P0621IDENTIFYING PATIENTS WHO NEED LONG TERM FOLLOW UP AFTER RECEIVING RENAL SUPPORT ON ITU

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Naomi Edney ◽  
Daniel Adlington ◽  
Coralie Bingham ◽  
Christopher Mulgrew ◽  
Richard Oram
Keyword(s):  
Primary Care ◽  
Renal Function ◽  
Kidney Disease ◽  
Post Discharge ◽  
Icu Stay ◽  
Increased Risk ◽  
Icu Discharge ◽  
Ckd Stage

Abstract Background and Aims The incidence of acute kidney injury (AKI) is between 20-50% in a critically ill population. AKI is associated with increased risk of chronic kidney disease (CKD), end stage kidney disease (ESKD) and death. 30% of patients on ICU with AKI will have pre-existing CKD1. Arrangements for renal follow up of patients who develop AKI whilst on ICU vary between centres. We aimed to review the renal function pre admission and at one and two years after discharge for all patients who received renal replacement therapy (RRT) with haemofiltration or haemodialysis on ICU during 2016. We reviewed how many were under renal follow up and aimed to identify techniques to improve follow up if required. Method We reviewed electronic records of all patients who received RRT on the ICU during 2016. We assessed demographic details, renal function, details of ICU stay and co morbidities. We excluded patients who died on ICU or received RRT for non-renal indications. Patients who were not under renal follow up were offered a single renal clinic at 2 years (2018) after their ICU discharge. In 2019 we set up a monthly electronic alert to the renal team for all patients who have received haemofiltration on ICU. Each patient’s case was reviewed and either renal follow up arranged or letter sent to primary care and the patient to ensure a 1 year post discharge renal function check to risk stratify them. Results 64 patients received RRT therapy in ICU in 2016 of whom 20 died during their ICU stay and 4 received RRT for non-renal indications. 40 patients were included in further analysis. The median (IQR, range) age was 60(49.5-69.5, 20-87) years. 21/40(53%) were admitted to ICU for sepsis and 8/40(20%) had CKD (defined by eGFR<60), and 6/40(15%) had ESKD, (5 on haemodialysis, 1 transplanted) prior to admission. 33% had diabetes and 64% had vascular disease. 7 were known to the renal team prior to admission and 14/40 (35%) underwent renal follow up post discharge. Excluding those on RRT prior to admission, median (IQR, range) pre-admission eGFR was 82 (55->90, 30->90). 3 patients were discharged on RRT. The majority of patients who were discharged from hospital off RRT met eGFR criteria for CKD stage 3, data available for 30, median eGFR 56 (range: 10->90, IQR: 26-83), N=16/30(54%), p=0.01 compared to pre ICU stay had CKD stage 3 by eGFR criteria. By one year 2 of 3 patients were still on RRT. The majority of patients from hospital off RRT still met eGFR criteria for CKD stage 3, data available for 29, median eGFR 57 (range: 14->90, IQR: 39-77), N=15/29(52%) had CKD stage 3 by eGFR criteria. By 2 years, data available for 19, median GFR was 51 (range: 12->90, IQR: 32-86) with 11/19 (57%) meeting CKD stage 3 eGFR. Discharge eGFR was moderately correlated with 2 year follow up eGFR (r=0.49, p=0.03) and post discharge CKD stage 3 did not predict future CKD stage 3 (p=0.35) whereas eGFR at 1 year post discharge was much more strongly correlated with final follow up eGFR (spearman’s r=0.95, p<0.0001) and CKD stage 3 at 1 year predicted CKD at 2 years (p=0.003). Of those with CKD stage 3 at 2 years 5/11 (45%) were followed up in a renal clinic. In 2019, 34 electronic notifications were received. Primary care notified of 11 patients to ensure renal function measured at 1 year. 7 patients died, 8 patients already know to the renal team, 6 patients had new renal follow made at discharge and 2 patients had follow up under other medical specialities. Conclusion eGFR at 1 year post discharge from ICU is the best predictor of long term CKD and this could be used to target patients who need continued renal follow up. Electronic notifications from ICU can help accomplish this.

scholarly journals Dietary Micronutrients and Risk of Chronic Kidney Disease: A Cohort Study with 12 Year Follow-Up

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1517
Author(s):  
Juyeon Lee ◽  
Kook-Hwan Oh ◽  
Sue-Kyung Park
Keyword(s):  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Epidemiologic Study ◽  
Population Based ◽  
Dietary Guidelines ◽  
Dietary Intakes ◽  
Increased Risk ◽  
Ckd Stage

