)-ELISA and an immunocapture TOF mass-spectrometry (IC-TOF-MS) assay. Exploiting these 2 methods and our previously described weak cation exchange (WCX)-TOF-MS assay, we measured serum hepcidin concentrations in 186 patients with various disorders of iron metabolism and in 23 healthy controls. RESULTS We found that (a) the relative differences in median hepcidin concentrations in various diseases to be similar, although the absolute concentrations measured with c-ELISA and WCX-TOF-MS differed; (b) hepcidin isoforms contributed to differences in hepcidin concentrations between methods, which were most prominent in patients with chronic kidney disease; and (c) hepcidin concentrations measured by both the c-ELISA and IC-TOF-MS correlated with ferritin concentrations &lt;60 μg/L, and were suitable for distinguishing between iron deficiency anemia (IDA) and the combination of IDA and anemia of chronic disease. CONCLUSIONS c-ELISA is the method of choice for the large-scale quantification of serum hepcidin concentrations, because of its low limit of detection, low cost, and high-throughput. Because of its specificity for bioactive hepcidin-25, WCX-TOF-MS can be regarded as a valuable special-purpose assay for disorders with variable concentrations of hepcidin isoforms, such as chronic kidney disease.

scholarly journals Quality improvement at scale: evaluation of the drivers and barriers to adoption and sustainability of an intervention to reduce late referral in chronic kidney disease

2020 ◽  
Vol 9 (4) ◽  
pp. e001045
Author(s):  
Nicola Thomas ◽  
Michael Nation ◽  
Lesley Woolnough ◽  
Hugh Gallagher
Keyword(s):  
Chronic Kidney Disease ◽  
Quality Improvement ◽  
Kidney Disease ◽  
Kidney Function ◽  
Large Scale ◽  
Evaluation Study ◽  
Quality Improvement Project ◽  
Developmental Evaluation ◽  
Improvement Project ◽  
National Quality

This quality improvement project aimed to drive large scale and sustained change to reduce the burden of chronic kidney disease in the UK. The intervention is a software program that extracts relevant biochemical data from laboratory databases which then generate graphs of estimated kidney function (eGFR) over time. Graphs showing progressive kidney disease are sent directly back to general practitioners (GPs) to alert them to rereview patient care and if necessary, refer to renal services. The aim of this evaluation study was to explain the barriers and drivers to implementation and adoption of the eGFR graph intervention. This evaluation study involved 5 of the 20 participating renal units (sites) . A developmental evaluation approach was used. Methods included collection of descriptive data about graph reporting; GP surveys (n=68); focus groups (n=4) with practices; face-to-face interviews with secondary care clinicians (n=10). Results showed the mean number of graphs reviewed per week per site was 230, taking 1 hour per week per site. Only 18.2% graphs highlighted a concerning decline in kidney function. Important enablers to sustain the intervention were low cost, easy to understand, a sense of local ownership and perceived impact. Barriers included nephrologists’ perceived increase in new referrals. We concluded that developmental evaluation can explain the barriers/drivers to implementation of a national quality improvement project that involves a variety of different stakeholders. The intervention has the potential to slow down progression of kidney disease due to the eGFR prompts alerting GPs to review the patient record and take action, such as reviewing medications and referring to renal teams if progressive kidney disease had not been identified previously.

Hepcidin Level and Iron Parameters in Patients with Chronic Kidney Disease

2015 ◽  
Vol 5 (3) ◽  
pp. 149
Author(s):  
Ja Young Seo ◽  
Young Hee Song ◽  
Mi-Jung Park ◽  
Moon Jin Kim ◽  
Yiel-Hea Seo ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Hepcidin Level ◽  
Iron Parameters
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