scholarly journals mHealth App for Patient Self-Management of Chronic Kidney Disease Improves Renal Outcome: Pilot Study (Preprint)

2018 ◽  
Author(s):  
Xuyong Chen ◽  
Shasha Xie ◽  
Xiaojuan Yu ◽  
Zhibin Chen ◽  
Min Zhuo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Pilot Study ◽  
Kidney Disease ◽  
Mobile Application ◽  
Self Management ◽  
Control Group ◽  
The Mean ◽  
Physician Patient ◽  
Experimental Group

BACKGROUND The prevalence of chronic kidney disease (CKD) is approximately 850 million worldwide and 120 million in China. Approximately 2% of the CKD population will progress to end-stage renal disease (ESRD) requiring renal replacement therapy or transplantation. The total health care expenditure on dialysis for the entire ESRD population in China is estimated to be 240 billion RMB per year. Using mobile health information technologies to conduct low-cost, large-scale, and personalized populational health interventions show a great promise. OBJECTIVE In this pilot study, we assessed the feasibility and clinical effectiveness of a mobile application designed to improve patient's self-management of chronic kidney disease over a 3-month intervention with a pre-post design and a quasi-trial design. METHODS Patients with CKD stage 1-3 and uncontrolled proteinuria (proteinuria>1g per day) were recruited. Eligible patients who were waitlisted served as the control. Patients in the experiment group were invited to install a mobile application known as Shen Shang Xian (Chinese pinyin for kidney online) for CKD self-management. The enrollment included a questionnaire for medical history and self-reported objective physical parameters and laboratory values. Each participant was assigned to one nephrologist who communicated with the patient on an ad-hoc basis. Blood pressure and laboratory test results were entered by the patients on a regular basis. The application has a built-in clinical decision algorithm to generate health recommendations to users based on one's data-entry. The application also sends various alerts to patient's nephrologist for timely interventions. Blood pressure, proteinuria, serum creatinine and eGFR were measured before and after the management period. RESULTS Fifty-three patients were enrolled in the experimental group and 11 patients were in the control group. The average daily usage in minutes was 11.2 (25%-75% quartile [7.5, 16]) and the average of total physician-patient conversation was 116 (25%-75% quartile [51, 274]). There is a significant correlation between average daily usage and physician-patient conversation (R2=0.30, P<.001). The starting eGFR was 102 ml/1.73cm2 (95% CI 92-105]) in the experimental group and 118 ml/1.73cm2 (95% CI 100-134]) in the control group (P=.04). The body mass index (BMI), blood pressure, and proteinuria had no statistical significance. At the end of the study, the mean change of proteinuria was -1.39 g (95% CI -2.07 to -0.72]) in the experimental group and 0.37 g (95% CI -2.11-2.85]) in the control group (P=.14). After adjusted for ACEi/ARB use, the mean change of proteinuria was -1.46 vs 0.47 in the experimental group vs the control group respectively (P=.16). The eGFR was not changed at the end of the study. There was no correlation between the average daily use and change of proteinuria. CONCLUSIONS Participants used the mobile app on a daily basis and communicated with the nephrologists for their CKD management. Patients who used the CKD self-management app exhibited a non-statistically significant trend of proteinuria reduction after 3 months. This pilot study was underpowered and the follow-up period was short. A larger retrospective controlled trial is needed to confirm the effectiveness of mHealth app in CKD self-management.

scholarly journals Investigation of the effect of the virtual reality application on experimental pain severity in healthy

2019 ◽  
Vol 65 (3) ◽  
pp. 446-451
Author(s):  
Dilek Karaman ◽  
Funda Erol ◽  
Dilek Yılmaz ◽  
Yurdanur Dikmen
Keyword(s):  
Blood Pressure ◽  
Virtual Reality ◽  
Control Group ◽  
Control Groups ◽  
Adult Type ◽  
Significant Difference ◽  
The Mean ◽  
And Control ◽  
Experimental Group ◽  
Virtual Reality Application

