scholarly journals Predictors of long-term renal function after kidney surgery for patients with preoperative chronic kidney disease

2020 ◽  
Vol 15 (2) ◽  
Author(s):  
Andrew Silagy ◽  
Emily Zabor ◽  
Roy Mano ◽  
Renzo DiNatale ◽  
Julian Marcon ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Kidney Cancer ◽  
Cumulative Incidence ◽  
Radical Nephrectomy ◽  
Cox Regression ◽  
Cancer Specific Survival ◽  
Kidney Surgery ◽  
Ckd Stage

Introduction: We evaluated the trajectory of estimated glomerular filtration rate (eGFR) after kidney surgery in patients with kidney cancer and chronic kidney disease (CKD). Methods: We identified 1204 consecutive patients in our institutional database with preoperative CKD undergoing partial or radical nephrectomy from 1998–2016. Postoperative eGFR was tracked, with patients censored when receiving dialysis or kidney transplantation. A multivariable mixed-effects models assessed associations between preoperative baseline patient and tumor characteristics, and longitudinal eGFR. The Kaplan-Meier method and multivariable Cox regression were used to estimate overall survival, cancer-specific survival, and cumulative incidence of dialysis. Results: Preoperatively, 892 (74.1%), 271 (22.5%), and 41 (3.4%) patients had CKD stage 3a, 3b, and 4/5, respectively. There were 55 patients dialyzed and 355 deaths (99 from kidney cancer). Median followup was 8.1 years, with 25 781 postoperative eGFR measurements. Factors associated with decreasing eGFR postoperatively included radical nephrectomy, male gender, older age, increased body mass index (BMI), and cardiovascular risk factors. We observed a significant interaction effect between time from surgery and preoperative CKD stage: the eGFR of stage 3a patients improved, while stage ≥3b declined (p<0.001). The two- year and five-year cumulative incidence of dialysis was 1.8% (1.1–2.6%) and 3.1% (2.2–4.2%), respectively. The cumulative incidence of dialysis, with death as a competing event, significantly differed by preoperative CKD stage. Conclusions: Preoperative CKD stage ≥3b is independently associated with a higher risk of declining renal function, dialysis, and mortality. With careful selection, patients with preoperative CKD withstand kidney surgery with low rates of dialysis.

scholarly journals P0949EFFECT OF DIETARY PHOSPHORUS RESTRICTION ON FIBROBLAST GROWTH FACTOR,KLOTHO AND BODY COMPOSITION IN CHRONIC KIDNEY DISEASE PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Trisha Sachan ◽  
Anita Saxena ◽  
Amit Gupta
Keyword(s):  
Chronic Kidney Disease ◽  
Body Composition ◽  
Renal Function ◽  
Kidney Disease ◽  
Urinary Protein ◽  
Dietary Phosphorus ◽  
Ckd Stage ◽  
Significant Difference ◽  
The Mean ◽  
Fgf 23

