scholarly journals Association of Glomerular Filtration Rate and Carotid Intima-Media Thickness in Non-Diabetic Chronic Kidney Disease Patients over a 4-Year Follow-Up

Life ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 204 ◽  
Author(s):  
Azer Rizikalo ◽  
Slavica Coric ◽  
Andrija Matetic ◽  
Mirjana Vasilj ◽  
Zoran Tocilj ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Media Thickness ◽  
Stage 4

Patients with chronic kidney disease (CKD) have increased risk of cardiovascular events. However, the association of glomerular filtration rate (GFR) and carotid intima-media thickness (CIMT) in non-diabetic CKD patients is under-investigated. This prospective study was conducted at University Clinical Hospital Mostar over a 4-year period and enrolled a total of 100 patients with stage 2 and 4 CKD (50 patients per group). Stage 4 CKD group had significantly higher baseline CIMT values (1.13 ± 0.25 vs. 0.74 ± 0.03 mm, P < 0.001), and more atherosclerotic plaques at the study onset (13 (26%) vs. 0 (0%), P < 0.001) compared to stage 2 CKD. A statistically significant 4-year increase in GFR (coefficient of 2.51, 3.25, 2.71 and 1.50 for 1-year, 2-year, 3-year and 4-year follow-up, respectively, P < 0.05) with non-significant CIMT alterations has been observed in stage 2 CKD. Furthermore, linear mixed effects analysis revealed significant decrease in GFR (coefficient of −6.69, −5.12, −3.18 and −1.77 for 1-year, 2-year, 3-year and 4-year follow-up, respectively, P < 0.001) with increase in CIMT (coefficient of 0.20, 0.14, 0.07 and 0.03 for 1-year, 2-year, 3-year and 4-year follow-up, respectively, P < 0.001) in stage 4 CKD. GFR and CIMT showed significant negative correlation in both CKD groups during all follow-up phases (P < 0.001). Furthermore, multiple linear regression analysis revealed significant independent prediction of CIMT by baseline GFR (B = −0.85, P < 0.001), while there was no significant prediction of CIMT with other covariates. In conclusion, this study demonstrates significant association of GFR and CIMT in non-diabetic stage 2 and stage 4 CKD during the 4-year follow-up.

scholarly journals Approaches for the identification of chronic kidney disease in CPRD–HES-linked studies

2020 ◽  
Author(s):  
Sreeram Ramagopalan ◽  
Thomas P Leahy ◽  
Elaine Stamp ◽  
Cormac Sammon
Keyword(s):  
Chronic Kidney Disease ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Nonvalvular Atrial Fibrillation ◽  
Diagnostic Codes ◽  
Stage 4

Aim: There are different methods to identify chronic kidney disease (CKD) in Clinical Practice Research Datalink (CPRD)-Hospital Episode Statistics (HES). Methods: Using CPRD-HES, nonvalvular atrial fibrillation patients were classified according to CKD category. Results: Using glomerular filtration rate/estimated glomerular filtration rate tests only to identify patients with CKD resulted in 3.5% stage 2, 2.7% stage 3, 0.3% stage 4 and 0.03% stage 5. Using data from diagnostic codes to identify patients with CKD resulted in 1.4% stage 3, 0.4% stage 4 and 0.3% stage 5. Using test records and codes resulted in 3.5% stage 2, 4.0% stage 3, 0.6% stage 4 and 0.4% stage 5. Conclusion: To identify CKD status in CPRD-HES, a combination of test records and codes should be used. Using diagnostic codes only significantly underestimates CKD prevalence.

scholarly journals Correlation of Carotid Artery Intima-Media Thickness with Age, Body Mass Index and Glomerular Filtration Rate in Chronic Kidney Disease Patients

2021 ◽  
Vol 33 (2) ◽  
pp. 147-151
Author(s):  
Amir Mohammad Kaiser ◽  
Rafi Nazrul Islam ◽  
Miliva Mozaffor ◽  
Salahuddin Feroz ◽  
Md Mustafizur Rahman
Keyword(s):  
Body Mass Index ◽  
Chronic Kidney Disease ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Body Mass ◽  
Filtration Rate ◽  
Intima Media Thickness ◽  
Significant Difference ◽  
Positive Correlations

