scholarly journals Clonal hematopoiesis of indeterminate potential is associated with worse kidney function and anemia in a cohort of patients with advanced chronic kidney disease

2021 ◽  
Author(s):  
Caitlyn Vlasschaert ◽  
Amy J. M. McNaughton ◽  
Wilma Hopman ◽  
Bryan Kestenbaum ◽  
Cassianne Robinson-Cohen ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Hematopoietic Stem ◽  
Clonal Hematopoiesis ◽  
Lower Baseline ◽  
Increased Risk ◽  
Aging Populations ◽  
Lower Egfr ◽  
Age And Sex

Background: Clonal hematopoiesis of indeterminate potential (CHIP) is an inflammatory premalignant disorder resulting from acquired genetic mutations in hematopoietic stem cells. CHIP is common in aging populations and associated with cardiovascular morbidity and overall mortality, but its role in chronic kidney disease (CKD) has not been investigated. Methods: We performed targeted sequencing to detect CHIP mutations in a cohort of 87 adults with eGFR < 60 ml/min/1.73m2. Kidney function, hematologic, and mineral bone disease parameters were assessed cross-sectionally at baseline, and a total of 2,091 creatinine measurements and 3,382 hemoglobin measurements were retrospectively collected over the following 12-year period. Results: At baseline, 20 of 87 (23%) cohort participants had CHIP detected. Those with CHIP had lower baseline eGFR (22.3 +/- 11.2 vs. 28.2 +/- 11.5 ml/min/1.73 m2, P = 0.04) in age- and sex-adjusted regression models. Individuals with CHIP had a 2.5-fold increased risk of incident 50% decline in eGFR or ESKD in a Cox proportional hazard model adjusted for age and sex (95% confidence interval, 1.3-4.7). The annualized rate of eGFR decline adjusted for age and sex was -2.3 +/- 1.1 ml/min/1.73m2 per year in those with CHIP versus -1.6 +/- 0.5 ml/min/1.73m2 per year in those without CHIP. Further, those with CHIP had lower hemoglobin at baseline (11.6 +/- 0.3 vs. 12.8 +/- 0.2 g/dL, P = 0.0003) and throughout the follow-up period despite a greater use of erythropoiesis-stimulating agents. Conclusion: In those with pre-existing CKD, CHIP was associated with lower eGFR at baseline, faster progression of CKD, and anemia.

scholarly journals Everyday Discrimination and Kidney Function Among Older Adults: Evidence From the Health and Retirement Study

2019 ◽  
Vol 75 (3) ◽  
pp. 517-521
Author(s):  
Ryon J Cobb ◽  
Roland J Thorpe ◽  
Keith C Norris
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
The United States ◽  
Health And Retirement Study ◽  
Disease Epidemiology ◽  
Lower Egfr ◽  
Everyday Discrimination ◽  
Retirement Study

Abstract Background With advancing age, there is an increase in the time of and number of experiences with psychosocial stressors that may lead to the initiation and/or progression of chronic kidney disease (CKD). Our study tests whether one type of experience, everyday discrimination, predicts kidney function among middle and older adults. Methods The data were from 10 973 respondents (ages 52–100) in the 2006/2008 Health and Retirement Study, an ongoing biennial nationally representative survey of older adults in the United States. Estimated glomerular filtration rate (eGFR) derives from the Chronic Kidney Disease Epidemiology Collaboration equation. Our indicator of everyday discrimination is drawn from self-reports from respondents. Ordinary Least Squared regression (OLS) models with robust standard errors are applied to test hypotheses regarding the link between everyday discrimination and kidney function. Results Everyday discrimination was associated with poorer kidney function among respondents in our study. Respondents with higher everyday discrimination scores had lower eGFR after adjusting for demographic characteristics (B = −1.35, p &lt; .05), and while attenuated, remained significant (B = −0.79, p &lt; .05) after further adjustments for clinical, health behavior, and socioeconomic covariates. Conclusions Our study suggests everyday discrimination is independently associated with lower eGFR. These findings highlight the importance of psychosocial factors in predicting insufficiency in kidney function among middle-aged and older adults.

