Loss of the Normal Gradient in Arterial Compliance and Outcomes of Chronic Kidney Disease Patients

Background: In dialysis patients, loss of the normal gradient in arterial compliance, assessed by the pulse wave velocity (PWV) ratio, predicts all-cause mortality better than does carotid-femoral PWV (CF-PWV) alone. However, the prognostic significance of the PWV ratio for outcome in chronic kidney disease (CKD) patients remains unclear. Methods: In this longitudinal cohort study, CKD patients who visited our CKD management clinic between April 27, 2006, and March 27, 2008, were included and followed up. To assess the gradient in arterial compliance, the PWV ratio was calculated using CF-PWV divided by carotid-radial PWV. Results: A total of 209 patients in CKD stages 1–4 with a median follow-up of 3.74 years were included. Patients with higher PWV ratio were relatively older (p < 0.001) and had worse renal function (p < 0.001), more hypertension (p < 0.001), diabetes mellitus (p < 0.001), and cardiovascular or cerebrovascular disease (p < 0.001). The median time to patient outcome (death, renal replacement therapy, or double increase in serum creatinine from baseline) in the group with a PWV ratio above the median (89.8 months, 95% CI 84.2–95.5) was shorter than that in the group with a PWV ratio below the median (105.3 months, 95% CI 101.3–109.3, p = 0.001). Univariate Cox regression analysis showed that both PWV ratio and CF-PWV were significantly associated with patient outcome. In multivariate Cox regression analysis, both PWV ratio and CF-PWV were associated with patient outcome. However, the HR for CF-PWV (2.177, 95% CI 1.064–4.453, p = 0.033) was slightly higher than that for PWV ratio (2.091, 95% CI 1.049–4.167, p = 0.036). There was a significant interaction effect between PWV ratio and CKD stage. It was shown that patients with advanced CKD stages and higher PWV ratios had a significantly higher risk of adverse CKD outcome (p = 0.006). Conclusions: The PWV ratio, as a measure of loss of the normal gradient in arterial compliance, was associated with CKD patient outcome. Patients with advanced CKD and a higher PWV ratio had a significantly higher risk of adverse CKD outcome.

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MO159CHA2DS2-VASC SCORE AS A PREDICTOR OF CARDIOVASCULAR MORTALITY IN CHRONIC KIDNEY DISEASE PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab092.0037 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Nina Vodošek Hojs ◽

Robert Ekart ◽

Sebastjan Bevc ◽

Nejc Piko ◽

Radovan Hojs

Keyword(s):

Chronic Kidney Disease ◽

Regression Analysis ◽

Cardiovascular Risk ◽

Kidney Disease ◽

Cardiovascular Mortality ◽

Cox Regression ◽

High Sensitivity ◽

Cardiovascular Death ◽

Cox Regression Analysis

Abstract Background and Aims Cardiovascular mortality is high in chronic kidney disease (CKD) patients. Recognizing patients with higher cardiovascular risk might help in their treatment. CHA2DS2-VASc score was originally used to predict cerebral infarction in patients with atrial fibrillation (AF). However, it is also useful in predicting outcome in different cardiovascular conditions, independent of the presence of AF. Therefore, the aim of our research was to assess the role of CHA2DS2-VASc score in cardiovascular mortality in CKD patients. Method Eighty-seven non-dialysis CKD patients from our outpatient clinic were included. At the time of inclusion, medical history data and standard blood results were collected and CHA2DS2-VASc score was calculated. Patients were followed for assigned time or until their death. Mean follow-up time was 1696.45±564.60 days. Results Descriptive statistics of our patients are presented in table 1. During follow-up 11 patients suffered from cardiovascular death. Univariate Cox regression analysis showed that CHA2DS2-VASc score is a significant predictor of cardiovascular mortality (HR: 2.19, CI: 1.42-3.37, p=0.001). In multivariate Cox regression analysis in which CHA2DS2-VASc score, serum creatinine, urinary albumin/creatinine, haemoglobin, high sensitivity CRP and intact PTH were included, CHA2DS2-VASc score was an independent predictor of cardiovascular mortality (HR: 2.04, CI: 1.20-3.45, p=0.008) (table 2). Conclusion CHA2DS2-VASc score is a simple and quick way to identify cardiovascular risk in CKD patients.

