scholarly journals The Role of Prognostic and Predictive Biomarkers for Assessing Cardiovascular Risk in Chronic Kidney Disease Patients

2020 ◽  
Vol 2020 ◽  
pp. 1-13 ◽  
Author(s):  
Michele Provenzano ◽  
Michele Andreucci ◽  
Luca De Nicola ◽  
Carlo Garofalo ◽  
Yuri Battaglia ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Specific Treatment ◽  
Predictive Biomarkers ◽  
Major Complication ◽  
Global Dimension ◽  
Prognostic Biomarkers ◽  
Improve Risk Stratification ◽  
Markers Of Inflammation ◽  
Cv Disease

Chronic kidney disease (CKD) is currently defined as the presence of proteinuria and/or an eGFR<60 mL/min/1.73m2 on the basis of the renal diagnosis. The global dimension of CKD is relevant, since its prevalence and incidence have doubled in the past three decades worldwide. A major complication that occurs in CKD patients is the development of cardiovascular (CV) disease, being the incidence rate of fatal/nonfatal CV events similar to the rate of ESKD in CKD. Moreover, CKD is a multifactorial disease where multiple mechanisms contribute to the individual prognosis. The correct development of novel biomarkers of CV risk may help clinicians to ameliorate the management of CKD patients. Biomarkers of CV risk in CKD patients are classifiable as prognostic, which help to improve CV risk prediction regardless of treatment, and predictive, which allow the selection of individuals who are likely to respond to a specific treatment. Several prognostic (cystatin C, cardiac troponins, markers of inflammation, and fibrosis) and predictive (genes, metalloproteinases, and complex classifiers) biomarkers have been developed. Despite previous biomarkers providing information on the pathophysiological mechanisms of CV risk in CKD beyond proteinuria and eGFR, only a minority have been adopted in clinical use. This mainly depends on heterogeneous results and lack of validation of biomarkers. The purpose of this review is to present an update on the already assessed biomarkers of CV risk in CKD and examine the strategies for a correct development of biomarkers in clinical practice. Development of both predictive and prognostic biomarkers is an important task for nephrologists. Predictive biomarkers are useful for designing novel clinical trials (enrichment design) and for better understanding of the variability in response to the current available treatments for CV risk. Prognostic biomarkers could help to improve risk stratification and anticipate diagnosis of CV disease, such as heart failure and coronary heart disease.

scholarly journals OMICS in Chronic Kidney Disease: Focus on Prognosis and Prediction

2021 ◽  
Vol 23 (1) ◽  
pp. 336
Author(s):  
Michele Provenzano ◽  
Raffaele Serra ◽  
Carlo Garofalo ◽  
Ashour Michael ◽  
Giuseppina Crugliano ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Predictive Biomarkers ◽  
Ckd Progression ◽  
Additional Information ◽  
Improve Risk Stratification ◽  
Prognosis And Prediction ◽  
Future Events ◽  
Disease Focus ◽  
Pathophysiologic Mechanisms

Chronic kidney disease (CKD) patients are characterized by a high residual risk for cardiovascular (CV) events and CKD progression. This has prompted the implementation of new prognostic and predictive biomarkers with the aim of mitigating this risk. The ‘omics’ techniques, namely genomics, proteomics, metabolomics, and transcriptomics, are excellent candidates to provide a better understanding of pathophysiologic mechanisms of disease in CKD, to improve risk stratification of patients with respect to future cardiovascular events, and to identify CKD patients who are likely to respond to a treatment. Following such a strategy, a reliable risk of future events for a particular patient may be calculated and consequently the patient would also benefit from the best available treatment based on their risk profile. Moreover, a further step forward can be represented by the aggregation of multiple omics information by combining different techniques and/or different biological samples. This has already been shown to yield additional information by revealing with more accuracy the exact individual pathway of disease.