scholarly journals The evaluation of kidney function in living kidney donor candidates

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0003052021
Author(s):  
Neetika Garg ◽  
Emilio D. Poggio ◽  
Didier Mandelbrot
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Creatinine Clearance ◽  
Kidney Function ◽  
The United States ◽  
Estimated Gfr ◽  
Kidney Donors ◽  
Living Kidney Donors ◽  
Increased Risk ◽  
Measured Gfr

Living kidney donors incur a small increased risk of end-stage kidney disease (ESKD), of which pre-donation glomerular filtration rate (GFR) is an important determinant. As a result, kidney function assessment is central to the donor candidate evaluation and selection process. This article reviews the different methods of GFR assessment including estimated GFR, creatinine clearance and measured GFR, and the current guidelines on GFR thresholds for donor acceptance. Estimated GFR obtained using the 2009 Chronic Kidney Disease Epidemiology Collaboration equation, while the best of estimating estimations, tends to underestimate and has limited accuracy, especially near normal GFR values. In the United States, the Organ Procurement and Transplantation Network policy on living donation mandates either measured GFR or creatinine clearance as part of evaluation. Measured GFR is considered the gold standard, although there is some variation in performance characteristics depending on the marker and technique used. Major limitations of creatinine clearance are dependency on accuracy of timed collection, and overestimation as a result of distal tubular creatinine secretion. GFR declines with healthy aging, and most international guidelines recommend use of age-adapted selection criteria. The 2017 Kidney Disease: Improving Global Outcomes Guideline for the Evaluation and Care of Living Kidney Donors diverges from other guidelines and recommends using absolute cut-off of <60 ml/min/1.73m2 for exclusion and of ≥90 ml/min/1.73m2 for acceptance, and determination of candidacy with intermediate GFR based on long-term ESKD risk. However, several concerns for this strategy exist, including inappropriate acceptance of younger candidates due to underestimation of risk, and exclusion of older candidates whose kidney function is in fact appropriate for age. Role of cystatin C and other newer biomarkers, as well as data on impact of pre-donation GFR on not just ESKD risk but also advanced chronic kidney disease risk and cardiovascular outcomes are needed.

Smoking, Smoking Cessation, and Progression of Chronic Kidney Disease: Results From KNOW-CKD Study

2020 ◽  
Author(s):  
Sangmi Lee ◽  
Shinchan Kang ◽  
Young Su Joo ◽  
Changhyun Lee ◽  
Ki Heon Nam ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Smoking Cessation ◽  
Cohort Study ◽  
Kidney Disease ◽  
Kidney Function ◽  
Primary Outcome ◽  
Incidence Rates ◽  
Ckd Progression ◽  
Increased Risk ◽  
Never Smokers

