scholarly journals Moderate–Vigorous Physical Activity and Clinical Outcomes in Adults with Nondialysis Chronic Kidney Disease

2021 ◽  
Vol 10 (15) ◽  
pp. 3365
Author(s):  
Ji Kim ◽  
Young Hyun ◽  
Kyu-Beck Lee ◽  
Sung Lee ◽  
Hayne Park ◽  
...  
Keyword(s):  
Physical Activity ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Clinical Outcomes ◽  
Lower Risk ◽  
Vigorous Physical Activity ◽  
Moderate Amount ◽  
Kaplan Meier ◽  
Cox Proportional Hazard Models ◽  
End Stage

The health benefits of physical activity (PA) are well known. However, the association between an adequate amount of moderate–vigorous PA (MVPA) and clinical outcomes has limited evidence in chronic kidney disease (CKD). We assessed PA using a self-administered questionnaire. The amount of MVPA was categorized into four groups: none, low, moderate, and high (0, <7.5, 7.5–14.9, and 15.0–29.9 metabolic equivalent-hours/week, respectively). We analyzed the association between the amount of MVPA and clinical outcomes. Among a total of 1909 adults with CKD, adults with MVPA showed various beneficial outcomes compared to those with no MVPA in a Kaplan–Meier curve followed over a median of 5.9 years. In multivariable-adjusted Cox proportional hazard models, a low and a moderate amount of MVPA was associated with a lower risk of all-cause death. A moderate amount of MVPA was associated with a lower risk of cardiovascular events. A high amount of MVPA was associated with a lower risk of end-stage kidney disease in ESKD in 1324 adults with eGFR <60 mL/min/1.73 m2. Age and sex modified the relationships between MVPA and clinical outcomes. MVPA is associated with various beneficial outcomes across the amount of MVPA. PA plans should be tailored for individual adults with CKD.

scholarly journals Physical activity in chronic kidney disease and the EXerCise Introduction To Enhance trial

2020 ◽  
Vol 35 (Supplement_2) ◽  
pp. ii18-ii22 ◽  
Author(s):  
Francesca Mallamaci ◽  
Anna Pisano ◽  
Giovanni Tripepi
Keyword(s):  
Physical Activity ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Clinical Outcomes ◽  
Sedentary Lifestyle ◽  
Public Health Problem ◽  
Epidemiological Studies ◽  
Dialysis Patients ◽  
Increased Risk ◽  
Reduced Physical Activity

Abstract It is well known from observational studies that sedentary lifestyle and reduced physical activity are common in dialysis and chronic kidney disease (CKD) patients and associate with an increased risk of morbidity and mortality in this patient population. Epidemiological studies indicate that CKD patients undergo physical activity ~9 days/month and 43.9% of dialysis patients report not exercising at all. On the basis of awareness about the strong link between sedentary lifestyle and adverse clinical outcomes, the National Kidney Foundation and Kidney Disease: Improving Global Outcomes have provided specific recommendations for physical activity in patients with kidney disease. Given the fact that CKD is a public health problem and it is still debated which type of exercise should be prescribed in these patients, this review focuses on the most robust evidence accumulated so far on the beneficial effect of various types of physical exercise on clinical outcomes in CKD and dialysis patients. This review does not treat this very important topic in another CKD category of patients, such as kidney-transplanted patients, for whom a special issue should be dedicated.

scholarly journals P0912THE SERUM CREATININE TO CYSTATIN C RATIO AND CLINICAL OUTCOMES IN PATIENTS WITH NON-DIALYSIS CHRONIC KIDNEY DISEASE: THE KNOW-CKD COHORT

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Kyu-Beck Lee ◽  
Young Youl Hyun ◽  
Kook-Hwan Oh ◽  
Curie Ahn
Keyword(s):  
Physical Activity ◽  
Chronic Kidney Disease ◽  
Standard Deviation ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Cystatin C ◽  
Early Stage ◽  
Vigorous Physical Activity ◽  
Elderly Age ◽  
Hazard Ratios

Abstract Background and Aims Muscle wasting leads to poor outcomes in patient with chronic kidney disease (CKD). The serum creatinine to cystatin C (Cr/CysC) ratio has been reported as marker for muscle mass and may predict outcomes in chronic diseases. We hypothesized that the Cr/CysC ratio would be a predictor of outcomes in CKD. Method We investigated a total of 2142 patients (male 61%, aged 54±12 year) with CKD followed for a median of 3.74 years. We assessed the factors associated with Cr/CysC ratio and the relationship between Cr/CysC ratio and outcomes of end-stage renal disease (ESRD), cardiovascular event (CVE), and mortality. Results The Cr/CysC ratio significantly correlated with age (r=-0.18), estimated glomerular filtration rate (eGFR) (r=-0.21), serum albumin (r=0.11), 24-hour urine creatinine (r=0.38), and moderate to vigorous physical activity time (r=0.07). After adjusting for age, sex, eGFR, and log urine albumin creatinine ratio (model 1), the hazard ratios for ESRD, CVE, and mortality were 0.96 (95% CI, 0.86-1.07), 0.78 (95% CI, 0.61-0.99), and 0.72 (95% CI, 0.53-0.97) per 1 standard deviation Cr/CysC increase (0.21), respectively. After full adjustment for model 1 variables plus lifestyle factors, laboratory factors, and comorbidities (model 2), the hazard ratios for ESRD, CVE, and mortality were 0.99 (95% CI, 0.88-1.10), 0.84 (95% CI, 0.65-1.07), and 0.75 (95% CI, 0.55-0.99) per 1 standard deviation Cr/CysC increase (0.24), respectively. In subgroup of the elderly (age&gt;65 year) and early stage CKD (eGFR&gt;60 ml/min/1.73m2), the hazard ratios for CVE were significantly lower in patients with high Cr/CysC ratio. Conclusion Cr/CysC ratio correlates with muscle biomarkers and physical activity. A higher Cr/CysC ratio is associated with low CVE and mortality, but not ESRD in CKD.

