Effect of statins on atherosclerosis in chronic kidney disease patients guided by CD4+CD28nullT cells over duration of six months

Abstract Objectives Chronic kidney disease and atherosclerosis are considered to be inflammatory process in which T cells and cytokines participate. This study determines the effect of statin therapy as an anti-inflammatory agent on the level of CD4+CD28null T lymphocyte population, and subsequently on atherosclerosis in patients with chronic renal disease. Methods We recruited 90 chronic kidney disease patients. The patients were divided into three groups according to carotid intimal medial thickness (CIMT) as an indicator of atherosclerosis. Two groups (group A in whom CIMT above 0.95 mm and B in whom CIMT below 0.95 mm) were given statin (atorvastatin 20mg) while the third group (group C in whom CIMT below 0.95 mm) continue only on the conservative treatment for CKD patients. CD4+CD28null T cells was measured in the three groups at the beginning of the study and after 6 months of statin therapy. Results CD4+CD28null T cells was decreased in statin groups (group A and B) when compared to no-statin group (group C) at the end of the study. Multivariable regression analysis for the effect of statin therapy showed that statin can independently increase the percentage of decrease both CD4+CD28null cells at the end of our study (p-value <0.0001). Conclusion Our study demonstrates that statins reduce CD4+CD28null T cells in CKD patients especially with atherosclerosis suggesting that statins may help in altering the inflammatory process that lead to atherosclerosis.

Download Full-text

ASSESSMENT OF LIPID PROFILE AMONG PATIENTS OF NON-DIABETIC CHRONIC KIDNEY DISEASE AT TERTIARY CARE CENTRE

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i11.753 ◽

2019 ◽

Vol 3 (11) ◽

Author(s):

Dr Bakul Gupta

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Renal Disease ◽

Lipid Profile ◽

Chronic Renal Disease ◽

Tertiary Care ◽

Study Participant ◽

P Value ◽

Additional Risk Factor ◽

Study Participants

Background: Various studies have shown the association between dyslipidemia and cardio-vascular risk among patients of chronic renal disease but the association non-significant than patients with normal renal function. There was lack of evidence exists because patients with chronic renal disease were excluded from the major clinical studies where the association with that target dyslipidemia treatment was being evaluated Material & Methods: The present prospective study was conducted among the patients of Chronic Kidney Disease above 18 years of age and diagnosed on the basis of history, detailed clinical examination, and biochemical and sonological examination based upon National Kidney Foundation (NKF) criteria were enrolled into the study. Clearance from hospital ethics committee was taken before start of study. Written informed consent was taken from each study participant. Results: In the present study out of total study participants of chronic kidney disease 46% were in the 3rd stage of CKD, 38% were in the 4th stage of CKD and 16% were in the 5th stage of CKD. Out of total study participants of chronic kidney disease, 82% were managed by conservative treatment and 18% were being managed by hemodialysis. Out of total study participants of chronic kidney disease, 38% had normal lipid profile while 62% patients had dyslipidemia. We found statistically significant (p value < 0.05) association between dyslipidemia and hemodialysis and association between dyslipidemia and stages of chronic kidney disease was statistically non- significant (p value > 0.05). Conclusion: We concluded from the present study that dyslipidemia is significantly associated as an additional risk factor in patients of Chronic Kidney Disease. We found significant association of hemodialysis with abnormal lipid profile. Key words: Chronic kidney disease, dyslipidemia, hemodialysis.

