THE RELATIONSHIP OF KIDNEY FUNCTION WITH ARTERIAL WALL CONDITION IN INDIVIDUALS WITHOUT CHRONIC KIDNEY DISEASE AND CARDIOVASCULAR DISEASES

Background: Chronic kidney disease (CKD) is a known risk factor for cardiovascular disease (CVD). However, there is a small information about increased risk of CVD already with a slight decrease in kidney function. Substrate for CVD development is subclinical changes in the arterial wall, which can be accelerated by known risk factorsHypothesis: We have assumed that even an initial impairment of kidney function were capable of adversely affecting on the arterial wall.Objective: To examine the association of kidney function with the condition of the arterial wall in persons without CKD and CVD in different age groups.Materials and methods: The study group included 253 subjects free of known CVD and CKD. The average age of the subjects was 51.5 ± 13.3 g. There were 172 women and 81 men. The group of conditionally “older” (women> 55 years, men> 45 years) was 117 people, conditionally “younger” (women ≤ 55 years, men ≤ 45 years) - 136. 55 subjects had arterial hypertension 1-2 st. All subjects had a glomerular filtration rate (GFR) ≥60 ml / min / 1.73 m2, albuminuria <30 mg /24h. When assessing the condition of the arterial wall, the pulse wave velocity (PWV)> 10 m / s had 93 people, the complex intima-media thickness (CIMT)> 0.9 mm had 42 people, the presence of atherosclerotic plaques (AP) had 106 people, and a decrease in endothelium-dependent vasodilation (EDVD) <10% in 86 people. An elevated urea level> 8.3 mmol / l in the blood was detected in 10 people. Determination of creatinine, urea in the blood serum was carried out by routine methods. Measurement of PWV with the help of applanation tonometry. Measurement of CIMT and determination of AP was carried out by means of duplex scanning of carotid arteries. Measurement of EDVD - using a test with reactive hyperemia.Results: Statistical analysis of the results of this study was carried out using the SAS application statistical software package (StatisticalAnalysisSystem, SAS InstituteInc., USA). In the course of multivariate linear regression analysis, a statistically significant independent association of the urea level with CIMT (β = 0.023, p = 0.023) was detected in the “older” group taking into account the correction for sex, systolic blood pressure level, smoking, body mass index, fasting glucose level and albuminuria. Independent relationships of levels of GFR, creatinine and albuminuria with parameters of the vascular wall were not revealed.Conclusions: The level of urea had a direct independent relationship with CIMT in the older age group, which is more likely due to the ability of urea to enhance oxidative stress. Interrelations of the level of GFR, albuminuria, creatinine with the condition of the arterial wall were not obtained in the study group

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The evaluation of kidney function in living kidney donor candidates

Kidney360 ◽

10.34067/kid.0003052021 ◽

2021 ◽

pp. 10.34067/KID.0003052021

Author(s):

Neetika Garg ◽

Emilio D. Poggio ◽

Didier Mandelbrot

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Creatinine Clearance ◽

Kidney Function ◽

The United States ◽

Estimated Gfr ◽

Kidney Donors ◽

Living Kidney Donors ◽

Increased Risk ◽

Measured Gfr

Living kidney donors incur a small increased risk of end-stage kidney disease (ESKD), of which pre-donation glomerular filtration rate (GFR) is an important determinant. As a result, kidney function assessment is central to the donor candidate evaluation and selection process. This article reviews the different methods of GFR assessment including estimated GFR, creatinine clearance and measured GFR, and the current guidelines on GFR thresholds for donor acceptance. Estimated GFR obtained using the 2009 Chronic Kidney Disease Epidemiology Collaboration equation, while the best of estimating estimations, tends to underestimate and has limited accuracy, especially near normal GFR values. In the United States, the Organ Procurement and Transplantation Network policy on living donation mandates either measured GFR or creatinine clearance as part of evaluation. Measured GFR is considered the gold standard, although there is some variation in performance characteristics depending on the marker and technique used. Major limitations of creatinine clearance are dependency on accuracy of timed collection, and overestimation as a result of distal tubular creatinine secretion. GFR declines with healthy aging, and most international guidelines recommend use of age-adapted selection criteria. The 2017 Kidney Disease: Improving Global Outcomes Guideline for the Evaluation and Care of Living Kidney Donors diverges from other guidelines and recommends using absolute cut-off of <60 ml/min/1.73m2 for exclusion and of ≥90 ml/min/1.73m2 for acceptance, and determination of candidacy with intermediate GFR based on long-term ESKD risk. However, several concerns for this strategy exist, including inappropriate acceptance of younger candidates due to underestimation of risk, and exclusion of older candidates whose kidney function is in fact appropriate for age. Role of cystatin C and other newer biomarkers, as well as data on impact of pre-donation GFR on not just ESKD risk but also advanced chronic kidney disease risk and cardiovascular outcomes are needed.

