scholarly journals P0714RELATIONSHIP BETWEEN BIOLOGICAL AGE ESTIMATED BY SKIN AUTOFLUORESCENCE, CHRONOLOGICAL AGE, AND MORTALITY IN CHRONIC KIDNEY DISEASE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Hokuto Morohoshi ◽  
Ken Iseri ◽  
Lu Dai ◽  
Thomas Ebert ◽  
Anna Witasp ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Nutritional Status ◽  
Mortality Risk ◽  
Biological Age ◽  
Chronological Age ◽  
Skin Autofluorescence ◽  
Risk Of Death ◽  
Inflammatory Status ◽  
All Cause Mortality

Abstract Background and Aims While chronological age associates with increased risk of death, there is a quest for markers of biological age in chronic kidney disease (CKD) that better reflect accumulation of tissue and cellular damage, which could contribute to shorter life span. Skin autofluorescence (SAF) is a biomarker for accumulation of advanced glycation end products in skin that associate with chronological age and with factors that may increase mortality risk. However, the predictive capacity of SAF for mortality has not been fully elucidated in CKD. We have investigated the relationship between biological age calculated by SAF, chronological age and all-cause mortality in patients with CKD stage 5. Method In a cohort of 199 CKD5 patients (non-dialysis CKD5, n=100, hemodialysis, n=27 and peritoneal dialysis, n=72; median age 66 years, 34% females, 21% diabetes (DM), 20% cardiovascular disease (CVD), and 34% malnourished), we calculated biological age by a formula based on SAF measurements using the AGE Reader. Framingham risk score, coronary artery calcium score, the heart rate-corrected augmentation index, body composition, nutritional status, handgrip strength, and various biochemical markers (hemoglobin, albumin, creatinine, intact-parathyroid hormone, triglyceride, cholesterol, HDL-cholesterol, high-sensitivity C-reactive protein (hsCRP), and interleukin (IL)-6) were recorded at baseline. During median follow-up of 38 months, 34 patients died, and 51 patients underwent renal transplantation. We analyzed spline curves showing sub-distribution hazard risk (sHR) for all-cause mortality with biological age calculated by SAF and chronological age by the Fine and Gray competing risk analysis. Results There was a significant association between biological age calculated by SAF and chronological age (rho=0.48; p<0.001). IL-6 and hsCRP were positively associated both with biological age according to SAF measurement (IL-6: rho=0.34, p<0.001; n=155 and hsCRP: rho=0.31, p<0.001; n=199) and chronological age (IL-6: rho=0.47, p<0.001; n=155 and hsCRP: rho=0.40, p<0.001; n=199). The multivariate spline curve showing sHR for all-cause mortality associated positively with chronological age (sHR: 1.04, p=0.035) and biological age calculated by SAF (sHR: 1.01, p=0.048) when adjusted for sex, DM, CVD, nutritional status, 1-standard deviation increase of hsCRP, and CKD5 groups. Conclusion All-cause mortality risk increased linearly with higher chronological age and SAF-estimated biological age - and with similar magnitude of sHR for the two - suggesting that prediction of mortality risk based on SAF is not superior compared to chronological age in CKD. We conclude that biological age calculated by SAF and chronological age are equally robust predictors of clinical outcomes in CKD; however, both indices are influenced by the inflammatory status.

scholarly journals P0669HIGH ESTIMATED PHENOTYPIC AGE ASSOCIATES WITH WORSE CLINICAL OUTCOME IN CHRONIC KIDNEY DISEASE PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Hokuto Morohoshi ◽  
Ken Iseri ◽  
Lu Dai ◽  
Thomas Ebert ◽  
Anna Witasp ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Risk Analysis ◽  
Nutritional Status ◽  
Mortality Risk ◽  
Competing Risk ◽  
Chronological Age ◽  
Competing Risk Analysis ◽  
Inflammatory Status ◽  
All Cause Mortality

