Evaluation of the level of natriuretic peptides in the diagnosis and characterization of chronic kidney disease and cardiorenal syndrome in children

2021 ◽  
Vol 25 (6) ◽  
pp. 87-92
Author(s):  
A. M. Mambetova ◽  
D. V. Bizheva ◽  
I. K. Thabisimova
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Natriuretic Peptides ◽  
Cardiorenal Syndrome ◽  
Stage I ◽  
Group Iii ◽  
Early Stages ◽  
Group I ◽  
Ckd Stage

BACKGROUND. Natriuretic peptides have cardio- and renoprotective effects, inhibiting inflammatory and proliferative processes. The role of natriuretic peptides in the early diagnosis and characterization of chronic kidney disease (CKD) and cardiovascular complications as the disease development and progresses has not been studied.TNEAIM: to study the level of natriuretic peptides in children depending on the stage of CKD development and to assess the significance of this indicator.PATIENTS AND METHODS. The study involved 93 children with congenital diseases of the urinary system at the age from 3 to 18 years. Three groups were identified: group I - 54 patients with CKD stage I , group II - 29 patients with CKD stage II; Group III - 10 children with CKD stages IV-V (patients with CKD stages IV and V were combined due to their small amount). Control group - 10 clinically healthy children of the corresponding age. The N-terminal propeptide of natriuretic hormone (NT-proBNP) was determined in the blood by the enzyme-linked immunosorbent assay.RESULTS. An increase in the level of NT-proBNP by 28.7% takes place already in the early stages of CKD. With the progression of CKD, an increase in the level of NT-proBNP was noted from 57.4 % in children in the group of patients with stage I CKD to 80 % in children in group III patients. The maximum concentrations of NT-proBNP, many times higher than those in CKD stages I and II, were observed in children with CKD stages IV-V. The degree of increase in the level of NT-proBNP correlated with the severity of CKD.CONCLUSION. In the diagnosis and characterization of CKD and cardiorenal syndrome in children, the determination of the level of natriuretic peptides is of great importance. A high level of natriuretic peptides characterizes the presence of cardiorenal relationships and can be used as an additional criterion for assessing the severity of CKD, including at the early stages of its development.

scholarly journals Chronic kidney disease impact on total joint arthroplasty outcomes: A National Inpatient Sample-based study

2020 ◽  
Vol 28 (3) ◽  
pp. 230949902091612
Author(s):  
Allyson N DiMagno ◽  
Inaya Hajj-Hussein ◽  
Amjad El Othmani ◽  
Jordan Stasch ◽  
Zain Sayeed ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Stage I ◽  
Stage Iii ◽  
Total Charge ◽  
National Inpatient Sample ◽  
Group I ◽  
Ckd Stage

Introduction: In the United States, chronic kidney disease (CKD) affects roughly 11% of the population or 19.2 million people. As the prevalence of CKD and demand for total joint arthroplasty (TJA) continue to rise, it is critical to assess the impact of CKD on postoperative clinical and economic outcomes. Methods: Discharge data from 2006 to 2011 National Inpatient Sample were used for this study. A total of 851,150 TJA patients were divided into three cohorts: group 1 included no CKD, CKD stage I, and CKD stage II; group 2 included CKD stage III and stage IV; group 3 included CKD stage V. Inverse probability of treatment weighting/propensity score weighting was used to predict outcome variables as a function of age, sex, and Elixhauser comorbidities. Patients were compared against group I for in-hospital postoperative outcomes. Results: Stage III/IV CKD patients undergoing primary TJA had higher odds of any complication (odds ratio (OR), 2.63; p < 0.0001), longer length of stay (LOS), and higher total charge (LOS, 4.34 vs. 3.48 days; total charge, US$56,003 vs. US$46,115; p < 0.0001) when compared to patients with no CKD/stage I or II. Similarly, stage V CKD patients undergoing primary TJA had higher odds of any complication (OR, 1.64; p < 0.0001), longer LOS, and higher total charges (LOS, 5.81 vs. 3.48 days; total charge, US$59,869 vs. US$46,115) than their counterparts with no CKD/stage I or II CKD. Discussion: Our results indicate that stage III, IV, or V CKD, compared with those with no CKD, stage I or II patients are at a greater risk for postoperative complications and consume more resources following TJA.

