scholarly journals A propensity-score matched observational study of remdesivir in patients with COVID-19 and severe kidney disease

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0006152021
Author(s):  
Rituvanthikaa Seethapathy ◽  
Sophia Zhao ◽  
Joshua D. Long ◽  
Ian A. Strohbehn ◽  
Meghan E. Sise
Keyword(s):  
Kidney Disease ◽  
Propensity Score ◽  
Propensity Scores ◽  
Altered Mental Status ◽  
Control Group ◽  
Increased Risk ◽  
Kidney Replacement Therapy ◽  
Clinically Significant ◽  
End Stage ◽  
Matched Study

Background: Remdesivir is not currently approved for patients with estimated glomerular filtration rate (eGFR) < 30mL/min/1.73m2. We aimed to determine the safety of remdesivir in patients with kidney failure. Methods: Retrospective cohort study of patients with COVID-19 hospitalized between May 2020 to January 2021 with eGFR <30 mL/min/1.73m2 who received remdesivir and historical controls with COVID-19 hospitalized between March 1, 2020 - April 30, 2020 prior to Emergency Use Authorization of remdesivir within a large healthcare system. Patients were 1:1 matched by propensity scores accounting for factors associated with treatment assignment. Adverse events and hospital outcomes were recorded by manual chart review. Results: The overall cohort included 34 hospitalized patients who initiated remdesivir within 72 hours of hospital admission with eGFR <30 mL/min/1.73m2 and 217 COVID-19 controls with eGFR <30 mL/min/1.73m2. The propensity score-matched cohort included 31 remdesivir treated cases and 31 non-remdesivir-treated controls. The mean age was 74.0 (SD: 13.8), 56.6% female, 67.7% white. A total of 25.5% had end-stage kidney disease. Among patients who were not on dialysis prior to initiating remdesivir, one developed worsening kidney function (defined ≥ 50% increase in creatinine or initiation of kidney replacement therapy) compared to three in the historical control group. There was no increased risk of cardiac arrythmia, cardiac arrest, altered mental status, or clinically significant anemia or liver function test abnormalities. There was a significantly increased risk of hyperglycemia, which may be partly explained by the increased use of dexamethasone in the remdesivir-treated population. Conclusion: In this propensity-score matched study, remdesivir was well tolerated in patients with eGFR < 30 mL/min/1.73m2.

scholarly journals Association of Opium Consumption and Coronary Artery Ectasia: A Propensity Score-matched Study

2020 ◽  
Author(s):  
Mahan Shafie ◽  
Arya Aminorroaya ◽  
Ali Vasheghani-Farahani ◽  
Arash Jalali ◽  
Abdolvahab Baradaran
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Propensity Score ◽  
Control Group ◽  
Coronary Artery Ectasia ◽  
Increased Risk ◽  
Significant Difference ◽  
Artery Disease ◽  
Matched Study ◽  
Coronary Angiograms

Abstract Background: Opium consumption is associated with an increased risk of atherosclerosis and a hyper-inflammatory state that are suggested as contributing factors to the development of coronary artery ectasia (CAE). We aimed to determine if opium consumption is an independent risk factor of CAE. Methods: In this propensity score-matched study, we enrolled patients who underwent elective coronary angiography between September 2004 and March 2017 in Tehran Heart Center. We studied patients with CAE and without coronary artery disease as cases. The control group, patients with normal coronary angiograms, were selected after applying the propensity score matching to match for age, sex, diabetes mellitus, hypertension, hyperlipidemia, family history of coronary artery disease, and cigarette smoking.Results: We studied 242 patients with pure CAE and selected 968 control patients. The prevalence of opium consumption was not significantly different across these groups, 17 (7.5%) in the pure CAE group compared to 76 (8.6%) in the control group (Odds ratio: 0.81; p=0.455). Amongst the patients with pure CAE, Markis scores were not significantly different between opium consumers and non-consumers (p=0.136).Conclusions: We found no significant difference regarding opium consumption between patients with pure CAE and patients with normal coronary angiograms. In addition, there is no correlation between opium consumption and Markis scores in patients with pure CAE.

