Increased Proteinuria is Associated with Increased Aortic Arch Calcification, Cardio-Thoracic Ratio, Rapid Renal Progression and Increased Overall and Cardiovascular Mortality in Chronic Kidney Disease

AbstractObjective: Our study aimed to validate the neutrophil-to-lymphocyte ratio (NLR) as a marker for aortic arch calcification in hypertensive patients with less advanced chronic kidney disease (CKD).Methods: A number of forty-four hypertensive patients with chronic kidney disease (categories G3a and G3b – 2012 KDIGO nomenclature) were included in the study. Considering the presence of aortic arch calcification (AAC) on chest X-ray, the study population was divided into two groups: 27 patients AAC present and seventeen without aortic arch calcification. Laboratory data were collected for each patient and NLR was computed. Comorbidities were also recorded: stable coronary artery disease, lower extremity arterial disease and hypertensive heart disease.Results: A positive correlation between neutrophil-to-lymphocyte ratio and aortic arch calcification in hypertensive CKD patients was identified. Furthermore, advanced age, increased alkaline phosphatase and increased erythrocyte sedimentation rate had a positive association with aortic arch calcification. We found no statistical correlation between neutrophil-to-lymphocyte ratio and other laboratory features in both groups of patients.Conclusions: Neutrophil-to-lymphocyte ratio may be viewed as a potential risk factor for vascular calcification in patients with moderate chronic kidney disease; nevertheless, future extensive studies are necessary. In the management of hypertensive patients, general medicine might particularly benefit of this simple, readily available inflammatory marker.

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Aortic Arch Calcification Predicts the Renal Function Progression in Patients with Stage 3 to 5 Chronic Kidney Disease

BioMed Research International ◽

10.1155/2015/131263 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Lung-Chih Li ◽

Yueh-Ting Lee ◽

Yi-Wei Lee ◽

Chia-An Chou ◽

Chien-Te Lee

Keyword(s):

Chronic Kidney Disease ◽

Renal Function ◽

Kidney Disease ◽

Aortic Arch ◽

Estimated Glomerular Filtration Rate ◽

X Ray ◽

Chest X Ray ◽

Independent Determinant ◽

Egfr Decline ◽

Aortic Arch Calcification

Introduction. The presence of aortic arch calcification (AoAC) and cardiomegaly on chest radiography has been demonstrated as important risk factors for cardiovascular mortality in patients with chronic kidney disease (CKD). However, the interrelationship among AoAC, cardiomegaly, and renal function progression remains unclear. The aim of this study is to assess whether AoAC and cardiomegaly are independently associated with the renal function progression in patients with stages 3–5 CKD.Methods. We retrospectively determined AoAC and cardiomegaly by chest X-ray in 237 patients, followed up for at least three years without entering dialysis and classified into 4 groups according to the presence or absence of AoAC and cardiomegaly. The change in renal function was measured by the slope of estimated glomerular filtration rate (eGFR).Results. Of the 237 patients, the rate of eGFR decline was significantly higher in the group with coexistence of AoAC and cardiomegaly than any other groups. Baseline AoAC and proteinuria were independently associated with eGFR decline. AoAC were independently determined by age, eGFR slope, and cardiomegaly.Conclusions. The coexistence of AoAC and cardiomegaly is associated with faster eGFR decline. AoAC is an independent determinant of renal outcomes in patients with CKD stages 3–5.

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Pathological Findings in Chest Radiographs of Chronic Kidney Disease Patients Undergoing Hemodialysis

SRIWIJAYA JOURNAL OF MEDICINE ◽

10.32539/sjm.v4i1.247 ◽

2021 ◽

Vol 4 (1) ◽

pp. 38-45

Author(s):

Siti Nurhayati Utami ◽

Hanna Marsinta Uli ◽

Indri Seta Septadina

Keyword(s):

