Abstract 022: Cystatin C Strengthens the Association of Kidney Function with Mortality and End-Stage Renal Disease

Background: Adding cystatin C to serum creatinine improves accuracy of estimated glomerular filtration rate (eGFR), but the impact on detection, staging and prognosis of chronic kidney disease (CKD) across diverse populations has not been determined. Methods: Meta-analyses including 11 general population cohorts (N=90,750 participants) and 5 CKD cohorts (N=2,960) with standardized serum creatinine and cystatin C at baseline. We compared associations of baseline GFR estimated by CKD-EPI equations using creatinine (eGFR cr ) vs. cystatin C (eGFR cys ) with mortality (13,202 deaths from 15 cohorts) and incident end-stage renal disease (ESRD) (1,654 cases from 7 cohorts) during mean follow-up of 7.7 years and studied prognostic consequences of reclassification. Results: In the general population cohorts, mean eGFRs were 85 ml/min/1.73m 2 for both equations but prevalence of eGFR<60 ml/min/1.73m 2 was higher for eGFR cys vs. eGFR cr (13.7% vs. 9.7% [12,403 vs. 8,833 of 90,750]). Across all eGFR cr categories (≥90, 60-89, 45-59, 30-44, 15-29, and <15 ml/min/1.73m 2 ), upward and downward reclassification by eGFR cys was associated with lower and higher risk, respectively; net reclassification improvement for eGFR cys compared with eGFR cr was 0.23 (0.18-0.28) for mortality and 0.10 (0.00-0.21) for ESRD. Among participants with eGFR cr 45-59 ml/min/1.73m 2 (N=6,358), ~40% were reclassified to higher eGFR cys categories and had lower risks of mortality (adjusted hazard ratio 0.66; 95% CI 0.57-0.77) and ESRD (0.20; 0.08-0.53) compared to those who were not reclassified. Among participants with eGFR cr 60-89 ml/min/1.73m 2 (N=43,630), ~13% were reclassified to lower eGFR cys categories and had higher risk for mortality (1.57; 1.39-1.78) and ESRD (2.66; 1.52-4.67) compared to no reclassification. The results for CKD cohorts were largely similar. Conclusions: Cystatin C strengthens the association of eGFR with risk across diverse populations providing a potentially useful adjunct to eGFR cr for detection and staging of CKD.

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Comparative Study of Serum Cystatin C and Serum Creatinine Level in Before and After Hemodialysis

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i39a32147 ◽

2021 ◽

pp. 102-106

Author(s):

Dattu Hawale ◽

Ranjit Ambad ◽

Nandkishor Bankar ◽

Raunak Kotecha

Keyword(s):

Renal Disease ◽

Serum Creatinine ◽

Comparative Study ◽

Cystatin C ◽

End Stage Renal Disease ◽

Serum Cystatin C ◽

Creatinine Concentration ◽

Serum Cystatin ◽

Stage Renal Disease ◽

End Stage

Background: Chronic kidney disease (CKD) is a pathophysiologic process characterised by a decrease in nephron number and function, which often leads to end-stage renal disease (ESRD). Serum plasma cystatin C is a new test for determining kidney function. Its accuracy in determining the efficacy of haemodialysis in patients with end-stage renal disease has yet to be determined. Serum cystatin C, which is formed at a constant rate by all nucleated cells and filtered freely by the glomerulus, is neither secreted nor reabsorbed, and is unaffected by non-renal influences. Materials and Methods: This study was a comparative study, conducted in the nephrology Department at DMMC & SMHRC, Nagpur in collaboration with ABVRH and JNMC Wardha, Sawangi (Meghe) during September 2020 to March 2021. Total 25 patient (End stage renal disease) included for the present study, the age group 30-60 years with 17 male patients and 08 female patients. Result: Serum creatinine concentration in the before hemodialysis with 8.72±3.00 and for the after hemodialysis 3.20±1.18(P < 0.0001). The serum cystatin C concentration in the before hemodialysis 5.50±2.09 and for the after hemodialysis 8.7±1.75(P < 0.0001). the process of hemodialysis leads to a significantly low in a serum creatinine concentration as compared to before hemodialysis. The serum cystatin C concentration significantly increase in the after hemodialysis patient as compared to before hemodialysis. Conclusion: Hemodialysis adequacy cannot be determined using serum cystatin C. It does, however, serve as a surrogate marker of dialysis inadequacy, particularly when low flux membranes are used. Routine examination of serum cystatin C in hemodialysis patients will help in the monitoring of the patient's overall clinical condition.

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Changes in metabolic syndrome status affect the incidence of end-stage renal disease in the general population: a nationwide cohort study

Scientific Reports ◽

10.1038/s41598-021-81396-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Eun Sil Koh ◽

Kyung Do Han ◽

Mee Kyoung Kim ◽

Eun Sook Kim ◽

Min-Kyung Lee ◽

...

