Guideline-Directed Medical Therapy in Patients with Chronic Kidney Disease Undergoing Peripheral Vascular Intervention

2021 ◽  
Vol 52 (10-11) ◽  
pp. 845-853
Author(s):  
Qurat-Ul-Ain Jelani ◽  
Fiorella Llanos-Chea ◽  
Pragati Bogra ◽  
Camila Trejo-Paredes ◽  
Jiaming Huang ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Medical Therapy ◽  
Enzyme Inhibitor ◽  
Limb Ischemia ◽  
Peripheral Vascular ◽  
Vascular Intervention ◽  
Before And After ◽  
Prescription Rates ◽  
Site Variability

<b><i>Introduction:</i></b> Guideline-directed medical therapy (GDMT) is imperative to improve cardiovascular and limb outcomes for patients with critical limb ischemia (CLI), especially amongst those at highest risk for poor outcomes, including those with comorbid chronic kidney disease (CKD). Our objective was to examine GDMT prescription rates and their variation across individual sites for patients with CLI undergoing peripheral vascular interventions (PVIs), by their comorbid CKD status. <b><i>Methods:</i></b> Patients with CLI who underwent PVI (October 2016–April 2019) were included from the Vascular Quality Initiative (VQI) database. CKD was defined as GFR &#x3c;60 mL/min/1.73 m<sup>2</sup>. GDMT included the composite use of antiplatelet therapy and a statin, as well as an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker if hypertension was present. The use of GDMT before and after the index procedure was summarized in those with and without CKD. Adjusted median odds ratios (MORs) for site variability were calculated. <b><i>Results:</i></b> The study included 28,652 patients, with a mean age of 69.4 ± 11.7 years, and 40.8% were females. A total of 47.5% had CKD. Patients with CKD versus those without CKD had lower prescription rates both before (31.7% vs. 38.9%) and after (36.5% vs. 48.8%) PVI (<i>p</i> &#x3c; 0.0001). Significant site variability was observed in the delivery of GDMT in both the non-CKD and CKD groups before and after PVI (adjusted MORs: 1.31–1.41). <b><i>Discussion/Conclusion:</i></b> In patients with CLI undergoing PVI, patients with comorbid CKD were less likely to receive GDMT. Significant variability of GDMT was observed across sites. These findings indicate that significant improvements must be made in the medical management of patients with CLI, particularly in patients at high risk for poor clinical outcomes.

Effect of Chronic Kidney Disease on Mortality in Patients Who Underwent Lower Extremity Peripheral Vascular Intervention

2017 ◽  
Vol 119 (4) ◽  
pp. 669-674 ◽  
Author(s):  
Joe X. Xie ◽  
Thomas J. Glorioso ◽  
Philip B. Dattilo ◽  
Vikas Aggarwal ◽  
P. Michael Ho ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Lower Extremity ◽  
Peripheral Vascular ◽  
Vascular Intervention ◽  
Peripheral Vascular Intervention

scholarly journals Targeting Uremic Toxins to Prevent Peripheral Vascular Complications in Chronic Kidney Disease

Toxins ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 808
Author(s):  
Chia-Lin Wu ◽  
Der-Cherng Tarng
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Vascular Complications ◽  
Renin Angiotensin System ◽  
Limb Ischemia ◽  
Uremic Toxins ◽  
Uremic Toxin ◽  
Peripheral Vascular

Chronic kidney disease (CKD) exhibits progressive kidney dysfunction and leads to disturbed homeostasis, including accumulation of uremic toxins, activated renin-angiotensin system, and increased oxidative stress and proinflammatory cytokines. Patients with CKD are prone to developing the peripheral vascular disease (PVD), leading to poorer outcomes than those without CKD. Cumulative evidence has showed that the synergy of uremic milieu and PVD could exaggerate vascular complications such as limb ischemia, amputation, stenosis, or thrombosis of a dialysis vascular access, and increase mortality risk. The role of uremic toxins in the pathogenesis of vascular dysfunction in CKD has been investigated. Moreover, growing evidence has shown the promising role of uremic toxins as a therapeutic target for PVD in CKD. This review focused on uremic toxins in the pathophysiology, in vitro and animal models, and current novel clinical approaches in reducing the uremic toxin to prevent peripheral vascular complications in CKD patients.