scholarly journals Cardiopulmonary exercise testing (CPET) in patients with end-stage kidney disease (ESKD): principles, methodology and clinical applications of the optimal tool for exercise tolerance evaluation

2021 ◽  
Author(s):  
Eva Pella ◽  
Afroditi Boutou ◽  
Aristi Boulmpou ◽  
Christodoulos E Papadopoulos ◽  
Aikaterini Papagianni ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Exercise Intolerance ◽  
End Stage Kidney Disease ◽  
Exercise Limitation ◽  
Cardiopulmonary Exercise ◽  
Functional Reserves ◽  
Increased Risk ◽  
End Stage

Abstract Chronic kidney disease (CKD), especially end-stage kidney disease (ESKD), is associated with increased risk for cardiovascular events and all-cause mortality. Exercise intolerance as well as reduced cardiovascular reserve are extremely common in patients with CKD. Cardiopulmonary exercise testing (CPET) is a non-invasive, dynamic technique that provides an integrative evaluation of cardiovascular, pulmonary, neuropsychological and metabolic function during maximal or submaximal exercise, allowing the evaluation of functional reserves of these systems. This assessment is based on the principle that system failure typically occurs when the system is under stress and, thus, CPET is currently considered to be the gold-standard for identifying exercise limitation and differentiating its causes. It has been widely used in several medical fields for risk stratification, clinical evaluation and other applications but its use in everyday practice for CKD patients is scarce. This article describes the basic principles and methodology of CPET and provides an overview of important studies that utilized CPET in patients with ESKD, in an effort to increase awareness of CPET capabilities among practicing nephrologists.

scholarly journals Protection of Residual Renal Function and Nutritional Treatment: First Step Strategy for Reduction of Uremic Toxins in End-Stage Kidney Disease Patients

Toxins ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 289
Author(s):  
Adamasco Cupisti ◽  
Piergiorgio Bolasco ◽  
Claudia D’Alessandro ◽  
Domenico Giannese ◽  
Alice Sabatino ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Residual Renal Function ◽  
The Body ◽  
Uremic Toxins ◽  
End Stage Kidney Disease ◽  
Waste Products ◽  
Hemodialysis Treatment ◽  
Life Saving ◽  
Kidney Replacement Therapy ◽  
End Stage

The retention of uremic toxins and their pathological effects occurs in the advanced phases of chronic kidney disease (CKD), mainly in stage 5, when the implementation of conventional thrice-weekly hemodialysis is the prevalent and life-saving treatment. However, the start of hemodialysis is associated with both an acceleration of the loss of residual kidney function (RKF) and the shift to an increased intake of proteins, which are precursors of uremic toxins. In this phase, hemodialysis treatment is the only way to remove toxins from the body, but it can be largely inefficient in the case of high molecular weight and/or protein-bound molecules. Instead, even very low levels of RKF are crucial for uremic toxins excretion, which in most cases are protein-derived waste products generated by the intestinal microbiota. Protection of RKF can be obtained even in patients with end-stage kidney disease (ESKD) by a gradual and soft shift to kidney replacement therapy (KRT), for example by combining a once-a-week hemodialysis program with a low or very low-protein diet on the extra-dialysis days. This approach could represent a tailored strategy aimed at limiting the retention of both inorganic and organic toxins. In this paper, we discuss the combination of upstream (i.e., reduced production) and downstream (i.e., increased removal) strategies to reduce the concentration of uremic toxins in patients with ESKD during the transition phase from pure conservative management to full hemodialysis treatment.