Keyword(s):

Metabolic Syndrome ◽

General Population ◽

Renal Disease ◽

End Stage Renal Disease ◽

Group Versus ◽

National Health Insurance System ◽

Nationally Representative ◽

Stage Renal Disease ◽

End Stage ◽

The Impact

AbstractFew studies have investigated the impact of a change in metabolic syndrome (MetS) components on clinical renal outcomes in the general population. Using nationally representative data from the Korean National Health Insurance System, 13,310,924 subjects who underwent two health examinations over 2 years and were free from end-stage renal disease (ESRD) from 2009 to 2012 were followed to the end of 2016. The subjects were divided into four groups according to the change in MetS components between the two visits over 2 years: no MetS (–/–), post-MetS (–/+), pre-MetS (+/–), and both MetS (+/+). After a median follow up of 5.11 years, 18,582 incident ESRD cases were identified. In the multivariate adjusted model, the hazard ratio (HR) and 95% confidence interval (CI) for the development of ESRD in the both-MetS (+/+) group compared with the no-MetS (–/–) group was 5.65 (95% CI, 5.42–5.89), which was independent of age, sex, and baseline estimated glomerular filtration rate. Additionally, the HR for the pre-MetS (+/–) group versus the no-MetS (–/–) group was 2.28 (2.15–2.42). In subgroup analysis according to renal function, the impact of a change in MetS on the incidence of ESRD was more pronounced in individuals with advanced renal dysfunction. Subjects with resolved MetS components had a decreased risk of ESRD, but not as low as those that never had MetS components. This provides evidence supporting the strategy of modulating MetS in the general population to prevent the development of ESRD.

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P1007CHANGES IN METABOLIC SYNDROME COMPONENTS AND RISK OF END STAGE RENAL DISEASE: A NATIONWIDE COHORT STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1007 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Eun Sil Koh ◽

Yura Chae ◽

Sungjin Chung ◽

Hyuk Sang Kwon

Keyword(s):

Metabolic Syndrome ◽

General Population ◽

Renal Disease ◽

End Stage Renal Disease ◽

Group Versus ◽

National Health Insurance System ◽

Nationally Representative ◽

Stage Renal Disease ◽

End Stage ◽

The Impact

Abstract Background and Aims Few studies have investigated the impact of a change in metabolic syndrome (MetS) components on clinical renal outcomes in the general population. Method Using nationally representative data from the Korean National Health Insurance System, 13,310,924 subjects who underwent two health examinations over 2 years and were free from end-stage renal disease (ESRD) from 2009 to 2012 were followed to the end of 2016. The subjects were divided into four groups according to the change in MetS components between the two visits over 2 years: no MetS (–/–), post-MetS (–/+), pre-MetS (+/–), and both MetS (+/+). Results After a median follow up of 5.11 years, 18,582 incident ESRD cases were identified. In the multivariate adjusted model, the hazard ratio (HR) and 95% confidence interval (CI) for the development of ESRD in the both-MetS (+/+) group compared with the no-MetS (–/–) group was 5.65 (95% CI, 5.42–5.89), which was independent of age, sex, and baseline estimated glomerular filtration rate. Additionally, the HR for the pre-MetS (+/-) group versus the no-MetS (–/–) group was 2.28 (2.15–2.42). In subgroup analysis according to renal function, the impact of a change in MetS on the incidence of ESRD was more pronounced in individuals with advanced renal dysfunction. Subjects with resolved MetS components had a decreased risk of ESRD, but not as low as those that never had MetS components. Conclusion This provides evidence supporting the strategy of modulating MetS in the general population to prevent the development of ESRD.

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Depression among end-stage renal disease patients undergoing hemodialysis: a cross-sectional study from Palestine

Renal Replacement Therapy ◽

10.1186/s41100-021-00331-1 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Samah W. Al-Jabi ◽

Ansam Sous ◽

Fatimah Jorf ◽

Mahmoud Taqatqa ◽

Mahdi Allan ◽

...

Keyword(s):

Renal Disease ◽

Low Income ◽

End Stage Renal Disease ◽

West Bank ◽

Psychological Status ◽

The West ◽

Depression Prevalence ◽

Stage Renal Disease ◽

End Stage ◽

The Impact

Abstract Background The impact of end-stage renal disease on the patient’s psychological status necessitates the value of increasing depression awareness. The current study aimed to assess the depression prevalence among Palestinian hemodialyzed patients and its association with patients’ characteristics. Methods A convenience clustered sampling technique was followed. Sample was collected from ten hemodialysis centers in the West Bank, Palestine, during 3 months in 2015. We used the Beck Depression Inventory-II scale (BDI-II) to evaluate depression among participants. All data were analyzed using Statistical Package for the Social Sciences version 16.0. Results Two hundred and eighty-six hemodialyzed patients were interviewed. The mean age (± standard deviation) of the patients was 52.0 ± 14.3 years, and most participants were males 172 (60.1%). Regarding the dialysis characteristics, the median of years of dialysis was 2 years (1–4). The prevalence of depression was 73.1%. Elderly patients (p = 0.001), female (p = 0.036), living in rural areas or camp (p = 0.032), low income (p = 0.041), unemployment (p = 0.001), not doing regular exercise (p = 0.001), and having multi comorbidities (p = 0.001) were significantly associated with more depression scores. The results of binary logistic regression showed that only patients who were living in camps, patients who were previously employed, and patients who were not practicing exercise remained significantly associated with a higher depression score. Conclusions This study is the first one confirmed about depression and its prevalence among hemodialyzed patients in the West Bank, Palestine. Compared to other communities, the study found a higher depression prevalence rate. There is a need to offer psychological interviews and non-pharmacological and pharmacological interventions.

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