Diabetes Mellitus ◽

Chronic Kidney Disease ◽

Pleural Effusion ◽

Kidney Disease ◽

Pulmonary Edema ◽

Aortic Arch ◽

Medical Records ◽

Chest Radiographs ◽

Age Range ◽

Aortic Arch Calcification

Chronic kidney disease is a condition in which there is destruction of the kidneys along with structural or functional abnormalities, with or without decreased glomerular filtration rate for more than 3 months. The common treatment for this condition is hemodialysis, however, it may cause complications, specifically cardiovascular and non-cardiovascular system dysfunctions that can be observed through thorax imaging. This study aims to observe pathologic thorax imaging findings on chronic kidney disease patients undergoing hemodialysis at RSUP Dr. Mohammad Hoesin Palembang. This study is a descriptive study using a cross-sectional design. The data is gathered from medical records from the Medical Records & Radiology Department of RSUP Dr. Mohammad Hoesin Palembang that have passed the inclusion and exclusion criteria. The data is processed using the SPSS application version 25. The results of this study indicate that, based on risk factors, patients are generally in the 55-64 age range (41%), female (60%), and with a normal BMI/normal weight (52%). Based on the patients’ comorbid diseases, patients mostly have hypertension (59%), followed by diabetes mellitus (46%). Analysis of the chest radiographs indicate that (70%) of patients have cardiomegaly; (22%) of patients have grade 1, (15%) have grade 2, (7%) have grade 3 aortic arch calcification; (49%) have pulmonary edema; (31%) have unilateral pleural effusion, and (14%) have bilateral pleural effusion. The majority of chronic kidney disease patients undergoing hemodialysis at RSUP Dr. Mohammad Hoesin Palembang are in the 55-64 age range, female, and with normal BMI. The most common comorbid conditions are hypertension and diabetes mellitus. Analysis of the chest radiographs indicate that the majority of patients have cardiomegaly; grade 1, 2, and 3 aortic arch calcification; pulmonary edema; unilateral and bilateral pleural effusion.

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Aortic arch calcification in hypertensive patients with chronic kidney disease

Romanian Journal of Medical Practice ◽

10.37897/rjmp.2019.2.17 ◽

2019 ◽

Vol 15 (2) ◽

pp. 182-187

Author(s):

Claudia Floriana Suciu ◽

◽

Andreea Varga ◽

Corneliu Florin Buicu ◽

Valeria Herdea ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Aortic Arch ◽

Hypertensive Patients ◽

Aortic Arch Calcification

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378 CUMULATIVE IMPACT OF HYPERTENSION, TYPE 2 DIABETES AND CHRONIC KIDNEY DISEASE ON ALL-CAUSE AND CARDIOVASCULAR MORTALITY

Journal of Hypertension ◽

10.1097/01.hjh.0000420227.30125.8d ◽

2012 ◽

Vol 30 ◽

pp. e111-e112

Author(s):

Yasuharu Tabara ◽

Takashi Ando ◽

Yasuo Ohashi ◽

Akiko Harada ◽

Hideaki Nakagawa ◽

...

Keyword(s):

Type 2 Diabetes ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Cardiovascular Mortality ◽

Cumulative Impact

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Osteoprotegerin is a marker of cardiovascular mortality in patients with chronic kidney disease stages 3–5

Scientific Reports ◽

10.1038/s41598-021-82072-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Gustavo Lenci Marques ◽

Shirley Hayashi ◽

Anna Bjällmark ◽

Matilda Larsson ◽

Miguel Riella ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Multivariate Analysis ◽

Kidney Disease ◽

Cardiovascular Mortality ◽

Osteoclast Differentiation ◽

Survival Rates ◽

Elevated Serum ◽

High Sensitivity ◽

Intima Media Thickness

AbstractCardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD). Osteoprotegerin (OPG), known to regulate bone mass by inhibiting osteoclast differentiation and activation, might also play a role in vascular calcification. Increased circulating OPG levels in patients with CKD are associated with aortic calcification and increased mortality. We assessed the predictive role of OPG for all-cause and cardiovascular mortality in patients with CKD stages 3–5 over a 5-year follow-up period. We evaluated the relationship between OPG and all-cause and cardiovascular mortality in 145 CKD patients (stages 3–5) in a prospective observational follow-up study. Inflammation markers, including high-sensitivity C-reactive protein, standard echocardiography, and estimation of intima-media thickness in the common carotid artery, were assessed at baseline, and correlations with OPG levels were determined. The cutoff values for OPG were defined using ROC curves for cardiovascular mortality. Survival was assessed during follow up lasting for up to 5.5 years using Fine and Gray model. A total of 145 (89 men; age 58.9 ± 15.0 years) were followed up. The cutoff value for OPG determined using ROC was 10 pmol/L for general causes mortality and 10.08 pmol/L for CV causes mortality. Patients with higher serum OPG levels presented with higher mortality rates compared to patients with lower levels. Aalen–Johansen cumulative incidence curve analysis demonstrated significantly worse survival rates in individuals with higher baseline OPG levels for all-cause and cardiovascular mortality (p < 0.001). In multivariate analysis, OPG was a marker of general and cardiovascular mortality independent of sex, age, CVD, diabetes, and CRP levels. When CKD stages were included in the multivariate analysis, OPG was an independent marker of all-cause mortality but not cardiovascular mortality. Elevated serum OPG levels were associated with higher all-cause and cardiovascular mortality risk, independent of age, CVD, diabetes, and inflammatory markers, in patients with CKD.

