MO609PREVALENCE OF MALNUTRITION AND INFLAMMATION IN NONDIALYZED PATIENTS WITH CHRONIC KIDNEY DISEASE: A CLINICAL STUDY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Manzoor Parry ◽  
Hamad Jeelani
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Serum Albumin ◽  
Serum Ferritin ◽  
Chronic Glomerulonephritis ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
North East ◽  
Inflammatory Status ◽  
Initiation Of Dialysis

Abstract Background and Aims The prevalence of chronic kidney disease (CKD) in India varies from 0.16–0.78%. The reported incidence of malnutrition in CKD patients is 37–84%. There is a paucity of data on the quantification of malnutrition and inflammation in undialyzed patients of CKD from north east of India. This study analyzed the prevalence and causes of malnutrition and inflammation in patients with CKD before the initiation of dialysis treatment. Method This study was conducted from May 2017 to May 2019 in the department of nephrology Guahati medical college hospital. Assessment of nutritional and inflammatory status was carried out in patients with CKD before initiation of dialysis. Serum albumin; body mass index (BMI); triceps skin fold thickness (TST); mid-arm muscle circumference (MAMC); and subjective global assessment (SGA) scoring were used for assessment of nutritional parameters. Serum C-reactive protein; serum albumin and serum ferritin level were used to assess the inflammatory status in these patients. Results A total of 528 (male:female= 359:169) patients with CKD participated in this study. Diabetic Nephropathy (35%) was the most common; followed by; hypertension (23%) and chronic glomerulonephritis (20 %). The evidence of malnutrition was noted in 344 (65%). The mean age of patients with malnutrition was 52.8±12.45 years with a male predominance (68%). On the basis of SGA score; malnutrition was noted in 344 patients (mild moderate [36%]; severe; [30%]); remaining (34%) were well nourished. Thus; evidence of Malnutrition was noted in 65% of patients with CKD.). Serum total protein & albumin were higher in the non-malnourished patients in comparison to malnourished (5.83±1.0 vs 5.31±1.12 p<0.05; 3.65±0.7 vs 2.62±0.74) The inflammatory markers (serum ferritin & C reactive protein) were elevated significantly in patients with malnutrition in comparison to those without malnutrition (308.15±60.18 mg/dL vs. 251.64±63.14 mg/dL; p < 0.001; 77% vs. 50%; p < 0.01). Conclusion Malnutrition and inflammation are common in patients with CKD before the commencement of dialysis. This indicates that an emphasis should be placed on the assessment and prevention or correction of malnutrition and inflammatory burden in these patients with CKD.

MO560IS SERUM ERYTHROPOIETIN CORRELATED WITH IRON METABOLISM AND INFLAMMATION IN NON-DIALYSIS CHRONIC KIDNEY DISEASE PATIENTS WITH ANEMIA?

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Cristina-Stela Capusa ◽  
Ana-Maria Mehedinti ◽  
Ana Stanciu ◽  
Gabriela-Adriana Talimba ◽  
Liliana Viasu ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Bone Marrow ◽  
Kidney Disease ◽  
Serum Albumin ◽  
Serum Ferritin ◽  
Iron Metabolism ◽  
Mean Corpuscular Hemoglobin ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Serum Hepcidin

