P0670DIFFUSIONAL KURTOSIS IMAGING PREDICTS THE PROGNOSIS OF CHRONIC KIDNEY DISEASE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Yan Liu ◽  
Gu-mu-yang Zhang ◽  
Xiaoyan Peng ◽  
Xuemei Li ◽  
Hao Sun ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Iga Nephropathy ◽  
Clinical Outcomes ◽  
Renal Fibrosis ◽  
Prognostic Value ◽  
Mean Value ◽  
Non Invasive ◽  
The Mean

Abstract Background and Aims Renal fibrosis is the strongest prognosis predictor of ESRD in chronic kidney disease (CKD), but non-invasive and repeatable imaging markers are missing. Magnetic resonance imaging (MRI) has wide range of applications in renal parenchymal diseases, and diffusional kurtosis imaging (DKI) is a new promising noninvasive method of MRI which can provide more information about non-Gaussian diffusion using a polynomial model. We had successfully used DKI to assess renal fibrosis in IgA nephropathy in our previous work. This study aimed to evaluate the prognostic value of DKI in CKD. Method We prospectively enrolled forty-two CKD patients in our study in Jan. 2017. On recruitment, the basic clinical data were documented, and DKI was performed on a clinical 3T MR scanner. Region-of-interest (ROI) measurements were performed to determine apparent diffusion coefficient (ADC), kurtosis (K) and diffusivity (D) of the cortex of the kidneys. We had followed up these patients for 3 years, and collected all the clinical data and outcomes. The prognostic value of DKI metrics and clinical parameters were investigated. Results Forty-two patients consisted of 26 males and 16 females with mean age of 41.3±15.4 years. The most common etiology was IgA nephropathy (25/42, 59.5%). At baseline, the mean value of serum creatinine (SCr) was 224.4±156.2μmol/L. Among them, 18 patients had eGFR≥45ml/min and 24 patients had eGFR<45ml/min. According to the etiology and CKD classification, all the patients had received appropriate treatment. Besides supportive treatment and management of CKD complications, 21 patients (50%) had received corticosteroid and/or immunosuppressants treatment. After 36 months follow up, 12 patients had progressed to end stage renal disease (ESRD), and the mean value of SCr of the remaining 30 patients was 153.0±78.8umol/L. The Kaplan-Meyer survival regression showed that the patients with eGFR<45ml/min had worse clinical outcomes (p=0.0006). ROC analysis and Kaplan-Meyer survival regression showed that DKI metrics (K≥0.66 or ADC<1.35) not only predicted severe renal fibrosis, but also had worse clinical outcomes (p=0.01 and p<0.0001) (Figure 1). According to the COX regression analysis, both K (K≥0.66, HR 4.676, 95%CI 1.262-17.325) and ADC (ADC<1.35, HR 13.118, 95%CI 3.499-49.178) values, but not age, gender and eGFR group (cut-off value: 45ml/min), were the independent risk factors for the progression to ESRD. Conclusion Renal ADC and K values obtained from DKI showed significant predictive value for the prognosis of CKD, could be a promising non-invasive technique in patients follow-up.

scholarly journals Plasma natriuretic peptide level is an independent determinant of major clinical outcomes in atrial fibrillation patients without heart failure: the Fushimi AF Registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Hamatani ◽  
M Iguchi ◽  
Y Aono ◽  
K Ishigami ◽  
S Ikeda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Clinical Outcomes ◽  
Prognostic Marker ◽  
Oral Anticoagulants ◽  
Systemic Embolism ◽  
The Mean

