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Sample records for kabsorption coefficient-distribution ckd

  1. Chronic Kidney Disease (CKD)

    Science.gov (United States)

    ... CKD treated? Kidney-friendly diet for CKD What causes chronic kidney disease (CKD)? Anyone can get CKD. Some people are ... and high blood pressure are the most common causes of CKD. If you have diabetes or high blood pressure, ...

  2. Attenuation studies near K-absorption edges using Compton scattered 241Am gamma rays

    Indian Academy of Sciences (India)

    K K Abdullah; N Ramachandran; K Karunakaran Nair; B R S Babu; Antony Josephm; Rajive Thomas; K M Varier

    2008-04-01

    We have carried out photon attenuation measurements at several energies in the range from 49.38 keV to 57.96 keV around the K-absorption edges of the rare earth elements Sm, Eu, Gd, Tb, Dy and Er using 59.54 keV gamma rays from 241Am source after Compton scattering from an aluminium target. Pellets of oxides of the rare earth elements were chosen as mixture absorbers in these investigations. A narrow beam good geometry set-up was used for the attenuation measurements. The scattered gamma rays were detected by an HPGe detector. The results are consistent with theoretical values derived from the XCOM package.

  3. Sedimentation coefficient distributions of large particles.

    Science.gov (United States)

    Schuck, Peter

    2016-07-21

    The spatial and temporal evolution of concentration boundaries in sedimentation velocity analytical ultracentrifugation reports on the size distribution of particles with high hydrodynamic resolution. For large particles such as large protein complexes, fibrils, viral particles, or nanoparticles, sedimentation conditions usually allow migration from diffusion to be neglected relative to sedimentation. In this case, the shape of the sedimentation boundaries of polydisperse mixtures relates directly to the underlying size-distributions. Integral and derivative methods for calculating sedimentation coefficient distributions g*(s) of large particles from experimental boundary profiles have been developed previously, and are recapitulated here in a common theoretical framework. This leads to a previously unrecognized relationship between g*(s) and the time-derivative of concentration profiles. Of closed analytical form, it is analogous to the well-known Bridgman relationship for the radial derivative. It provides a quantitative description of the effect of substituting the time-derivative by scan differences with finite time intervals, which appears as a skewed box average of the true distribution. This helps to theoretically clarify the differences between results from time-derivative method and the approach of directly fitting the integral definition of g*(s) to the entirety of experimental boundary data.

  4. Multilayer electromechanical composites with controlled piezelectric coefficient distribution

    Science.gov (United States)

    Vartuli, James S.; Milius, David L.; Li, Xiaoping; Shih, Wan Y.; Shih, Wei-Heng; Prud'homme, Robert K.; Aksay, Ilhan A.

    1997-02-01

    We have fabricated multilayer electromechanical composites with controlled piezoelectric coefficient distributions using tape casting. Tapes of doped lead zirconate titanate were cut and stacked in accordance with their characteristic electromechanical coupling values and modulus of elasticity. This technique is an extremely versatile method to fabricate displacement actuators to fabricate monolithic ceramic parts with controlled material property gradients. To obtain a quantifiable method to optimize this type of transducer, we have devised a processing model. Given the functional distribution of the electromechanical coupling coefficient, d31, and the functional distribution of elastic modulus through the thickness of the transducer, the analysis predicts the displacement as a function of loading. The tape casting method coupled with the model provides an actuator that maximizes displacement and generated force for the given material properties.

  5. Epidemiology of hypertension in CKD.

    Science.gov (United States)

    Horowitz, Bruce; Miskulin, Dana; Zager, Philip

    2015-03-01

    Both hypertension (HTN) and CKD are serious interrelated global public health problems. Nearly 30% and 15% of US adults have HTN and CKD, respectively. Because HTN may cause or result from CKD, HTN prevalence is higher and control more difficult with worse kidney function. Etiology of CKD, presence and degree of albuminuria, and genetic factors all influence HTN severity and prevalence. In addition, socioeconomic and lifestyle factors influence HTN prevalence and control. There are racial and ethnic disparities in the prevalence, treatment, risks, and outcomes of HTN in patients with CKD. Control of blood pressure (BP) in Hispanic and African Americans with CKD is worse than it is whites. There are disparities in the patterns of treatment and rates of progression of CKD in patients with HTN. The presence and severity of CKD increase treatment resistance. HTN is also extremely prevalent in patients receiving hemodialysis, and optimal targets for BP control are being elucidated. Although the awareness, treatment, and control of HTN in CKD patients is improving, control of BP in patients at all stages of CKD remains suboptimal.

