scholarly journals Incidence Rate and Time to Occurrence of Renal Impairment and Chronic Kidney Disease among Thai HIV-infected Adults with Tenofovir Disoproxil Fumarate Use

2021 ◽  
Vol 15 (1) ◽  
pp. 73-80
Author(s):  
Jirayu Visuthranukul ◽  
Thanapoom Rattananupong ◽  
Phenphop Phansuea ◽  
Narin Hiransuthikul
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Renal Impairment ◽  
Incidence Rate ◽  
Tenofovir Disoproxil Fumarate ◽  
Incidence Rates ◽  
Rapid Decline ◽  
Kaplan Meier ◽  
Group A

Background: Tenofovir disoproxil fumarate (TDF) is a major antiretroviral therapy for Thai human immunodeficiency virus (HIV) infected adults. TDF is associated with a decrease in renal function. There is limited data about the use of TDF with the incidence and time to renal impairment and chronic kidney disease (CKD) in Thai HIV-infected adults. Objectives: To study the association of TDF with the incidence rate and duration of renal impairment and CKD in Thai patients. Methods: A retrospective cohort study in Thai naïve HIV-infected adults was conducted to compare the incidence rate and time to renal impairment and CKD in TDF and non-TDF groups. The incidence rate was analyzed by person-time. Time to renal impairment and CKD were analyzed by Kaplan-Meier curves and log-rank tests. Results: A total of 1,400 patients were enrolled. The incidence rates of renal impairment in TDF and non-TDF groups were 27.66/1,000 and 5.54/1,000 person-years. The rate ratio was 4.99 (95% confidence interval [CI] 2.66–9.35). The incidence rates of CKD in both groups were not significantly different. Themean difference of eGFR between the TDF and non-TDF groups was 1.92 ml/min/1.73 m2 (p = 0.022). Time to onset of renal impairment between the TDF and non-TDF groups was found to differ by approximately 20 months. Conclusion: The incidence rate of renal impairment was about five times higher in the TDF group. A rapid decline of eGFR occurred in the first 2–3 years of treatment. Therefore, the renal function of HIV-infected patients should be monitored so that the severity of renal impairment could be evaluated and CKD could be prevented.

Increasing Body Mass Index Predicts Rapid Decline in Renal Function: A 5 Year Retrospective Study

2018 ◽  
Vol 50 (07) ◽  
pp. 556-561 ◽  
Author(s):  
Xiaojing Ma ◽  
Chengyin Zhang ◽  
Hong Su ◽  
Xiaojie Gong ◽  
Xianglei Kong
Keyword(s):  
Body Mass Index ◽  
Chronic Kidney Disease ◽  
Renal Function ◽  
Retrospective Study ◽  
Kidney Disease ◽  
Body Mass ◽  
Adult Population ◽  
Rapid Decline ◽  
Logistic Regression Models ◽  
Baseline Bmi

AbstractWhile obesity is a recognized risk factor for chronic kidney disease, it remains unclear whether change in body mass index (ΔBMI ) is independently associated with decline in renal function (evaluated by the change in estimated glomerular filtration rate, ΔeGFR) over time. Accordingly, to help clarify this we conducted a retrospective study to measure the association of ΔBMI with decline in renal function in Chinese adult population. A total of 4007 adults (aged 45.3±13.7 years, 68.6% male) without chronic kidney disease at baseline were enrolled between 2008 and 2013. Logistic regression models were applied to explore the relationships between baseline BMI and ΔBMI, and rapid decline in renal function (defined as the lowest quartile of ΔeGFR ). During 5 years of follow-up, the ΔBMI and ΔeGFR were 0.47±1.6 (kg/m2) and –3.0±8.8 (ml/min/1.73 m2), respectively. After adjusted for potential confounders, ΔBMI (per 1 kg/m2 increase) was independently associated with the rapid decline in renal function [with a fully adjusted OR of 1.12 (95% CI, 1.05 to 1.20). By contrast, the baseline BMI was not associated with rapid decline in renal function [OR=1.05 (95% CI, 0.98 to 1.13)]. The results were robust among 2948 hypertension-free and diabetes-free participants, the adjusted ORs of ΔBMI and baseline BMI were 1.14 (95% CI, 1.05 to 1.23) and 1.0 (95% CI, 0.96 to 1.04) for rapid decline in renal function, respectively. The study revealed that increasing ΔBMI predicts rapid decline in renal function.