Abstract Background and Aims Ageing represents the greatest risk factor contributing to increased morbidity and mortality in most chronic diseases; it encompasses numerous biological changes resulting in declining physiological function and increasing burden of disease. Whether new biomarkers of ageing and risk scores for predicting physiological outcomes, including mortality, are applicable and more accurate than chronological age in patients with chronic kidney disease (CKD) is not clear. So far, the DNA methylation (DNAm) PhenoAge biomarker of ageing (Levine et al. Aging 2018) has not been tested in CKD. While we had no access to DNAm data, we applied the phenotypic age estimate proposed by Levine et al., which was included in their calculations of DNAm PhenoAge, and tested the relationship between estimated phenotypic age (ePhenoAge) and chronological age, respectively, with all-cause mortality in patients with CKD. Method In a cohort of 333 CKD patients (stage 1, n=78; stage 3-4, n=64; and stage 5, n=191) with median age 56 years, 43% females, 24% diabetes (DM), 25% cardiovascular disease (CVD), and 22% malnourished, we estimated age by ePhenoAge, using a formula with calculations based on nine biomarkers and chronological age, and compared this age index with chronological age. Framingham risk score, body composition, nutritional status, handgrip strength, and various biochemical markers (white blood cells, mean cell volume, hemoglobin, albumin, creatinine, glucose, calcium, alkaline phosphatase, intact-parathyroid hormone, triglyceride, cholesterol, HDL-cholesterol, high-sensitivity C-reactive protein (hsCRP), and interleukin (IL)-6) were recorded. During a median follow-up period of 52 months, 65 patients died, and 111 patients underwent renal transplantation. We used spline curve to illustrate sub-distribution hazard risk (sHR) for all-cause mortality versus increasing ePhenoAge and chronological age respectively as obtained by the Fine and Gray competing risk analysis. Results In univariate analyses, IL-6 (rho=0.49, p<0.001; n=268) and hsCRP (rho=0.37, p<0.001; n=333) were significantly correlated with ePhenoAge. The ePhenoAge remained significantly associated with hsCRP (p=0.02) when adjusted for sex, DM, CVD, nutritional status and CKD stages. The spline curves showing sHR for all-cause mortality derived from multivariate competing risk analysis and adjusted for sex, presence of DM and CVD, hsCRP, nutritional status and CKD stages, showed increased mortality risk with higher chronological age (sHR: 1.08, p<0.001). In contrast, the association of mortality with higher ePhenoAge (sHR: 1.04, p=0.06) was of borderline statistical significance. Conclusion All-cause mortality risk was associated with increasing chronological age in competing risk analysis with adjustments of confounders. A similar trend was observed for ePhenoAge, a finding which to a large extent may be explained by the inflammatory status of the study subjects. However, contrary to expectations, ePhenoAge was not as powerful as chronological age in predicting mortality, underlining that our knowledge about factors influencing phenotypic age in CKD patients is still limited. This should motivate further study of the potential role of other estimates of biological age in CKD.

scholarly journals Speckle Tracking Echocardiography and All-Cause and Cardiovascular Mortality Risk in Chronic Kidney Disease Patients

2019 ◽  
Vol 44 (4) ◽  
pp. 690-703 ◽  
Author(s):  
Laura Jahn ◽  
Rafael Kramann ◽  
Nikolaus Marx ◽  
Jürgen Floege ◽  
Michael Becker ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Mortality Risk ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Myocardial Dysfunction ◽  
Left Ventricular ◽  
Control Group ◽  
Increased Risk ◽  
All Cause Mortality

