Clinical Predictors of Preeclampsia in Pregnant Women with Chronic Kidney Disease

Background and Objectives: Pregnant women with chronic kidney disease (CKD) are at high risk of adverse maternal and fetal outcomes. Preeclampsia (PE) superimposed on CKD is estimated to occur in 21%–79% of pregnancies. Both conditions share common features such as proteinuria and hypertension, making differential diagnosis difficult. Objective: The aim of this study was to evaluate the incidence and the clinical-biological predictors of preeclampsia in pregnant women with CKD. Material and Methods: We retrospectively analyzed 34 pregnant women with pre-existing CKD admitted to our department between 2008 and 2017. Results: Among the 34 patients, 19 (55.8%) developed PE and the mean time of occurrence was 31.26 ± 2.68 weeks of gestation. The median value of 24-h proteinuria at referral was 0.87 g/day (interquartile range 0.42–1.50) and 47.1% of patients had proteinuria of ≥1 g/day. Patients with PE tended to be more hypertensive, with a more decreased renal function at referral and had significantly higher proteinuria (1.30 vs. 0.63 g/day, p = 0.02). Cox multivariate analysis revealed that proteinuria ≥1 g/day at referral and pre-existing hypertension were independently associated with PE (adjusted hazard ratio = 4.10, 95% confidence interval: 1.52–11.02, p = 0.005, adjusted hazard ratio = 2.62, 95% confidence interval: 1.01–6.77, p = 0.04, respectively). The cumulative risk of PE was significantly higher in pregnant women with proteinuria ≥1 g/day at referral (log-rank, p = 0.003). Proteinuria ≥ 1 g/day at referral and pre-exiting hypertension predicted PE development with accuracies of 73.5% and 64.7%, respectively. Conclusions: Pregnant patients with pre-existing CKD are at high risk of developing preeclampsia, while proteinuria ≥ 1 g/day at referral and pre-existing hypertension were independent predictors of superimposed preeclampsia.

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Serum Magnesium, Blood Pressure, and Risk of Hypertension and Chronic Kidney Disease Progression in the CRIC Study

Hypertension ◽

10.1161/hypertensionaha.121.17694 ◽

2021 ◽

Author(s):

Simon Correa ◽

Xavier E. Guerra-Torres ◽

Sushrut S. Waikar ◽

Finnian R. Mc Causland

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Disease Progression ◽

Lower Risk ◽

Serum Magnesium ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Ckd Progression ◽

Baseline Serum

Magnesium is involved in the regulation of blood pressure (BP). Abnormalities in serum magnesium are common in chronic kidney disease (CKD), yet its association with the development of hypertension and CKD progression in patients with CKD is unclear. We analyzed data from 3866 participants from the CRIC Study (Chronic Renal Insufficiency Cohort). Linear regression assessed the association of serum magnesium with baseline systolic BP (SBP) and diastolic BP (DBP). Logistic regression explored the association of serum magnesium with various definitions of hypertension. Cox proportional hazards models explored assessed the risk of incident hypertension and CKD progression. Mean serum magnesium was 2.0 mEq/L (±0.3 mEq/L). Higher magnesium was associated with lower SBP (−3.4 mm Hg [95% CI, −5.8 to −1.0 per 1 mEq/L]) and lower DBP (−2.9 mm Hg [95% CI, −4.3 to −1.5 per 1 mEq/L]). Higher magnesium was associated with a lower risk of American Heart Association–defined hypertension (SBP≥130 mm Hg or DBP≥80 mm Hg) at baseline (adjusted hazard ratio, 0.65 [95% CI, 0.49–0.86 per 1 mEq/L]), a lower risk of suboptimally controlled BP (SBP≥120 mm Hg or DBP≥80 mm Hg; adjusted odds ratio, 0.58 [95% CI, 0.43–0.78 per 1 mEq/L]). In time-to-event analyses, higher baseline serum magnesium was associated with a nominally lower risk of incident CRIC-defined hypertension (adjusted hazard ratio, 0.77 [95% CI, 0.46–1.31 per 1 mEq/L]). Higher magnesium was associated with a significantly lower risk of CKD progression (adjusted hazard ratio, 0.68 [95% CI, 0.54–0.86 per 1 mEq/L]). In patients with CKD, higher serum magnesium is associated with lower SBP and DBP, and with a lower risk of hypertension and CKD progression. In patients with CKD, whether magnesium supplementation could optimize BP control and prevent disease progression deserves further investigation.