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Clonal hematopoiesis of indeterminate potential is associated with worse kidney function and anemia in a cohort of patients with advanced chronic kidney disease

10.1101/2021.06.30.21259343 ◽

2021 ◽

Author(s):

Caitlyn Vlasschaert ◽

Amy J. M. McNaughton ◽

Wilma Hopman ◽

Bryan Kestenbaum ◽

Cassianne Robinson-Cohen ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Kidney Function ◽

Hematopoietic Stem ◽

Clonal Hematopoiesis ◽

Lower Baseline ◽

Increased Risk ◽

Aging Populations ◽

Lower Egfr ◽

Age And Sex

Background: Clonal hematopoiesis of indeterminate potential (CHIP) is an inflammatory premalignant disorder resulting from acquired genetic mutations in hematopoietic stem cells. CHIP is common in aging populations and associated with cardiovascular morbidity and overall mortality, but its role in chronic kidney disease (CKD) has not been investigated. Methods: We performed targeted sequencing to detect CHIP mutations in a cohort of 87 adults with eGFR < 60 ml/min/1.73m2. Kidney function, hematologic, and mineral bone disease parameters were assessed cross-sectionally at baseline, and a total of 2,091 creatinine measurements and 3,382 hemoglobin measurements were retrospectively collected over the following 12-year period. Results: At baseline, 20 of 87 (23%) cohort participants had CHIP detected. Those with CHIP had lower baseline eGFR (22.3 +/- 11.2 vs. 28.2 +/- 11.5 ml/min/1.73 m2, P = 0.04) in age- and sex-adjusted regression models. Individuals with CHIP had a 2.5-fold increased risk of incident 50% decline in eGFR or ESKD in a Cox proportional hazard model adjusted for age and sex (95% confidence interval, 1.3-4.7). The annualized rate of eGFR decline adjusted for age and sex was -2.3 +/- 1.1 ml/min/1.73m2 per year in those with CHIP versus -1.6 +/- 0.5 ml/min/1.73m2 per year in those without CHIP. Further, those with CHIP had lower hemoglobin at baseline (11.6 +/- 0.3 vs. 12.8 +/- 0.2 g/dL, P = 0.0003) and throughout the follow-up period despite a greater use of erythropoiesis-stimulating agents. Conclusion: In those with pre-existing CKD, CHIP was associated with lower eGFR at baseline, faster progression of CKD, and anemia.

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Description of Serum Urea and Creatinine Levels Pre Hemodialysis and Post Hemodialysis at Royal Prima Hospital in Chronic Kidney Disease

Archives of The Medicine and Case Reports ◽

10.37275/amcr.v2i2.19 ◽

2021 ◽

Vol 2 (2) ◽

pp. 118-123

Author(s):