Abstract Background and Aims Both the relative erythropoietin (Epo) deficiency and its relationship with serum hemoglobin (Hb) are widely postulated in chronic kidney disease (CKD), but the influence of chronic inflammation and iron status on serum Epo levels is still a matter of debate, with yet divergent reported results. Therefore, we aimed to assess the determinants of serum Epo in non-dialysis CKD patients. Method Fifty-two adults with CKD and anemia (defined as Hb <12g/dL), in stable clinical condition, never treated with erythropoiesis-stimulating agents (ESA) entered this cross-sectional, single-center study. Diabetes mellitus, active infectious and inflammatory diseases, malignancy, anemia of other causes than CKD, current immunosuppressive therapy, iron supplementation and blood transfusions in the previous six months were exclusion criteria. The subjects were mostly men (56%), elderly (two thirds over 60 years), with advanced CKD [71% in CKD stages G4-G5, median estimated glomerular filtration rate – eGFR 14.5 (95%CI 16 to 25) mL/min], moderate anemia [Hb 9.8 (95%CI 9.2 to 9.9) g/dL], and mild to moderate inflammation [C-reactive protein 6 (95%CI 9.2 to 18.4) mg/L]. Serum Epo was assessed by ELISA (Abcam® 119522). Complete blood count, reticulocyte index, peripheral blood smear, bone marrow aspiration (Perls’ stain), serum ferritin, and transferrin saturation, were used to investigate anemia and iron metabolism. Parameters of kidney disease (CKD etiology, eGFR and proteinuria), demographic data (age, gender), C-reactive protein, serum albumin, and serum hepcidin-25 (Hep-25, Bachem® commercial ELISA kit) were also analyzed. Results The median serum Epo of the whole cohort was 4.8 (95%CI 5.1 to 9.9) mU/mL. According to median Epo, subjects were clustered in Group 1 (below median, G1) and Group 2 (above median, G2). Estimated GFR and serum Hep-25 were lower in G1 than in G2 [10.6 (95%CI 9.7 to 20.8) vs. 26 (95%CI 19.1 to 32.8) mL/min, p=0.004, and 62.6 (95%CI 51.0 to 85.1) vs. 95.4 (95%CI 77.0 to 108.5) ng/mL, p=0.03, respectively]. All the other investigated parameters were similar in the two groups. In bivariate analysis (Spearman rank correlation), serum Epo was positively associated only with eGFR (rs=0.40, p=0.003). Marginal associations with the percentage of bone marrow sideroblasts, as marker of the iron available for erythropoiesis (rs=0.25, p=0.08), erythrocyte mean corpuscular hemoglobin concentration (rs=−0.26, p=0.07), and reticulocyte index (rs=0.24, p=0.09) were observed. Conversely, serum Epo was not related to hemoglobin, indices of iron stores (e.g. serum ferritin and iron content in bone marrow macrophages), inflammation and nutritional status (e.g. C-reactive protein and serum albumin). In a model of multiple linear regression which explained 14% of serum Epo variation, eGFR was the only determinant: Beta 0.14 (95%CI 0.05 to 0.23), p=0.004. Also, a binary logistic multiple regression model predicting serum Epo lower or higher than the median retained the eGFR as an independent predictor, while serum hepcidin showed only borderline significance: Conclusion Kidney function is the main determinant of endogenous erythropoietin level in moderately anemic patients with advanced CKD, ESA or iron naive, while serum hepcidin-25 seems to exert a limited influence.

scholarly journals Periodontitis Predicts Elevated C-reactive Protein Levels in Chronic Kidney Disease

2011 ◽  
Vol 90 (12) ◽  
pp. 1411-1415 ◽  
Author(s):  
E. Ioannidou ◽  
H. Swede ◽  
A. Dongari-Bagtzoglou
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Case Definition ◽  
Cutoff Point ◽  
C Reactive Protein ◽  
Protein Levels ◽  
Reactive Protein ◽  
Inflammatory Status ◽  
Periodontal Infection ◽  
Serum Crp

Based on the existing evidence supporting a state of chronic inflammation in chronic kidney disease (CKD), we hypothesized that periodontal infection may affect the systemic inflammatory status of a nationally representative CKD population as measured by serum C-reactive protein (CRP). We examined this hypothesis using the National Health and Nutrition Examination Survey 1988-1994 (NHANES III) dataset including 2303 individuals. We followed the American Academy of Periodontology (AAP)/Centers for Disease Control and Prevention (CDC) case definition for periodontitis. We used a cutoff point of 30% sites with (PD) ≥ 5 mm and (CAL) ≥ 4 mm to define generalized periodontitis cases. We estimated glomerular filtration rate based on cystatin C levels using the relevant equation. Urinary albumin-to-creatinine ratio was calculated in milligrams per gram with a cutoff point of 30 mg/g. CKD was defined based on eGFR < 60 mL/min/1.73m2 and albuminuria ≥ 30 mg/g. Periodontitis was found in 427 (12.3%) individuals. Of individuals with periodontitis, 41.8% had serum CRP higher than 0.3 mg/dL compared with 27.1% of non-periodontitis and 53.1% of edentulous individuals (p = 0.001 for all comparisons). When the extent of periodontitis was used as one of the independent variables, the parsimonious model showed a strong independent association between extent of periodontitis and serum CRP levels (OR = 2.0, CI95% = 1.2-3.6).

