Abstract P602: Patiromer Decreased Aldosterone, Urine Albumin/Creatinine Ratio, and Blood Pressure in Patients with Chronic Kidney Disease and Hyperkalemia on RAAS Inhibitors: Results from OPAL-HK

Hypertension ◽  
2015 ◽  
Vol 66 (suppl_1) ◽  
Author(s):  
Matthew Weir ◽  
George Bakris ◽  
Coleman Gross ◽  
Martha Mayo ◽  
Dahlia Garza ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Plasma Renin ◽  
Creatinine Ratio ◽  
Phase 3 ◽  
Albumin Creatinine Ratio ◽  
Urine Albumin ◽  
Raas Inhibitors ◽  
Withdrawal Phase

Introduction: Elevated aldosterone (ALD) is associated with chronic kidney disease (CKD) and cardiovascular (CV) complications. Patiromer, a nonabsorbed potassium (K + )-binding polymer, decreases serum K + (sK + ) and may allow increased use of RAAS inhibitors (RAASi) in patients (pts) with CKD and hyperkalemia (HK). This analysis examined the effect of patiromer on ALD, urinary albumin/creatinine ratio (ACR), and blood pressure (BP) in pts with CKD on RAASi. Methods: OPAL-HK was a 2-part, phase 3 study in 243 CKD pts with sK + 5.1–<6.5 mEq/L on RAASi. Pts received patiromer for 4 wks (Part A); pts with moderate-severe HK at baseline (sK + ≥5.5 mEq/L) and sK + 3.8–<5.1 at Part A wk 4 continued on patiromer (n=55) or switched to placebo (n=52) in the 8-wk withdrawal phase (Part B). RAASi were stable prior to and during Part A. Changes in ALD, ACR, and systolic BP/diastolic BP (SBP/DBP) were analyzed. Results: After 4 wks of patiromer sK + , serum ALD and urine ALD/creatinine decreased, while plasma renin activity (PRA) was unchanged; SBP, DBP, and ACR also declined (Table). Mean±SE changes (ng/dL) in serum ALD from Part A wk 4 to Part B wk 4 and to Part B wk 8 were 4.6±1.6 (p<0.01) and 5.7±1.8 (p<0.01) in the placebo and 0.9±1.0 (p=NS) and 0.2±0.8 (p=NS) in the patiromer groups, respectively. Compared with Part A wk 4, SBP (mm Hg) was further reduced at Part B wk 4 (3.1±2.1, p=NS) and Part B wk 8 (5.4±1.9, p<0.01) with maintained improvement in ACR in patiromer pts. Conclusions: Patiromer reduced both sK + and ALD (independent of PRA) in CKD pts with HK on RAASi. ALD reductions correlated with lower BP and ACR. Reduction in sK + may have lowered ALD possibly improving BP and ACR.

scholarly journals Prevalence of Early Chronic Kidney Disease and Main Associated Factors in Spanish Population: Populational Study

2019 ◽  
Vol 8 (9) ◽  
pp. 1384 ◽  
Author(s):  
Carmen Expósito ◽  
Guillem Pera ◽  
Lluís Rodríguez ◽  
Ingrid Arteaga ◽  
Alba Martínez ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Multivariate Logistic Regression Model ◽  
Creatinine Ratio ◽  
Multivariate Logistic Regression ◽  
Albumin Creatinine Ratio ◽  
Factors Associated ◽  
Urine Albumin ◽  
Primary Healthcare Centers

The aim of this study was to determine the prevalence of early chronic kidney disease (EKD) (stages 1 and 2) and the factors associated. This was a populational study including individuals from 18–75 years randomly selected from 18 Primary Healthcare centers in the area of Barcelonès Nord and Maresme (Catalunya, Spain). Variables: anamnesis, physical examination, blood pressure, and analysis. EKD was defined with by a glomerular filtration rate (GFR) ≥60 mL/min/1.73 m2 and albumin/creatinine ratio (ACR) ≥17 mg/g in men and ≥25 mg/g in women confirmed with two determinations. 2871 individuals: 43% men, mean age 55 years (19–75), 32.2% obese, 50.5% abdominal obesity, 21.1% hypertensive, and 10.6% diabetic. Prevalence of EKD: With one determination 157 individuals (5.5%), 110 men (9%) and 47 women (2.8%); with two determinations 109 individuals (3.8%), 85 men (7%), and 24 women (1.5%). Factors independently associated with the multivariate logistic regression model: Man (OR 3.35), blood pressure ≥ 135/85 mmHg (OR 2.29), BMI ≥ 30 kg/m2 (OR 2.48), glycemia ≥ 100 mg/dL (OR 1.73), smoker (OR 1.67) and age (OR 1.04). The prevalence varies if the diagnosis is established based on one or two analytical determinations, overestimated if only one determination is made and depends on the value chosen to define urine albumin excretion.