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Renal dysfunction indicative of outcomes in hospitalized patients with takotsubo syndrome

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872617715019 ◽

2017 ◽

Vol 7 (8) ◽

pp. 723-731 ◽

Cited By ~ 3

Author(s):

Kaoru Ando ◽

Hiroyasu Sukekawa ◽

Aoi Takahata ◽

Yusuke Kobari ◽

Hayato Tsuchiya ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Confidence Interval ◽

Renal Dysfunction ◽

Left Ventricular ◽

Hazard Ratio ◽

Hospitalized Patients ◽

Rank Test ◽

Takotsubo Syndrome ◽

Pump Failure

Background: Left ventricular dysfunction as part of takotsubo syndrome is reversible, and the long-term prognosis appears favorable. However, life-threatening complications are not uncommon during the acute phase, and it remains unclear whether renal dysfunction is a factor in complications suffered by hospitalized patients with takotsubo syndrome. The present study was conducted to investigate the implications of renal dysfunction in this setting. Methods: Data from 61 consecutive patients (male, 21; female, 40) diagnosed with takotsubo syndrome at our hospital between years 2010 and 2016 were evaluated retrospectively. In-hospital complications by definition were all-cause deaths and severe pump failure (Killip class ≥III). Results: Overall, 30 patients (49%) developed renal dysfunction. In the 32 patients (52%) who suffered in-hospital complications (mortality, 10; severe pump failure, 22), estimated glomerular filtration rate (eGFR) was significantly lower by comparison (51.3±29.8 vs. 69.5±29.0; p=0.019). Low eGFR (<30 ml/min per 1.73m2) proved independently predictive of in-hospital complications (hazard ratio =2.84, 95% confidence interval: 1.20–6.69) in multivariate Cox hazard analysis, also showing a significant association with peak event rate of Kaplan–Meier curve (log-rank test, p=0.0073). Similarly, patients with chronic kidney disease were at significantly greater risk of in-hospital complications (hazard ratio=2.49, 95% confidence interval: 1.01–5.98), relative to non-compromised counterparts (eGFR >60 ml/min per 1.73m2). Conclusion: Renal dysfunction is a simple but useful means of predicting complications in hospitalized patients with takotsubo syndrome, especially those with chronic kidney disease.

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Impact of Transition in Metabolic Health and Obesity on the Incident Chronic Kidney Disease: A Nationwide Cohort Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa033 ◽

2020 ◽

Vol 105 (3) ◽

pp. e148-e157 ◽

Cited By ~ 2

Author(s):

Yun Kyung Cho ◽

Jiwoo Lee ◽

Hwi Seung Kim ◽

Joong-Yeol Park ◽

Woo Je Lee ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Confidence Interval ◽

Dynamic Condition ◽

National Sample ◽

Metabolic Health ◽

Hazard Ratio ◽

Longitudinal Change ◽

Increased Risk ◽

Metabolically Healthy

Abstract Context Metabolically healthy obesity (MHO) is a dynamic condition. Objective To evaluate the risk of chronic kidney disease (CKD) among people with MHO according to its longitudinal change. Design Observational study. Setting A nationwide population-based cohort. Participants A total of 514 866 people from the Korean National Health Insurance Service-National Sample Cohort. Intervention The initial presence and changes of obesity (using body mass index [BMI] and waist circumference [WC]) and metabolic health status. Main outcome Measure Incident CKD from 2011 to 2015. Results Of the people classified as MHO at baseline (BMI criteria), 47.6% remained as MHO in 2011 and 2012, whereas 12.1%, 5.5%, and 34.8% were classified as metabolically healthy, non-obese (MHNO), metabolically unhealthy, non-obese, and metabolically unhealthy, obese, respectively. The risk of incident CKD in the baseline MHO group was higher than that in the MHNO group (hazard ratio, 1.23; 95% confidence interval, 1.12-1.36). However, when transition was taken into account, people who converted to MHNO were not at increased risk (hazard ratio, 0.98; 95% confidence interval, 0.72-1.32), whereas the stable MHO group and the groups that evolved to metabolically unhealthy status had a higher risk of incident CKD than the stable MHNO group. When the risk was analyzed using WC criteria, it showed a similar pattern to BMI criteria except for the stable MHO group. Conclusions MHO was a dynamic condition, and people with MHO constituted a heterogeneous group. Although the MHO phenotype was generally associated with incident CKD, maintenance of metabolic health and weight reduction might alleviate the risk of CKD.