We investigated the association between dietary micronutrient intakes and the risk of chronic kidney disease (CKD) in the Ansan-Ansung study of the Korean Genome and Epidemiologic Study (KoGES), a population-based prospective cohort study. Of 9079 cohort participants with a baseline estimate glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 and a urine albumin to creatinine ratio (UACR) <300 mg/g and who were not diagnosed with CKD, we ascertained 1392 new CKD cases over 12 year follow-up periods. The risk of CKD according to dietary micronutrient intakes was presented using hazard ratios (HRs) and 95% confidence intervals (95% CIs) in a full multivariable Cox proportional hazard models, adjusted for multiple micronutrients and important clinico-epidemiological risk factors. Low dietary intakes of phosphorus (<400 mg/day), vitamin B2 (<0.7 mg/day) and high dietary intake of vitamin B6 (≥1.6 mg/day) and C (≥100 mg/day) were associated with an increased risk of CKD stage 3B and over, compared with the intake at recommended levels (HR = 6.78 [95%CI = 2.18–21.11]; HR = 2.90 [95%CI = 1.01–8.33]; HR = 2.71 [95%CI = 1.26–5.81]; HR = 1.83 [95%CI = 1.00–3.33], respectively). In the restricted population, excluding new CKD cases defined within 2 years, an additional association with low folate levels (<100 µg/day) in higher risk of CKD stage 3B and over was observed (HR = 6.72 [95%CI = 1.40–32.16]). None of the micronutrients showed a significant association with the risk of developing CKD stage 3A. Adequate intake of micronutrients may lower the risk of CKD stage 3B and over, suggesting that dietary guidelines are needed in the general population to prevent CKD.

scholarly journals MP31-19 LONG-TERM FOLLOW-UP OF RENAL FUNCTION AND DEVELOPMENT OF CHRONIC KIDNEY DISEASE AFTER PARTIAL NEPHRECTOMY

2019 ◽  
Vol 201 (Supplement 4) ◽  
Author(s):  
Takashi Ikeda* ◽  
Toshio Takagi ◽  
Hiroki Ishihara ◽  
Hironori Fukuda ◽  
Kazuhiko Yoshida ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Partial Nephrectomy ◽  
Long Term Follow Up

Risk of Stroke, Bleeding, and Death in Patients with Nonvalvular Atrial Fibrillation and Chronic Kidney Disease

Cardiology ◽  
2020 ◽  
Vol 145 (3) ◽  
pp. 178-186
Author(s):  
Yoav Arnson ◽  
Moshe Hoshen ◽  
Adi Berliner-Sendrey ◽  
Orna Reges ◽  
Ran Balicer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Impaired Renal Function ◽  
Bleeding Risk ◽  
Intracranial Bleeding ◽  
Increased Risk ◽  
Ckd Stage ◽  
Stroke Death

Introduction: Atrial fibrillation (AF) and chronic kidney disease (CKD) are both associated with increased risk of stroke, and CKD carries a higher bleeding risk. Oral anticoagulation (OAC) treatment is used to reduce the risk of stroke in patients with nonvalvular AF (NVAF); however, the risk versus benefit of OAC for advanced CKD is continuously debated. We aim to assess the management and outcomes of NVAF patients with impaired renal function within a population-based cohort. Methods: We conducted a retrospective observational cohort study using ICD-9 healthcare coding. Patients with incident NVAF between 2004 and 2015 were identified stratified by CKD stage. We compared treatment strategies and estimated risks of stroke, death, or any major bleeding based on CKD stages and OAC treatment. Results: We identified 85,116 patients with incident NVAF. Patients with impaired renal function were older and had more comorbidities. OAC was most common among stage 2 CKD patients (49%) and least in stages 4–5 CKD patients (27.6%). Higher CKD stages were associated with worse outcomes. Stroke rates increased from 1.04 events per 100 person-years (PY) in stage 1 CKD to 3.72 in stages 4–5 CKD. Mortality increased from 3.42 to 32.95 events/100 PY, and bleeding rates increased from 0.89 to 4.91 events/100 PY. OAC was associated with reduced stroke and intracranial bleeding risk regardless of CKD stage, and with a reduced mortality risk in stages 1–3 CKD. Conclusion: Among NVAF patients, advanced renal failure is associated with higher risk of stroke, death, and bleeding. OAC was associated with reduced stroke and intracranial bleeding risk, and with improved survival in stages 1–3 CKD.