Abstract Background Atrial fibrillation (AF) increases the risk of death, stroke/systemic embolism and heart failure (HF). Plasma natriuretic peptide (NP) level is an important prognostic marker in HF patients. However, little is known regarding the prognostic significance of plasma NP level in AF patients without HF. Purpose The aim of this study is to investigate the relationship between plasma NP level and clinical outcomes such as all-cause death, stroke/systemic embolism and HF hospitalization during follow-up period in AF patients without HF. Methods The Fushimi AF Registry is a community-based prospective survey of AF patients in our city. The inclusion criterion of the registry is the documentation of AF at 12-lead electrocardiogram or Holter monitoring at any time, and there are no exclusion criteria. We started to enroll patients from March 2011, and follow-up data were available for 4,466 patients by the end of November 2019. From the registry, we excluded 1,220 patients without a pre-existing HF (defined as having one of the following; prior hospitalization for HF, New York Heart Association class ≥2, or left ventricular ejection fraction <40%). Among 3,246 AF patients without HF, we investigated 1,189 patients with the data of plasma BNP (n=401) or N-terminal pro-BNP (n=788) level at the enrollment. We divided the patients according to the quartile of each plasma BNP or NT-pro BNP level and compared the backgrounds and outcomes between these 4 groups stratified by plasma NP level. Results Of 1,189 patients, the mean age was 72.1±10.2 years, 454 (38%) were female and 684 (58%) were paroxysmal AF. The mean CHADS2 and CHA2DS2-VASc score were 1.6±1.1 and 2.9±1.5, respectively. Oral anticoagulants were prescribed in 671 (56%) at baseline. The median (interquartile range) BNP and N-terminal pro-BNP level were 84 (38, 176) and 500 (155, 984) pg/ml, respectively. Patients with high plasma NP level were older, and demonstrated lower prevalence of paroxysmal AF, higher CHADS2 and CHA2DS2-VASc scores and higher prevalence of chronic kidney disease and oral anticoagulants prescription (all P<0.01). A total of 165 all-cause death, 114 stroke/systemic embolism and 103 HF hospitalization occurred during the median follow-up period of 5.0 years. Kaplan-Meier curves demonstrated that higher plasma NP level was significantly associated with the incidences of all-cause death, stroke/systemic embolism and HF hospitalization in AF patients without HF (Figure 1A). Multivariable Cox regression analysis revealed that plasma NP level could stratify the risk of clinical outcomes even after adjustment by type of AF, CHA2DS2-VASc score, chronic kidney disease and oral anticoagulant prescription (Figure 1B). Conclusion Plasma NP level is a significant prognostic marker for all-cause death, stroke/systemic embolism and HF hospitalization in AF patients without HF, suggesting the importance of measuring plasma NP level in AF patients even without HF. Figure 1 Funding Acknowledgement Type of funding source: None

Systematic Review and Meta-analyses of Effects of Phosphate-lowering Agents in Non-dialysis Chronic Kidney Disease

2021 ◽  
pp. ASN.2021040554
Author(s):  
Nicole Lioufas ◽  
Elaine Pascoe ◽  
Carmel Hawley ◽  
Grahame Elder ◽  
Sunil Badve ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Clinical Outcomes ◽  
Serum Phosphate ◽  
Risk Of Bias ◽  
Lowering Therapy ◽  
Mean Differences ◽  
Meta Analyses