Raymond Nazimuddin Putra ◽

Valentine Athania Br Perangin-angin ◽

Sahna Ferdinand ◽

Erny Tandanu

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Serum Level ◽

Creatinine Level ◽

Kidney Function ◽

Kidney Failure ◽

Chronic Kidney Failure ◽

Serum Urea ◽

Urea Level ◽

Gradual Loss

Chronic Kidney Failure describes as the gradual loss of kidney functionand it is irreversible, to replace the loss of kidney function a therapy tokidney function is needed, which is hemodialysis. The objective of thisresearch is to know the levels of ureu and creatinine serum for prehemodialysis and post hemodialysis at RSU Royal Prima Medan. Themethods that are being used for this research is descriptive with 54 patientsas samples. The results of this research is loss of urea and creatinine serumlevel, with the average of urea level for pre hemodialysis is 128.11 mg/dL,and the average of urea level for post hemodialysis is 43.26 mg/dL with1,8% patient with low urea level, 50% with normal urea level, and 48.2%with high urea level. The average of creatine level for pre hemodialysis is11.56 mg/dL, and the average of creatine levels is 4.3 mg/dL, with all of thepatient still have a high creatinine levels. The conclusion is there is drop forboth urea and creatinen serum level, but the urea level for half of the patientdid not go down to normal, and for the creatinine level there is none of thepatient creatinine level that go down to normal.

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Correlation Between Soluble Klotho and Vascular Calcification in Chronic Kidney Disease: A Meta-Analysis and Systematic Review

Frontiers in Physiology ◽

10.3389/fphys.2021.711904 ◽

2021 ◽

Vol 12 ◽

Author(s):

QiFeng Liu ◽

LiXia Yu ◽

XiaoYa Yin ◽

JianMing Ye ◽

ShaSha Li

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Publication Bias ◽

Vascular Calcification ◽

Meta Analysis ◽

Linear Regression Analysis ◽

Significant Heterogeneity ◽

Multivariate Linear Regression Analysis ◽

Inverse Association ◽

Increased Risk

Background: The correlation between soluble Klotho (sKlotho) level and vascular calcification (VC) in patients with chronic kidney disease (CKD) remains controversial. Using meta-analysis, we aimed to address this controversy and assess the feasibility of applying sKlotho as a biomarker for VC.Methods: Medical electronic databases were thoroughly searched for eligible publications on the association between sKlotho level and VC in CKD patients. Effectors, including correlation coefficients (r), odds ratios (ORs), hazard ratio (HR) or β-values, and 95% confidence intervals (CIs) were extracted and combined according to study design or effector calculation method. Pooled effectors were generated using both random-effects models and fixed-effects models according to I2-value. Origin of heterogeneity was explored by sensitivity analysis and subgroup analysis.Results: Ten studies with 1,204 participants from a total of 1,199 publications were eligible and included in this meta-analysis. The combined correlation coefficient (r) was [−0.33 (−0.62, −0.04)] with significant heterogeneity (I2 = 89%, p < 0.001) based on Spearman correlation analysis, and this significant association was also demonstrated in subgroups. There was no evidence of publication bias. The combined OR was [3.27 (1.70, 6.30)] with no evidence of heterogeneity (I2 = 0%, p = 0.48) when sKlotho was treated as a categorical variable or [1.05 (1.01, 1.09)] with moderate heterogeneity (I2 = 63%, p = 0.10) when sKlotho was treated as a continuous variable based on multivariate logistic regression. No significant association was observed and the pooled OR was [0.29 (0.01, 11.15)] with high heterogeneity (I2 = 96%, p < 0.001) according to multivariate linear regression analysis. There was an inverse association between sKlotho and parathyroid hormone levels. The combined coefficient (r) was [−0.20 (−0.40, −0.01)] with significant heterogeneity (I2 = 86%, p < 0.001), and without obvious publication bias. No significant association was found between sKlotho and calcium or phosphate levels.Conclusion: There exists a significant association between decreased sKlotho level and increased risk of VC in CKD patients. This raises the possibility of applying sKlotho as a biomarker for VC in CKD populations. Large, prospective, well-designed studies or interventional clinical trials are required to validate our findings.

