Prevalence and Correlates of Chronic Kidney Disease in Patients with hypertension in Rural Malawi

2019 ◽  
Author(s):  
Chiyembekezo Kachimanga ◽  
Lawrence Nazimera ◽  
Enoch Ndarama ◽  
Richard Kamwezi ◽  
Limbani Thengo ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Regression Analysis ◽  
Kidney Disease ◽  
Renal Insufficiency ◽  
Medical Records ◽  
Filtration Rate ◽  
Hypertensive Patients ◽  
Ckd Stage ◽  
The Mean ◽  
Very High

Abstract Background The prevalence of chronic kidney disease (CKD) in patients with hypertension is very high in Africa. We investigated the prevalence and correlates of CKD in patients with hypertension attending longitudinal care in rural Malawi, where currently no data on prevalence of CKD in patients with hypertension exists. Methods We retrospectively reviewed medical records of all hypertensive patients who were screened for CKD between January 2018 and April 2019. Screening was done using serum creatinine and CKD epidemiology formula was used to estimate the glomerular filtration rate (eGFR). We used Kidney Disease: Improving Global Outcomes definitions of renal insufficiency and CKD. Logistic regression analysis was used to identify correlates of CKD. Results During the study duration, 1197 patients with hypertension were screened for CKD. The mean creatinine and eGFR was 0.90 mg/dl (Confidence Interval (CI) 0.85-0.94 mg/dl) and 84.1 ml/min/1.73m2 (CI 82.7-85.4 ml/min/1.73m2) respectively. About half of the patients had a normal eGFR (48.3%, n=578) and 36.3% (n=435) had mildly decreased eGFR. The prevalence of renal insufficiency was 15.4% (CI 13.4-17.5, 184/1197) and the prevalence of CKD was 7.1% (CI 5.7-8.7%). By eGFR category in the CKD patients, 41.2% (n=35), 31.8% (n=27), 24.7% (n=21) and 2.3% (n=2) had CKD stage 3a, 3b, 4 and 5 respectively. CKD was strongly associated with age and diabetes. Conclusions We found moderately high renal insufficiency and CKD in this cohort. We propose investing in screening for CKD in patients with hypertension in other clinics in Malawi.

scholarly journals P0949EFFECT OF DIETARY PHOSPHORUS RESTRICTION ON FIBROBLAST GROWTH FACTOR,KLOTHO AND BODY COMPOSITION IN CHRONIC KIDNEY DISEASE PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Trisha Sachan ◽  
Anita Saxena ◽  
Amit Gupta
Keyword(s):  
Chronic Kidney Disease ◽  
Body Composition ◽  
Renal Function ◽  
Kidney Disease ◽  
Urinary Protein ◽  
Dietary Phosphorus ◽  
Ckd Stage ◽  
Significant Difference ◽  
The Mean ◽  
Fgf 23