Background: Benefits of phosphate-lowering interventions on clinical outcomes in patients with chronic kidney disease (CKD) are unclear; systematic reviews have predominantly involved dialysis patients. This study aimed to summarize evidence from randomized controlled trials (RCTs) concerning benefits and risks of non-calcium-based phosphate-lowering treatment in non-dialysis CKD. Methods: We conducted a systematic review and meta-analyses of RCTs involving noncalcium-based phosphate-lowering therapy compared to placebo, calcium-based binders, or no study medication, in adults with CKD not on dialysis or post-transplant. RCTs had ≥3 months follow up and outcomes included biomarkers of mineral metabolism, cardiovascular parameters, and adverse events. Outcomes were meta-analyzed using the Sidik-Jonkman method for random effects. Unstandardized mean differences were used as effect sizes for continuous outcomes, with common measurement units and Hedge's g standardized mean differences (SMD) otherwise. Odds ratios were used for binary outcomes. Cochrane risk of bias and GRADE assessment determined the certainty of evidence. Results: Twenty trials involving 2,498 participants (median sample size 120, median follow up 9 months) were eligible for inclusion. Overall, risk of bias was low. Compared with placebo, non calcium-based phosphate binders reduced serum phosphate (12 trials, weighted mean difference -0.37, 95% CI -0.58,-0.15 mg/dL, low certainty evidence) and urinary phosphate excretion (8 trials, SMD -0.61, 95% CI -0.90,-0.31, low certainty evidence), but resulted in increased constipation (9 trials, log odds ratio [OR] 0.93, 95% CI 0.02, 1.83, low certainty evidence) and greater vascular calcification score (3 trials, SMD 0.47, 95% CI 0.17, 0.77, very low certainty evidence). Data for effects of phosphate-lowering therapy on cardiovascular events (log OR 0.51 [95% CI -0.51, 1.17]) and death were scant. Conclusions: Non-calcium-based phosphate-lowering therapy reduced serum phosphate and urinary phosphate excretion, but there was an unclear effect on clinical outcomes and intermediate cardiovascular end-points. Adequately powered RCTs are required to evaluate benefits and risks of phosphate-lowering therapy on patient-centered outcomes.

Beta-blockers in elderly patients with left ventricular systolic dysfunction and chronic kidney disease: danger or benefit?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Martinez Milla ◽  
M Cortes ◽  
M Lopez-Castillo ◽  
A Devesa-Arbiol ◽  
A.L Rivero-Monteagudo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Propensity Score ◽  
Ejection Fraction ◽  
Beta Blockers ◽  
Hospital Records ◽  
Propensity Score Matching Analysis ◽  
The Mean

Abstract Introduction Beta-blockers (BB) have been shown to reduce mortality in patients with HFrEF. However, there is little data on the benefit of these therapies in patients with chronic kidney disease and even less in older patients. The aim of this work is to evaluate the role of beta-blockers in patients ≥75 years along the spectrum of kidney disease. Methods From January 2008 to July 2014, we consecutively enlisted 802 patients aged >75 years that had ejection fraction ≤35%. From this group we included 380 patients that had CKD (defined as a glomerular filtration rate (GFR) ≤60 ml/min/1.73m2). Clinical, echocardiographic and electrocardiographic data were taken from hospital records. Follow-up was made via telephone and hospital records as well. Propensity score matching analysis was made to assess the relationship between treatment with BB and occurrence of major adverse cardiovascular event (MACE) composite of death for any cause or heart failure. hospitalization. Multivariate Cox regression analysis was also made in the different groups of CKD (45–60 ml/min/1.73m2, 30–45 ml/min/1.73m2, <30 ml/min/1.73m2) in order to assess the effect of BB over mortality and CV events in each subgroup. Results 390 patients were included. Male represented 62.3% of all participants, and the mean age was 82.6±4.1 years. The mean ejection fraction was 27.9±6.5%. Ischemic etiology was found in 50.6% of cases. Glomerular filtrate (GF) was 60 to 45 ml/min/1.73 m2 in 50.3% of patients, 45–30 ml/min/1.73 m2 in 37.4% and <30 ml/min/1.73 m2 in 12.3%. At the end of the follow-up, 67.4% of the patients were on beta-blocker treatment. The mean follow-up was 32±23 months. During the study period, 211 patients (54.1%) died and 257 patients (65.9%) had a major cardiovascular event (death or hospitalization for heart failure). After propensity score matching analysis, 178 were considered (89 each group) and they have no significant difference in baseline characteristics. BBs were found to significantly reduce mortality (HR 0.45 (95% CI, 0.27–0.75). When the effect of BB over the different subgroups of CKD was analyzed, it was seen also that BB reduced mortality in patients with eGFR 45–60 ml/min/1.73 m2 (HR 0.47 (95% CI, 0.26–0.86), in patients with eGFR 30–45 ml/min/1.73 m2 (HR 0.55 (95% CI, 0.26–1.06)and in eGFR <30 ml/min/1.73 m2 (HR 0.29 (95% CI, 0.11–0.76) Conclusion The use of beta-blockers in elderly patients with HFrEF and kidney DISEASE was associated with increased survival, regardless of the degree of kidney failure. There is a need to raise awareness of the benefits of beta-blocker use in these patients to promote their use where possible. Funding Acknowledgement Type of funding source: None

scholarly journals Cardiovascular Outcomes in African Americans with Sickle Cell Trait and Chronic Kidney Disease

