Cardiovascular calcification in chronic kidney disease: Risk factors and effect of α-keto acid tablets

Purpose: To investigate the effect of α-keto acid tablets, and risk factors for cardiovascular calcification in patients with chronic kidney disease (CKD).Methods: A total of 128 CKD patients were enrolled in this study. They were randomly assigned to study and control groups, each with 64 patients. Control patients received symptomatic treatment, while the study group patients received α-keto acid tablets plus. Indices of cardiovascular calcification, blood lipids and mineral metabolism were determined in the 2 groups of patients and compared. Risk factors for cardiovascular calcification were also analyzed.Results: After treatment, the two groups had decreased CACS scores and reduced serum FGF-23levels, with lower values in patients in the study group. Levels of Klotho and fetuin-A were significantly elevated after treatment, with higher values observed in study group patients. The degree of cardiovascular calcification was markedly lower in study group than that in controls. There was no significant difference in blood Ca level between the control and study groups before and after treatment. Logistic multivariate analysis demonstrated that hyperlipidemia, hyperphosphatemia, hypercalcemia, hypertension and diabetes put patients at risk for cardiovascular calcification.Conclusion: Compound α-keto acid tablets delay cardiovascular calcification in patients with CKD, and alleviate symptoms of related risk factors for cardiovascular calcification.

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THU0300 RISK FACTORS FOR COMPLICATIONS AND REFRACTORY COURSE IN PATIENTS WITH ANCA-ASSOCIATED SYSTEMIC VASCULITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.6460 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 378.2-378

Author(s):

A. Chudinov ◽

I. Belyaeva ◽

M. Pervakova ◽

V. Mazurov ◽

O. Inamova ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Induction Therapy ◽

Granulomatosis With Polyangiitis ◽

Disease Risk ◽

Systemic Vasculitis ◽

Cardiovascular Complications ◽

Infectious Complications ◽

Eosinophilic Granulomatosis With Polyangiitis

Background:ANCA-associated systemic vasculitis (AAV) is characterized by a high incidence of complications and high mortality. The most significant complications during the first 3 years of the disease are infectious and cardiovascular. Development of chronic kidney disease also impairs the prognosis of AAV. Refractory to induction therapy can significantly increase the severity of organ lesions in patients with AAV.Objectives:The aim of this study was to determine risk factors for complications and refractory course in patients with AAV.Methods:Patients with granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA) were observed during the first 3 years of the disease and included in this study between 2010 and 2018. Most common infectious complications requiring inpatient treatment were pneumonia, mycosis, sepsis, purulent arthritis, purulent otitis media. Cardiovascular complications included pulmonary thromboembolism, myocardial infarction, ischemic stroke, venous thrombosis.Results:In total 209 (165 [79%] female and mean age 51.8 ± 13.2 years) AAV patients (94 GPA; 46 MPA; and 69 EGPA) were included in the analysis. Risk factors for infectious complications were BVAS level at the beginning of induction therapy > 25 (OR – 2.92, 95% CI (1.53;5.45) p<0.001), usage of prednisone in doses more than 60 mg / day at the induction of remission (OR – 2.76, 95% CI (1.45;5.29) p=0.003), usage of prednisone in doses ≥ 10 mg / day after 6 months of induction therapy (OR – 2.60, 95% CI (1.38;4.93) p=0.003), ANCA-PR3 positivity (OR – 2.25, 95% CI (1.13;4.46) p=0.017) and presence of diabetes mellitus in the AAV onset (OR – 1.77, 95% CI (1.14;3.45) p=0.038). Patients with AAV had following risk factors for cardiovascular complications: male (OR – 2.28, 95% CI (1.33;3.88) p=0.002), BVAS level > 25 (OR – 2.1, 95% CI (1.11;3.16) p=0.008) and presence of coronary artery disease in the AAV onset (OR – 2.2, 95% CI (1.18;4.10) p=0.015). ANCA positivity (OR – 5.62, 95% CI (2.1;14.9) p<0.001), presence of rapidly progressive glomerulonephritis in the first 3 months from onset AAV (OR – 5.02, 95% CI (3.42;7.35) p<0.001) and over 60 years of age (OR – 2.17, 95% CI (1.38;3.44) p=0.001) were risk factors of development of chronic kidney disease. Risk factors for refractory to induction therapy in patients with AAV were ANCA-PR3 positivity (OR – 3.13, 95% CI (1.63;6.02) p<0.001), BVAS level > 25 (OR – 2.63, 95% CI (1.74;4.34) p<0.001), initiation of therapy after 4 months from the onset of clinical manifestations (OR – 2.17, 95% CI (1.26;3.91) p=0.005). We additionally defined that identification of pathological phenotypes of alpha-1-antitrypsin was risk factors for refractory course in patients with GPA manifestations (OR – 2.66, 95% CI (1.12;6.33) p=0.048).Conclusion:Our study has shown that high disease activity, ANCA positivity and comorbid pathology increase risk of serious complications. Early administration of immunosuppressive therapy, adequate steroid dosing and use of risk factors for complications and refractory course in clinical practice can significantly improve the prognosis of AAV.Disclosure of Interests:None declared