Abstract Background and Aims Changes in dietary phosphorus regulate serum FGF-23, parathyroid hormone, 1,25(OH)(2)D and Klotho concentrations . Cardiovascular disease (CVD) is the principal killer of patients with chronic kidney disease and hyperphosphetemia is a potent risk factor it. Of many causative factors for CVD in CKD, dietary interventions involving restriction of dietary phosphorous intake can help reduce onset of CVD at early stages of CKD with other corrective measures. Muscle wasting is a consequence of uremic syndrome which alters body composition. The aim of the study was to study effect of dietary phosphorous restriction on FGF-23, iPTH, Klotho, 1,25(OH)(2)D and body composition in chronic kidney disease patients. Method This is a longitudinal study with 12 months intervention, approved by Ethics Committee of the institute. A total 132 subjects were recruited (66 healthy controls, 66 CKD patient. of 66 patients 33 were in CKD stage 1 and 33 in stage 2. GFR was calculated with the help of MDRD formula. Biochemical parameters of subjects were evaluated at baseline, 6 and 12 months along with the anthropometric measurements (body weight, height, mid upper arm circumference (MUAC), and skin folds). Three days dietary recall was taken to evaluate energy, protein and phosphorous intake. CKD patients whose dietary phosphorous intake was more than 1000 mg/day, were given intense dietary counseling and prescribed dietary modifications by restricting dietary phosphorous between 800-1000 mg/day. Results The mean age of controls and patients was 37.01±9.62 and 38.27±12.06 and eGFR of 136.94±11.77 and 83.69±17.37 respectively. One way ANOVA showed significant difference among controls and the study groups in hemoglobin (p<0.001), s albumin (p<0.001), FGF-23 (p<0.001), klotho (p<0.001), urinary protein (p<0.001) and Nephron Index (p<0.001).The mean energy intake (p = 0.001) and dietary phosphorous intake (p<0.001) of the CKD patients decreased significantly with the decline in the renal function along with the anthropometric measures i.e. BMI (p = 0.041),WHR (p = 0.015) and all four skin folds (p<0.001). On applying Pearson’s correlation, eGFR correlated negatively with urinary protein (-0.739, 0.000), FGF-23 (-0.679, 0.000) and serum phosphorous (-0.697, 0.000) and positively with klotho (0.872, 0.000). FGF-23 correlated negatively with klotho (-0.742, 0.000). Dietary phosphorous was found to be positively correlated with urinary protein (0.496, 0.000), serum phosphorous (0.680, 0.000) and FGF-23 (0.573, 0.000) and negatively with Klotho (-0.602, 0.000). Nephron index revealed a positive correlation with eGFR (0.529, 0.000). Urinary protein correlated negatively with klotho (-0.810, 0.000). A multiple linear regression was run to predict eGFR from anthropometric variables such as BMI, WHR, MUAC, skin folds thickness and handgrip strength. All anthropometric variables predicted decline in eGFR (p<0.05, R2 =0.223). At 6 and 12 months; repeated ANOVAs analysis showed a statistically significant difference in serum creatinine (p=0.000), serum phosphorous (p=0.000), FGF-23(p=0.000) and klotho (p=0.000). Conclusion Elevated levels of FGF-23 and decreased Klotho levels, with the moderate decline in renal function improved with the restricted phosphorous diet at 6 and 12 months emphasizing the importance of phosphorus restriction at an early stage.

Abstract 321: Impact Of Chronic Kidney Disease On Heart Failure Outcomes In A Minority Cohort

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
TAOPHEEQ MUSTAPHA ◽  
VARIJA BHOGIREDDY ◽  
HARTMAN MADU ◽  
ADU BOACHIE ◽  
ABDUL OSENI ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
African American ◽  
Kidney Disease ◽  
Prognostic Impact ◽  
Mortality And Morbidity ◽  
Ckd Stage ◽  
Significant Difference ◽  
The Mean ◽  
The Impact

BACKGROUND: Heart failure (HF) and Chronic kidney disease (CKD) are major public health problems that often co-exist with a resultant high mortality and morbidity. Most of the studies evaluating their reciprocal prognostic impact have focused on mortality in majority populations. There is limited literature on the impact of CKD on HF morbidities in ethnic minorities. AIMS: Our study seeks to compare HF outcomes in patients with or without CKD in an African-American predominant cohort. METHODS: We obtained data from the NGH at Meharry Heart Failure Cohort; a comprehensive retrospective HF database comprised of patient care data (HF admissions, non-HF admissions, and emergency room visits) were assessed from January 2006 to December 2008. The study group consist of 306 subjects with a mean age of 65±15 years. 81% were African-American (AA), 19% Caucasian and 48.5% are females. Following the NKF KDOQI guidelines, 5 stages of CKD were outlined based on GFR. RESULTS: The overall prevalence of CKD in this population is 54.2%. CKD stage 1 was most prevalent with 45.8%, prevalence for stages 2-5 are 21.6%, 18.3%, 9.5% and 4.9% respectively. The comparison of the mean of ER visits, non HF hospitalizations and HF hospitalizations between normal and CKD patients was done using independent t-test and showed no significant difference in the mean number of ER visits (p=0.564), or HF hospitalizations(p=0.235). However, there is a statistically significant difference in the mean number of non -HF hospitalizations between normal and CKD patients (p=0.031). CONCLUSION: This study shows that the prevalence of CKD in this minority -predominant HF cohort is similar to prior studies in majority populations. However, only the non-HF hospitalizations were significantly increased in the CKD group. Future prospective studies will be needed to define the implications of this in the management of HF patients with CKD.