scholarly journals Chronic Kidney Disease, Hypertension and Cardiovascular Sequelae during Long Term Follow up of Adults with Atypical Hemolytic Uremic Syndrome

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3754-3754 ◽  
Author(s):  
Shruti Chaturvedi ◽  
Alison R. Moliterno ◽  
Samuel A. Merrill ◽  
Evan M Braunstein ◽  
Xuan Yuan ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Atypical Hemolytic Uremic Syndrome ◽  
Left Ventricular ◽  
Myocardial Infarctions ◽  
Ckd Stage ◽  
Uremic Syndrome ◽  
St Elevation

Abstract INTRODUCTION: Atypical hemolytic uremic syndrome (aHUS) is a complement mediated thrombotic microangiopathy that predominantly affects the kidneys although extra-renal manifestations are common. In the pre-eculizumab era, 40-65% of patients either died or had end stage renal disease (ESRD) at 1 year. Long-term renal and cardiovascular outcomes are less well described in the eculizumab era. We conducted this cohort study to describe the renal and cardiovascular outcomes of adult survivors of aHUS, both on and off continued eculizumab therapy. METHODS: Patients with aHUS were identified from the prospective Complement Associated Disease Registry and through the Center for Clinical Data Analysis at Johns Hopkins University. Demographic and clinical data were abstracted, including details of aHUS diagnosis, laboratory studies, treatment, and outcomes including renal function, hypertension and echocardiographic studies. The prevalence of hypertension was compared between patients with and without chronic kidney disease (CKD) using the chi squared test. RESULTS: 45 individuals with aHUS were followed at Johns Hopkins Hospital with a median [interquartile range (IQR)] time since diagnosis of 37.4 [IQR 20.7, 62.6] months. Median age at diagnosis was 32.5 [IQR 23.2, 49.2] years and 71.1% were female. Acute kidney injury was present in 98% (44/45); however, neurologic (64.4%), gastrointestinal (68.8%), and cardiovascular (55.5%) involvement was also common (Table 1). Hypertensive urgency or emergency was present in 40% (18/45), while 13.3% (6/45) had an acute coronary syndrome during the acute episode (2 ST elevation myocardial infarctions and 4 non-ST elevation myocardial infarctions). Complement gene sequencing was completed for 34 patients, of which 8 had variants in CFH, one in CFH and CD46, 5 in other genes (MCP1, CFHR1 homozygous deletion, DGKE, THBD, and THBD with del(CFH-SCR20-CFHR1-int5)]and 20 patients had no pathogenic variants. Thirty-two (71.1%) patients were treated initially with plasma exchange (median 6 [3, 12] exchanges). Thirty-nine (86.7%) received eculizumab (5 started at the time of renal transplant after developing ESRD), and 20 of these (51%) have since discontinued therapy. Median duration of eculizumab therapy was 2.7 [0.9-11.3] months for those who stopped therapy and 29.5 [8.8-55] months for those who continued. One patient died due to a myocardial infarction during the aHUS episode. Of the 44 survivors, 15 (34.1%) had complete renal recovery, 9 (20.5%) had chronic kidney disease (CKD) stage 1-4, and 20 (45.5%) developed CKD stage 5 requiring dialysis at 3 months after the acute episode. Fifteen patients underwent subsequent renal transplantation. At the end of follow up, 23 (52.2%) had CKD [2.2% stage 2, 15.6% stage 3, 4.4% stage 4 and 28.9% stage 5) (Figure 1A). Although not statistically significant, there was a higher rate of CKD (63.1% versus 52.6%, P=0.511) among those not on eculizumab; however, this primarily reflects eculizumab being stopped after ESRD. Hypertension was present in 35 (79.5%) survivors (Figure 1B), of which 14 (40%) had incident hypertension. The prevalence of hypertension was not significantly different between patients with CKD and normal renal function (87% versus 71.4%, P=0.202). Thirty-one (70.4%) were on antihypertensive therapy, and 67% (21 of 31) of these were not controlled to <140/90 mmHg despite the use of multiple agents (Figure 1C). Echocardiograms were performed in 29 (64.4%) individuals (12 within 3 months of diagnosis, and 17 after 3 months). Of these 17, 29.4% were normal studies, 23.5% had reduced left ventricular ejection fraction, 29.4% demonstrated left ventricular hypertrophy or diastolic dysfunction, and 11.7% had pulmonary hypertension. CONCLUSION: Malignant hypertension and cardiac involvement are common during acute aHUS. aHUS survivors also have a high prevalence of hypertension, including a notable incidence of new onset as well as uncontrolled hypertension following aHUS diagnosis. CKD is present in the majority of survivors, and structural cardiopulmonary disease is common. Complement activation has been implicated in the pathogenesis of cardiovascular disease. Further investigation is needed to evaluate the epidemiology of cardiovascular sequelae in aHUS, their associations with specific complement mutations, and optimal management. Disclosures No relevant conflicts of interest to declare.