Abstract Introduction In patients with chronic kidney disease (CKD), studies investigating the association between smoking and deterioration of kidney function are scarce. Aims and Methods We analyzed data for 1,951 patients with an estimated glomerular filtration rate (eGFR) ≥15 mL/min/1.73 m2 enrolled in the KoreaN cohort study for Outcome in patients With Chronic Kidney Disease (KNOW-CKD) from 2011 to 2016. Patients were categorized by smoking load. Primary outcome was a composite of a ≥50% reduction in eGFR, initiation of dialysis, or kidney transplantation. Results There were 967 never-smokers and 369, 276, and 339 smokers who smoked &lt;15, 15 to 29, ≥30 pack-years, respectively. During a mean follow-up of 3.0 years, the incidence rates (95% confidence interval [CI]) of the primary outcome were 54.3 (46.4–63.5), 46.9 (35.9–61.4), 69.2 (52.9–90.6), and 76.3 (60.7–96.0) events per 1,000 person-yr in never-, &lt;15, 15 to 29, and ≥30 pack-year smokers. In cause-specific hazard model after adjustment of confounding factors, smokers were associated with 1.09 (0.73–1.63), 1.48 (1.00–2.18), and 1.94 (1.35–2.77) fold increased risk (95% CI) of primary outcome in &lt;15, 15–29, and ≥30 pack-year smokers compared with never-smokers. The association of longer smoking duration with higher risk of CKD progression was evident particularly in patients with eGFR &lt; 45 mL/min/1.73 m2 and proteinuria ≥ 1.0 g/g. In contrast, the risk of adverse kidney outcome decreased with longer smoking-free periods among former-smokers. Conclusions These findings suggest potentially harmful effects of the degree of exposure to smoking on the progression of CKD. Implications Among patients with CKD, there has been lack of studies on the association between smoking and CKD progression and studies to date have yielded conflicting results. In this prospective cohort study involving Korean CKD patients, smoking was associated with significantly higher risk of worsening kidney function. Furthermore, the risk of adverse kidney outcome was incrementally higher as smoking pack-years were higher. As the duration of smoking cessation increased, the hazard ratios for adverse kidney outcome were attenuated, suggesting that quitting smoking may be a modifiable factor to delay CKD progression.

scholarly journals Association of pesticides and kidney function among adults in the US population 2001-2010

2021 ◽  
Author(s):  
En-Tzu Wan ◽  
Darsy Darssan ◽  
Shamshad Karatela ◽  
Simon Reid ◽  
Nicholas Osborne
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Dichlorophenoxyacetic Acid ◽  
Cross Sectional ◽  
Agricultural Communities ◽  
Health And Nutrition ◽  
Increased Risk ◽  
Pesticide Exposures ◽  
2,4 Dichlorophenoxyacetic Acid

Abstract Background Chronic kidney disease with unknown cause (CKDu) is prevalent in tropical and agricultural communities, however, its aetiology remains unclear. The objective of this study was to examine the association between pesticide exposures and the risk of kidney function loss using four waves of the National Health and Nutrition Examination Survey (NHANES) to identify a pathological pathway. Methods We pooled data from four cross-sectional waves of NHANES, providing 41,847 participants in total. Sub-population analyses for 2,4-dichlorophenoxyacetic acid (2,4-D), 3,5,6- trichloropyridinol, 3-phenoxybenzoic acid (3-PBA) and Malathion were conducted using. Logistic regression to estimate the odds ratios (ORs) and 95% CIs of the association between log-pesticide levels and kidney function. Results We found that Malathion acid increased the risk of low kidney function among the Malathion sub-population (aOR = 1.26, 95% CI = 1.01–1.56) in the adjusted model. Significantly increased risk of low kidney function was not found among the 2,4-D (aOR = 0.88, 95% CI = 0.72–1.09), 3,5,6-trichloropyridinol (aOR = 0.96, 95% CI = 0.83–1.12) and 3-PBA (aOR = 1.03, 95% CI = 0.94–1.13) subpopulations. Conclusions Our findings provide evidence of altered kidney function in people exposed to Malathion, highlighting the need to focus on Malathion acid as a potential cause of renal injury or chronic kidney disease.

Chronic kidney disease and the risk of incident renal and urothelial cancer in a population-based cohort of 1.2 million adults.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 351-351
Author(s):  
William Thomas Lowrance ◽  
Natalia Udaltsova ◽  
Juan Ordoñez ◽  
Paul Russo ◽  
Alan S. Go
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cancer Risk ◽  
Urothelial Cancer ◽  
Population Based ◽  
Incident Cancer ◽  
Increased Risk ◽  
Lower Egfr ◽  
Risk Of Cancer