A Study of Sleep Disorders in Patients with Chronic Kidney Disease (CKD)

2017 ◽  
Vol 9 (5) ◽  
Author(s):  
Hussein A. ◽  
El–Hadidy A. ◽  
Gomaa N. ◽  
Amin Y. ◽  
El-Shabouny T.
Keyword(s):  
Chronic Kidney Disease ◽  
Sleep Apnea ◽  
Kidney Disease ◽  
Respiratory Distress ◽  
Oxygen Saturation ◽  
Kidney Function ◽  
Group Iii ◽  
Group I ◽  
Ckd Stage ◽  
Group Ii

Sleep apnea is an important comorbidity in patients with chronic kidney disease (CKD). Although the increased prevalence of sleep apnea in patients with CKD is well established, few studies have examined the full spectrum of kidney function. We sought to determine the prevalence of sleep apnea and associated nocturnal hypoxia in patients with CKD. We hypothesized that the prevalence of sleep apnea would increase progressively as kidney function declines. 45 patients were recruited from outpatient nephrology clinics, nephrology department, and hemodialysis units. All patients completed an overnight inpatient polysomnograhy test to determine the prevalence of sleep apnea (AHI ≥ 5 events /h) and nocturnal hypoxia (oxygen saturation (SaO2) below 90% for ≥12% of the nocturnal monitoring time). Patients were stratified according to their estimated glomerular filtration rate (eGFR) at the time of the study visit into three groups as follows: CKD stage 2 (eGFR 60 to 89 mL/min/1.73 m2) (control group), CKD stages 3 and 4 (eGFR 15 to 59 mL/min/1.73 m2), and CKD stage 5 (eGFR less than 15 mL/min/1.73 m2). eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Out of the 45 patients included in our study with the full spectrum of kidney function, ranging from those with eGFR 60 to 89 ml/min./1.73m2 to patients with eGFR less than 15 ml/min./1.73m2, 15 (33.3%) had sleep apnea (Mean AHI; 8.71±5.86). Our study found that prevalence of sleep apnea increased as kidney function declined (Group (I), 20%; Group (II), 36.4%; Group (III), 37.5%). Furthermore, severity of sleep apnea increased as kidney function declined (Group (I), mean AHI: 5.75±0.35; Group (II), mean AHI: 6±1.38; Group (III), mean AHI: 10.6±7.04). We also found that prevalence of nocturnal hypoxia which is characteristically associated with sleep apnea was greater among groups (II) and (III) (27.3% and 16.7%, respectively) than in group (I) (10%). Severity of nocturnal hypoxia increased as kidney function declined (Group (I), 13%; Group (II), 13.6±1.22%; Group (III), 16.75±3.30%). Overall, 8 out of the 45 studied CKD patients (17.8%) had nocturnal hypoxia (Mean SaO2 below 90% for ≥12% of the nocturnal monitoring time; 15.1±2.87%). Our study revealed that as kidney function declined, Apnea/Hypopnea (AHI) indices increased, oxygen desaturation indices increased, minimal peripheral capillary oxygen saturation values decreased, peripheral capillary oxygen saturation time less than 90% increased, and snore indices increased. Also, respiratory distress index (RDI) was higher among groups (II) and (III) than in group (I). However, only differences between groups as regards respiratory distress events, respiratory distress indices, snore events, and snore indices were statistically significant. These results show that as kidney function declines, several respiratory parameters deteriorate during sleep. In addition, wake events and indices, and sleep stage 1 (%) increased as kidney function deteriorated. Sleep efficiency (%) was highest among group (I) patients and lower among groups (II) and (III), Light sleep (%) was lowest among group (I) patients and higher among groups (II) and (III), and deep sleep (%) was highest among group (I) patients and lower among groups (II) and (III). It is clear from the above results that as kidney function declines, sleep efficiency deteriorates, wake indices increase, light sleep (%) increases, and deep sleep (%) decreases. We concluded that prevalence and severity of sleep apnea in patients with CKD increase as kidney function declines. Almost 18% of patients with CKD experience nocturnal hypoxia, which may contribute to loss of kidney function.