An observational study of the effects of telmisartan on insulin resistance in hypertensive patients with chronic kidney disease undergoing hemodialysis

2019 ◽  
Author(s):  
budi suprapti ◽  
Bayu Dharma ◽  
Mahadri Drik ◽  
Zamrottul Izzah ◽  
Wenny Nilamsari ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Antihypertensive Drugs ◽  
Model Assessment ◽  
Hypertensive Patients ◽  
Fasting Plasma ◽  
Homeostatic Model Assessment ◽  
Observational Cohort ◽  
The Mean

Abstract Background In the clinical setting, the activity of telmisartan in decreasing insulin resistance has been proven superior to other antihypertensive drugs in hypertensive patients. However, there has been no published study in determining the effect of telmisartan on insulin resistance in hypertensive chronic kidney disease patients undergoing hemodialysis.Objective To analyze the effect of telmisartan on insulin resistance in hypertensive patients undergoing hemodialysis.Method It was a prospective observational cohort study in 16 chronic kidney disease patients undergoing regular hemodialysis and using telmisartan who met the inclusion criteria.Results Sixteen patients received telmisartan, 12 were male patients and four were female. The mean age was 45 ± 8 years and the mean body mass index was 22.85 ± 1.99. Hypertensive chronic kidney disease was the highest etiology (56%) for hemodialysis. Mean percentage of fasting plasma insulin and homeostatic model assessment of insulin resistance concentratons decreased significantly by 22.6% (P<0.05) and 22.9% (P<0.05) respectively after 3-month administration. On the other hand, the mean percentage of fasting plasma glucose concentrations declined by 2.9% (P=0.187, Zcount<1.96) after 3-month of treatment.Conclusion Administration of telmisartan for three months decreases insulin resistance significantly in hypertensive patients undergoing hemodialysis.

Analysing the impact of a guideline for the use of new potassium binders for treatment of chronic hyperkalaemia to maximise inhibition of renin–angiotensin–aldosterone system (RAAS) within the general nephrology clinic?

2020 ◽  
Author(s):  
Priyank Patel ◽  
Andrew Frankel
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Ckd Stage ◽  
The Mean ◽  
Potassium Binders ◽  
The Impact ◽  
Chronic Use

Abstract Background Renin–angiotensin–aldosterone system (RAAS) inhibitors provide significant cardiorenal benefits with improved long-term outcomes for patients. This is most significant for patients receiving maximal RAAS inhibition, but some patients are unable to tolerate this therapy because of hyperkalaemia. Recently published National Institute for Health and Care Excellence (NICE) technology appraisal guidance recommended using sodium zirconium cyclosilicate (SZC) and patiromer for patients with chronic kidney disease (CKD) stage 3b to 5 or heart failure with reduced ejection fraction, who are not taking an optimised dosage of RAAS inhibitor because of hyperkalaemia. Objective Determine the impact of a locally produced guideline on effective implementation of NICE recommendation for use of SZC or patiromer to help maximise inhibition of the renin–angiotensin–aldosterone system within the general nephrology clinic. Methods A local guideline to practically support the implementation of recommendations made by NICE in the chronic use of new potassium binders was produced. One hundred sequential patients in a general nephrology clinic with non-immune chronic kidney disease (CKD 3 to 5) had their electronic records reviewed. Those with an indication for RAAS inhibition were identified. Results Of the 100 consecutive patients audited, 46 were female and 54 were male. The mean age of these patients was 64 and the mean estimated glomerular filtration rate (eGFR) was 33. Sixty-eight patients had an indication for being on RAAS inhibition with only 10 on maximal doses. Of the remaining 58 patients, 26 (45%) were limited by hyperkalaemia. Of these 26 patients, 12 of these patients (46%) had hyperkalaemia associated with an episode of acute kidney injury (AKI). Therefore, 14% of patients attending a general nephrology clinic were identified suitable for SZC and patiromer. Conclusions A significant proportion (14%) of unselected patients attending a general nephrology clinic were not on optimum RAAS inhibition due to hyperkalaemia. These patients would meet the criteria established within a working guideline for the implementation of the chronic use of SZC or patiromer and are likely to attain prognostic long-term benefit by using these new potassium binders to maximise RAAS inhibition. This analysis has implications for renal centres across the UK.