scholarly journals PATIENT WITH MYELODYSPLASTIC SYNDROME IN EMERGENCY DEPARTMENT

2019 ◽  
Vol 141 (7-8) ◽  
pp. 247-249
Keyword(s):  
Chronic Kidney Disease ◽  
Emergency Department ◽  
Kidney Disease ◽  
Myelodysplastic Syndromes ◽  
Specific Treatment ◽  
Reference Value ◽  
Front Wall ◽  
Hematopoietic Stem ◽  
Coronary Syndrome ◽  
Associated Conditions

Myelodysplastic syndromes (MDS) are a group of clonal disorders arising from hematopoietic stem cells and are generally characterized by inefficient hematopoiesis and dysplasia. The International Prognostic Scoring Sytem (IPSS) is an important standard for assessing prognosis of primary untreated adult patients with myelodysplastic syndromes (MDS). Ineffective hematopoiesis leading to anemia is the most common cause of the arrival of patients with MDS in the emergency room . Patients with MDS have a number of associated conditions such as chronic kidney disease and hypertension, and may be present as acute coronary syndrome. We report a case of a 83-year-old female with MDS that was diagnosed in 2014 and had no specific treatment. She presented to the emergency department at the beginning of 2016 because of epigastric and chest pain that began in the morning. Diagnosis of subacute STEMI with a scar formed on front wall and elevated high-sensitivity troponin (hsTnI) which amounted to 1,369 ng / L (reference value < 15.6 ng / L) was made, and the patient was hospitalized in the Coronary Care Unit . The care for this population of patients, mainly elderly, in the emergency department requires a comprehensive approach due to the presence of associated conditions such as hypertension, chronic kidney disease and ischemic heart disease. Cardiovascular diseases (CVD) are the leading cause of death in all countries worldwide.

scholarly journals Strategies to improve monitoring disease progression, assessing cardiovascular risk, and defining prognostic biomarkers in chronic kidney disease

2017 ◽  
Vol 7 (2) ◽  
pp. 107-113 ◽  
Author(s):  
Michelle J. Pena ◽  
Peter Stenvinkel ◽  
Matthias Kretzler ◽  
Dwomoa Adu ◽  
Sanjay Kumar Agarwal ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Cardiovascular Risk ◽  
Kidney Disease ◽  
Disease Progression ◽  
Prognostic Biomarkers

Role of Imaging in Chronic Kidney Disease

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.

Chronic kidney disease-mineral and bone disorder

2018 ◽  
Author(s):  
Stuart M. Sprague ◽  
Menaka Sarav
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Osteodystrophy ◽  
Mineral Metabolism ◽  
Bone Biopsy ◽  
Fibroblast Growth Factor 23 ◽  
Critical Role ◽  
Specific Treatment ◽  
Mineral And Bone Disorder ◽  
Bone Disorder

The kidneys play a critical role in maintaining normal serum calcium and phosphorus concentrations, under the regulation of three main hormones: parathyroid hormone, calcitriol, and fibroblast growth factor 23. With the progression of chronic kidney disease (CKD), most patients develop CKD–mineral and bone disorder (CKD-MBD), which is a systemic disorder involving derangement in mineral metabolism, renal osteodystrophy, and extraskeletal calcification. Disturbances in mineral metabolism develop early in CKD and include phosphate retention, hypocalcaemia, vitamin D deficiency, and hyperparathyroidism. Renal osteodystrophy involves pathologic changes of bone morphology related to progressive CKD and is quantifiable by histomorphometry, based on bone biopsy. CKD-MBD is associated with significant morbidity, including bone loss, fractures, cardiovascular disease, immune suppression, as well as increased mortality. As the disorder begins early in the course of CKD, a proactive approach with intervention is important. Therapeutic strategies could then be employed to prevent and correct these disturbances, aiming to improve cardiovascular outcomes and survival. Current practice guidelines for CKD-MBD are based on insufficient data and high-quality studies are required before specific treatment can be advocated strongly.

scholarly journals Should We Consider the Cardiovascular System While Evaluating CKD-MBD?

