scholarly journals Racial Disparities in Creatinine-based Kidney Function Estimates Among HIV-infected Adults

2016 ◽  
Vol 26 (2) ◽  
pp. 213 ◽  
Author(s):  
Naomi Anker ◽  
Rebecca Scherzer ◽  
Carmen Peralta ◽  
Neil Powe ◽  
Tanushree Banjeree ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Racial Differences ◽  
Kidney Function ◽  
Filtration Rate ◽  
Department Of Veterans Affairs ◽  
Black And White ◽  
Risk Of Death ◽  
Mdrd Formula ◽  
The Impact

<p><strong>Objective</strong>: The aim of our study was to investigate whether current eGFR equations in clinical use might systematically overestimate the kidney function, and thus misclassify CKD status, of Black Americans with HIV. Specifically, we evaluated the impact of removing the race coefficient from the MDRD and CKD-EPI equations on comparisons between Black and White HIV-infected veterans related to: 1) the prevalence of reduced eGFR; 2) the distribution of eGFR values; and 3) the relationship between eGFR and all-cause mortality.</p><p><strong>Design:</strong> Retrospective cohort study.</p><p><strong>Setting:</strong> The Department of Veterans Affairs (VA) HIV Clinical Case Registry (CCR), which actively monitors all HIV-infected persons receiving care in the VA nationally.</p><p><strong>Patients/Participants:</strong> 21,905 treatmentnaïve HIV-infected veterans.</p><p><strong>Main Outcome Measures:</strong> Estimated glomerular filtration rate (eGFR) using the abbreviated Modification of Diet in Renal Disease (MDRD) formula with and without (MDRD-RCR) the race coefficient and allcause mortality.</p><p><strong>Results:</strong> Persons with eGFR &lt;45 mL/ min/1.73m2 had a higher risk of death compared with those with eGFR &gt;80 mL/ min/1.73m2 among both Blacks (HR=2.8, 95%CI: 2.4-3.3) and Whites (HR=1.9, 95%CI: 1.4-2.6), but the association appeared to be stronger in Blacks (P=.038, test for interaction). Blacks with eGFR 45- 60 mL/min/1.73m2 also had a higher risk of death (HR=1.7, 95%CI: 1.4-2.1) but Whites did not (HR=0.86, 95%CI: .67- 1.10; test for interaction: P&lt;.0001). Racial differences were substantially attenuated when eGFR was re-calculated without the race coefficient.</p><p><strong>Conclusions:</strong> Our findings suggest that clinicians may want to consider estimating glomerular filtration rate without the race coefficient in Blacks with HIV. <em>Ethn Dis.</em> 2016;26(2):213-220; doi:10.18865/ ed.26.2.213</p>

scholarly journals A Risk Score to Guide Cystatin C Testing to Detect Occult-Reduced Estimated Glomerular Filtration Rate

2015 ◽  
Vol 42 (2) ◽  
pp. 141-147 ◽  
Author(s):  
Carmen A. Peralta ◽  
Paul Muntner ◽  
Rebecca Scherzer ◽  
Suzanne Judd ◽  
Mary Cushman ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Racial Differences ◽  
Kidney Function ◽  
Cystatin C ◽  
Risk Score ◽  
Filtration Rate ◽  
Bayesian Model Averaging ◽  
Estimated Glomerular Filtration Rate ◽  
Risk Function

Background/Aims: Persons with occult-reduced estimated glomerular filtration rate (eGFR <60 ml/min/1.73 m2 detected by serum cystatin C but missed by creatinine) have high risk for complications. Among persons with preserved kidney function by creatinine-based eGFR (eGFRcreat >60 ml/min/1.73 m2), tools to guide cystatin C testing are needed. Methods: We developed a risk score to estimate an individual's probability of reduced eGFR by cystatin C (eGFRcys <60 ml/min/1.73 m2) in The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study and externally validated in the Third National Health and Nutrition Examination Survey (NHANES III). We used logistic regression with Bayesian model averaging and variables available in practice. We assessed performance characteristics using calibration and discrimination measures. Results: Among 24,877 adults with preserved kidney function by creatinine, 13.5% had reduced eGFRcys. Older and Black participants, current smokers and those with higher body mass index, lower eGFRcreat, diabetes, hypertension and history of cardiovascular disease were more likely to have occult-reduced eGFR (p < 0.001). The final risk function had a c-statistic of 0.87 in REGARDS and 0.84 in NHANES. By risk score, 72% of occult-reduced eGFR cases were detected by screening only 22% of participants. Conclusions: A risk score using characteristics readily accessible in clinical practice can identify the majority of persons with reduced eGFRcys, which is missed by creatinine.