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CHA2DS2-VASc Score as a Predictor of Cardiovascular and All-Cause Mortality in Chronic Kidney Disease Patients

American Journal of Nephrology ◽

10.1159/000516121 ◽

2021 ◽

pp. 1-8

Author(s):

Nina Vodošek Hojs ◽

Robert Ekart ◽

Sebastjan Bevc ◽

Nejc Piko ◽

Radovan Hojs

Keyword(s):

Chronic Kidney Disease ◽

Regression Analysis ◽

Kidney Disease ◽

Cox Regression ◽

Smoking Status ◽

High Sensitivity ◽

Cox Regression Analysis ◽

Reactive Protein ◽

All Cause Mortality

Introduction: Chronic kidney disease (CKD) is a risk factor for cardiovascular and all-cause mortality. Recognition of high-risk patients is important and could lead to a different approach and better treatment. The CHA2DS2-VASc score was originally used to predict cerebral infarction in patients with atrial fibrillation (AF), but it is also a useful predictor of outcome in other cardiovascular conditions, independent of AF. Therefore, the aim of our research was to assess the role of CHA2DS2-VASc score in predicting cardiovascular and all-cause mortality in CKD patients. Methods: Stable nondialysis CKD patients were included. At the time of inclusion, medical history data and standard blood results were collected and CHA2DS2-VASc score was calculated. Patients were followed till the same end date, until kidney transplantation or until their death. Results: Eighty-seven CKD patients were included (60.3 ± 12.8 years, 66% male). Mean follow-up time was 1,696.5 ± 564.6 days. During the follow-up, 21 patients died and 11 because of cardiovascular reasons. Univariate Cox regression analysis showed that CHA2DS2-VASc score is a significant predictor of cardiovascular and all-cause mortality. In multivariate Cox regression analysis, in which CHA2DS2-VASc score, serum creatinine, urinary albumin/creatinine, hemoglobin, high-sensitivity C-reactive protein, and intact parathyroid hormone were included, CHA2DS2-VASc score was an independent predictor of cardiovascular (HR: 2.04, CI: 1.20–3.45, p = 0.008) and all-cause mortality (HR: 2.06, CI: 1.43–2.97, p = 0.001). The same was true after adding total cholesterol, triglycerides, and smoking status to both the analyses. Conclusion: The CHA2DS2-VASc score is a simple, practical, and quick way to identify the risk for cardiovascular and all-cause mortality in CKD patients.

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Evaluation of functional outcome of bilateral kidney tumors after sequential surgery

BMC Cancer ◽

10.1186/s12885-021-08324-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jung Kwon Kim ◽

Hwanik Kim ◽

Hakmin Lee ◽

Jong Jin Oh ◽

Sangchul Lee ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Glomerular Filtration ◽