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Abstract MP74: Long Term Risk-Factor Profiles for Chronic Kidney Disease in the Framingham Heart Study

Circulation ◽

10.1161/circ.127.suppl_12.amp74 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Gearoid M McMahon ◽

Sarah R Preis ◽

Shih-Jen Hwang ◽

Caroline S Fox

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Risk Factor ◽

Kidney Disease ◽

Framingham Heart Study ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Standard Deviation Increase ◽

Heart Study ◽

Increased Risk

Background: Chronic Kidney Disease (CKD) is an important public health issue and is associated with an increased risk of cardiovascular disease. Risk factors for CKD are well established, but most are typically assessed at or near the time of CKD diagnosis. Our hypothesis was that risk factors for CKD are present earlier in the course of the disease. We compared the prevalence of risk factors between CKD cases and controls at time points up to 30 years prior to CKD diagnosis. Methods: Participants were drawn from the Framingham Heart Study Offspring cohort. CKD was defined as an estimated glomerular filtration rate of ≤60ml/min/1.73m2. Incident CKD cases occurring at examination cycles 6, 7, and 8 were age- and sex-matched 1:2 to controls. Risk factors including systolic blood pressure (SBP), hypertension, lipids, diabetes, smoking status, body mass index (BMI) and dipstick proteinuria were measured at the time of CKD diagnosis and 10, 20 and 30 years prior. Logistic regression models, adjusted for age, sex, and time period, were constructed to compare risk factor profiles at each time point between cases and controls Results: During follow-up, 441 new cases of CKD were identified and these were matched to 882 controls (mean age 69.2 years, 52.4% women). Up to 30 years prior to CKD diagnosis, those who ultimately developed CKD were more likely to have hypertension (OR 1.74, CI 1.21-2.49), be obese (OR 1.74, CI 1.15-2.63) and have higher triglycerides (OR 1.43, CI 1.12-1.84, p=0.005 per 1 standard deviation increase). Each 10mmHg increase in SBP was associated with an OR of 1.22 for future CKD (95% CI 1.10-1.35) Additionally, cases were more likely to have diabetes (OR 2.90, CI 1.59-5.29) and be on antihypertensive therapy (OR 1.65, CI 1.14-2.40, p=0.009) up to 20 years prior to diagnosis. Increasing HDLc was associated with a lower risk of CKD (OR 0.84, CI 0.81-0.97 per 10mg/dl). Conclusions: As many as 30 years prior to diagnosis, risk factors for CKD are identifiable. In particular, modifiable risk factors such as obesity, hypertension and dyslipidemia are present early in the course of the disease. These findings demonstrate the importance of early identification of risk factors in patients at risk of CKD through a life-course approach.

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Cholecalciferol v. ergocalciferol for 25-hydroxyvitamin D (25(OH)D) repletion in chronic kidney disease: a randomised clinical trial

British Journal Of Nutrition ◽

10.1017/s000711451600427x ◽

2016 ◽

Vol 116 (12) ◽

pp. 2074-2081 ◽

Cited By ~ 10

Author(s):

James B. Wetmore ◽

Cassandra Kimber ◽

Jonathan D. Mahnken ◽

Jason R. Stubbs

Keyword(s):

Clinical Trial ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Mineral Metabolism ◽

Substantial Reduction ◽

Randomised Clinical Trial ◽

Optimal Method ◽

Hydroxyvitamin D ◽

Significant Difference ◽

25 Hydroxyvitamin D

AbstractPatients with chronic kidney disease (CKD) demonstrate complex mineral metabolism derangements and a high prevalence of vitamin D deficiency. However, the optimal method of 25-hydroxyvitamin D (25(OH)D) repletion is unknown, and trials analysing the comparative efficacy of cholecalciferol and ergocalciferol in this population are lacking. We conducted a randomised clinical trial of cholecalciferol 1250μg (50 000 IU) weekly v. ergocalciferol 1250μg (50 000 IU) weekly for 12 weeks in forty-four non-dialysis-dependent patients with stage 3–5 CKD. The primary outcome was change in total 25(OH)D from baseline to week 12 (immediately after therapy). Secondary analyses included the change in 1,25-dihydroxyvitamin D (1,25(OH)2D), parathyroid hormone (PTH), D2 and D3 sub-fractions of 25(OH)D and 1,25(OH)2D and total 25(OH)D from baseline to week 18 (6 weeks after therapy). Cholecalciferol therapy yielded a greater change in total 25(OH)D (45·0 (sd 16·5) ng/ml) v. ergocalciferol (30·7 (sd 15·3) ng/ml) from baseline to week 12 (P<0·01); this observation partially resulted from a substantial reduction in the 25(OH)D3 sub-fraction with ergocalciferol. However, following cessation of therapy, no statistical difference was observed for total 25(OH)D change from baseline to week 18 between cholecalciferol and ergocalciferol groups (22·4 (sd 12·7) v. 17·6 (sd 8·9) ng/ml, respectively; P=0·17). We observed no significant difference between these therapies with regard to changes in serum PTH or 1,25(OH)2D. Therapy with cholecalciferol, compared with ergocalciferol, is more effective at raising serum 25(OH)D in non-dialysis-dependent CKD patients while active therapy is ongoing. However, levels of 25(OH)D declined substantially in both arms following cessation of therapy, suggesting the need for maintenance therapy to sustain levels.

