scholarly journals Recovery of new-onset kidney disease in COVID-19 patients discharged from hospital

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nan-Hui Zhang ◽  
Yi-Chun Cheng ◽  
Ran Luo ◽  
Chun-Xiu Zhang ◽  
Shu-Wang Ge ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Kidney Diseases ◽  
Descriptive Statistics ◽  
Limited Information ◽  
High Discharge ◽  
Discharged Patients ◽  
Recovery Group ◽  
Abundant Data ◽  
New Onset

Abstract Background Coronavirus disease 2019 (COVID-19) has emerged as a major global health threat with a great number of deaths worldwide. Despite abundant data on that many COVID-19 patients also displayed kidney disease, there is limited information available about the recovery of kidney disease after discharge. Methods Retrospective and prospective cohort study to patients with new-onset kidney disease during the COVID-19 hospitalization, admitted between January 28 to February 26, 2020. The median follow-up was 4 months after discharge. The follow-up patients were divided into the recovery group and non-recovery group. Descriptive statistics and between-groups comparison were used. Results In total, 143 discharged patients with new-onset kidney disease during the COVID-19 hospitalization were included. Patients had a median age was 64 (IQR, 51–70) years, and 59.4% of patients were men. During 4-months median follow-up, 91% (130 of 143) patients recovered from kidney disease, and 9% (13 of 143) patients haven’t recovered. The median age of patients in the non-recovery group was 72 years, which was significantly higher than the median age of 62 years in the recovery group. Discharge serum creatinine was significantly higher in the non-recovery group than in the recovery group. Conclusions Most of the new-onset kidney diseases during hospitalization of COVID-19 patients recovered 4 months after discharge. We recommend that COVID-19 patients with new-onset kidney disease be followed after discharge to assess kidney recovery, especially elderly patients or patients with high discharge creatinine.

scholarly journals Obesity, Abdominal Obesity and Chronic Kidney Disease in Young Adults: A Nationwide Population-Based Cohort Study

2021 ◽  
Vol 10 (5) ◽  
pp. 1065
Author(s):  
Eun Hui Bae ◽  
Sang Yeob Lim ◽  
Jin-Hyung Jung ◽  
Tae Ryom Oh ◽  
Hong Sang Choi ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Young Adults ◽  
Kidney Disease ◽  
Abdominal Obesity ◽  
Population Based ◽  
Baseline Body Mass Index ◽  
Increased Risk ◽  
Baseline Examination ◽  
New Onset

Obesity has become a pandemic. It is one of the strongest risk-factors of new-onset chronic kidney disease (CKD). However, the effects of obesity and abdominal obesity on the risk of developing CKD in young adults has not been elucidated. From a nationwide health screening database, we included 3,030,884 young adults aged 20–39 years without CKD during a baseline examination in 2009–2010, who could follow up during 2013–2016. Patients were stratified into five levels based on their baseline body mass index (BMI) and six levels based on their waist circumference (WC; 5-cm increments). The primary outcome was the development of CKD. During the follow up, until 2016, 5853 (0.19%) participants developed CKD. Both BMI and WC showed a U-shaped relationship with CKD risk, identifying the cut-off values as a BMI of 21 and WC of 72 cm in young adults. The obesity group (odd ratio [OR] = 1.320, 95% confidence interval [CI]: 1.247–1.397) and abdominal obesity group (male WC ≥ 90, female WC ≥ 85) (OR = 1.208, 95%CI: 1.332–1.290) showed a higher CKD risk than the non-obesity or non-abdominal obesity groups after adjusting for covariates. In the CKD risk by obesity composite, the obesity displayed by the abdominal obesity group showed the highest CKD risk (OR = 1.502, 95%CI: 1.190–1.895), especially in those under 30 years old. During subgroup analysis, the diabetes mellitus (DM) group with obesity or abdominal obesity paradoxically showed a lower CKD risk compared with the non-obesity or non-abdominal obesity group. Obesity and abdominal obesity are associated with increased risk of developing CKD in young adults but a decreased risk in young adults with diabetes.

scholarly journals Interatrial block, P terminal force or fragmented QRS do not predict new-onset atrial fibrillation in patients with severe chronic kidney disease

