MO040REAL-WORLD USE OF TOLVAPTAN AND ITS IMPACT ON EGFR IN A NORTH EAST UK COHORT

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Eleftherios Gkekas ◽  
Tsz Yau Tiffany Tang ◽  
Alan Green ◽  
Han Davidson ◽  
Rachel Fraser ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Retrospective Review ◽  
Real Life ◽  
Rapid Progression ◽  
Dramatic Improvement ◽  
North East ◽  
Ckd Stage ◽  
Pre Treatment ◽  
Egfr Decline ◽  
Egfr Slope

Abstract Background and Aims Autosomal dominant polycystic kidney disease (ADPKD) is a cause of progressive chronic kidney failure (CKD) and end stage kidney disease (ESKD). Tolvaptan has been shown within clinical trials to slow down decline of kidney function in patients with ADPKD at risk of rapid progression. We performed a retrospective review of a cohort of ADPKD patients who had been established on tolvaptan therapy to determine its efficacy in a real- world clinic setting. Method Subjects who had a clinical diagnosis of ADPKD and who had been established on tolvaptan for a period of >18 months were reviewed retrospectively in terms of their eGFR. Subjects were between the ages of 18-65 years old and both males and females were included in this study. Other inclusion criteria involved a pre-treatment slope of <-2.5 ml/min/1.73m2 based on readings for a 3 year period, a pre-treatment eGFR of 30-90 ml/min/1.73m2 and ability to tolerate tolvaptan treatment and be maintained on treatment for at least12 months. We calculated based on eGFR slopes, predicted time to reach CKD stage 5 with and without tolvaptan therapy. Given this was a retrospective review, eGFR were estimated during clinic visits whilst on tolvaptan treatment, rather than after a drug washout period. Results The cohort of patients included 20 from Newcastle upon Tyne Hospitals and 2 from Sunderland Royal Infirmary. The mean rate of eGFR decline prior to treatment was -5.92 ml/min/1.73m2 per year for the cohort. Following tolvaptan treatment, the average decline in eGFR was reduced to -2.57 ml/min/1.73m2 per year. Therefore, tolvaptan lessened average eGFR decline within this cohort by 3.35 ml/min/1.73m2 per year, gaining 7 years and 9 months delay until CKD stage 5. The majority of patients (n=19) received full dose tolvaptan (90mg/30mg). At an individual level, 3 patients failed to respond at all to tolvaptan, with no improvement in decline of GFR and 2 others had a very mild improvement only (change in eGFR slope of <0.5 ml/min/1.73m2 per year). 6 patients had a dramatic improvement in eGFR slope (>5 ml/min/1.73m2 per year). Conclusion The real life use of tolvaptan seemed to give a dramatic improvement in eGFR slopes, much more than the previously reported clinical studies have shown. This may be in part due to patient selection and only including patients who tolerated therapy, a “tolvaptan clinic” effect where great personal care is given to these patients and to excellent compliance with medication. Reasons for both non-response and exaggerated response need to be evaluated carefully to determine how individualisation of tolvaptan therapy can be best used.

scholarly journals Ready to Change: Attitudes of an Elderly CKD Stage 3–5 Population towards Testing Protein-Free Food

Nutrients ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3519
Author(s):  
Elisa Longhitano ◽  
Tiziana Trabace ◽  
Antioco Fois ◽  
Antoine Chatrenet ◽  
Maria Rita Moio ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Dietary Habits ◽  
Real Life ◽  
Implementation Strategies ◽  
Free Food ◽  
Life Study ◽  
Ckd Stage ◽  
Lower Egfr ◽  
Comorbidity Index ◽  
Refusal To Participate

The recent Kidney Disease Outcomes Quality Initiative (K-DOQI) guidelines suggest an early start of protein restriction, raising issues on willingness to change dietary habits. The aim of this exploratory real-life study was to report on a test of dietary products (protein-free, not previously available in France) in a large, mainly elderly, chronic kidney disease (CKD) population (220 patients, median age: 77.5 years, Charlson comorbidity index (CCI): seven, malnutrition inflammation score (MIS): five, estimated glomerular filtration rate (eGFR): 26 mL/min), also as a means to tailor further implementation strategies. Forty-nine patients (22.28%) were considered to be poor candidates for the trial (metabolically unstable or with psychological, psychiatric or logistic barriers); of the remaining 171, 80.70% agreed to participate. Patients to whom the diet was not proposed had lower eGFR and higher comorbidity (eGFR 21 vs. 27 p = 0.021; MIS six vs. four p: <0.001). Patients who refused were 10 years older than those who accepted (83 vs. 73 years p < 0.001), with a higher CCI (eight vs. seven p = 0.008) and MIS (five vs. four p = 0.01). In the logistic regression, only age was significantly associated with refusal to participate (Odds ratio (OR): 5.408; 95% CI: 1.894 to 15.447). No difference was found according to low/intermediate/high frequency of weekly use of protein-free food. Our study suggests that most of the patients are ready to test new diet approaches. Only old age correlated with refusal, but frequency of implementation depended on individual preferences, underlying the importance of tailored approaches to improve adherence.

