A CONTINUED STUDY TO DERTERMINE THE ASSOCIATION BETWEEN CHRONIC KIDNEY DISEASE AND NON-ALCOHALIC FATTY LIVER DISEASE AND ITS EFFECT ON eGFR

2021 ◽  
pp. 133-136
Author(s):  
Arvind Gupta ◽  
Poonam Gupta ◽  
Anubha Srivastava ◽  
Amit Kumar Panday
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Physical Examination ◽  
Sample Size ◽  
Care Center ◽  
Tertiary Care ◽  
Ckd Stage ◽  
High Prevalence ◽  
Larger Sample

Background: The present study was conduct in Motilal Nehru Medical College, Swaroop Rani Nehru Hospital Prayagraj, a tertiary care center and data was collected over a period from January 2019 to April 2020. All 78 patients of CKD attending OPD & IPD of General Medicine and Nephrology, diagnosed by suggestive symptoms and conrmed by physical examination and laboratory investigations were taken , Among the subjects, those having NAFLD were grouped as cases. Patients of Chronic Kidney disease not having NAFLD were grouped as controls. Aim & Objective: To study the prevalence of NAFLD in patients of CKD and establish the association between NAFLD and CKD by studying the effect of NAFLD on eGFR. Methodology: This was a 16 month case control study. Total 78 patients with age 18-65 years , Either sex with Chronic kidney disease diagnosed by USG, KFT, physical examination and having NAFLD Patients with known diagnosis of metabolic syndrome, diabetes and/or hypothyroidism. Those on hepatotoxic medication (amiodarone, barbiturates, glucocorticoids, etc.). The data so collected was entered into computer using Microsoft Excel 2013 software and was subjected to statistical analysis. Result : The ndings of present study thus reafrm the observations of previous studies that highlight a high prevalence of NAFLD in CKD patients and link it to the deranged metabolic factors. In present study we could not found a convincing evidence supporting a relationship between NAFLD and its severity with progression of CKD, probably owing to three major factors – rst, owing to Discussion 71 limitation of study population in only CKD stage 3 and secondly, owing to absence of retrospective data tracing the time of development of NAFLD in these patients and thirdly, inability to carry out long-time follow-up of patients. In present study, though minor changes in eGFR values in patients were seen, however, during the limited period of follow-up no shift from Stage 3 to other stages of CKD was observed. All the patients were regular in follow-up and had a good medical compliance and in general did not show a phenomenal deterioration in renal function within the short span of study. Keeping in view these limitations, further studies are recommended on a larger sample size with inclusion of patients from different stages of CKD spanning over a longer duration of follow-up to see whether NAFLD presence and its severity has a relationship with long-term progression of CKD. Conclusion: The present study showed that, CKD patients had a high prevalence of NAFLD. The ndings also show that FIB-4 scores are useful noninvasive methods for detection of NAFLD in CKD patients. The ndings showed a possible signicant association between NAFLD and lower eGFR rates. One of the limitations of the present study was presence of only Stage 3 CKD patients, owing to which the linear correlations between eGFR and NAFLD severity could not be assessed properly. Further studies on larger sample size with inclusion of patients with other CKD stages too are recommended.

scholarly journals Chronic kidney disease progression among patients with type 2 diabetes identified in US administrative claims: a population cohort study

2020 ◽  
Author(s):  
Csaba P Kovesdy ◽  
Danielle Isaman ◽  
Natalia Petruski-Ivleva ◽  
Linda Fried ◽  
Michael Blankenburg ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Disease Progression ◽  
Administrative Claims ◽  
Short Period ◽  
Ckd Stage

Abstract Background Chronic kidney disease (CKD), one of the most common complications of type 2 diabetes (T2D), is associated with poor health outcomes and high healthcare expenditures. As the CKD population increases, a better understanding of the prevalence and progression of CKD is critical. However, few contemporary studies have explored the progression of CKD relative to its onset in T2D patients using established markers derived from real-world care settings. Methods This retrospective, population-based cohort study assessed CKD progression among adults with T2D and with newly recognized CKD identified from US administrative claims data between 1 January 2008 and 30 September 2018. Included were patients with T2D and laboratory evidence of CKD as indicated by the established estimated glomerular filtration rate (eGFR) and urine albumin:creatinine ratio (UACR) criteria. Disease progression was described as transitions across the eGFR- and UACR-based stages. Results A total of 65 731 and 23 035 patients with T2D contributed to the analysis of eGFR- and UACR-based CKD stage progression, respectively. CKD worsening was observed in approximately 10–17% of patients over a median follow-up of 2 years. Approximately one-third of patients experienced an increase in eGFR values or a decrease in UACR values during follow-up. Conclusions A relatively high proportion of patients were observed with disease progression over a short period of time, highlighting the need for better identification of patients at risk of rapidly progressive CKD. Future studies are needed to determine the clinical characteristics of these patients to inform earlier diagnostic and therapeutic interventions aimed at slowing disease progression.