SUMMARY OBJECTIVE: This study aimed to investigate the effect of virtual reality application on experimental ischemic pain created with a blood pressure instrument in healthy volunteers. METHODS: The research sample consisted of 172 volunteer adult students who conformed to the inclusion criteria. These individuals were assigned into an experimental (n=86) and a control group (n=86) by a simple randomization method. All individuals in the experimental and control groups wereexperimentally subjected to pain for two minutes by applying 260 mmHg of pressure 3-4 cm above the antecubital region of the left arm with an aneroid adult-type blood pressure instrument. During the procedure, the volunteers in the experimental group watched virtual reality images, while those in the control group received no intervention. Immediately after the procedure, the pain levels of the individuals in both groups were assessed with a Visual Analog Scale (VAS). RESULTS: We found that the mean pain score of the individuals in the experimental group was 2.62±1.82, and that of individuals in the control group was 5.75±1.65. Results of the statistical analysis showed a statistically significant difference between the mean pain scores of the individuals in the experimental and control groups (p<0.001). CONCLUSION: This study found that the use of virtual reality was effective in reducing the level of pain in healthy individuals. This method used a smartphone with widespread availability and ease of transportation, which can be used by health professionals as a non-pharmacological method in the management of pain.

scholarly journals Study of serum homocysteine level in patients with chronic kidney disease and its association with renal function and serum albumin

2020 ◽  
Vol 8 (6) ◽  
pp. 2195
Author(s):  
Vandana Yadav ◽  
Vivek Prakash ◽  
Bushra Fiza ◽  
Maheep Sinha
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Serum Albumin ◽  
Control Group ◽  
Serum Homocysteine ◽  
The Mean ◽  
Gandhi Medical College ◽  
And Control

 Background: Chronic kidney disease (CKD) includes irreversible destruction of nephrons leading to progressive decline in glomerular filtration rate. A preferential defect in Homocysteine disposal could hypothetically occur in CKD and subsequently lead to hyperhomocysteinemia. Understanding the status of Homocysteine and other parameters in CKD is useful in the management of the disease. Objective of the study is to estimate serum Homocysteine in CKD patients and its association with renal function and serum albumin in patients with CKD.Methods: The study design involves hospital based observational comparative study. The study was conducted in Department of Biochemistry in association with Department of Nephrology of Mahatma Gandhi Medical College and Hospital, Jaipur between May 2017 to June 2018. 100 diagnosed patients of CKD, visiting the Outpatient Department of Nephrology were enrolled as cases for the study. Patients having cardiovascular disease, Chronic liver disease, Age more than 60 years and pregnant females were excluded from study. The control group consists of 100 age and sex matched healthy individuals.Results: The mean serum creatinine levels of case and control group were 7.50±3.74 mg% and 0.83±0.22 mg% respectively. The mean of serum homocysteine levels of subject group was 27.35±12.52 µmol/L while the mean serum homocysteine levels of control group was 11.06±3.52 µmol/L. The serum homocysteine levels were significantly higher in the CKD patient group. The serum level of albumin in CKD patients and control group were 2.86±0.86 g/dl and 4.10±0.58 g/dl respectively. A positive correlation was found between serum creatinine and serum homocysteine levels. A negative correlation between serum homocysteine and serum albumin was found.Conclusions: Findings of the present study exhibit that serum homocysteine levels are elevated in CKD in comparison to healthy controls and it is positively correlated with serum creatinine level.

scholarly journals Effectiveness of Nursing Intervention Strategies on Physiological and Psychosocial Problems among Patients with Chronic Kidney Disease in Selected Hospital of Kashmir

2020 ◽  
Vol 09 (01) ◽  
pp. 1-12
Author(s):  
Dilshada Wani ◽  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Biochemical Parameters ◽  
Psychosocial Problems ◽  
Nursing Intervention ◽  
Health Problems ◽  
Intervention Strategies ◽  
Physiological Parameters ◽  
Control Group ◽  
Experimental Group

Background:Chronic Kidney Disease (CKD) is a worldwide serious condition associated with increased premature mortality, decreased quality of life and increased health-care expenditures. Learning about issues such as: disease process, strict adherence to renal diet, exercises and relaxation therapies in addition to adherence the medical treatment have helped chronic kidney disease patients to self regulate and improve their physical and social functioning. With this background the investigator got strongly convinced to design some evidence based ‘Nursing intervention strategies’ for CKD patients through clinical research to alleviate their sufferings with better clinical outcomes. Methodology:A quasi-experimental study based upon two group pre-test post-test control group design was conducted on 200 adult chronic kidney disease patients (100=experimental group and 100=control group) with an aim to evaluate the effectiveness of ‘Nursing intervention strategies’ in improving their physiological and psychosocial problems in nephrology ward of a tertiary care hospital of Jammu and Kashmir i.e. Sher-i-Kashmir Institute of Medical Sciences (SKIMS) from 5th March 2012 to 31st July 2013. Result: The findings revealed that the subjects in experimental group who received the ‘Nursing Intervention Strategies’ for two weeks within hospital as well as at home till first follow up visit had shown a significant (p ≤ 0.05) improvement in 9 health problems, 11 biochemical parameters, 5 physiological parameters and 2 psychosocial parameters than the subjects in control group who reported improvement in: only 6 health problems; 5 biochemical parameters and 3 physiological parameters. Conclusion: It can be concluded that ‘Nursing Intervention Strategies’ such as: Dietary advice, progressive muscle relaxation, deep breathing, leg massaging, leg elevation and talk therapy were effective in reducing the magnitude of physiological and psychosocial problems among chronic kidney disease patients. However the long term efficacy of these strategies needs to be investigated.