Download Full-text

Change in Hemoglobin with Androgen and Low Dose Erythropoietin Versus Erythropoietin Alone in Patients of Anemia of Chronic Kidney Disease

10.53350/pjmhs2115113296 ◽

2021 ◽

Vol 15 (11) ◽

pp. 3296-3298

Author(s):

Muhammad Abdul Azim Baig ◽

Ishtiaq Alam ◽

Faheem Usman Sulehri ◽

Irfana Hassan ◽

Aliya Jafri ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Low Dose ◽

Operational Definition ◽

P Value ◽

Care Hospital ◽

Significant Difference ◽

Group A ◽

The Mean ◽

Group B

Objectives: To determine the mean rise in hemoglobin with androgen and low dose erythropoietin versus erythropoietin alone in patients of anemia of chronic kidney disease. Methodology: A randomized control trial was conducted at a tertiary care hospital between October 2019 to April 2020. Both male and female from age >17years to 70 years with anemia of CKD as per operational definition were included. Patients with a history of blood transfusion in the last three months. Patients already on Erythropoietin therapy or those with uncontrolled hypertension BP >190/105 mm Hg at the time of study were excluded. Relevant data including demographic details, baseline hemoglobin was noted. Patients were randomly assigned to group A or group B by lottery method. Patients in group A were given 100mg of androgen (Nandrolone Decanoate) intramuscularly once weekly plus low dose of erythropoietin (2000 units twice weekly) subcutaneously for 6 months and patients in group B were given standard dose of erythropoietin (4000 units twice weekly) subcutaneously for 6 months. Rise in hemoglobin was recorded as per operational definition. Follow up was ensured by taking telephone contact. Data was recorded on pre-designed proforma. Results: Mean Hb levels after treatment were calculated as 12.48+1.20 in Group-A and 11.12+1.32 in Group-B, p value was calculated as 0.0001 showing a significant difference between the two groups, comparison of mean increase in Hb levels after treatment were calculated as 3.0+0.09 in Group-A and 1.72+0.67 in Group-B, p value was calculated as 0.0001 showing a significant difference between the two groups. Conclusion: We concluded that there was significantly greater rise in the mean hemoglobin with androgen plus low dose erythropoietin as compared to erythropoietin alone in treatment of anemia of chronic kidney disease. Nevertheless, further large-scale and multi-center studies will be needed to further explore the long-term efficacy and adverse effects of androgens among patients of anemia of chronic kidney disease. Keywords: Chronic kidney disease, anemia, androgen and low dose erythropoietin versus erythropoietin alone, mean increase

Download Full-text

Stroke in chronic renal failure

Orvosi Hetilap ◽

10.1556/oh.2008.28292 ◽

2008 ◽

Vol 149 (15) ◽

pp. 691-696

Author(s):

Dániel Bereczki

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Renal Disease ◽

Chronic Renal Disease ◽

Kidney Diseases ◽

Cerebrovascular Diseases ◽

Lipid Lowering ◽

Increased Risk ◽

Intracerebral Hemorrhages

Chronic kidney diseases and cardiovascular diseases have several common risk factors like hypertension and diabetes. In chronic renal disease stroke risk is several times higher than in the average population. The combination of classical risk factors and those characteristic of chronic kidney disease might explain this increased risk. Among acute cerebrovascular diseases intracerebral hemorrhages are more frequent than in those with normal kidney function. The outcome of stroke is worse in chronic kidney disease. The treatment of stroke (thrombolysis, antiplatelet and anticoagulant treatment, statins, etc.) is an area of clinical research in this patient group. There are no reliable data on the application of thrombolysis in acute stroke in patients with chronic renal disease. Aspirin might be administered. Carefulness, individual considerations and lower doses might be appropriate when using other treatments. The condition of the kidney as well as other associated diseases should be considered during administration of antihypertensive and lipid lowering medications.