scholarly journals C - reactive protein predictive marker value and its significance in management of pre dialysis chronic kidney disease patients when correlated with total serum proteins and serum albumin levels: experience in a teaching institution

2017 ◽  
Vol 4 (1) ◽  
pp. 162 ◽  
Author(s):  
Balvinder Singh Arora ◽  
Indu Biswal ◽  
Poornima Sen ◽  
Santhosh Rajan ◽  
Amjad Ali ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Serum Albumin ◽  
Serum Proteins ◽  
Total Serum ◽  
P Value ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Significant Difference ◽  
The Mean

Background: Chronic kidney disease (CKD) is imposing newer challenges, not only globally, but, also in India, especially managing the end stage renal disease (ESRD). Screening for CKD at an early stage, by, high sensitivity C reactive protein (hsCRP) with or without other clinical, biochemical or anthropometric parameters helps initiate specific therapy to reduce the progression of renal disease. Although, malnutrition, inflammation and cardio vascular diseases (CVD) have been shown as significant independent risk factors of mortality in CKD patients, but, whether there exists any relationship between hsCRP and serum proteins and serum albumin levels, one of the important indicators of PEM, has not been extensively studied in pre-dialysis CKD patients.Methods: The study included a total of 60 adult subjects. Of these, 30 were study cases who fulfilled the case definition of CKD and were compared with 30 patients who did not show any signs or symptoms of CKD. As per the objective - hsCRP values were estimated by ELISA test, quantified and statistically correlated with total serum proteins and albumin levels.Results: A significant difference was found in the mean value of hsCRP in cases and in controls (p value 0.001). No significant difference was observed in the mean level of total serum protein in cases and controls, but, the mean differences in the level of serum albumin between cases and controls was significant. The association of serum albumin and hsCRP was found to be significant (p value <0.001). If a level of serum albumin < 3.5 is taken as a marker of malnutrition, it is found that 66.66% of patients have hypo-albuminaemia.Conclusions: The present study comes to an important conclusion that hsCRP is a useful  independent predictor of CKD and if correlated with serum albumin levels, it would help clinician manage the patient effectively by initiating an aggressive yet very appropriate therapy at the pre-dialysis stage with the likelihood of an ‘evidence based’ reduction in morbidity and mortality.

scholarly journals Clinical impact of advanced chronic kidney disease in patients with non-HIV pulmonary cryptococcosis

2020 ◽  
Author(s):  
Hiroki Tashiro ◽  
Tetsuro Haraguchi ◽  
Koichiro Takahashi ◽  
Hironori Sadamatsu ◽  
Ryo Tajiri ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Blood Cell ◽  
Serum Albumin ◽  
Cell Count ◽  
Clinical Characteristics ◽  
C Reactive Protein ◽  
Pulmonary Cryptococcosis ◽  
Blood Cell Count ◽  
Reactive Protein

Abstract Background Pulmonary cryptococcosis is an uncommon infectious disease that can develop in both immunocompromised and immunocompetent patients. The severity of chronic kidney disease (CKD) was reported to be one of the risk factors for pulmonary cryptococcosis, but its clinical characteristics have not been fully assessed. The purpose of this study was to clarify the clinical characteristics of advanced CKD in patients with pulmonary cryptococcosis. Methods The present study retrospectively investigated 56 patients who had non-human immunodeficiency virus (HIV) pulmonary cryptococcosis and were treated at Saga University Hospital between 2005 and 2018.The clinical characteristics were evaluated and compared between patients with estimated glomerular filtration rate (eGFR) >45 mL/min/1.73 m2 (n = 42, early CKD) and those with eGFR <45 mL/min/1.73 m2 (n = 14, advanced CKD. Results Compared with patients with early CKD, those with advanced CKD had significantly higher rate of disseminated cryptococcosis (21.4% vs. 2.4%, p = 0.03); lower percentage of patients who recovered after treatment (63.6% vs. 92.5%, p = 0.02); and more frequent clinical features of fever (57.1% vs. 19.0%, p <0.01), pleural effusion (21.4% vs. 2.4%, p = 0.03), high white blood cell count (8550/mL vs. 6150/mL, p = 0.01) and C-reactive protein (CRP) (2.1 mg/dL vs. 0.2 mg/dL, p = 0.02), and low level of serum albumin (3.0 g/dL vs. 3.8 g/dL, p <0.01). Multivariate analysis adjusted by immunosuppressive drug use indicated the significant factors of fever (odds ratio or β value [95% confidence interval] 6.4 [1.65 – 20.09], p <0.01), high white blood cell count (1293.2 [110.2 – 2476.2], p = 0.03), C-reactive protein (0.89 [0.18 – 1.59], p = 0.01) and low level of serum albumin (- 0.34 [-0.54 – -0.14], p <0.01) in patients with eGFR <45 mL/min/1.73m2. Conclusion Advanced CKD was associated with poor clinical characteristics and outcomes in patients with non-HIV pulmonary cryptococcosis.