scholarly journals Preeclampsia and the risk of chronic kidney disease: a national registry-based cohort study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
P M Barrett ◽  
F P McCarthy ◽  
M Evans ◽  
M Kublickas ◽  
I J Perry ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Absolute Risk ◽  
Population Based ◽  
National Registry ◽  
Medical Birth Register ◽  
Increased Risk ◽  
History Of

Abstract Background Preeclampsia is associated with increased risk of future cardiovascular disease, but evidence for associations with chronic kidney disease (CKD) has been inconsistent to date. We aimed to measure associations between preeclampsia and long-term CKD in a population-based sample of parous women, and to identify whether the risk differs by CKD subtype. Methods Using data from the Swedish Medical Birth Register, singleton live births from 1973-2012 were identified and linked to data from the Swedish Renal Register and National Patient Register (up to 2013). Preeclampsia was the main exposure of interest and was treated as a time-dependent variable. The primary outcome was maternal CKD, and this was classified into 5 subtypes: hypertensive, diabetic, glomerular/proteinuric, tubulo-interstitial, other/non-specific CKD. Cox proportional hazard regression models were used for analysis. Women with pre-pregnancy comorbidities were excluded. Results The dataset included 1,924,591 unique women who had 3,726,819 singleton pregnancies. The median follow-up was 20.7 (interquartile range 9.9-30.0) years. Overall, 90,964 women (4.7%) experienced preeclampsia and 18,146 (0.9%) developed CKD. Women who had preeclampsia had higher risk of developing any CKD during follow-up (aHR 1.88, 95% CI 1.79-1.98). The risk differed by CKD subtype, and was higher for hypertensive CKD (aHR 3.76, aHR 3.09-4.57), diabetic CKD (aHR 3.45, 95% CI 2.83-4.21) and glomerular/proteinuric CKD (aHR 2.08, 95% CI 1.90-2.29). Women who had preterm preeclampsia, recurrent preeclampsia, or preeclampsia complicated by pre-pregnancy obesity were also at greater risk of any CKD. Conclusions Women with a history of preeclampsia are at increased risk of long-term CKD. The risk is most marked for hypertensive CKD, diabetic CKD, and glomerular/proteinuric CKD. The absolute risk of CKD related to preeclampsia is substantial, and these women may warrant systematic renal monitoring in the years following delivery. Key messages Preeclampsia is an independent predictor of long-term risk of chronic kidney disease in otherwise healthy parous women. Women with a history of preeclampsia may warrant systematic renal monitoring through additional blood pressure, blood glucose, and proteinuria checks.

scholarly journals Long-term kidney function in children with Wilms tumour and constitutional WT1 pathogenic variant

2021 ◽  
Author(s):  
Maria Pia Falcone ◽  
Kathryn Pritchard-Jones ◽  
Jesper Brok ◽  
William Mifsud ◽  
Richard D. Williams ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Kidney Function ◽  
Kidney Failure ◽  
Patient Survival ◽  
Pathogenic Variant ◽  
International Studies ◽  
Wilms Tumour ◽  
Increased Risk