  6. [Causes and characteristics of CKD].

    Science.gov (United States)

    Moriyama, Toshiki

    2008-09-01

    Chronic kidney disease (CKD) is common in Japan and worldwide. The estimated prevalence of CKD in Japanese adults was 10.6% in 2005, based on the survey conducted by the Japanese Society of Nephrology. The most common risk factors for CKD include diabetes, hypertension and cardiovascular disease. Major outcomes of CKD include progression to kidney failure and increased risk for cardiovascular disease. CKD is usually silent until its late stages, thus many patients with CKD are detected only shortly before the onset of symptomatic kidney failure, when there are few opportunities to prevent adverse outcomes. Earlier detection allows for more time for evaluation and treatment but requires explicit testing strategies for asymptomatic individuals at increased risk. Understanding the strengths and limitations of CKD testing and risk factors of CKD is critical for appropriate management of CKD patients. The goal of this paper is to discuss CKD testing and early detection in clinical practice and its application to public health initiatives, with attention to limitations and appropriate interpretation.

  7. Dietary Patterns and CKD Progression.

    Science.gov (United States)

    Banerjee, Tanushree; Liu, Yang; Crews, Deidra C

    2016-01-01

    Chronic kidney disease (CKD) patients and their clinicians seek ways to mitigate the risk of CKD progression and its associated complications. Emerging data suggest that dietary modifications may be beneficial adjuvant approaches to reducing the risk of adverse CKD outcomes. This review focuses on several different dietary patterns, including the Dietary Approaches to Stop Hypertension and Mediterranean diets, and their kidney health benefits. We discuss how healthful dietary patterns are lower in dietary acid load and how improving diet quality may slow the progression of CKD. We also discuss some barriers that may impede socially disadvantaged individuals from following healthful diets. Dietary patterns low in dietary acid load might slow the progression of CKD. Current evidence suggests that a reduction in dietary acid load could be beneficial in patients with CKD, but the supremacy of any particular diet is yet to be established. Additional randomized controlled dietary interventions among CKD patients are needed to inform evidence-based recommendations, which can be tailored to an individual's preferences and ability to access healthful foods. © 2016 S. Karger AG, Basel.

  8. Exercise in Individuals with CKD

    OpenAIRE

    Johansen, Kirsten L.; Painter, Patricia

    2011-01-01

    There are few studies evaluating exercise in the nondialysis chronic kidney disease (CKD) population. This review covers the rationale for exercise among patients with CKD not requiring dialysis and the effects of exercise training on physical functioning, progression of kidney disease, and cardiovascular risk factors. In addition, we address the issue of the risk of exercise and make recommendations for implementation of exercise in this population.

  9. Niacin and progression of CKD.

    Science.gov (United States)

    Streja, Elani; Kovesdy, Csaba P; Streja, Dan A; Moradi, Hamid; Kalantar-Zadeh, Kamyar; Kashyap, Moti L

    2015-05-01

    Niacin is the oldest drug available for the treatment of dyslipidemia. It has been studied extensively and tested in clinical trials of atherosclerotic cardiovascular disease prevention and regression in the general population, but not specifically in patients with chronic kidney disease (CKD), who are at extremely high residual risk despite current therapy. Despite the current controversy about recent trials with niacin, including their limitations, there may be a place for this agent in select patients with CKD with dyslipidemia. Niacin has a favorable unique impact on factors affecting the rate of glomerular filtration rate decline, including high-density lipoprotein (HDL) particle number and function, triglyceride levels, oxidant stress, inflammation and endothelial function, and lowering of serum phosphorus levels by reducing dietary phosphorus absorption in the gastrointestinal tract. These effects may slow glomerular filtration rate decline and ultimately improve CKD outcomes and prevent cardiovascular risk. This review presents the clinically relevant concept that niacin holds significant potential as a renoprotective therapeutic agent. In addition, this review concludes that clinical investigations to assess the effect of niacin (in addition to aggressive low-density lipoprotein cholesterol lowering) on reduction of cardiovascular events in patients with CKD with very low HDL cholesterol (or those with identified dysfunctional HDL) and elevated triglyceride levels need to be considered seriously to address the high residual risk in this population.