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Rates of New Human Papillomavirus Detection and Loss of Detection in Middle-aged Women by Recent and Past Sexual Behavior

The Journal of Infectious Diseases ◽

10.1093/infdis/jiaa557 ◽

2020 ◽

Author(s):

Proma Paul ◽

Anne Hammer ◽

Anne F Rositch ◽

Anne E Burke ◽

Raphael P Viscidi ◽

...

Keyword(s):

Sexual Behavior ◽

Human Papillomavirus ◽

High Risk ◽

Confidence Interval ◽

Hpv Vaccination ◽

Hazard Ratio ◽

Adjusted Hazard Ratio ◽

Middle Aged ◽

Detection Rates ◽

High Risk Hpv

Abstract Background Understanding the source of newly detected human papillomavirus (HPV) in middle-aged women is important to inform preventive strategies, such as screening and HPV vaccination. Methods We conducted a prospective cohort study in Baltimore, Maryland. Women aged 35–60 years underwent HPV testing and completed health and sexual behavior questionnaires every 6 months over a 2-year period. New detection/loss of detection rates were calculated and adjusted hazard ratios were used to identify risk factors for new detection. Results The new and loss of detection analyses included 731 women, and 104 positive for high-risk HPV. The rate of new high-risk HPV detection was 5.0 per 1000 woman-months. Reporting a new sex partner was associated with higher detection rates (adjusted hazard ratio, 8.1; 95% confidence interval, 3.5–18.6), but accounted only for 19.4% of all new detections. Among monogamous and sexually abstinent women, new detection was higher in women reporting ≥5 lifetime sexual partners than in those reporting <5 (adjusted hazard ratio, 2.2; 95% confidence interval, 1.2–4.2). Conclusion Although women remain at risk of HPV acquisition from new sex partners as they age, our results suggest that most new detections in middle-aged women reflect recurrence of previously acquired HPV.

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Investigating the Relationship Between Age and Kidney Failure in Adults With Category 4 Chronic Kidney Disease

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358120966819 ◽

2020 ◽

Vol 7 ◽

pp. 205435812096681

Author(s):

Huda Al-Wahsh ◽

Ngan N. Lam ◽

Ping Liu ◽

Robert R. Quinn ◽

Marta Fiocco ◽

...

Keyword(s):