scholarly journals Prediction of non-responsiveness to pre-dialysis care program in patients with chronic kidney disease: a retrospective cohort analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Emily K. King ◽  
Ming-Han Hsieh ◽  
David R. Chang ◽  
Cheng-Ting Lu ◽  
I-Wen Ting ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cohort Analysis ◽  
Care Program ◽  
Rapid Progression ◽  
Net Benefit ◽  
Risk Equation ◽  
Ckd Stage ◽  
All Cause Mortality ◽  
Stage Renal Disease

AbstractThe responsiveness of patients with chronic kidney disease (CKD) to nephrologists’ care is unpredictable. We defined the longitudinal stages (LSs) 1–5 of estimated glomerular filtration rate (eGFR) by group-based trajectory modeling for repeated eGFR measurements of 7135 patients with CKD aged 20–90 years from a 13-year pre-end-stage renal disease (ESRD) care registry. Patients were considered nonresponsive to the pre-dialysis care if they had a more advanced eGFR LS compared with the baseline. Conversely, those with improved or stable eGFR LS were considered responsive. The proportion of patients with CKD stage progression increased with the increase in the baseline CKD stage (stages 1–2: 29.2%; stage 4: 45.8%). The adjusted times to ESRD and all-cause mortality in patients with eGFR LS-5 were 92% (95% confidence interval [CI] 86–96%) and 57% (95% CI 48–65%) shorter, respectively, than in patients with eGFR LS-3A. Among patients with baseline CKD stages 3 and 4, the adjusted times to ESRD and all-cause death in the nonresponsive patients were 39% (95% CI 33–44%) and 20% (95% CI 14–26%) shorter, respectively, than in the responsive patients. Our proposed Renal Care Responsiveness Prediction (RCRP) model performed significantly better than the conventional Kidney Failure Risk Equation in discrimination, calibration, and net benefit according to decision curve analysis. Non-responsiveness to nephrologists’ care is associated with rapid progression to ESRD and all-cause mortality. The RCRP model improves early identification of responsiveness based on variables collected during enrollment in a pre-ESRD program. Urgent attention should be given to characterize the underlying heterogeneous responsiveness to pre-dialysis care.

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 Acid retention in chronic kidney disease is inversely related to GFR

2018 ◽  
Vol 314 (5) ◽  
pp. F985-F991 ◽  
Author(s):  
Nimrit Goraya ◽  
Jan Simoni ◽  
Lauren N. Sager ◽  
Jessica Pruszynski ◽  
Donald E. Wesson
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cross Sectional ◽  
Time Points ◽  
Ckd Stage ◽  
Lower Egfr ◽  
Gfr Decline ◽  
The Difference ◽  
Stage 1 ◽  
Egfr Decline

Greater H+ retention in animal models of chronic kidney disease (CKD) mediates faster glomerular filtration rate (GFR) decline and dietary H+ reduction slows eGFR decline in CKD patients with reduced eGFR and H+ retention due to the high acid (H+) diets of developed societies. We examined if H+ retention in CKD is inversely associated with estimated GFR (eGFR) using cross-sectional and longitudinal analysis of individuals with CKD stage 1 (>90 ml·min− 1·1.73 m−2), CKD stage 2 (60–89 ml/min per 1.73 m2), and CKD stage 3 (30–59 ml·min− 1·1.73 m−2) eGFR. H+ retention was assessed using the difference between observed and expected plasma total CO2 2 h after 0.5 meq/kg body wt oral NaHCO3. H+ retention was higher in CKD 2 vs. CKD 1 ( P < 0.01) and in CKD 3 vs. CKD 2 ( P < 0.02) at baseline and 5 yr, and was higher in CKD 2 vs. CKD 1 ( P < 0.01) at 10 yr. All groups had lower eGFR at subsequent time points ( P < 0.01) but H+ retention was not different among the three time points for CKD 1. By contrast, eGFR decrease was associated with higher H+ retention in CKD 2 at 5 yr ( P = 0.04) and 10 yr ( P < 0.01) and with higher H+ retention in CKD 3 at 5 yr ( P < 0.01). Yearly eGFR decline rate was faster in CKD 2 vs. CKD 1 ( P < 0.01) and in CKD 3 vs. CKD 2 ( P < 0.01). The data show that H+ retention is inversely associated with eGFR, with faster eGFR decline, and support the need for greater dietary H+ reduction therapy for CKD individuals with lower eGFR.