  10. CKD273, a New Proteomics Classifier Assessing CKD and Its Prognosis

    Science.gov (United States)

    Argilés, Àngel; Siwy, Justyna; Duranton, Flore; Gayrard, Nathalie; Dakna, Mohammed; Lundin, Ulrika; Osaba, Lourdes; Delles, Christian; Mourad, Georges; Weinberger, Klaus M.; Mischak, Harald

    2013-01-01

    National Kidney Foundation CKD staging has allowed uniformity in studies on CKD. However, early diagnosis and predicting progression to end stage renal disease are yet to be improved. Seventy six patients with different levels of CKD, including outpatients and dialysed patients were studied for transcriptome, metabolome and proteome description. High resolution urinary proteome analysis was blindly performed in the 53 non-anuric out of the 76 CKD patients. In addition to routine clinical parameters, CKD273, a urinary proteomics-based classifier and its peptides were quantified. The baseline values were analyzed with regard to the clinical parameters and the occurrence of death or renal death during follow-up (3.6 years) as the main outcome measurements. None of the patients with CKD2730.55. Unsupervised clustering analysis of the CKD273 peptides separated the patients into two main groups differing in CKD associated parameters. Among the 273 biomarkers, peptides derived from serum proteins were relatively increased in patients with lower glomerular filtration rate, while collagen-derived peptides were relatively decreased (p<0.05; Spearman). CKD273 was different in the groups with different renal function (p<0.003). The CKD273 classifier separated CKD patients according to their renal function and informed on the likelihood of experiencing adverse outcome. Recently defined in a large population, CKD273 is the first proteomic-based classifier successfully tested for prognosis of CKD progression in an independent cohort. PMID:23690958

  11. Adaptive Zero-Coefficient Distribution Scan for Inter Block Mode Coding of H.264/AVC

    Science.gov (United States)

    Wang, Jing-Xin; Su, Alvin W. Y.

    Scanning quantized transform coefficients is an important tool for video coding. For example, the MPEG-4 video coder adopts three different scans to get better coding efficiency. This paper proposes an adaptive zero-coefficient distribution scan in inter block coding. The proposed method attempts to improve H.264/AVC zero coefficient coding by modifying the scan operation. Since the zero-coefficient distribution is changed by the proposed scan method, new VLC tables for syntax elements used in context-adaptive variable length coding (CAVLC) are also provided. The savings in bit-rate range from 2.2% to 5.1% in the high bit-rate cases, depending on different test sequences.

  12. Masked Uncontrolled Hypertension in CKD.

    Science.gov (United States)

    Agarwal, Rajiv; Pappas, Maria K; Sinha, Arjun D

    2016-03-01

    Masked uncontrolled hypertension (MUCH) is diagnosed in patients treated for hypertension who are normotensive in the clinic but hypertensive outside. In this study of 333 veterans with CKD, we prospectively evaluated the prevalence of MUCH as determined by ambulatory BP monitoring using three definitions of hypertension (daytime hypertension ≥135/85 mmHg; either nighttime hypertension ≥120/70 mmHg or daytime hypertension; and 24-hour hypertension ≥130/80 mmHg) or by home BP monitoring (hypertension ≥135/85 mmHg). The prevalence of MUCH was 26.7% by daytime ambulatory BP, 32.8% by 24-hour ambulatory BP, 56.1% by daytime or night-time ambulatory BP, and 50.8% by home BP. To assess the reproducibility of the diagnosis, we repeated these measurements after 4 weeks. Agreement in MUCH diagnosis by ambulatory BP was 75-78% (κ coefficient for agreement, 0.44-0.51), depending on the definition used. In contrast, home BP showed an agreement of only 63% and a κ coefficient of 0.25. Prevalence of MUCH increased with increasing clinic systolic BP: 2% in the 90-110 mmHg group, 17% in the 110-119 mmHg group, 34% in the 120-129 mmHg group, and 66% in the 130-139 mmHg group. Clinic BP was a good determinant of MUCH (receiver operating characteristic area under the curve 0.82; 95% confidence interval 0.76-0.87). In diagnosing MUCH, home BP was not different from clinic BP. In conclusion, among people with CKD, MUCH is common and reproducible, and should be suspected when clinic BP is in the prehypertensive range. Confirmation of MUCH diagnosis should rely on ambulatory BP monitoring.

