scholarly journals Chronic kidney disease in patients with recurrent nephrolithiasis and concomitant damage to the cardiovascular system

2021 ◽  
Vol 9 (3) ◽  
pp. 52-61
Author(s):  
R. V. Royuk ◽  
S. K. Yarovoy
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Control Group ◽  
Group Iii ◽  
Group I ◽  
Ckd Stage ◽  
Group Ii ◽  
Recurrent Nephrolithiasis

Introduction. Chronic kidney disease (CKD) is commonly diagnosed in patients with cardiovascular diseases (CVDs) and also manifests itself in most patients with urolithiasis. Numerous studies have shown that renal dysfunction is not only directly related to the high risk of developing various CVDs and chronic heart failure (CHF) as one of the most common complications but also the mortality rate in comorbid patients. CKD and CHF have similar pathogenetic mechanisms and common target organs; co-existing, both pathological conditions accelerate the progression of major diseases and significantly aggravate their course. In patients with recurrent nephrolithiasis combined with CVDs, all the causes leading to the formation of CKD (recurrent obstructive pyelonephritis, nephroangiosclerosis, etc.) are present to some extent.Purpose of the study. To evaluate the incidence and characteristics of CKD in patients suffering from recurrent urolithiasis associated with CVDs.Materials and methods. The prospective study included 406 patients who were treated for recurrent nephrolithiasis and concomitant CVDs from 2007 to 2020 (Urology Division, Burdenko Principal Military Clinical Hospital). From long-term follow-up respondents who lived at least 10 years after inclusion in the study (n = 52), three groups were formed: group I (n = 18) included patients with a combination of essential hypertension (EH) and ischemic heart disease (IHD), complicated by CHF; group II (n = 15) consisted of patients with uncomplicated CVDs (EH – 7 patients, IHD – 8 patients). The control group III (n = 19) included respondents suffering from nephrolithiasis without CVDs. The glomerular filtration rate (GFR) was determined by the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) following the Russian National Guidelines for «Chronic Kidney Disease». The analysis of the obtained data was carried out using Statistica 8.0; the Fisher and Wilcoxon criteria were calculated; the differences were considered significant at p < 0.05.Results. All patients included in the study were repeatedly hospitalized urgently and as planned and underwent at least one non-invasive manipulation or surgery. The average age of the patients was 58.9 ± 2.95 years; men predominated (~ 75 – 78%). A GFR decrease was recorded in 41.1% of patients included in the study, in 40.5% of patients with a combination of nephrolithiasis and uncomplicated CVDs, Also, its decrease was found in 60 (58.8%) of patients with chronic heart failure (CHF) in 41.1% of cases from the general sample and 40.5% of patients without CHF. CKD stage II occurred in 44 (43.1%) cases of CHF; CKD stages III Ca and Cb were detected in 10 (9.8%) and 4 (1%) cases, respectively; CKD stage IV developed in 1 (0.25%) patient with one of the re-hospitalizations. Of the 52 patients included in the second study part, the ratio of men and women was 41/11 (78.8 and 21.2%, respectively). All three groups were also dominated by men. The initial values of GFR in group I patients significantly differed from those in the control group; in group II, statistically significant differences appeared 4 years after the s the study initiation, and in group I – after 2 years. A sharp (1.5-fold) significant decrease in renal filtration function was registered in group I by the 6th research year, in group II (1.3-fold) – by the 8th research year, and in group III (1.28-fold) – only by the 10th research year. The GFR level in group I and group II decreased during the 1st follow-up year by 2.36 and 1.65 times, respectively.Conclusion. CKD in patients suffering from recurrent nephrolithiasis in combination with IHD and EH is generally benign. The progression rate of filtration deficiency is relatively low and is (at least in the early stages) about 4.5 ml/min per year. The addition of CHF increases the rate of decline in renal filtration function by up to 25% (from 4 ml/min per year to 5 ml/min per year). The main negative effect of concomitant CVDs (especially complicated CHF) is not an ultrahigh decrease in GFR but a reduction in kidney functioning stable period up to complete cessation.

