Gustatory Function and the Uremic Toxin, Phosphate, Are Modulators of the Risk of Vascular Calcification among Patients with Chronic Kidney Disease: A Pilot Study

Patients with chronic kidney disease (CKD) have an increased risk of vascular calcification (VC), including aortic arch calcification (AAC). Few investigated the influence of gustatory function on the probability of having VC. We examined whether gustatory function results modulated the probability of having VC in patients with CKD. We prospectively enrolled adults with CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2), with their AAC rated semi-quantitatively and gustatory function assessed by objective and subjective approaches. Multiple logistic regression was used to analyze the relationship between gustatory function results and AAC. Those with AAC had significantly better objective gustatory function in aggregate scores (p = 0.039) and categories (p = 0.022) and less defective bitter taste (p = 0.045) and scores (p = 0.037) than those without. Multiple regression analyses showed that higher aggregate scores (odds ratio (OR) 1.288, p = 0.032), or better gustatory function, and higher bitter taste scores (OR 2.558, p = 0.019) were each associated with a higher probability of having AAC among CKD patients; such an association was modulated by serum phosphate levels. In conclusion, better gustatory function was independently correlated with having AAC among CKD patients. A follow-up of VC severity may be an underrecognized component of care for CKD patients with a preserved gustatory function.

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P0856LOW BONE MASS IS SIGNIFICANTLY ASSOCIATED WITH AN INCREASED RISK OF ANEMIA IN PATIENTS WITH CKD

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0856 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Seonyeong Lee ◽

Yooju Nam ◽

Hyung Woo Kim ◽

Jae Hyun Chang ◽

Tae-Hyun Yoo

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Bone Mass ◽

Mass Density ◽

Bone Mass Density ◽

Mineral Density ◽

Multivariable Logistic Regression Model ◽

Increased Risk ◽

The Relationship

Abstract Background and Aims Hypoxia has been considered to be a risk factor for osteoporosis. Several studies have reported on the close associations between the anemia and an increased risk of bone loss. However, the relationship between hemoglobin levels and bone mineral density(BMD) has not been established in chronic kidney disease (CKD) patients. Therefore, the aim of this study is to investigate the relationship between BMD and anemia in a non-dialysis CKD cohort. Method Among 2,238 patients with non-dialysis CKD enrolled in the KoreaN cohort study for Outcome in patients With Chronic Kidney Disease (KNOW-CKD), 2,115 patients who measured hemoglobin(Hb) and BMD were included in the analysis. We defined anemia as hemoglobin(Hb) levels of < 13.0 g/dL and 12.0 g/dL for males and females, respectively. The primary endpoint was the onset of a 15% decline in Hemoglobin during follow-up. Results The mean age was 53.6 ± 12.2 years and 1,292(61.1%) patients were males. The BMD score was positively correlated with hemoglobin levels (β, 0.658; 95% CI, 0.215-1.101; P 0.004). In the multivariable logistic regression model, the prevalence of anemia was significantly higher in the osteoporosis group than that in the normal BMD group (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.03-2.46, P=0.038). Among 1010 patients without data of following hemoglobin levels, 396 (19.7%) patients developed 15% decline in hemoglobin level during a median follow-up duration of 36 (interquartile range, 10-60) months. In the fully adjusted multivariable Cox models, risk of developing the 15% decline of hemoglobin was significantly higher in the osteoporosis group (HR, 1.45; 95% CI, 1.03-2.05; P= 0.035) as compared to normal BMD group. Conclusion This study showed that low bone mass density was independently related with anemia and hemoglobin levels in patients with non-dialysis CKD. Our findings suggest that preserve bone mass be important to maintain the levels of hemoglobin with CKD patients.

