scholarly journals A Step Closer to the “Fourth 90”: A Practical Narrative Review of Diagnosis and Management of Nutritional Issues of People Living with HIV

Diagnostics ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 2047
Author(s):  
Davide Fiore Bavaro ◽  
Paola Laghetti ◽  
Mariacristina Poliseno ◽  
Nicolò De Gennaro ◽  
Francesco Di Gennaro ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Cardiovascular Risk ◽  
Kidney Disease ◽  
Current Knowledge ◽  
Disease Stage ◽  
Oral Glucose ◽  
People Living With Hiv ◽  
Diagnosis And Management ◽  
Increased Risk ◽  
Living With Hiv

The quality of life of people living with HIV (PLWH) has remarkably increased thanks to the introduction of combined antiretroviral therapy. Still, PLWH are exposed to an increased risk of cardiovascular diseases, diabetes, chronic kidney disease, and liver disease. Hence, the purpose of this review is to summarize the current knowledge about diagnosis and nutritional management with specific indication of macro and micronutrients intake for the main comorbidities of PLWH. In fact, a prompt diagnosis and management of lifestyle behaviors are fundamental steps to reach the “fourth 90”. To achieve an early diagnosis of these comorbidities, clinicians have at their disposal algorithms such as the Framingham Score to assess cardiovascular risk; transient elastography and liver biopsy to detect NAFLD and NASH; and markers such as the oral glucose tolerance test and GFR to identify glucose impairment and renal failure, respectively. Furthermore, maintenance of ideal body weight is the goal for reducing cardiovascular risk and to improve diabetes, steatosis and fibrosis; while Mediterranean and low-carbohydrate diets are the dietetic approaches proposed for cardioprotective effects and for glycemic control, respectively. Conversely, diet management of chronic kidney disease requires different nutritional assessment, especially regarding protein intake, according to disease stage and eventually concomitant diabetes.

scholarly journals Atorvastatin treatment does not abolish inflammatory mediated cardiovascular risk in subjects with chronic kidney disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Renate M. Hoogeveen ◽  
Simone L. Verweij ◽  
Yannick Kaiser ◽  
Jeffrey Kroon ◽  
Hein J. Verberne ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Cardiovascular Risk ◽  
Kidney Disease ◽  
Arterial Wall ◽  
Ldl Cholesterol ◽  
Statin Treatment ◽  
Receptor Expression ◽  
Disease Stage ◽  
Cellular Inflammation

AbstractIndividuals with chronic kidney disease are at an increased risk for cardiovascular disease. This risk may partially be explained by a chronic inflammatory state in these patients, reflected by increased arterial wall and cellular inflammation. Statin treatment decreases cardiovascular risk and arterial inflammation in non-CKD subjects. In patients with declining kidney function, cardiovascular benefit resulting from statin therapy is attenuated, possibly due to persisting inflammation. In the current study, we assessed the effect of statin treatment on arterial wall and cellular inflammation. Fourteen patients with chronic kidney disease stage 3 or 4, defined by an estimated Glomerular Filtration Rate between 15 and 60 mL/min/1.73 m2, without cardiovascular disease were included in a single center, open label study to assess the effect of atorvastatin 40 mg once daily for 12 weeks (NTR6896). At baseline and at 12 weeks of treatment, we assessed arterial wall inflammation by 18F-fluoro-deoxyglucose positron-emission tomography computed tomography (18F-FDG PET/CT) and the phenotype of circulating monocytes were assessed. Treatment with atorvastatin resulted in a 46% reduction in LDL-cholesterol, but this was not accompanied by an attenuation in arterial wall inflammation in the aorta or carotid arteries, nor with changes in chemokine receptor expression of circulating monocytes. Statin treatment does not abolish arterial wall or cellular inflammation in subjects with mild to moderate chronic kidney disease. These results imply that CKD-associated inflammatory activity is mediated by factors beyond LDL-cholesterol and specific anti-inflammatory interventions might be necessary to further dampen the inflammatory driven CV risk in these subjects.

Eculizumab discontinuation in children and adults with atypical haemolytic uremic syndrome: a prospective multicentric study

Blood ◽  
2020 ◽  
Author(s):  
Fadi Fakhouri ◽  
Marc Fila ◽  
Aurelie Hummel ◽  
David Ribes ◽  
Anne-Laure Sellier-Leclerc ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Rare Variants ◽  
Multivariable Analysis ◽  
Disease Stage ◽  
Multicentric Study ◽  
Haemolytic Uremic Syndrome ◽  
Increased Risk ◽  
Uremic Syndrome ◽  
Complement Gene