Abstract Background and Aims Changes in dietary phosphorus regulate serum FGF-23, parathyroid hormone, 1,25(OH)(2)D and Klotho concentrations . Cardiovascular disease (CVD) is the principal killer of patients with chronic kidney disease and hyperphosphetemia is a potent risk factor it. Of many causative factors for CVD in CKD, dietary interventions involving restriction of dietary phosphorous intake can help reduce onset of CVD at early stages of CKD with other corrective measures. Muscle wasting is a consequence of uremic syndrome which alters body composition. The aim of the study was to study effect of dietary phosphorous restriction on FGF-23, iPTH, Klotho, 1,25(OH)(2)D and body composition in chronic kidney disease patients. Method This is a longitudinal study with 12 months intervention, approved by Ethics Committee of the institute. A total 132 subjects were recruited (66 healthy controls, 66 CKD patient. of 66 patients 33 were in CKD stage 1 and 33 in stage 2. GFR was calculated with the help of MDRD formula. Biochemical parameters of subjects were evaluated at baseline, 6 and 12 months along with the anthropometric measurements (body weight, height, mid upper arm circumference (MUAC), and skin folds). Three days dietary recall was taken to evaluate energy, protein and phosphorous intake. CKD patients whose dietary phosphorous intake was more than 1000 mg/day, were given intense dietary counseling and prescribed dietary modifications by restricting dietary phosphorous between 800-1000 mg/day. Results The mean age of controls and patients was 37.01±9.62 and 38.27±12.06 and eGFR of 136.94±11.77 and 83.69±17.37 respectively. One way ANOVA showed significant difference among controls and the study groups in hemoglobin (p&lt;0.001), s albumin (p&lt;0.001), FGF-23 (p&lt;0.001), klotho (p&lt;0.001), urinary protein (p&lt;0.001) and Nephron Index (p&lt;0.001).The mean energy intake (p = 0.001) and dietary phosphorous intake (p&lt;0.001) of the CKD patients decreased significantly with the decline in the renal function along with the anthropometric measures i.e. BMI (p = 0.041),WHR (p = 0.015) and all four skin folds (p&lt;0.001). On applying Pearson’s correlation, eGFR correlated negatively with urinary protein (-0.739, 0.000), FGF-23 (-0.679, 0.000) and serum phosphorous (-0.697, 0.000) and positively with klotho (0.872, 0.000). FGF-23 correlated negatively with klotho (-0.742, 0.000). Dietary phosphorous was found to be positively correlated with urinary protein (0.496, 0.000), serum phosphorous (0.680, 0.000) and FGF-23 (0.573, 0.000) and negatively with Klotho (-0.602, 0.000). Nephron index revealed a positive correlation with eGFR (0.529, 0.000). Urinary protein correlated negatively with klotho (-0.810, 0.000). A multiple linear regression was run to predict eGFR from anthropometric variables such as BMI, WHR, MUAC, skin folds thickness and handgrip strength. All anthropometric variables predicted decline in eGFR (p&lt;0.05, R2 =0.223). At 6 and 12 months; repeated ANOVAs analysis showed a statistically significant difference in serum creatinine (p=0.000), serum phosphorous (p=0.000), FGF-23(p=0.000) and klotho (p=0.000). Conclusion Elevated levels of FGF-23 and decreased Klotho levels, with the moderate decline in renal function improved with the restricted phosphorous diet at 6 and 12 months emphasizing the importance of phosphorus restriction at an early stage.

Risk of Stroke, Bleeding, and Death in Patients with Nonvalvular Atrial Fibrillation and Chronic Kidney Disease

Cardiology ◽  
2020 ◽  
Vol 145 (3) ◽  
pp. 178-186
Author(s):  
Yoav Arnson ◽  
Moshe Hoshen ◽  
Adi Berliner-Sendrey ◽  
Orna Reges ◽  
Ran Balicer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Impaired Renal Function ◽  
Bleeding Risk ◽  
Intracranial Bleeding ◽  
Increased Risk ◽  
Ckd Stage ◽  
Stroke Death

Introduction: Atrial fibrillation (AF) and chronic kidney disease (CKD) are both associated with increased risk of stroke, and CKD carries a higher bleeding risk. Oral anticoagulation (OAC) treatment is used to reduce the risk of stroke in patients with nonvalvular AF (NVAF); however, the risk versus benefit of OAC for advanced CKD is continuously debated. We aim to assess the management and outcomes of NVAF patients with impaired renal function within a population-based cohort. Methods: We conducted a retrospective observational cohort study using ICD-9 healthcare coding. Patients with incident NVAF between 2004 and 2015 were identified stratified by CKD stage. We compared treatment strategies and estimated risks of stroke, death, or any major bleeding based on CKD stages and OAC treatment. Results: We identified 85,116 patients with incident NVAF. Patients with impaired renal function were older and had more comorbidities. OAC was most common among stage 2 CKD patients (49%) and least in stages 4–5 CKD patients (27.6%). Higher CKD stages were associated with worse outcomes. Stroke rates increased from 1.04 events per 100 person-years (PY) in stage 1 CKD to 3.72 in stages 4–5 CKD. Mortality increased from 3.42 to 32.95 events/100 PY, and bleeding rates increased from 0.89 to 4.91 events/100 PY. OAC was associated with reduced stroke and intracranial bleeding risk regardless of CKD stage, and with a reduced mortality risk in stages 1–3 CKD. Conclusion: Among NVAF patients, advanced renal failure is associated with higher risk of stroke, death, and bleeding. OAC was associated with reduced stroke and intracranial bleeding risk, and with improved survival in stages 1–3 CKD.

scholarly journals The Risk of Tuberculosis Infection in Non-dialysis Chronic Kidney Disease Patients

2021 ◽  
Vol 8 ◽  
Author(s):  
Chia-Hsiang Li ◽  
Hung-Jen Chen ◽  
Wei-Chun Chen ◽  
Chih-Yen Tu ◽  
Te-Chun Hsia ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Body Mass ◽  
Lower Risk ◽  
Tuberculosis Infection ◽  
University Hospital ◽  
Ckd Stage ◽  
Time Varying Covariates