A Study of Sleep Disorders in Patients with Chronic Kidney Disease (CKD)

2017 ◽  
Vol 9 (5) ◽  
Author(s):  
Hussein A. ◽  
El–Hadidy A. ◽  
Gomaa N. ◽  
Amin Y. ◽  
El-Shabouny T.
Keyword(s):  
Chronic Kidney Disease ◽  
Sleep Apnea ◽  
Kidney Disease ◽  
Respiratory Distress ◽  
Oxygen Saturation ◽  
Kidney Function ◽  
Group Iii ◽  
Group I ◽  
Ckd Stage ◽  
Group Ii

Sleep apnea is an important comorbidity in patients with chronic kidney disease (CKD). Although the increased prevalence of sleep apnea in patients with CKD is well established, few studies have examined the full spectrum of kidney function. We sought to determine the prevalence of sleep apnea and associated nocturnal hypoxia in patients with CKD. We hypothesized that the prevalence of sleep apnea would increase progressively as kidney function declines. 45 patients were recruited from outpatient nephrology clinics, nephrology department, and hemodialysis units. All patients completed an overnight inpatient polysomnograhy test to determine the prevalence of sleep apnea (AHI ≥ 5 events /h) and nocturnal hypoxia (oxygen saturation (SaO2) below 90% for ≥12% of the nocturnal monitoring time). Patients were stratified according to their estimated glomerular filtration rate (eGFR) at the time of the study visit into three groups as follows: CKD stage 2 (eGFR 60 to 89 mL/min/1.73 m2) (control group), CKD stages 3 and 4 (eGFR 15 to 59 mL/min/1.73 m2), and CKD stage 5 (eGFR less than 15 mL/min/1.73 m2). eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Out of the 45 patients included in our study with the full spectrum of kidney function, ranging from those with eGFR 60 to 89 ml/min./1.73m2 to patients with eGFR less than 15 ml/min./1.73m2, 15 (33.3%) had sleep apnea (Mean AHI; 8.71±5.86). Our study found that prevalence of sleep apnea increased as kidney function declined (Group (I), 20%; Group (II), 36.4%; Group (III), 37.5%). Furthermore, severity of sleep apnea increased as kidney function declined (Group (I), mean AHI: 5.75±0.35; Group (II), mean AHI: 6±1.38; Group (III), mean AHI: 10.6±7.04). We also found that prevalence of nocturnal hypoxia which is characteristically associated with sleep apnea was greater among groups (II) and (III) (27.3% and 16.7%, respectively) than in group (I) (10%). Severity of nocturnal hypoxia increased as kidney function declined (Group (I), 13%; Group (II), 13.6±1.22%; Group (III), 16.75±3.30%). Overall, 8 out of the 45 studied CKD patients (17.8%) had nocturnal hypoxia (Mean SaO2 below 90% for ≥12% of the nocturnal monitoring time; 15.1±2.87%). Our study revealed that as kidney function declined, Apnea/Hypopnea (AHI) indices increased, oxygen desaturation indices increased, minimal peripheral capillary oxygen saturation values decreased, peripheral capillary oxygen saturation time less than 90% increased, and snore indices increased. Also, respiratory distress index (RDI) was higher among groups (II) and (III) than in group (I). However, only differences between groups as regards respiratory distress events, respiratory distress indices, snore events, and snore indices were statistically significant. These results show that as kidney function declines, several respiratory parameters deteriorate during sleep. In addition, wake events and indices, and sleep stage 1 (%) increased as kidney function deteriorated. Sleep efficiency (%) was highest among group (I) patients and lower among groups (II) and (III), Light sleep (%) was lowest among group (I) patients and higher among groups (II) and (III), and deep sleep (%) was highest among group (I) patients and lower among groups (II) and (III). It is clear from the above results that as kidney function declines, sleep efficiency deteriorates, wake indices increase, light sleep (%) increases, and deep sleep (%) decreases. We concluded that prevalence and severity of sleep apnea in patients with CKD increase as kidney function declines. Almost 18% of patients with CKD experience nocturnal hypoxia, which may contribute to loss of kidney function.