scholarly journals Chronic kidney disease in patients with recurrent nephrolithiasis and concomitant damage to the cardiovascular system

2021 ◽  
Vol 9 (3) ◽  
pp. 52-61
Author(s):  
R. V. Royuk ◽  
S. K. Yarovoy
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Control Group ◽  
Group Iii ◽  
Group I ◽  
Ckd Stage ◽  
Group Ii ◽  
Recurrent Nephrolithiasis

Introduction. Chronic kidney disease (CKD) is commonly diagnosed in patients with cardiovascular diseases (CVDs) and also manifests itself in most patients with urolithiasis. Numerous studies have shown that renal dysfunction is not only directly related to the high risk of developing various CVDs and chronic heart failure (CHF) as one of the most common complications but also the mortality rate in comorbid patients. CKD and CHF have similar pathogenetic mechanisms and common target organs; co-existing, both pathological conditions accelerate the progression of major diseases and significantly aggravate their course. In patients with recurrent nephrolithiasis combined with CVDs, all the causes leading to the formation of CKD (recurrent obstructive pyelonephritis, nephroangiosclerosis, etc.) are present to some extent.Purpose of the study. To evaluate the incidence and characteristics of CKD in patients suffering from recurrent urolithiasis associated with CVDs.Materials and methods. The prospective study included 406 patients who were treated for recurrent nephrolithiasis and concomitant CVDs from 2007 to 2020 (Urology Division, Burdenko Principal Military Clinical Hospital). From long-term follow-up respondents who lived at least 10 years after inclusion in the study (n = 52), three groups were formed: group I (n = 18) included patients with a combination of essential hypertension (EH) and ischemic heart disease (IHD), complicated by CHF; group II (n = 15) consisted of patients with uncomplicated CVDs (EH – 7 patients, IHD – 8 patients). The control group III (n = 19) included respondents suffering from nephrolithiasis without CVDs. The glomerular filtration rate (GFR) was determined by the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) following the Russian National Guidelines for «Chronic Kidney Disease». The analysis of the obtained data was carried out using Statistica 8.0; the Fisher and Wilcoxon criteria were calculated; the differences were considered significant at p < 0.05.Results. All patients included in the study were repeatedly hospitalized urgently and as planned and underwent at least one non-invasive manipulation or surgery. The average age of the patients was 58.9 ± 2.95 years; men predominated (~ 75 – 78%). A GFR decrease was recorded in 41.1% of patients included in the study, in 40.5% of patients with a combination of nephrolithiasis and uncomplicated CVDs, Also, its decrease was found in 60 (58.8%) of patients with chronic heart failure (CHF) in 41.1% of cases from the general sample and 40.5% of patients without CHF. CKD stage II occurred in 44 (43.1%) cases of CHF; CKD stages III Ca and Cb were detected in 10 (9.8%) and 4 (1%) cases, respectively; CKD stage IV developed in 1 (0.25%) patient with one of the re-hospitalizations. Of the 52 patients included in the second study part, the ratio of men and women was 41/11 (78.8 and 21.2%, respectively). All three groups were also dominated by men. The initial values of GFR in group I patients significantly differed from those in the control group; in group II, statistically significant differences appeared 4 years after the s the study initiation, and in group I – after 2 years. A sharp (1.5-fold) significant decrease in renal filtration function was registered in group I by the 6th research year, in group II (1.3-fold) – by the 8th research year, and in group III (1.28-fold) – only by the 10th research year. The GFR level in group I and group II decreased during the 1st follow-up year by 2.36 and 1.65 times, respectively.Conclusion. CKD in patients suffering from recurrent nephrolithiasis in combination with IHD and EH is generally benign. The progression rate of filtration deficiency is relatively low and is (at least in the early stages) about 4.5 ml/min per year. The addition of CHF increases the rate of decline in renal filtration function by up to 25% (from 4 ml/min per year to 5 ml/min per year). The main negative effect of concomitant CVDs (especially complicated CHF) is not an ultrahigh decrease in GFR but a reduction in kidney functioning stable period up to complete cessation.