scholarly journals A Pilot Study Evaluating the Effects of a Technology-Based and Positive Psychological Training Intervention on Blood Pressure in African Americans With Hypertension

2021 ◽  
Vol 12 ◽  
pp. 215013272110561
Author(s):  
Carolyn H. Still ◽  
Seunghee P. Margevicius ◽  
Jackson T. Wright ◽  
Suebarn Ruksakulpiwat ◽  
Shirley M. Moore
Keyword(s):  
Blood Pressure ◽  
Pilot Study ◽  
African Americans ◽  
Behavioral Interventions ◽  
Comparison Group ◽  
Medication Management ◽  
Time Frame ◽  
Self Management ◽  
Psychological Training ◽  
Experimental Group

Behavioral interventions consolidating technology are underutilized and do not reach diverse populations such as African Americans with hypertension. This pilot study aimed to evaluate the effects of a theoretically derived, technology-based intervention in African Americans with hypertension. African Americans with hypertension (N = 18; age range 25-85; 72.22% females) were randomized to the technology-based plus positive psychological training (PPT) experimental group (n = 10) or the comparison group (n = 8) for 12 weeks. The technology-based intervention included analytic components (web-based education, self-monitoring of blood pressure [BP], and medication management using a commercially free app-Medisafe) and an emotional component (comprised of skills and behaviors directed at engaging 1 in positive activities to help build increasing healthy behaviors). The comparison group received the technology-based intervention alone. Demographic information, self-management cognitive processes, self-management behaviors, and health status outcomes were assessed. After completing the 12-week intervention, the groups did not significantly differ in health outcomes, health behavior outcomes, and technology utilization outcomes. Mean systolic BP decrease 6.02 mmHg (standard deviation [SD] = 22.75) in the comparison group and 1.1 mmHg (SD = 20.64; P = .439) in the experimental group. Diastolic BP decreased 0.1 mmHg (SD = 11.78) in the comparison group and 1.5 mmHg (SD = 12.7; P = .757) in the experimental group. Our findings suggest that behavioral interventions using technology have the potential to improve self-management outcomes among African American populations. Further research is warranted in a larger sample size and a longer time frame to identify the intervention’s effectiveness.

Chlortalidone and bumetanide in advanced chronic kidney disease: HEBE-CKD Trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Solis-Jimenez ◽  
R Valdez-Ortiz ◽  
L.M Perez-Navarro ◽  
J.E Reyes-Tovilla
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Treatment Group ◽  
Kidney Disease ◽  
Volume Overload ◽  
Systemic Blood Pressure ◽  
Control Group ◽  
Systemic Blood ◽  
Advanced Chronic Kidney Disease ◽  
Dual Treatment