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Tapio Hellman ◽  
Markus Hakamäki ◽  
Roosa Lankinen ◽  
Niina Koivuviita ◽  
Jussi Pärkkä ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
P Wave ◽  
Stage 4 ◽  
Ckd Stage ◽  
Severe Chronic Kidney Disease ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Background The prevalence of left atrial enlargement (LAE) and fragmented QRS (fQRS) diagnosed using ECG criteria in patients with severe chronic kidney disease (CKD) is unknown. Furthermore, there is limited data on predicting new-onset atrial fibrillation (AF) with LAE or fQRS in this patient group. Methods We enrolled 165 consecutive non-dialysis patients with CKD stage 4–5 without prior AF diagnosis between 2013 and 2017 in a prospective follow-up cohort study. LAE was defined as total P-wave duration ≥120 ms in lead II ± > 1 biphasic P-waves in leads II, III or aVF; or duration of terminal negative portion of P-wave > 40 ms or depth of terminal negative portion of P-wave > 1 mm in lead V1 from a baseline ECG, respectively. fQRS was defined as the presence of a notched R or S wave or the presence of ≥1 additional R waves (R’) or; in the presence of a wide QRS complex (> 120 ms), > 2 notches in R or S waves in two contiguous leads corresponding to a myocardial region, respectively. Results Mean age of the patients was 59 (SD 14) years, 56/165 (33.9%) were female and the mean estimated glomerular filtration rate was 12.8 ml/min/1.73m2. Altogether 29/165 (17.6%) patients were observed with new-onset AF within median follow-up of 3 [IQR 3, range 2–6] years. At baseline, 137/165 (83.0%) and 144/165 (87.3%) patients were observed with LAE and fQRS, respectively. Furthermore, LAE and fQRS co-existed in 121/165 (73.3%) patients. Neither findings were associated with the risk of new-onset AF within follow-up. Conclusion The prevalence of LAE and fQRS at baseline in this study on CKD stage 4–5 patients not on dialysis was very high. However, LAE or fQRS failed to predict occurrence of new-onset AF in these patients.

scholarly journals Association Between Blood Lipid Profile and the Incident CKD in the General Chinese Population: A Retrospective Study

2020 ◽  
Author(s):  
Jian Liu ◽  
Geping Yu ◽  
Xialian Yu ◽  
Yunzi Liu ◽  
Weiming Wang
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Diseases ◽  
Blood Lipid ◽  
Health Examination ◽  
Blood Lipid Profile ◽  
Logistic Analysis ◽  
Lower Baseline ◽  
Lipid Parameters

Abstract Background: Prevalence of dyslipidemia in china is rising and the pattern of dyslipidemia in china is different from western countries. Our study aimed to investigate the association between hyperlipidemia and chronic kidney disease in the general population.Methods: We conducted a retrospective, longitudinal cohort study of a health examination center database in China. Subjects who had at least three visits from 2011 to 2018 with normal baseline eGFR were enrolled. We evaluated the association of the lipid parameters with the incident chronic kidney diseases. Results: Totally, 8087 participants without kidney damage were identified. After the mean 5.51 years follow-up, 211 participants developed chronic kidney disease. Compared to non-CKD, participants developing CKD had lower baseline HDL-c (1.35±0.36 vs 1.24±0.36 mmol/L, p<0.001) and higher Lg(triglyceride) (0.15±0.27 vs 0.19±0.24, p=0.037). There was no difference of LDL-c (2.72±0.72 vs 2.72±0.71 mmol/L, p= 0.971) and total cholesterol (4.86±0.92 vs 4.80±0.89 mmol/L, p= 0.329) in two groups. Multi-variable logistic analysis showed that lower HDL-c was an independent risk of incident CKD (OR [95%] =1.61[1.02, 2.55], P=0.04) in participants.Conclusion: A lower HDL-c affects incident CKD in Chinese general population.

MO1005ADPEDKD: A GLOBAL ONLINE PLATFORM TO EXPLORE THE CHILDHOOD PHENOTYPE OF AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE*

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Angélique Dachy ◽  
Stéphanie De Rechter ◽  
Lisa Guay-Woodford ◽  
Andrew John Mallett ◽  
Tess Harris ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Longitudinal Data ◽  
Polycystic Kidney Disease ◽  
Autosomal Dominant ◽  
Kidney Diseases ◽  
Polycystic Kidney ◽  
Autosomal Dominant Polycystic Kidney ◽  
Tract Infections ◽  
Prospective Longitudinal