Toxins ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 140 ◽  
Author(s):  
Merita Rroji ◽  
Andreja Figurek ◽  
Goce Spasovski
Keyword(s):  
Chronic Kidney Disease ◽  
Parathyroid Hormone ◽  
Kidney Disease ◽  
Mineral And Bone Disorder ◽  
Disease Modifying Drugs ◽  
Potential Association ◽  
Bone Disorder ◽  
Risk Of Progression ◽  
Disease Modifying ◽  
Cv Disease

Cardiovascular (CV) disease is highly prevalent in the population with chronic kidney disease (CKD), where the risk of CV death in early stages far exceeds the risk of progression to dialysis. The presence of chronic kidney disease-mineral and bone disorder (CKD-MBD) has shown a strong correlation with CV events and mortality. As a non-atheromatous process, it could be partially explained why standard CV disease-modifying drugs do not provide such an impact on CV mortality in CKD as observed in the general population. We summarize the potential association of CV comorbidities with the older (parathyroid hormone, phosphate) and newer (FGF23, Klotho, sclerostin) CKD-MBD biomarkers.

AGE, RAGE and Diabetic Nephropathy

2010 ◽  
Vol 8 (2) ◽  
pp. 84
Author(s):  
MaÏté Daroux ◽  
Nicolas Grossin ◽  
Eric Boulanger ◽  
◽  
◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Diabetic Nephropathy ◽  
Kidney Disease ◽  
Advanced Glycation End Products ◽  
Specific Treatment ◽  
Therapeutic Approaches ◽  
Advanced Glycation ◽  
Glycation End Products ◽  
End Products ◽  
Immunohistochemical Studies

Diabetes is a disease that is present worldwide and which is associated with a large number of potential complications including chronic kidney disease (CKD). Several factors have been implicated in the development of the latter, including advanced glycation end-products (AGEs), which are formed from the interaction between sugar and proteins. AGE toxicity may be triggered via different mechanisms, especially by receptor binding. Immunohistochemical studies have demonstrated the presence of AGEs in all renal structures (vessels, glomeruli, tubules and the interstitium). They appear to be involved in the exacerbation of renal injury observed during diabetic nephropathy. At present, no specific treatment is yet available, although several therapeutic approaches are under development.

scholarly journals Beneficial Effects of 6-Month Supplementation with Omega-3 Acids on Selected Inflammatory Markers in Patients with Chronic Kidney Disease Stages 1–3

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Agnieszka Pluta ◽  
Paweł Stróżecki ◽  
Jacek Kęsy ◽  
Kinga Lis ◽  
Beata Sulikowska ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Serum Concentration ◽  
Reference Group ◽  
Omega 3 ◽  
Alpha Linolenic Acid ◽  
Beneficial Effects ◽  
Markers Of Inflammation ◽  
Wbc Count

Introduction. Chronic kidney disease (CKD) is accompanied by inflammation. The aim of this study was to evaluate the effect of 6-month supplementation with omega-3 acids on selected markers of inflammation in patients with CKD stages 1–3. Methods. Six-month supplementation with omega-3 acids (2 g/day) was administered to 87 CKD patients and to 27 healthy individuals. At baseline and after follow-up, blood was taken for C-reactive protein (CRP) and monocyte chemotactic protein-1 (MCP-1) concentration and white blood cell (WBC) count. Serum concentration of omega-3 acids—eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and alpha-linolenic acid (ALA)—was determined using gas chromatography. And 24-hour urinary collection was performed to measure MCP-1 excretion. Results. After six-month omega-3 supplementation, ALA concentration increased in CKD patients and in the reference group, while EPA and DHA did not change. At follow-up, a significant decrease in urinary MCP-1 excretion in CKD (p=0.0012) and in the reference group (p=0.001) was found. CRP, serum MCP-1, and WBC did not change significantly. The estimated glomerular filtration rate (eGFR) did not change significantly in the CKD group. Conclusions. The reduction of urinary MCP-1 excretion in the absence of MCP-1 serum concentration may suggest a beneficial effect of omega-3 supplementation on tubular MCP-1 production. Trial Registration. This study was registered in ClinicalTrials.gov (identifier: NCT02147002).

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