Background: Patients with chronic kidney disease (CKD) receiving maintenance renal replacement therapy are at higher risk of tuberculosis (TB) infection. The risk of TB infection in CKD patients not receiving dialysis is unknown.Aim: We conduct this study to test the hypothesis that TB infection is negatively correlated to renal function.Design: Non-dialysis CKD stage 1–5 patients, admitted in China Medical University Hospital from January of 2003 to May of 2014, were enrolled in this study and were prospectively followed up to the diagnosis of TB, death, loss to follow-up, or December 2014. The risk factors of TB infection were analyzed using competing-risks regression analysis with time-varying covariates. The initiation of dialysis and patients' death were considered as competing events. Patients' estimated glomerular filtration rate (eGFR) and body mass index (BMI) were recorded at enrollment.Results: They were followed-up for a median duration of 1.4 years. Of the 7221 patients, TB infection was identified in 114 patients. Higher eGFR was associated with lower risk of TB infection (P &lt; 0.01). The adjusted subdistribution hazard ratio (aSHR) was 0.82 [95% confidence interval (CI), 0.72 to 0.94] for every 5 ml/min/1.73 m2 increase in eGFR. In addition, higher BMI (p = 0.01) was associated with a lower risk of TB infection and the aSHR was 0.91 (95% CI, 0.85 to 0.98) for every 1 kg/m2 increase in BMI.Conclusion: Renal function and body mass index are independently associated with the risk of tuberculosis infection in patients with chronic kidney disease not receiving dialysis.

P0739PANEL OF SENSITIVE BIOMARKERS OF THE PRIMARY RESPONSE TO RENAL INJURY FOR AN EARLY DIAGNOSIS OF CHRONIC KIDNEY DISEASE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Maria João Valente ◽  
Susana Rocha ◽  
Irina Lousa ◽  
Flávio Reis ◽  
Sara Nunes ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Renal Injury ◽  
Primary Response ◽  
Control Group ◽  
Tubulointerstitial Injury ◽  
Markers Of Inflammation ◽  
Tnf Α ◽  
Ckd Stage

Abstract Background and Aims The identification of early kidney injury biomarkers is of utmost importance, since most widely used markers of kidney function vary only after several biological changes. Biomarkers allowing an earlier diagnosis of chronic kidney disease (CKD) would avoid delays in the treatment of patients. It is unlikely that a single marker is sufficient to detect the onset of CKD considering the multiple pathophysiological changes underlying primary renal response to renal injury. Several markers of inflammation, endothelial (dys)function, glomerular and tubulointerstitial injuries have been proposed and could be used combined as a panel of markers with different specificities, allowing an early detection of renal injury. Our aim was to study a panel of biomarkers proposed as early markers of renal injury, with different specificities, to evaluate and compare their sensitivities at different CKD stages. Method In this preliminary study, we enrolled 22 healthy individuals and 27 CKD patients separated into 3 groups, according to the CKD stage: 9 in stages 1 and 2; 9 in stage 3, and 9 in stages 4 and 5. None of the patients presented inflammatory, infectious or neoplastic diseases. Diagnosis and CKD stage assignment were performed according to KDIGO guidelines. We evaluated circulating levels of cystatin C (CystC), creatinine (Cr), beta trace protein (BTP) as markers of renal function; tissue inhibitor metalloproteinase 1 (TIMP-1), neutrophil gelatinase-associated lipocalin (NGAL) and transforming growth factor-β (TGF-β) as markers of interstitial tubulointerstitial injury; asymmetric dimethylarginine (ADMA) and tissue plasminogen activator (t-PA), as markers of endothelial (dys)function; pentraxin 3 (PTX3), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), as markers of inflammation; and, pro B-type natriuretic peptides (proBNP), as a marker of cardiac (dys)function. Results In early stages of CKD (1 and 2), we found significant changes in markers of renal function (BTP, but not Cr and CystC), of tubular interstitial injury (TIMP-1 and TGF-β), of inflammation (TNF-α), of endothelial (ADMA) and cardiac (proBNP) dysfunction (vs. controls). In stage 3, we found significant changes (vs. stages 1-2) in markers of renal function (Cr and CystC), inflammation (TNF-α, IL-6), endothelial dysfunction (t-PA) and tubulointerstitial injury (TIMP-1); in stages 4-5 (vs. stage 3), we found significant changes only in the classic marker, Cr, and a trend towards increased CystC. Moreover, we found that at stages 1-2 all patients showed higher levels of BTP and proBNP when compared to the median value in the control group; TIMP-1 and ADMA were increased in 7/9 patients; TNF-α was increased in 7/9 patients; and 7/9 patients had lower values of TGF-β compared to the median value of controls. For the classical markers, Cr and CystC, we found that 5/9 and 4/9 patients, respectively, had lower values than the median value of controls; however, only 2/9 patients showed abnormal creatinine values (vs. reference values). Conclusion Our data suggest that a panel including classic (Cr and CystC) and more sensitive blood markers of the primary response to renal injury (BTP, TIMP-1 or TGF-β, ADMA, TNF-α and proBNP) would allow an earlier diagnosis of CKD, avoiding a delay in diagnosis and management of CKD patients.