scholarly journals Chronic kidney disease predicts poor outcomes of COVID-19 patients

2021 ◽  
Author(s):  
Mahmut Gok ◽  
Hakki Cetinkaya ◽  
Tugba Kandemir ◽  
Erdem Karahan ◽  
İzzet Burak Tuncer ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Multivariate Regression Analysis ◽  
Hospital Data ◽  
Group I ◽  
Ckd Stage ◽  
Comorbid Diseases ◽  
Group Ii ◽  
Poor Outcomes

Abstract Purpose The recent outbreak of COVID-19 rapidly spread worldwide. Comorbid diseases are determinants of the severity of COVID-19 infection and mortality. The aim of this study was to explore the potential association between chronic kidney disease (CKD) and the severity of COVID-19 infection. Methods The study included 609 consecutive adult patients (male: 54.52%, mean age: 59.23 ± 15.55 years) hospitalized with the diagnosis of COVID-19 in a tertiary level hospital. Data were collected from the electronic health records of the hospital. The patients were separated into two groups: Group I included COVID-19-positive patients with CKD stage 1–2, and Group II included COVID-19-positive with CKD stage 3–5. The relationships were examined between CKD stage, laboratory parameters and mortality. Results Significant differences were determined between the groups in respect of the inflammation parameters and the parameters used in prognosis. In Group II, statistically significantly higher rates were determined of comorbid diseases [hypertension (p < 0.001) and diabetes mellitus (p < 0.001), acute kidney injury (AKI), which was found to be associated with mortality (p < 0.001), and mortality (p < 0.001)]. In multivariate regression analysis, CKD stage 3–5, AKI, male gender, hypertension, DM and malignancy were found to be significant independent variables increasing mortality. Conclusion The prevelance of CKD stage 3–5 on admission is associated with a high risk of in-hospital mortality in patients with COVID-19. Close follow-up can be recommended for patients with a reduced glomerular filtration rate (GFR).

Evaluation of the level of natriuretic peptides in the diagnosis and characterization of chronic kidney disease and cardiorenal syndrome in children

2021 ◽  
Vol 25 (6) ◽  
pp. 87-92
Author(s):  
A. M. Mambetova ◽  
D. V. Bizheva ◽  
I. K. Thabisimova
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Natriuretic Peptides ◽  
Cardiorenal Syndrome ◽  
Stage I ◽  
Group Iii ◽  
Early Stages ◽  
Group I ◽  
Ckd Stage

BACKGROUND. Natriuretic peptides have cardio- and renoprotective effects, inhibiting inflammatory and proliferative processes. The role of natriuretic peptides in the early diagnosis and characterization of chronic kidney disease (CKD) and cardiovascular complications as the disease development and progresses has not been studied.TNEAIM: to study the level of natriuretic peptides in children depending on the stage of CKD development and to assess the significance of this indicator.PATIENTS AND METHODS. The study involved 93 children with congenital diseases of the urinary system at the age from 3 to 18 years. Three groups were identified: group I - 54 patients with CKD stage I , group II - 29 patients with CKD stage II; Group III - 10 children with CKD stages IV-V (patients with CKD stages IV and V were combined due to their small amount). Control group - 10 clinically healthy children of the corresponding age. The N-terminal propeptide of natriuretic hormone (NT-proBNP) was determined in the blood by the enzyme-linked immunosorbent assay.RESULTS. An increase in the level of NT-proBNP by 28.7% takes place already in the early stages of CKD. With the progression of CKD, an increase in the level of NT-proBNP was noted from 57.4 % in children in the group of patients with stage I CKD to 80 % in children in group III patients. The maximum concentrations of NT-proBNP, many times higher than those in CKD stages I and II, were observed in children with CKD stages IV-V. The degree of increase in the level of NT-proBNP correlated with the severity of CKD.CONCLUSION. In the diagnosis and characterization of CKD and cardiorenal syndrome in children, the determination of the level of natriuretic peptides is of great importance. A high level of natriuretic peptides characterizes the presence of cardiorenal relationships and can be used as an additional criterion for assessing the severity of CKD, including at the early stages of its development.