Functional Outcomes ◽

Cox Regression ◽

De Novo ◽

Negative Impact ◽

Renal Tumors ◽

Cox Regression Analysis ◽

Ckd Stage

Abstract Background There are limited data concerning patients treated with sequential bilateral kidney surgery. Current guidelines still lack an optimal surgical sequencing approach. We evaluated renal functional outcomes after sequential partial nephrectomy (PN) and radical nephrectomy (RN) in patients with bilateral renal cell carcinoma (RCC). Methods A propensity score matched cohort of 267 patients (synchronous bilateral RCCs, N = 44 [88 lesions]; metachronous bilateral, N = 45 [90 lesions]; unilateral, N = 178) from two tertiary institutions were retrospectively analyzed. Synchronous bilateral RCCs were defined as diagnosis concomitantly or within 3 months of former tumor. Renal functional outcomes were defined as estimated glomerular filtration rate (eGFR) changes and de novo chronic kidney disease (CKD, stage ≥3) after surgery. Renal functional outcomes and clinical factors predicting de novo CKD were assessed using descriptive statistics and Cox regression analysis. Results In subgroup of bilateral RCCs, patients underwent sequential PN (N = 48), PN followed by RN (N = 8), or RN followed by PN (N = 25). Final postoperative estimated glomerular filtration rates (eGFRs) were 79.4, 41.4, and 61.2 ml/minute/1.73 m2, respectively (p = 0.003). There were significant differences in eGFR decline from baseline and de novo chronic kidney disease (CKD stage ≥ III) among groups, with PN followed by RN group showing the worst functional outcomes (all p < 0.05). Moreover, sequential PN subgroup in bilateral RCC showed significantly higher rate of de novo CKD than unilateral RCC group (13.8% vs. 6.9%, p = 0.016). On multivariate analysis, hypertension (p = 0.010) and surgery sequence (PN followed by RN, p < 0.001) were significant predictors of de novo CKD. Conclusions The surgery sequence should be prudently determined in bilateral renal tumors. PN followed by RN showed a negative impact on renal functional preservation. Nephron-sparing surgery should be considered for all amenable bilateral RCCs.

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Prognostic Significance of PD-L1 and mTOR Expression in Oral Squamous Cell Carcinoma

Journal of Health Science and Medical Research ◽

10.31584/jhsmr.2020745 ◽

2020 ◽

Author(s):

Nattinee Charoen ◽

Kitti Jantharapattana ◽

Paramee Thongsuksai

Keyword(s):

Squamous Cell Carcinoma ◽

Regression Analysis ◽

Prognostic Factors ◽

Oral Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Cox Regression ◽

Prognostic Significance ◽

P Value ◽

Cox Regression Analysis

Objective: Programmed cell death ligand 1 (PD-L1) and mammalian target of rapamycin (mTOR) are key players in host immune evasion and oncogenic activation, respectively. Evidence of the prognostic role in oral squamous cell carcinoma (OSCC) is conflicting. This study examined the associations of PD-L1 and mTOR expression with 5-year overall survival in OSCC patients. Material and Methods: The expressions of PD-L1 and mTOR proteins were immunohistochemically evaluated on tissue microarrays of 191 patients with OSCC who were treated by surgery at Songklanagarind Hospital, Thailand from 2008 to 2011. Cox regression analysis was used to determine independent prognostic factors. Results: PD-L1 expression was observed in 14.1% of cases while mTOR expression was present in 74.3% of cases. Females were more likely to have tumors with PD-L1 (p-value=0.007) and mTOR expressions (p-value=0.003) than males. In addition, lower clinical stage and well differentiated tumor are more likely to have mTOR expression (p-value= 0.038 and p-value<0.001, respectively). Cox regression analysis showed that age, tumor stage, nodal stage, combined surgical treatment with radiation or chemoradiation therapy, surgical margin status, PD-L1 expression and mTOR expression are independent prognostic factors. High PD-L1 expression (hazard ratio (HR) 3.14, 95% confidence interval (CI), 1.26–7.79) and high mTOR expression (HR 1.69, 95% CI, 1.00–2.84) are strong predictors of poor outcome. Conclusion: A proportion of OSCC expressed PD-L1 and mTOR proteins. Expression of PD-L1 and mTOR proteins are strong prognostic factors of OSCC.

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Construction and Validation of a Metabolic Reprogramming Related Prognostic Model for Hepatocellular Carcinoma

10.21203/rs.3.rs-97188/v1 ◽

2020 ◽

Author(s):

Xiaohong - Liu ◽

Qian - Xu ◽

Zi-Jing - Li ◽

Bin - Xiong

Keyword(s):