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Smoking, Smoking Cessation, and Progression of Chronic Kidney Disease: Results From KNOW-CKD Study

Nicotine & Tobacco Research ◽

10.1093/ntr/ntaa071 ◽

2020 ◽

Author(s):

Sangmi Lee ◽

Shinchan Kang ◽

Young Su Joo ◽

Changhyun Lee ◽

Ki Heon Nam ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Smoking Cessation ◽

Cohort Study ◽

Kidney Disease ◽

Kidney Function ◽

Primary Outcome ◽

Incidence Rates ◽

Ckd Progression ◽

Increased Risk ◽

Never Smokers

Abstract Introduction In patients with chronic kidney disease (CKD), studies investigating the association between smoking and deterioration of kidney function are scarce. Aims and Methods We analyzed data for 1,951 patients with an estimated glomerular filtration rate (eGFR) ≥15 mL/min/1.73 m2 enrolled in the KoreaN cohort study for Outcome in patients With Chronic Kidney Disease (KNOW-CKD) from 2011 to 2016. Patients were categorized by smoking load. Primary outcome was a composite of a ≥50% reduction in eGFR, initiation of dialysis, or kidney transplantation. Results There were 967 never-smokers and 369, 276, and 339 smokers who smoked <15, 15 to 29, ≥30 pack-years, respectively. During a mean follow-up of 3.0 years, the incidence rates (95% confidence interval [CI]) of the primary outcome were 54.3 (46.4–63.5), 46.9 (35.9–61.4), 69.2 (52.9–90.6), and 76.3 (60.7–96.0) events per 1,000 person-yr in never-, <15, 15 to 29, and ≥30 pack-year smokers. In cause-specific hazard model after adjustment of confounding factors, smokers were associated with 1.09 (0.73–1.63), 1.48 (1.00–2.18), and 1.94 (1.35–2.77) fold increased risk (95% CI) of primary outcome in <15, 15–29, and ≥30 pack-year smokers compared with never-smokers. The association of longer smoking duration with higher risk of CKD progression was evident particularly in patients with eGFR < 45 mL/min/1.73 m2 and proteinuria ≥ 1.0 g/g. In contrast, the risk of adverse kidney outcome decreased with longer smoking-free periods among former-smokers. Conclusions These findings suggest potentially harmful effects of the degree of exposure to smoking on the progression of CKD. Implications Among patients with CKD, there has been lack of studies on the association between smoking and CKD progression and studies to date have yielded conflicting results. In this prospective cohort study involving Korean CKD patients, smoking was associated with significantly higher risk of worsening kidney function. Furthermore, the risk of adverse kidney outcome was incrementally higher as smoking pack-years were higher. As the duration of smoking cessation increased, the hazard ratios for adverse kidney outcome were attenuated, suggesting that quitting smoking may be a modifiable factor to delay CKD progression.

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Association of pesticides and kidney function among adults in the US population 2001-2010

10.21203/rs.3.rs-452983/v1 ◽

2021 ◽

Author(s):

En-Tzu Wan ◽

Darsy Darssan ◽

Shamshad Karatela ◽

Simon Reid ◽

Nicholas Osborne

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Kidney Function ◽

Dichlorophenoxyacetic Acid ◽

Cross Sectional ◽

Agricultural Communities ◽

Health And Nutrition ◽

Increased Risk ◽

Pesticide Exposures ◽

2,4 Dichlorophenoxyacetic Acid

Abstract Background Chronic kidney disease with unknown cause (CKDu) is prevalent in tropical and agricultural communities, however, its aetiology remains unclear. The objective of this study was to examine the association between pesticide exposures and the risk of kidney function loss using four waves of the National Health and Nutrition Examination Survey (NHANES) to identify a pathological pathway. Methods We pooled data from four cross-sectional waves of NHANES, providing 41,847 participants in total. Sub-population analyses for 2,4-dichlorophenoxyacetic acid (2,4-D), 3,5,6- trichloropyridinol, 3-phenoxybenzoic acid (3-PBA) and Malathion were conducted using. Logistic regression to estimate the odds ratios (ORs) and 95% CIs of the association between log-pesticide levels and kidney function. Results We found that Malathion acid increased the risk of low kidney function among the Malathion sub-population (aOR = 1.26, 95% CI = 1.01–1.56) in the adjusted model. Significantly increased risk of low kidney function was not found among the 2,4-D (aOR = 0.88, 95% CI = 0.72–1.09), 3,5,6-trichloropyridinol (aOR = 0.96, 95% CI = 0.83–1.12) and 3-PBA (aOR = 1.03, 95% CI = 0.94–1.13) subpopulations. Conclusions Our findings provide evidence of altered kidney function in people exposed to Malathion, highlighting the need to focus on Malathion acid as a potential cause of renal injury or chronic kidney disease.