2019 ◽  
Vol 49 (2) ◽  
pp. 93-102 ◽  
Author(s):  
Kabir O. Olaniran ◽  
Nwamaka D. Eneanya ◽  
Andrew S. Allegretti ◽  
Sophia H. Zhao ◽  
Maureen M. Achebe ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
African American ◽  
Cardiovascular Risk ◽  
African Americans ◽  
Kidney Disease ◽  
Sickle Cell ◽  
Sickle Cell Trait ◽  
Increased Risk ◽  
The Mean

Background: Sickle cell trait (SCT) is common among African Americans and has been historically considered to be benign. Recently, SCT has been associated with an increased risk for chronic kidney disease (CKD) and cardiovascular disease in the general population. Our understanding of SCT has been extrapolated largely from data of patients with sickle cell disease (SCD). Notably, in SCD, the outcomes differ by sex. The effect of SCT on cardiovascular risk in the African American CKD population is unknown, and the interaction between SCT and sex on cardiovascular risk has not been investigated. Methods: We performed a 2-center retrospective cohort study of all African American patients with SCT using international classification of disease diagnosis codes and CKD (using the 2012 Kidney Disease Improving Global Outcomes criteria) with at least 1 year of follow-up between January 2005 and December 2017. A reference group of ­African American CKD patients without SCT was used as a comparator during the same period. SCT patients and the reference patients were matched at baseline for age, sex, comorbidities, and proteinuria. Primary outcomes were incident coronary artery disease (CAD), incident stroke, and all-cause mortality. Analysis of effect modification between sex and SCT on primary outcomes was performed. Results: We identified 621 African American CKD patients, 217 SCT patients, and 404 reference patients. The mean age was 56 ± 13 years and 66% were female. The mean estimated glomerular filtration rate was 69 ± 30 mL/min. The mean follow-up time was 8 ± 4 years. There were no significant differences in the primary outcomes comparing SCT patients to matched controls. The interaction term between SCT and sex, however, was significant in the CAD model (p < 0.01). Stratification by sex showed no increased risk in females but a significantly increased risk for CAD in male SCT patients (hazard ratio [HR] 2.14; 95% CI 1.18–3.86), which persisted after multivariable analysis (HR 2.13; 95% CI 1.17–3.86). Conclusion: SCT is associated with an increased risk for CAD in African American males with CKD. The excess risk in males with SCT appears to follow the same pattern as risk in males with SCD. Larger studies are needed to confirm these findings.

scholarly journals Circulating Lactonase Activity but Not Protein Level of PON-1 Predicts Adverse Outcomes in Subjects with Chronic Kidney Disease

2019 ◽  
Vol 8 (7) ◽  
pp. 1034 ◽  
Author(s):  
Chrysan J. Mohammed ◽  
Yanmei Xie ◽  
Pamela S. Brewster ◽  
Subhanwita Ghosh ◽  
Prabhatchandra Dube ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Clinical Outcomes ◽  
Prognostic Value ◽  
Oxidant Stress ◽  
Adverse Outcomes ◽  
Protein Levels ◽  
Traditional Risk Factors ◽  
Apparently Healthy