scholarly journals The Use of Imaging Techniques in Chronic Kidney Disease-Mineral and Bone Disorders (CKD-MBD)—A Systematic Review

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 772
Author(s):  
Ana Pimentel ◽  
Jordi Bover ◽  
Grahame Elder ◽  
Martine Cohen-Solal ◽  
Pablo Antonio Ureña-Torres
Keyword(s):  
Computed Tomography ◽  
Chronic Kidney Disease ◽  
Magnetic Resonance ◽  
Kidney Disease ◽  
Imaging Techniques ◽  
Quantitative Computed Tomography ◽  
Vertebral Fracture Assessment ◽  
Vascular Calcifications ◽  
Ckd Stage

Although frequently silent, mineral and bone disease (MBD) is one of the most precocious complication of chronic kidney disease (CKD) and is omnipresent in patients with CKD stage 5. Its pathophysiology is complex, but basically, disturbances in vitamin D, phosphate, and calcium metabolism lead to a diverse range of clinical manifestations with secondary hyperparathyroidism usually being the most frequent. With the decline in renal function, CKD-MBD may induce microstructural changes in bone, vascular system and soft tissues, which results in macrostructural lesions, such as low bone mineral density (BMD) resulting in skeletal fractures, vascular and soft tissue calcifications. Moreover, low BMD, fractures, and vascular calcifications are linked with increased risk of cardiovascular mortality and all-cause mortality. Therefore, a better characterization of CKD-MBD patterns, beyond biochemical markers, is helpful to adapt therapies and monitor strategies as used in the general population. An in-depth characterization of bone health is required, which includes an evaluation of cortical and trabecular bone structure and density and the degree of bone remodeling through bone biomarkers. Standard radiological imaging is generally used for the diagnosis of fracture or pseudo-fractures, vascular calcifications and other features of CKD-MBD. However, bone fractures can also be diagnosed using computed tomography (CT) scan, magnetic resonance (MR) imaging and vertebral fracture assessment (VFA). Fracture risk can be predicted by bone densitometry using dual-energy X-ray absorptiometry (DXA), quantitative computed tomography (QTC) and peripheral quantitative computed tomography (pQTC), quantitative ultrasound (QUS) and most recently magnetic resonance micro-imaging. Quantitative methods to assess bone consistency and strength complete the study and adjust the clinical management when integrated with clinical factors. The aim of this review is to provide a brief and comprehensive update of imaging techniques available for the diagnosis, prevention, treatment and monitoring of CKD-MBD.

scholarly journals Chronic kidney disease predicts poor outcomes of COVID-19 patients

2021 ◽  
Author(s):  
Mahmut Gok ◽  
Hakki Cetinkaya ◽  
Tugba Kandemir ◽  
Erdem Karahan ◽  
İzzet Burak Tuncer ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Multivariate Regression Analysis ◽  
Hospital Data ◽  
Group I ◽  
Ckd Stage ◽  
Comorbid Diseases ◽  
Group Ii ◽  
Poor Outcomes

Abstract Purpose The recent outbreak of COVID-19 rapidly spread worldwide. Comorbid diseases are determinants of the severity of COVID-19 infection and mortality. The aim of this study was to explore the potential association between chronic kidney disease (CKD) and the severity of COVID-19 infection. Methods The study included 609 consecutive adult patients (male: 54.52%, mean age: 59.23 ± 15.55 years) hospitalized with the diagnosis of COVID-19 in a tertiary level hospital. Data were collected from the electronic health records of the hospital. The patients were separated into two groups: Group I included COVID-19-positive patients with CKD stage 1–2, and Group II included COVID-19-positive with CKD stage 3–5. The relationships were examined between CKD stage, laboratory parameters and mortality. Results Significant differences were determined between the groups in respect of the inflammation parameters and the parameters used in prognosis. In Group II, statistically significantly higher rates were determined of comorbid diseases [hypertension (p < 0.001) and diabetes mellitus (p < 0.001), acute kidney injury (AKI), which was found to be associated with mortality (p < 0.001), and mortality (p < 0.001)]. In multivariate regression analysis, CKD stage 3–5, AKI, male gender, hypertension, DM and malignancy were found to be significant independent variables increasing mortality. Conclusion The prevelance of CKD stage 3–5 on admission is associated with a high risk of in-hospital mortality in patients with COVID-19. Close follow-up can be recommended for patients with a reduced glomerular filtration rate (GFR).