Download Full-text

HUBUNGAN EFIKASI DIRI DENGAN KUALITAS HIDUP PASIEN GAGAL GINJAL KRONIK YANG MENJALANI HEMODIALISIS

Journal of Holistic Nursing Science ◽

10.31603/nursing.v5i2.2430 ◽

2018 ◽

Vol 5 (2) ◽

pp. 56-63

Author(s):

Abdul Wakhid ◽

Estri Linda Wijayanti ◽

Liyanovitasari Liyanovitasari

Keyword(s):

Quality Of Life ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Self Efficacy ◽

Healing Process ◽

Sampling Technique ◽

P Value ◽

Cross Sectional ◽

Kolmogorov Smirnov

Background: Self efficacy can optimize the quality of life of clients who undergo the healing process due to chronic diseases. Individuals with higher self-efficacy move their personal and social resources proactively to maintain and improve the quality and length of their lives so that they experience a better quality of life. Objectives: the purpose of this study was to find the correlation between self efficacy and quality of life of patients with chronic kidney disease who undergo hemodialysis at RSUD Semarang Regency. Metode: This type of research was descriptive correlation with cross sectional approach. The samples in this study more 76 people with total sampling technique. The data collection tool for self efficacy was measured by General Self-Efficacy scale, for quality of life with WHOQoL-BREF. Statistical test used Kolmogorov-smirnov. Result: The result showed that self efficacy in patients with chronic kidney disease was mostly in moderate category (53,9%), quality of life in patients with chronic kidney disease was mostly in good category (68,4%). There was a correlation between self efficacy and quality of life of patients with chronic kidney disease who undergo hemodialysis at RSUD Semarang Regency, the result obtained p-value of 0.000 <α (0,05). Suggestion: Patients with chronic kidney disease can maintain good quality of life by helping to generate positive self-esteem and high self efficacy.

Download Full-text

Biochemical and Paraclinical Evaluation of Organ Damage in Arterial Hypertension with Associated Chronic Kidney Disease

Revista de Chimie ◽

10.37358/rc.20.6.8183 ◽

2020 ◽

Vol 71 (6) ◽

pp. 194-204

Author(s):

Teim Baaj ◽

Ahmed Abu-Awwad ◽

Mircea Botoca ◽

Octavian Marius Cretu ◽

Elena Ardeleanu ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Cardiovascular Risk ◽

Kidney Disease ◽

Ventricular Hypertrophy ◽

Ankle Brachial Index ◽

Intima Media Thickness ◽

Organ Damage ◽

Left Ventricular ◽

Study Group ◽

Group A

Organ damages, which contribute to the overall cardiovascular risk of hypertensive patients, should be early detected, prevented and treated. The study evaluated organ damage in a hypertensive study group with chronic kidney disease (CKD), compared with a study group of hypertension without CKD. Albuminuria was present in 41.2% and reduced estimated glomerular filtration rate [60 ml/min/m2 was present in 72.5% of hypertensive with CKD. The comparison of organ damage revealed in the CKD group a statistical significant higher prevalence of organ damage as follows: intima-media thickness ]0.9 mm in 39.9% vs 10.5%, carotid plaques in 28.2% vs 12.6%, left ventricular hypertrophy in 39.9% vs 31%, ankle brachial index in 6.2% vs 3.5%. Early detection and treatment of additional cardiovascular risk factors as dyslipidaemia and hyperglycaemia, that have significant role in the pathogenesis of organ damage, contribute to the better prevention of cardiovascular and renal complications in hypertension with CKD.

Download Full-text

Acute coronary syndromes in chronic kidney disease patients: the good, the bad or the ugly?

European Heart Journal ◽

10.1093/ehjci/ehaa946.1514 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C Saleiro ◽

D De Campos ◽

J Lopes ◽

R Teixeira ◽

J.P Sousa ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Systolic Function ◽