Abstract Introduction Current treatment for hypertension and volume overload in chronic kidney disease consists of loop diuretics, nevertheless, chronic use leads to adaptive changes at the distal nephron, which in turn decreases their efficacy. The use of thiazide diuretics could be another treatment option in these patients, notwithstanding, there's not enough evidence to justify their use in this population. Purpose To evaluate the efficacy and safety of treatment with bumetanide plus chlorthalidone in in patients with advanced chronic kidney disease. Methods A double-blind randomized controlled trial was conducted at our hospital. Thirty-two patients with hypertension, chronic kidney disease stage IV/V, and chronic loop diuretic use where divided in two groups. The dual treatment group received bumetanide (4 mg QD) plus chlorthalidone (100 mg QD), while the control group was given bumetanide (4 mg QD) plus placebo, both for twenty-eight days. Systemic blood pressure, bioimpedance, and urinary electrolytes were measured at seven and twenty-eight days of treatment. Results There was a significant decrease of systemic blood pressure in the dual treatment group when compared with the control group; systolic blood pressure −26.1±15.3 vs. −10±23.3 mmHg (p=0.028), diastolic blood pressure −13.5±10.7 vs. −3.4±11.9 mmHg (p=0.018), and mean arterial pressure −18.1±8.7 vs. −5.4±14.3 mmHg (p=0.006). There was also a significant decrease of volume overload in the dual treatment group when compared to the control group; total body water −4.36±3.29 vs. +0.075±1.78 litres (p&lt;0.001), extracellular water −2.55±1.1 vs. +0.150±1.2 litres (p&lt;0.001), and extracellular water to total body water ratio −2.92±4.76 vs. −0.24±1.42 (p=0.039). The treatment group increased its fractional excretion of sodium, while the control group demonstrated an increase, though differences were non-significant. As for adverse effects, there was a non-significant increase of urea and creatinine levels in the dual treatment group when compared with controls. Conclusions In advanced chronic kidney disease plus hypertension patients whose treatment with loop diuretics is insufficient, combined use of bumetanide plus chlorthalidone can be useful for systemic blood pressure and volume overload control. Figure 1 Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Hospital General de México

Effect of Patient-Centered Self-Management Program on Blood Pressure, Renal Function Control, and the Quality of Life of Patients With Hypertensive Nephropathy: A Longitudinal Randomized Controlled Trial

2021 ◽  
pp. 109980042110618
Author(s):  
Mei-Chen Lee ◽  
Shu-Fang Vivienne Wu ◽  
Kuo-Cheng Lu ◽  
Wen-Hug Wang ◽  
Yen-Yen Chen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Blood Pressure ◽  
Controlled Trial ◽  
Management Program ◽  
Self Management ◽  
Control Group ◽  
Patient Centered ◽  
Hypertensive Nephropathy ◽  
Experimental Group

This longitudinal study with a randomized controlled trial evaluated the long-term effectiveness of the patient-centered self-management intervention program on the control of blood pressure and renal function, as well as the quality of life of patients with hypertensive nephropathy. The control group ( n = 38) received usual care while the experimental group ( n = 38) participated in a patient-centered self-management program. After the pre-test, the intervention was performed with the experimental group once a week for a total of 4 weeks. Then, the post-test was performed 1, 3, and 6 months later. A questionnaire was used to collect the demographic data and disease characteristics, laboratory data, and quality of life scale. This study tracked three time points (i.e., 1, 3, and 6 months) after the intervention and found that the experimental group achieved significant results in controlling systolic blood pressure ( p < 0.001), diastolic blood pressure ( p = 0.007), and eGFR ( p = 0.013). Significant results were achieved in the overall quality of life ( p < 0.001) and the quality of life in the physical (PHC; p < 0.001) and mental health components (MHC; p < 0.001). Furthermore, the effects in the experimental group lasted for as long as 6 months and were better than those in the control group. Moreover, this program can provide nursing staff with a reference different from traditional health education methods.

Abstract 16296: Heart Failure-Smart Life: Effects of a Mobile-based Education and Self-management Program for Patients With Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jeong-Ah Ahn ◽  
Eui-Young Choi ◽  
Jin-Sun Park
Keyword(s):  
Heart Failure ◽  
Diastolic Function ◽  
Management Program ◽  
Functional Class ◽  
Mobile App ◽  
Self Management ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
The Mean ◽  
Experimental Group

Introduction: It is considered an important strategy to support heart failure (HF) patients for lifetime self-management. However, some programs for HF patients made them difficult to revisit the hospital or due to economic burden. Therefore, a practical alternative to a comprehensive and user-friendly self-management program for HF patients is needed. Purpose: The aim of this study was to develop a mobile App program for HF patients, and to identify the impact of the program on patients with HF. Methods: We developed a mobile App program, named “HF-Smart Life”. This App installed the configurations and functions of educational materials using pictures and animations, daily health (blood pressure and body weight) check-up diary, Q & A, and 1:1 chat considering user’s convenience. Regarding the experimental study, we employed a quasi-experimental design to evaluate the effects of the program in 74 patients with HF. The experimental group participated to use the mobile App program, including education, feedbacks on self-management, and monitoring in their daily life, for 3 months. Results: Participants of the program (n=36) exhibited significantly improved NYHA functional class and cardiac diastolic function (E/Ea ratio measured by echocardiogram) than the control group (n=38) after 3 months. The mean NYHA function class of the experimental group changed from 2.14 to 1.82, and that of the control group changed from 2.66 to 2.38 (F=9.260, p=.003). Also, the mean E/Ea ratio decreased from 12.24 to 11.35 in the experimental group, whereas that of the control group increased from 14.70 to 16.42 (F=5,280, p=.024). However, there was no significant difference between the groups with cardiac systolic function (left ventricular ejection fraction measured by echocardiogram) and quality of life. Conclusions: This mobile App program showed effectively improvements in HF patients' symptom (functional) class and cardiac diastolic function. Future study is needed to investigate the long-term effects of the mobile-based education and self-management program in HF population. Funding: This research was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (NRF-2017R1C1B1007090 & 2019R1F1A1063148).

