European Consensus Statement on the diagnosis and management of osteoporosis in chronic kidney disease stages G4–G5D

Abstract Controlling the excessive fracture burden in patients with chronic kidney disease (CKD) Stages G4–G5D remains an impressive challenge. The reasons are 2-fold. First, the pathophysiology of bone fragility in patients with CKD G4–G5D is complex and multifaceted, comprising a mixture of age-related (primary male/postmenopausal), drug-induced and CKD-related bone abnormalities. Second, our current armamentarium of osteoporosis medications has not been developed for, or adequately studied in patients with CKD G4–G5D, partly related to difficulties in diagnosing osteoporosis in this specific setting and fear of complications. Doubts about the optimal diagnostic and therapeutic approach fuel inertia in daily clinical practice. The scope of the present consensus paper is to review and update the assessment and diagnosis of osteoporosis in patients with CKD G4-G5D and to discuss the therapeutic interventions available and the manner in which these can be used to develop management strategies for the prevention of fragility fracture. As such, it aims to stimulate a cohesive approach to the management of osteoporosis in patients with CKD G4–G5D to replace current variations in care and treatment nihilism.

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Laxative use in patients with advanced chronic kidney disease transitioning to dialysis

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa205 ◽

2020 ◽

Author(s):

Keiichi Sumida ◽

Ankur A Dashputre ◽

Praveen K Potukuchi ◽

Fridtjof Thomas ◽

Yoshitsugu Obi ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Transition Period ◽

Management Strategies ◽

Opioid Analgesics ◽

Drug Induced ◽

Advanced Chronic Kidney Disease ◽

Laxative Use ◽

Stage Renal Disease ◽

End Stage

Abstract Background Constipation is highly prevalent in patients with chronic kidney disease (CKD), particularly among those with end-stage renal disease (ESRD), partly due to their dietary restrictions, comorbidities and medications. Laxatives are typically used for constipation management; however, little is known about laxative use and its associated factors in patients with advanced CKD transitioning to ESRD. Methods In a retrospective cohort of 102 477 US veterans transitioning to dialysis between October 2007 and March 2015, we examined the proportion of patients who filled a prescription for any type of laxative within each 6-month period over 36 months pre- and post-transition to ESRD. Factors associated with laxative use during the last 1-year pre-ESRD period were identified by multivariable logistic regression. Results The proportion of patients prescribed laxatives increased as patients progressed to ESRD, peaking at 37.1% in the 6 months immediately following ESRD transition, then remaining fairly stable throughout the post-ESRD transition period. Among laxative users, stool softeners were the most commonly prescribed (∼30%), followed by hyperosmotics (∼20%), stimulants (∼10%), bulk formers (∼3%), chloride channel activator (<1%) and several combinations of these. The use of anticoagulants, oral iron supplements, non-opioid analgesics, antihistamines and opioid analgesics were among the factors independently associated with pre-ESRD laxative use. Conclusion The use of laxatives increased considerably as patients neared transition to ESRD, likely mirroring the increasing burden of drug-induced constipation during the ESRD transition period. Findings may provide novel insight into better management strategies to alleviate constipation symptoms and reduce medication requirements in patients with advanced CKD.

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Cardiovascular Calcification in Chronic Kidney Disease—Therapeutic Opportunities

Toxins ◽

10.3390/toxins12030181 ◽

2020 ◽

Vol 12 (3) ◽

pp. 181 ◽

Cited By ~ 1

Author(s):

Anika Himmelsbach ◽

Carina Ciliox ◽

Claudia Goettsch

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Imaging Techniques ◽

Management Strategies ◽

Clinical Manifestations ◽

Therapeutic Interventions ◽

Rodent Models ◽

Treatment And Prevention ◽

Resolution Imaging ◽

Meta Analyses

Patients with chronic kidney disease (CKD) are highly susceptible to cardiovascular (CV) complications, thus suffering from clinical manifestations such as heart failure and stroke. CV calcification greatly contributes to the increased CV risk in CKD patients. However, no clinically viable therapies towards treatment and prevention of CV calcification or early biomarkers have been approved to date, which is largely attributed to the asymptomatic progression of calcification and the dearth of high-resolution imaging techniques to detect early calcification prior to the ‘point of no return’. Clearly, new intervention and management strategies are essential to reduce CV risk factors in CKD patients. In experimental rodent models, novel promising therapeutic interventions demonstrate decreased CKD-induced calcification and prevent CV complications. Potential diagnostic markers such as the serum T50 assay, which demonstrates an association of serum calcification propensity with all-cause mortality and CV death in CKD patients, have been developed. This review provides an overview of the latest observations and evaluates the potential of these new interventions in relation to CV calcification in CKD patients. To this end, potential therapeutics have been analyzed, and their properties compared via experimental rodent models, human clinical trials, and meta-analyses.