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Dietary Micronutrients and Risk of Chronic Kidney Disease: A Cohort Study with 12 Year Follow-Up

Nutrients ◽

10.3390/nu13051517 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1517

Author(s):

Juyeon Lee ◽

Kook-Hwan Oh ◽

Sue-Kyung Park

Keyword(s):

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Epidemiologic Study ◽

Population Based ◽

Dietary Guidelines ◽

Dietary Intakes ◽

Increased Risk ◽

Ckd Stage

We investigated the association between dietary micronutrient intakes and the risk of chronic kidney disease (CKD) in the Ansan-Ansung study of the Korean Genome and Epidemiologic Study (KoGES), a population-based prospective cohort study. Of 9079 cohort participants with a baseline estimate glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 and a urine albumin to creatinine ratio (UACR) <300 mg/g and who were not diagnosed with CKD, we ascertained 1392 new CKD cases over 12 year follow-up periods. The risk of CKD according to dietary micronutrient intakes was presented using hazard ratios (HRs) and 95% confidence intervals (95% CIs) in a full multivariable Cox proportional hazard models, adjusted for multiple micronutrients and important clinico-epidemiological risk factors. Low dietary intakes of phosphorus (<400 mg/day), vitamin B2 (<0.7 mg/day) and high dietary intake of vitamin B6 (≥1.6 mg/day) and C (≥100 mg/day) were associated with an increased risk of CKD stage 3B and over, compared with the intake at recommended levels (HR = 6.78 [95%CI = 2.18–21.11]; HR = 2.90 [95%CI = 1.01–8.33]; HR = 2.71 [95%CI = 1.26–5.81]; HR = 1.83 [95%CI = 1.00–3.33], respectively). In the restricted population, excluding new CKD cases defined within 2 years, an additional association with low folate levels (<100 µg/day) in higher risk of CKD stage 3B and over was observed (HR = 6.72 [95%CI = 1.40–32.16]). None of the micronutrients showed a significant association with the risk of developing CKD stage 3A. Adequate intake of micronutrients may lower the risk of CKD stage 3B and over, suggesting that dietary guidelines are needed in the general population to prevent CKD.

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Obesity, Abdominal Obesity and Chronic Kidney Disease in Young Adults: A Nationwide Population-Based Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm10051065 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1065

Author(s):

Eun Hui Bae ◽

Sang Yeob Lim ◽

Jin-Hyung Jung ◽

Tae Ryom Oh ◽

Hong Sang Choi ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Young Adults ◽

Kidney Disease ◽

Abdominal Obesity ◽

Population Based ◽

Baseline Body Mass Index ◽

Increased Risk ◽

Baseline Examination ◽

New Onset

Obesity has become a pandemic. It is one of the strongest risk-factors of new-onset chronic kidney disease (CKD). However, the effects of obesity and abdominal obesity on the risk of developing CKD in young adults has not been elucidated. From a nationwide health screening database, we included 3,030,884 young adults aged 20–39 years without CKD during a baseline examination in 2009–2010, who could follow up during 2013–2016. Patients were stratified into five levels based on their baseline body mass index (BMI) and six levels based on their waist circumference (WC; 5-cm increments). The primary outcome was the development of CKD. During the follow up, until 2016, 5853 (0.19%) participants developed CKD. Both BMI and WC showed a U-shaped relationship with CKD risk, identifying the cut-off values as a BMI of 21 and WC of 72 cm in young adults. The obesity group (odd ratio [OR] = 1.320, 95% confidence interval [CI]: 1.247–1.397) and abdominal obesity group (male WC ≥ 90, female WC ≥ 85) (OR = 1.208, 95%CI: 1.332–1.290) showed a higher CKD risk than the non-obesity or non-abdominal obesity groups after adjusting for covariates. In the CKD risk by obesity composite, the obesity displayed by the abdominal obesity group showed the highest CKD risk (OR = 1.502, 95%CI: 1.190–1.895), especially in those under 30 years old. During subgroup analysis, the diabetes mellitus (DM) group with obesity or abdominal obesity paradoxically showed a lower CKD risk compared with the non-obesity or non-abdominal obesity group. Obesity and abdominal obesity are associated with increased risk of developing CKD in young adults but a decreased risk in young adults with diabetes.