Introduction: Ultrasound measurements of the intima media thickness (IMT) in the carotid arteries is a strong predictor for cardiovascular events both in the general and diseased population. Materials & Methods: This cross-sectional analytic study was conducted to observe correlation of CIMT with age, body mass index (BMI) and glomerular filtration rate (GFR) in chronic kidney disease (CKD). The study was done in Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, on 80 chronic kidney disease patients, from July 2014 to June 2015. All the biochemical parameters were measured according to the standard laboratory techniques. Body mass index (BMI) was calculated by person’s body weight divided by height. Glomerular filtration rate (GFR) was calculated using the modification of diet in renal disease (MDRD) formula. CIMT measurement was done by duplex study of carotid vessels through high resolution B-mode ultrasound. Results: Mean age of the patients was 36.1±9.5 years. 20 (25%), 26 (32.5%) and 34 (42.5%) patients were in CKD stage 3, 4 and 5 respectively. Age, serum creatinine and GFR showed statistically significant difference among stage 3, 4 and 5 CKD patients (p<0.001). However, no difference was evident in BMI and mean CIMT among stage 3, 4 and 5 CKD patients. Significant positive correlations were found between age and CIMT (r=+0.332; p=0.003) and BMI and CIMT (r=+0.294; p=0.008). However, no significant correlation was evident with estimated glomerular filtration rate (eGFR) and CIMT (r=–0.181; p=0.109). Conclusion: Age, serum creatinine and estimated glomerular filtration rate showed statistically significant difference among different stages of CKD patients (stage 3, 4 and 5). There were significant positive correlations found in between age and CIMT as well as BMI and CIMT in chronic kidney disease patients, with an exception to GFR and CIMT. Medicine Today 2021 Vol.33(2): 147-151

scholarly journals Dynamics of Kidney Function in Patients with Chronic Kidney Disease and Atrial Fibrillation Who Receive Dabigatran

2021 ◽  
Vol 17 (2) ◽  
pp. 186-192
Author(s):  
N. A. Novikova ◽  
Z. K. Salpagarova ◽  
M. I. Chashkina ◽  
A. A. Bykova ◽  
Z. A. Alimova ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Anticoagulant Therapy ◽  
Filtration Rate ◽  
Observation Period

Atrial fibrillation (AF) is the most frequent type of supraventricular arrhythmias. The anticoagulant therapy should be prescribed to prevent thromboembolic events. According to randomized clinical trials, anticoagulants do not always prove their high efficiency in the real clinical practice. It is a complicated issue for any doctor to prescribe the anticoagulant therapy for patients with AF and CKD. 30 % of patients with atrial fibrillation are known to have chronic kidney disease, while 10-15% of patients with chronic kidney disease are diagnosed with atrial fibrillation. Currently, there are scarce studies into the use of direct oral anticoagulants in patients with atrial fibrillation and chronic kidney disease (in case of Glomerular Filtration Rate (GFR) below 45 ml/min/1.73 m2).Aim. To determine the dynamics of GFR in patients with AF and CKD (in case of GFR below 45 ml/min/1.73 m2).Material and Methods. The sub-analysis was carried out to examine a single-centre prospective study into the optimization of the anticoagulant therapy in the outpatient practice. Initially, 133 dabigatran taking patients were enrolled in the study, and 79 patients were included in the final analysis. Endpoints were changes in Glomerular Filtration Rate (CKD-EPI) formulae as of the inclusion date, in 6, 12, 24 and 60 months after the inclusion. Changes in the renal function shall mean a decrease or increase in GFR by ≥5 ml/min.Results. The average follow-up period for patients was 1785 ± 218 days. A GFR>45 ml/min/1.73 m2 occurred in 116 (87.2%) patients, and a GFR <45 ml/min/1.73 m2 was found in 17 (12.8%) patients. The average HAS-BLED score was 1.8, and CHA2DS2VASc score - 3.8. During the observation period, there were 3 cases of major bleeding and 133 cases of minor bleeding. Both major (р=0.025) and minor (р=0.012) bleeding were statistically significant more frequent in patients with GFR below 45 ml/min. During 5 years of follow-up, 66 (49.6%) patients had an average decrease in GFR of 3.32 ml/min/1.73 m2 per year. Patients with the initially declined GFR (below 45 ml/min) did not demonstrate a significant dynamic of the renal function during the dabigatran therapy. The mortality rate in this group during the observation period was 61.5%.Conclusion. In 49.6% of patients during 5 years of follow-up, GFR decreased by an average of 3.32 ml/min/1.73 m2 per year, which does not exceed the indicators typical for patients with cardiovascular events and CKD.