Abstract Background Wilms tumour (WT) survivors, especially patients with associated syndromes or genitourinary anomalies due to constitutional WT1 pathogenic variant, have increased risk of kidney failure. We describe the long-term kidney function in children with WT and WT1 pathogenic variant to inform the surgical strategy and oncological management of such complex children. Methods Retrospective analysis of patients with WT and constitutional WT1 pathogenic variant treated at a single centre between 1993 and 2016, reviewing genotype, phenotype, tumour histology, laterality, treatment, patient survival, and kidney outcome. Results We identified 25 patients (60% male, median age at diagnosis 14 months, range 4–74 months) with WT1 deletion (4), missense (2), nonsense (8), frameshift (7), or splice site (4) pathogenic variant. Thirteen (52%) had bilateral disease, 3 (12%) had WT-aniridia, 1 had incomplete Denys-Drash syndrome, 11 (44%) had genitourinary malformation, and 10 (40%) had no phenotypic anomalies. Patient survival was 100% and 3 patients were in remission after relapse at median follow-up of 9 years. Seven patients (28%) commenced chronic dialysis of which 3 were after bilateral nephrectomies. The overall kidney survival for this cohort as mean time to start of dialysis was 13.38 years (95% CI: 10.3–16.4), where 7 patients experienced kidney failure at a median of 5.6 years. All of these 7 patients were subsequently transplanted. In addition, 2 patients have stage III and stage IV chronic kidney disease and 12 patients have albuminuria and/or treatment with ACE inhibitors. Four patients (3 frameshift; 1 WT1 deletion) had normal blood pressure and kidney function without proteinuria at follow-up from 1.5 to 12 years. Conclusions Despite the known high risk of kidney disease in patients with WT and constitutional WT1 pathogenic variant, nearly two-thirds of patients had sustained native kidney function, suggesting that nephron-sparing surgery (NSS) should be attempted when possible without compromising oncological risk. Larger international studies are needed for accurate assessment of WT1genotype-kidney function phenotype correlation.

Long-term effects on renal function and blood pressure of treatment with cisplatin, vinblastine, and bleomycin in patients with germ cell cancer.

1988 ◽  
Vol 6 (11) ◽  
pp. 1728-1731 ◽  
Author(s):  
S W Hansen ◽  
S Groth ◽  
G Daugaard ◽  
N Rossing ◽  
M Rørth
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Germ Cell ◽  
Cell Cancer ◽  
Germ Cell Cancer ◽  
Long Term Effects ◽  
Increased Risk ◽  
The Mean

Long-term effects of cisplatin on renal function were investigated in 34 patients with germ cell cancer observed for a median of 65 months (range, 43 to 97 months). All patients achieved a complete remission after treatment with cisplatin (median dose 583 mg/m2), vinblastine, and bleomycin. None of the patients relapsed during follow-up. During treatment the glomerular filtration rate (GFR) decreased by 18% (P less than .05). During follow-up kidney function recovered in ten patients and partly improved in eight patients. Changes in plasma creatinine did not consistently correspond to alterations in GFR. The mean increase in systolic blood pressure during follow-up did not differ from the increase seen in a group of age-matched healthy men. The mean increase in diastolic pressure, however, was significant (P less than .05), but was entirely due to hypertension observed in six patients. Renography of these patients was normal. We conclude that the decrease in GFR observed during treatment with cisplatin is partly reversible. Cisplatin-treated patients have an increased risk of developing hypertension years after treatment.

scholarly journals 134 Does a Purely Occipital Lobe Stroke Lead to Significant Long Term Disability and Handicap?

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Naomi Davey ◽  
Sarah McNally ◽  
Kerri Donnelly ◽  
Mary Kate Meagher ◽  
Imelda Noone ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Occipital Lobe ◽  
Cognitive Testing ◽  
Phone Call ◽  
Motor Deficit ◽  
Post Discharge ◽  
Vascular Events ◽  
Increased Risk

Abstract Background Occipital lobe strokes are characterised by a visual field deficit (VFD) and the absence of a motor deficit. A persistent VFD may have significant long-term implications for a patient and their lifestyle. Our aim was to assess the overall impact of these events particularly patients’ ability to return to driving. Methods All patients admitted with an acute occipital lobe stroke to a Dublin teaching hospital in 2017 were identified. Case notes were retrospectively reviewed to identify patients’ pre-stroke function, stroke pathology, neurological losses and further vascular events. A follow up phone call was made 18 months after the event to assess if previous drivers had returned to driving and required the installation of formalised home supports after discharge. Results In 2017, 37 of 311 stroke patients admitted had a confirmed occipital lobe stroke. 33 of these patients (89.1%) had ischemic events. The median age was 76 (50-93) years old. Twenty-nine patients were able to undergo formal cognitive testing; the median Montreal Cognitive Assessment (MOCA) was 18 (2-29). 15 patients (40.5%) had underlying Atrial Fibrillation with one (6.7%) of this cohort being identified post discharge; 14 (85.7%) of those patients with ischemic strokes were anticoagulated for atrial fibrillation. The median length of stay was 33.9 days, with a range of 2-391 days. Further vascular events occurred in 2 (5.8%) of the patients. A follow up phone call was made to the 15 patients who drove prior to their event. 12 patients (80%) could not resume driving due to persistent VFD. One (7%) of the previous drivers had a home care package installed since discharge. Conclusion A persistent VFD results in long term problems including an increased risk of further vascular events, a reduction in overall independence and quality of life following an occipital lobe stroke. This study has led to a business plan for a dedicated hemianopia clinic.