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Association of Body Weight Variability with Adverse Cardiovascular Outcomes in Patients with Pre-Dialysis Chronic Kidney Disease

Nutrients ◽

10.3390/nu13103381 ◽

2021 ◽

Vol 13 (10) ◽

pp. 3381

Author(s):

Sang Heon Suh ◽

Tae Ryom Oh ◽

Hong Sang Choi ◽

Chang Seong Kim ◽

Eun Hui Bae ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Body Weight ◽

Kidney Disease ◽

Primary Outcome ◽

Body Weight Gain ◽

Absolute Difference ◽

Composite Outcome ◽

Increased Risk ◽

All Cause Mortality

To investigate the association of body weight variability (BWV) with adverse cardiovascular (CV) outcomes in patient with pre-dialysis chronic kidney disease (CKD), a total of 1867 participants with pre-dialysis CKD from Korean Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD) were analyzed. BWV was defined as the average absolute difference between successive values. The primary outcome was a composite of non-fatal CV events and all-cause mortality. Secondary outcomes were fatal and non-fatal CV events and all-cause mortality. High BWV was associated with increased risk of the composite outcome (adjusted hazard ratio (HR) 1.745, 95% confidence interval (CI) 1.065 to 2.847) as well as fatal and non-fatal CV events (adjusted HR 1.845, 95% CI 1.136 to 2.996) and all-cause mortality (adjusted HR 1.861, 95% CI 1.101 to 3.145). High BWV was associated with increased risk of fatal and non-fatal CV events, even in subjects without significant body weight gain or loss during follow-up periods (adjusted HR 2.755, 95% CI 1.114 to 6.813). In conclusion, high BWV is associated with adverse CV outcomes in patients with pre-dialysis CKD.

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Vascular Calcification in Patients with Early-Stage Chronic Kidney Disease: The Pivotal Role of Estimated Glomerular Filtration Rate

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.06.12611 ◽

2021 ◽

Vol 104 (6) ◽

pp. 989-997

Keyword(s):

Chronic Kidney Disease ◽

Glomerular Filtration Rate ◽

Kidney Disease ◽

Glomerular Filtration ◽

Vascular Calcification ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Early Stage ◽

Abdominal Aortic Calcification ◽

Abdominal Aortic

Background: Vascular calcification in advanced chronic kidney disease (CKD) is correlated with uremic toxins and severely impaired calciumphosphate- parathyroid metabolism. The association factors of vascular calcification in early-stage CKD are still unestablished. Objective: To identify the risk factors for vascular calcification in the early-stage CKD, which was the non-target population, different from other previous studies that explored this association in advanced stage CKD. Materials and Methods: The present study was a longitudinal study conducted to examine the risk factors of vascular calcification in CKD stage G2 and G3 patients who had no previous cardiovascular diseases. All parameters including coronary artery calcification (CAC) and abdominal aortic calcification (AAC) at baseline and after twelve months were evaluated. Results: Twenty-two patients without established cardiovascular diseases were included and completed the follow-up period. Mean baseline LDL was 99 mg/dL and no patient received statin. At 12-month, the median CAC score was significantly increased to 266 (126 to 956) versus 282 (198 to 846), (p=0.024]. By multivariable analysis in generalized estimating equations, only estimated glomerular filtration rate (eGFR) was associated with CAC score greater than 400 (aOR 0.92, p=0.041), and AAC score greater than 5 (aOR 0.90, p=0.023). Conclusion: In early-stage CKD, eGFR was associated with vascular calcification. Further studies should explore the potential benefits of delaying CKD progression on vascular calcification in the early-stage CKD patients. Keywords: Chronic kidney disease; Vascular calcification; Coronary artery calcification; Abdominal aortic calcification; Glomerular filtration rate; Renal function

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Chronic kidney disease and undiagnosed atrial fibrillation in individuals with diabetes

Cardiovascular Diabetology ◽

10.1186/s12933-020-01128-y ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Nam Ju Heo ◽

Sang Youl Rhee ◽

Jill Waalen ◽

Steven Steinhubl

Keyword(s):

Atrial Fibrillation ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Clinical Symptoms ◽

