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 <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 <= 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%

scholarly journals Oral Factor Xa Inhibitors versus Warfarin for the Treatment of Venous Thromboembolism in Advanced Chronic Kidney Disease

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Tania Ahuja ◽  
Kelly Sessa ◽  
Cristian Merchan ◽  
John Papadopoulos ◽  
David Green
Keyword(s):  
Chronic Kidney Disease ◽  
Venous Thromboembolism ◽  
Kidney Disease ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Safety Data ◽  
Factor Xa ◽  
Factor Xa Inhibitors ◽  
Advanced Chronic Kidney Disease ◽  
Ckd Stage

Introduction. Warfarin remains the preferred oral anticoagulant for the treatment of venous thromboembolism (VTE) in patients with advanced chronic kidney disease (CKD). Although the direct oral anticoagulants (DOACs) have become preferred for treatment of VTE in the general population, patients with advanced CKD were excluded from the landmark trials. Postmarketing, safety data have demonstrated oral factor Xa inhibitors (OFXais) such as apixaban and rivaroxaban to be alternatives to warfarin for the prevention of stroke and systemic embolism in patients with atrial fibrillation. However, it remains unknown if these safety data can be extrapolated to the treatment of VTE and CKD. Methods. A retrospective cohort study from January 2013 to October 2019 was performed at NYU Langone Health. All adult patients with CKD stage 4 or greater, treated with anticoagulation for VTE, were screened. The primary outcome was tolerability of anticoagulant therapy at 3 months, defined as a composite of bleeding, thromboembolic events, and/or discontinuation rates. The secondary outcomes included bleeding, discontinuations, and recurrent thromboembolism. Results. There were 56 patients evaluated, of which 39 (70%) received warfarin and 17 (30%) received an OFXai (apixaban or rivaroxaban). Tolerability at 3 months was assessed in 48/56 patients (86%). A total of 34/48 (71%) patients tolerated anticoagulation at 3 months, 12 (80%) in the OFXai arm, and 22 (67%) in the warfarin arm ( p = 0.498 ). There were 10/48 (21%) patients that experienced any bleeding events within 3 months, 7 on warfarin, and 3 on apixaban. Recurrence of thromboembolism within 3 months occurred in 3 patients on warfarin, with no recurrence in the OFXai arm. Discussion. OFXais were better tolerated compared to warfarin for the treatment of VTE in CKD, with lower rates of bleeding, discontinuations, and recurrent thromboembolism in a small cohort. Future prospective studies are necessary to confirm these findings.

scholarly journals CORELLATION BRANCHED CHAIN AMINO ACID IN INHIBITING THE PROGRESSIVITY OF CHRONIC KIDNEY DISEASE STAGE 2-4 IN CHILDREN

2019 ◽  
Vol 26 (2) ◽  
Author(s):  
Esthy Poespitaningtyas ◽  
Roedi Irawan ◽  
Ninik Asmaningsih Soemyarso ◽  
Jusak Nugraha
Keyword(s):  
Chronic Kidney Disease ◽  
Amino Acid ◽  
Kidney Disease ◽  
Nutritional Status ◽  
Controlled Trial ◽  
Chronic Kidney Disease Stage ◽  
Disease Stage ◽  
Branched Chain Amino Acid ◽  
Ckd Stage ◽  
Branched Chain