scholarly journals P0279DIABETIC KIDNEY DISEASE VERSUS CHRONIC KIDNEY DISEASE IN ADULTS WITHOUT DIABETES MELLITUS: A RENAL SURVIVAL ANALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Gabriel Stefan ◽  
Ligia Petrescu ◽  
Simona Stancu ◽  
Gabriel Mircescu
Keyword(s):  
Kidney Disease ◽  
Cox Regression ◽  
Kidney Diseases ◽  
Renal Outcome ◽  
Total Serum ◽  
Rapid Progression ◽  
Renal Survival ◽  
Arterial Blood ◽  
Egfr Decline

Abstract Background and Aims Diabetic kidney disease (DKD) is the most common cause of end-stage renal disease, but the decline in kidney function varies considerably between chronic kidney diseases (CKD), and determinants of renal function loss, early in the course of the disease, are still a matter of debate. Method We retrospectively examined the renal outcome at 31 July 2017 of 309 CKD patients (age 59.1 (50.1-68.6) years; 60% male; eGFR 32.7 (21.7-44.8) mL/min) admitted in our hospital during January 2007-December 2012 with a median follow up time of 7.2 (95%CI, 6.8-7.6) years. Only patients who had at least 3 admissions and who were alive during the study period were included. CKD was defined as the presence of an eGFR &lt;60ml/min/1.73m2 or the presence of albuminuria &gt;30mg/g creatinine for more than 3 months. The primary endpoint was renal survival defined as renal replacement therapy (RRT) initiation. Factors affecting renal survival were evaluated in a Cox proportional hazard model. Results DKD (24%), glomerular (GN, 24%), tubulo-interstitial (TIN, 27%) and vascular nephropathies (VN, 25%) were the causes of CKD. Patients with DKD (66.8 (56.5-72.2) years) and VN (68.5 (59.7-76.2) years) were older than those with GN (50.3 (37.4-59.0) years) and TIN (55.6 (45.8-61.8) years). Moreover, the highest cardiovascular comorbidity score was found in patients with VN and DKD (p&lt;0.001). Median eGFR decline was -1.23 ( -3.39 – 0.35) mL/min/year; 29% of the patients had CKD progression of &gt;3mL/min/year and 14% had rapid progression (&gt;5mL/min/year). Patients with GN had the lowest eGFR (26.8 (19.1-38.9) versus DKD 36.2 (23.4-47.7), VN 34.9 (22.4-51.0), TIN 32.4 (21.8-44.8) mL/min, p&lt;0.001), the fastest eGFR decline (-3.1 versus DKD -1.9, VN -1, TIN -1,2 mL/min/year, p 0.5) and the highest proteinuria (2.7 versus DKD 1.4, VN 0.4, TIN 0.6 g/24h, p&lt;0.001). During follow up, 29% of the studied patients started RRT; mean renal survival time for the entire cohort was 7.4 (95%CI, 7.0-7.8) years. CKD cause (versus DKD p=0.04, Figure 1), lower eGFR (HR 0.89 (95%CI, 0.85-0.93)), elevated albuminuria (HR 1.4 (95%CI, 1.2-1.7)), higher total serum cholesterol (HR 1.00 (95%CI, 1.00-1.01)) and elevated mean arterial blood pressure (HR 1.03 (95%CI, 1.00-1.06)) were associated with RRT initiation in the Cox regression model. Conclusion Patients with DKD and VN had similar poorer renal survival as compared with GN and TIN. Earlier referral to the diabetic renal clinic and intensive management of the modifiable risk factors (albuminuria, hypercholesterolemia, hypertention) are necessary to retard progression of CKD and, subsequently, prolong renal survival.

scholarly journals Defining and Predicting Rapid Egfr Decline in Sickle Cell Disease