Screening Program ◽

Renal Involvement ◽

Newly Diagnosed ◽

Mortality And Morbidity ◽

Increased Risk

Abstract Background Diabetes is an independent risk factor for atrial fibrillation (AF), which is associated with increases in mortality and morbidity, as well as a diminished quality of life. Renal involvement in diabetes is common, and since chronic kidney disease (CKD) shares several of the same putative mechanisms as AF, it may contribute to its increased risk in individuals with diabetes. The objective of this study is to identify the relationship between CKD and the rates of newly-diagnosed AF in individuals with diabetes taking part in a screening program using a self-applied wearable electrocardiogram (ECG) patch. Materials and methods The study included 608 individuals with a diagnosis of diabetes among 1738 total actively monitored participants in the prospective mHealth Screening to Prevent Strokes (mSToPS) trial. Participants, without a prior diagnosis of AF, wore an ECG patch for 2 weeks, twice, over a 4-months period and followed clinically through claims data for 1 year. Definitions of CKD included ICD-9 or ICD-10 chronic renal failure diagnostic codes, and the Health Profile Database algorithm. Individuals requiring dialysis were excluded from trial enrollment. Results Ninety-six (15.8%) of study participants with diabetes also had a diagnosis of CKD. Over 12 months of follow-up, 19 new cases of AF were detected among the 608 participants. AF was newly diagnosed in 7.3% of participants with CKD and 2.3% in those without (P < 0.05) over 12 months of follow-up. In a univariate Cox proportional hazard regression analysis, the risk of incident AF was 3 times higher in individuals with CKD relative to those without CKD: hazard ratios (HR) 3.106 (95% CI 1.2–7.9). After adjusting for the effect of age, sex, and hypertension, the risk of incident AF was still significantly higher in those with CKD: HR 2.886 (95% CI 1.1–7.5). Conclusion Among individuals with diabetes, CKD significantly increases the risk of incident AF. Identification of AF prior to clinical symptoms through active ECG screening could help to improve the clinical outcomes in individuals with CKD and diabetes.

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

American Journal of Nephrology ◽

10.1159/000496058 ◽

2019 ◽

Vol 49 (2) ◽

pp. 93-102 ◽

Cited By ~ 3

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.

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The first consecutive 5000 patients with Coronavirus Disease 2019 from Qatar; a nation-wide cohort study

BMC Infectious Diseases ◽

10.1186/s12879-020-05511-8 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Ali S. Omrani ◽

Muna A. Almaslamani ◽

Joanne Daghfal ◽

Rand A. Alattar ◽

Mohamed Elgara ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Older Age ◽

Icu Admission ◽

Increased Risk ◽

All Cause Mortality ◽

Male Sex

Abstract Background There are limited data on Coronavirus Disease 2019 (COVID-19) outcomes at a national level, and none after 60 days of follow up. The aim of this study was to describe national, 60-day all-cause mortality associated with COVID-19, and to identify risk factors associated with admission to an intensive care unit (ICU). Methods This was a retrospective cohort study including the first consecutive 5000 patients with COVID-19 in Qatar who completed 60 days of follow up by June 17, 2020. The primary outcome was all-cause mortality at 60 days after COVID-19 diagnosis. In addition, we explored risk factors for admission to ICU. Results Included patients were diagnosed with COVID-19 between February 28 and April 17, 2020. The majority (4436, 88.7%) were males and the median age was 35 years [interquartile range (IQR) 28–43]. By 60 days after COVID-19 diagnosis, 14 patients (0.28%) had died, 10 (0.2%) were still in hospital, and two (0.04%) were still in ICU. Fatal COVID-19 cases had a median age of 59.5 years (IQR 55.8–68), and were mostly males (13, 92.9%). All included pregnant women (26, 0.5%), children (131, 2.6%), and healthcare workers (135, 2.7%) were alive and not hospitalized at the end of follow up. A total of 1424 patients (28.5%) required hospitalization, out of which 108 (7.6%) were admitted to ICU. Most frequent co-morbidities in hospitalized adults were diabetes (23.2%), and hypertension (20.7%). Multivariable logistic regression showed that older age [adjusted odds ratio (aOR) 1.041, 95% confidence interval (CI) 1.022–1.061 per year increase; P < 0.001], male sex (aOR 4.375, 95% CI 1.964–9.744; P < 0.001), diabetes (aOR 1.698, 95% CI 1.050–2.746; P 0.031), chronic kidney disease (aOR 3.590, 95% CI 1.596–8.079, P 0.002), and higher BMI (aOR 1.067, 95% CI 1.027–1.108 per unit increase; P 0.001), were all independently associated with increased risk of ICU admission. Conclusions In a relatively younger national cohort with a low co-morbidity burden, COVID-19 was associated with low all-cause mortality. Independent risk factors for ICU admission included older age, male sex, higher BMI, and co-existing diabetes or chronic kidney disease.