The burden of cardiovascular disease and death in chronic kidney disease (CKD) outpaces that of the other diseases and is not adequately described by traditional risk factors alone. Diminished activity of paraoxonase (PON)-1 is associated with increased oxidant stress, a common feature underlying the pathogenesis of CKD. We aimed to assess the prognostic value of circulating PON-1 protein and PON lactonase activity on adverse clinical outcomes across various stages and etiologies of CKD. Circulating PON-1 protein levels and PON lactonase activity were measured simultaneously in patients with CKD as well as a cohort of apparently healthy non-CKD subjects. Both circulating PON-1 protein levels and PON lactonase activity were significantly lower in CKD patients compared to the non-CKD subjects. Similarly, across all stages of CKD, circulating PON-1 protein and PON lactonase activity were significantly lower in patients with CKD compared to the non-CKD controls. Circulating PON lactonase activity, but not protein levels, predicted future adverse clinical outcomes, even after adjustment for traditional risk factors. The combination of lower circulating protein levels and higher activity within the CKD subjects were associated with the best survival outcomes. These findings demonstrate that diminished circulating PON lactonase activity, but not protein levels, predicts higher risk of future adverse clinical outcomes in patients with CKD.

Assessment of the association between neuropeptide Y and chronic kidney disease progression

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Saeed Abdel Wahab Saeed ◽  
Haitham Ezzat Abdelaziz ◽  
Nahla Mohamed Teama ◽  
Hend Ahmed Abouelsaad
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Neuropeptide Y ◽  
Complete Blood Count ◽  
Strong Association ◽  
T Test ◽  
Abdominal Ultrasonography ◽  
Organ Systems ◽  
The Mean

Abstract Background Neuropeptide Y (NPY) is a sympathetic neurotransmitter with wide-ranging effects in various organ systems, from the central nervous system (CNS) to the cardiovascular (CV) system, the bone and the renal system. There is a strong association between serum concentration of NpY and deterioration of eGFR and proteinuria as suggested by recent studies [1,2], however, its real effect on chronic kidney disease (CKD) progression is uncertain. Purpose of the study Assess the relationship between NpY and progression of CKD. Settings and Design An observational, prospective case-control study of thirty CKD adult patients and thirty healthy control adult subjects. Methods and Material All participants were conducted to renal function tests (serum creatinin, blood urea, serum Na, K, P and Ca and calculation of estimated glomerular filtration rate), complete blood count, urinary protein/creatinin ratio, serum NpY and pelvi-abdominal ultrasonography at baseline and repeated for the patients only after six months as follow up. Statistical analysis used Statistical presentation and analysis of the present study was conducted, using the mean, standard deviation, student t-test, Paired t-test, Chi-square, Linear Correlation Coefficient and Analysis of variance [ANOVA] tests by SPSS V17. Results The mean of serum NpY was 438.333 ± 206.850 at baseline then became 630.667 ± 264.926 after follow up. Urinary PCR ranged from 0.2- 3.1 at baseline to 0.2- 2 after six months. The patients’ group mean eGFR was 36.900±17.851 and became 31.373±17.852 ml/min/1.73m2. Conclusion Serum NpY could be a useful marker that can be used as diagnostic and progression predictor for CKD.

scholarly journals The frequency of bone fractures among patients with chronic kidney disease not on dialysis: two-year follow-up

2017 ◽  
Vol 55 (4) ◽  
pp. 222-228 ◽  
Author(s):  
Andreja Figurek ◽  
Vlastimir Vlatkovic ◽  
Dragan Vojvodic ◽  
Branislav Gasic ◽  
Milorad Grujicic
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Bone Fractures ◽  
The Other ◽  
Mineral And Bone Disorder ◽  
Bone Disorder ◽  
The Mean ◽  
Frax Score ◽  
Pth Level