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 122-122
Author(s):  
Santosh L. Saraf ◽  
Jin Han ◽  
Maria Armila Ruiz ◽  
Andrew Srisuwananukorn ◽  
David Shuey ◽  
...  
Keyword(s):  
High Risk ◽  
Kidney Disease ◽  
Sickle Cell ◽  
Research Funding ◽  
Rapid Decline ◽  
Advisory Committees ◽  
Urine Albumin ◽  
Egfr Decline ◽  
Egfr Slope

Abstract Chronic kidney disease is observed in up to 50% of adults with sickle cell disease (SCD) and is a consistent predictor for increased morbidity and early mortality. Progression of kidney disease can be manifested by a rapid decline in estimated glomerular filtration rate (eGFR). In retrospective studies, up to 38% of SCD patients have a rapid decline in kidney function, defined from the non-SCD literature as an eGFR slope &lt; -3.0 mL/min/1.73m 2. Clinical and genetic predictors and the appropriate cutoff for rapid eGFR decline in SCD are unclear, but are paramount for guiding intervention studies in sickle cell nephropathy. We investigated 1) genetic, laboratory, and clinical risk factors for eGFR decline and 2) the rate of eGFR decline that best predicted mortality risk in a longitudinal cohort of SCD patients enrolled in a prospective registry at our institution. Between 10/2009 and 2/2018, 439 SCD patients were recruited. Blood samples, clinical and laboratory data were collected after obtaining consent at the time of enrolment during a clinic visit without the patient being in a vaso-occlusive crisis. 352 SCD patients with &gt; 6 months of outpatient eGFR assessments were included in this analysis. The eGFR slope was calculated for each patient by linear regression of eGFR by time. Genotyping for the APOL1 G1 and G2 kidney risk variants and alpha thalassemia were performed by PCR. High-risk APOL1 status was defined as being either homozygous or compound heterozygous for the G1 and/or G2 variants. The statistical analyses for predictors of eGFR decline were conducted using linear regression, adjusting for age, sex, SCD genotype, hydroxyurea use, angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) use, and baseline eGFR. Median and interquartile ranges (IQR) are provided. The median age of the cohort was 32 years old (IQR, 24 - 43 years), 60% were female, 76% had Hb SS or Sβ 0-thalassemia genotype, 47% were on hydroxyurea, and 12% were on ACEi or ARB therapy. With a median follow up of 6.7 (IQR, 3.8 - 8.5) years, the median annual eGFR slope was -0.9 (IQR, -3.6 to 1.1) mL/min/1.73m 2. A faster rate of eGFR decline was observed in SCD patients with the Hb SS or Sβ 0-thalassemia genotype, with high-risk APOL1 status, and in those without coinheritance of α-thalassemia (Figure 1A). The urine albumin concentration, based on the average of two consecutive values from the time of enrolment, was significantly associated with a more rapid eGFR decline (β -0.63, P &lt; 0.0001). An albuminuria cutoff of ≥ 100 mg/g creatinine was a stronger predictor for eGFR decline than cutoffs of ≥ 30 or ≥ 300 mg/g (Figure 1B). During the follow up period, we observed 26 deaths (7.4% mortality). An annual eGFR slope of &lt; -6 mL/min/1.73m 2 was independently associated with a greater risk for mortality, after adjusting for age, sex, SCD genotype, hydroxyurea use, ACEi or ARB use, and baseline eGFR (Figure 1C). Using receiver operating curves, this cutoff was also associated with the largest area under the curve for predicting mortality. Our data highlights genetic risk factors and supports albuminuria as an independent predictor of eGFR decline in a longitudinal cohort of SCD patients. We also demonstrate that an annual eGFR slope of &lt; -6 mL/min/1.73m 2 is the strongest predictor for mortality in our cohort. This threshold will need to be validated in other longitudinal SCD cohorts. The association of urine albumin ≥ 100 mg/g creatinine with eGFR decline supports using this cutoff as a clinical biomarker to identify high risk patients for kidney disease progression and for initiating disease modifying and reno-protective therapies. Figure 1 Figure 1. Disclosures Saraf: Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees, Research Funding; Pfizer: Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding. Gordeuk: Modus Therapeutics: Consultancy; Novartis: Research Funding; Incyte: Research Funding; Emmaus: Consultancy, Research Funding; Global Blood Therapeutics: Consultancy, Research Funding; CSL Behring: Consultancy.

