Assessment Of "Breath Print" In Patients With Chronic Kidney Disease During Dialysis By Non-Invasive Breath Screening Of Exhaled Volatile Compounds Using An Electronic Nose

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.

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Aortic Calcification Affects Noninvasive Estimates of Central Blood Pressure in Patients with Severe Chronic Kidney Disease

Kidney & Blood Pressure Research ◽

10.1159/000501226 ◽

2019 ◽

Vol 44 (4) ◽

pp. 704-714 ◽

Cited By ~ 1

Author(s):

Rasmus Kirkeskov Carlsen ◽

Simon Winther ◽

Christian D. Peters ◽

Esben Laugesen ◽

Dinah S. Khatir ◽

...

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Calcium Score ◽

Mean Difference ◽

Aortic Calcification ◽

Ct Scans ◽

Central Blood Pressure ◽

Non Invasive ◽

Ckd Stage

Background: Central blood pressure (BP) assessed noninvasively considerably underestimates true invasively measured aortic BP in chronic kidney disease (CKD) patients. The difference between the estimated and the true aortic BP increases with decreasing estimated glomerular filtration rates (eGFR). The present study investigated whether aortic calcification affects noninvasive estimates of central BP. Methods: Twenty-four patients with CKD stage 4–5 undergoing coronary angiography and an aortic computed tomography scan were included (63% males, age [mean ± SD ] 53 ± 11 years, and eGFR 9 ± 5 mL/min/1.73 m2). Invasive aortic BP was measured through the angiography catheter, while non-invasive central BP was obtained using radial artery tonometry with a SphygmoCor® device. The Agatston calcium score (CS) in the aorta was quantified on CT scans using the CS on CT scans. Results: The invasive aortic systolic BP (SBP) was 152 ± 23 mm Hg, while the estimated central SBP was 133 ± 20 mm Hg. Ten patients had a CS of 0 in the aorta, while 14 patients had a CS >0 in the aorta. The estimated central SBP was lower than the invasive aortic SBP in patients with aortic calcification compared to patients without (mean difference 8 mm Hg, 95% CI 0.3–16; p = 0.04). The brachial SBP was lower than the aortic SBP in patients with aortic calcification compared to patients without (mean difference 10 mm Hg, 95% CI 2–19; p = 0.02). Conclusion: In patients with advanced CKD the presence of aortic calcification is associated with a higher difference between invasively measured central aortic BP and non-invasive estimates of central BP as compared to patients without calcifications.

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Role of Imaging in Chronic Kidney Disease

10.1093/med/9780199392094.003.0017 ◽

2015 ◽

Author(s):

Sameer Ather ◽

Ayman Farag ◽

Vikas Bhatia ◽

Fadi G. Hage

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Risk Stratification ◽

Non Invasive ◽

Improve Risk Stratification ◽

Short And Long Term ◽

Artery Disease ◽

Long Term Prognosis ◽

Stage Renal Disease ◽

End Stage

Cardiovascular disease is highly prevalent in patients with chronic kidney disease (CKD) and is the biggest contributor of death in these patients. Myocardial perfusion imaging (MPI) is a validated tool for diagnosing coronary artery disease (CAD) and for predicting short and long term prognosis in this patient population. Non-invasive stress imaging, with MPI or other imaging modalities, is widely used for risk stratification in patients with end-stage renal disease (ESRD) being evaluated for kidney transplantation due to the paucity of donor organs and the high cardiovascular risk of patients on the transplant waiting list. In this Chapter we will review the data on diagnostic accuracy and risk stratification using MPI in patients with CKD and ESRD highlighting the special challenges that are unique to this population. We will also discuss novel indicators that have been used in these patients to improve risk stratification.

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P0670DIFFUSIONAL KURTOSIS IMAGING PREDICTS THE PROGNOSIS OF CHRONIC KIDNEY DISEASE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0670 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Yan Liu ◽