Background and Objectives: Patients with chronic kidney disease (CKD) exhibit a highly increased risk of cardiovascular (CV) morbidity and mortality. Subtle changes in left ventricular function can be detected by two-dimensional (2D) speckle tracking echocardiography (STE). This study investigated whether myocardial dysfunction detected by 2D STE may aid in CV and all-cause mortality risk assessment in patients with CKD stages 3 and 4. Method: A study group of 285 patients (CKD 3: 193 patients; CKD 4: 92 patients) and a healthy control group (34 participants) were included in the retrospective study. 2D STE values as well as early and late diastolic strain rates were measured in ventricular longitudinal, circumferential and radial directions. Patients’ CV and all-cause outcome was determined. Results: In the CKD group all measured longitudinal STE values and radial strain were significantly reduced compared to the control group. Cox proportional hazards regression revealed global longitudinal strain to predict CV and all-cause mortality (hazard ratio [HR] 1.15, 95% CI 1.06–1.25; p = 0.0008 and HR 1.09, 95% CI 1.04–1.14; p = 0.0003). After adjustment for sex, age, diabetes, estimated glomerular filtration rate, and preexisting CV disease, this association was maintained for CV mortality and all-cause mortality (HR 1.16, 95% CI 1.06–1.27; p = 0.0019 and HR 1.08, 95% CI 1.03–1.14; p = 0.0026, respectively). Conclusions: The present study shows that 2D STE detects reduced left ventricular myocardial function and allows the prediction of CV and all-cause mortality in patients at CKD stages 3 and 4.

scholarly journals Long-Term Effects of Spironolactone on Kidney Function and Hyperkalemia-Associated Hospitalization in Patients with Chronic Kidney Disease

2018 ◽  
Vol 7 (11) ◽  
pp. 459 ◽  
Author(s):  
Chen-Ta Yang ◽  
Chew-Teng Kor ◽  
Yao-Peng Hsieh
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Incidence Rate ◽  
Cardiovascular Mortality ◽  
Left Ventricular ◽  
Major Adverse Cardiovascular Events ◽  
P Value ◽  
Mineralocorticoid Receptor Antagonist ◽  
Risk Of Death ◽  
All Cause Mortality

Background: Spironolactone, a non-selective mineralocorticoid receptor antagonist, can protect against cardiac fibrosis and left ventricular dysfunction, and improve endothelial dysfunction and proteinuria. However, the safety and effects of spironolactone on patient-centered cardiovascular and renal endpoints remain unclear. Methods: We identified predialysis stage 3–4 chronic kidney disease (CKD) patients between 2000 and 2013 from the Longitudinal Health Insurance Database 2005 (LHID 2005). The outcomes of interest were end-stage renal disease (ESRD), major adverse cardiovascular events (MACE), hospitalization for heart failure (HHF), hyperkalemia-associated hospitalization (HKAH), all-cause mortality and cardiovascular mortality. The Fine and Gray sub-distribution hazards approach was adopted to adjust for the competing risk of death. Results: After the propensity score matching, 693 patients with stage 3–4 CKD were spironolactone users and 1386 were nonusers. During the follow-up period, spironolactone users had a lower incidence rate for ESRD than spironolactone non-users (39.2 vs. 53.69 per 1000 person-years) and a higher incidence rate for HKAH (54.79 vs. 18.57 per 1000 person-years). The adjusted hazard ratios for ESRD of spironolactone users versus non-users were 0.66 (95% CI, 0.51–0.84; p value < 0.001) and 3.17 (95% CI, 2.41–4.17; p value < 0.001) for HKAH. A dose-response relationship was found between spironolactone use and risk of ESRD and HKAH. There were no statistical differences in MACE, HHF, all-cause mortality and cardiovascular mortality between spironolactone users and non-users. Conclusion: Spironolactone represented a promising treatment option to retard CKD progression to ESRD amongst stage 3–4 CKD patients, but strategic treatments to prevent hyperkalemia should be enforced.

scholarly journals Sex Difference in the Association between Physical Activity and All-Cause Mortality in Ambulatory Patients with Chronic Kidney Disease

2021 ◽  
Vol 18 (7) ◽  
pp. 3698
Author(s):  
Stig Molsted ◽  
Inge Eidemak ◽  
Mette Aadahl
Keyword(s):  
Physical Activity ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Mortality Risk ◽  
Activity Level ◽  
Stage 4 ◽  
Ckd Stage ◽  
Ambulatory Patients ◽  
All Cause Mortality ◽  
Maintenance Dialysis