scholarly journals Sex-Related Disparities in CKD Progression

2018 ◽  
Vol 30 (1) ◽  
pp. 137-146 ◽  
Author(s):  
Ana C. Ricardo ◽  
Wei Yang ◽  
Daohang Sha ◽  
Lawrence J. Appel ◽  
Jing Chen ◽  
...  
Keyword(s):  
Lower Risk ◽  
The United States ◽  
Ckd Progression ◽  
Ckd Stage ◽  
Multivariable Regression ◽  
Multivariable Regression Models ◽  
Multivariable Adjustment ◽  
Egfr Decline ◽  
Egfr Slope

BackgroundIn the United States, incidence of ESRD is 1.5 times higher in men than in women, despite men’s lower prevalence of CKD. Prior studies, limited by inclusion of small percentages of minorities and other factors, suggested that men have more rapid CKD progression, but this finding has been inconsistent.MethodsIn our prospective investigation of sex differences in CKD progression, we used data from 3939 adults (1778 women and 2161 men) enrolled in the Chronic Renal Insufficiency Cohort Study, a large, diverse CKD cohort. We evaluated associations between sex (women versus men) and outcomes, specifically incident ESRD (defined as undergoing dialysis or a kidney transplant), 50% eGFR decline from baseline, incident CKD stage 5 (eGFR<15 ml/min per 1.73 m2), eGFR slope, and all-cause death.ResultsParticipants’ mean age was 58 years at study entry; 42% were non-Hispanic black, and 13% were Hispanic. During median follow-up of 6.9 years, 844 individuals developed ESRD, and 853 died. In multivariable regression models, compared with men, women had significantly lower risk of ESRD, 50% eGFR decline, progression to CKD stage 5, and death. The mean unadjusted eGFR slope was −1.09 ml/min per 1.73 m2 per year in women and −1.43 ml/min per 1.73 m2 per year in men, but this difference was not significant after multivariable adjustment.ConclusionsIn this CKD cohort, women had lower risk of CKD progression and death compared with men. Additional investigation is needed to identify biologic and psychosocial factors underlying these sex-related differences.

scholarly journals Clinical events and patient-reported outcome measures during CKD progression: findings from the CRIC study

2020 ◽  
Author(s):  
Morgan E Grams ◽  
Aditya Surapaneni ◽  
Lawrence J Appel ◽  
James P Lash ◽  
Jesse Hsu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Kidney Disease ◽  
Kidney Function ◽  
Outcome Measures ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Clinical Events ◽  
Ckd Stage ◽  
Patient Reported ◽  
Egfr Decline

Abstract Background Patients with chronic kidney disease (CKD) face risk of end-stage kidney disease (ESKD), cardiovascular disease (CVD), and death, but also decline in kidney function, quality of life (QOL), and mental and physical well-being. This study describes the multidimensional trajectories of CKD using clinical events, kidney function, and patient-reported outcome measures. We hypothesized that more advanced CKD stages would associate with more rapid decline in each outcome. Methods Among 3,939 participants enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study, we evaluated multidimensional disease trajectories by G- and A-stages of enrollment eGFR and albuminuria, respectively. These trajectories included clinical events (ESKD, CVD, heart failure, death), eGFR decline, and patient-reported outcome measures (kidney disease QOL [KDQOL] burden, effects, and symptoms questionnaires, as well as the short-form-12 mental and physical composite).We also evaluated a group-based multi-trajectory model to group participants on the basis of longitudinal patient-reported outcome measures and compared group assignments by enrollment G- and A-stage. Results Mean participant age was 58 years, 45% were women, mean baseline eGFR was 44 mL/min/1.73 m2, and median urine albumin-to-creatinine ratio was 52 mg/g. The incidence of all clinical events was greater and eGFR decline was faster with more advanced G- and A-stages. While baseline KDQOL and physical component measures were lower with more advanced G- and A-stage of CKD; changes in patient-reported outcome measures were inconsistently related to the baseline CKD stage. Groups formed on patient-reported outcome measure trajectories were fairly distinct from existing CKD staging (observed agreement, 60.6%) but also were associated with risk of ESKD, CVD, heart failure, and death. Conclusions More advanced baseline CKD stage was associated with higher risk of clinical events and faster eGFR decline, but was only weakly related to changes in patient-reported metrics over time.

scholarly journals Aortic Root Dilatation Is Attenuated with Diabetes but Is Not Associated with Renal Progression in Chronic Kidney Disease