scholarly journals The Effect of Animal-Assisted Therapy on the State of Patients’ Health After a Stroke: A Pilot Study

2019 ◽  
Vol 16 (18) ◽  
pp. 3272 ◽  
Author(s):  
Kristýna Machová ◽  
Radka Procházková ◽  
Michal Říha ◽  
Ivona Svobodová
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Pilot Study ◽  
Occupational Therapy ◽  
Barthel Index ◽  
Animal Assisted Therapy ◽  
Control Group ◽  
Physical Constraints ◽  
Significant Aspect ◽  
Experimental Group

A stroke is a condition that can give rise to consequences such as cognitive and physical constraints, which sometimes manifest in the psychological condition of the patient. Such patients commence rehabilitation as soon as is possible, which involves a multi-disciplinary approach to treatment. One aspect of complementary rehabilitation could be animal-assisted therapy (AAT). A total of 15 individuals were split into an experimental group comprising 6 patients (2 males, 4 females), and a control group of 9 patients (3 males, 6 females). The participants in the control group were aged from 43 to 87 years and the experimental group featured participants aged from 45 to 76 years. Both groups received standard physiotherapy and occupational therapy. In addition, the experimental group was supplemented with AAT, with the animal in question being a dog. The tools primarily applied to measure the outcomes were the Barthel index, blood pressure, and heart rate measurements, whereas the Likert scale was employed to discern the mood of the patients. The results showed that changes in the values for heart rate and blood pressure were insignificant. However, a statistically significant aspect of the research pertained to the patients confirming that they felt better after the AAT sessions. Hence, AAT could potentially bolster the effectiveness of other therapies.

scholarly journals Content and Quality of Websites for Patients With Chronic Kidney Disease: An Environmental Scan

2019 ◽  
Vol 6 ◽  
pp. 205435811986309 ◽  
Author(s):  
Michelle Smekal ◽  
Sarah Gil ◽  
Maoliosa Donald ◽  
Heather Beanlands ◽  
Sharon Straus ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Grade Level ◽  
Information Needs ◽  
The United States ◽  
Self Management ◽  
Accessible Information ◽  
Reading Grade Level ◽  
The Mean

Background: Although numerous websites for patients with chronic kidney disease (CKD) are available, little is known about their content and quality. Objective: To evaluate the quality of CKD websites, and the degree to which they align with information needs identified by patients with CKD. Methods: We identified websites by entering “chronic kidney disease” in 3 search engines: Google.com (with regional variants for Australia, Canada, the United Kingdom, and the United States), Bing.com, and Yahoo.com. We included the first 50 unique English-language sites from each search. We evaluated website content using a 30-point scale comprising 8 priority content domains identified by patients with CKD ( understanding CKD, diet, symptoms, medications, mental/physical health, finances, travel, and work/school). We used standardized tools to evaluate usability, reliability, and readability (DISCERN, HONcode, LIDA, Reading Ease, and Reading Grade Level). Two reviewers independently conducted the search, screen, and evaluation. Results: Of the 2093 websites identified, 115 were included. Overall, sites covered a mean (SD) of 29% (17.8) of the CKD content areas. The proportion of sites covering content related to understanding CKD, symptoms, and diet was highest (97%, 80%, and 72%, respectively). The proportion of sites covering travel, finances, and work/school content was lowest (22%, 12%, and 12%, respectively). The mean (SD) scores for DISCERN, LIDA and HONcode were 68% (14.6), 71% (14.4), and 75% (17.2), respectively, considered above average for usability and reliability. The mean (SD) Reading Grade Level was 10.6 (2.8) and Reading Ease was 49.8 (14.4), suggesting poor readability. Conclusions: Although many CKD web sites were of reasonable quality, their readability was poor. Furthermore, most sites covered less than 30% of the content patients identified as important for CKD self-management. These results will inform content gaps in internet-accessible information on CKD self-management that should be addressed by future eHealth web-based tools.