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The Relationship Between Blood Pressure Variability And Renal Progression In Hypertensive Patients With Chronic Kidney Disease

Gevher Nesibe Journal, IESDR ◽

10.46648/gnj.270 ◽

2021 ◽

Vol 6 (14) ◽

pp. 80-88

Author(s):

Huseyin Duru ◽

Ekrem KARA

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Blood Pressure Measurement ◽

Rapid Progression ◽

Night Time ◽

Hypertensive Patients ◽

Significant Difference ◽

Renal Progression

Objective: To evaluate the effect of 24 hour systolic blood pressure (SBP) and diastolic blood pressure (DBP) variability (BPV) on renal progression in hypertensive patients with chronic kidney disease (CKD) Methods: A total 59 hypertensive patients (mean age: 54.2±14.6 years, 50.8% male) with CKD who underwent 24 hours ambulatory blood pressure measurement (ABPM) were included. Data on SBP, DBP, BPV coefficients (VC) for SBP (SBP-CV) and DBP (DBP-CV) were recorded. A decrease in e-GFR of <5 ml/min/year was considered as normal renal progression and a decrease in ≥5 ml/min/year was considered as rapid renal progression. Results: Overall, 40.6% of the patients had uncontrolled HT, while 45.8% had non-dipper pattern. Mean±SD daytime and night-time SBP and SBP-VC values were 135.3±17.9 mmHg, 128.6±23.0 mmHg, 11.7±2.8 and 9.5±3.6, respectively. Mean±SD daytime and nigh-time DBP and DBP-VC values were 84.5±13.4 mmHg, 77.2±16.1 mmHg, 13.8±3.8 and 12.0±3.7, respectively. Rapid renal progression was detected in 25.4% of patients with no significant difference in daytime, night-time and total SBP, SBP-VC, DBP and DBP-VC values between patients with rapid vs. natural renal progression. The regression analysis adjusted for age, gender, presence of DM, baseline e-GFR and dipping status revealed no significant impact of SBP-VC and DBP-VC in predicting rapid progression (p> 0.05). Conclusion: In conclusion, our finding revealed no significant association between BPV and renal progression in hypertensive patients with CKD. Larger scale prospective, randomized controlled trials with longer follow-up are needed to clarify this issue.

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B type natriuretic peptide and troponin T as independent predictors of cardiovascular mortality in predialysis patients with chronic kidney disease

Timocki medicinski glasnik ◽

10.5937/tmg1702069t ◽

2017 ◽

Vol 42 (2) ◽

pp. 69-78

Author(s):

Biserka Tirmenstajn-Jankovic ◽

Dusan Bastac ◽

Zoran Radojicic ◽

Svetlana Zikic ◽

Milenko Zivanovic

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Natriuretic Peptide ◽

Cardiovascular Mortality ◽

Troponin T

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Left Ventricular Mass Regression, All-Cause and Cardiovascular Mortality in Chronic Kidney Disease: A Meta-Analysis

10.21203/rs.3.rs-699938/v1 ◽

2021 ◽

Author(s):

Kevin C. Maki ◽

Meredith L. Wilcox ◽

Mary R. Dicklin ◽

Rahul Kakkar ◽

Michael H. Davidson

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Left Ventricular Mass ◽

Cardiovascular Mortality ◽

Meta Analysis ◽

Left Ventricular ◽

Secondary Outcome ◽

Ventricular Mass ◽

Increased Risk ◽

All Cause Mortality

Abstract Background Cardiovascular disease is an important driver of the increased mortality associated with chronic kidney disease (CKD). Higher left ventricular mass (LVM) predicts increased risk of adverse cardiovascular outcomes and total mortality, but previous reviews have shown no clear association between intervention-induced LVM change and all-cause or cardiovascular mortality in CKD. Methods The primary objective of this meta-analysis was to investigate whether treatment-induced reductions in LVM over periods ≥ 12 months were associated with all-cause mortality in patients with CKD. Cardiovascular mortality was investigated as a secondary outcome. Measures of association in the form of relative risks (RRs) with associated variability and precision (95% confidence intervals [CIs]) were extracted directly from each study, when reported, or were calculated based on the published data, if possible, and pooled RR estimates were determined. Results The meta-analysis included 38 trials with duration ≥ 12 months: 6 of erythropoietin stimulating agents treating to higher vs. lower hemoglobin targets, 10 of renin-angiotensin-aldosterone system inhibitors vs. placebo or another blood pressure lowering agent, 14 of modified hemodialysis regimens, and 8 of other types of interventions. All-cause mortality was reported in 116/2385 (4.86%) subjects in intervention groups and 161/2404 (6.70%) subjects in control groups. The pooled RR estimate of the 24 trials ≥ 12 months with ≥ 1 event in ≥ 1 group was 0.72 (95% CI 0.57 to 0.91, p = 0.005), with little heterogeneity across studies. Directionalities of the associations in intervention subgroups were the same. Sensitivity analyses of ≥ 6 months (31 trials), ≥ 9 months (26 trials), and > 12 months (9 trials), and including studies with no events in either group, demonstrated similar risk reductions to the primary analysis. The point estimate for cardiovascular mortality was similar to all-cause mortality, but not statistically significant: RR 0.66, 95% CI 0.38 to 1.15. Conclusions These results suggest that LVM regression may be a useful surrogate marker for benefits of interventions intended to reduce mortality risk in patients with CKD.

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