scholarly journals Effects of Renal Impairment and Hemodialysis on the Pharmacokinetics and Safety of the Glecaprevir and Pibrentasvir Combination in Hepatitis C Virus-Negative Subjects

2017 ◽  
Vol 62 (3) ◽  
Author(s):  
Matthew P. Kosloski ◽  
Weihan Zhao ◽  
Thomas C. Marbury ◽  
Richard A. Preston ◽  
Michael G. Collins ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Kidney Disease ◽  
Renal Impairment ◽  
Combined Treatment ◽  
Hcv Infection ◽  
Renal Elimination ◽  
Genotype 2

ABSTRACT Hepatitis C virus (HCV) infection is an independent risk factor for developing chronic renal impairment and end-stage renal disease. Limited treatment options are available for HCV genotype 2, 3, 5, and 6 infections in patients with an estimated glomerular filtration rate (eGFR) of <30 ml/min. Glecaprevir and pibrentasvir are active against all six major HCV genotypes, are primarily excreted in the bile, and have minimal renal elimination. Therefore, combined treatment with these direct-acting antivirals may be useful for patients with HCV infection and chronic kidney disease. A phase 1, multicenter, open-label study evaluated the effects of renal impairment on the pharmacokinetics and safety of glecaprevir-pibrentasvir. In substudy 1, 38 subjects with stage 2 to 5 chronic kidney disease who were not on dialysis or who had normal renal function received single doses of the combination of 300 mg glecaprevir and 120 mg pibrentasvir. In substudy 2, 8 subjects requiring hemodialysis received single doses of the combination of 300 mg glecaprevir and 120 mg pibrentasvir under dialysis and nondialysis conditions. Regression analyses demonstrated increased glecaprevir and pibrentasvir plasma exposures, as determined by the area under the curve, with decreasing renal function, up to 56% and 46%, respectively, in subjects with an eGFR of <15 ml/min/1.73 m 2 . In dialysis-dependent subjects, glecaprevir and pibrentasvir exposures were similar (≤18% difference) when study drugs were administered before hemodialysis or on a nondialysis day. Adverse events were mostly mild, with the most common being self-limited fatigue (3 subjects). The study findings support the clinical evaluation of glecaprevir-pibrentasvir without dose adjustment in HCV-infected subjects with renal impairment. (This study has been registered at ClinicalTrials.gov under registration number NCT02442258.)

Asymptomatic hypertension-mediated organ damage in patients with or without moderate to severe chronic kidney disease

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Schiavone ◽  
C Gobbi ◽  
A Ratti ◽  
G Ferrari ◽  
A Villarini ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Renal Impairment ◽  
Severe Renal Impairment ◽  
Organ Damage ◽  
Vascular Damage ◽  
Hypertensive Patients ◽  
Severe Chronic Kidney Disease ◽  
Fundus Oculi