scholarly journals The impact of chronic kidney disease on outcomes following peripheral vascular intervention

2020 ◽  
Vol 43 (11) ◽  
pp. 1308-1316 ◽  
Author(s):  
Dennis I. Narcisse ◽  
Elizabeth Hope Weissler ◽  
Jennifer A. Rymer ◽  
Ehrin J. Armstrong ◽  
Eric A. Secemsky ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Peripheral Vascular ◽  
Vascular Intervention ◽  
Peripheral Vascular Intervention ◽  
The Impact

Hematologic Abnormalities in Chronic Kidney Disease

2018 ◽  
Author(s):  
Michael Auerbach ◽  
John Anderson ◽  
Khalid Al Talib
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Oral Anticoagulants ◽  
Infusion Reaction ◽  
Nonvalvular Atrial Fibrillation ◽  
Novel Oral Anticoagulant ◽  
Before And After ◽  
Iv Iron ◽  
A Minor

The focus of this review is on information practical to the practicing nephrologist and internists managing patients with chronic kidney disease (CKD), with an emphasis on the quantitative aspects of risk, diagnosis, treatment, and prognosis. Consequently, anemia associated with non–dialysis-associated CKD is emphasized, with special attention to the role of erythropoiesis-stimulating agents and intravenous (IV) iron in treating the anemia of CKD, as well as sections on uremic bleeding and anticoagulation in CKD patients. Figures show a patient before and after a minor infusion reaction, an algorithm outlining grading and management of acute hypersensitivity reactions to IV iron infusions, and an algorithm for the management of uremic platelet dysfunction. Tables list Food and Drug Administration-recommended dose adjustments for novel oral anticoagulant (NOACs) in CKD patients, evidence for preprocedural withholding of NOACs, and management guidelines for anticoagulation in nonvalvular atrial fibrillation and venous thromboembolism. This review contains 2 highly rendered figures, 3 tables, and 101 references. Key words: Chronic kidney disease; CKD; Anemia of chronic kidney disease; Anemia of CKD; Uremic bleeding; Anticoagulation in CKD; Novel oral anticoagulants in CKD; NOAC CKD

scholarly journals A Whole Food Plant-Based Diet With a Novel Potassium-Binding Resin in a Patient With Advanced Chronic Kidney Disease

2020 ◽  
Vol 14 (6) ◽  
pp. 592-594
Author(s):  
Dario Manley-Casco ◽  
Paul Berkowitz
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Enzyme Inhibitor ◽  
Standard Of Care ◽  
Food Plant ◽  
Major Health Problem ◽  
Progression Of Kidney Disease ◽  
Standard Of Care Treatment ◽  
Potassium Binders ◽  
Potassium Binding

Chronic kidney disease (CKD) is a major health problem with substantial morbidity and mortality. Plant-based diets decrease the incidence of CKD and progression of kidney disease and help prevent and treat the important comorbidities of obesity, type 2 diabetes, hypertension, and cardiovascular disease. However, in patients with CKD, there is concern that a plant-based diet may contribute to life-threatening hyperkalemia. We present a patient with CKD secondary to hypertensive glomerulosclerosis that worsened despite standard of care treatment. Shared decision making was used to initiate a whole food plant-based diet along with a potassium-binding resin (Patiromer) to control the potassium levels. The patient was able to be maintained on the whole food plant-based diet and an angiotensin-converting enzyme inhibitor without the development of hyperkalemia. This case shows that patients with CKD may be able to enjoy the benefits of a whole food plant-based diet while decreasing the risk of hyperkalemia by using the new potassium binders.