scholarly journals Effect of Atorvastatin and Losartan on Glomerular Filtration Rate in Patients With Mild to Moderate Chronic Kidney Disease

KYAMC Journal ◽  
2019 ◽  
Vol 10 (1) ◽  
pp. 43-47
Author(s):  
Md Moniruzzaman Khan ◽  
Zesmin Fauzia Dewan ◽  
AKM Shahidur Rahman ◽  
Bakhtiare Md Shoeb Nomany ◽  
Ahmed Salam Mir ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Kidney Diseases ◽  
Cell Damage ◽  
Renoprotective Effect ◽  
Ckd Stage

Background: Atorvastatin, a member of HMG CO-A reductase inhibitors, has been shown to have renoprotective effect in patients with Chronic Kidney Disease (CKD). Statins are supposed to decrease the oxidized lipid particles, suppress the activity of inflammatory mediators and prevent vascular thrombosis and thus could minimize renal cell damage. Losartan, an antihypertensive drug also diminishes proteinuria in patients with chronic kidney diseases or diabetes mellitus. Therefore the effect of concurrent use of atorvastatin and losartan on Glomerular Filtration Rate (GFR) could be a matter of interest from both Pharmacological and Clinical perspective. Objective: To assess the renoprotective effect of atorvastatin and losartan in patients with chronic kidney disease treated at Bangabandhu Sheikh Mujib Medical University (BSMMU). Materials and Method: Total forty four (44) patients suffering from CKD (stage one to stage three) were enrolled into two groups. Patients in Group A, received atorvastatin (10 mg) and losartan (50 mg) once daily for eight weeks. Patients in Group B, received losartan but not atorvastatin for the same duration. Serum creatinine level was measured at the commencement and also after eight weeks to calculate estimated glomerular filtration rate (eGFR) in individual patients with MDRD (Modification of Diet in Renal Disease) study equation. Results: There was significant (P < 0.001) reduction of Serum Creatinine and significant (P < 0.001) increase in e GFR in the patients, treated with atorvastatin and losartan. Conclusion: Concurrent administration of atorvastatin and losartan increased glomerular filtration rate (GFR) significantly in patients with chronic kidney disease. KYAMC Journal Vol. 10, No.-1, April 2019, Page 43-47

P200 Arterial stiffness in patients with mild-to-moderate renal impairment

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
A B Md Radzi ◽  
S S Kasim
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Arterial Stiffness ◽  
Medical Center ◽  
Linear Regression Analysis ◽  
Younger Age ◽  
Stage 4 ◽  
Ckd Stage ◽  
Significant Difference ◽  
The Mean