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

Nutrients ◽  
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.

MO515CONSTIPATION IN CHRONIC KIDNEY DISEASE: PREVALENCE AND RISK FACTORS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Sourabh Sharma ◽  
Neha Sharma ◽  
Kailash Sharma
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Tertiary Care ◽  
Functional Constipation ◽  
Common Symptom ◽  
Psychological Burden ◽  
Ckd Stage ◽  
Stool Form ◽  
Rome Iv

Abstract Background and Aims Among various gastrointestinal disorders, constipation is one of the most common symptom in chronic kidney disease (CKD). However it is often neglected by nephrologists as self-limiting condition. Constipation impacts quality of life in multiple ways and increases socio-psychological burden. Constipation and associated risk factors have been poorly studied and most studies are retrospective. Method We enrolled CKD stage 3 to 5 patients on regular follow-up with nephrologist from June 2018 to June 2020, at a tertiary care centre in North India. Constipation was defined using Rome IV criteria (Functional constipation) which is composed of six constipation related symptoms, and diagnosis of constipation is established by presence of two or more symptoms for at least 3 months. Patients were also asked to maintain a 7 day prospective stool diary. It consisted of seven day written prospective chart of stool form and frequency. Patients were instructed to record when each bowel movement happened and to mark stool form type for each movement as described in words and pictures on Bristol Stool Form Scale (BSFS). Opioid induced constipation was defined as per Rome IV criteria. The diagnostic criteria is similar to functional constipation, but with requisite that new or worsening symptoms occurred when initiating, changing or increasing opioid therapy. Results Two hundred twenty five patients were studied out of which 59 (26.2%) patients were in CKD stage3, eighty one (36%) patients were in CKD stage4 and 85 (37.8%) patients were in stage5. Out of 85 CKD stage5 patients, 23 (27%) were on dialysis. Mean age of patients was 49.1 years. Out of 225 patients, 135 (60%) were male. Constipation symptoms and diagnosis reported in each stage has been depicted in Table 1. Clinical correlates of constipation has been depicted in Table 2. Conclusion Constipation measured using Rome IV criteria affects around two-third of CKD stage 3-5 patients. Diabetes, hypertension and opioid use has been found to be significantly associated with constipation.

scholarly journals Interatrial block, P terminal force or fragmented QRS do not predict new-onset atrial fibrillation in patients with severe chronic kidney disease

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Tapio Hellman ◽  
Markus Hakamäki ◽  
Roosa Lankinen ◽  
Niina Koivuviita ◽  
Jussi Pärkkä ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
P Wave ◽  
Stage 4 ◽  
Ckd Stage ◽  
Severe Chronic Kidney Disease ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Background The prevalence of left atrial enlargement (LAE) and fragmented QRS (fQRS) diagnosed using ECG criteria in patients with severe chronic kidney disease (CKD) is unknown. Furthermore, there is limited data on predicting new-onset atrial fibrillation (AF) with LAE or fQRS in this patient group. Methods We enrolled 165 consecutive non-dialysis patients with CKD stage 4–5 without prior AF diagnosis between 2013 and 2017 in a prospective follow-up cohort study. LAE was defined as total P-wave duration ≥120 ms in lead II ± > 1 biphasic P-waves in leads II, III or aVF; or duration of terminal negative portion of P-wave > 40 ms or depth of terminal negative portion of P-wave > 1 mm in lead V1 from a baseline ECG, respectively. fQRS was defined as the presence of a notched R or S wave or the presence of ≥1 additional R waves (R’) or; in the presence of a wide QRS complex (> 120 ms), > 2 notches in R or S waves in two contiguous leads corresponding to a myocardial region, respectively. Results Mean age of the patients was 59 (SD 14) years, 56/165 (33.9%) were female and the mean estimated glomerular filtration rate was 12.8 ml/min/1.73m2. Altogether 29/165 (17.6%) patients were observed with new-onset AF within median follow-up of 3 [IQR 3, range 2–6] years. At baseline, 137/165 (83.0%) and 144/165 (87.3%) patients were observed with LAE and fQRS, respectively. Furthermore, LAE and fQRS co-existed in 121/165 (73.3%) patients. Neither findings were associated with the risk of new-onset AF within follow-up. Conclusion The prevalence of LAE and fQRS at baseline in this study on CKD stage 4–5 patients not on dialysis was very high. However, LAE or fQRS failed to predict occurrence of new-onset AF in these patients.

scholarly journals Chronic kidney disease in children: A report from a tertiary care center over 11 years.