Abstract Introduction Moderate or severe chronic kidney disease (CKD) is regarded as high or very high risk factor in the Systematic COronary Risk Evaluation (SCORE) system, as stated in the ESC guidelines on arterial hypertension. Assessment of cardiovascular (CV) risk should be completed evaluating hypertension-mediated organ damage (HMOD). Purpose The aim of our study was to find out differences in HMOD in patients with or without moderate to severe chronic kidney disease (CKD). Methods We enrolled 80 consecutive non-diabetic hypertensive patients, divided into two groups according to the presence of impaired renal function, evaluated by estimated glomerular filtration rate (eGFR): moderate to severe CKD group (n=26 patients, eGFR &lt;60 mL/min/1.73 m2) and mild CKD - normal renal function group (n=54 patients, eGFR ≥60 mL/min/1.73 m2). A transthoracic echocardiogram was performed to evaluate cardiac HMOD. Small and large vessel damage was assessed by means of non-mydriatic digital fundus oculi examination in order to detect arteriolar narrowing using arteriolar-venular ratio (AVr), applanation tonometry to measure carotid-femoral pulse wave velocity (cfPWV) and carotid ultrasound to quantify intima-media tickness (IMT). Results Moderate to severe CKD patients appeared to be older (mean age 75.54±8.06 vs 63.38±9.62, p=0.001) and showed lower level of total and LDL cholesterol. Both groups showed abnormal values of cfPWV, but these were significantly higher in the presence of moderate to severe CKD (14.12±7.93 m/s vs 10.94±5.81 m/s, p=0.03). Abnormal AVr values were found in patients with higher grade of CKD, with statistically significant differences in the two groups (0.75±0.015 vs 0.81±0.06, p=0.00001). Carotid IMT resulted to be at the upper limit of normality in both groups (0.95±0.15 vs 0.90±0.18, p=0.35). With regard to echocardiography evaluation, left ventricular mass index (LVMi: 105.04±0.4 vs 96.35±1.7, p=0.06) and relative wall thickness (RWT: 0.43±0.02 vs 0.42±0.05, p=0.41) did not differ significantly in the two groups, with a mild trend for LVMi. Both groups showed abnormal diastolic dysfunction on average, but no differences emerged in the presence of more severe renal impairment (deceleration time 281.74±0.37 vs 256.30±0.54, p=0.08; E/A 0.86±0.03 vs 0.95±0.25, p=0.20; E/e' 7.89±2.93 vs 7.60±2.46, p=0.66). Conclusions Our study showed significant differences in HMOD in presence of moderate to severe renal impairment. Moderate to severe CKD seemed to be associated to vascular damage (hypertensive retinopathy and arterial stiffness), while no significant differences in echocardiographic markers of cardiac remodeling were found, suggesting that systemic vascular damage is more closely linked to CKD than cardiac damage. Therefore, the use of fundus oculi examination and PWV should always be considered to properly assess the target organ damage in hypertensive patients with CKD. Funding Acknowledgement Type of funding source: None

scholarly journals POS0643 ARE BIOLOGIC AND TARGETED SYNTHETIC DMARDS SAFE TO USE IN PATIENTS WITH RENAL IMPAIRMENT?

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 560.1-560
Author(s):  
F. Rees ◽  
M. Jasim
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Renal Impairment ◽  
Safety Profile ◽  
Ckd Stage ◽  
Synthetic Dmards ◽  
Renal Safety