Abstract Background Arterial damage in chronic kidney disease (CKD) is characterized by aortic stiffness. This is seen in elderly patients with advanced CKD. The association between arterial stiffness and early CKD is not well established. Objective: We aimed to study arterial stiffness using pulse wave velocity (PWV) among patients with chronic kidney disease (CKD) stage 2 to 4 and normal renal function in younger-age population. Design and Method: Patients with confirmed CKD stage 2 to 4 were recruited from various clinics from Universiti Teknologi MARA Medical Center, Sungai Buloh, Malaysia from 1st August 2015 until 31st January 2018. Sociodemographic and anthropometric indices were recorded on recruitment. Each patient underwent carotid-femoral (aortic) PWV measurement to determine arterial stiffness. PWV is determined using a one-probe device (SphygmoSore XCEL). Results: 87 patients with CKD stage 2–4 and 87 control patients were recruited. The mean age was 47 ± 5.4 years. CKD patients had a higher mean PWV (7.8 m/s ± 1.7) than healthy controls (5.6 m/s ± 1.0) (p &lt; 0.001, 95% CI –2.59, –1.77). There was significant difference of mean PWV between control (5.6 m/s ± 1.0) and CKD stage 2 (7.6 m/s ± 1.5) (p &lt; 0.001, 95% CI –2.40, –1.49). Our results showed a stepwise increase in PWV from control subjects, CKD stage 2 through stage 4 (p &lt; 0.001). The mean difference of PWV between CKD stage 2 (7.6 m/s, ± 1.5) and stage 4 (9.0 m/s, ± 0.8) was 1.43 (p &lt; 0.001, 95% CI –2.50, -0.35). There was significant difference of mean PWV between diabetes mellitus (DM) (8.2 m/s ± 1.8) and non-DM (7.3 m/s ± 1.3) patients with CKD stage 2–4 (p = 0.022, 95% CI –1.50, –0.12). Mutiple linear regression analysis showed only age (β = 0.078, p = 0.014), mean arterial pressure (MAP) (β = 0.031, p = 0.007) and diuretics usage as the combination antihypertensive medication (β = 0.839, p = 0.018) were independently associated with PWV (r2 = 0.249, p &lt; 0.001). Conclusions: This study shows that arterial stiffness as assessed by PWV occurs early in CKD patient and increased arterial stiffness occurs in parallel with decline of glomerular filtration rate in patients with mild-to-moderate CKD of younger age population.

Early Glomerular Filtration Rate Loss as a Marker of Diabetic Nephropathy

2012 ◽  
Vol 08 (01) ◽  
pp. 40 ◽  
Author(s):  
George Jerums ◽  
Elif Ekinci ◽  
Sianna Panagiotopoulos ◽  
Richard J MacIsaac ◽  
◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Type 1 Diabetes ◽  
Diabetic Nephropathy ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Clinical Level ◽  
Ckd Stage

In the early 1980s, studies in type 1 diabetes suggested that glomerular filtration rate (GFR) loss begins with the onset of macroalbuminuria. However, recent evidence indicates that up to one-quarter of subjects with diabetes reach a GFR of less than 60 ml/min/1.73 m2(chronic kidney disease [CKD] stage 3) before developing micro- or macroalbuminuria. Furthermore, the prospective loss of GFR can be detected in early diabetic nephropathy (DN) well before CKD stage 3. Early GFR loss usually reflects DN in type 1 diabetes but, in older patients with type 2 diabetes, the assessment of early GFR loss needs to take into account the effects of aging. The assessment of GFR is now feasible at clinical level, using formulas based on serum creatinine, age, gender, and ethnicity. Overall, the estimation of early GFR loss is more accurate with the Chronic Kidney Disease Epidemiology (CKD–EPI) formula than with the Modification of Diet in Renal Disease (MDRD) study formula, but there is some evidence that the CKD-EPI formula does not exhibit better performance than the MDRD formula for estimating GFR in diabetes. Both formulas underestimate GFR in the hyperfiltration range. Formulas based on the reciprocal of cystatin C can also be used to estimate GFR, but their cost and lack of assay standardization have delayed their use at clinical level. In summary, early GFR loss is an important marker of DN as well as a potentially reversible target for interventions in DN.