scholarly journals Pharmacological cardioversion of recent-onset atrial fibrillation in patients with chronic kidney disease: sub-analysis of the CANT study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
B Ceynowa-Sielawko ◽  
M Wybraniec ◽  
A Topp-Zielinska ◽  
A Maciag ◽  
D Miskowiec ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Sinus Rhythm ◽  
Public Institution ◽  
Group Iii ◽  
Recent Onset ◽  
Group I ◽  
Pharmacological Cardioversion ◽  
Onset Atrial Fibrillation

Abstract Purpose Pharmacological cardioversion (PCV) is commonly a primary option for termination of recent-onset atrial fibrillation (AF) at the emergency departments (ED), and there are reports proving that antazoline is a noteworthy agent to restore sinus rhythm. This is a sub-analysis of the CANT study evaluating the effectiveness and safety of antazoline in patients with AF at different stages of chronic kidney disease (CKD). Methods Total n=777 patients admitted to ED for the urgent termination of AF were included into this analysis. We analysed the results concerning effectiveness and safety of PCV with special consideration of antazoline, in patients at 3 stages of CKD defined on the basis of eGFR (CKD-EPI): Group I ≥60 mL/min (n=531), Group II 45–59 mL/min (n=149), and Group III &lt;45 mL/min (n=97). Primary end-point was the termination of AF, a restoration of a sinus rhythm and its persistence until discharge. Results Patients of group III were older and with higher prevalence of comorbidities, however, we have not found statistically significant differences in overall effectiveness of PCV in comparison with the other groups. In patients receiving amiodarone, the PCV success rate was similar in all the studied groups, but along with a renal function decline, it decreased in patients receiving antazoline (79.1 vs 35%; p&lt;0.001), and it increased close to a significant manner in patients receiving propafenone (69.9 vs 100%; p=0.067; Figure). In patients of Group I, antazoline restored a sinus rhythm as effectively as propafenone and amiodarone, however in patients of Group III, both antazoline and amiodarone became less effective in restoring a sinus rhythm than propafenone (p=0.002 and p=0.034, respectively). The rate of safety endpoint was highest in patients of Group III (eGFR&lt;45 mL/min), and it was significantly higher than in patients of Group I and II (p=0.008 and p=0.036, respectively). We have not observed antazoline-related adverse events in any of studied groups of patients. Conclusion This real-world registry analysis revealed a different influence of CKD on individual drug effectiveness, and while propafenone and amiodarone maintained their AF termination efficacy, antazoline became significantly less effective in restoring sinus rhythm. Its favourable safety profile has not changed. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): The study received no external funding

scholarly journals Interpretation of Erythropoietin and Haemoglobin Levels in Patients with Various Stages of Chronic Kidney Disease

2017 ◽  
Vol 36 (2) ◽  
pp. 145-152 ◽  
Author(s):  
Mirsad Panjeta ◽  
Ismet Tahirović ◽  
Emin Sofić ◽  
Jozo Ćorić ◽  
Amela Dervišević
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Control Group ◽  
Glycoprotein Hormone ◽  
Cross Sectional ◽  
Group Iii ◽  
Spectrophotometric Methods ◽  
Group I ◽  
Blood Haemoglobin