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Confidence Interval ◽

Risk Prediction ◽

Kidney Failure ◽

Cox Regression ◽

Hazard Ratio ◽

Administrative Databases ◽

The Relationship

Background: In people with severe chronic kidney disease (CKD), there is an inverse relationship between age and kidney failure. If this relationship is the same at any age (linear), one effect (hazard ratio) will be sufficient for accurate risk prediction; if it is nonlinear, the effect will vary with age. Objective: To investigate the relationship between age and kidney failure in adults with category G4 chronic kidney disease (G4 CKD). Methods: We performed a population-based study using linked administrative databases in Alberta, Canada, to study adults with G4 CKD (estimated glomerular filtration rate [eGFR] = 15-30 mL/min/1.73 m2) and without previously documented eGFR <15 mL/min/1.73 m2 or renal replacement. We used cause-specific Cox regression to model the relationship between age and the hazard of kidney failure (the earlier of eGFR <10 mL/min/1.73 m2 or receipt of renal replacement) and death, incorporating spline terms to capture any nonlinear effect of age. We included sex, diabetes mellitus, cardiovascular disease, albuminuria, and eGFR in all models. Results: Of the 27 823 participants (97 731 patient-years at risk; mean age = 76 years, ±13), 19% developed kidney failure and 51% died. The decline in the hazard of kidney failure associated with a given increase in age was not constant but became progressively larger as people aged; that is, the hazard ratio became progressively smaller (closer to 0). Assuming an eGFR of 25 mL/min/1.73 m2, for every 10-year increase in age, the hazard ratio declined from 0.76 (95% confidence interval = 0.73-0.79) at age 50 years to 0.43 (95% confidence interval = 34-56) at age 80 years in people without cardiovascular disease, and from 0.75 (95% confidence interval = 0.70-0.79) at age 50 years to 0.36 (95% confidence interval = 0.29-0.45) at age 80 years in people with cardiovascular disease. Conclusions: The relationship between kidney failure and age varies with age. An age-dependent effect, rather than a constant effect, needs to be specified to accurately predict risk. These findings have implications for risk prediction and advanced care planning.

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Dulaglutide in Diabetes and Chronic Kidney Disease: AWARD-7 Exploratory Analysis of Clinical Outcomes

Kidney360 ◽

10.34067/kid.0005852020 ◽

2020 ◽

pp. 10.34067/KID.0005852020

Author(s):

Katherine R. Tuttle ◽

Brian Rayner ◽

Mark C. Lakshmanan ◽

Anita Y.M. Kwan ◽

Manige Konig ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Confidence Interval ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Cox Proportional Hazards Model ◽

Clinical Event ◽

Composite Outcome ◽

Egfr Decline

Background: In the AWARD-7 trial of participants with type 2 diabetes (T2DM) and moderate-to-severe chronic kidney disease (CKD), dulaglutide (DU) treatment slowed decline in estimated glomerular filtration rate (eGFR) compared to insulin glargine (IG). Treatment with doses of either DU or IG resulted in similar levels of glycemic control and blood pressure. The aim of this analysis was to determine the risk of clinical event outcomes between treatment groups. Methods: Participants with T2DM and CKD categories 3-4 were randomized (1:1:1) to DU 0.75 mg or 1.5 mg weekly or IG daily as basal therapy, with titrated insulin lispro, for one year. The time to occurrence of the composite outcome of ≥40% eGFR decline, end-stage kidney disease (ESKD), or death due to kidney disease was compared using a Cox proportional hazards model. Results: Patients treated with DU 1.5 mg weekly versus IG daily for 1 year had a lower risk of ≥40% eGFR decline or ESKD events in the overall study population (5.2% versus 10.8%; hazard ratio 0.45, 95% confidence interval 0.20-0.97, P=0.042). Most events occurred in the subset with macroalbuminuria, where risk of the composite outcome was substantially lower for DU 1.5 mg versus IG (7.1% versus 22.2%; hazard ratio 0.25, 95% confidence interval 0.10-0.68, P=0.006). No deaths occurred. Conclusions: Treatment with DU 1.5 mg weekly was associated with a clinically relevant risk reduction of ≥40% eGFR decline or ESKD compared to IG daily, particularly in the macroalbuminuria subgroup of participants with T2DM and moderate-to-severe CKD.

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Mineralocorticoid Receptor Antagonists and Renal Outcomes in Heart Failure Patients with and without Chronic Kidney Disease

Cardiorenal Medicine ◽

10.1159/000503223 ◽

2019 ◽

Vol 10 (1) ◽

pp. 32-41 ◽

Cited By ~ 1

Author(s):

Thomas A. Mavrakanas ◽

Nadia Giannetti ◽

Ruth Sapir-Pichhadze ◽

Ahsan Alam

Keyword(s):

Heart Failure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Confidence Interval ◽