scholarly journals CLINICAL PROFILE OF MINERAL BONE DISORDERS (RENAL OSTEODYSTROPHY) IN CHRONIC KIDNEY DISEASE PATIENTS

2021 ◽  
pp. 107-110
Author(s):  
ASHISH KHATTAR ◽  
KARTHIK RAO N ◽  
RAVINDRA PRABHU ◽  
BUDDHI RAJ POKHREL ◽  
SHANTI GURUNG ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Radial Artery ◽  
Renal Osteodystrophy ◽  
Clinical Profile ◽  
Biochemical Tests ◽  
Bone Disorders ◽  
Ckd Stage ◽  
High Prevalence ◽  
The Mean

Objective: The objective of the study was to evaluate the clinical profile of mineral bone disorders (renal osteodystrophy) in chronic kidney disease (CKD) patients. Methods: A retrospective study was performed involving 100 patients above 15 years of age with previously diagnosed chronic renal failure. A series of tests such as biochemical, radiological, and arterial calcifications were monitored. The mean age of subjects in our study was 52.54 years. Results: Biochemical tests revealed that hypocalcemia was present in 54% of the patients, and hyperphosphatemia was seen in 84% of the participants, while only 22% of the participants had high alkaline phosphate (ALP) levels. Radiological tests revealed that 39 patients had aortic calcification, 42 patients had radial artery calcification, and 27 patients had both. Subperiosteal resorption was seen on 29 participants. The majority of the vascular calcification and subperiosteal resorption was seen in patients with CKD Stage 5, and both aortic and radial artery calcifications were significantly associated with subperiosteal bone resorption. Conclusion: The results point toward a high prevalence of derangement in the mineral, vascular and valvular calcifications. Serum total ALP can serve as a biochemical marker to identify a pattern of bone turnover where intact parathyroid hormone is not available. The results highlight that serum phosphorus and Ca × P product levels were significantly associated with both aortic and radial artery calcifications. There was no significant association of these calcifications with serum calcium and ALP levels.

scholarly journals Gambaran kadar ureum pada pasien penyakit ginjal kronik stadium 5 non dialisis

2016 ◽  
Vol 4 (2) ◽  
Author(s):  
Irendem K. A. Loho ◽  
Glady I. Rambert ◽  
Mayer F. Wowor
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Laboratory Tests ◽  
Filtration Rate ◽  
Descriptive Study ◽  
Clinical Syndrome ◽  
Blood Samples ◽  
Pathophysiological Process ◽  
Ckd Stage ◽  
Observational Descriptive Study

Abstract: Chronic kidney disease (CKD) is a pathophysiological process with diverse etiology, resulting in a progressive decreased in renal function, and generally ends up with kidney failure. In CKD patient, the level of urea increases -uremia- a clinical syndrome that occurs in all organs due to the increased level of urea. During catabolism process, protein is broken down into amino acids and deamination ammonia which is further synthesized to become urea. Increased level of urea depends on the glomerular filtration rate (GFR). Decreased of GFR (<15ml / min) can cause renal failure and uremia. This study aimed to determine the levels of urea in patients with stage 5 CKD non-dialysis. This was an observational descriptive study. This study was conducted from December 2015 to January 2016 at two hospitals, Prof. Dr. R. D. Kandou Hospital and Adventist Hospital Manado. Samples were blood samples of all patients suffering from CKD stage 5 non-dyalisis within the specified time. The results of laboratory tests showed that of 35 patients diagnosed with stage 5 CKD non-dialysis all had increased urea levels (100%). Conclusion: There was an increase in urea level of patients with stage 5 chronic kidney disease non-dialysis either of outpatients or inpatients.Keywords: urea serum, stage 5 non-dialysis chronic kidney disease.Abstrak: Penyakit ginjal kronik (PGK) merupakan suatu proses patofisiologi dengan etiologi beragam, mengakibatkan penurunan fungsi ginjal yang progresif dan umumnya berakhir dengan gagal ginjal. Umumnya pada PGK terjadi peningkatan kadar ureum dan mengakibat-kan terjadinya uremia yaitu suatu sindrom klinik yang terjadi pada semua organ akibat meningkatnya kadar ureum. Dalam proses katabolisme, protein dipecah menjadi asam amino dan deaminasi ammonia yang selanjutnya disintesis menjadi urea. Peningkatan kadar ureum bergantung pada tingkat laju filtrasi glomerulus (LFG). Pada penurunan LFG (<15ml/mnt) dapat terjadi gagal ginjal dan uremia. Penelitian ini bertujuan untuk mengetahui gambaran kadar ureum pada pasien penyakit ginjal kronik stadium 5 non-dialisis. Jenis penelitian ini ialah deskriptif observasional. Penelitian dilakukan sejak Desember 2015-Januari 2016 di RSUP Prof. Dr. R. D. Kandou dan RS Advent Teling Manado. Sampel penelitian ialah sampel darah dari semua pasien yang menderita penyakit ginjal kronik stadium 5 nondialisis dalam kurun waktu yang ditentukan. Hasil pemeriksaan laboratorium dari 35 pasien yang terdiagnosis penyakit ginjal kronik stadium 5 non dialisis memperlihatkan peningkatan kadar ureum serum (100%). Simpulan: Terjadi peningkatan kadar ureum serum pada pasien penyakit ginjal kronik stadium 5 non-dialisis baik yang dirawat jalan maupun dirawat inap.Kata kunci: ureum, penyakit ginjal kronik stadium 5 non dialisis