scholarly journals Interpretation of Erythropoietin and Haemoglobin Levels in Patients with Various Stages of Chronic Kidney Disease

2017 ◽  
Vol 36 (2) ◽  
pp. 145-152 ◽  
Author(s):  
Mirsad Panjeta ◽  
Ismet Tahirović ◽  
Emin Sofić ◽  
Jozo Ćorić ◽  
Amela Dervišević
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Control Group ◽  
Glycoprotein Hormone ◽  
Cross Sectional ◽  
Group Iii ◽  
Spectrophotometric Methods ◽  
Group I ◽  
Blood Haemoglobin

SummaryBackground: The production of erythrocytes is regulated by the hormone erythropoietin (EPO), which maintains the blood haemoglobin (Hb) levels constant under normal conditions. Human EPO is a glycoprotein hormone and its synthesis is controlled by the hypoxia-inducible transcription factor. The aim of this study was to establish EPO and Hb levels in patients with chronic kidney disease (CKD), as well as in control subjects, and to investigate the relationship between these parameters.Methods: This cross-sectional, observational study included 356 subjects with CKD divided into 4 subgroups according to their glomerular filtration rate (GFR). The control group consisted of 206 age and sex matched healthy subjects with GFR rate ≥90 mL/min/1.73 m2. EPO, Hb and serum creatinine levels were determined by using immunochemical and spectrophotometric methods. GFR was determined using the MDRD formula.Results: The CKD patients had significantly lower levels of haemoglobin (p<0.0005) and hematocrit (p<0.0005) compared to control group. Our results showed that Hb levels decreased, whereas serum creatinine increased with the increasing renal failure. The CKD patients in all four groups had significantly lower (p<0.0005) Hb levels, and significantly higher (p<0.0005) creatinine levels compared to the control group. The median EPO in group I and II were significantly higher (p=0.002; p=0.018), while median EPO in group III and IV were significantly lower (p=0.03; p=0.011) compared to the control group.Conclusions: In patients with CKD, GFR positively correlated with Hb and EPO, while the correlation between GFR and serum creatinine was negative.

scholarly journals Developmental milestones of vertically HIV infected and seroreverters children: follow up of 83 children

2001 ◽  
Vol 59 (3B) ◽  
pp. 691-695 ◽  
Author(s):  
Isac Bruck ◽  
Tony Tannous Tahan ◽  
Cristina Rodrigues da Cruz ◽  
Luzilma Terezinha Flenik Martins ◽  
Sérgio Antonio Antoniuk ◽  
...  
Keyword(s):  
Screening Tests ◽  
Control Group ◽  
Basal Ganglia Calcification ◽  
Group Iii ◽  
Computed Tomographic ◽  
Group I ◽  
Immunodeficiency Virus ◽  
Neurological Exam ◽  
Group Ii

The aim of the study was to detect neurological abnormalities in human immunodeficiency virus (HIV) infected children. This was achieved by a prospective evaluation, from November/1995 to April/2000, of 43 HIV infected children (group I) and 40 HIV seroreverters children (group II) through neurological exam and neurodevelopmental tests: Denver Developmental Screening Test (DDST) and Clinical Adaptive Test / Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS). A control group (III), of 67 children, were evaluated by CAT/CLAMS. Hyperactivity, irritability and hypotonia were the findings on neurological examination, without statistical differences between group I and II. On CAT/CLAMS, the group I developmental quotient (DQ) was significantly lower than the other groups. The same occurred in DDST, with group I presenting significantly more failures than group II. Nineteen HIV children of group I had brain computed tomographic scan, with abnormalities in three of them (basal ganglia calcification, white matter hypodensity and asymmetry of lateral ventricles). We conclude that in HIV infected children a neurodevelopment delay occur early in the disease, and it can be detected by screening tests.

scholarly journals The Correlation between Serum Creatinine and PTH Levels in Dialysis Patients in Egypt