scholarly journals MO529PREVALENCE AND DETERMINANT FACTORS OF DEPRESSION AND ANXIETY IN PEOPLE WITH CHRONIC KIDNEY DISEASE : A MOROCCAN CROSS-SECTIONAL  STUDY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Amina Chrifi Alaoui ◽  
Mohammed Omari ◽  
Noura Qarmiche ◽  
Omar Kouiri ◽  
Basmat Amal Chouhani ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Depression Scale ◽  
Clinical Information ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Depression And Anxiety ◽  
Cross Sectional ◽  
Determinant Factors ◽  
Before And After

Abstract Background and Aims The Chronic kidney disease (CKD), like many chronic illnesses, is invariably associated with various psychiatric conditions and poorer quality of life. This study aims to assess the prevalence of depression and anxiety among CKD patient and their determinant factors. Method this is a cross sectional single center study in a Moroccan university hospital. Patients aged ≥ 18 years old and followed for more than one year were included. The data was collected using a questionnaire for sociodemographic and clinical information and the Hospital anxiety and depression scale (HADS) to assess depression and anxiety prevalence. After the description of the population’s characteristics, the statistical analysis aimed to assess the association between depression and anxiety disorders and the estimated glomerular filtration rate before and after adjustment on several confounding factors. Results 88 patients were included (63.6% of them were women, the mean age was 61.8±14.0 years), 21 were on stage 3, 46 were on stage 4, and 21 were on stage 5 of the CKD. The median of depression sub-score was 5.00[2.00; 10.0], the median of anxiety sub-score was 6.00[4.00; 9.00], and the median of the global score was 11.0[7.00; 20.0], 22.0% of included patients had depression and 22.0% had anxiety. Both depression and anxiety scores were associated to eGFR before and after adjustment (p= 0.001, p&lt;0.001and p=0.04, p=0.03 respectively). Conclusion This study showed that depression and anxiety are strongly related to the CKD progression, which should motivate both doctors and nurses to improve their psychological care toward CKD patients.

scholarly journals Diabetes potentiates ROS production in granulocytes from patients with chronic kidney disease

2021 ◽  
Vol 9 (1) ◽  
pp. 9-14
Author(s):  
Jose Augusto Nogueira-Machado ◽  
Gabriela Rossi Ferreira ◽  
Caroline Maria Oliveira Volpe ◽  
Pedro Henrique Villar-Delfino ◽  
Fabiana Rocha Silva
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Nadph Oxidase ◽  
Ros Generation ◽  
Ros Production ◽  
Clinical Prognosis ◽  
Before And After ◽  
Healthy Control ◽  
Toll Receptor

Background: Type 2 diabetes (DM2) and chronic kidney disease (CKD) are inflammatory pathologies. Diabetes is characterized by hyperglycemia and CKD by the gradual and irreversible loss of kidney function. Both diseases develop oxidative stress, and reactive oxygen species (ROS) play a pivotal role in the pathogenesis. This study aimed to determine ROS production by granulocytes from renal patients (CKD) with or without diabetes. Methods: Granulocytes from patients with DM2, CKD, CKD-DM2, and healthy controls were purified using the Ficoll-Hypaque gradient method. Granulocyte ROS generation in the absence or the presence of PDB (an activator of NADPH-oxidase) or Concanavalin A (Toll- receptor 3,9 activator) was evaluated in a luminol-dependent chemiluminescence method. The cell-free DNA in the serum of DM2, CKD, and CKD-DM2 patients was measured by the fluorescence method before and after hemodialysis. Results: Our results show a significant increase in ROS production by granulocytes from patients with CKD, DM2, and CKD-DM2 compared to healthy control (p<0.05). CKD-DM2 group produced the most significant ROS levels with or without NADPH-oxidase activation. ROS production showed a significant increase in the presence of ConA. In contrast, mitochondrial (internal) ROS showed a different ROS response. DNA extrusion was higher in the CKD-DM2 group after hemodialysis suggesting cell death. Conclusion: The results demonstrated that CKD-DM2 patients produced high ROS generation levels and increased DNA extrusion after hemodialysis. It may suggest that CKD-DM2 disease is more severe and has a worse clinical prognosis.

Sign in / Sign up

Export Citation Format

Share Document