Abstract Introduction. Renal osteodystrophy is a severe complication of chronic kidney disease (CKD) that increases morbidity and mortality in these patients. Mineral and bone disorder starts early in CKD and affects the incidence of bone fractures. The aim of this study was to observe the frequency of diverse bone fractures in patients with CKD not on dialysis. Methods. This cohort study included 68 patients that were followed during the two-year period. The patients were divided into two cohorts: one that developed bone fractures and the other that did not. There were 35 (51.5%) men and 33 (48.5%) women. The mean age of patients ranged 62.88±11.60 years. During follow-up serum values of chronic kidney disease – mineral and bone indicators were measured. The methods of descriptive and analytical statistics were used in order to analyze obtained data. Results. During this two-year follow-up seven patients developed bone fractures. Among them, females dominated (6 patients) compared to males (only 1 patient). The most common were fractures of forearm. The mean level of parathyroid hormone (PTH) at the beginning of the monitoring was higher in the group of patients with bone fractures (165.25 ± 47.69 pg/mL) in regard to another group (103.96 ± 81.55 pg/mL). After two-year follow-up, this difference became statistically significant at the level p < 0.05. Patients that developed bone fractures had higher FRAX (Fracture Risk Assessment) score compared to another group. Conclusion. In our study, about 10% of patients had bone fractures in the two-year follow-up period. Patients who developed fractures had a higher PTH level and FRAX score.

scholarly journals Asymptomatic Ventricular Arrhythmia and Clinical Outcomes in Chronic Kidney Disease: A Pilot Study

2016 ◽  
Vol 7 (1) ◽  
pp. 66-73 ◽  
Author(s):  
Fabiana Oliveira Bastos Bonato ◽  
Renato Watanabe ◽  
Marcelo Montebello Lemos ◽  
José Luiz Cassiolato ◽  
Myles Wolf ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Pilot Study ◽  
Kidney Disease ◽  
Ventricular Arrhythmia ◽  
Clinical Outcomes ◽  
Cardiovascular Events ◽  
Composite Outcome ◽  
Ventricular Extrasystoles ◽  
Increased Risk

Background/Aims: Ventricular arrhythmia is associated with increased risk of cardiovascular events and death in the general population. Sudden death is a leading cause of death in end-stage renal disease. We aimed at evaluating the effects of ventricular arrhythmia on clinical outcomes in patients with earlier stages of chronic kidney disease (CKD). Methods: In a prospective study of 109 nondialyzed CKD patients (estimated glomerular filtration rate 34.8 ± 16.1 ml/min/1.73 m2, 57 ± 11.4 years, 61% male, 24% diabetics), we tested the hypothesis that the presence of subclinical complex ventricular arrhythmia, assessed by 24-hour electrocardiogram, is associated with increased risks of cardiovascular events, hospitalization, and death and with their composite outcome during 24 months of follow-up. Complex ventricular arrhythmia was defined as the presence of multifocal ventricular extrasystoles, paired ventricular extrasystoles, nonsustained ventricular tachycardia, or R wave over T wave. Results: We identified complex ventricular arrhythmia in 14% of participants at baseline. During follow-up, 11 cardiovascular events, 15 hospitalizations, and 4 deaths occurred. The presence of complex ventricular arrhythmia was associated with cardiovascular events (p < 0.001), hospitalization (p = 0.018), mortality (p < 0.001), and the composite outcome (p < 0.001). In multivariate Cox regression analysis, adjusting for demographic characteristics, complex ventricular arrhythmia was associated with increased risk of the composite outcome (HR 4.40; 95% CI 1.60-12.12; p = 0.004). Conclusion: In this pilot study, the presence of asymptomatic complex ventricular arrhythmia was associated with poor clinical outcomes in nondialyzed CKD patients.

scholarly journals Effects of dapagliflozin on mortality in patients with chronic kidney disease: a pre-specified analysis from the DAPA-CKD randomized controlled trial

2021 ◽  
Vol 42 (13) ◽  
pp. 1216-1227
Author(s):  
Hiddo J L Heerspink ◽  
C David Sjöström ◽  
Niels Jongs ◽  
Glenn M Chertow ◽  
Mikhail Kosiborod ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Relative Risk ◽  
Kidney Disease ◽  
Risk Reduction ◽  
Relative Risk Reduction ◽  
Controlled Trial ◽  
Cardiovascular Death ◽  
All Cause Mortality ◽  
The Mean