Background:Chronic kidney disease (CKD) is defined as a permanent (minimum three month) reduction in glomerular filtration rate. [1] 10-30% of rheumatoid arthritis (RA) patients have CKD, compared to 5% of the general population.[1] There are several causes of CKD associated with RA including persistent inflammation, cardiovascular risk factors, frequent use of non-steroidal anti-inflammatory drugs and amyloidosis.[1] CKD in RA patients is associated with increased mortality.[2]The use of biologic and targeted synthetic DMARDs for treating RA has increased significantly in recent years. Studies have shown these therapies might reduce the risk of developing CKD in RA. [3] However, conversely, biologics have been linked to the development of glomerulonephritis.[4]Surprisingly few studies have explored the use of biologics in patients with pre-existing renal disease and whether they contribute to renal impairment themselves.Objectives:Our objectives were to explore the renal safety profile of biologic and targeted synthetic DMARDs in a real-world cohort of RA patients with and without pre-existing CKD.Methods:A retrospective observational study was completed using the Biologic Therapy Database at Cannock Chase Hospital. Inclusion criteria were a diagnosis of RA and current treatment with a biologic or targeted synthetic DMARD.Demographic data, renal function at biologic initiation and any deterioration of renal function were among the recorded information for each patient. Patients with insufficient information available via electronic patient records were excluded.Results:998 RA patients on biologics were identified, of whom 213 were excluded. Of the 785 remaining patients, a 3:1 female to male ratio was noted with a mean age of 62. 40% of patients were on an anti-TNF, 22% rituximab, 15% abatacept, 15% JAK inhibitors and 9% anti-IL6 respectively. At biologic initiation 92% of the patients had a GFR of >60 ml/min per 1.73m2, 4.8% had a GFR of 30-60 (CKD stage 3a-3b), <1% stage 4 CKD. No patients in the cohort had CKD stage 5 at biologic initiation.Overall, 13 patients had significant pre-existing CKD (eGFR <45) of these, 6 were treated with abatacept. 7/13 patients had no co-morbid risk factors for CKD – of those remaining, 2 were hypertensive, 2 diabetic and 2 both. None of these 13 patients experienced a drop in renal function by more than 1 stage since initiation of current biologic.Of those patients without prior CKD at the point of biologic initiation (GFR >45), only 15 patients (2%) developed new renal impairment whilst on biologic treatment. 10 patients’ renal function dropped by one stage and five patients by two stages. Crucially, 12 of the 15 patients were aged ≥75yrs and 10 patients had at least one other associated risk factor (e.g. diabetes). Only one patient in the cohort developed renal impairment as a direct result of a biologic - minimal-change disease secondary to etanercept.Conclusion:Our findings indicate that biologic treatments have a good renal safety profile – even with pre-existing CKD. RA patients most at risk of developing CKD whilst on biologics are likely to have other risk factors such as diabetes or hypertension. As previously stated, there is a very rare association of anti-TNF biologics causing glomerulonephritis.References:[1]Couderc M, et al. Prevalence of Renal Impairment in Patients with Rheumatoid Arthritis: Results from a Cross-Sectional Multicenter Study. Arthritis Care Res. 2016 May 1;68(5):638–44.[2]Chiu HY, et al. Increased risk of chronic kidney disease in rheumatoid arthritis associated with cardiovascular complications - A national population-based cohort study. PLoS One. 2015 Sep 25;10(9).[3]Sumida K, et al. Treatment of rheumatoid arthritis with biologic agents lowers the risk of incident chronic kidney disease. Kidney Int. 2018 May 1;93(5):1207–16.[4]Piga M, et al. Biologics-induced autoimmune renal disorders in chronic inflammatory rheumatic diseases: Systematic literature review and analysis of a monocentric cohort. Vol. 13, Autoimmunity Reviews. Elsevier; 2014. p. 873–9.Disclosure of Interests:None declared

Urine S-Adenosylmethionine are Related to Degree of Renal Insufficiency in Patients with Chronic Kidney Disease

2020 ◽  
Vol 52 (1) ◽  
pp. 47-56
Author(s):  
Maria Petrovna Kruglova ◽  
Alexander Vladimirovich Ivanov ◽  
Edward Danielevich Virus ◽  
Polina Olegovna Bulgakova ◽  
Andrey Segeevich Samokhin ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Renal Impairment ◽  
Healthcare Professionals ◽  
Severe Renal Impairment ◽  
Additional Advantage ◽  
Renal Function Decline ◽  
Study Results ◽  
Urine Levels