Chronic kidney disease (CKD) is not uncommon issue in children. CKD is the abnormality of structure or function of the kidney that occurs for more than 3 months. Progresivity of CKD characterized by the presence of longitudinal decline in Glomerulus Filtration Rate (GFR), proteinuria and hypertension. One of the recommendations of the prevention of nutritional supplementation in CKD by administering oral Branched Chain Amino Acid (BCAA). Recently, there has been no research to figure the effects of the of BCAA on children with CKD stage 2-4. Randomized pre-post test controlled trial study was conducted in Nephrology pediatric outpatient clinic Dr. Soetomo hospital with CKD stage 2-4, divided into 2 groups, the BCAA and placebo, followed for 8 weeks to be evaluated for GFR, albumin, proteinuria, blood pressure and nutritional status. Sixteen children with CKD stage 2-4 were enrolled in this study, 71.4% of patients were boys. The mean age was 12.5 (SD 2.90) years. CKD stage 2 about 50% (p=0,767). Nephrotic syndrome was the most common underlying cause of CKD (p=0,149). Moderate malnutrition was about 50% (p=1,000) and short stature was 64.28% (p=1.000). In BCAA group there was decrease of GFR -5.08±7,13 (p=0.055), increase of albumin serum 0.20±0.23 (p=0,062), decrease of delta systole -11,57±15.08 (p=0,565) and diastole -4,85±16.25 (p=0,708), weight loss -0.07±1.01 (p=0.828), an increase of height 0.14±0.24 (p=0,771), and a decrease in BMI -0.03±0.74 (p=0,389). The conclusion in this study is Branched chain amino acid (Leucine, Isoleucine and Valine) supplementation did not provide significant effect in inhibiting progresivity of CKD stage 2-4 in children and improvement of nutritional status.

Safety and Efficacy of Apixaban Versus Warfarin in Patients With Advanced Chronic Kidney Disease

2018 ◽  
Vol 52 (11) ◽  
pp. 1078-1084 ◽  
Author(s):  
Joseph H. Schafer ◽  
Ashley L. Casey ◽  
Kristina A. Dupre ◽  
Britta A. Staubes
Keyword(s):  
Chronic Kidney Disease ◽  
Ischemic Stroke ◽  
Kidney Disease ◽  
Major Bleeding ◽  
Warfarin Therapy ◽  
Advanced Chronic Kidney Disease ◽  
Major Bleed ◽  
Time Period ◽  
Stage 4 ◽  
Ckd Stage

Background: Because of a lack of comparative data on anticoagulant use in the advanced chronic kidney disease (CKD) population, guidelines recommend warfarin for atrial fibrillation and venous thromboembolism (VTE) treatment in these patients. However, apixaban has specific dosing recommendations in CKD leading to use in clinical practice. Objective: To evaluate major bleeding, stroke, and thromboembolism rates in patients with CKD stage 4, stage 5, and dialysis on apixaban or warfarin therapy. Methods: This was a retrospective cohort study of patients with advanced CKD receiving apixaban or warfarin. The primary outcome was the occurrence of major bleeding at 3 months after enrollment. Secondary outcomes included occurrence of major bleeding, occurrence of ischemic stroke, and recurrence of VTE at 3 to 6 and 6 to 12 months. Results: A total of 604 patients were included in the analysis. The percentage of apixaban and warfarin patients with a major bleed at 0 to 3, 3 to 6, and 6 to 12 months were 8.3% versus 9.9% ( P=0.48), 1.4% versus 4% ( P=0.07), and 1.5% versus 8.4% ( P<0.001), respectively. There were no differences in rates of ischemic stroke or recurrent VTE at any time period. Conclusion and Relevance: Patients with advanced CKD taking apixaban had similar bleeding rates at 3 months compared with those taking warfarin. However, those who continued therapy had higher major bleeding rates with warfarin between 6 and 12 months. This study provides knowledge on the effects of a direct oral anticoagulant in a population that was excluded from all major trials.

scholarly journals Decreased Bioimpedance Phase Angle in Patients with Diabetic Chronic Kidney Disease Stage 5

Nutrients ◽  
2019 ◽  
Vol 11 (12) ◽  
pp. 2874
Author(s):  
Byoung-Geun Han ◽  
Jun Young Lee ◽  
Jae-Seok Kim ◽  
Jae-Won Yang
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Nutritional Status ◽  
Phase Angle ◽  
Chronic Kidney Disease Stage ◽  
Multivariate Logistic Regression Analysis ◽  
Albumin Level ◽  
Disease Stage ◽  
Lean Tissue ◽  
Ckd Stage