Hepatocellular Carcinoma ◽

Regression Analysis ◽

Risk Score ◽

Prognostic Model ◽

Cox Regression ◽

Expression Profiles ◽

Prognostic Significance ◽

Metabolic Reprogramming ◽

Cox Regression Analysis ◽

Metabolic Genes

Abstract BackgroundMetabolic reprogramming is an important hallmark in the development of malignancies. Numerous metabolic genes have been demonstrated to participate in the progression of hepatocellular carcinoma (HCC). However, the prognostic significance of the metabolic genes in HCC remains elusive. MethodsWe downloaded the gene expression profiles and clinical information from the GEO, TCGA and ICGC databases. The differently expressed metabolic genes were identified by using Limma R package. Univariate Cox regression analysis and LASSO (Least absolute shrinkage and selection operator) Cox regression analysis were utilized to uncover the prognostic significance of metabolic genes. A metabolism-related prognostic model was constructed in TCGA cohort and validated in ICGC cohort. Furthermore, we constructed a nomogram to improve the accuracy of the prognostic model by using the multivariate Cox regression analysis.ResultsThe high-risk score predicted poor prognosis for HCC patients in the TCGA cohort, as confirmed in the ICGC cohort (P < 0.001). And in the multivariate Cox regression analysis, we observed that risk score could act as an independent prognostic factor for the TCGA cohort (HR (hazard ratio) 3.635, 95% CI (confidence interval)2.382-5.549) and the ICGC cohort (HR1.905, 95%CI 1.328-2.731). In addition, we constructed a nomogram for clinical use, which suggested a better prognostic model than risk score.ConclusionsOur study identified several metabolic genes with important prognostic value for HCC. These metabolic genes can influence the progression of HCC by regulating tumor biology and can also provide metabolic targets for the precise treatment of HCC.

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Bypass Grafting vs Endovascular Therapy in Patients With Non-Dialysis-Dependent Chronic Kidney Disease and Chronic Limb-Threatening Ischemia (CRITISCH Registry)

Journal of Endovascular Therapy ◽

10.1177/1526602820938465 ◽

2020 ◽

Vol 27 (4) ◽

pp. 599-607

Author(s):

Konstantinos Stavroulakis ◽

Asimakis Gkremoutis ◽

Matthias Borowski ◽

Giovanni Torsello ◽

Dittmar Böckler ◽

...

Keyword(s):

Myocardial Infarction ◽

Chronic Kidney Disease ◽

Overall Survival ◽

Kidney Disease ◽

Endovascular Therapy ◽

Proportional Hazards ◽

Cox Regression ◽

Cox Proportional Hazards ◽

Bypass Grafting ◽

Cox Regression Analysis

Purpose: To report the outcomes of bypass grafting (BG) vs endovascular therapy (EVT) in patients with non-dialysis-dependent chronic kidney disease (CKD) and chronic limb-threatening ischemia (CLTI). Materials and Methods: The CRITISCH Registry is a prospective, national, interdisciplinary, multicenter registry evaluating the current practice of all available treatment options in 1200 consecutive CLTI patients. For the purposes of this analysis, only the 337 patients with non-dialysis-dependent CKD treated by either BG (n=86; median 78 years, 48 men) or EVT (n=251; median age 80 years, 135 men) were analyzed. The primary composite outcome was amputation-free survival (AFS); secondary outcomes were overall survival (OS) and amputation-free time (AFT). All outcomes were evaluated in Cox proportional hazards models; the results are reported as the hazard ratio (HR) and 95% confidence interval (CI). Results: The Cox regression analysis revealed a significantly greater hazard of amputation or death after BG (HR 1.78, 95% CI 1.05 to 3.03, p=0.028). The models for AFT and overall survival also suggested a higher hazard for BG, but the differences were not significant (AFT: HR 1.66, 95% CI 0.78 to 3.53, p=0.188; OS: HR 1.41, 95% CI 0.80 to 2.47, p=0.348). The absence of runoff vessels (HR 1.73, 95% CI 1.15 to 2.60, p=0.008) was associated with a decreased AFS. The likelihood of amputation was higher in male patients (HR 2.21, 95% CI 1.10 to 4.45, p=0.027) and was associated with a lack of runoff vessels (HR 1.95, 95% CI 0.96 to 3.95, p=0.065) and myocardial infarction (HR 3.74, 95% CI 1.23 to 11.35, p=0.020). Death was more likely in patients without runoff vessels (HR 1.76, 95% CI 1.11 to 2.80, p=0.016) and those with a higher risk score (HR 1.73, 95% CI 1.03 to 2.91, p=0.038). Conclusion: This analysis suggested that BG was associated with poorer AFS than EVT in patients with non-dialysis-dependent CKD and CLTI. Male sex, previous myocardial infarction, and the absence of runoff vessels were additionally identified as predictors of poorer outcomes.