scholarly journals The eGFR Change and Risk Factors in Moderate Chronic Kidney Disease Patients after Successful HCV Clearance by Direct Anti-viral Agents

2021 ◽  
Author(s):  
Yen-Chi Hu ◽  
Keng-Hsin Lan ◽  
Chia-Ling Lu ◽  
Yi-Hsiang Huang ◽  
Ming-Chih Hou
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Malignant Disease ◽  
Meld Score ◽  
Hcv Infection ◽  
Hcv Rna ◽  
Ckd Stage ◽  
Egfr Decline

Abstract Background –Chronic HCV infection is related not only to chronic kidney disease(CKD) but also accelerates renal deterioration. Treatment with Direct-acting antiviralagents (DAA) could slow renal function decline in some trials, but the long-termoutcomes of renal function changes following HCV elimination by DAA remainedinconclusive. Methods – This retrospective study analyzed the data of HCV infected patients withCKD stage 3 who were treated with DAA and achieved sustained virologic response at12weeks after treatment (SVR12) during 2017-2020 at a single medical center. Results – Among 130 HCV infection and CKD stage 3 patients treated with DAA, 77patients had no eGFR decline at SVR 12, and 53 patients had eGFR declined at SVR12. The eGFR change on SVR 12 can be predictor for eGFR change on SVR96 (Oddratio 3.088, p= 0.053). Patients with Diabetes Mellites (DM) (p=0.016, OR 2.6) ishighly associated with eGFR decline after DAA treatment. Renal functiondeterioration during DAA treatment is associated to long-term renal functiondecline(p=0.000). Lower HCV RNA titer(p=0.024), higher baseline MELD score(p=0.008), or con-current malignant disease under treatment(p=0.044) are more vulnerable to eGFR decrease upon DAA treatment. Conclusion –Among patients with HCV infection and CKD stage 3, comorbidity withDM, have less benefit to renal function after HCV elimination by DAA. Higherbaseline HCV RNA viral load and MELD score are precipitating factors to the renalfunction impairment. Treatment to malignant disease, either by systemic or localizedtreatment, increases the risk of renal function impairment during DAA treatment.The eGFR change on SVR 12 can be used to predict long-term eGFR change for theCKD stage 3 patients.

scholarly journals Circulating endothelin-1 levels are positively associated with chronic kidney disease in women but not in men: a longitudinal study in the Vara-Skövde cohort

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Margareta I. Hellgren ◽  
Per-Anders Jansson ◽  
Hormoz Alayar ◽  
Ulf Lindblad ◽  
Bledar Daka
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Ldl Cholesterol ◽  
Binary Logistic Regression ◽  
Current Smoking ◽  
Endothelin 1 ◽  
Increased Risk ◽  
Ckd Stage ◽  
Successful Analysis

Abstract Background The vasoconstricting peptide endothelin-1 (ET-1) is associated with endothelial dysfunction. The aim of this paper was to investigate whether circulating ET-1 levels predicts chronic kidney disease (CKD) in a prospective population study. Methods In 2002–2005, 2816 participants (30–74 years) were randomly selected from two municipalities in South-Western Sweden and followed up in a representative sample of 1327 individuals after 10 years. Endothelin-1 levels were assessed at baseline. Outcome was defined as CKD stage 3 or above based on eGFR < 60 mL/min/1.73m2. Those 1314 participants with successful analysis of ET-1 were further analyzed using binary logistic regression. Results At follow-up, 51 (8%) men and 47 (7,8%) women had CKD stage 3 and above. Based on levels of ET-1 the population was divided into quintiles showing that women in the highest quintile (n = 132) had a significantly increased risk of developing CKD during the follow up period (OR = 2.54, 95% CI:1.19–5.45, p = 0.02) compared with the other quintiles (1–4). The association was borderline significant after adjusted for age, current smoking, alcohol consumption, hypertension, diabetes, BMI, high- sensitive CRP and LDL-cholesterol (OR = 2.25, 95% CI:0.97–5.24, p = 0.06). No significant differences were observed between quintiles of ET-1 and development of CKD in men (NS). Conclusions High levels of ET-1 are associated with development of CKD in women.

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