scholarly journals Effects of blood urea nitrogen independent of the estimated glomerular filtration rate on the development of anemia in non-dialysis chronic kidney disease: The results of the KNOW-CKD study

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257305
Author(s):  
Hyo Jin Kim ◽  
Tae Eun Kim ◽  
Miyeun Han ◽  
Yongin Yi ◽  
Jong Cheol Jeong ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Regression Analysis ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Protein Intake ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Cox Regression ◽  
Hemoglobin Level

Background Anemia is a common complication of chronic kidney disease (CKD). Blood urea nitrogen (BUN) in CKD represents nitrogenous uremic toxin accumulation which could be involved in anemia of CKD. We investigated the effects of BUN independent of estimated glomerular filtration rate (eGFR) on anemia in non-dialysis CKD (NDCKD). Methods This prospective study included 2,196 subjects enrolled in the KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD) cohort with BUN and hemoglobin level data. Initially, we investigated the association between BUN and hemoglobin level. To examine the impact of baseline BUN on the incident anemia, a longitudinal study was performed on 1,169 patients without anemia at study enrollment. BUN residuals were obtained from the fitted curve between BUN and eGFR. Anemia was defined as a hemoglobin level of <13.0 g/dL for men and <12.0 g/dL for women. Results BUN residuals were not related to eGFR but to daily protein intake (DPI), while BUN was related to both eGFR and DPI. BUN was inversely associated with hemoglobin level (β -0.03; 95% confidence interval [CI] -0.04, -0.03; P <0.001) in the multivariable linear regression analysis adjusted for multiple confounders including eGFR, and BUN residual used instead of BUN was also inversely associated with hemoglobin level (β -0.03; 95% CI -0.04, -0.02; P <0.001). Among the 1,169 subjects without anemia at baseline, 414 (35.4%) subjects newly developed anemia during the follow-up period of 37.5 ± 22.1 months. In the multivariable Cox regression analysis with adjustment, both high BUN level (Hazard ratio [HR] 1.02; 95% CI 1.01, 1.04; P = 0.002) and BUN residual used instead of BUN (HR 1.02; 95% CI 1.00, 1.04; P = 0.031) increased the risk of anemia development. Moreover, BUN, rather than eGFR, increased the risk of anemia development in patients with CKD stage 3 in the multivariable Cox regression. Conclusion Higher BUN levels derived from inappropriately high protein intake relative to renal function were associated with low hemoglobin levels and the increased risk of anemia independent of eGFR in NDCKD patients.

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