Abstract 145: Rates of Transfusion and Progression to End-Stage Renal Disease in Chronic Kidney Disease Patients Undergoing Transradial Versus Transfemoral Cardiac Catheterization - An Analysis from the VA CART Program

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Amit N Vora ◽  
Maggie A Stanislawski ◽  
John S Rumsfeld ◽  
Thomas M Maddox ◽  
Mladen Vidovich ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cardiac Catheterization ◽  
High Risk Population ◽  
Post Procedure ◽  
Increased Risk ◽  
Significant Difference ◽  
Independent Association ◽  
Stage Renal Disease ◽  
End Stage

Background: Patients with chronic kidney disease (CKD) are at increased risk of bleeding and transfusion after cardiac catheterization. Whether rates of these complications or progression to new dialysis are increased in this high-risk population undergoing transradial (TR) access compared to transfemoral (TF) access is unknown. Methods: From the Veterans Affairs Clinical Assessment, Reporting, and Tracking (CART) Program between 10/2007-09/2012 we identified 40,160 CKD patients undergoing cardiac catheterization with baseline glomerular filtration rate (GFR) ≤ 60 ml/min. We used multivariable Cox modeling to determine the independent association between TR access and post-procedure transfusion as well as progression to new dialysis using TF as the reference. Results: Overall, 3,828 (9.5%) of CKD patients underwent TR access and tended to be slightly younger but overall had similar rates of CKD severity compared with TF patients (GFR 45-60 ml/min: 77.0% vs. 77.0%; GFR 30-44 ml/min: 19.7% vs. 19.3%; GFR 15-29 ml/min: 3.3% vs. 3.7%, p=0.35). TR patients had longer fluoroscopy times (8.1 vs 6.9 minutes, p=<0.0001) but decreased contrast use (90.0 vs 100.0 ml, p=<0.0001). Among the 31,692 patients with a full year of follow-up, 42 (1.7%) of TR patients and 545 (1.9%) of TF patients progressed to new dialysis within 1 year (p=0.64). However, only 33 (0.9%) of TR patients compared with 570 TF patients (1.6%) needed post-procedure blood transfusion (p=0.0006). After multivariable adjustment, there was no significant difference in progression to ESRD between TR and TF patients but TR was associated with a significant decrease in transfusion (Figure). Conclusion: Among CKD patients undergoing cardiac catheterization in the VA health system, TR access is associated with a decreased risk for post-procedure transfusion compared with TF access. There was no significant difference between the two approaches with respect to progression to ESRD. These data suggest that TR is a reasonable option for patients with any level of CKD undergoing cardiac catheterization.

Abstract 14301: Effects of Septal Reduction Therapy on Acute Cardiovascular Events and All-cause Mortality in Patients With Obstructive Hypertrophic Cardiomyopathy: Propensity Score-matched Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sae Morita ◽  
Yanling Zhao ◽  
Kohei Hasegawa ◽  
Muredach P Reilly ◽  
Mathew S Maurer ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Propensity Score ◽  
New York State ◽  
Control Group ◽  
Short Term ◽  
Alcohol Septal Ablation ◽  
Septal Myectomy ◽  
All Cause Mortality ◽  
Obstructive Hypertrophic Cardiomyopathy ◽  
Matched Study

Introduction: Septal reduction therapy (SRT) - i.e., septal myectomy and alcohol septal ablation - has been used to treat medically-refractory obstructive hypertrophic cardiomyopathy (HOCM) for a few decades. However, the effects of SRT on the risk of acute cardiovascular (CV) events and all-cause mortality are largely unknown. Hypothesis: SRT is associated with a long-term decrease in acute CV events and a short-term increase in all-cause mortality in patients with HOCM. Methods: We performed a propensity score (PS)-matched study using all-payer databases that capture all hospitalizations and outpatient visits in New York State. We identified patients with HOCM who underwent SRT between January 1, 2007 and December 31, 2014 (i.e., the SRT group) and those who have never had SRT but had at least one hospitalization for HOCM during the same period (i.e., the control group). We performed 1:1 PS matching using age, sex, race/ethnicity, source of payment, season and year of starting event follow-up (i.e., the day of SRT or the index hospitalization), and Elixhauser comorbidity measures. The primary outcomes were (1) acute CV event (i.e., emergency department visit or unplanned hospitalization for CV disease) during 1-360 days and 361-720 days and (2) 7-, 15-, 30-, 180-, and 360-day all-cause mortality. We compared the risk of the outcome event using logistic regression models. Results: The analytic cohort consisted of 690 patients with HOCM (i.e., 345 PS-matched pairs). The SRT group had a lower risk of acute CV event during 361-720 days (OR 0.44; 95% CI, 0.20-0.97; P=0.04) but a higher risk of 7-day mortality (11 vs. 2 in the control group; P=0.03). The SRT group had a non-significant trend towards lower all-cause mortality in longer terms ( Figure ). Conclusion: In this population-based PS-matched study of patients with HOCM, SRT was associated with a reduced risk of acute CV events in the second post-procedure year at the sacrifice of a short-term increase in all-cause mortality.