Abstract Background and Aims Autosomal Dominant Polycystic Kidney Disease (ADPKD) is the 4th common cause of renal replacement therapy worldwide. As the disorder has been historically considered an adult-onset disease, there is a lack of longitudinal data from large pediatric cohorts. However, evidence is growing that first manifestations of ADPKD may be detected in childhood and children represent a specific target population for future treatment, allowing a better chance of preserving long term kidney function. To better define the pediatric spectrum of the disease, a global multicenter observational study on childhood-diagnosed ADPKD was launched in 2017. Method The ADPedKD registry is a worldwide web-based database, including both retrospective and prospective longitudinal data from young ADPKD patients (≤19 years). Australia, North-America and the United Kingdom joined the initiative with their source databases, namely the KidGen Collaborative (KidGen), NIH-funded Hepato-Renal Fibrocystic Disease (HRFD) and National Registry of Rare Kidney Diseases (RaDaR). Under informed consent, de-identified patient data, including genetics, radiological and laboratory findings, treatments and follow-up were enrolled in the database accessible via https://www.ADPedKd.org/. Results 1019 ADPKD children (from 89 centers and 33 countries) are enrolled in the registry of which 167 patients from RaDaR, 17 from KidGen, 11 from HRFD and 824 from ADPedKD (401 male/ 423 female) with a mean (± SD) age at diagnosis of 6.3 ± 5.2 years. 81 children (9.8%) were diagnosed prenatally at a mean gestational age of 26.8 ± 7.8 weeks. Reasons for initial visit were: family screening in 325 (39.4%), postnatal incidental finding in 223 (27.0%), presenting features (such as hematuria, hypertension, urinary tract infections and flank or back pain) in 150 (18.2%) or unknown/not available in 126 (15.3%). Genetic testing was performed in 42.8% of the population, with the following results: PKD1 mutation (85.4%), PKD2 mutation (11.7%) and others (6.0%). Conclusion The ADPedKD registry is a unique source of clinical observational data that will provide deep phenotyping of children with ADPKD and will allow to define unified diagnostic, treatment and follow-up recommendations.

Association of chronic co-morbidities with long term survival with metastatic renal cell carcinoma (mRCC).

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 472-472
Author(s):  
Matthew T. Campbell ◽  
Amishi Yogesh Shah ◽  
Kirtan Das Nautiyal ◽  
Neda Hashemi ◽  
Paul Gettys Corn ◽  
...  
Keyword(s):  
Targeted Therapy ◽  
Systemic Therapy ◽  
De Novo ◽  
Mtor Inhibitors ◽  
Descriptive Statistics ◽  
Term Survival ◽  
Long Term Survivors ◽  
New Onset

472 Background: Since the introduction of targeted therapy, patients (pts) with mRCC are living longer. Cumulative toxicities of sequential targeted therapies remain an area largely unexplored. Methods: A retrospective review of consecutive mRCC pts evaluated at MDACC from 1/1/2001 to 12/31/2008 was conducted. We characterized pts who lived >4 yrs with metastatic disease. In the table below, de novo hypertension (HTN) refers to new onset HTN on VEGF or mTOR targeted therapy (TT), HTN exacerbation refers to HTN in pts with already documented HTN on TT, HTN exacerbation after de novo HTN refers to pts who had exacerbations during subsequent TT after de novo HTN on TT. Descriptive statistics were used. Results: 205 pts with evaluable initial data were characterized for baseline co-morbidities listed in the table below; 37 pts did not have adequate follow up. Of the remaining 168 pts, 12 were managed with surgical resections only and did not receive any systemic therapy, 12 pts received systemic therapy (Tx), but not TT, and 144 received TT: 142 pts (84.5%) received at least 1 VEGF-directed agent, 115 pts (68.5%) received multiple VEGF-directed agents, 75 pts (44.6%) received mTOR inhibitors. Conclusions: Development of HTN and HTN exacerbations are markers of treatment efficacy. The long-term survivors identified in our series had high rates of HTN, hyperlipidemia, hypothyroidism, and VTE. Toxicity cost is an important aspect of long-term survivorship and warrants continued study. [Table: see text]

scholarly journals Diabetológia és szervátültetés

2018 ◽  
Vol 159 (46) ◽  
pp. 1930-1939 ◽  
Author(s):  
László Wagner ◽  
István Wittmann ◽  
László Piros ◽  
Réka P. Szabó ◽  
Péter Szakály
Keyword(s):  
Diabetic Nephropathy ◽  
Kidney Diseases ◽  
Vascular Complications ◽  
Diabetic Patients ◽  
Insulin Administration ◽  
Insulin Independence ◽  
End Stage ◽  
New Onset