scholarly journals P0807THE IMPACT OF GLOMERULAR FILTRATION RATE IN HEART FAILURE PATIENTS WITH CARDIAC IMPLANTABLE DEVICES - MYTH OR FACT?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Natacha Rodrigues ◽  
Afonso N Ferreira ◽  
Pedro António ◽  
Mafalda Carrington ◽  
João De Sousa ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Clinical Characteristics ◽  
Filtration Rate ◽  
Independent Predictor ◽  
Implantable Devices ◽  
Risk Of Death ◽  
All Cause Mortality ◽  
The Impact

Abstract Background and Aims Heart Failure (HF) and chronic kidney disease (CKD) are both epidemic, frequently simultaneous and sharing well knowned risk factors. Implantable devices can improve quality of life and reduce mortality in a selected population. Data derived from meta-analyses show both survival benefit in CKD patients receiving devices and increased risk of death in device patients with CKD. Little is Known about the impact of glomerular filtration rate (GFR) across the different stages of CKD in the vital prognoses of HF patients submitted to cardiac resynchronization therapy (CRT) or implantable cardiac defibrillator (ICD) implants. To evaluate the impact of CKD in all-cause mortality in HF patients who implanted a CRT or ICD. Method Prospective single-center study of patients who implanted CRT or ICD between 2015 and 2019. Clinical characteristics were evaluated at baseline and mortality was assessed using the national registry. CKD was evaluated according to the GFR by CKD-EPI equation according to the KDIGO guidelines. We performed univariate and multivariate analysis to compare clinical characteristics of patients who died and who survived using the Cox regression and Kaplan-Meier methods. For the predictor GFR levels, and according to the KDIGO classification, we assessed the best cut-off value for mortality using the area under the ROC curve (AUC) method. Results From 2015-2019, 974 devices were implanted, 414 ICDs and 560 CRTs (23.3% female, 67.6±12.1, follow-up duration 26.4±16.5 months). A total of 161 patients (16.5%) died during follow-up. GFR at the time of device implant was significantly lower in patients who died compared to those who survived (49.7 vs 67.3ml/min/1.73m2, p&lt;0.001). When evaluating predictors for all-cause mortality by multivariate analysis, GFR at the time of device implant was an independent predictor of mortality, even when adjusted for age, gender, arterial hypertension and diabetes (HR 1.12; 95% CI 1.04-1.16, p&lt;0.001). The best GFR cut-off value to predict mortality with a 69% sensitivity and 65% specificity was 75ml/min/1.73m2 (AUC 0.70). Patients with a GFR &lt; 75ml/min/1.73m2 at the time of implant have a 2.5-fold higher risk of death (HR 2.5; 95% CI 1.6-3.9, p&lt;0.001). Risk of death significantly increases along GFR decline, almost doubling each stage, with 2.7 for stage 3a (p=0.2), 5.5 for stage 3b, 9.5 for stage 4 and 14.7-fold higher risk of death for stage 5 (p&lt;0.001). Conclusion In our cohort of HF patients who underwent CRT or ICD implant, glomerular filtration rate was an independent predictor for all-cause mortality. Additionally, GFR&lt;75ml/min/1.73m2 at the time of device implant increased by 2.5-fold the risk of death, the risk doubles for each CKD stage increase, reaching a dramatic 14.7- fold higher risk of death for stage 5 patients. CKD should not postpone device implant, as its deterioration significantly increases the risk of death.

scholarly journals Jämförelse av CKD-EPI och MDRD ekvationsformler för estimerad glomerulär filtrationshastighet.

2020 ◽  
Vol 6 (1) ◽  
pp. 13-31
Author(s):  
Amanda Lundén ◽  
Ulrika Hafstad ◽  
Sara Larsson
Keyword(s):  
Glomerular Filtration Rate ◽  
Contrast Media ◽  
Glomerular Filtration ◽  
Kidney Function ◽  
Filtration Rate ◽  
Literature Study ◽  
Estimated Gfr ◽  
Contrast Induced Nephropathy ◽  
Mdrd Formula ◽  
The Moment

Introduction: In the profession as radiology nurse contrast media is used daily in radiologic examinations. In order to determine the volume of contrast media that patients should be administered and to prevent contrast-induced nephropathy equation formulas are applied to calculate the kidney function glomerular filtration rate. Two formulas were compared the CKD-EPI and MDRD. The aim was to compare which of the two most commonly used equation formulas is the most optimal for calculating estimated GFR. Methods: This study was conducted as a literature study, where 11 articles were quality assessed and compiled. Results: The CKD-EPI formula generally showed better performance for estimating GFR in accuracy, precision and bias than the MDRD formula. However, both equation formulas present inadequacies and are not universal as they are not applicable to all individuals. Conclusions: At the moment the CKD-EPI formula appears to be the most applicable, although more research is required in order to develop equation formulas which cater to all types of patients.

scholarly journals The impact of glomerular filtration rate estimation on cardiovascular events in elderly patients undergoing coronary angiography