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Prevalence and risk factors for chronic kidney disease of unknown cause in Malawi: a cross-sectional analysis in a rural and urban population

BMC Nephrology ◽

10.1186/s12882-020-02034-x ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Sophie A. Hamilton ◽

Wisdom P. Nakanga ◽

Josephine E. Prynn ◽

Amelia C. Crampin ◽

Daniela Fecht ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Kidney Function ◽

Potential Risk ◽

Cross Sectional ◽

Tropical Countries ◽

Increased Risk ◽

Potential Risk Factors ◽

The Mean

Abstract Background An epidemic of chronic kidney disease of unknown cause (CKDu) is occurring in rural communities in tropical regions of low-and middle-income countries in South America and India. Little information is available from Southern African countries which have similar climatic and occupational characteristics to CKDu-endemic countries. We investigated whether CKDu is prevalent in Malawi and identified its potential risk factors in this setting. Methods We conducted a cross-sectional study from January–August 2018 collecting bio samples and anthropometric data in two Malawian populations. The sample comprised adults > 18 years (n = 821) without diabetes, hypertension, and proteinuria. Estimates of glomerular filtration rate (eGFR) were calculated using the CKD-EPI equation. Linear and logistic regression models were applied with potential risk factors, to estimate risk of reduced eGFR. Results The mean eGFR was 117.1 ± 16.0 ml/min per 1.73m2 and the mean participant age was 33.5 ± 12.7 years. The prevalence of eGFR< 60 was 0.2% (95% confidence interval (95% CI) 0.1, 0.9); the prevalence of eGFR< 90 was 5% (95% CI =3.2, 6.3). We observed a higher prevalence in the rural population (5% (3.6, 7.8)), versus urban (3% (1.4, 6.7)). Age and BMI were associated with reduced eGFR< 90 [Odds ratio (OR) (95%CI) =3.59 (2.58, 5.21) per ten-year increment]; [OR (95%CI) =2.01 (1.27, 3.43) per 5 kg/m2 increment] respectively. No increased risk of eGFR < 90 was observed for rural participants [OR (95%CI) =1.75 (0.50, 6.30)]. Conclusions Reduced kidney function consistent with the definition of CKDu is not common in the areas of Malawi sampled, compared to that observed in other tropical or sub-tropical countries in Central America and South Asia. Reduced eGFR< 90 was related to age, BMI, and was more common in rural areas. These findings are important as they contradict some current hypothesis that CKDu is endemic across tropical and sub-tropical countries. This study has enabled standardized comparisons of impaired kidney function between and within tropical/subtropical regions of the world and will help form the basis for further etiological research, surveillance strategies, and the implementation and evaluation of interventions.

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Chronic kidney disease, heart failure and neprilysin inhibition

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfz058 ◽

2019 ◽

Vol 35 (4) ◽

pp. 558-564 ◽

Cited By ~ 5

Author(s):

Richard Haynes ◽

Doreen Zhu ◽

Parminder K Judge ◽

William G Herrington ◽

Philip A Kalra ◽

...

Keyword(s):

Heart Failure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Kidney Function ◽