The optimal duration of eculizumab treatment in patients with atypical haemolytic uremic syndrome (aHUS) remains poorly defined. We conducted a prospective national multicentric open-label study in order to assess eculizumab discontinuation in children and adults with aHUS. Fifty-five patients (including 19 children) discontinued eculizumab (mean duration of treatment, 16.5 months). Twenty-eight (51%) patients had complement gene rare variants, mostly in MCP (n= 12, 22%), CFH (n= 6, 11%) and CFI (n=6, 10%) genes. At eculizumab discontinuation, 17 (30%) and 4 (7%) patients had chronic kidney disease stage 3 and 4, respectively. During follow-up, 13 (23%) patients (6 children and 7 adults) experienced aHUS relapse. In multivariable analysis, female gender and the presence of a rare complement gene variant were associated with an increased risk of aHUS relapse, whereas requirement for dialysis during previous episodes of acute aHUS was not. In addition, an increased soluble C5b-9 plasma level at eculizumab discontinuation was associated with a higher risk of aHUS relapse in all patients and in the subset of carriers of complement gene rare variants, in log rank test and in multivariable analysis. Among the 13 relapsing patients, who were all restarted on eculizumab, 11 regained their baseline renal function and two had a worsening of their pre-existing chronic kidney disease, including one patient who progressed to end-stage renal disease. A strategy of eculizumab discontinuation in aHUS patients based on complement genetics is reasonable and safe. It improves the management and quality of life of a sizeable proportion of aHUS patients while reducing the cost of treatment. Trail registration number: NCT02574403.

scholarly journals Cardiovascular Outcomes in African Americans with Sickle Cell Trait and Chronic Kidney Disease

2019 ◽  
Vol 49 (2) ◽  
pp. 93-102 ◽  
Author(s):  
Kabir O. Olaniran ◽  
Nwamaka D. Eneanya ◽  
Andrew S. Allegretti ◽  
Sophia H. Zhao ◽  
Maureen M. Achebe ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
African American ◽  
Cardiovascular Risk ◽  
African Americans ◽  
Kidney Disease ◽  
Sickle Cell ◽  
Sickle Cell Trait ◽  
Increased Risk ◽  
The Mean

Background: Sickle cell trait (SCT) is common among African Americans and has been historically considered to be benign. Recently, SCT has been associated with an increased risk for chronic kidney disease (CKD) and cardiovascular disease in the general population. Our understanding of SCT has been extrapolated largely from data of patients with sickle cell disease (SCD). Notably, in SCD, the outcomes differ by sex. The effect of SCT on cardiovascular risk in the African American CKD population is unknown, and the interaction between SCT and sex on cardiovascular risk has not been investigated. Methods: We performed a 2-center retrospective cohort study of all African American patients with SCT using international classification of disease diagnosis codes and CKD (using the 2012 Kidney Disease Improving Global Outcomes criteria) with at least 1 year of follow-up between January 2005 and December 2017. A reference group of ­African American CKD patients without SCT was used as a comparator during the same period. SCT patients and the reference patients were matched at baseline for age, sex, comorbidities, and proteinuria. Primary outcomes were incident coronary artery disease (CAD), incident stroke, and all-cause mortality. Analysis of effect modification between sex and SCT on primary outcomes was performed. Results: We identified 621 African American CKD patients, 217 SCT patients, and 404 reference patients. The mean age was 56 ± 13 years and 66% were female. The mean estimated glomerular filtration rate was 69 ± 30 mL/min. The mean follow-up time was 8 ± 4 years. There were no significant differences in the primary outcomes comparing SCT patients to matched controls. The interaction term between SCT and sex, however, was significant in the CAD model (p < 0.01). Stratification by sex showed no increased risk in females but a significantly increased risk for CAD in male SCT patients (hazard ratio [HR] 2.14; 95% CI 1.18–3.86), which persisted after multivariable analysis (HR 2.13; 95% CI 1.17–3.86). Conclusion: SCT is associated with an increased risk for CAD in African American males with CKD. The excess risk in males with SCT appears to follow the same pattern as risk in males with SCD. Larger studies are needed to confirm these findings.

scholarly journals Medium Grade Proteinuria Is Not a Relevant Predictor of Chronic Kidney Disease in People Living with HIV/AIDS

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S219-S219
Author(s):  
Ulrich Seybold ◽  
Svenja Schrader ◽  
Andreas Zeder ◽  
Johannes R Bogner
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
People Living With Hiv ◽  
Living With Hiv ◽  
Hiv Aids

scholarly journals Cardiovascular Risk Factors and Chronic Kidney Disease—FGF23: A Key Molecule in the Cardiovascular Disease

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Rika Jimbo ◽  
Tatsuo Shimosawa
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Cardiovascular Risk ◽  
Kidney Disease ◽  
Fibroblast Growth Factor 23 ◽  
Left Ventricular ◽  
Cardiovascular Risks ◽  
Mineral And Bone Disorder ◽  
Promising Target ◽  
Increased Risk

Patients with chronic kidney disease (CKD) are at increased risk of mortality, mainly from cardiovascular disease. Moreover, abnormal mineral and bone metabolism, the so-called CKD-mineral and bone disorder (MBD), occurs from early stages of CKD. This CKD-MBD presents a strong cardiovascular risk for CKD patients. Discovery of fibroblast growth factor 23 (FGF23) has altered our understanding of CKD-MBD and has revealed more complex cross-talk and endocrine feedback loops between the kidney, parathyroid gland, intestines, and bone. During the past decade, reports of clinical studies have described the association between FGF23 and cardiovascular risks, left ventricular hypertrophy, and vascular calcification. Recent translational reports have described the existence of FGF23-Klotho axis in the vasculature and the causative effect of FGF23 on cardiovascular disease. These findings suggest FGF23 as a promising target for novel therapeutic approaches to improve clinical outcomes of CKD patients.