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Differences in Risk Factors for Diabetic Retinopathy in Type 1 and Type 2 Diabetes Mellitus Patients in North-East Poland

Medicina ◽

10.3390/medicina56040177 ◽

2020 ◽

Vol 56 (4) ◽

pp. 177

Author(s):

Wojciech Matuszewski ◽

Magdalena M. Stefanowicz-Rutkowska ◽

Magdalena Szychlińska ◽

Elżbieta Bandurska-Stankiewicz

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Type 2 Diabetes ◽

Chronic Kidney Disease ◽

Type 2 Diabetes Mellitus ◽

Diabetic Retinopathy ◽

Kidney Disease ◽

Study Group

Background and Objective: Nowadays, diabetes is one of the main causes of blindness in the world. Identification and differentiation of risk factors for diabetic retinopathy depending on the type of diabetes gives us the opportunity to fight and prevent this complication. Aim of the research: To assess differences in the risk factors for diabetic retinopathy in type 1 and type 2 diabetes mellitus patients in Warmia and Mazury Region, Poland. Materials and Methods: Risk factors for diabetic retinopathy (DR) were assessed on the basis of an original questionnaire, which included: personal data, clinical history of diabetes and eye disease. Elements of clinical examination: blood pressure, BMI, waist circumference. Indicators of diabetes metabolic control: mean glycemia, glycated hemoglobin (HbA1c), total cholesterol and triglycerides, creatinine, glomerular filtration rate (GFR), albumin–creatinine ratio in urine. Results: The study group included 315 (26%) patients with DM1 and 894 (74%) patients with DM2. Risk factors were estimated on the basis of logistic regression and verified with Student’s t-test. Statistically significant dependencies were found in both groups between the occurrence of diabetic retinopathy and diabetes duration, HbA1c, triglyceride concentrations, indicators of kidney function and cigarette smoking status. In the DM2 group, the development of DR was significantly influenced by the implemented models of diabetic treatment. Conclusions: In the whole study group, the risk of DR was associated with the duration of diabetes, HbA1c, triglyceride concentrations and smoking. In DM1 patients, the risk of DR was associated with diabetic kidney disease in the G1A1/A2 stage of chronic kidney disease, and in DM2 patients with the G2 stage of chronic kidney disease. An important risk factor for DR in DM2 patients was associated with late introduction of insulin therapy.

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Association of Hantavirus Infections and Leptospirosis With the Occurrence of Chronic Kidney Disease of Uncertain Etiology in the North Central Province of Sri Lanka: A Prospective Study With Patients and Healthy Persons

Frontiers in Cellular and Infection Microbiology ◽

10.3389/fcimb.2020.556737 ◽

2020 ◽

Vol 10 ◽

Author(s):

N. P. Sunil-Chandra ◽

J. A. A. S. Jayaweera ◽

W. Kumbukgolla ◽

M. V. M. L. Jayasundara

Keyword(s):

Chronic Kidney Disease ◽

Sri Lanka ◽

Kidney Disease ◽

Significant Risk ◽

Study Groups ◽

Hantavirus Infection ◽

Strain Specificity ◽

Climate Conditions ◽

Significant Difference ◽

Uncertain Etiology

Chronic Kidney disease of uncertain etiology (CKDu) has become a significant disease burden, affecting farming community of Sri Lanka and the exact etiology, which could be multifactorial, is not hitherto established. This study is aimed to determine the association of past hantavirus infection and leptospirosis with the occurrence of CKDu. A cohort (n = 179) of known CKDu patients living in high-CKDu prevalent areas of Anuradhapura district of Sri Lanka was compared with a group of 49 healthy, sex-matched younger blood relatives of CKDu patients (control-1) and another 48 healthy, age, and sex-matched individuals living in low-CKDu prevalent area (control-2) of the same district where same life style and climate conditions prevail. Fifty out of 179 (27.9%) CKDu patients, 16/49 (32.7%) of control-1 and 7/48 (14.6%) of control-2 were found positive for IgG antibodies to Puumala, Hantaan or both strains of hantaviruses. Hantaan strain specificity was found to be predominant in all study groups. Hantavirus IgG sero-prevalence of healthy individuals living in low-CKDu prevalent area was significantly lower compared to CKDu patients and healthy younger blood relatives living in high-CKDu prevalent areas (p = 0.03). Past hantavirus infection possesses a significant risk for the occurrence of CKDu (OR = 4.5; 95% CI-3.1-5.4, p = 0.02). In contrast, IgG seroprevalence to hantaviruses was not significantly different in CKDu patients and healthy younger blood relatives living in high-CKDu prevalent areas indicating past hantavirus infection has no association with the occurrence of CKDu or possibly, younger relatives may develop CKDu in subsequent years. Seroprevalence to leptospirosis showed no significant difference between CKDu patients and healthy controls.

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