  13. Nutrition and Physical Activity in CKD patients

    Directory of Open Access Journals (Sweden)

    Adamasco Cupisti

    2014-07-01

    Full Text Available Chronic kidney disease (CKD patients are at risk for protein-energy wasting, abnormal body composition and impaired physical capacity. These complications lead to increased risk of hospitalization, morbidity and mortality.In CKD patient as well as in healthy people, there is a close association between nutrition and physical activity. Namely, inadequate nutrient (energy intake impairs physical performance thus favoring a sedentary lifestyle: this further contributes to loss of muscle strength and mass, which limit the quality of life and rehabilitation of CKD patients. In CKD as well as in end-stage-renal-disease patients, regular physical activity coupled with adequate energy and protein intake counteracts protein-energy wasting and related comorbidity and mortality. In summary, exercise training can positively influence nutritional status and the perception of well-being of CKD patients and may facilitate the anabolic effects of nutritional interventions.

  14. Upper gastrointestinal bleeding in patients with CKD.

    Science.gov (United States)

    Liang, Chih-Chia; Wang, Su-Ming; Kuo, Huey-Liang; Chang, Chiz-Tzung; Liu, Jiung-Hsiun; Lin, Hsin-Hung; Wang, I-Kuan; Yang, Ya-Fei; Lu, Yueh-Ju; Chou, Che-Yi; Huang, Chiu-Ching

    2014-08-07

    Patients with CKD receiving maintenance dialysis are at risk for upper gastrointestinal bleeding. However, the risk of upper gastrointestinal bleeding in patients with early CKD who are not receiving dialysis is unknown. The hypothesis was that their risk of upper gastrointestinal bleeding is negatively linked to renal function. To test this hypothesis, the association between eGFR and risk of upper gastrointestinal bleeding in patients with stages 3-5 CKD who were not receiving dialysis was analyzed. Patients with stages 3-5 CKD in the CKD program from 2003 to 2009 were enrolled and prospectively followed until December of 2012 to monitor the development of upper gastrointestinal bleeding. The risk of upper gastrointestinal bleeding was analyzed using competing-risks regression with time-varying covariates. In total, 2968 patients with stages 3-5 CKD who were not receiving dialysis were followed for a median of 1.9 years. The incidence of upper gastrointestinal bleeding per 100 patient-years was 3.7 (95% confidence interval, 3.5 to 3.9) in patients with stage 3 CKD, 5.0 (95% confidence interval, 4.8 to 5.3) in patients with stage 4 CKD, and 13.9 (95% confidence interval, 13.1 to 14.8) in patients with stage 5 CKD. Higher eGFR was associated with a lower risk of upper gastrointestinal bleeding (P=0.03), with a subdistribution hazard ratio of 0.93 (95% confidence interval, 0.87 to 0.99) for every 5 ml/min per 1.73 m(2) higher eGFR. A history of upper gastrointestinal bleeding (Pupper gastrointestinal bleeding risk. In patients with CKD who are not receiving dialysis, lower renal function is associated with higher risk for upper gastrointestinal bleeding. The risk is higher in patients with previous upper gastrointestinal bleeding history and low serum albumin. Copyright © 2014 by the American Society of Nephrology.

  15. CKD and nonalcoholic fatty liver disease.

    Science.gov (United States)

    Targher, Giovanni; Chonchol, Michel B; Byrne, Christopher D

    2014-10-01

    The possible link between nonalcoholic fatty liver disease and chronic kidney disease (CKD) recently has attracted considerable scientific interest. Accumulating clinical evidence indicates that the presence and severity of nonalcoholic fatty liver disease is associated significantly with CKD (defined as decreased estimated glomerular filtration rate and/or proteinuria) and that nonalcoholic fatty liver disease predicts the development and progression of CKD, independently of traditional cardiorenal risk factors. Experimental evidence also suggests that nonalcoholic fatty liver disease itself may exacerbate systemic and hepatic insulin resistance, cause atherogenic dyslipidemia, and release a variety of proinflammatory, procoagulant, pro-oxidant, and profibrogenic mediators that play important roles in the development and progression of CKD. However, despite the growing evidence linking nonalcoholic fatty liver disease with CKD, it has not been definitively established whether a causal association exists. The clinical implication for these findings is that patients with nonalcoholic fatty liver disease may benefit from more intensive surveillance or early treatment interventions to decrease the risk of CKD. In this review, we discuss the evidence linking nonalcoholic fatty liver disease with CKD and the putative mechanisms by which nonalcoholic fatty liver disease contributes to kidney damage. We also briefly discuss current treatment options for this increasingly prevalent disease that is likely to have an important future impact on the global burden of disease.