2021 ◽  
Vol 11 (10) ◽  
pp. 972
Author(s):  
Pei-Yu Wu ◽  
Jiun-Chi Huang ◽  
Yi-Hsueh Liu ◽  
Ho-Ming Su ◽  
Szu-Chia Chen ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Wave Velocity ◽  
Aortic Root ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ckd Stage ◽  
Aortic Root Dilatation ◽  
Egfr Slope

Patients with chronic kidney disease (CKD) often have cardiac functional and structural abnormalities which can lead to adverse cardiovascular outcomes. In this study, we investigated associations between diabetes mellitus (DM) and cardiac functional and structural parameters in patients with CKD focusing on aortic root diameter (ARD). We also investigated associations of renal outcomes with DM and cardiac functional and structural characteristics. We enrolled 419 patients with CKD stage 3–5 were enrolled. ARD was normalized to body surface area (BSA) (ARD/BSA), and the rate of decline in renal function was assessed by the estimated glomerular filtration rate (eGFR) slope (mL/min/1.73 m2/year). ARD/BSA ≥2.1 cm/m2 in men or ≥2.2 cm/m2 in women was defined as indicating aortic root dilatation. The patients with DM had lower ARD/BSA, higher left atrial dimension (LAD), lower left ventricular ejection fraction, lower ratio of peak early transmitral filling wave velocity to peak late transmitral filling wave velocity, and higher left ventricular relative wall thickness, than those without DM. After multivariable analysis, DM (vs. non-DM; coefficient β, −0.060; p = 0.018) was significantly associated with low ARD/BSA. Significantly fewer patients with DM had aortic root dilatation compared to those without DM (14.3% vs. 23.1%, p = 0.022). In the patients with DM, there were significant associations between a high left ventricular mass index (LVMI) (per 1 g/m2, β, −0.016; p = 0.040) and high LAD (per 1 cm; β, −1.965; p < 0.001) with a low eGFR slope. However, other parameters, including ARD/BSA, were not associated with eGFR slope. Furthermore, there were no associations between eGFR slope and any of the echocardiographic parameters in the patients without DM. Aortic root dilatation was attenuated in the patients with DM, but it was not associated with a decline in renal function. However, high LAD and LVMI were associated with rapid renal function decline in the CKD patients with DM.

scholarly journals To what extent can we achieve mineral bone metabolism treatment targets suggested by KDIGO guidelines among chronic kidney disease stage 3-5 non-dialysis patients?

2021 ◽  
Author(s):  
Mevlut Tamer Dincer ◽  
Seyda Gul Ozcan ◽  
Selma Alagoz ◽  
Cebrail Karaca ◽  
Sibel Hamarat Gulcicek ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Chronic Kidney Disease Stage ◽  
Real Life ◽  
Hypovitaminosis D ◽  
Disease Stage ◽  
Cross Sectional ◽  
Therapeutic Inertia ◽  
Vitamin D Levels ◽  
Ckd Stage

Background Real-life data on the predialysis management of chronic kidney disease (CKD) is scarce. We aimed to investigate the current clinical practice and compliance among nephrologists with KDIGO CKD mineral bone disorders (MBD) guidelines. Methods We performed a multicenter cross-sectional study. We recruited stage 3-5 non-dialysis (ND) CKD patients and recorded data related to CKD MBD from two consecutive outpatient clinical visits apart 3 to 6 months. We calculated therapeutic inertia for hyperphosphatemia, hypocalcemia, hyperparathyroidism, and hypovitaminosis D and overtreatment for hypophosphatemia, hypercalcemia, hypoparathyroidism, and hypervitaminosis D. Results We examined a total of 302 patients (male: 48.7%, median age: 67 years). The persistence of low 25-OH vitamin D levels (61.7%) was the most common laboratory abnormality related to CKD-MBD, followed by hyperparathyroidism (14.8%), hyperphosphatemia (7.9%), and hypocalcemia (0.0%). According to our results, therapeutic inertia seems to be a more common problem than overtreatment for all the CKD-MBD laboratory parameters that we examined. Therapeutic inertia frequency was highest for hypovitaminosis D (81.1%), followed by hypocalcemia (75.0%), hyperparathyroidism (59.0%), and hyperphosphatemia (30.4%), respectively. Conclusion We found that CKD-MBD is not optimally managed in CKD stage 3-5 ND patients. Clinicians should have an active attitude regarding the correction of MBD even at the earlier stages of CKD.

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