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Faculty Opinions recommendation of Association Between More Intensive vs Less Intensive Blood Pressure Lowering and Risk of Mortality in Chronic Kidney Disease Stages 3 to 5: A Systematic Review and Meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.730774395.793564583 ◽

2019 ◽

Author(s):

Luis Ruilope

Keyword(s):

Systematic Review ◽

Blood Pressure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Meta Analysis ◽

Blood Pressure Lowering ◽

Risk Of Mortality ◽

Pressure Lowering ◽

Disease Stages ◽

Intensive Blood Pressure

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Drug Induced Encephalopathy in Patients with Chronic Kidney Disease: A Case Series

BIRDEM Medical Journal ◽

10.3329/birdem.v8i2.36650 ◽

2018 ◽

Vol 8 (2) ◽

pp. 172-176

Author(s):

Wasim Md Mohosin Ul Haque ◽

Tabassum Samad ◽

Muhammad Abdur Rahim ◽

Shudhanshu Kumar Saha ◽

Sarwar Iqbal

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Renal Impairment ◽

Side Effect ◽

Case Series ◽

Special Group ◽

Drug Induced ◽

Reduced Dose

Drug induced encephalopathy is an established side effect of many drugs when used in a higher dose. Though we do not encounter this side effect frequently in our day to day practice, yet with renal impairment this is not uncommon. Even with a reduced dose many of these can precipitate encephalopathy in this special group of patients. We are presenting here a series of seven such cases of drug induced encephalopathy in patients with renal impairment.Birdem Med J 2018; 8(2): 172-176

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High-sensitive cardiac troponin for the diagnosis of acute myocardial infarction in different chronic kidney disease stages

BMC Cardiovascular Disorders ◽

10.1186/s12872-020-01746-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Daijin Ren ◽

Tianlun Huang ◽

Xin Liu ◽

Gaosi Xu

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Chronic Kidney Disease ◽

Renal Function ◽

Kidney Disease ◽

Cardiac Troponin ◽

Optimal Cutoff ◽

Cutoff Values ◽

Optimal Value ◽

Disease Stages

Abstract Background Chronic kidney disease (CKD) are associated with acute myocardial infarction (AMI). High-sensitive cardiac troponin (hs-cTn) has been evidenced to enhance the early diagnostic accuracy of AMI, but hs-cTn levels are often chronically elevated in CKD patients, which reduces their diagnostic utility. The aim of this study was to derive optimal cutoff-values of hs-cTn levels in patients with CKD and suspected AMI. Methods In this retrospective paper, a total of 3295 patients with chest pain (2758 in AMI group and 537 in Non-AMI group) were recruited, of whom 23.1% were had an estimated glomerular filtration rate (eGFR) of < 60 mL min−1 (1.73 m2)−1. Hs-cTnI values were measured at presentation. Results AMI was diagnosed in 83.7% of all patients. The optimal value of hs-TnI in diagnosing AMI was 1.15 ng mL−1, which were higher in males than females comparing different cutoff-values of subgroups divided by age, gender and renal function, and which increased monotonically with decreasing of eGFR because in patients with CKD without AMI, the correlation between hs-cTnI and renal function is low but significant (r2 = 0.067, P < 0.001). Conclusions Different optimal cutoff-values of hs-cTnI in the diagnosis of AMI in patients with CKD were helpful to the clinical diagnosis of AMI in various populations and were higher in males than females, but which was needed to be validated by multicenter randomized controlled clinical studies in the future.

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New Potential Biomarkers for Chronic Kidney Disease Management—A Review of the Literature

International Journal of Molecular Sciences ◽

10.3390/ijms22010043 ◽

2020 ◽

Vol 22 (1) ◽

pp. 43

Author(s):

Irina Lousa ◽

Flávio Reis ◽

Idalina Beirão ◽

Rui Alves ◽

Luís Belo ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Clinical Practice ◽

Kidney Disease ◽

Renal Damage ◽

Recent Literature ◽

Therapeutic Interventions ◽

Review Of The Literature ◽

Medical Need ◽

Early Use ◽

Reasonable Approach

The prevalence of chronic kidney disease (CKD) is increasing worldwide, and the mortality rate continues to be unacceptably high. The biomarkers currently used in clinical practice are considered relevant when there is already significant renal impairment compromising the early use of potentially successful therapeutic interventions. More sensitive and specific biomarkers to detect CKD earlier on and improve patients’ prognoses are an important unmet medical need. The aim of this review is to summarize the recent literature on new promising early CKD biomarkers of renal function, tubular lesions, endothelial dysfunction and inflammation, and on the auspicious findings from metabolomic studies in this field. Most of the studied biomarkers require further validation in large studies and in a broad range of populations in order to be implemented into routine CKD management. A panel of biomarkers, including earlier biomarkers of renal damage, seems to be a reasonable approach to be applied in clinical practice to allow earlier diagnosis and better disease characterization based on the underlying etiologic process.

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