351 Background: Prior studies have observed an increased risk of cancer in patients with end stage renal disease, but whether less severe chronic kidney disease influences the risk of cancer is uncertain. Methods: Among 1,190,538 adults at least 40 years of age and no prior dialysis, renal transplant or known cancer who received care within Kaiser Permanente Northern California, we examined the independent association between estimated glomerular filtration rate (eGFR) and the risk of cancer, overall and by type, between 2000 and 2008. Incident cancers were identified from a comprehensive regional cancer registry and potential confounders were ascertained using validated algorithms based on health plan electronic medical records. The impact of time-varying eGFR on incident cancer risk was examined using multivariable extended Cox regression, after excluding any cancers detected during the first two years of follow-up and any eGFR values within 3 months before a cancer diagnosis to reduce potential biases. Results: During 6,000,420 person-years of follow-up, 76,809 incident cancer diagnoses were identified among 72,875 patients (38,744 M, 34,131 F). After adjustment for possible confounding factors, the risk of renal cancer increased with lower eGFR (ml/min/1.73 m2): the adjusted hazard ratio [HR] for renal cancer was 1.35 (95% CI: 1.18–1.55) for eGFR 45–59, HR 1.65 (1.37 to 1.97) for eGFR 30–44, and HR 2.09 (1.62 to 2.70) for eGFR <30. There was a similar association between eGFR and urothelial cancer. However, there was not a significant multivariable association between eGFR and prostate, colorectal, lung, breast, or any cancer. Conclusions: We observed a graded, independent increased risk of renal and urothelial cancer risk with lower eGFR in a large, population-based cohort. However, lower eGFR was not significantly associated with other major cancer types. Additional research is needed to understand potential contributing mechanisms between reduced renal function and renal or urothelial malignancies, as well as whether differential cancer screening strategies are effective in patients with chronic kidney disease.

scholarly journals THE RELATIONSHIP OF KIDNEY FUNCTION WITH ARTERIAL WALL CONDITION IN INDIVIDUALS WITHOUT CHRONIC KIDNEY DISEASE AND CARDIOVASCULAR DISEASES

2017 ◽  
Vol 8 (2) ◽  
pp. 14-21
Author(s):  
V S Pykhtina ◽  
I D Strazhesko ◽  
O N Tkacheva ◽  
N V Sharashkina ◽  
V A Vygodin ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Arterial Wall ◽  
Study Group ◽  
Multivariate Linear Regression Analysis ◽  
Systolic Blood Pressure Level ◽  
Urea Level ◽  
Increased Risk

Background: Chronic kidney disease (CKD) is a known risk factor for cardiovascular disease (CVD). However, there is a small information about increased risk of CVD already with a slight decrease in kidney function. Substrate for CVD development is subclinical changes in the arterial wall, which can be accelerated by known risk factorsHypothesis: We have assumed that even an initial impairment of kidney function were capable of adversely affecting on the arterial wall.Objective: To examine the association of kidney function with the condition of the arterial wall in persons without CKD and CVD in different age groups.Materials and methods: The study group included 253 subjects free of known CVD and CKD. The average age of the subjects was 51.5 ± 13.3 g. There were 172 women and 81 men. The group of conditionally “older” (women> 55 years, men> 45 years) was 117 people, conditionally “younger” (women ≤ 55 years, men ≤ 45 years) - 136. 55 subjects had arterial hypertension 1-2 st. All subjects had a glomerular filtration rate (GFR) ≥60 ml / min / 1.73 m2, albuminuria <30 mg /24h. When assessing the condition of the arterial wall, the pulse wave velocity (PWV)> 10 m / s had 93 people, the complex intima-media thickness (CIMT)> 0.9 mm had 42 people, the presence of atherosclerotic plaques (AP) had 106 people, and a decrease in endothelium-dependent vasodilation (EDVD) <10% in 86 people. An elevated urea level> 8.3 mmol / l in the blood was detected in 10 people. Determination of creatinine, urea in the blood serum was carried out by routine methods. Measurement of PWV with the help of applanation tonometry. Measurement of CIMT and determination of AP was carried out by means of duplex scanning of carotid arteries. Measurement of EDVD - using a test with reactive hyperemia.Results: Statistical analysis of the results of this study was carried out using the SAS application statistical software package (StatisticalAnalysisSystem, SAS InstituteInc., USA). In the course of multivariate linear regression analysis, a statistically significant independent association of the urea level with CIMT (β = 0.023, p = 0.023) was detected in the “older” group taking into account the correction for sex, systolic blood pressure level, smoking, body mass index, fasting glucose level and albuminuria. Independent relationships of levels of GFR, creatinine and albuminuria with parameters of the vascular wall were not revealed.Conclusions: The level of urea had a direct independent relationship with CIMT in the older age group, which is more likely due to the ability of urea to enhance oxidative stress. Interrelations of the level of GFR, albuminuria, creatinine with the condition of the arterial wall were not obtained in the study group