(1) Background: The purpose of this article was to investigate the association between self-reported physical activity (PA) and all-cause mortality in ambulatory patients with chronic kidney disease (CKD), stage 4–5 including maintenance dialysis. (2) Methods: Ambulatory patients with CKD (eGFR < 30 mL/min/1.73 m2) with conservative treatment or chronic dialysis were included. PA was assessed using the Saltin–Grimby Physical Activity Level Scale. A Cox proportional hazards regression model––adjusted for age, sex, plasma–albumin, body mass index, socioeconomic status, and treatment––was applied. (3) Results: Participants (n = 374) were followed 39 ± 15 months from entry to death or censoring. Throughout the study period of 39 months, 156 deaths (42%) were registered. Regarding physical activity, 128 (34%) of the participants were inactive, 212 (57%) were moderately active, and 34 (9%) were highly or vigorously active. Moderate PA was associated with a decreased mortality risk in women (n = 150) compared to inactivity (HR 0.27 (0.15; 0.51), p < 0.001), whereas a high/vigorous level of PA was not significantly associated with mortality risk compared to inactivity. In men (n = 224), the associations between PA levels and mortality risk were not significant. (4) Conclusions: Moderate PA was associated with reduced all-cause mortality in ambulatory women with stage 4–5 CKD with or without maintenance dialysis treatment. Physical activity was not significantly associated with mortality in men.

scholarly journals The Impact of Age on Mortality in Chronic Haemodialysis Popu-Lation with COVID-19

2021 ◽  
Vol 10 (14) ◽  
pp. 3022
Author(s):  
Ander Vergara ◽  
Mireia Molina-Van den Bosch ◽  
Néstor Toapanta ◽  
Andrés Villegas ◽  
Luis Sánchez-Cámara ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Mortality Risk ◽  
The Elderly ◽  
Elderly Group ◽  
High Risk Population ◽  
Cox Regression Analysis ◽  
Risk Of Death ◽  
The Impact

Age and chronic kidney disease have been described as mortality risk factors for coronavirus disease 2019 (COVID-19). Currently, an important percentage of patients in haemodialysis are elderly. Herein, we investigated the impact of age on mortality among haemodialysis patients with COVID-19. Data was obtained from the Spanish COVID-19 chronic kidney disease (CKD) Working Group Registry. From 18 March 2020 to 27 August 2020, 930 patients on haemodialysis affected by COVID-19 were included in the Registry. A total of 254 patients were under 65 years old and 676 were 65 years or older (elderly group). Mortality was 25.1% higher (95% CI: 22.2–28.0%) in the elderly as compared to the non-elderly group. Death from COVID-19 was increased 6.2-fold in haemodialysis patients as compared to the mortality in the general population in a similar time frame. In the multivariate Cox regression analysis, age (hazard ratio (HR) 1.59, 95% CI: 1.31–1.93), dyspnea at presentation (HR 1.51, 95% CI: 1.11–2.04), pneumonia (HR 1.74, 95% CI: 1.10–2.73) and admission to hospital (HR 4.00, 95% CI: 1.83–8.70) were identified as independent mortality risk factors in the elderly haemodialysis population. Treatment with glucocorticoids reduced the risk of death (HR 0.68, 95% CI: 0.48–0.96). In conclusion, mortality is dramatically increased in elderly haemodialysis patients with COVID-19. Our results suggest that this high risk population should be prioritized in terms of protection and vaccination.

Therapeutic targets for the anemia of predialysis chronic kidney disease: a meta-analysis of randomized, controlled trials

2019 ◽  
Vol 67 (6) ◽  
pp. 1002-1008 ◽  
Author(s):  
Hongyong Liu ◽  
Yuqiu Ye ◽  
Yanbing Chen ◽  
Yunqiang Zhang ◽  
Shaomin Li ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Prognostic Impact ◽  
Stroke Treatment ◽  
Risk Of Death ◽  
Mesh Terms ◽  
Significant Difference ◽  
All Cause Mortality