Lv Function ◽

Angiotensin Ii Antagonist ◽

All Cause Mortality ◽

Group A ◽

Lv Ejection Fraction ◽

Group B ◽

Lv Systolic Function

Abstract Background Patients with chronic kidney disease (CKD) are at increased risk of composite cardiovascular (CV) events and all-cause mortality. However, current aggressiveness of therapeutic strategies may minimize the course of the disease. Aim To assess the prognostic impact of optimized medical treatment in a CKD population with acute coronary syndrome (ACS). Methods 355 ACS patients admitted to a single coronary care with CKD who were discharged from hospital were included. Those with end-stage renal disease were excluded. Three groups were created based on the KDIGO classification: Group A (Stage 3A, eGFR [estimated glomerular filtration rate] 45–59mL/min/1.73 m2) N=190; Group B (Stage 3B, eGFR 30–44mL/min/1.73 m2) N=113; and Group C (Stage 3B, eGFR 15–29mL/min/1.73 m2) N=52. The primary endpoint was long-term all-cause mortality. Kaplan-Meyer survival curves and Cox regression were done. The median of follow-up was 32 (IQ 15–70) months. Results Groups were similar regarding demographics, CV risk factors, ACS type, heart failure diagnosis, left ventricular (LV) systolic function, peak troponin, multivessel disease, treatment option (PCI, CABG or OMT) and medical therapy at discharge. More advance renal failure patients had a higher prevalence of diabetes mellitus (DM), a lower haemoglobin, a higher NT-proBNP and were less likely to receive ACE inhibitors/angiotensin II antagonist at discharge. 170 patients met the primary outcome. Kaplan-Meyer curves showed decreased survival with worse renal function (Group A 68% vs Group B 57% vs Group C 37%, Log Rank P=0.006 – Figure 1). After adjustment for age, DM, haemoglobin, NT-proBNP, LV systolic function and ACE inhibitors/angiotensin II antagonist at discharge, eGFR was not associated with increased death (HR 1.00, 95% CI 0.98–1.01). In this model, only age (HR 1.04, 95% CI 1.01–1.07), haemoglobin (HR 0.86, 95% CI 0.979–0.94), Nt-proBNP (HR 1.00, 95% CI 1.00–1.00) and impaired LV function (LV ejection fraction 40–49%: HR 2.95, 95% CI 1.89–4.81; LV ejection fraction <40%: HR 2.15, 95% CI 1.44–3.21) remained associated with the outcome. Conclusion The worse outcome attributed to CKD after an ACS seems to be related not the eGFR itself but to associated comorbidities such as age, anaemia, fluid overload and impaired LV function. The fact that some of these comorbidities may be altered by intensive therapy indicates that CKD patients should also be candidates to optimized medical treatment. Funding Acknowledgement Type of funding source: None

Download Full-text

A STUDY OF FASTING LIPID PROFILE IN CHRONIC KIDNEY DISEASE PATIENTS AT MEDICINE DEPARTMENT OF ANMMCH, GAYA, BIHAR

10.36106/ijsr/4032951 ◽

2021 ◽

pp. 75-76

Author(s):

Bharat Bhushan ◽

Debarshi Jana

Keyword(s):

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

P Value ◽

Low Density ◽

Healthy Controls ◽

Group 3 ◽

Group 2

Background: Dyslipidemia is very much common in chronic kidney disease patients and is responsible for cardiovascular disease (CKD) which is most common cause of mortality in them. So, it is necessary to study the lipid prole in CKD patients to prevent morbidity and mortality. Methods: Subjects each of 50 in number are grouped into healthy controls (group-1), CKD patients without hemodialysis (group-2), CKD patients with hemodialysis (group-3). After fasting of 12 hours, lipid prole is assessed in all cases. Results: In this study, there is increase in Total cholesterol (TC), Low Density lipoprotein (LDL), very Low-Density lipoprotein (VLDL) and Triglycerides (TG) and decrease in High Density Lipoprotein (HDL) in all CKD patients compared to healthy controls (p-value for each parameter <0.001). There is increase in TC, TG and VLDL in diabetic CKD patients compare to non-diabetic CKD patients and p-value for each parameter is <0.05. It was found that TG and VLDL increase and HDL decrease in group-3 compare to group-2 is statistically signicant (p-value for each <0.05) and no signicant variation in TC and LDL in these groups. Conclusions: Present study demonstrated that there is dyslipidemia in CKD patients irrespective of mode of management, but the derangement is much more common and signicant in CKD with hemodialysis group and they are at risk of cardiovascular disease. It is better to start lipid lowering drugs which decreases disease progression and dyslipidemia.