scholarly journals Prevalence and risk factors for chronic kidney disease of unknown cause in Malawi: a cross-sectional analysis in a rural and urban population

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Sophie A. Hamilton ◽  
Wisdom P. Nakanga ◽  
Josephine E. Prynn ◽  
Amelia C. Crampin ◽  
Daniela Fecht ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Potential Risk ◽  
Cross Sectional ◽  
Tropical Countries ◽  
Increased Risk ◽  
Potential Risk Factors ◽  
The Mean

Abstract Background An epidemic of chronic kidney disease of unknown cause (CKDu) is occurring in rural communities in tropical regions of low-and middle-income countries in South America and India. Little information is available from Southern African countries which have similar climatic and occupational characteristics to CKDu-endemic countries. We investigated whether CKDu is prevalent in Malawi and identified its potential risk factors in this setting. Methods We conducted a cross-sectional study from January–August 2018 collecting bio samples and anthropometric data in two Malawian populations. The sample comprised adults > 18 years (n = 821) without diabetes, hypertension, and proteinuria. Estimates of glomerular filtration rate (eGFR) were calculated using the CKD-EPI equation. Linear and logistic regression models were applied with potential risk factors, to estimate risk of reduced eGFR. Results The mean eGFR was 117.1 ± 16.0 ml/min per 1.73m2 and the mean participant age was 33.5 ± 12.7 years. The prevalence of eGFR< 60 was 0.2% (95% confidence interval (95% CI) 0.1, 0.9); the prevalence of eGFR< 90 was 5% (95% CI =3.2, 6.3). We observed a higher prevalence in the rural population (5% (3.6, 7.8)), versus urban (3% (1.4, 6.7)). Age and BMI were associated with reduced eGFR< 90 [Odds ratio (OR) (95%CI) =3.59 (2.58, 5.21) per ten-year increment]; [OR (95%CI) =2.01 (1.27, 3.43) per 5 kg/m2 increment] respectively. No increased risk of eGFR < 90 was observed for rural participants [OR (95%CI) =1.75 (0.50, 6.30)]. Conclusions Reduced kidney function consistent with the definition of CKDu is not common in the areas of Malawi sampled, compared to that observed in other tropical or sub-tropical countries in Central America and South Asia. Reduced eGFR< 90 was related to age, BMI, and was more common in rural areas. These findings are important as they contradict some current hypothesis that CKDu is endemic across tropical and sub-tropical countries. This study has enabled standardized comparisons of impaired kidney function between and within tropical/subtropical regions of the world and will help form the basis for further etiological research, surveillance strategies, and the implementation and evaluation of interventions.

scholarly journals Chronic kidney disease, heart failure and neprilysin inhibition

2019 ◽  
Vol 35 (4) ◽  
pp. 558-564 ◽  
Author(s):  
Richard Haynes ◽  
Doreen Zhu ◽  
Parminder K Judge ◽  
William G Herrington ◽  
Philip A Kalra ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Cardiac Biomarkers ◽  
Function Allocation ◽  
Increased Risk ◽  
Patients With Heart Failure ◽  
Neprilysin Inhibition ◽  
The Uk