scholarly journals Pregnancy Outcome Following Gestational Exposure to Fluoroquinolones: a Multicenter Prospective Controlled Study

1998 ◽  
Vol 42 (6) ◽  
pp. 1336-1339 ◽  
Author(s):  
Ronen Loebstein ◽  
Antonio Addis ◽  
Elaine Ho ◽  
Roseann Andreou ◽  
Suzanne Sage ◽  
...  
Keyword(s):  
Relative Risk ◽  
Confidence Interval ◽  
Pregnancy Outcome ◽  
Bacterial Resistance ◽  
Antimicrobial Agents ◽  
In Utero ◽  
Controlled Study ◽  
Control Group ◽  
Increased Risk ◽  
Clinically Significant

ABSTRACT Concerns regarding the teratogenicity of fluoroquinolones have resulted in their restricted use during gestation. This is despite an increasing need for their use due to emerging bacterial resistance. The objectives of the present investigation were to evaluate pregnancy and fetal outcomes following maternal exposure to fluoroquinolones and to examine whether in utero exposure to quinolones is associated with clinically significant musculoskeletal dysfunctions. We prospectively enrolled and followed up 200 women exposed to fluoroquinolones (norfloxacin, ciprofloxacin, ofloxacin) during gestation. Pregnancy outcome was compared with that for 200 controls matched for age and for smoking and alcohol consumption habits. Controls were exposed to nonteratogenic, nonembryotoxic antimicrobial agents matched by indication, duration of therapy (±3 days), and trimester of exposure. Rates of major congenital malformations did not differ between the group exposed to quinolones in the first trimester (2.2%) and the control group (2.6%) (relative risk, 0.85; 95% confidence interval, 0.21 to 3.49). Women treated with quinolones had a tendency for an increased rate of therapeutic abortions compared with the rate among women exposed to nonteratogens (relative risk, 4.50; 95% confidence interval, 0.98 to 20.57), resulting in lower live-birth rates (86 versus 94%; P = 0.02). The rates of spontaneous abortions, fetal distress, and prematurity and the birth weight did not differ between the groups. Gross motor developmental milestone achievements did not differ between the children of the mothers in the two groups. We concluded that the use of fluoroquinolones during embryogenesis is not associated with an increased risk of major malformations. There were no clinically significant musculoskeletal dysfunctions in children exposed to fluoroquinolones in utero. The higher rate of therapeutic abortions observed in quinolone-exposed women compared to that for their controls may be secondary to the misperception of a major risk related to quinolone use during pregnancy.

Abstract P374: Associations Of Renin-angiotensin System Blockade Discontinuation With End-stage Kidney Disease, Major Adverse Cardiovascular Events, And Death Among People With Chronic Kidney Disease

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Yao Qiao ◽  
Jung-im Shin ◽  
Teresa Chen ◽  
Lesley Inker ◽  
Josef Coresh ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Propensity Score ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
Matched Sample ◽  
End Stage Kidney Disease ◽  
Converting Enzyme Inhibitors ◽  
Significant Difference ◽  
End Stage ◽  
Egfr Decline