Abstract: Diabetes increases the risk of different kidney diseases. The most important is diabetic nephropathy, however, ischemic kidney disease, chronic pyleonephritis and papilla necrosis may also develop. The prognosis of diabetic nephropathy has improved recently, however, it is still the primary cause of dialysis and transplantation. Cardiovascular diseases predict mostly mortality in diabetic patients, however, cerebrovascular insults and peripheral obstructive arterial diseases necessitating lower limb amputations are also important. Diabetic retinopathy is almost always present with diabetic nephropathy. Diabetic neuropathy may also develop, furthermore vascular complications often combine. All these urge complex workup, follow-up and early treatment. If transplantation is indicated, preemptive operation should be preferred, and living donation shows the best outcomes. Different forms of carbohydrate disorder may occur after transplantation: new-onset diabetes or diabetes known before transplantation may progress. Renal transplantation with pancreas transplantation may be indicated in type 1 diabetes with end-stage diabetic nephropathy, most often simultaneously. This may result in normoglycemia and insulin-independence and the progression of other complications may also halt. Transplant associated hyperglycemia occurs in most of the patients early, however, it is often transitory. Despite stabilization of the patient and of the immunosuppressive therapy, about one third of the patients may develop posttransplant diabetes. Insulin secretion disorder is the primary cause, but insulin resistance is also needed. Insulin administration may help, however, other antidiabetics can also be useful. Carbohydrate metabolism should be checked in both cadaveric and living donors. The authors make an attempt to summarize the above conditions with Hungarian relevance as well. Orv Hetil. 2018; 159(46): 1930–1939.

scholarly journals P0279DIABETIC KIDNEY DISEASE VERSUS CHRONIC KIDNEY DISEASE IN ADULTS WITHOUT DIABETES MELLITUS: A RENAL SURVIVAL ANALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Gabriel Stefan ◽  
Ligia Petrescu ◽  
Simona Stancu ◽  
Gabriel Mircescu
Keyword(s):  
Kidney Disease ◽  
Cox Regression ◽  
Kidney Diseases ◽  
Renal Outcome ◽  
Total Serum ◽  
Rapid Progression ◽  
Renal Survival ◽  
Arterial Blood ◽  
Egfr Decline

Abstract Background and Aims Diabetic kidney disease (DKD) is the most common cause of end-stage renal disease, but the decline in kidney function varies considerably between chronic kidney diseases (CKD), and determinants of renal function loss, early in the course of the disease, are still a matter of debate. Method We retrospectively examined the renal outcome at 31 July 2017 of 309 CKD patients (age 59.1 (50.1-68.6) years; 60% male; eGFR 32.7 (21.7-44.8) mL/min) admitted in our hospital during January 2007-December 2012 with a median follow up time of 7.2 (95%CI, 6.8-7.6) years. Only patients who had at least 3 admissions and who were alive during the study period were included. CKD was defined as the presence of an eGFR &lt;60ml/min/1.73m2 or the presence of albuminuria &gt;30mg/g creatinine for more than 3 months. The primary endpoint was renal survival defined as renal replacement therapy (RRT) initiation. Factors affecting renal survival were evaluated in a Cox proportional hazard model. Results DKD (24%), glomerular (GN, 24%), tubulo-interstitial (TIN, 27%) and vascular nephropathies (VN, 25%) were the causes of CKD. Patients with DKD (66.8 (56.5-72.2) years) and VN (68.5 (59.7-76.2) years) were older than those with GN (50.3 (37.4-59.0) years) and TIN (55.6 (45.8-61.8) years). Moreover, the highest cardiovascular comorbidity score was found in patients with VN and DKD (p&lt;0.001). Median eGFR decline was -1.23 ( -3.39 – 0.35) mL/min/year; 29% of the patients had CKD progression of &gt;3mL/min/year and 14% had rapid progression (&gt;5mL/min/year). Patients with GN had the lowest eGFR (26.8 (19.1-38.9) versus DKD 36.2 (23.4-47.7), VN 34.9 (22.4-51.0), TIN 32.4 (21.8-44.8) mL/min, p&lt;0.001), the fastest eGFR decline (-3.1 versus DKD -1.9, VN -1, TIN -1,2 mL/min/year, p 0.5) and the highest proteinuria (2.7 versus DKD 1.4, VN 0.4, TIN 0.6 g/24h, p&lt;0.001). During follow up, 29% of the studied patients started RRT; mean renal survival time for the entire cohort was 7.4 (95%CI, 7.0-7.8) years. CKD cause (versus DKD p=0.04, Figure 1), lower eGFR (HR 0.89 (95%CI, 0.85-0.93)), elevated albuminuria (HR 1.4 (95%CI, 1.2-1.7)), higher total serum cholesterol (HR 1.00 (95%CI, 1.00-1.01)) and elevated mean arterial blood pressure (HR 1.03 (95%CI, 1.00-1.06)) were associated with RRT initiation in the Cox regression model. Conclusion Patients with DKD and VN had similar poorer renal survival as compared with GN and TIN. Earlier referral to the diabetic renal clinic and intensive management of the modifiable risk factors (albuminuria, hypercholesterolemia, hypertention) are necessary to retard progression of CKD and, subsequently, prolong renal survival.