scholarly journals POS0643 ARE BIOLOGIC AND TARGETED SYNTHETIC DMARDS SAFE TO USE IN PATIENTS WITH RENAL IMPAIRMENT?

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 560.1-560
Author(s):  
F. Rees ◽  
M. Jasim
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Renal Impairment ◽  
Safety Profile ◽  
Ckd Stage ◽  
Synthetic Dmards ◽  
Renal Safety

Background:Chronic kidney disease (CKD) is defined as a permanent (minimum three month) reduction in glomerular filtration rate. [1] 10-30% of rheumatoid arthritis (RA) patients have CKD, compared to 5% of the general population.[1] There are several causes of CKD associated with RA including persistent inflammation, cardiovascular risk factors, frequent use of non-steroidal anti-inflammatory drugs and amyloidosis.[1] CKD in RA patients is associated with increased mortality.[2]The use of biologic and targeted synthetic DMARDs for treating RA has increased significantly in recent years. Studies have shown these therapies might reduce the risk of developing CKD in RA. [3] However, conversely, biologics have been linked to the development of glomerulonephritis.[4]Surprisingly few studies have explored the use of biologics in patients with pre-existing renal disease and whether they contribute to renal impairment themselves.Objectives:Our objectives were to explore the renal safety profile of biologic and targeted synthetic DMARDs in a real-world cohort of RA patients with and without pre-existing CKD.Methods:A retrospective observational study was completed using the Biologic Therapy Database at Cannock Chase Hospital. Inclusion criteria were a diagnosis of RA and current treatment with a biologic or targeted synthetic DMARD.Demographic data, renal function at biologic initiation and any deterioration of renal function were among the recorded information for each patient. Patients with insufficient information available via electronic patient records were excluded.Results:998 RA patients on biologics were identified, of whom 213 were excluded. Of the 785 remaining patients, a 3:1 female to male ratio was noted with a mean age of 62. 40% of patients were on an anti-TNF, 22% rituximab, 15% abatacept, 15% JAK inhibitors and 9% anti-IL6 respectively. At biologic initiation 92% of the patients had a GFR of >60 ml/min per 1.73m2, 4.8% had a GFR of 30-60 (CKD stage 3a-3b), <1% stage 4 CKD. No patients in the cohort had CKD stage 5 at biologic initiation.Overall, 13 patients had significant pre-existing CKD (eGFR <45) of these, 6 were treated with abatacept. 7/13 patients had no co-morbid risk factors for CKD – of those remaining, 2 were hypertensive, 2 diabetic and 2 both. None of these 13 patients experienced a drop in renal function by more than 1 stage since initiation of current biologic.Of those patients without prior CKD at the point of biologic initiation (GFR >45), only 15 patients (2%) developed new renal impairment whilst on biologic treatment. 10 patients’ renal function dropped by one stage and five patients by two stages. Crucially, 12 of the 15 patients were aged ≥75yrs and 10 patients had at least one other associated risk factor (e.g. diabetes). Only one patient in the cohort developed renal impairment as a direct result of a biologic - minimal-change disease secondary to etanercept.Conclusion:Our findings indicate that biologic treatments have a good renal safety profile – even with pre-existing CKD. RA patients most at risk of developing CKD whilst on biologics are likely to have other risk factors such as diabetes or hypertension. As previously stated, there is a very rare association of anti-TNF biologics causing glomerulonephritis.References:[1]Couderc M, et al. Prevalence of Renal Impairment in Patients with Rheumatoid Arthritis: Results from a Cross-Sectional Multicenter Study. Arthritis Care Res. 2016 May 1;68(5):638–44.[2]Chiu HY, et al. Increased risk of chronic kidney disease in rheumatoid arthritis associated with cardiovascular complications - A national population-based cohort study. PLoS One. 2015 Sep 25;10(9).[3]Sumida K, et al. Treatment of rheumatoid arthritis with biologic agents lowers the risk of incident chronic kidney disease. Kidney Int. 2018 May 1;93(5):1207–16.[4]Piga M, et al. Biologics-induced autoimmune renal disorders in chronic inflammatory rheumatic diseases: Systematic literature review and analysis of a monocentric cohort. Vol. 13, Autoimmunity Reviews. Elsevier; 2014. p. 873–9.Disclosure of Interests:None declared