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Aker ◽  
A Eitan ◽  
W Saliba ◽  
R Jaffe ◽  
B Zafrir
Keyword(s):  
Glomerular Filtration Rate ◽  
Coronary Angiography ◽  
Elderly Patients ◽  
Glomerular Filtration ◽  
Kidney Function ◽  
Cardiovascular Events ◽  
Filtration Rate ◽  
Cardiovascular Comorbidities ◽  
The Impact

Abstract Objectives Estimation of kidney function by glomerular filtration rate (eGFR) is affected by age and is important for decision making regarding treatment and prognosis of patients with cardiovascular disease. We aimed to investigate the impact of eGFR on long-term cardiovascular outcomes in an elderly population undergoing coronary angiography for evaluation or treatment of coronary artery disease. Methods GFR was estimated according to Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation in 3,690 elderly patients (aged 70–100 years) undergoing coronary angiography. Patients receiving maintenance dialysis were excluded. The association between eGFR and long-term major adverse cardiovascular events (MACE) including myocardial infarction, ischemic stroke or death, was investigated. GFR was further calculated according to Modification of Diet in Renal Disease (MDRD) and the Cockroft-Gault equations, and compatibility between estimations was analyzed. Results Cardiovascular comorbidities were more prevalent with the reduction in kidney function as was the proportion of patients presenting with acute coronary syndromes. The adjusted hazard ratio (95% confidence interval) for MACE during a mean follow-up of 5 years was 0.98 (0.80–1.19), 1.05 (0.85–1.30), 1.45 (1.15–1.82), 2.20 (1.64–2.95) and 3.87 (2.28–6.58) in patients with eGFR 60–89, 45–59, 30–44, 15–29 and &lt;15 ml/min/1.73m2, respectively, compared to eGFR &gt;90 ml/min/1.73m2. Reclassification of eGFR stages by MDRD (upward 23.8%, downward 0.4%) and Cockroft-Gault (upward 4.3%, downward 28.1%) compared to CKD-EPI estimation, was noted. However, the association between eGFR stages and MACE was similar between equations. Conclusions Kidney function, as manifested by eGFR, has a graded inverse association with the burden of cardiovascular comorbidities and long-term adverse events in elderly patients undergoing coronary angiography. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals The Impact of Interlaboratory Differences in Cystatin C Assay Measurement on Glomerular Filtration Rate Estimation

2011 ◽  
Vol 6 (9) ◽  
pp. 2150-2156 ◽  
Author(s):  
Christine A. White ◽  
Andrew D. Rule ◽  
Christine P. Collier ◽  
Ayub Akbari ◽  
John C. Lieske ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Cystatin C ◽  
Filtration Rate ◽  
Rate Estimation ◽  
Glomerular Filtration Rate Estimation ◽  
The Impact

Transition from Antigenemia to Quantitative Nucleic Acid Amplification Testing in Kidney Transplant Recipients Receiving Preemptive Therapy for Cytomegalovirus Infection.

2021 ◽  
Author(s):  
Mônica Rika Nakamura ◽  
Lúcio R. Requião-Moura ◽  
Roberto Mayer Gallo ◽  
Camila Botelho ◽  
Júlia Taddeo ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Nucleic Acid ◽  
Acute Rejection ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Nucleic Acid Amplification ◽  
Rt Pcr ◽  
Cmv Infection ◽  
Preemptive Treatment ◽  
The Impact

Abstract Due to the high costs, the strategy to reduce the impact of cytomegalovirus (CMV) after kidney transplant (KT) involves preemptive treatment in low and middle-income countries. Thus, this retrospective cohort study compared the performance of antigenemia transitioned to quantitative nucleic acid amplification testing, RT-PCR, in KT recipients receiving preemptive treatment as a strategy to prevent CMV infection. Between 2016 and 2018, 363 patients were enrolled and received preemptive treatment based on antigenemia (n=177) or RT-PCR (n=186). The primary outcome was CMV infection or disease. There were no differences in one-year cumulative incidence of CMV-related events (50.8% vs. 44.1%, P=0.20), neither in time to diagnosis (47.0 vs. 47.0 days) among patients conducted by antigenemia vs. RT-PCR, respectively. The length of CMV first treatment was longer with RT-PCR (20.0 vs. 27.5 days, P<0.001), while the rate of retreatment was not different (14.7% vs. 11.8%, P=0.48). In the Cox regression, the variables associated with CMV-related events were acute rejection within 30 days (HR=2.05, p=0.01) and 30-day glomerular filtration rate (HR=0.98, p<0.001). In conclusion, acute rejection and glomerular filtration rate are risk factors for CMV infection and disease, showing comparable performance in the impact of CMV-related events between antigenemia and RT-PCR for preemptive treatment.

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