Early detection and regular monitoring of the nutritional status of patients with diabetic chronic kidney disease (DMCKD) with reliable tools are necessary. We aimed to determine the clinical significance of the phase angle (PhA) in patients with DMCKD stage 5 not undergoing dialysis. A total of 219 patients (non-diabetic CKD stage 5 [nDMCKD5], n = 84; diabetic CKD stage 5 [DMCKD5], n = 135) were analyzed. The nDMCKD5 group had a significantly higher PhA (p = 0.001), intracellular water/body weight (p = 0.001), and albumin level (p = 0.010) than the DMCKD5 group. The DMCKD5 group experienced significantly more overhydration (p < 0.001). The PhA was positively associated with the lean tissue index (LTI) (r = 0.332; p < 0.001), hemoglobin level (r = 0.223; p = 0.010), albumin level (r = 0.524; p < 0.001), and estimated glomerular filtration rate (eGFR; r = 0.204; p = 0.018) in the DMCKD5 group. Multivariate logistic regression analysis showed the eGFR (odds ratio [OR]: 0.824, 95% confidence interval [CI]: 0.698–0.974); p = 0.023), LTI (OR: 0.771, 95% CI: 0.642–0.926; p = 0.005), and albumin level (OR: 0.131, 95% CI: 0.051–0.338; p < 0.001) were significantly associated with undernutrition (PhA < 4.17°) in the DMCKD5 group. Our observations suggest that the PhA could be used as a marker to reflect the nutritional status in patients with DMCKD5.

scholarly journals Secondary hyperparathyroidism and adverse health outcomes in adults with chronic kidney disease

2021 ◽  
Author(s):  
Yang Xu ◽  
Marie Evans ◽  
Marco Soro ◽  
Peter Barany ◽  
Juan Jesus Carrero
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Health Outcomes ◽  
Secondary Hyperparathyroidism ◽  
Ckd Progression ◽  
Risk Of Death ◽  
Adverse Health ◽  
Adverse Health Outcomes ◽  
Increased Risk ◽  
Ckd Stage

Abstract Background Secondary hyperparathyroidism (sHPT) develops frequently in patients with chronic kidney disease (CKD). However, the burden and long-term impact of sHPT on the risk of adverse health outcomes are not well studied. Methods We evaluated all adults receiving nephrologist care in Stockholm during 2006–11 who were not undergoing kidney replacement therapy and had not developed sHPT. Incident sHPT was identified by using clinical diagnoses, initiated medications or two consecutive parathyroid hormone (PTH) measurements ≥130 pg/mL. We characterized sHPT incidence by estimated glomerular filtration rate (eGFR) strata, evaluated clinical predictors and quantified the association between incident sHPT (time-varying exposure) and the risk of fractures, CKD progression, major adverse cardiovascular events (MACEs) and death. Results We identified 2556 adults with CKD Stages 1–5 (mean age 66 years, 38% women), of whom 784 developed sHPT during follow-up. The incidence of sHPT increased with advancing CKD: from 57 cases/1000 person-years in CKD Stage G3 to 230 cases/1000 person-years in Stage G5. In multivariable analyses, low eGFR was the strongest sHPT predictor, followed by young age, male sex and diabetes. Incident sHPT was associated with a 1.3-fold (95% confidence interval 1.1–1.8) increased risk of death, a 2.2-fold (1.42–3.28) higher risk of MACEs, a 5.0-fold (3.5–7.2) higher risk of CKD progression and a 1.3-fold (1.5–2.2) higher risk of fractures. Results were consistent in stratified analyses and after excluding early events. Conclusions Our findings illustrate the burden of sHPT in advanced CKD and highlight the susceptibility for adverse outcomes of patients developing sHPT. This may inform clinical decisions regarding pre-sHPT risk stratification, PTH monitoring and risk-prevention strategies post-sHPT development.

scholarly journals Predicting mortality risk on dialysis and conservative care: development and internal validation of a prediction tool for older patients with advanced chronic kidney disease

2020 ◽  
Author(s):  
Chava L Ramspek ◽  
Wouter R Verberne ◽  
Marjolijn van Buren ◽  
Friedo W Dekker ◽  
Willem Jan W Bos ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Decision Making ◽  
Kidney Disease ◽  
Mortality Risk ◽  
Older Patients ◽  
Treatment Decision ◽  
Prediction Tool ◽  
Advanced Chronic Kidney Disease ◽  
Conservative Care ◽  
Ckd Stage