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Abnormal Serum Free Light Chain Ratios Are Associated with Earlier Time to First Treatment and Poor Survival in Patients with Chronic Lymphocytic Leukaemia

Blood ◽

10.1182/blood.v112.11.3141.3141 ◽

2008 ◽

Vol 112 (11) ◽

pp. 3141-3141

Author(s):

Guy Pratt ◽

Graham Mead ◽

Supratik Basu ◽

Abe Jacobs ◽

Roger Holder ◽

...

Keyword(s):

Regression Analysis ◽

Cox Regression ◽

Prognostic Significance ◽

Lymphocytic Leukemia ◽

Female Ratio ◽

Cox Regression Analysis ◽

Serum Free ◽

Kaplan Meier ◽

Mutational Status ◽

Time To First Treatment

Abstract Introduction: Serum free light chains (sFLC) have prognostic significance in plasma cell disorders. In B-cell chronic lymphocytic leukemia (CLL), a small study found 8/18 (44%) of patients to have abnormal FLC ratios but no assessment of prognostic value was published. The aim of the present study was to determine whether abnormal serum FLC concentrations are indicative of a poor prognosis in CLL patients. Methods: Sera were analysed from 381 previously diagnosed CLL patients (Stage A 307; B 30; C 26; 18 missing; male: Female Ratio 1.6:1, mean age 71 (29–98)) with samples taken before their first treatment (303) or after treatment (78). The study was approved by the Birmingham Heart of England NHS Trust Review Board. Patients were described using the Binet staging system and measured for prognostic markers including CD38, Zap70, mutational status, β2M and FLC. Kaplan Meier survival curves and Cox proportional hazards regression (age, sex, CD38, Zap 70, mutational status, β2M and sFLC) were calculated using SPSS v14. Results: 147/381 (39%) patient sera had abnormal sFLC ratios. Kaplan Meier analysis of all deaths showed abnormal ratios were significantly associated with worse survival (n=350, p<0.001). Analysis of deaths attributed to CLL (n=30) also indicated that an abnormal FLC ratio was predictive of shorter survival (p=0.001). However, for deaths not attributed to CLL (n=32), the FLC ratio was not significantly predictive of outcome (p=0.112). For Cox regression analysis (n=228) of deaths attributed to CLL only, three significant, independent, prognostic factors were identified: CD38 (p<0.001), abnormal ratio (p<0.001) and Stage (p=0.027). Analysis of the untreated patient population (n=303), using Kaplan Meier analysis of time to first treatment, found that an abnormal lambda ratio (p=0.04) but not an abnormal kappa ratio (p=0.443) predicted earlier treatment. For patients with an abnormal lambda ratio, the mean time to first treatment was 38 months earlier than those patients with a normal ratio. Cox regression analysis (n=171) of time to first treatment, found 4 significant, independent factors predicting earlier treatment: Zap70 (p<0.001), Age (p<0.001), abnormal sFLC ratio (p=0.001) and Stage (p=0.027). Conclusions: As shown in other monoclonal gammopathies, abnormal sFLC ratios were associated with poorer outcomes in patients with CLL. Furthermore, in an untreated population, patients with an abnormal lambda sFLC ratio required earlier treatment, indicating a pathological mechanism which is as yet unclear but which warrants further investigation.