Anemia is one of the major complications in predialysis patients with chronic kidney disease (CKD). A clearer cognition of the prognostic impact of hemoglobin (Hb) or hematocrit (Hct) target on the outcomes of predialysis patients with CKD is significant. This article aims to establish the suitable hemoglobin target to provide clinical guidance. MEDLINE, EmBase, the Cochrane Library and other databases were searched with both MeSH terms and keywords to gather researches that assessed all-cause mortality, stroke, treatment of renal replacement, and transfusion. The meta-analysis was accomplished via Revman 5.3 version. Totally, 13 eligible studies involving 7606 patients were included. There was a significantly lower risk of transfusion (risk ratio (RR) 0.59, 95% CI 0.52 to 0.67; p<0.00001) in the higher hemoglobin group than in the lower one. However, no significant difference was found in all-cause mortality (RR 1.10, 95% CI 0.98 to 1.23; p=0.11), stroke (RR 1.32, 95% CI 0.82 to 2.10; p=0.25) and treatment of renal replacement including hemodialysis, peritoneal dialysis and renal transplant (RR 1.08, 95% CI 0.95 to 1.22; p= 0.23) between the higher hemoglobin group and the lower one. The results favor the higher hemoglobin target. To target the higher hemoglobin when treating predialysis patients with CKD may decrease the risk of transfusion without increasing the risk of death, stoke, and treatment of renal replacement.

MO601THE ASSESSMENT OF NUTRITIONAL STATUS AND MORTALITY IN GERIATRIC PATIENTS WITH CKD 3B-5 STAGES

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Elina Borkhanova ◽  
Adelya Maksudova
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Nutritional Status ◽  
Geriatric Patients ◽  
Absolute Risk ◽  
Subjective Global Assessment ◽  
Advanced Chronic Kidney Disease ◽  
Risk Of Death ◽  
Ckd Stage ◽  
The Absolute

Abstract Background and Aims:. the prevalence of chronic kidney disease (CKD) increases with age–almost 50% of people over the age of 70 have stage 3-5 CKD. Geriatric patients with pre-dialysis stages of CKD are recommended to assess the risk of absolute probability of death of the patient both in the case of starting dialysis and without it. Malnutrition in this group of patients is the risk factor of mortality. The EQUAL study, a European Quality Study on treatment in advanced chronic kidney disease, showed that according to the Subjective Global Assessment Scale the majority of the geriatric patients with with incident glomerular filtration rate &lt;20mL/min/1.73m 2 (nondialysis) had a normal nutritional status (SGA 6-7), 26% had moderate PEW (SGA 3-5), and less than 1% had severe PEW (SGA 1-2). The aim is to assess prevalence of protein-energy wasting (PEW) and the absolute risk of death over 5 years in the geriatric patients with advanced chronic kidney disease (CKD). Method Materials and methods: a study of 151 geriatric patients with stage 3B-5 CKD, average age 77 ±8.6. Patient inclusion criteria: age 60-90 years, CKD stage 3B-5 (GFR in CKD-EPI &lt;= 45 ml / min / 1.73 m2. Patient exclusion criteria: oncological diseases; acute infections; severe mental illness (including alcoholism), any serious somatic diseases, according to the researcher. The patients were assessed by Subjective Global Assessment; to assess the estimated 5-year mortality rate, patient indicators were evaluated on the Banzal scale. All patients were evaluated for laboratory data (absolute number of lymphocytes, hemoglobin, red blood cells, creatinine, urea, total protein, blood albumin, total cholesterol, blood potassium, and proteinuria); The study group consisted of 105 patients with stage 3B CKD, 35 patients with stage 4 CKD, and 11 patients with stage 5 CKD. Results according to the SGA 66,7% of patients with CKD 3b stage have normal nutritional status, 26,6% patients are mild to moderate malnourishment, 6,7 % are malnourished. 60% of patients with CKD 4 stage have normal nutritional status, 31,2% patients had moderate PEW, 8,8% had severe PEW. In patients with CKD 5 72,7% had moderate PEW, 27,3% had severe PEW. The level of total protein in the blood serum is correlated with nutritional disorders on the SGA scale(r=-0.52) in geriatric patients with predialysis stages of CKD. During assessing the absolute risk of death within 5 years (Bansal Score) in 20.9% of patients with CKD3B, the estimated mortality rate was 40%, in 12.4% 54%, in 25.7% 69% and higher. All patients with stage 5 CKD had a mortality risk of 40% or higher. Indicators of the the Bansal scale significantly increased with a decrease in GFR (r= - 0.68, r=-0.46). The Banzal mortality index (r=0.32) significantly increased with increasing the level of serum phosphorus and uremia. Conclusion. The prevalence of nutritional disorders are observed in 33-40% of elderly patients with stage 3B-4 CKD and until 75% with stage 5CKD. During assessing the absolute risk of death over 5 years in the study population of geriatric patients with CKD stages 3B-5, a high risk on the Bansal scale (69% or higher) was observed in 25.7% with CKD stage 3B, 60%