Abstract Background Conservative care (CC) may be a valid alternative to dialysis for certain older patients with advanced chronic kidney disease (CKD). A model that predicts patient prognosis on both treatment pathways could be of value in shared decision-making. Therefore, the aim is to develop a prediction tool that predicts the mortality risk for the same patient for both dialysis and CC from the time of treatment decision. Methods CKD Stage 4/5 patients aged ≥70 years, treated at a single centre in the Netherlands, were included between 2004 and 2016. Predictors were collected at treatment decision and selected based on literature and an expert panel. Outcome was 2-year mortality. Basic and extended logistic regression models were developed for both the dialysis and CC groups. These models were internally validated with bootstrapping. Model performance was assessed with discrimination and calibration. Results In total, 366 patients were included, of which 126 chose CC. Pre-selected predictors for the basic model were age, estimated glomerular filtration rate, malignancy and cardiovascular disease. Discrimination was moderate, with optimism-corrected C-statistics ranging from 0.675 to 0.750. Calibration plots showed good calibration. Conclusions A prediction tool that predicts 2-year mortality was developed to provide older advanced CKD patients with individualized prognosis estimates for both dialysis and CC. Future studies are needed to test whether our findings hold in other CKD populations. Following external validation, this prediction tool could be used to compare a patient’s prognosis on both dialysis and CC, and help to inform treatment decision-making.

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&lt;0.001). IL-6 and hsCRP were positively associated both with biological age according to SAF measurement (IL-6: rho=0.34, p&lt;0.001; n=155 and hsCRP: rho=0.31, p&lt;0.001; n=199) and chronological age (IL-6: rho=0.47, p&lt;0.001; n=155 and hsCRP: rho=0.40, p&lt;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.

Does chronic kidney disease affect implant survival after primary hip and knee arthroplasty?

2021 ◽  
Vol 103-B (4) ◽  
pp. 689-695
Author(s):  
Pyry Jämsä ◽  
Aleksi Reito ◽  
Niku Oksala ◽  
Antti Eskelinen ◽  
Esa Jämsen
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Knee Arthroplasty ◽  
Competing Risk ◽  
Normal Kidney ◽  
Normal Kidney Function ◽  
Risk Of Death ◽  
Stage 4 ◽  
Ckd Stage

Aims To investigate whether chronic kidney disease (CKD) is associated with the risk of all-cause revision or revision due to a periprosthetic joint infection (PJI) after primary hip or knee arthroplasty. Methods This retrospective cohort study comprised 18,979 consecutive hip and knee arthroplasties from a single high-volume academic hospital. At a median of 5.6 years (interquartile range (IQR) 3.5 to 8.1), all deaths and revisions were counted. To overcome the competing risk of death, competing risk analysis using the cumulative incidence function (CIF) was applied to analyze the association between different stages of CKD and revisions. Confounding factors such as diabetes and BMI were considered using either a stratified CIF or the Fine and Gray model. Results There were 2,111 deaths (11.1%) and 677 revisions (3.6%) during the follow-up period. PJI was the reason for revision in 162 cases (0.9%). For hip arthroplasty, 3.5% of patients with CKD stage 1 (i.e. normal kidney function, NKF), 3.8% with CKD stage 2, 4.2% with CKD stage 3, and 0% with CKD stage 4 to 5 had undergone revision within eight years. For knee arthroplasty, 4.7% with NKF, 2.7% with CKD stage 2, 2.4% with CKD stage 3, and 7% of CKD stage 4 to 5 had had undergone revision. With the exception of knee arthroplasty patients in whom normal kidney function was associated with a greater probability of all-cause revision, there were no major differences in the rates of all-cause revisions or revisions due to PJIs between different CKD stages. The results remained unchanged when diabetes and BMI were considered. Conclusion We found no strong evidence that CKD was associated with an increased risk of all-cause or PJI-related revision. Selection bias probably explains the increased amount of all-cause revision operations in knee arthroplasty patients with normal kidney function. The effect of stage 4 to 5 CKD was difficult to evaluate because of the small number of patients. Cite this article: Bone Joint J 2021;103-B(4):689–695.

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