scholarly journals Struggles with infrastructures of information concerning hospital-to-home transitions

2020 ◽  
Vol 25 (1) ◽  
pp. 10-15
Author(s):  
Annelise Norlyk ◽  
Cecilia Lykke Deleuran ◽  
Bente Martinsen
Keyword(s):  
Information Flow ◽  
Limited Information ◽  
Focus Group Interviews ◽  
Unique Role ◽  
Content Analyses ◽  
Discharged Patients ◽  
Group Interviews ◽  
Professional Information ◽  
Hospital To Home

Homecare nurses play a unique role in providing care during the follow-up after hospital discharge and in preventing readmission. The aim of this study was to explore the key challenges faced by homecare nurses in relation to caring for discharged patients. Data were collected through five focus group interviews with 29 Danish homecare nurses and subjected to inductive content analyses. The key challenges faced by homecare nurses fell into three themes: struggling to see the bigger picture, caring for patients from a distance, and compromising on professionalism. The findings demonstrated a paradox between the need for information and the struggle to access this information due to complicated infrastructures of information-sharing. Homecare nurses took on a substantial responsibility in providing the best possible care despite having limited information. Ironically, by taking on this responsibility, they implicitly contribute to covering up the problems of organisational and professional information flow.

scholarly journals COVID-19 and kidney diseases: A meta-analysis of clinical outcomes

2021 ◽  
pp. 53-66
Author(s):  
Fateme Shamekhi Amiri
Keyword(s):  
Kidney Disease ◽  
Effect Size ◽  
Kidney Diseases ◽  
Meta Analysis ◽  
Graft Loss ◽  
Laboratory Data ◽  
Medium Effect ◽  
Study Results ◽  
Acute Kidney Disease

Abstract. Novel coronavirus 2019 (COVID-19) is a highly infectious disease that causes multiorgan failure and a high mortality rate. The present study aimed to investigate the association between COVID-19 infection and kidney dysfunction.Methods. In this meta-analysis study, 68 patients with kidney dysfunction and COVID-19 infection were analysed. Clinical features, laboratory data at initial presentation, management and, outcomes were collected. Risk of acute kidney injury (AKI), acute kidney disease (AKD) and chronic kidney disease (CKD) progression to kidney replacement therapy and graft loss were primary outcomes in this study. Results. The average age of patients at the time of diagnosis in COVID-19 nephropathy was 52.04 ± 14.42 years. There were ICU admission in 10/68 (14.7%) patients with COVID-19 nephropathy. There were a need for mechanical ventilation in 13/68 (19.1%) patients; 15/68 (22%) patients died during hospital course or post-discharge. There were AKI in 4/68 (5.8%) patients with COVID-19 nephropathy and AKD found in 14/68 (20.5%) patients with COVID-19 nephropathy during the follow-up. The median and interquartile range of SCr during the follow-up period was assessed at 1.74 mg/dl and 1.18 (Q3-Q1=2.73-1.55), respectively. The effect size of COVID-19 on AKI and AKD was assessed 0 and 0.003 using Cohen᾽s-d test. Eventually, 10 of 68 (14.7%) patients with COVID-19 nephropathy stayed on hemodialysis during the follow-up period and one of them remained on RRT but its type was not characterized. There were a total of 36/68 (52.9%) kidney transplant recipients and 10/36 (27.7%) of them developed AKI due to acute rejection. The effect size of elevated IL-6 on decreased estimated glomerular filtration rate (eGFR) in COVID-19 nephropathy was assessed 0.656 (medium effect size). Conclusion. The COVID-19 had a trivial (small) effect on eGFR declining. Future clinical research is required for investigating novel unknown findings in COVID-19 nephropathy.

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