Abstract Objective To determine whether urine S-adenosylmethionine (SAM) might be an indicator of chronic kidney disease (CKD). Methods We investigated urine levels of SAM and related metabolites (S-adenosylhomocysteine and homocysteine cysteine) in 62 patients (average age, 65.9 years) with CKD (stages II–V). Results Patients with stages III–V CKD stages have significantly decreased urine levels and SAM/S-adenosylhomocysteine ratio and also cysteine/homocysteine ratio in blood plasma (P &lt;.05), compared with patients with stage II CKD. Urine SAM levels allowed us to distinguish patients with mildly decreased kidney function from those with moderate to severe renal impairment (AUC, 0.791; sensitivity, 85%; specificity, 78.6%). Conclusions Our study results demonstrate that urine SAM is a potent biomarker for monitoring renal function decline at early CKD stages. Urine SAM testing confers an additional advantage to healthcare professionals in that it is noninvasive.

scholarly journals P748 Three-year echocardiographic outcomes in MitraClip patients with chronic kidney disease

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Tavernese ◽  
V Cammalleri ◽  
A Sanseviero ◽  
P De Vico ◽  
S Muscoli ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Systemic Hypertension ◽  
Systolic Pulmonary Artery Pressure ◽  
Kaplan Meier ◽  
Group A ◽  
Group B

Abstract Background Chronic kidney disease (CKD) has been shown to impact negatively the prognosis of patients with heart failure, coronary artery or valvular heart disease and emerged as predictor of poor outcomes in mitraclip population. Purpose Aim of our study was to evaluate three-year echocardiographic outcomes in CKD patients with severe mitral regurgitation (MR) treated with mitraclip. Methods This in an observational study including patients treated with mitraclip in our institution, who completed three years of follow up. Patients population was divided into two groups according to basal creatinine clearance (CrCl): group A, including patients with normal/mild decline of renal function (CrCl &gt; 60 ml/min) and group B, including patients with CKD (CrCl &lt; 60 ml/min). Demographic and procedural characteristics were compared, as well as echocardiographic data, including grade of MR, left ventricular ejection fraction (LVEF), mean transmitral gradient and systolic pulmonary artery pressure (sPAP). Kaplan-Meier survival curves were obtained. Results The study population consists of 107 patients (mean age 71 ± 9 years, 69% male): 57 belonging to group A and 50 to group B. Patients of group B had higher values of LogEuroScore (22 ± 10 vs.15 ± 9 p = 0,0002), systemic hypertension (92% vs. 74%, p = 0,026), complicated diabetes (46% vs. 24% p = 0,034) and NYHA IV before the procedure (24% vs 9 %, p = 0,059). Additionally, patients of group B had lower baseline LVEF (35 ± 11 vs. 41 ± 13; p = 0,012). Procedural success was similar between the two groups without significant difference in degree of MR reduction after mitraclip implantation. Echocardiographic follow-up showed that in group B, the LVEF did not improve after the treatment (more than 50% had LVEF &lt; 35% at 1,2 and 3 years) while in the group A it improved significantly (LVEF &lt; 35% from 47,6% at discharge to 29%, 32% and 31% at 1, 2 and 3 years, respectively). In comparison to group A, in group B a progressive increase in residual MR grade was observed (moderate-to-severe MR from 2% at discharge to 14%, 15%, and 27% at 1, 2 and 3 years, respectively) as well as in the mean transmitral gradient (from 3,90 ±1,6 mmHg after the mitraclip implantation to 5,28 ± 1,7; 5,73 ± 1,75; 6,06 ±1,75 at 1, 2 and 3 years, respectively) and sPAP (from 47 ± 12 mmHg at discharge to 49 ± 21; 51 ± 20; 48 ± 22 at 1, 2 and 3 years, respectively). Kaplan Meier estimate of survival free from in-hospital readmission was 77% in group A and 61% in group B (Log-Rank 4.563, p = 0,033) and survival free from cardiovascular death was 95% and 81,5%, in group A and B, respectively (Log-Rank 4.806, p = 0,028). Conclusion Our results suggest that CKD patients have poorer outcomes after mitraclip implantation with worsening of some echocardiographic parameters, particularly for residual MR degree, mean transmitral gradient and sPAP, without improvement in LVEF at one, two and three years of follow-up.

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