Mineralocorticoid Receptor ◽

Tertiary Care ◽

Hazard Ratio ◽

Control Group ◽

Mineralocorticoid Receptor Antagonists ◽

Receptor Antagonists

Introduction: The effect of mineralocorticoid receptor antagonists (MRAs) on chronic kidney disease (CKD) progression in patients with heart failure (HF) and with or without preexisting CKD has not been adequately studied. Methods: We conducted a retrospective cohort study including consecutive adult patients followed at the HF clinic of a tertiary care center who had already been on an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB). Exposure to MRAs was assessed at 6 months from registration. Patients who were never exposed to an MRA were the control group. Results: A total of 314 patients who were prescribed an MRA were compared to 1,116 patients who never received an MRA. Among them, 121 and 408 patients, respectively, had CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2). MRAs had to be discontinued in 36/121 patients with CKD (29.8%) and 57/165 patients without CKD (34.5%) (p = 0.39). MRA treatment was associated with a higher risk for persistent creatinine doubling among patients without CKD (hazard ratio 4.07, 95% confidence interval 1.41–11.73). A numerically lower risk was identified among CKD patients (hazard ratio 0.33, 95% confidence interval 0.04–2.78) (p for interaction = 0.009). The primary safety outcome, a composite of any doubling of serum creatinine or any episode of serious hyperkalemia (K+ >6 mmol/L), occurred more commonly in MRA users compared with nonusers in the subgroup of patients without CKD, but not in CKD patients (p for interaction = 0.02). Conclusion: MRA treatment in addition to an ACEI or an ARB could be safely prescribed in HF patients with CKD as it is not associated with persistent renal function decline, acute kidney injury, or serious hyperkalemia, compared with ACEI/ARB monotherapy.

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Sex modulates the association of radial artery augmentation index with renal function decline in individuals without chronic kidney disease

International Urology and Nephrology ◽

10.1007/s11255-020-02776-5 ◽

2021 ◽

Author(s):

Qiao Qin ◽

Fangfang Fan ◽

Jia Jia ◽

Yan Zhang ◽

Bo Zheng

Keyword(s):

Chronic Kidney Disease ◽

Renal Function ◽

Kidney Disease ◽

Arterial Stiffness ◽

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Augmentation Index ◽

Renal Function Decline

Abstract Purpose An increase in arterial stiffness is associated with rapid renal function decline (RFD) in patients with chronic kidney disease (CKD). The aim of this study was to investigate whether the radial augmentation index (rAI), a surrogate marker of arterial stiffness, affects RFD in individuals without CKD. Methods A total of 3165 Chinese participants from an atherosclerosis cohort with estimated glomerular filtration rates (eGFR) of ≥ 60 mL/min/1.73 m2 were included in this study. The baseline rAI normalized to a heart rate of 75 beats/min (rAIp75) was obtained using an arterial applanation tonometry probe. The eGFRs at both baseline and follow-up were calculated using the equation derived from the Chronic Kidney Disease Epidemiology Collaboration. The association of the rAIp75 with RFD (defined as a drop in the eGFR category accompanied by a ≥ 25% drop in eGFR from baseline or a sustained decline in eGFR of > 5 mL/min/1.73 m2/year) was evaluated using the multivariate regression model. Results During the 2.35-year follow-up, the incidence of RFD was 7.30%. The rAIp75 had no statistically independent association with RFD after adjustment for possible confounders (adjusted odds ratio = 1.12, 95% confidence interval: 0.99–1.27, p = 0.074). When stratified according to sex, the rAIp75 was significantly associated with RFD in women, but not in men (adjusted odds ratio and 95% confidence interval: 1.23[1.06–1.43], p = 0.007 for women, 0.94[0.76–1.16], p = 0.542 for men; p for interaction = 0.038). Conclusion The rAI might help screen for those at high risk of early rapid RFD in women without CKD.

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Risk for recurrent cardiovascular disease events among patients with diabetes and chronic kidney disease

Cardiovascular Diabetology ◽

10.1186/s12933-021-01247-0 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Demetria Hubbard ◽

Lisandro D. Colantonio ◽

Robert S. Rosenson ◽

Todd M. Brown ◽

Elizabeth A. Jackson ◽

...