SummaryBackground: The production of erythrocytes is regulated by the hormone erythropoietin (EPO), which maintains the blood haemoglobin (Hb) levels constant under normal conditions. Human EPO is a glycoprotein hormone and its synthesis is controlled by the hypoxia-inducible transcription factor. The aim of this study was to establish EPO and Hb levels in patients with chronic kidney disease (CKD), as well as in control subjects, and to investigate the relationship between these parameters.Methods: This cross-sectional, observational study included 356 subjects with CKD divided into 4 subgroups according to their glomerular filtration rate (GFR). The control group consisted of 206 age and sex matched healthy subjects with GFR rate ≥90 mL/min/1.73 m2. EPO, Hb and serum creatinine levels were determined by using immunochemical and spectrophotometric methods. GFR was determined using the MDRD formula.Results: The CKD patients had significantly lower levels of haemoglobin (p<0.0005) and hematocrit (p<0.0005) compared to control group. Our results showed that Hb levels decreased, whereas serum creatinine increased with the increasing renal failure. The CKD patients in all four groups had significantly lower (p<0.0005) Hb levels, and significantly higher (p<0.0005) creatinine levels compared to the control group. The median EPO in group I and II were significantly higher (p=0.002; p=0.018), while median EPO in group III and IV were significantly lower (p=0.03; p=0.011) compared to the control group.Conclusions: In patients with CKD, GFR positively correlated with Hb and EPO, while the correlation between GFR and serum creatinine was negative.

scholarly journals INFLUENCE OF ACECLOFENAK ON THE LEVEL OF PROAND ANTIINFLAMMATORY CYTOKINES IN THE PATIENTS WITH RHEUMATOID ARTHRITIS AND CHRONIC KIDNEY DISEASE

2015 ◽  
pp. 17-21
Author(s):  
O. Zubl ◽  
W. Roborchuks ◽  
G. Dotsyukl
Keyword(s):  
Rheumatoid Arthritis ◽  
Chronic Kidney Disease ◽  
Nephrotic Syndrome ◽  
Kidney Disease ◽  
Inflammatory Cytokines ◽  
Stage I ◽  
Complex Treatment ◽  
Inflammatory Drug ◽  
Ckd Stage ◽  
Anti Inflammatory

 The purpose - to investigate the effect of aceclofenac on the level of proand anti - inflammatory cytokines in patients with rheumatoid arthritis and chronic kidney disease. Material and Methods: The research included 88patients: 45 with rheumatoid arthritis (RA) without chronic kidney disease (CKD), 43 with RA and CKD stage I without nephrotic syndrome. In a complex therapie of patients it is included nonsteroid anti - inflammatory drug aceclofenac. Influence of aceclofenac was compared with meloxicam. It is investigated to patients the content IL - 1$, IL - 10, TNFa, TGF$1, MCP - 1 is the urine with an immunofermental method. Results. After two weeks of therapy with aceclofenac was revealed reduction IL - 1$ levels (p<0,05) and urinary (p<0,05), TNFa levels (p<0,05) in patients with RA and RA with CKD. Level of pro - sclerous cytokin TGFf>1 of blood (p<0,05) and urine (p<0,001) at patients with RA with CKD is reduced. Decrease in the MCP - 1 level in blood (in 1,5 times) and in urine (in 2 times) at patients with RA and CKD is revealed. Conclusion. Application of therapy with aceclofenac for complex treatment ofpatients with RA and CKD improves efficiency of treatment for these patients through improvement cytokines of blood and urine.  

PHARMACOECONOMICS OF ORAL PARICALCITOL THERAPY IN PATIENTS WITH A CHRONIC KIDNEY DISEASE AND SECONDARY HYPERPARATHYROIDISM

2019 ◽  
Vol 23 (1) ◽  
pp. 67-72
Author(s):  
A. V. Rudakova
Keyword(s):  
Chronic Kidney Disease ◽  
Cost Effectiveness ◽  
Kidney Disease ◽  
Secondary Hyperparathyroidism ◽  
Impact Analysis ◽  
Budget Impact ◽  
Budget Impact Analysis ◽  
Early Stages ◽  
Ckd Stage ◽  
The Cost