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Vascular Calcification as a Novel Risk Factor for Kidney Function Deterioration in the Nonelderly

Journal of the American Heart Association ◽

10.1161/jaha.120.019300 ◽

2021 ◽

Author(s):

Samel Park ◽

Nam‐Jun Cho ◽

Nam Hun Heo ◽

Eun‐Jung Rhee ◽

Hyowook Gil ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Renal Function ◽

Glomerular Filtration Rate ◽

Kidney Disease ◽

Glomerular Filtration ◽

Kidney Function ◽

Vascular Calcification ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Tertiary Teaching

Background The relationship between vascular calcification and chronic kidney disease is well known. However, whether vascular calcification affects renal function deterioration remains unclear. We investigated whether kidney function deteriorated more rapidly in individuals with higher vascular calcification indicated by the coronary artery calcium score (CACS). Methods and Results Individuals with a normal estimated glomerular filtration rate (>60 mL/min per 1.73 m 2 ) who underwent cardiac computed tomography in our institution (a tertiary teaching hospital in Cheonan, Korea) from January 2010 to July 2012 were retrospectively reviewed. All participants were aged 20 to 65 years. Among 739 patients, 447, 175, and 117 had CACSs of 0, 1 to 99, and ≥100 units, respectively. The participants were followed for 7.8 (interquartile range, 5.5–8.8) years. The adjusted annual estimated glomerular filtration rates declined more rapidly in patients in the CACS ≥100 group compared with those in the CACS 0 group (adjusted‐β, −0.40; 95% CI, −0.80 to −0.03) when estimated using a linear mixed model. The adjusted hazard ratio in the CACS ≥100 group for Kidney Disease: Improving Global Outcomes criteria (a drop in estimated glomerular filtration rate category accompanied by a 25% or greater drop in estimated glomerular filtration rate) was 2.52 (1.13–5.61). After propensity score matching, more prevalent renal outcomes (13.2%) were observed in patients with a CACS of ≥100 compared with those with a CACS of 0 (1.9%), with statistical significance ( P =0.004). Conclusions Our results showed that renal function declined more rapidly in patients with higher CACSs, suggesting that vascular calcification might be associated with chronic kidney disease progression.

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Hyperphosphatemia in chronic kidney disease

Medical Council ◽

10.21518/2079-701x-2019-16-78-85 ◽

2019 ◽

pp. 78-85

Author(s):

S. A. Martynov ◽

M. Sh. Shamkhalova

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Vascular Calcification ◽

Cardiovascular Events ◽

Cardiovascular Complications ◽

Phosphate Binding ◽

Renal Function Decline ◽

Increased Risk ◽

Binding Agents ◽

Key Factor

Hyperphosphatemia in renal pathology is a key factor for developing mineral and bone disorders. It can develop even in the early stages of renal function decline and predict the formation of vascular calcification and an increased risk for developing cardiovascular complications in patients with chronic kidney disease, especially in those, who receive program hemodialysis. The use of calcium-free phosphate-binding agents that are not associated with the risk for developing hypercalcemia can slow the development of vascular calcification, reduce the incidence of adverse cardiovascular events and mortality in patients with chronic kidney disease.

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