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S154-S154
Author(s):  
A S Boraik ◽  
M Abdelmonem ◽  
M Shedid ◽  
H M Abd Elaal ◽  
A Elhusseny ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Late Stage ◽  
The Body ◽  
Control Group ◽  
Study Group ◽  
Dialysis Patients ◽  
Group I ◽  
Group Ii

Abstract Introduction/Objective Chronic kidney disease (CKD) is affecting about 14% of the general population. CKD is associated with a decrease in calcium level in the body. In the early stages of (CKD), dialysis may not be needed. The late stages of CKD will require dialysis or a kidney transplant to save a life. Secondary hyperparathyroidism is a crucial disorder in CKD patients. It explains why the illness causes a significant change in bone and mineral metabolism. This study aims to study renal hyperparathyroidism (rHPT) in dialysis patients with late-stage of chronic kidney disease (CKD). Methods/Case Report A total of 55 subjects were enrolled in this study for late-stage dialysis patients from Egypt. Serum creatinine and PTH levels were measured. Among the 55 subjects; 41 subjects (74.5%) were males, 14 subjects (25.5%) were females with a mean age of 52.7 and 34.3 years for males and females, respectively. Subjects were divided into two groups; Study group I consists of 33 dialysis patients; three patients were females (9%) while 30 patients were males (91%), and control group II consists of 22 healthy individuals, 11 subjects were females (50%), and 11 subjects were males (50%). Results (if a Case Study enter NA) In our study, in comparison between two groups as regards blood investigations. The means of creatinine and PTH in the study group I were 8.93 mg/dl and 316.8, while in the control group II were 0.9, and 38.4 respectively. Comparing the two groups shows that mean of Creatinine and PTH in the study group was statistically significantly higher than the control group (p-value less than 0.001). Conclusion In patients with CKD, accurate measurement of (PTH) is critical for treatment decision-making to reduce the risk of bone and cardiovascular diseases. We recommend that patients with diabetes and high blood pressure be aware that they must take their medications consistently to avoid kidney problems.

scholarly journals Typical atrial flutter ablation and predictors of events in the follow-up

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
P Alves Da Silva ◽  
T Rodrigues ◽  
N Cunha ◽  
J Brito ◽  
S Couto-Pereira ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Atrial Flutter ◽  
Univariate Analysis ◽  
Bleeding Event ◽  
Group I ◽  
Typical Atrial Flutter ◽  
Clinical Records

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cavotricuspid isthmus ablation (CTA) is considered the main treatment for rhythm control in patients (pts) with typical atrial flutter (AFL). Although there is an established risk for embolic events in atrial fibrillation (AF), the results are not standardized for typical AFL. Currently, anticoagulation in AFL pts submitted to ablation is not consensual. Purpose To determine the incidence and predictors of major cardiovascular events (MACE) of pts submitted to CTA of typical AFL. Methods Single-center retrospective study of patients (pts) submitted to CTA between 2015 and 2019, comprising three groups: I – pts with lone AFL; II – patients with AFL and prior AF submitted to CTA only; and III – patients with AFL and prior AF submitted to IVP and CTA. Clinical records were analyzed to determine the occurrence of MACE during the long-term follow up, defined as death (of cardiovascular or unknown cause), stroke, clinically relevant bleed or hospitalization due to heart failure or arrhythmic events. Kaplan Meier survival curves were used to estimate the risk of events and the groups were compared using uni- and multivariate Cox regression analyses Results A total of 476 pts (66 ± 12 years, 80% males) underwent CTA: group I – 284 pts (60%), II – 109 pts (23%) and III – 83 pts (17%). Baseline characteristics were similar between groups, except for age with group I pts being older (68 ± 12, 67 ± 11, 61 ± 11, p &lt; 0.03). At presentation, the majority of the pts had palpitations (70.4%) and mild symptoms (70.8%). HTN and dyslipidemia were the most frequent cardiovascular risk factors, 69.5% and 53.9%, respectively, and heart failure was not frequent (27.7%) with only 5.4% of pts with LVEF &lt; 30% and 12.4% with left atrium &gt; 50ml/m2. During a mean follow-up of 2.8 years, the incidence of MACE events was 102 (21,4%). Regarding MACE components: 54 pts (11.5%) died from cardiovascular death, 20 pts had stroke (4.5%), 13 (3.8%) had a clinically relevant bleeding event, and 51 pts (11.4%) were hospitalized due to heart failure or arrhythmic events. On univariate analysis, arterial peripheric disease (p = 0.018), HTN (p = 0.046), chronic kidney disease (p &lt;0.001), chronic pulmonary disease (p = 0.0024), heart failure (p &lt;0.001), cerebrovascular disease (p 0.029), body mass index (p = 0.01), age (p &lt;0.001), CHADsVASc score (p &lt; 0.001) and left atrial diameter (p= 0.01) were associated with the occurrence of MACE. However only age (HR 1.073; 95%CI 1.03-1.06, p &lt; 0.001) and chronic kidney disease (HR 0.37; 95%CI 0.186-0.765, p = 0.007) were independent predictors of major events. Conclusions In our cohort of pts with AFL, stroke and bleeding occurred in a minority of pts. Age and chronic kidney disease predicted MACE events during follow-up. Abstract Figure. CKD as FLA predictor