Download Full-text

MO794EVALUATION OF THE BONE ELASTIC STRUCTURE IN PERSONS WITH AND WITHOUT CHRONIC KIDNEY DISEASE ON DIALYSIS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab096.003 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Pietro Manuel Ferraro ◽

Alessandra Nicolosi ◽

Alessandro Naticchia ◽

Nicola Panocchia ◽

Giuseppe Grandaliano ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Linear Regression ◽

Bone Structure ◽

Bone Fractures ◽

Elastic Structure ◽

Absolute Difference ◽

P Value ◽

Non Invasive ◽

Age And Sex

Abstract Background and Aims Chronic kidney disease is a frequent condition, characterized, especially in its more advanced stages, by an array of derangements in bone structure and density, resulting in a higher rate of bone fractures. Current strategies to monitor the bone status and assess the risk of bone fractures in CKD patients are limited. The Bone Elastic Structure (BES) test is a recently-developed non-invasive tool that measures the elastic characteristics of the trabecular bone by simulating the application of loads on a virtual biopsy obtained from radiographic images of the proximal epiphyses in the patient’s hand fingers. The simulation results are combined to obtain a parameter defined Bone Structure Index (BSI). The aim of our study is to explore whether the BES test could be a useful monitoring tool of bone status in patients with CKD on dialysis by exploring whether such patients have different BSI values compared with persons without CKD. Method The BES test was performed on a sample of 41 patients undergoing chronic hemodialysis (HD) and the BSI compared with a group of 374 persons with normal renal function who had undergone the BES test in previous studies. Differences in BSI and 95% confidence intervals (CIs) between the two groups were obtained and tested for statistical significance with a linear regression model including BSI as the dependent variable and kidney status (HD vs no HD) as the independent variable, adjusted for age and sex. Subgroup effects were explored by including interaction terms (age x kidney status, age x sex, kidney status x sex) in the model. Finally, to further remove the potential confounding by age and sex, each HD patient was individually matched with up to 4 non-HD participants based on sex and age (with a 5-year caliper) and a matched analysis was conducted on BSI values. Results Average (SD) age was 64 (17) years in the HD group and 60 (12) years in the non-HD group, with a prevalence of males of 49% and 16%, respectively. The individual values of BSI divided by kidney status and sex in Figure. The multivariate linear regression model showed that, after adjustment for age and sex, the BSI in the HD group was significantly lower compared with the non-HD group (HD 145, 95% CI 140, 154; non-HD 179, 95% CI 177, 181; absolute difference −32, 95% CI −40, −25; p-value < 0.001). There was no significant interaction between age, sex and kidney status on BSI values (all p-values > 0.05). Individual matching was successful for 36 out of 41 HD patients, who were matched to 127 non-HD participants; matched analysis confirmed the results (absolute difference −31, 95% CI −40, −23; p-value < 0.001). Conclusion The output of a non-invasive tool to determine the bone elastic structure appeared to be strongly associated with kidney function after control for differences in age and sex. Further studies are needed to determine the potential application of the BES test in patients with CKD.

Download Full-text

To Study Thyroid Function and Lipid Profile Levels in Chronic Kidney Disease Patients in a Tertiary Care Hospital of North India

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/544 ◽

2021 ◽

Vol 8 (32) ◽

pp. 2980-2987

Author(s):

Navjot Kaur Layal ◽

Tejinder Sikri ◽

Jaskiran Kaur ◽

Jasmine Kaur ◽

Hardeep Singh Deep

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Lipid Profile ◽

Thyroid Dysfunction ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Low Density ◽