Selective vitamin D receptors agonist paricalcitol can increase probability of proteinuria reduction at patients with the chronic kidney disease (CKD) and secondary hyperparathyroid-ism. THE AIM of this study was to determine the cost effectiveness of oral paricalcitol in patients with a CKD and secondary hyperparathyroidism and to carry out the budget impact analysis to understand the potential financial effect of introducing this drug in a health plan. MATERIALS AND METHODS. Assessment was carried out from a health care payer per-spective with use of the 5-year temporary horizon. Markov modeling on the basis of results of double blind trials at whom the efficacy of a paricalcitol at patients with hyperparathyroidism was estimated is carried out. The analysis is carried out taking into account tariffs of compulsory health insurances across St. Petersburg for 2018. Cost of paricalcitol corresponded to the price of registration including VAT for 2018 and 10% of a trade extra charge (5061.27 rub for 28 caps. on 1 mcg). During cost-effectiveness assessment clinical and economic outcomes were discounted at 3,5% a year. The budget impact analysis was carried out without discount-ing. RESULTS. Purpose of an oral paricalcitol to patients with CKD stage 3-4 and secondary hyperparathyroidism allows to increase time before transition to dialysis and life expectancy on average for 0,049-0,134 and for 0,033-0,144 year, respectively (when calculating without dis-counting). The cost effectiveness of an oral paricalcitol is higher at early stages of a nephropathy – 1,377 million rubles / year without dialysis gained, 1,408 million rubles / life year gained and 1,647 million rubles / QALY. At the same time paricalcitol therapy of patients with early stages of a nephropathy demands increase of cumulative expenses in 5 years by 2,24 times. CONCLUSIONS. Oral paricalcitol therapy in patients with a CKD and secondary hyperparathyroidism, according to results of modeling, allows to postpone transition of patients to dial-ysis and, taking into account the made assumptions, can be considered in patients with early stages of a nephropathy as economically acceptable intervention.

scholarly journals Updated Clinical Practice Guideline on Use of Gadolinium-Based Contrast Agents in Kidney Disease Issued by the Canadian Association of Radiologists

2019 ◽  
Vol 70 (3) ◽  
pp. 226-232 ◽  
Author(s):  
Nicola Schieda ◽  
Pejman Jabehdar Maralani ◽  
Casey Hurrell ◽  
Anne K. Tsampalieros ◽  
Swapnil Hiremath
Keyword(s):  
Clinical Practice ◽  
Kidney Disease ◽  
Contrast Agents ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Group Iii ◽  
Canadian Association ◽  
Group I ◽  
Ckd Stage ◽  
Group Ii

In 2017, the Canadian Association of Radiologists issued a clinical practice guideline (CPG) regarding the use of gadolinium-based contrast agents (GBCAs) in patients with acute kidney injury (AKI), chronic kidney disease (CKD), or on dialysis due to mounting evidence indicating that nephrogenic systemic fibrosis (NSF) occurs with extreme rarity or not at all when using Group II GBCAs or the Group III GBCA gadoxetic acid (compared to first generation Group I linear GBCAs). One of the goals of the work group was to re-evaluate the CPG after 24 months to determine the effect of more liberal use of GBCA on reported cases of NSF in patients with AKI, CKD Stage 4 or 5 (estimated glomerular filtration rate [eGFR] < 30 mL/min/1.73 m2), or those that are dialysis-dependent. A comprehensive review of the literature was conducted by a subcommittee of the initial CPG panel between the dates of January 1, 2017-December 31, 2018 to identify new unconfounded cases of NSF linked to Group II or Group III GBCAs and an updated CPG developed. To our knowledge, when using a Group II or Group III GBCA between 2017-2018, only a single unconfounded case report of a fibrosing dermopathy has been reported in a patient who received gadobenate dimeglumine with Stage 2 CKD. No other unconfounded cases of NSF have been reported with Group II or III agents in during this timeframe. The subcommittee concluded that the main recommendations from the 2017 CPG should remain unaltered, but agreed that screening for renal disease in the outpatient setting is no longer justifiable, cost-effective or recommended. Patients on hemodialysis (HD) should, however, be identified prior to GBCA administration to arrange timely HD to optimize gadolinium clearance, although there remains no evidence that HD reduces the risk of NSF. When administering Group II or III GBCAs to patients with AKI, on dialysis or with severe CKD, informed consent relating to NSF is also no longer explicitly recommended.

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