scholarly journals The role of urine albumin creatinine ratio and serum β2 microglobulin as biomarkers of chronic kidney disease

2019 ◽  
Vol 38 (3) ◽  
pp. 172
Author(s):  
Augustine Onovuakpo Eguvbe ◽  
Marcellinus Uchechukwu Nwagu ◽  
Eshiotseme Sylvester Idogun ◽  
Adeyinka Abdulrasaq Akande
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Receiver Operating Curve ◽  
Strong Positive Correlation ◽  
Creatinine Ratio ◽  
Albumin Creatinine Ratio ◽  
Β2 Microglobulin ◽  
Urine Albumin ◽  
Urine Albumin Creatinine Ratio

<p><strong>BACKGROUND</strong></p><p>Chronic kidney disease (CKD) is an increasing burden on individuals and on the healthcare system. The need to identify more sensitive and specific markers of CKD cannot be overemphasized to facilitate detection and appropriate intervention. β2 microglobulin is one of such markers of CKD. The aim of this study was to investigate the sensitivities and specificities of serum β2 microglobulin and major biochemical markers of CKD, namely creatinine and urine albumin.</p><p><strong> </strong></p><p><strong>METHODS</strong></p><p>This was a hospital-based cross-sectional study involving 124 subjects with CKD and 124 healthy controls. Participants were categorized in two groups : group 1 the CKD based on persistent reduction in GFR &lt;60 mL/min/1.73 m2 and group 2 healthy subjects as controls. Blood (serum) samples of participants were analyzed for serum creatinine and serum β2 microglobulin while their urine samples were analyzed for creatinine and albumin. Urine albumin creatinine ratio (UACR) was calculated from the results of the analyses.</p><p><strong> </strong></p><p><strong>RESULTS</strong></p><p>There was a very strong positive correlation of serum β2 microglobulin with serum creatinine (r=0.750; p=0.000) and UACR (r=0.775; p=0.000), respectively. Also, there was a very strong negative correlation between serum β2 microglobulin and eGFR (r=-0.866; p=0.000). UACR had the highest sensitivity and specificity as shown by receiver operating curve characteristics (ROC) analysis.</p><p><strong> </strong></p><p><strong>CONCLUSION</strong></p><p>In CKD, UACR and serum β2 microglobulin had the best diagnostic value. Periodic renal assessment of renal patients is mandatory as they may be affected by hidden renal dysfunction.</p>

Abstract 4351: Albuminuria is a Risk Factor for Adverse Events in Heart Failure Independent of the Presence of Chronic Kidney Disease

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Adheesh Agnihotri ◽  
Kalkidan Bishu ◽  
James Arnold ◽  
Gary Gustafson ◽  
Inder S Anand
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Risk Factor ◽  
Kidney Disease ◽  
Adverse Events ◽  
Systolic Blood Pressure ◽  
Left Ventricular ◽  
Creatinine Ratio ◽  
Albumin Creatinine Ratio

Background : Chronic kidney disease (CKD) is a known risk factor for adverse events in patients with heart failure (HF). Whether albuminuria defined as urine albumin creatinine ratio ≥30 mg/g with or without CKD is also a risk factor for adverse events, is unclear. Methods : Data was abstracted from the electronic medical records of 442 patients admitted to the Minneapolis VA Medical Center with a primary diagnosis of HF, and an outpatient measurement of albumin creatinine ratio between September 2002 and March 2006. Multivariable Cox regression analysis was used to determine the impact of albuminuria on mortality and hospitalizations for HF at 1-year. Results : Albuminuria was seen in 54% (238/442) patients at baseline. Patients with albuminuria were more likely to have edema, higher systolic blood pressure, left ventricular hypertrophy, lower eGFR and use of beta-blockers (all p<0.05). Albuminuria correlated (p<0.05) with serum creatinine (rho=0.23), systolic blood pressure (0.37), and LVEF (0.13). The presence of albuminuria did not increase the risk of death (HR 0.65, 95% CI 0.38 –1.11), but was strongly associated with the risk of hospitalization for HF at 1-year (HR 1.77, 95% CI 1.11–2.82, p=0.017) independent of age, gender, h/o HTN, DM, CAD, PVD, COPD, CKD, atrial fibrillation, EF, use of ACE-I, spironolactone and beta-blocker. Conclusion : The presence of albuminuria is an independent prognostic marker for hospitalizations for heart failure.