scholarly journals Updated Clinical Practice Guideline on Use of Gadolinium-Based Contrast Agents in Kidney Disease Issued by the Canadian Association of Radiologists

2019 ◽  
Vol 70 (3) ◽  
pp. 226-232 ◽  
Author(s):  
Nicola Schieda ◽  
Pejman Jabehdar Maralani ◽  
Casey Hurrell ◽  
Anne K. Tsampalieros ◽  
Swapnil Hiremath
Keyword(s):  
Clinical Practice ◽  
Kidney Disease ◽  
Contrast Agents ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Group Iii ◽  
Canadian Association ◽  
Group I ◽  
Ckd Stage ◽  
Group Ii

In 2017, the Canadian Association of Radiologists issued a clinical practice guideline (CPG) regarding the use of gadolinium-based contrast agents (GBCAs) in patients with acute kidney injury (AKI), chronic kidney disease (CKD), or on dialysis due to mounting evidence indicating that nephrogenic systemic fibrosis (NSF) occurs with extreme rarity or not at all when using Group II GBCAs or the Group III GBCA gadoxetic acid (compared to first generation Group I linear GBCAs). One of the goals of the work group was to re-evaluate the CPG after 24 months to determine the effect of more liberal use of GBCA on reported cases of NSF in patients with AKI, CKD Stage 4 or 5 (estimated glomerular filtration rate [eGFR] < 30 mL/min/1.73 m2), or those that are dialysis-dependent. A comprehensive review of the literature was conducted by a subcommittee of the initial CPG panel between the dates of January 1, 2017-December 31, 2018 to identify new unconfounded cases of NSF linked to Group II or Group III GBCAs and an updated CPG developed. To our knowledge, when using a Group II or Group III GBCA between 2017-2018, only a single unconfounded case report of a fibrosing dermopathy has been reported in a patient who received gadobenate dimeglumine with Stage 2 CKD. No other unconfounded cases of NSF have been reported with Group II or III agents in during this timeframe. The subcommittee concluded that the main recommendations from the 2017 CPG should remain unaltered, but agreed that screening for renal disease in the outpatient setting is no longer justifiable, cost-effective or recommended. Patients on hemodialysis (HD) should, however, be identified prior to GBCA administration to arrange timely HD to optimize gadolinium clearance, although there remains no evidence that HD reduces the risk of NSF. When administering Group II or III GBCAs to patients with AKI, on dialysis or with severe CKD, informed consent relating to NSF is also no longer explicitly recommended.

scholarly journals Echo- and B-Type Natriuretic Peptide-Guided Follow-Up versus Symptom-Guided Follow-Up: Comparison of the Outcome in Ambulatory Heart Failure Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Gani Bajraktari ◽  
Nicola Riccardo Pugliese ◽  
Andreina D’Agostino ◽  
Gian Marco Rosa ◽  
Pranvera Ibrahimi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Natriuretic Peptide ◽  
Cox Regression ◽  
Left Ventricular ◽  
Number Needed To Treat ◽  
Group Iii ◽  
Versus Group ◽  
Group I ◽  
Group Ii