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Effects of blood urea nitrogen independent of the estimated glomerular filtration rate on the development of anemia in non-dialysis chronic kidney disease: The results of the KNOW-CKD study

PLoS ONE ◽

10.1371/journal.pone.0257305 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0257305

Author(s):

Hyo Jin Kim ◽

Tae Eun Kim ◽

Miyeun Han ◽

Yongin Yi ◽

Jong Cheol Jeong ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Regression Analysis ◽

Glomerular Filtration Rate ◽

Kidney Disease ◽

Glomerular Filtration ◽

Protein Intake ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Cox Regression ◽

Hemoglobin Level

Background Anemia is a common complication of chronic kidney disease (CKD). Blood urea nitrogen (BUN) in CKD represents nitrogenous uremic toxin accumulation which could be involved in anemia of CKD. We investigated the effects of BUN independent of estimated glomerular filtration rate (eGFR) on anemia in non-dialysis CKD (NDCKD). Methods This prospective study included 2,196 subjects enrolled in the KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD) cohort with BUN and hemoglobin level data. Initially, we investigated the association between BUN and hemoglobin level. To examine the impact of baseline BUN on the incident anemia, a longitudinal study was performed on 1,169 patients without anemia at study enrollment. BUN residuals were obtained from the fitted curve between BUN and eGFR. Anemia was defined as a hemoglobin level of <13.0 g/dL for men and <12.0 g/dL for women. Results BUN residuals were not related to eGFR but to daily protein intake (DPI), while BUN was related to both eGFR and DPI. BUN was inversely associated with hemoglobin level (β -0.03; 95% confidence interval [CI] -0.04, -0.03; P <0.001) in the multivariable linear regression analysis adjusted for multiple confounders including eGFR, and BUN residual used instead of BUN was also inversely associated with hemoglobin level (β -0.03; 95% CI -0.04, -0.02; P <0.001). Among the 1,169 subjects without anemia at baseline, 414 (35.4%) subjects newly developed anemia during the follow-up period of 37.5 ± 22.1 months. In the multivariable Cox regression analysis with adjustment, both high BUN level (Hazard ratio [HR] 1.02; 95% CI 1.01, 1.04; P = 0.002) and BUN residual used instead of BUN (HR 1.02; 95% CI 1.00, 1.04; P = 0.031) increased the risk of anemia development. Moreover, BUN, rather than eGFR, increased the risk of anemia development in patients with CKD stage 3 in the multivariable Cox regression. Conclusion Higher BUN levels derived from inappropriately high protein intake relative to renal function were associated with low hemoglobin levels and the increased risk of anemia independent of eGFR in NDCKD patients.

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Chemoradiation-induced changes in systemic inflammatory markers and their prognostic significance in oesophageal squamous cell carcinoma

British Journal of Radiology ◽

10.1259/bjr.20200314 ◽

2021 ◽

pp. 20200314

Author(s):

Ni Sann Khin ◽

Sze Huey Tan ◽

Michael LC Wang ◽

Tian Rui Siow ◽

Faye LWT Lim ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Regression Analysis ◽

Prognostic Factors ◽

Cell Carcinoma ◽

Inflammatory Markers ◽

Cox Regression ◽

Prognostic Significance ◽

Oesophageal Squamous Cell Carcinoma ◽

Cox Regression Analysis ◽

Inflammatory State

Objective: Chemoradiation (CRT) may induce a change in systemic inflammatory state which could affect clinical outcomes in oesophageal cancer. We aimed to evaluate the changes and prognostic significance of systemic inflammatory markers following definitive CRT in oesophageal squamous cell carcinoma. Methods: A total of 53 patients treated with concurrent CRT were included in this retrospective analysis. We compared neutrophils, lymphocytes, platelets, neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) before and after CRT using Wilcoxon signed-rank test. Overall survival (OS) and progression-free survival (PFS) were calculated. Univariable and multivariable survival analysis were performed using Cox regression analysis. Clinical univariable survival prognostic factors with p < 0.1 were included in a multivariable cox regression analysis for backward stepwise model selection. Results: Both NLR (median ∆+2.8 [IQR −0.11, 8.62], p < 001) and PLR (median ∆+227 [81.3–523.5], p < 0.001) increased significantly after CRT. Higher levels of pre-CRT, post-CRT and change (∆) in NLR and PLR were associated with inferior OS and PFS. Post-CRT NLR (HR 1.04, 95% CI 1.02–1.07, p < 0.001), post-CRT platelets (HR 1.03, 95% CI 1.01–1.05, p = 0.005), cT-stage (HR 3.83, 95% CI 1.39–10.60, p = 0.01) and RT dose (HR 0.41, 95% CI 0.21–0.81, p = 0.01) were independent prognostic factors for OS in multivariable analysis. Change in NLR (HR 1.04, 95% CI 1.01–1.06, p = 0.001), post-CRT platelets (HR 1.03, 95% CI 1.01–1.05, p = 0.002), cT-stage (HR 3.98, 95% CI 1.55–10.25, p = 0.004) and RT dose (HR 0.41, 95% CI 0.21–0.80, p = 0.009) were independent prognostic factors for PFS. Conclusion: Both NLR and PLR increased following definitive CRT. Post-CRT NLR and ∆NLR were associated with adverse survival in oesophageal SCC. Advances in knowledge: We showed that CRT increased PLR and NLR, possibly reflecting a systemic inflammatory state which were associated with poor clinical outcomes in oesophageal SCC.