scholarly journals The eGFR Change and Risk Factors in Moderate Chronic Kidney Disease Patients after Successful HCV Clearance by Direct Anti-viral Agents

2021 ◽  
Author(s):  
Yen-Chi Hu ◽  
Keng-Hsin Lan ◽  
Chia-Ling Lu ◽  
Yi-Hsiang Huang ◽  
Ming-Chih Hou
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Malignant Disease ◽  
Meld Score ◽  
Hcv Infection ◽  
Hcv Rna ◽  
Ckd Stage ◽  
Egfr Decline

Abstract Background –Chronic HCV infection is related not only to chronic kidney disease(CKD) but also accelerates renal deterioration. Treatment with Direct-acting antiviralagents (DAA) could slow renal function decline in some trials, but the long-termoutcomes of renal function changes following HCV elimination by DAA remainedinconclusive. Methods – This retrospective study analyzed the data of HCV infected patients withCKD stage 3 who were treated with DAA and achieved sustained virologic response at12weeks after treatment (SVR12) during 2017-2020 at a single medical center. Results – Among 130 HCV infection and CKD stage 3 patients treated with DAA, 77patients had no eGFR decline at SVR 12, and 53 patients had eGFR declined at SVR12. The eGFR change on SVR 12 can be predictor for eGFR change on SVR96 (Oddratio 3.088, p= 0.053). Patients with Diabetes Mellites (DM) (p=0.016, OR 2.6) ishighly associated with eGFR decline after DAA treatment. Renal functiondeterioration during DAA treatment is associated to long-term renal functiondecline(p=0.000). Lower HCV RNA titer(p=0.024), higher baseline MELD score(p=0.008), or con-current malignant disease under treatment(p=0.044) are more vulnerable to eGFR decrease upon DAA treatment. Conclusion –Among patients with HCV infection and CKD stage 3, comorbidity withDM, have less benefit to renal function after HCV elimination by DAA. Higherbaseline HCV RNA viral load and MELD score are precipitating factors to the renalfunction impairment. Treatment to malignant disease, either by systemic or localizedtreatment, increases the risk of renal function impairment during DAA treatment.The eGFR change on SVR 12 can be used to predict long-term eGFR change for theCKD stage 3 patients.

scholarly journals Indoxyl sulfate has a dominant role regarding the risks during different stages of chronic kidney disease

2020 ◽  
Author(s):  
Cheng-Hsu Chen ◽  
Shih-Chien Huang ◽  
Pei-Chih Lin ◽  
Shang-Feng Tsai ◽  
Yi-Chia Huang
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Dominant Role ◽  
Plasma Homocysteine ◽  
Uremic Toxins ◽  
Indoxyl Sulfate ◽  
Antioxidant Enzyme Activities ◽  
Uremic Toxin ◽  
Ckd Stage

Abstract Background: Increased levels of uremic toxins and decreased antioxidant capacities have a significant impact on the progression of chronic kidney disease (CKD). However, it is unclear whether they interact with each other in order to mediate the damage of renal function. The purpose of this study was to determine whether uremic toxins [i.e., homocysteine and indoxyl sulfate (IS)] and glutathione-dependent antioxidant enzyme activities are dependently or independently associated with each other in affecting renal function during different stages of CKD patients.Methods: One hundred thirty-two patients diagnosed with CKD stage 1 to 5 participated in this cross-sectional study.Results: Patients who had reached an advanced CKD stage experienced a gradual increase in plasma uremic toxin levels, along with decreased glutathione peroxidase (GSH-Px) activities. Plasma homocysteine, cysteine and IS concentrations were positively associated with each other, but negatively correlated to GSH-Px activity levels after adjusting potential confounders in all CKD patients. Although plasma homocysteine, cysteine, IS and GSH-Px levels were significantly associated with renal function, only plasma IS levels still had a significant association with renal function after these parameters were simultaneously adjusted.Conclusions: IS plays a more dominant role than other factors in affecting renal function, where a higher IS concentration needs to be controlled in order to defer the progressive loss of renal function.