scholarly journals Association of HbA1C Variability and Renal Progression in Patients with Type 2 Diabetes with Chronic Kidney Disease Stages 3–4

2018 ◽  
Vol 19 (12) ◽  
pp. 4116 ◽  
Author(s):  
Mei-Yueh Lee ◽  
Jiun-Chi Huang ◽  
Szu-Chia Chen ◽  
Hsin-Ying Chiou ◽  
Pei-Yu Wu
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Lower Risk ◽  
Glycosylated Hemoglobin ◽  
Diabetic Patients ◽  
Patients With Diabetes ◽  
Cox Analysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Hba1c Variability

Little is known about the predictive value of glycosylated hemoglobin (HbA1C) variability in patients with advanced chronic kidney disease (CKD). The aim of this study was to investigate whether HbA1C variability is associated with progression to end-stage renal disease in diabetic patients with stages 3–5 CKD, and whether different stages of CKD affect these associations. Three hundred and eighty-eight patients with diabetes and stages 3–5 CKD were enrolled in this longitudinal study. Intra-individual HbA1C variability was defined as the standard deviation (SD) of HbA1C, and the renal endpoint was defined as commencing dialysis. The results indicated that, during a median follow-up period of 3.5 years, 108 patients started dialysis. Adjusted Cox analysis showed an association between the highest tertile of HbA1C SD (tertile 3 vs. tertile 1) and a lower risk of the renal endpoint (hazard ratio = 0.175; 95% confidence interval = 0.059–0.518; p = 0.002) in the patients with an HbA1C level ≥ 7% and stages 3–4 CKD, but not in stage 5 CKD. Further subgroup analysis showed that the highest two tertiles of HbA1C SD were associated with a lower risk of the renal endpoint in the group with a decreasing trend of HbA1C. Our results demonstrated that greater HbA1C variability and a decreasing trend of HbA1C, which may be related to intensive diabetes control, was associated with a lower risk of progression to dialysis in the patients with stages 3–4 CKD and poor glycemic control (HbA1c ≥ 7%).

scholarly journals The association of physical function and physical activity with all-cause mortality and adverse clinical outcomes in nondialysis chronic kidney disease: a systematic review

2018 ◽  
Vol 9 (11) ◽  
pp. 209-226 ◽  
Author(s):  
Heather J. MacKinnon ◽  
Thomas J. Wilkinson ◽  
Amy L. Clarke ◽  
Douglas W. Gould ◽  
Thomas F. O’Sullivan ◽  
...  
Keyword(s):  
Physical Activity ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Physical Function ◽  
Clinical Outcomes ◽  
Research Quality ◽  
Measurement Tool ◽  
Cochrane Central Register ◽  
Renal Transplant Recipients ◽  
All Cause Mortality

Objective: People with nondialysis-dependent chronic kidney disease (CKD) and renal transplant recipients (RTRs) have compromised physical function and reduced physical activity (PA) levels. Whilst established in healthy older adults and other chronic diseases, this association remains underexplored in CKD. We aimed to review the existing research investigating poor physical function and PA with clinical outcome in nondialysis CKD. Data sources: Electronic databases (PubMed, MEDLINE, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials) were searched until December 2017 for cohort studies reporting objective or subjective measures of PA and physical function and the associations with adverse clinical outcomes and all-cause mortality in patients with nondialysis CKD stages 1–5 and RTRs. The protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42016039060). Review methods: Study quality was assessed using the Newcastle-Ottawa Scale and the Agency for Healthcare and Research Quality (AHRQ) standards. Results: A total of 29 studies were included; 12 reporting on physical function and 17 on PA. Only eight studies were conducted with RTRs. The majority were classified as ‘good’ according to the AHRQ standards. Although not appropriate for meta-analysis due to variance in the outcome measures reported, a coherent pattern was seen with higher mortality rates or prevalence of adverse clinical events associated with lower PA and physical function levels, irrespective of the measurement tool used. Sources of bias included incomplete description of participant flow through the study and over reliance on self-report measures. Conclusions: In nondialysis CKD, survival rates correlate with greater PA and physical function levels. Further trials are required to investigate causality and the effectiveness of physical function and PA interventions in improving outcomes. Future work should identify standard assessment protocols for PA and physical function.