Abstract 2280: Urine Albumin/creatinine Ratio, Cardiac Structure And Diastolic Function In Patients With Hypertension And Diastolic Dysfunction: The Validd Study

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Anil Verma ◽  
Rajesh Janardhanan ◽  
William L Daley ◽  
Susan Ritter ◽  
William A Kaye ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Organ Damage ◽  
Left Ventricular ◽  
Creatinine Ratio ◽  
Albumin Creatinine Ratio ◽  
End Organ Damage ◽  
Urine Albumin ◽  
Urine Albumin Creatinine Ratio

Background: Increasing urine albumin/creatinine ratio (ACR) is associated with systemic microvascular damage and increased cardiovascular morbidity and mortality. However, the relationship between albuminuria and left ventricular (LV) diastolic function, an early measure of myocardial end-organ damage in hypertension, has not been well defined. Methods: Urine ACR and echocardiographic measures of LV structure and function were assessed in 384 patients enrolled in the VALsartan In Diastolic Dysfunction (VALIDD) trial with mild hypertension and no heart failure and evidence of diastolic dysfunction based on Doppler assessment of myocardial relaxation velocities. Results: Urine ACR was undetected in 151 (39.3%) subjects, between 1 to 30 mg/g in 194 (50.5%), and > 30mg/g in 39 (10.2%). The mean blood pressure in the cohort was 143.8 ± 16.1/86.2 ± 10.3 mmHg and LV hypertrophy was present in < 4% of enrolled patients. Higher urine ACR was associated with lower annular relaxation velocity (E′), higher E/E′ (Figure ), higher prevalence of concentric LV remodeling and higher NT-ProBNP even after adjusting for age, diabetes, systolic BP, eGFR and LV mass index (LVMi) (p < 0.02 for all associations). Conclusion: Albuminuria is associated with worsening diastolic function in patients with hypertension, and both measures may represent important and modifiable markers of early end-organ damage even in patients with mild blood pressure elevation. E′ stratified by urine albumin creatinine ratio E/E′ stratified by urine albumin creatinine ratio

scholarly journals Serum Carnosinase-1 and Albuminuria Rather than the CNDP1 Genotype Correlate with Urinary Carnosinase-1 in Diabetic and Nondiabetic Patients with Chronic Kidney Disease

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Angelica Rodriguez-Niño ◽  
Sibylle J. Hauske ◽  
Anna Herold ◽  
Jiedong Qiu ◽  
Jacob van den Born ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Healthy Subjects ◽  
Linear Regression Analysis ◽  
Multivariate Linear Regression Analysis ◽  
Creatinine Ratio ◽  
Healthy Individuals ◽  
Albumin Creatinine Ratio ◽  
Spot Urine

Background. Carnosinase-1 (CN-1) can be detected in 24 h urine of healthy individuals and patients with type 2 diabetes (T2DM). We aimed to assess whether urinary CN-1 is also reliably measured in spot urine and investigated its association with renal function and the albumin/creatinine ratio (ACR). We also assessed associations between the CNDP1 (CTG)n genotype and CN-1 concentrations in serum and urine. Methods. Patients with T2DM (n=85) and nondiabetic patients with chronic kidney disease (CKD) (n=26) stratified by albuminuria (ACR≤300 mg/g or ACR>300 mg/g) recruited from the nephrology clinic and healthy subjects (n=24) were studied. Results. Urinary CN-1 was more frequently detected and displayed higher concentrations in patients with ACR>300 mg/g as compared to those with ACR≤300 mg/g irrespective of the baseline disease (T2DM: 554 ng/ml [IQR 212-934 ng/ml] vs. 31 ng/ml [IQR 31-63 ng/ml] (p<0.0001) and nondiabetic CKD: 197 ng/ml [IQR 112-739] vs. 31 ng/ml [IQR 31-226 ng/ml] (p=0.015)). A positive correlation between urinary CN-1 and ACR was found (r=0.68, p<0.0001). Multivariate linear regression analysis revealed that ACR and serum CN-1 concentrations but not eGFR or the CNDP1 genotype are independent predictors of urinary CN-1, explaining 47% of variation of urinary CN-1 concentrations (R2=0.47, p<0.0001). Conclusion. These results confirm and extend previous findings on urinary CN-1 concentrations, suggesting that assessment of CN-1 in spot urine is as reliable as in 24 h urine and may indicate that urinary CN-1 in macroalbuminuric patients is primarily serum-derived and not locally produced.

scholarly journals Relation between Blood Pressure Management and Renal Effects of Sodium-Glucose Cotransporter 2 Inhibitors in Diabetic Patients with Chronic Kidney Disease

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Kazuo Kobayashi ◽  
Masao Toyoda ◽  
Noriko Kaneyama ◽  
Nobuo Hatori ◽  
Takayuki Furuki ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Urinary Albumin ◽  
Analysis Of Covariance ◽  
Creatinine Ratio ◽  
Pressure Management ◽  
Albumin Creatinine Ratio ◽  
Blood Pressure Management ◽  
Sodium Glucose Cotransporter ◽  
Covariance Models