Cardiac Biomarkers ◽

Function Allocation ◽

Increased Risk ◽

Patients With Heart Failure ◽

Neprilysin Inhibition ◽

The Uk

Abstract Patients with chronic kidney disease are at increased risk of cardiovascular disease and this often manifests clinically like heart failure. Conversely, patients with heart failure frequently have reduced kidney function. The links between the kidneys and cardiovascular system are being elucidated, with blood pressure being a key risk factor. Patients with heart failure have benefitted from many trials which have now established a strong evidence based on which to base management. However, patients with advanced kidney disease have often been excluded from these trials. Nevertheless, there is little evidence that the benefits of such treatments are modified by the presence or absence of kidney disease, but more direct evidence among patients with advanced kidney disease is required. Neprilysin inhibition is the most recent treatment to be shown to improve outcomes among patients with heart failure. The UK HARP-III trial assessed whether neprilysin inhibition improved kidney function in the short- to medium-term and its effects on cardiovascular biomarkers. Although no effect (compared to irbesartan control) was found on kidney function, allocation to neprilysin inhibition (sacubitril/valsartan) did reduce cardiac biomarkers more than irbesartan, suggesting that this treatment might improve cardiovascular outcomes in this population. Larger clinical outcomes trials are needed to test this hypothesis.

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Description of Serum Urea and Creatinine Levels Pre Hemodialysis and Post Hemodialysis at Royal Prima Hospital in Chronic Kidney Disease

Archives of The Medicine and Case Reports ◽

10.37275/amcr.v2i1.22 ◽

2021 ◽

Vol 2 (1) ◽

pp. 119-124

Author(s):

Raymond Nazimuddin Putra ◽

Valentine Athania Br Perangin-angin ◽

Sahna Ferdinand ◽

Erny Tandanu

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Serum Level ◽

Creatinine Level ◽

Kidney Function ◽

Kidney Failure ◽

Serum Urea ◽

Urea Level ◽

Gradual Loss

A B S T R A C TChronic Kidney Failure describes as the gradual loss of kidney function and it isirreversible, to replace the loss of kidney function a therapy to kidney function isneeded, which is hemodialysis. The objective of this research is to know the levels ofureu and creatinine serum for pre hemodialysis and post hemodialysis at RSU RoyalPrima Medan. The methods that are being used for this research is descriptive with54 patients as samples. The results of this research is loss of urea and creatinineserum level, with the average of urea level for pre hemodialysis is 128.11 mg/dL, andthe average of urea level for post hemodialysis is 43.26 mg/dL with 1,8% patient withlow urea level, 50% with normal urea level, and 48.2% with high urea level. Theaverage of creatine level for pre hemodialysis is 11.56 mg/dL, and the average ofcreatine levels is 4.3 mg/dL, with all of the patient still have a high creatinine levels.The conclusion is there is drop for both urea and creatinen serum level, but the urealevel for half of the patient did not go down to normal, and for the creatinine levelthere is none of the patient creatinine level that go down to normal.

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Serum uric acid, kidney function and acute ischemic stroke outcomes in elderly patients: a single-cohort, perspective study

Neurology International ◽

10.4081/ni.2017.6920 ◽

2017 ◽

Vol 9 (1) ◽

Cited By ~ 6

Author(s):

Lorenzo Falsetti ◽

William Capeci ◽

Nicola Tarquinio ◽

Giovanna Viticchi ◽

Mauro Silvestrini ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Uric Acid ◽

Ischemic Stroke ◽

Kidney Disease ◽

Elderly Patients ◽

Hospital Mortality ◽

Acute Ischemic Stroke ◽

Serum Uric Acid ◽

Kidney Function ◽

Increased Risk

Chronic kidney disease and hyperuricemia have been associated to an increased risk and a worse prognosis in acute ischemic stroke. Several mechanisms, including platelet dysfunction, coagulation disorders, endothelial dysfunction, inflammation, and an increased risk of atrial fibrillation could be implicated. The role of serum uric acid in this setting is still object of debate. We enrolled all the consecutive patients admitted to our department for acute ischemic stroke. Cox regression analysis was used to evaluate the risk of in-hospital death considering serum uric acid levels and all the comorbidities. In the overall sample, hyperuricemia was independently associated to an increased risk of in-hospital mortality. This effect was stronger in patients with chronic kidney disease while, in the group of patients with normal renal function, the relationship between hyperuricemia and increased stroke mortality was not confirmed. Hyperuricemia could be associated to higher in-hospital mortality for ischemic stroke among elderly patients when affected by kidney disease. Survival does not seem to be affected by hyperuricemia in patients with normal kidney function.

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