Keyword(s):

Myocardial Infarction ◽

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Health Insurance ◽

High Risk ◽

Kidney Disease ◽

Peripheral Artery ◽

Increased Risk ◽

Patients With Diabetes ◽

Very High

Abstract Background Adults who have experienced multiple cardiovascular disease (CVD) events have a very high risk for additional events. Diabetes and chronic kidney disease (CKD) are each associated with an increased risk for recurrent CVD events following a myocardial infarction (MI). Methods We compared the risk for recurrent CVD events among US adults with health insurance who were hospitalized for an MI between 2014 and 2017 and had (1) CVD prior to their MI but were free from diabetes or CKD (prior CVD), and those without CVD prior to their MI who had (2) diabetes only, (3) CKD only and (4) both diabetes and CKD. We followed patients from hospital discharge through December 31, 2018 for recurrent CVD events including coronary, stroke, and peripheral artery events. Results Among 162,730 patients, 55.2% had prior CVD, and 28.3%, 8.3%, and 8.2% had diabetes only, CKD only, and both diabetes and CKD, respectively. The rate for recurrent CVD events per 1000 person-years was 135 among patients with prior CVD and 110, 124 and 171 among those with diabetes only, CKD only and both diabetes and CKD, respectively. Compared to patients with prior CVD, the multivariable-adjusted hazard ratio for recurrent CVD events was 0.92 (95%CI 0.90–0.95), 0.89 (95%CI: 0.85–0.93), and 1.18 (95%CI: 1.14–1.22) among those with diabetes only, CKD only, and both diabetes and CKD, respectively. Conclusion Following MI, adults with both diabetes and CKD had a higher risk for recurrent CVD events compared to those with prior CVD without diabetes or CKD.

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Chronic kidney disease stage stratifies short- and long-term outcomes after aortic root replacement

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivaa320 ◽

2020 ◽

Author(s):

Tsuyoshi Yamabe ◽

Yanling Zhao ◽

Paul A Kurlansky ◽

Suzuka Nitta ◽

Saveliy Kelebeyev ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Confidence Interval ◽

Aortic Root Replacement ◽

Mortality Hazard ◽

Group 3 ◽

Group 2 ◽

Mortality Hazard Ratio ◽

Group 1

Abstract OBJECTIVES Chronic kidney disease (CKD) is prevalent in patients undergoing cardiovascular surgery, and it negatively impacts procedural outcomes; however, its influence on the outcomes of aortic surgery has not been well studied. This study aims to elucidate the importance of CKD on the outcomes of aortic root replacement (ARR). METHODS Patients who underwent ARR between 2005 and 2019 were retrospectively reviewed (n = 882). Patients were divided into 3 groups based on the Kidney Disease: Improving Global Outcomes criteria: Group 1 [estimated glomerular filtration rate (eGFR) ≥ 60 ml/min/1.73 m2, n = 421); Group 2 (eGFR = 30–59 ml/min/1.73 m2, n = 424); and Group 3 (eGFR < 30 ml/min/1.73 m2, n = 37). To reduce potential confounding, a propensity score matching was also performed between Group 1 and the combined group of Group 2 and Group 3. The primary end point was 10-year survival. Secondary end points were in-hospital mortality and perioperative morbidity. RESULTS Severe CKD patients presented with more advanced overall chronic and acute illnesses. Kaplan–Meier analysis showed a significant correlation between CKD stage and 10-year survival (log-rank P < 0.001). The number of events for Group 1 was 15, Group 2 was 49 and Group 3 was 11 in 10 years. Group 3 had significantly higher in-hospital mortality (13.5% vs 3.5% in Group 2 vs 0.7% in Group 1, P < 0.001) and stroke (8.1% vs 7.1% vs 1.2%, P < 0.001) as well as introduction to new dialysis (27.0% vs 5.4% vs 1.7%, P < 0.001). eGFR was shown to be an independent predictor of mortality (hazard ratio, 0.98; 95% confidence interval, 0.96–0.99). Comparison between propensity matched groups showed similar postoperative outcomes, and eGFR was still identified as a predictor of mortality (hazard ratio, 0.97; 95% confidence interval, 0.95–0.99). CONCLUSIONS Higher stage in CKD negatively impacts the long-term survival in patients who are undergoing ARR.

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