Aim. The renoprotective effect of sodium-glucose cotransporter 2 inhibitors is thought to be due, at least in part, to a decrease in blood pressure. The aim of this study was to determine the renal effects of these inhibitors in low blood pressure patients and the dependence of such effect on blood pressure management status. Methods. The subjects of this retrospective study were 740 patients with type 2 diabetes mellitus and chronic kidney disease who had been managed at the clinical facilities of the Kanagawa Physicians Association. Data on blood pressure management status and urinary albumin-creatinine ratio were analyzed before and after treatment. Results. Changes in the logarithmic value of urinary albumin-creatinine ratio in 327 patients with blood pressure<130/80 mmHg at the initiation of treatment and in 413 patients with BP above 130/80 mmHg were −0.13±1.05 and −0.24±0.97, respectively. However, there was no significant difference between the two groups by analysis of covariance models after adjustment of the logarithmic value of urinary albumin-creatinine ratio at initiation of treatment. Changes in the logarithmic value of urinary albumin-creatinine ratio in patients with mean blood pressure of <102 mmHg (n=537) and those with ≥102 mmHg (n=203) at the time of the survey were −0.25±1.02 and −0.03±0.97, respectively, and the difference was significant in analysis of covariance models even after adjustment for the logarithmic value of urinary albumin-creatinine ratio at initiation of treatment (p<0.001). Conclusion. Our results confirmed that blood pressure management status after treatment with SGLT2 inhibitors influences the extent of change in urinary albumin-creatinine ratio. Stricter blood pressure management is needed to allow the renoprotective effects of sodium-glucose cotransporter 2 inhibitors.

scholarly journals Effects of the Soluble Guanylate Cyclase Stimulator Praliciguat in Diabetic Kidney Disease

2020 ◽  
Vol 16 (1) ◽  
pp. 59-69
Author(s):  
John P. Hanrahan ◽  
Ian H. de Boer ◽  
George L. Bakris ◽  
Phebe J. Wilson ◽  
James D. Wakefield ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Guanylate Cyclase ◽  
Diabetic Kidney Disease ◽  
Soluble Guanylate Cyclase ◽  
Creatinine Ratio ◽  
Primary Efficacy ◽  
Albumin Creatinine Ratio ◽  
Diabetic Kidney ◽  
Urine Albumin ◽  
Urine Albumin Creatinine Ratio

Background and objectivesImpaired nitric oxide signaling through soluble guanylate cyclase has been implicated in the pathophysiology of diabetic kidney disease. Praliciguat, a soluble guanylate cyclase stimulator that amplifies nitric oxide signaling, inhibited kidney inflammation and fibrosis in animal models.Design, setting, participants, & measurementsIn a phase 2 trial, 156 adults with type 2 diabetes, eGFR 30–75 ml/min per 1.73 m2, and urine albumin-creatinine ratio 200–5000 mg/g treated with renin-angiotensin system inhibitors were randomly allocated 1:1:1 to placebo, 20 mg praliciguat, or 40 mg praliciguat daily for 12 weeks. The primary efficacy and safety outcomes were change from baseline to weeks 8 and 12 in urine albumin-creatinine ratio and treatment-emergent adverse events, respectively. Other outcomes assessed were 24-hour ambulatory BP and metabolic parameters.ResultsOf 156 participants randomized, 140 (90%) completed the study. The primary efficacy analysis demonstrated a mean change from baseline in urine albumin-creatinine ratio of −28% (90% confidence interval, −36 to −18) in the pooled praliciguat group and −15% (−28 to 0.4) in the placebo group (difference −15%; −31 to 4; P=0.17). Between-group decreases from baseline to week 12 for praliciguat versus placebo were seen in mean 24-hour systolic BP (−4 mm Hg; −8 to −1), hemoglobin A1c (−0.3%; −0.5 to −0.03), and serum cholesterol (−10 mg/dl; −19 to −1). The incidence of treatment-emergent adverse events was similar in the pooled praliciguat and placebo groups (42% and 44%, respectively). Serious adverse events, events leading to study drug discontinuation, and events potentially related to BP lowering were reported at higher frequency in the 40-mg group but were similar in 20-mg and placebo groups.ConclusionsPraliciguat treatment for 12 weeks did not significantly reduce albuminuria compared with placebo in the primary efficacy analysis. Nonetheless, the observed changes in urine albumin-creatinine ratio, BP, and metabolic variables may support further investigation of praliciguat in diabetic kidney disease.Clinical Trial registry name and registration number:A Study to Evaluate the Soluble Guanylate Cyclase (sGC) Stimulator IW-1973 in Diabetic Nephropathy/Diabetic Kidney Disease as Measured by Albuminuria, NCT03217591

Sign in / Sign up

Export Citation Format

Share Document