Gu-mu-yang Zhang ◽

Xiaoyan Peng ◽

Xuemei Li ◽

Hao Sun ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Iga Nephropathy ◽

Clinical Outcomes ◽

Renal Fibrosis ◽

Prognostic Value ◽

Mean Value ◽

Non Invasive ◽

The Mean

Abstract Background and Aims Renal fibrosis is the strongest prognosis predictor of ESRD in chronic kidney disease (CKD), but non-invasive and repeatable imaging markers are missing. Magnetic resonance imaging (MRI) has wide range of applications in renal parenchymal diseases, and diffusional kurtosis imaging (DKI) is a new promising noninvasive method of MRI which can provide more information about non-Gaussian diffusion using a polynomial model. We had successfully used DKI to assess renal fibrosis in IgA nephropathy in our previous work. This study aimed to evaluate the prognostic value of DKI in CKD. Method We prospectively enrolled forty-two CKD patients in our study in Jan. 2017. On recruitment, the basic clinical data were documented, and DKI was performed on a clinical 3T MR scanner. Region-of-interest (ROI) measurements were performed to determine apparent diffusion coefficient (ADC), kurtosis (K) and diffusivity (D) of the cortex of the kidneys. We had followed up these patients for 3 years, and collected all the clinical data and outcomes. The prognostic value of DKI metrics and clinical parameters were investigated. Results Forty-two patients consisted of 26 males and 16 females with mean age of 41.3±15.4 years. The most common etiology was IgA nephropathy (25/42, 59.5%). At baseline, the mean value of serum creatinine (SCr) was 224.4±156.2μmol/L. Among them, 18 patients had eGFR≥45ml/min and 24 patients had eGFR<45ml/min. According to the etiology and CKD classification, all the patients had received appropriate treatment. Besides supportive treatment and management of CKD complications, 21 patients (50%) had received corticosteroid and/or immunosuppressants treatment. After 36 months follow up, 12 patients had progressed to end stage renal disease (ESRD), and the mean value of SCr of the remaining 30 patients was 153.0±78.8umol/L. The Kaplan-Meyer survival regression showed that the patients with eGFR<45ml/min had worse clinical outcomes (p=0.0006). ROC analysis and Kaplan-Meyer survival regression showed that DKI metrics (K≥0.66 or ADC<1.35) not only predicted severe renal fibrosis, but also had worse clinical outcomes (p=0.01 and p<0.0001) (Figure 1). According to the COX regression analysis, both K (K≥0.66, HR 4.676, 95%CI 1.262-17.325) and ADC (ADC<1.35, HR 13.118, 95%CI 3.499-49.178) values, but not age, gender and eGFR group (cut-off value: 45ml/min), were the independent risk factors for the progression to ESRD. Conclusion Renal ADC and K values obtained from DKI showed significant predictive value for the prognosis of CKD, could be a promising non-invasive technique in patients follow-up.

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Non-invasive risk assessment in patients with chronic kidney disease

Journal of Nuclear Cardiology ◽

10.1007/s12350-011-9359-y ◽

2011 ◽

Vol 18 (3) ◽

pp. 472-485 ◽

Cited By ~ 3

Author(s):

Abdul Hakeem ◽

Sabha Bhatti ◽

Alejandro R. Trevino ◽

Zainab Samad ◽

Su Min Chang

Keyword(s):

Risk Assessment ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Non Invasive

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Analysis of salivary components as non-invasive biomarkers for monitoring chronic kidney disease

International Journal of Medical Engineering and Informatics ◽

10.1504/ijmei.2020.106896 ◽

2020 ◽

Vol 12 (2) ◽

pp. 95 ◽

Cited By ~ 1

Author(s):

Navaneeth Bhaskar ◽

M. Suchetha

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Non Invasive

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2.5 COMPARISON OF NON-INVASIVE AND INVASIVE MEASUREMENTS OF CENTRAL BLOOD PRESSURE IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Artery Research ◽

10.1016/j.artres.2014.09.061 ◽

2014 ◽

Vol 8 (4) ◽

pp. 124

Author(s):

R. Carlsen ◽

C. Peters ◽

D. Khatir ◽

E. Laugesen ◽

S. Winther ◽

...

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Central Blood Pressure ◽

Non Invasive

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Effect of Haemodialysis on QTc in Newly Diagnosed Chronic Kidney Disease Patients

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/45428.14113 ◽

2020 ◽

Author(s):

Siddharth Gosavi ◽

TV Pradeep ◽

Amogh Ananda Rao ◽

Sissmol Davis ◽

Bharat Pulavarti ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Qt Interval ◽

General Medicine ◽

Cardiac Monitoring ◽

Qtc Interval ◽

Newly Diagnosed ◽

Qtc Prolongation ◽

Sodium Potassium ◽

Non Invasive

Introduction: Cardiovascular disease and mortality is twice as common in patients with Chronic Kidney Disease (CKD) compared to the general population. The QT interval which depicts ventricular repolarisation, is a crude non-invasive marker of susceptibility to ventricular arrhythmias. Effects of haemodialysis on corrected QT (QTc) interval in newly diagnosed CKD patients is undocumented till date. Aim: To assess the effect of haemodialysis on QTc in patients with newly diagnosed CKD. Materials and Methods: This was a prospective cohort study of 50 newly diagnosed CKD patients admitted for their first session of haemodialysis in the Departments of General Medicine and Nephrology, at Bapuji Hospital between October and November 2019. ECGs were recorded before the first and after the third session of haemodialysis. Serum electrolytes (sodium, potassium, chloride, phosphorous and calcium), blood sugar and haemoglobin levels before haemodialysis were recorded. QT interval was calculated and corrected using Bazett’s and Framingham’s methods. Descriptive statistics, simple and multiple linear regression were used for analysis using Microsoft® Excel. Results: The mean predialysis QTc was 0.434 seconds and postdialysis QTc was 0.477 seconds. QTc prolongation was observed in 44 (88%) patients (mean=0.042 seconds). The QTc prolongation correlated positively with postdialysis QTc (p=0.00001, Framingham; p=0.0009, Bazett) (RBazett=0.61 and RFramingham=0.74). Conclusion: Substantial QTc prolongation after three sessions of haemodialysis screens a population that has a greater risk of adverse cardiovascular events. This warrants vigilant cardiac monitoring in patients on haemodialysis.

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