scholarly journals Clinical impact of advance chronic kidney disease in patients with non-HIV pulmonary cryptococcosis

2020 ◽  
Author(s):  
Hiroki Tashiro ◽  
Tetsuro Haraguchi ◽  
Koichiro Takahashi ◽  
Hironori Sadamatsu ◽  
Ryo Tajiri ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Blood Cell ◽  
Serum Albumin ◽  
Cell Count ◽  
Clinical Characteristics ◽  
C Reactive Protein ◽  
Pulmonary Cryptococcosis ◽  
Blood Cell Count ◽  
Reactive Protein

Abstract Background: Pulmonary cryptococcosis is an uncommon infectious disease that can develop in both immunocompromised and immunocompetent patients. Severity of chronic kidney disease (CKD) was reported to be one of the risk factors for pulmonary cryptococcosis, but its clinical characteristics have not been fully assessed. The purpose of this study is to clarify clinical characteristics of advance CKD in patients with pulmonary cryptococcosis.Methods: The present study retrospectively investigated 56 patients who had pulmonary cryptococcosis with non-human immunodeficiency virus (HIV) infection and were treated at Saga University Hospital between 2005 and 2018. The clinical characteristics were evaluated and compared between patients with estimated glomerular filtration rate (eGFR) >45 mL/min/1.73m2 (n = 42) (early CKD) and those with eGFR <45 mL/min/1.73m2 (n = 14) (advance CKD).Results: Compared with patients with early CKD, those with advance CKD had significantly higher rate of disseminated cryptococcosis (21.4% vs 2.4%, p = 0.03); lower percentage of patients who recovered after treatment (63.6% vs 92.5%, p = 0.02); and more frequent clinical features of fever (57.1% vs 19.0%, p < 0.01), pleural effusion (21.4% vs 2.4%, p = 0.03), high white blood cell count (8550/ml vs 6150/ml, p = 0.01) and C-reactive protein (2.1 mg/dl vs 0.2 mg/dl, p = 0.02), and low level of serum albumin (3.0 g/dl vs 3.8 g/dl, p <0.01). Multivariate analysis adjusted by immunosuppressive drug use indicated significant differences of fever (odds ratio or β value [95% confidence interval] 6.4 [1.65 – 20.09], p <0.01), high white blood cell count (1293.2 [110.2 – 2476.2], p = 0.03), C-reactive protein (0.89 [0.18 – 1.59], p = 0.01) and low level of serum albumin (- 0.34 [-0.54 – -0.14], p <0.01) in patients with eGFR <45 mL/min/1.73m2.Conclusion: Advance CKD is associated with poor clinical characteristics and outcomes in patients with non-HIV pulmonary cryptococcosis.

1856 ASSOCIATION OF RISE IN C-REACTIVE PROTEIN WITH DE NOVO CHRONIC KIDNEY DISEASE AFTER PARTIAL NEPHRECTOMY

2012 ◽  
Vol 187 (4S) ◽  
Author(s):  
Seth A. Cohen ◽  
Kerrin L. Palazzi ◽  
Ryan P. Kopp ◽  
Reza Mehrazin ◽  
Samuel K. Park ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Partial Nephrectomy ◽  
De Novo ◽  
C Reactive Protein ◽  
Reactive Protein
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