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P0752THE EXPRESSION AND DIAGNOSTIC VALUE OF URINE ANGIOTENSINOGEN IN CHRONIC KIDNEY DISEASE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0752 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Qiuyan Huang ◽

Junzhe Chen ◽

Ying Tang ◽

Yanchun Xu ◽

Anping Xu

Keyword(s):

Chronic Kidney Disease ◽

Regression Analysis ◽

Kidney Disease ◽

Linear Regression ◽

Predictive Value ◽

Linear Regression Analysis ◽

Diagnostic Value ◽

Glomerular Sclerosis ◽

Ckd Stage ◽

Stage 1

Abstract Background and Aims This article aims to detect the expression of urine angiotensinogen (uAGT) in patients with chronic kidney disease (CKD) and its correlation with clinical and renal pathology. Method Patients who diagnosed with CKD and undergoing renal biopsy for the first visit to Sun Yat-sen Memorial Hospital from March 1st ,2018 to October 1st, 2019 were enrolled. First morning urine samples from CKD patients before renal biopsy and healthy volunteers as controls were collected during the same period. These samples were tested for uAGT by ELISA. Linear regression analysis was used to explore the correlation between uAGT and clinical indicators as well as renal pathology in CKD patients. The receiver operating curve (ROC curve) was used to explore the diagnostic value of uAGT for CKD stage 3 or above and glomerular sclerosis ratio>50%. Results A total of 133 CKD patients with 59 (44.4%) in stage 1, 31 (23.3%) in CKD stage 2, 17 (12.8%) in stage 3, 17 (12.8%) in stage 4 and 9 (6.7%) in stage 5 were included in our study. At the same time, 20 healthy volunteers were included as control. uAGT levels of CKD patients were significantly higher than healthy controls(275.0 vs 774.2,P<0.001). Compared with CKD stage 1-2 patients, uAGT levels in patients with stage CKD 3 or above were significantly increased, and the difference was statistically significant (P<0.001) (Table 1). The result of multivariate linear regression analysis showed that uAGT levels in CKD patients were positively correlated with 24h urine protein (beta = 0.193, P = 0.012) and negatively correlated with eGFR (beta = -0.489, P<0.001) (Table 2). We also demonstrated that uAGT was positively correlated with the ratio of glomerular sclerosis(P = 0.003) (Table 3). Our results showed that the area under the curve (AUC)of uAGT for the diagnosis of renal function with CKD stage 3 or above was 0.789 (Figure 1) with the cut-off value was1959.9pg/ml. The sensitivity and specificity were 51.2% and 97.3% respectively, Furthermore, the positive predictive value (PPV) was 88.0% and negative predictive value (NPV) was 82.95%.The AUC of uAGT for the diagnosis of renal pathological glomerular sclerosis ratio>50% was 0.677 (Figure 2).The cut-off value of uAGT was 2131.8pg/ml.The sensitivity and specificity were 50% and 89.5% respectively. Meanwhile, the PPV was 41.67% and the NPV was 92.25%. Conclusion uAGT was significantly increased in CKD patients, which is closely related with the urinary protein, eGFR, and renal pathology.The specific cut-off value of uAGT can be used as a predictive indicator of advanced CKD stage and severe glomerular sclerosis.

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