  16. Does AKI truly lead to CKD?

    Science.gov (United States)

    Rifkin, Dena E; Coca, Steven G; Kalantar-Zadeh, Kamyar

    2012-06-01

    Acute kidney injury (AKI) has been implicated as an independent risk factor for the development of CKD in recent observational studies. The presumption in the nephrology community is that this association represents a causal relationship. However, because of potential problems related to residual confounding (shared risk factors), ascertainment bias (sicker patients have more follow-up assessments), misclassification of exposure (problems with defining baseline kidney function and AKI representing a discrete event versus progression of renal disease), and misclassification of outcome (de novo CKD versus CKD progression), it is difficult to conclude with certainty that AKI is truly causal for CKD. In this review we highlight several of the Hill causality criteria to examine the existing evidence and point out the missing elements that preclude defining AKI as a cause of CKD in the general population. Only well-designed studies with rigorous assessment of kidney function in all participants (AKI and non-AKI) before and after the episode or hospitalization or randomized, controlled trials demonstrating that prevention or treatment of AKI reduces the incidence of subsequent CKD can clarify the causal nature of the AKI-CKD relationship.

  17. Management of Gout and Hyperuricemia in CKD.

    Science.gov (United States)

    Vargas-Santos, Ana Beatriz; Neogi, Tuhina

    2017-09-01

    Hyperuricemia and gout, the clinical manifestation of monosodium urate crystal deposition, are common in patients with chronic kidney disease (CKD). Although the presence of CKD poses additional challenges in gout management, effective urate lowering is possible for most patients with CKD. Initial doses of urate-lowering therapy are lower than in the non-CKD population, whereas incremental dose escalation is guided by regular monitoring of serum urate levels to reach the target level of gout flares with presently available agents can be more challenging due to potential nephrotoxicity and/or contraindications in the setting of other common comorbid conditions. At present, asymptomatic hyperuricemia is not an indication for urate-lowering therapy, though emerging data may support a potential renoprotective effect. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  18. Epidemiology and Challenges to the Management of Advanced CKD.

    Science.gov (United States)

    Hazzan, Azzour D; Halinski, Candice; Agoritsas, Sofia; Fishbane, Steven; DeVita, Maria V

    2016-07-01

    Advanced CKD is a period of CKD that differs greatly from earlier stages of CKD in terms of treatment goals. Treatment during this period presents particular challenges as further loss of kidney function heralds the need for renal replacement therapy. Successful management during this period increases the likelihood of improved transitions to ESRD. However, there are substantial barriers to optimal advanced CKD care. In this review, we will discuss advanced CKD definitions and epidemiology and outcomes.

  19. Metabolic Acidosis of CKD: An Update.

    Science.gov (United States)

    Kraut, Jeffrey A; Madias, Nicolaos E

    2016-02-01

    The kidney has the principal role in the maintenance of acid-base balance. Therefore, a decrease in renal ammonium excretion and a positive acid balance often leading to a reduction in serum bicarbonate concentration are observed in the course of chronic kidney disease (CKD). The decrease in serum bicarbonate concentration is usually absent until glomerular filtration rate decreases to acidosis, high-anion gap acidosis, or both can be found at all stages of CKD. The acidosis can be associated with muscle wasting, bone disease, hypoalbuminemia, inflammation, progression of CKD, and increased mortality. Administration of base may decrease muscle wasting, improve bone disease, and slow the progression of CKD. Base is suggested when serum bicarbonate concentration is  24 mEq/L might be associated with worsening of cardiovascular disease adds complexity to treatment decisions. Further study of the mechanisms through which metabolic acidosis contributes to the progression of CKD, as well as the pathways involved in mediating the benefits and complications of base therapy, is warranted.

  20. A randomized trial of dietary sodium restriction in CKD

    National Research Council Canada - National Science Library

    McMahon, Emma J; Bauer, Judith D; Hawley, Carmel M; Isbel, Nicole M; Stowasser, Michael; Johnson, David W; Campbell, Katrina L

    2013-01-01

    There is a paucity of quality evidence regarding the effects of sodium restriction in patients with CKD, particularly in patients with pre-end stage CKD, where controlling modifiable risk factors may...