scholarly journals The Resistive Index Is a Marker of Renal Function, Pathology, Prognosis, and Responsiveness to Steroid Therapy in Chronic Kidney Disease Patients

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Kikuno Hanamura ◽  
Akihiro Tojo ◽  
Satoshi Kinugasa ◽  
Kensuke Asaba ◽  
Toshiro Fujita
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Steroid Therapy ◽  
Resistive Index ◽  
Prognostic Indicator ◽  
Renal Resistive Index ◽  
Renal Survival ◽  
Histological Damage ◽  
Ckd Stage

To evaluate the significance of the renal resistive index (RI) as a noninvasive marker of renal histological damage and a prognostic indicator, we examined RI by Doppler ultrasonography in 202 chronic kidney disease (CKD) patients who underwent renal biopsy. RI increased as the CKD stage progressed and correlated with age, systolic blood pressure, estimated glomerular filtration rate (eGFR), and renal histological changes, including glomerulosclerosis, arteriolosclerosis, and tubulointerstitial damage. Prognostic evaluation with a median follow-up period of 38.5 months revealed that patients withRI≥0.7(high RI group,n=39) had significantly poorer renal survival than those withRI<0.65(normal RI group,n=120) and0.65≤RI<0.7(high-normal RI group,n=43). The patients in the high-normal RI group showed good response to steroids. However, in the high RI group, steroid therapy did not significantly improve renal survival. Of the clinical indices studied,RI≥0.7, hypertension, proteinuria, and low eGFR at diagnosis were independent risk factors for worsening renal dysfunction. In conclusion, RI in CKD patients was considered as a marker of renal function, histological damage, and renal prognosis, and a possible determinant of indication for steroids.

scholarly journals Loss of the Normal Gradient in Arterial Compliance and Outcomes of Chronic Kidney Disease Patients

2019 ◽  
Vol 9 (5) ◽  
pp. 297-307
Author(s):  
Qiong Bai ◽  
Chun-Yan Su ◽  
Ai-Hua Zhang ◽  
Tao Wang ◽  
Wen Tang
Keyword(s):  
Patient Outcome ◽  
Chronic Kidney Disease ◽  
Regression Analysis ◽  
Kidney Disease ◽  
Cox Regression ◽  
Arterial Compliance ◽  
Prognostic Significance ◽  
Significant Interaction Effect ◽  
Cox Regression Analysis ◽  
Ckd Stage

Background: In dialysis patients, loss of the normal gradient in arterial compliance, assessed by the pulse wave velocity (PWV) ratio, predicts all-cause mortality better than does carotid-femoral PWV (CF-PWV) alone. However, the prognostic significance of the PWV ratio for outcome in chronic kidney disease (CKD) patients remains unclear. Methods: In this longitudinal cohort study, CKD patients who visited our CKD management clinic between April 27, 2006, and March 27, 2008, were included and followed up. To assess the gradient in arterial compliance, the PWV ratio was calculated using CF-PWV divided by carotid-radial PWV. Results: A total of 209 patients in CKD stages 1–4 with a median follow-up of 3.74 years were included. Patients with higher PWV ratio were relatively older (p < 0.001) and had worse renal function (p < 0.001), more hypertension (p < 0.001), diabetes mellitus (p < 0.001), and cardiovascular or cerebrovascular disease (p < 0.001). The median time to patient outcome (death, renal replacement therapy, or double increase in serum creatinine from baseline) in the group with a PWV ratio above the median (89.8 months, 95% CI 84.2–95.5) was shorter than that in the group with a PWV ratio below the median (105.3 months, 95% CI 101.3–109.3, p = 0.001). Univariate Cox regression analysis showed that both PWV ratio and CF-PWV were significantly associated with patient outcome. In multivariate Cox regression analysis, both PWV ratio and CF-PWV were associated with patient outcome. However, the HR for CF-PWV (2.177, 95% CI 1.064–4.453, p = 0.033) was slightly higher than that for PWV ratio (2.091, 95% CI 1.049–4.167, p = 0.036). There was a significant interaction effect between PWV ratio and CKD stage. It was shown that patients with advanced CKD stages and higher PWV ratios had a significantly higher risk of adverse CKD outcome (p = 0.006). Conclusions: The PWV ratio, as a measure of loss of the normal gradient in arterial compliance, was associated with CKD patient outcome. Patients with advanced CKD and a higher PWV ratio had a significantly higher risk of adverse CKD outcome.

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