Pediatric problems of stratification of the severity of  stages, cardiovascular complications and renal forecast  of chronic kidney disease by NKF-K / DOQI (2002) and  KDIGO (2012) classifications

Chronic kidney disease (CKD) in children is a global problem worldwide. The article discusses the problem of stratification of CKD severity according to the classifications of the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (NKF-K / DOQI) (2002) and Kidney Disease Improving Global Outcomes (KDIGO) (2012) in pediatric patients. There are limitations in assessing severity of CKD stages C1-5 according to NKF-K / DOQI (2002) and KDIGO (2012) in children under 2 years of age who have a low glomerular filtration rate in contrast to adults. The stratification of the severity of stages 1-5 of CKD, cardiovascular complications and renal prognosis in children and adolescents according to the classifications NKF-K / DOQI (2002) [3] and KDIGO (2012) [14] are discussed. In adult patients with CKD, there is a compelling case for identifying of C3a and C3b sub stages in 3 stages of CKD according to KDIGO (2012) was that renal and cardiovascular prognosis are different with GFR 45-59 ml/min/1.73 m 2and GFR 30-44 ml/min/1.73 m 2 . The prognosis of the risk of developing cardiovascular diseases and complications for stages C2-5 in accordance with the KDIGO classification (2012) in children and adults differ. As follows from the publications, children with CKD in the pre-dialysis stages C2-4 form a high-risk group, with C4-5 on dialysis a group of very high risk of complications associated with cardiovascular pathology. Cardiovascular complications account for more than 30 % of all deaths of pediatric patients with CKD C4-5 on dialysis. The arguments justifying the allocation of CKD stages C1-5 in children under 2 years of age in accordance with the classification of NKF-K/DOQI (2002) are presented.

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Classification of patients at risk for chronic kidney disease by use of eGFR and albuminuria

Биомедицинска истраживања ◽

10.7251/bii1501028s ◽

2015 ◽

Vol 9 (1) ◽

Author(s):

Jelena Seferović ◽

Višnja Ležaić

Keyword(s):

Chronic Kidney Disease ◽

At Risk ◽

High Risk ◽

Kidney Disease ◽

Blood Pressure Measurement ◽

Staging System ◽

The Elderly ◽

High Risk Group ◽

Hypertensive Patients

Introduction. Screening for chronic kidney disease (CKD) has been advisedin high-risk populations. However, data on the prevalence of early asymptomaticstages vary and depend on the definition of CKD. In the present studysubjects at risk for CKD (patients with diabetes mellitus type 2-DM2, withhypertension and older than 60 years without diabetes and hypertension)were classified in categories defined by eGFR and albuminuria staging system.Methods. After regular check-up in primary health center, 285 consecutivepatients at risk for CKD, were selected: 75 patients with well-controlled DM2without hypertension, 130 with hypertension and 80 subjects older than 60years without diabetes or hypertension. Screening included a questionnaire,blood pressure measurement, single albuminuria determined by immunonephelometry,and eGFR estimation using MDRD.Results. Six DM2 patients, 15 withe hyprtension and 12 elderly had eGFR<60(assessed in ml/min/1.73m2) with optimal albuminuria. High albuminuriawas observed in one DM2 and four hypertensive patients, and 28 elderly.When eGFR and albuminuria staging system for predicting risk for majorCKD outcomes was used, 41.2% of the elderly were classified in the moderateand 8.8% in the high risk group, for DM2 patients these percentages were9.3% and 0%, and for hypertensive patients 16.9% and 4.7%, respectively.Conclusion. The majority of examined patients did not have CKD, and in allthree groups most individuals with reduced eGFR did not have albuminuria>30mg/g. Using the classification of CKD based on eGFR and albuminuria,

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The Effect of Admission Renal Function on the Treatment and Outcome of Patients with Acute Coronary Syndrome

Cardiorenal Medicine ◽

10.1159/000455239 ◽

2017 ◽

Vol 7 (3) ◽

pp. 169-178 ◽

Cited By ~ 4

Author(s):

Zach Rozenbaum ◽

Sydney Benchetrit ◽

Saar Minha ◽

Yoram Neuman ◽

Meital Shlezinger ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Acute Coronary Syndrome ◽