Abstract 15052: Association of Thiazide Diuretics Usage and Clinical Outcomes in Chronic Kidney Disease: Analysis of the Nationwide Cohort Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hugo Y Lin
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Clinical Outcomes ◽  
Clinical Effects ◽  
Thiazide Diuretics ◽  
Beneficial Effects ◽  
Cox Proportional Hazard Regression ◽  
Peripheral Arterial ◽  
Stage Renal Disease ◽  
End Stage

Introduction: Hypertension (HTN) is not uncommon in patients with chronic kidney disease (CKD). Thiazide diuretics (THZ) are widely used for the management of HTN. The clinical outcomes of THZ usage in patients with CKD remain uncertain. Hypothesis: The aim of this study is to examine the clinical effects of THZ usage in patients with CKD by utilizing a nationwide cohort. Methods: The THZ cohort included 8501 patients; each patient was age- and sex-matched with one THZ nonuser in the CKD population. The Cox proportional hazard regression analysis was conducted to estimate the effects of THZ on the mortality, incidence of end-stage renal disease (ESRD), congestive heart failure (CHF), acute myocardial infarction (AMI), peripheral arterial occlusive disease (PAOD) and stroke. Results: The mortality rate was significantly lower in THZ users than in THZ nonusers (hazard ratio [HR] = 0.65; 95% confidence interval [CI] = 0.60-0.71, p <0.001). The HR for the incidences of ESRD, AMI, PAOD and stroke were significantly ( p <0.05) lower in THZ users (HR=0.71, CI= 0.66-0.77; HR=0.82, CI=0.76-0.89; HR=0.68, CI=0.63-0.74; HR=0.91, CI=0.84-0.98) than in THZ nonusers. In THZ subgroup analysis, clothalidone users had significantly lower incidences of mortality, ESRD, and PAOD (HR=0.62, CI= 0.40-0.97, p =0.037; HR=0.54, CI=0.36-0.82, p =0.004; HR=0.60, CI=0.39-0.94, p =0.026) than nonusers. Indapamide users had significant lower incidences of mortality, ESRD, AMI and PAOD (HR=0.64, CI= 0.57-0.71, p <0.001; HR=0.72, CI=0.65-0.79, p <0.001; HR=0.89, CI=0.81-0.98, p =0.018; HR=0.69, CI=0.62-0.78, p <0.001) than nonusers. However, Metolazone users had significantly higher incidences of ESRD, CHF, and AMI (HR=1.28, CI= 1.06-1.54, p =0.009; HR=1.60, CI=1.33-1.92, p <0.001; HR=1.41, CI=1.08-1.59, p =0.007) than nonusers. Conclusions: In patients with CKD who receive therapy with THZ, both clothalidone and Indapamide users exhibit significantly beneficial effects of mortality, ESRD, and PAOD. Indapamide users revealed significantly advantageous results of AMI. However, Metolazone users had significantly higher incidences of ESRD, CHF, and AMI. A further randomized control trial to clarify the effect of THZ usage in patients with CKD is a necessity.

scholarly journals Neurotoxicity following the Ingestion of Bilimbi Fruit (Averrhoa bilimbi) in an End-Stage Renal Disease Patient on Hemodialysis

2017 ◽  
Vol 7 (1) ◽  
pp. 6-12
Author(s):  
Camille Pereira Caetano ◽  
Cinara Barros de Sá ◽  
Bruno Antônio Paixão Faleiros ◽  
Marcelo Fonseca Coutinho Fernandes Gomes ◽  
Edna Regina Silva Pereira
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Disease Patient ◽  
Infectious Complications ◽  
Seizure Disorder ◽  
Temporal Association ◽  
Moderate Amount ◽  
Star Fruit ◽  
Stage Renal Disease ◽  
End Stage

Introduction: The toxic effects of the ingestion of star fruit (Averrhoa carambola) in chronic kidney disease patients are well described in the literature. Recently, the compound caramboxin has been isolated, explaining the mechanisms of its neurotoxicity. Bilimbi fruit belongs to the family Oxalidaceae, Averrhoa bilimbi species, and exhibits similar biochemical characteristics to star fruit. Objective: To report the case of a patient with chronic kidney disease who developed a seizure disorder after the ingestion of bilimbi fruit. Case Report: A 69-year-old man with chronic kidney disease on hemodialysis therapy had intractable hiccups, myoclonus, and generalized tonic-clonic seizures after the consumption of a moderate amount of bilimbi fruit. The electroencephalogram showed a pattern of seizure disorder despite the use of anticonvulsant drugs. Renal replacement therapy was maintained during the whole period and prescribed according to the patient’s hemodynamic status. Despite showing clinical resolution of the seizure disorder, the patient died on the 27th day of hospitalization for infectious complications. Conclusions: The neurologic status without any other known cause and with clear temporal association with the ingestion of the fruit suggests the diagnosis of neurotoxicity. We propose the hypothesis that the bilimbi fruit has neurotoxic effects similar to those exhibited by the star fruit.

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