scholarly journals Πρώιμοι δείκτες νεφρικής και ενδοθηλιακής δυσλειτουργίας σε παιδιά με δυσλιπιδαιμία

2020 ◽  
Author(s):  
Χρυσούλα Κοσμέρη
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Flow Mediated Dilation ◽  
Media Thickness

Σκοπός της μελέτης: Η αξιολόγηση δεικτών πρώιμης ενδοθηλιακής, αγγειακής και νεφρικής βλάβης σε παιδιά με δυσλιπιδαιμία. Μεθοδολογία: Πρόκειται για μια συγχρονική μελέτη παρατήρησης που περιελάμβανε 100 παιδιά ηλικίας 7 με 16 ετών με πρωτοπαθή δυσλιπιδαιμία και 100 υγιή παιδιά αντίστοιχης ηλικίας και φύλου, διάρκειας 3 ετών. Αποκλείσθηκαν από τη μελέτη παιδιά με ιστορικό δευτεροπαθούς δυσλιπιδαιμίας, νεφρικής νόσου, χρόνιας φαρμακευτικής αγωγής και οξείας ή χρόνιας φλεγμονώδους διαδικασίας. Η ενδοθηλιακή δυσλειτουργία και οι πρώιμες αγγειακές βλάβες αξιολογήθηκαν μετρώντας τη ροοεξαρτώμενη αγγειοδιαστολή (flow-mediated dilation, FMD) της βραχιόνιας αρτηρίας και το πάχος του έσω-μέσου χιτώνα των καρωτίδων (carotid intima-media thickness, cIMT), αντίστοιχα. Η νεφρική δυσλειτουργία αξιολογήθηκε μετρώντας στον ορό τα επίπεδα κρεατινίνης και συστατίνης C, τη β2μικροσφαιρίνη ούρων και το λόγο αλβουμίνης προς κρεατινίνη ούρων. Επίσης υπολογίσθηκε ο εκτιμώμενος ρυθμός σπειραματικής διήθησης (estimated glomerular filtration rate, eGFR) με βάση την κρεατινίνη και την συστατίνη C. Τέλος, προσδιορίσθηκαν τα επίπεδα της βιταμίνης 25(ΟΗ)D και στις δύο ομάδες. Αποτελέσματα: Οι δύο ομάδες δε διέφεραν στα ανθρωπομετρικά χαρακτηριστικά και στο οικογενειακό ιστορικό. Η μέση τιμή του δείκτη FMD ήταν μειωμένη στα παιδιά με δυσλιπιδαιμία σε σχέση με την ομάδα ελέγχου (8,504 ± 4,73 % vs 10,535 ± 4,35 %, p=0,004), ενώ του cIMT δε διέφερε στις δύο ομάδες. Η διαφορά στην μέση τιμή του δείκτη FMD ήταν πιο εμφανής στην ηλικιακή ομάδα 13 ετών και άνω. Η Lp(a) βρέθηκε ο μόνος ανεξάρτητος παράγοντας που επηρέαζε τις τιμές του FMD (beta=-0,29, p=0,01). Δεν υπήρχε διαφορά στις δύο ομάδες όσον αφορά τους δείκτες νεφρικής λειτουργίας. Παρ’ όλα αυτά, ο λόγος αλβουμίνης προς κρεατινίνη στα ούρα βρέθηκε υψηλότερος στα παιδιά με δυσλιπιδαιμία σε σχέση με την ομάδα ελέγχου (διάμεση τιμή, 0,007 vs 0,005, p=0,004). Οι τιμές του λόγου αλβουμίνης προς κρεατινίνη στα ούρα σχετίσθηκαν θετικά με τις τιμές του λόγου τριγλυκεριδίων προς HDL χοληστερόλη (r=0,28, p=0,013). Η μέση τιμή των επιπέδων της βιταμίνης 25(ΟΗ)D ήταν σημαντικά χαμηλότερη στα παιδιά με δυσλιπιδαιμία σε σύγκριση με την ομάδα ελέγχου (24±8 vs 27±10 ng/ml, p=0,03). Στα παιδιά με δυσλιπιδαιμία οι τιμές των επιπέδων της βιταμίνης D είχαν αρνητική συσχέτιση με αυτές του ΒΜΙ (r=-0,34, p=0,001) και της non-HDL χοληστερόλης (r=-0,21, p=0,04). Συμπέρασμα: Στα δυσλιπιδαιμικά παιδιά της μελέτης διαπιστώθηκε ενδοθηλιακή δυσλειτουργία, πριν από την ανάπτυξη πρώιμων αγγειακών αλλαγών, ενώ η Lp(a) βρέθηκε ο μόνος ανεξάρτητος παράγοντας κινδύνου για την ανάπτυξη ενδοθηλιακής δυσλειτουργίας. Αντίθετα, νεφρική δυσλειτουργία δε διαπιστώθηκε στα παιδιά με δυσλιπιδαιμία. Ο παρατηρούμενος αυξημένος λόγος αλβουμίνης προς κρεατινίνη ούρων στα παιδιά με δυσλιπιδαιμία μπορεί να αποτελεί δείκτη γενικευμένης συστηματικής ενδοθηλιακής δυσλειτουργίας και πρώιμης νεφρικής βλάβης. Αυτά τα παιδιά χρειάζονται μακροχρόνια παρακολούθηση για την έγκαιρη ανίχνευση πιθανής αλβουμινουρίας και νεφρικής δυσλειτουργίας μετέπειτα στην ζωή τους.