Renal Function ◽

High Risk ◽

Kidney Disease ◽

Angiotensin Receptor Blockers ◽

High Risk Group ◽

Inverse Association ◽

Invasive Treatment ◽

Coronary Syndrome

Background: Chronic kidney disease is a frequent comorbidity among patients with acute coronary syndrome (ACS). We aimed to evaluate treatment characteristics in ACS patients according to their renal function and to assess the effect of differences in therapy on clinical outcomes. Methods: Included were patients with ACS enrolled in the biennial Acute Coronary Syndrome Israeli Surveys (ACSIS) during 2000-2013. Excluded were patients with cardiogenic shock at presentation. The estimated glomerular filtration rate (eGFR) was calculated using the simplified Modification of Diet in Renal Disease (MDRD) formula. The distribution of the eGFRs was divided into 4 categories (<45, 45-59.9, 60-74.9, and ≥75 mL/min/1.73 m2). The primary endpoint was all-cause mortality at 1 year. Results: A total of 13,194 patients with ACS were included. Patients with a reduced eGFR were less likely to be admitted to a coronary care unit and had lower rates of coronary angiograms and subsequent percutaneous coronary interventions. Furthermore, as the eGFR was lower, the patients were less frequently treated with aspirin, clopidogrel, β-blockers, and ACE inhibitors/angiotensin receptor blockers. We demonstrated an inverse association between renal function and 1-year mortality, with the highest mortality rates observed in the group with the lowest eGFR (HR = 3.8, 95% CI 2.9-4.9, p < 0.0001). Differences in mortality remained significant following a multivariate analysis for all the baseline characteristics as well as for invasive and medical treatment (HR = 2.7, 95% CI 1.9-3.7, p < 0.0001). Conclusions: ACS patients with chronic kidney disease represent a high-risk group with an increased mortality risk. Despite this high risk, these patients are less frequently selected for an invasive treatment strategy and are less commonly treated with guideline-based medications. However, reduced renal function was associated with higher mortality regardless of the variations in therapy.

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The Relationship between Health-Promoting Behaviors and Resilience in Patients with Chronic Kidney Disease

The Scientific World JOURNAL ◽

10.1155/2013/124973 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 16

Author(s):

Li-Ching Ma ◽

Hong-Jer Chang ◽

Yueh-Min Liu ◽

Hsiang-Li Hsieh ◽

Lan Lo ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Nursing Education ◽

High Risk ◽

Kidney Disease ◽

Occupational Status ◽

High Risk Group ◽

Cross Sectional ◽

Health Promoting Behaviors ◽

Factors Affecting ◽

Health Promoting

This cross-sectional research study explored differences in health-promoting behavior and resilience among three groups of chronic kidney disease patients (high-risk, early chronic kidney disease; early CKD and pre-end stage renal disease; pre-ESRD) treated at the Nephrology outpatient clinic in northern Taiwan. A total of 150 CKD outpatients were interviewed using structured questionnaires including a CKD Health to Promote Lifestyle Scale, and resilience scale. We found that the pre-ESRD group had lower resilience than either high-risk or early CKD groups. Factors affecting pre-ESRD resilience were gender, occupational status, diabetes and health-promoting behaviors. Factors affecting resilience of the high-risk group included level of education and health-promoting behaviors while factors affecting resilience in the early CKD group involved whether they are employed and health promoting behaviors. A significant positive correlation was found between health promoting behavior and resilience in all study subjects. Multiple regression analysis found that factors which could effectively predict resilience in patients at high-risk for CKD were gender, whether the patient had a job, nutrition, self-actualization, and stress level, accounting for 69.7% of the variance. Therefore, nursing education should focus on health promotion advocacy throughout the life of not only patients but also their families.

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International prescribing patterns and polypharmacy in older people with advanced chronic kidney disease: results from the European Quality study

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa064 ◽

2020 ◽

Cited By ~ 2

Author(s):

Samantha Hayward ◽

Barnaby Hole ◽

Rachel Denholm ◽

Polly Duncan ◽

James E Morris ◽

...

Keyword(s):

Chronic Kidney Disease ◽

High Risk ◽

Kidney Disease ◽

Older People ◽

Reference Group ◽

Practice Variation ◽

High Risk Group ◽

Prescribing Patterns ◽

International Differences ◽

Cardiovascular Medications

Abstract Background People with chronic kidney disease (CKD) are at high risk of polypharmacy. However, no previous study has investigated international prescribing patterns in this group. This article aims to examine prescribing and polypharmacy patterns among older people with advanced CKD across the countries involved in the European Quality (EQUAL) study. Methods The EQUAL study is an international prospective cohort study of patients ≥65 years of age with advanced CKD. Baseline demographic, clinical and medication data were analysed and reported descriptively. Polypharmacy was defined as ≥5 medications and hyperpolypharmacy as ≥10. Univariable and multivariable linear regressions were used to determine associations between country and the number of prescribed medications. Univariable and multivariable logistic regression were used to determine associations between country and hyperpolypharmacy. Results Of the 1317 participants from five European countries, 91% were experiencing polypharmacy and 43% were experiencing hyperpolypharmacy. Cardiovascular medications were the most prescribed medications (mean 3.5 per person). There were international differences in prescribing, with significantly greater hyperpolypharmacy in Germany {odds ratio (OR) 2.75 [95% confidence interval (CI) 1.73–4.37]; P < 0.001, reference group UK}, the Netherlands [OR 1.91 (95% CI 1.32–2.76); P = 0.001] and Italy [OR 1.57 (95% CI 1.15–2.15); P = 0.004]. People in Poland experienced the least hyperpolypharmacy [OR 0.39 (95% CI 0.17–0.87); P = 0.021]. Conclusions Hyperpolypharmacy is common among older people with advanced CKD, with significant international differences in the number of medications prescribed. Practice variation may represent a lack of consensus regarding appropriate prescribing for this high-risk group for whom pharmacological treatment has great potential for harm as well as benefit.

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