2012 ◽  
Vol 1 (3) ◽  
pp. 177-182 ◽  
Author(s):  
Alaleh Gheissari ◽  
Saeedeh Hemmatzadeh ◽  
Alireza Merrikhi ◽  
Sharareh Fadaei Tehrani ◽  
Yahya Madihi
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center

scholarly journals CLINICAL PROFILE OF MINERAL BONE DISORDERS (RENAL OSTEODYSTROPHY) IN CHRONIC KIDNEY DISEASE PATIENTS

2021 ◽  
pp. 107-110
Author(s):  
ASHISH KHATTAR ◽  
KARTHIK RAO N ◽  
RAVINDRA PRABHU ◽  
BUDDHI RAJ POKHREL ◽  
SHANTI GURUNG ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Radial Artery ◽  
Renal Osteodystrophy ◽  
Clinical Profile ◽  
Biochemical Tests ◽  
Bone Disorders ◽  
Ckd Stage ◽  
High Prevalence ◽  
The Mean

Objective: The objective of the study was to evaluate the clinical profile of mineral bone disorders (renal osteodystrophy) in chronic kidney disease (CKD) patients. Methods: A retrospective study was performed involving 100 patients above 15 years of age with previously diagnosed chronic renal failure. A series of tests such as biochemical, radiological, and arterial calcifications were monitored. The mean age of subjects in our study was 52.54 years. Results: Biochemical tests revealed that hypocalcemia was present in 54% of the patients, and hyperphosphatemia was seen in 84% of the participants, while only 22% of the participants had high alkaline phosphate (ALP) levels. Radiological tests revealed that 39 patients had aortic calcification, 42 patients had radial artery calcification, and 27 patients had both. Subperiosteal resorption was seen on 29 participants. The majority of the vascular calcification and subperiosteal resorption was seen in patients with CKD Stage 5, and both aortic and radial artery calcifications were significantly associated with subperiosteal bone resorption. Conclusion: The results point toward a high prevalence of derangement in the mineral, vascular and valvular calcifications. Serum total ALP can serve as a biochemical marker to identify a pattern of bone turnover where intact parathyroid hormone is not available. The results highlight that serum phosphorus and Ca × P product levels were significantly associated with both aortic and radial artery calcifications. There was no significant association of these calcifications with serum calcium and ALP levels.

scholarly journals Chronic Kidney Disease, Hypertension and Cardiovascular Sequelae during Long Term Follow up of Adults with Atypical Hemolytic Uremic Syndrome

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3754-3754 ◽  
Author(s):  
Shruti Chaturvedi ◽  
Alison R. Moliterno ◽  
Samuel A. Merrill ◽  
Evan M Braunstein ◽  
Xuan Yuan ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Atypical Hemolytic Uremic Syndrome ◽  
Left Ventricular ◽  
Myocardial Infarctions ◽  
Ckd Stage ◽  
Uremic Syndrome ◽  
St Elevation