Care Hospital ◽

Low T3 ◽

Group A

BACKGROUND Chronic kidney disease (CKD) includes a spectrum of different pathophysiology processes associated with abnormal kidney function, and a progressive decline in GFR. Progression of CKD is associated with having a number of complications, including thyroid dysfunction, dyslipidaemia, and cardiovascular diseases. METHODS The present study was conducted among 60 CKD patients (cases) and 60 healthy controls to compare their thyroid and lipid profile, who attended the Department of Medicine in SGRDIMSR, Sri Amritsar from January 2019 to December 2020.These 60 CKD patients were grouped as group A. Group A was further divided into various stages as per KIDGO staging according to GFR. 60 healthy individuals were taken as controls and were kept as Group B. Demographic features (age and sex) and medical history of diabetes mellitus, hypertension were noted and blood samples (5mL) were analysed for blood urea, serum creatinine, free triiodothyronine (T3), free thyroxine (T4), thyroid stimulating hormone (TSH), total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), very low density lipoprotein (VLDL) and triglycerides. RESULTS Thyroid dysfunction was observed in patients of CKD, the most common being overt hypothyroidism (56.6 %) followed by subclinical hypothyroidism (16.6 %), low T3 (15 %), and hyperthyroidism (1.6 %). Hypercholesterolemia, low HDL, elevated LDL, VLDL and triglyceride levels were observed in 74.9 %, 85.0 %, 38.3 %, 41.6 % and 76.6 % patients, respectively. Patients with CKD with 5 had significantly higher risk of having thyroid dysfunction and dyslipidaemia as compared to patients with stage 3 and 4. CONCLUSIONS Thyroid dysfunction and dyslipidaemia were common in patients with CKD. Prevalence of hypothyroidism, dyslipidaemia increases with progression of CKD. Hence early detection of thyroid dysfunction and dyslipidaemia is imperative to improve mortality and morbidity of CKD patients. KEYWORDS Chronic Kidney Disease, Dyslipidaemia, Thyroid Dysfunction

Download Full-text

The Unravelled Link between Chronic Kidney Disease and Hepatitis C Infection

New Journal of Science ◽

10.1155/2014/180203 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9 ◽

Cited By ~ 7

Author(s):

Fabrizio Fabrizi ◽

Piergiorgio Messa ◽

Paul Martin

Keyword(s):

Chronic Kidney Disease ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Kidney Disease ◽

Renal Disease ◽

Chronic Renal Disease ◽

World Health ◽

Adjusted Relative Risk ◽

Hepatitis C Infection ◽

Increased Risk

The 2011 report of the World Health Organization General Assembly on noncommunicable diseases identified chronic kidney disease as a worldwide health issue posing a heavy economic burden. Hepatitis C virus infection, which is responsible for over 1 million deaths resulting from cirrhosis and liver cancer, is linked to chronic kidney disease in several ways; some forms of renal disease are precipitated by hepatitis C and patients with end-stage chronic renal disease are at increased risk for acquiring HCV. The aim of this review is to update the evidence on the relationship between hepatitis C infection and chronic kidney disease. Information has been accumulated in the last decade indicating that HCV plays an adverse effect on the incidence and progression of chronic kidney disease; a novel meta-analysis of observational studies (seven longitudinal studies; 890,560 unique individuals) found a relationship between hepatitis C seropositivity and incidence of reduced estimated glomerular filtration rate (adjusted relative risk, 1.70; 95% CI, 1.20; 2.39; P=0.002) in the adult general population. In addition to conventional risk factors, hepatitis C may be an additional factor for the development of chronic kidney disease, and an atheromasic activity of hepatitis C virus has been mentioned. The link between hepatitis C and atherosclerosis could also explain the excess risk of cardiovascular mortality that has been observed among hepatitis C virus seropositive patients undergoing maintenance dialysis. A number of biologically plausible mechanisms related to hepatitis C virus have been hypothesized to contribute to atherosclerosis. Implementation of effective treatment intervention towards hepatitis C is required to decrease the healthcare burden of hepatitis C and to prevent the progression of chronic renal disease.

Download Full-text