Recent European Society of Cardiology and American Heart Association/American College of Cardiology Guidelines did not recommend biomarker-guided therapy in the management of heart failure (HF) patients. Combination of echo- and B-type natriuretic peptide (BNP) may be an alternative approach in guiding ambulatory HF management. Our aim was to determine whether a therapy guided by echo markers of left ventricular filling pressure (LVFP), lung ultrasound (LUS) assessment of B-lines, and BNP improves outcomes of HF patients. Consecutive outpatients with LV ejection fraction (EF) ≤ 50% have been prospectively enrolled. In Group I (n=224), follow-up was guided by echo and BNP with the goal of achieving E-wave deceleration time (EDT) ≥ 150 ms, tissue Doppler index E/e′ < 13, B-line numbers < 15, and BNP ≤ 125 pg/ml or decrease >30%; in Group II (n=293), follow-up was clinically guided, while the remaining 277 patients (Group III) did not receive any dedicated follow-up. At 60 months, survival was 88% in Group I compared to 75% in Group II and 54% in Group III (χ2 53.5; p<0.0001). Survival curves exhibited statistically significant differences using Mantel–Cox analysis. The number needed to treat to spare one death was 7.9 (Group I versus Group II) and 3.8 (Group I versus Group III). At multivariate Cox regression analyses, major predictors of all-cause mortality were follow-up E/e′ (HR: 1.05; p=0.0038) and BNP >125 pg/ml or decrease ≤30% (HR: 4.90; p=0.0054), while BNP > 125 pg/ml or decrease ≤30% and B-line numbers ≥15 were associated with the combined end point of death and HF hospitalization. Evidence-based HF treatment guided by serum biomarkers and ultrasound with the goal of reducing elevated BNP and LVFP, and resolving pulmonary congestion was associated with better clinical outcomes and can be valuable in guiding ambulatory HF management.

scholarly journals Usefulness of Contrast-Enhanced Ultrasound in the Evaluation of Chronic Kidney Disease

2021 ◽  
Vol 17 ◽  
Author(s):  
Byoung Hee Han ◽  
Sung Bin Park
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Microvascular Perfusion ◽  
Contrast Enhanced Ultrasound ◽  
Control Groups ◽  
Group Iii ◽  
Group I ◽  
Contrast Enhanced ◽  
Group Ii ◽  
And Control

Background: Contrast-enhanced ultrasound (CEUS) can provide more improved images of renal blood flow and much more information of both macro- and microcirculation of the kidney as comparing to Doppler US. Objective: To investigate the usefulness of CEUS by analyzing differences in perfusion-related parameters among the three chronic kidney disease (CKD) subgroups and the control group. Methods: Thirty-eight patients with CKD and 21 controls who were age matched (20−49 years) and included. Included CKD patients were stratified into three groups according to their eGFR: group I, eGFR ≥ 60 ml/min/1.73 m2 (GFR category I and II); group II, 30 ml/min/1.73 m2 ≤ eGFR < 60 ml/min/1.73 m2 (GFR category III); and group III, eGFR < 30 ml/min/1.73 m2 (GFR category IV and V). Comparisons with the controls (eGFR > 90 ml/min/1.73 m2 ) were performed. Real-time and dynamic renal cortex imaging was performed using CEUS. Time-intensity curves and several bolus model quantitative perfusion parameters were created using the VueBox® quantification software. We compared the parameters among the CKD subgroups and between the CKD and control groups. Results: Eight patients were included in group I, 12 patients in group II, and 18 patients in group III. Significant differences were noted in the wash-in and wash-out rates between the CKD and control groups (p = 0.027 and p = 0.018, respectively), but not between those of the CKD subgroups. There were no significant differences of other perfusion parameters among the CKD subgroups and between the CKD and control groups. Conclusion: A few perfusion related CEUS parameters (WiR and WoR) can be used as markers of renal microvascular perfusion relating renal function. CEUS can effectively and quantitatively exhibit the renal microvascular perfusion in patients with CKD as well as normal control participants.

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