Socio-Economic Disparities in the Distribution of Cardiovascular Risk in Chronic Kidney Disease Stage 3

2012 ◽  
Vol 122 (1-2) ◽  
pp. 58-65 ◽  
Author(s):  
Simon D.S. Fraser ◽  
Paul J. Roderick ◽  
Natasha J. McIntyre ◽  
Scott Harris ◽  
Christopher W. McIntyre ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Cardiovascular Risk ◽  
Kidney Disease ◽  
Chronic Kidney Disease Stage ◽  
Disease Stage ◽  
Economic Disparities

Chronic kidney disease is highly prevalent in people living with HIV in a mainly Caucasian European cohort

HIV Medicine ◽  
2019 ◽  
Vol 21 (6) ◽  
Author(s):  
R Chazot ◽  
E Botelho‐Nevers ◽  
A Fresard ◽  
F Lucht ◽  
C Mariat ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
People Living With Hiv ◽  
Living With Hiv

Abstract P296: Age-related Differences in Risk Factors for Mortality Among Individuals with Chronic Kidney Disease: The REGARDS Study

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Rikki M Tanner ◽  
Barrett Bowling ◽  
Monika M Safford ◽  
Orlando Gutiérrez ◽  
Lisandro D Colantonio ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Chronic Kidney Disease ◽  
Cardiovascular Risk ◽  
Kidney Disease ◽  
Cardiovascular Risk Factors ◽  
Older Individuals ◽  
Increased Risk ◽  
Regards Study

At younger ages, chronic kidney disease (CKD) is a progressive disorder associated with an increased risk for end-stage renal disease (ESRD). Older individuals with CKD are 10 to 20 times more likely to die than progress to ESRD. We hypothesized that, among individuals with CKD, the association between traditional cardiovascular risk factors with mortality would be weaker and the association between psychosocial risk factors with mortality would be stronger for individuals ≥ 75 years of age compared to those < 75 years of age. We included 5,924 REasons for Geographic And Racial Differences in Stroke (REGARDS) study participants with CKD without ESRD at baseline. CKD was defined as an albumin-to-creatinine ratio ≥ 30 mg/g or an estimated glomerular filtration rate < 60 mL/min/1.73m2. The 12-item Short Form Health Survey (SF-12) was administered and low physical and mental component scores (PCS and MCS) were defined as scores in the lowest quintile. Mortality was assessed through biannual telephone follow-up and contact with proxies provided by the study participant upon recruitment. Date of death was confirmed through death certificates, National Death Index, or Social Security Death Index. Over a median follow-up of 5.0 years, 1,255 deaths occurred. The mortality rate was 30.9 (95% CI: 28.6 - 33.4) and 74.8 (95% CI: 69.2 - 80.8) per 1,000 person-years for individuals < 75 years and ≥ 75 years of age, respectively. Diabetes, history of stroke, and systolic blood pressure were associated with an increased risk for mortality among individuals < 75 years of age but not among those ≥ 75 years of age (Table 1). Low PCS was associated with a higher risk for mortality for both younger and older adults. Symptoms of depression and low MCS were not associated with mortality in either age group. In conclusion, some cardiovascular risk factors are associated with an increased risk for mortality among younger but not older individuals with CKD. These data suggest approaches to reduce mortality risk may differ for younger and older adults with CKD.

scholarly journals Epicardial Adipose Tissue, Adiponectin and Leptin: A Potential Source of Cardiovascular Risk in Chronic Kidney Disease

2020 ◽  
Vol 21 (3) ◽  
pp. 978 ◽  
Author(s):  
Luis D’Marco ◽  
Maria Jesús Puchades ◽  
Jose Luis Gorriz ◽  
Maria Romero-Parra ◽  
Marcos Lima-Martínez ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Adipose Tissue ◽  
Cardiovascular Risk ◽  
Kidney Disease ◽  
General Population ◽  
Epicardial Adipose Tissue ◽  
Atherosclerotic Cardiovascular Disease ◽  
Increased Risk ◽  
The Impact

The importance of cardiometabolic factors in the inception and progression of atherosclerotic cardiovascular disease is increasingly being recognized. Beyond diabetes mellitus and metabolic syndrome, other factors may be responsible in patients with chronic kidney disease (CKD) for the high prevalence of cardiovascular disease, which is estimated to be 5- to 20-fold higher than in the general population. Although undefined uremic toxins are often blamed for part of the increased risk, visceral adipose tissue, and in particular epicardial adipose tissue (EAT), have been the focus of intense research in the past two decades. In fact, several lines of evidence suggest their involvement in atherosclerosis development and its complications. EAT may promote atherosclerosis through paracrine and endocrine pathways exerted via the secretion of adipocytokines such as adiponectin and leptin. In this article we review the current knowledge of the impact of EAT on cardiovascular outcomes in the general population and in patients with CKD. Special reference will be made to adiponectin and leptin as possible mediators of the increased cardiovascular risk linked with EAT.

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