Introduction: Among individuals with impaired kidney function, whether and when angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin II receptor blockers (ARB) should be discontinued is unclear. We investigated the associations of ACE-I/ARB discontinuation with end-stage kidney disease (ESKD), major adverse cardiovascular events (MACE), and mortality in individuals who had an eGFR decline to below 30 ml/min/1.73m 2 . Hypothesis: Patients with ACE-I/ARB discontinuation after an eGFR decline to below 30 ml/min/1.73m 2 are at higher risks of ESKD, MACE, and mortality. Methods: Using electronic health records data from the Geisinger Health System, we identified individuals who initiated ACE-I/ARB between 01/01/2004 and 02/28/2019 and had an eGFR decline to below 30 ml/min/1.73m 2 . We classified patients based on whether they discontinued ACE-I/ARB within six months following the eGFR decline. We assessed the associations of ACE-I/ARB discontinuation with ESKD, MACE, and mortality over the subsequent five years in a propensity-score matched sample. Results: Among the 3879 patients who met eligibility criteria, 1219 discontinued ACE-I/ARB within six months after eGFR decline to below 30 ml/min/1.73m 2 . The propensity-score matched sample contained 1190 patients under each arm. ACE-I/ARB discontinuation was associated with higher risks of mortality (hazard ratio (HR): 1.45 [95% confidence interval (CI): 1.26-1.67]) and MACE (HR: 1.37 [95% CI: 1.20-1.57]), but no significant difference in risk of ESKD (HR: 1.31 [95% CI: 0.95-1.81]). Similar patterns held when evaluating ACE-I/ARB discontinuation following a 40% or greater decline in eGFR within a year. Conclusions: Our findings suggest there may be benefits of continued use of ACE-I/ARB in individuals who had an eGFR decline to below 30 ml/min/1.73m 2 .

scholarly journals Recovery of kidney function in patients treated with maintenance dialysis—a report from the ERA-EDTA registry

2020 ◽  
Author(s):  
Lily Jakulj ◽  
Anneke Kramer ◽  
Anders Åsberg ◽  
Johan de Meester ◽  
Carmen Santiuste de Pablos ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Kidney Function ◽  
Cox Regression ◽  
Kidney Diseases ◽  
Early Event ◽  
Tubular Necrosis ◽  
Kidney Replacement Therapy ◽  
Maintenance Dialysis ◽  
One Year ◽  
End Stage

Abstract Background Literature on recovery of kidney function (RKF) in patients with end-stage kidney disease treated with maintenance dialysis (i.e. over 90 days) is limited. We assessed the incidence of RKF and its associated characteristics in a European cohort of dialysis patients. Methods We included adult patients from the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry who started maintenance dialysis in 1997-2016. Sustained RKF was defined as permanent discontinuation of dialysis. Temporary discontinuation of ≥ 30 days (non-sustained RKF) was also evaluated. Factors associated with RKF adjusted for potential confounders were studied using Cox-regression analyses. Results RKF occurred in 7,657 (1.8%) of 440,996 patients of whom 71% experienced sustained RKF. Approximately 90% of all recoveries occurred within the first two years after day 91 of dialysis. Of patients with non-sustained RKF, 39% restarted kidney replacement therapy within one year. Sustained RKF was strongly associated with the following underlying kidney diseases (as registered by the treating physician): tubular necrosis (irreversible) or cortical necrosis (adjusted Hazard Ratio [aHR]: 20.4, 95%CI: 17.9-23.1), systemic sclerosis (aHR: 18.5, 95%CI: 13.8-24.7) and hemolytic uremic syndrome (aHR: 17.3, 95%CI: 13.9-21.6). Weaker associations were found for hemodialysis as first dialysis-modality (aHR: 1.5, 95%CI: 1.4-1.6) and dialysis initiation at an older age (aHR: 1.8, 95%CI: 1.6-2.0) or in a more recent time-period (aHR: 2.4, 95%CI: 2.1-2.7). Conclusions Definitive discontinuation of maintenance dialysis is a rare and not necessarily an early event. Certain clinical characteristics, but mostly the type of underlying kidney disease, are associated with a higher likelihood of RKF.

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