Abstract Patients with chronic kidney disease are at increased risk of cardiovascular disease and this often manifests clinically like heart failure. Conversely, patients with heart failure frequently have reduced kidney function. The links between the kidneys and cardiovascular system are being elucidated, with blood pressure being a key risk factor. Patients with heart failure have benefitted from many trials which have now established a strong evidence based on which to base management. However, patients with advanced kidney disease have often been excluded from these trials. Nevertheless, there is little evidence that the benefits of such treatments are modified by the presence or absence of kidney disease, but more direct evidence among patients with advanced kidney disease is required. Neprilysin inhibition is the most recent treatment to be shown to improve outcomes among patients with heart failure. The UK HARP-III trial assessed whether neprilysin inhibition improved kidney function in the short- to medium-term and its effects on cardiovascular biomarkers. Although no effect (compared to irbesartan control) was found on kidney function, allocation to neprilysin inhibition (sacubitril/valsartan) did reduce cardiac biomarkers more than irbesartan, suggesting that this treatment might improve cardiovascular outcomes in this population. Larger clinical outcomes trials are needed to test this hypothesis.

scholarly journals Serum uric acid, kidney function and acute ischemic stroke outcomes in elderly patients: a single-cohort, perspective study

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Lorenzo Falsetti ◽  
William Capeci ◽  
Nicola Tarquinio ◽  
Giovanna Viticchi ◽  
Mauro Silvestrini ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Uric Acid ◽  
Ischemic Stroke ◽  
Kidney Disease ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Serum Uric Acid ◽  
Kidney Function ◽  
Increased Risk

Chronic kidney disease and hyperuricemia have been associated to an increased risk and a worse prognosis in acute ischemic stroke. Several mechanisms, including platelet dysfunction, coagulation disorders, endothelial dysfunction, inflammation, and an increased risk of atrial fibrillation could be implicated. The role of serum uric acid in this setting is still object of debate. We enrolled all the consecutive patients admitted to our department for acute ischemic stroke. Cox regression analysis was used to evaluate the risk of in-hospital death considering serum uric acid levels and all the comorbidities. In the overall sample, hyperuricemia was independently associated to an increased risk of in-hospital mortality. This effect was stronger in patients with chronic kidney disease while, in the group of patients with normal renal function, the relationship between hyperuricemia and increased stroke mortality was not confirmed. Hyperuricemia could be associated to higher in-hospital mortality for ischemic stroke among elderly patients when affected by kidney disease. Survival does not seem to be affected by hyperuricemia in patients with normal kidney function.

SPRINT—A Kidney-Centric Narrative Review: Recent Advances in Hypertension

Hypertension ◽  
2021 ◽  
Author(s):  
Austin H. Hu ◽  
Tara I. Chang
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Systolic Blood Pressure ◽  
Kidney Function ◽  
Pressure Therapy ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Moderate Chronic Kidney Disease ◽  
Intensive Blood Pressure

Hypertension is a potent cardiovascular risk factor with deleterious end-organ effects and is especially prevalent among patients with chronic kidney disease. The SPRINT (Systolic Blood Pressure Intervention Trial) enrolled patients at an elevated cardiac risk including patients with mild to moderate chronic kidney disease and found that an intensive systolic blood pressure goal of <120 mm Hg significantly reduced the rates of adverse cardiovascular events and all-cause mortality and nonsignificantly reduced the rates of probable dementia; these results were consistent whether one had chronic kidney disease or not. However, results of intensive blood pressure therapy on chronic kidney disease progression were inconclusive, and there was an increased risk of incident chronic kidney disease and acute kidney injury, but the declines in kidney function appear to be hemodynamically driven and reversible. Overall, an intensive blood pressure target is effective in reducing cardiovascular disease and all-cause mortality and may reduce the risk of probable dementia in patients with mild to moderate chronic kidney disease. More studies are needed to determine its long-term effects on kidney function.

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