Abstract Aims  Mortality rates from chronic kidney disease (CKD) have increased in the last decade. In this pre-specified analysis of the DAPA-CKD trial, we determined the effects of dapagliflozin on cardiovascular and non-cardiovascular causes of death. Methods and results  DAPA-CKD was an international, randomized, placebo-controlled trial with a median of 2.4 years of follow-up. Eligible participants were adult patients with CKD, defined as a urinary albumin-to-creatinine ratio (UACR) 200–5000 mg/g and an estimated glomerular filtration rate (eGFR) 25–75 mL/min/1.73 m2. All-cause mortality was a key secondary endpoint. Cardiovascular and non-cardiovascular death was adjudicated by an independent clinical events committee. The DAPA-CKD trial randomized participants to dapagliflozin 10 mg/day (n = 2152) or placebo (n = 2152). The mean age was 62 years, 33% were women, the mean eGFR was 43.1 mL/min/1.73 m2, and the median UACR was 949 mg/g. During follow-up, 247 (5.7%) patients died, of whom 91 (36.8%) died due to cardiovascular causes, 102 (41.3%) due to non-cardiovascular causes, and in 54 (21.9%) patients, the cause of death was undetermined. The relative risk reduction for all-cause mortality with dapagliflozin (31%, hazard ratio [HR] [95% confidence interval (CI)] 0.69 [0.53, 0.88]; P = 0.003) was consistent across pre-specified subgroups. The effect on all-cause mortality was driven largely by a 46% relative risk reduction of non-cardiovascular death (HR [95% CI] 0.54 [0.36, 0.82]). Deaths due to infections and malignancies were the most frequently occurring causes of non-cardiovascular deaths and were reduced with dapagliflozin vs. placebo. Conclusion  In patients with CKD, dapagliflozin prolonged survival irrespective of baseline patient characteristics. The benefits were driven largely by reductions in non-cardiovascular death.

Counting Polar Symptoms: How to Represent Results?

Homeopathy ◽  
2020 ◽  
Author(s):  
Lex Rutten ◽  
José Eizayaga ◽  
Harleen Kaur ◽  
Chetna Deep Lamba ◽  
Jyoti Sachdeva ◽  
...  
Keyword(s):  
Observational Study ◽  
Frequency Distribution ◽  
Chronic Cough ◽  
Prognostic Value ◽  
Prospective Observational Study ◽  
Mean Value ◽  
Centre Of Mass ◽  
Central Council ◽  
The Mean

Abstract Background Polar symptoms (PS)—symptoms with opposite values—are frequently used in homeopathy, but have many misleading entries in the repertory. This is caused by using absolute occurrence of symptoms, causing the same medicine to appear in both (opposite) symptom rubrics, and by lack of comparison with other medicines. Some PS, like ‘aversion/desire for sweets’ have a frequency distribution that is not evenly distributed around the neutral value: a desire for sweets is much more common than aversion. A desire for sweets is an indication for a specific medicine only if this desire occurs more frequently in this specific medicine population than in the remainder of the population. We need to find the best way to represent this difference. Methods A multi-centre, explorative, prospective, observational study was conducted by nine centres of the Central Council for Research in Homoeopathy. Two-hundred and sixteen patients were enrolled with chronic cough lasting more than 8 weeks, and received usual homeopathic care. During intake, 30 general PS, 27 polar cough symptoms and 3 non-polar cough symptoms were checked. Different ways of representing results were explored, including two quantities borrowed from mechanics: Centre of Mass (CoM) and Leverage. Results At the fourth follow-up, three medicines with more than 10 cases with good results were identified: 20 Phosphorus, 19 Pulsatilla and 13 Sulphur. The mean value of the frequency distribution of some symptoms in the whole sample was considerably different from the neutral value. Comparing a medicine population with the remainder of the respective population can give results that differ from polarity analysis. For some symptoms, the ‘distance’ (Leverage) between the CoMs of the medicine population and the remainder of the population was clearer than the likelihood ratio (LR). Conclusion If the LR value is not clear about the prognostic value in PS, notions from mechanics such as CoM and Leverage can clarify how to interpret a polar symptom.

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