scholarly journals Analysis of the effect of immunosuppressive therapy on the progression of chronic kidney disease with mesangioproliferative nephritis

2020 ◽  
Vol 101 (2) ◽  
pp. 175-181
Author(s):  
O N Sigitova ◽  
T Yu Kim ◽  
A V Sineglazova ◽  
G R Kamasheva ◽  
R A Nadeeva
Keyword(s):  
Chronic Kidney Disease ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Immunosuppressive Therapy ◽  
Filtration Rate ◽  
Pulse Mode ◽  
Progression Rate ◽  
Mesangioproliferative Glomerulonephritis

Aim. To assess the effect of immunosuppressive cyclophosphamide therapy and its regimens on the rate of progression of chronic kidney disease in mesangioproliferative glomerulonephritis. Methods. 72 patients with mesangioproliferative glomerulonephritis and indications for immunosuppressive therapy with disease activation were included in the comparative analysis: 56 patients received cyclophosphan in conventional doses (26 patients with daily or every other day, 30 patients with in pulse mode 1 time per month), and 16 patients did not receive cyclophosphan. Duration of the disease before observation ranged from 0 to 33.58 years, a median follow-up was 6.00 (interquartile range 1.6313.17) years, and after observation from 0 to 5 years with the median follow-up was 2.00 (1.003.50) years. The examination included nephrobiopsia with a morphological diagnosis, activity index/sclerosis, and glomerulonephritis progression rate for decreased glomerular filtration rate (ml/min/1.73 m per year). Results. The progression rate of chronic kidney disease was higher in the group of patients not receiving immunosuppressive therapy, 5.57 (3.277.95) ml/min/1.73 m2 per year compared with of the treated patients group, 3.05 (2.046.78) ml/min/1.73 m2 per year (p=0.040). There were no differences in the rate of decrease in glomerular filtration rate between groups depending on the treatment regimen: 4.86 (2.126.77) ml/min/1.73 m2 per year with regular and 3.67 (2.04 6.91) ml/min/1.73 m2 per year with a pulse mode (p=0.720). The rate of glomerulonephritis also did not differ significantly: 1.0 (1.02.0) and 2.0 (1.02.0) relapses over 5 years, respectively (p=0.691) in both treatment regimens. Conclusion. The treatment of patients with mesangioproliferative glomerulonephritis with cyclophosphane, in combination with prednisone or without it, regardless of the treatment regimen induces a slowdown in the progression of chronic kidney disease, improving the long-term prognosis and without affecting the frequency of relapses of the disease.

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