MO487DYSNATRAEMIA AND ASSOCIATED MORTALITY RISK THRESHOLDS ARE MODIFIED BY KIDNEY FUNCTION IN THE IRISH HEALTH SYSTEM: THE NATIONAL KIDNEY DISEASE SURVEILLANCE SYSTEM (NKDSS)

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Conor Walsh ◽  
Leonard Browne ◽  
Austin Stack
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Mortality Risk ◽  
Surveillance System ◽  
Disease Surveillance ◽  
Optimal Range ◽  
Disease Surveillance System ◽  
All Cause Mortality ◽  
The Impact

Abstract Background and Aims Dysnatraemia is associated with increased mortality risk in the general population, but it is unclear to what extent kidney function influences this relationship. We investigated the impact of dysnatraemia on total and cardiovascular (CV) mortality while exploring the concurrent impact of chronic kidney disease. Method We utilised data from the Irish Kidney Disease Surveillance System (NKSS) to explore the association of serum sodium (Na+) (mmol/L) and mortality in a longitudinal cohort study. We identified all adult individuals (age &gt; 18 years) who accessed health care from January 1st, 2007 and December 31st, 2013 in a regional health system with complete data on serum Na+, associated laboratory indicators and vital status up to 31st December 2013 (n = 32, 686). Patients receiving dialysis were excluded. The primary exposure was serum Na+ first recorded during the study period for each patient with a concurrent serum glucose measurement. Chronic kidney disease was defined as eGFR &lt;60ml/min/1.73m² vs greater recorded at index date. The association of serum Na+ with all-cause (ACM) and CV mortality was explored in categories and as a continuous variable using polynomial splines. Multivariable Cox regression with competing risks determined hazard ratios (HR) and 95% confidence intervals with adjustment for baseline health indicators. Results There were 5,118 deaths (15.7%) over a median follow up of 5.5 years. In multivariable adjusted models, the association of serum Na+ with all-cause and CV mortality followed a non-linear, u-shaped pattern. For all-cause mortality, the optimal range for greatest survival was between 139-146 mmol/L [HR 1.02 (1.00-1.03) and HR 1.19 (1.02-1.38) respectively, while for CV mortality, the optimal range was much narrower at 134-143mmol/L [HR 1.16 (1.02-1.23) and HR 1.09 (1.01-1.89) respectively] (Figure 1). The impact of serum Na+ on mortality was modified by baseline kidney function (p value &lt; 0.001 for interaction). In stratified analysis, the impact of serum Na+ on all-cause mortality was greatly attenuated among patients with GFR&lt; 60 ml/min/m², than above. This pattern was replicated in analyses of CV mortality. Conclusion This study supports the view that hypernatraemia and hyponatraemia are better tolerated with poorer kidney function. The risk thresholds for mortality were much narrower for CV death than all-cause death suggesting that these thresholds be taken into account to inform decision making and therapeutic interventions. Funding source Health Research Board (HRB-SDAP-2019-036), Midwest Research and Education Foundation (MKid)

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