P0195THE RELATIONSHIP BETWEEN CALCIFICATION INHIBITOR LEVELS IN CHRONIC KIDNEY DISEASE AND THE DEVELOPMENT OF ATHEROSCLEROSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Can Sevinc ◽  
Gulay Yilmaz ◽  
Sedat Ustundag
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Carotid Artery ◽  
Linear Relationship ◽  
Vascular Calcification ◽  
Intima Media Thickness ◽  
Control Group ◽  
Fetuin A ◽  
Healthy Control ◽  
The Mean

Abstract Background and Aims Atherosclerosis and its associated cardiovascular diseases starting from the early stages of chronic kidney disease (CKD) are the most important cause of increased morbi-mortality in the CKD process. In studies performed in patients with end-stage renal disease (ESRD), it is observed that the calcification occured in the vascular structures was an important component of the atero-arteriolosclerosis process. The number of studies investigating the relationship between vascular calcification and the development of atherosclerosis and increased morbi-mortality in the process of CKD are quite small and limited to patients undergoing hemodialysis (HD) treatment for ESRD. We aimed to investigate the factors affecting the development of atherosclerosis and the role of calcification inhibitors fetuin-A, matrix-Gla protein (MGP), osteoprotegerin (OPG) in atherosclerosis progress. Method Our study was planned to investigate the relationship of serum OPG, MGP and fetuin-A levels with the development of atherosclerosis in the stage 2-3-4-5 chronic kidney patients who did not require dialysis treatment. Thirty-two (17 female, 15 male) healthy individuals and 92 (49 females, 43 males) CKD cases were included. The healthy control group did not have a history of regular use of medication for any reason, known acute or chronic disease. Chronic kidney disease group, with no acute disease, no history of known malignancy and cerebrovascular disease. The patients' GFR was also calculated with CKD-EPI Formula. The mean carotid artery intima media thickness was calculated by dividing the sum of right and left carotid artery intima media thickness. Statistical analysis was performed with IBM SPSS Statistics 20.0.0. Results The laboratory data of the healthy control group, stage 2 CKD group, stage 3 CKD group, stage 4 CKD group and stage 5 CKD groups were statistically compared with the healthy control group, between themselves and the whole CKD group, the results were given in Table-1. Chronic kidney disease group divided into two groups; carotid artery intima media thickness less than 0.750 millimeters (without subclinical atherosclerosis) and those above 0.750 millimeters (with subclinical atherosclerosis). The mean C-IMT, CRP, FETUIN-A, OPG and MGP of the two groups were compared statistically and the results are shown in Table-2. In chronic kidney patients, age (r = 0.493, p &lt;0.001), BMI (r = 0.337, p = 0.001), CRP (r = 0.301, p = 0.004), TG (r = 0.245, p = 0.019 ), urea (r = 0.228, p = 0.029), SBP (r = 0.212, p = 0.043), fasting blood sugar (r = 0.212, p = 0.043) have positive linear relationship, fetuin-A (r = -0.409, P = 0.001), OPG (r = -0.235, p = 0.024), GFR (r = -0.209, p = 0.046) have a negative linear relationship with CIMT. The multiple relationships between CIMT and other variables are given in Table-3. The mean CIMT (r =-0.417, p = 0.001), right CIMT (r = -0.412, p = 0.001), left CIMT (r = -0.410, p = 0.001), urea (r = -353, p = 0.007), CRP (r = -0.322, p = 0.014), UPE (r = -0.301, p = 0.022), creatinine (r = -0.277, p = 0.035), age (r = -0.262, p = 0.047) show a negative linear relationship with Fetuin-A. Multiple relationships between fetuin-A and other variables are given in Table-4. Conclusion Our study shows that; In particular, fetuin-A levels, which is a vascular calcification inhibitor, begin to decline from the early stages of CKD and is significantly lower in patients with atherosclerosis. This suggests that fetuin-A may be used as an early marker in CKD with increased cardiovascular mortality. On the other hand, contradictions related to the levels of OPG and MGP in CKD and its role in the development of atherosclerosis continue. The results in our study also support this situation. Reducing mortality and morbidity in CKD primarily depends on reducing the risk of cardiovascular events. Pre-recognition of these risks is important, so large-scale studies on vascular calcification inhibitors are needed.

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