Abstract INTRODUCTION: Atypical hemolytic uremic syndrome (aHUS) is a complement mediated thrombotic microangiopathy that predominantly affects the kidneys although extra-renal manifestations are common. In the pre-eculizumab era, 40-65% of patients either died or had end stage renal disease (ESRD) at 1 year. Long-term renal and cardiovascular outcomes are less well described in the eculizumab era. We conducted this cohort study to describe the renal and cardiovascular outcomes of adult survivors of aHUS, both on and off continued eculizumab therapy. METHODS: Patients with aHUS were identified from the prospective Complement Associated Disease Registry and through the Center for Clinical Data Analysis at Johns Hopkins University. Demographic and clinical data were abstracted, including details of aHUS diagnosis, laboratory studies, treatment, and outcomes including renal function, hypertension and echocardiographic studies. The prevalence of hypertension was compared between patients with and without chronic kidney disease (CKD) using the chi squared test. RESULTS: 45 individuals with aHUS were followed at Johns Hopkins Hospital with a median [interquartile range (IQR)] time since diagnosis of 37.4 [IQR 20.7, 62.6] months. Median age at diagnosis was 32.5 [IQR 23.2, 49.2] years and 71.1% were female. Acute kidney injury was present in 98% (44/45); however, neurologic (64.4%), gastrointestinal (68.8%), and cardiovascular (55.5%) involvement was also common (Table 1). Hypertensive urgency or emergency was present in 40% (18/45), while 13.3% (6/45) had an acute coronary syndrome during the acute episode (2 ST elevation myocardial infarctions and 4 non-ST elevation myocardial infarctions). Complement gene sequencing was completed for 34 patients, of which 8 had variants in CFH, one in CFH and CD46, 5 in other genes (MCP1, CFHR1 homozygous deletion, DGKE, THBD, and THBD with del(CFH-SCR20-CFHR1-int5)]and 20 patients had no pathogenic variants. Thirty-two (71.1%) patients were treated initially with plasma exchange (median 6 [3, 12] exchanges). Thirty-nine (86.7%) received eculizumab (5 started at the time of renal transplant after developing ESRD), and 20 of these (51%) have since discontinued therapy. Median duration of eculizumab therapy was 2.7 [0.9-11.3] months for those who stopped therapy and 29.5 [8.8-55] months for those who continued. One patient died due to a myocardial infarction during the aHUS episode. Of the 44 survivors, 15 (34.1%) had complete renal recovery, 9 (20.5%) had chronic kidney disease (CKD) stage 1-4, and 20 (45.5%) developed CKD stage 5 requiring dialysis at 3 months after the acute episode. Fifteen patients underwent subsequent renal transplantation. At the end of follow up, 23 (52.2%) had CKD [2.2% stage 2, 15.6% stage 3, 4.4% stage 4 and 28.9% stage 5) (Figure 1A). Although not statistically significant, there was a higher rate of CKD (63.1% versus 52.6%, P=0.511) among those not on eculizumab; however, this primarily reflects eculizumab being stopped after ESRD. Hypertension was present in 35 (79.5%) survivors (Figure 1B), of which 14 (40%) had incident hypertension. The prevalence of hypertension was not significantly different between patients with CKD and normal renal function (87% versus 71.4%, P=0.202). Thirty-one (70.4%) were on antihypertensive therapy, and 67% (21 of 31) of these were not controlled to <140/90 mmHg despite the use of multiple agents (Figure 1C). Echocardiograms were performed in 29 (64.4%) individuals (12 within 3 months of diagnosis, and 17 after 3 months). Of these 17, 29.4% were normal studies, 23.5% had reduced left ventricular ejection fraction, 29.4% demonstrated left ventricular hypertrophy or diastolic dysfunction, and 11.7% had pulmonary hypertension. CONCLUSION: Malignant hypertension and cardiac involvement are common during acute aHUS. aHUS survivors also have a high prevalence of hypertension, including a notable incidence of new onset as well as uncontrolled hypertension following aHUS diagnosis. CKD is present in the majority of survivors, and structural cardiopulmonary disease is common. Complement activation has been implicated in the pathogenesis of cardiovascular disease. Further investigation is needed to evaluate the epidemiology of cardiovascular sequelae in aHUS, their associations with specific complement mutations, and optimal management. Disclosures No relevant conflicts of interest to declare.

scholarly journals Dental health assessed using panoramic radiograph and adverse events in chronic kidney disease stage 4–5 patients transitioning to dialysis and transplantation–A prospective cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0258055
Author(s):  
Mikko J. Järvisalo ◽  
Viljami Jokihaka ◽  
Markus Hakamäki ◽  
Roosa Lankinen ◽  
Heidi Helin ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Oral Health ◽  
Kidney Disease ◽  
Dental Health ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Stage 4 ◽  
Ckd Stage ◽  
Maintenance Dialysis

Background and aims Oral health could potentially be a modifiable risk factor for adverse outcomes in chronic kidney disease (CKD) patients transitioning from predialysis treatment to maintenance dialysis and transplantation. We aimed to study the association between an index of radiographically assessed oral health, Panoramic Tomographic Index (PTI), and cardiovascular and all-cause mortality, major adverse cardiovascular events (MACEs) and episodes of bacteremia and laboratory measurements during a three-year prospective follow-up in CKD stage 4–5 patients not on maintenance dialysis at baseline. Methods Altogether 190 CKD stage 4–5 patients without maintenance dialysis attended panoramic dental radiographs in the beginning of the study. The patients were followed up for three years or until death. MACEs and episodes of bacteremia were recorded during follow-up. Laboratory sampling for C-reactive protein and leukocytes was repeated tri-monthly. Results PTI was not associated with baseline laboratory parameters or C-reactive protein or leukocytes examined as repeated measures through the 3-year follow-up. During follow-up, 22 patients had at least one episode of bacteremia, but only 2 of the bacteremias were considered to be of oral origin. PTI was not associated with incident bacteremia during follow-up. Thirty-six patients died during follow-up including 17 patients due to cardiovascular causes. During follow-up 42 patients were observed with a MACE. PTI was independently associated with all-cause (HR 1.074 95% CI 1.029–1.122, p = 0.001) and cardiovascular (HR 1.105, 95% CI 1.057–1.157, p<0.0001) mortality, as well as, incident MACEs (HR 1.071 95% CI 1.031–1.113, p = 0.0004) in the multivariable Cox models adjusted for age and kidney transplantation or CKD treatment modality during follow-up. Conclusions Radiographically assessed dental health is independently associated with all-cause and cardiovascular mortality and MACEs but not with the incidence of bacteremia in CKD stage 4–5 patients transitioning to maintenance dialysis and renal transplantation during follow-up.

Sign in / Sign up

Export Citation Format

Share Document