  1. Defective skeletal mineralization in pediatric CKD.

    Science.gov (United States)

    Wesseling-Perry, Katherine

    2015-04-01

    Although traditional diagnosis and treatment of renal osteodystrophy focused on changes in bone turnover, current data demonstrate that abnormalities in skeletal mineralization are also prevalent in pediatric chronic kidney disease (CKD) and likely contribute to skeletal morbidities that continue to plague this population. It is now clear that alterations in osteocyte biology, manifested by changes in osteocytic protein expression, occur in early CKD before abnormalities in traditional measures of mineral metabolism are apparent and may contribute to defective skeletal mineralization. Current treatment paradigms advocate the use of 1,25(OH)2vitamin D for the control of secondary hyperparathyroidism; however, these agents fail to correct defective skeletal mineralization and may exacerbate already altered osteocyte biology. Further studies are critically needed to identify the initial trigger for abnormalities of skeletal mineralization as well as the potential effects that current therapeutic options may have on osteocyte biology and bone mineralization.

  2. Pharmacologic Issues in treating hypertension in CKD.

    Science.gov (United States)

    Sica, Domenic A

    2011-01-01

    Antihypertensive drugs are prescribed to patients with CKD to slow down the rate of loss of residual kidney function; to reduce proteinuria, when present; and to protect other target organs from damage that is mediated by elevated blood pressure (BP). In most patients, a diuretic and a renin system blocking drug, such as an angiotensin-converting enzyme inhibitor, angiotensin receptor antagonist, or an aldosterone receptor antagonist are used. Often, 3 or more drugs are needed to achieve BP goals. Many drugs are eliminated through the kidney and in some cases dosage reductions are advisable to avoid adverse effects from high levels of medication. This article will review the various classes of antihypertensive drugs used in the management of high BP in patients with CKD, with an emphasis on pitfalls that arise when kidney function is impaired. 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  3. Urinary Sodium and Potassium Excretion and CKD Progression.

    Science.gov (United States)

    He, Jiang; Mills, Katherine T; Appel, Lawrence J; Yang, Wei; Chen, Jing; Lee, Belinda T; Rosas, Sylvia E; Porter, Anna; Makos, Gail; Weir, Matthew R; Hamm, L Lee; Kusek, John W

    2016-04-01

    CKD is a major risk factor for ESRD, cardiovascular disease, and premature death. Whether dietary sodium and potassium intake affect CKD progression remains unclear. We prospectively studied the association of urinary sodium and potassium excretion with CKD progression and all-cause mortality among 3939 patients with CKD in the Chronic Renal Insufficiency Cohort Study. Urinary sodium and potassium excretion were measured using three 24-hour urine specimens, and CKD progression was defined as incident ESRD or halving of eGFR. During follow-up, 939 CKD progression events and 540 deaths occurred. Compared with the lowest quartile of urinary sodium excretion (CKD progression, 1.45 (1.08 to 1.95) for all-cause mortality, and 1.43 (1.18 to 1.73) for the composite outcome of CKD progression and all-cause mortality after adjusting for multiple covariates, including baseline eGFR. Additionally, compared with the lowest quartile of urinary potassium excretion (CKD progression, 0.98 (0.71 to 1.35) for all-cause mortality, and 1.42 (1.15 to 1.74) for the composite outcome. These data indicate that high urinary sodium and potassium excretion are associated with increased risk of CKD progression. Clinical trials are warranted to test the effect of sodium and potassium reduction on CKD progression.

  4. A randomized trial of dietary sodium restriction in CKD.

    Science.gov (United States)

    McMahon, Emma J; Bauer, Judith D; Hawley, Carmel M; Isbel, Nicole M; Stowasser, Michael; Johnson, David W; Campbell, Katrina L

    2013-12-01

    There is a paucity of quality evidence regarding the effects of sodium restriction in patients with CKD, particularly in patients with pre-end stage CKD, where controlling modifiable risk factors may be especially important for delaying CKD progression and cardiovascular events. We conducted a double-blind placebo-controlled randomized crossover trial assessing the effects of high versus low sodium intake on ambulatory BP, 24-hour protein and albumin excretion, fluid status (body composition monitor), renin and aldosterone levels, and arterial stiffness (pulse wave velocity and augmentation index) in 20 adult patients with hypertensive stage 3-4 CKD as phase 1 of the LowSALT CKD study. Overall, salt restriction resulted in statistically significant and clinically important reductions in BP (mean reduction of systolic/diastolic BP, 10/4 mm Hg; 95% confidence interval, 5 to 15 /1 to 6 mm Hg), extracellular fluid volume, albuminuria, and proteinuria in patients with moderate-to-severe CKD. The magnitude of change was more pronounced than the magnitude reported in patients without CKD, suggesting that patients with CKD are particularly salt sensitive. Although studies with longer intervention times and larger sample sizes are needed to confirm these benefits, this study indicates that sodium restriction should be emphasized in the management of patients with CKD as a means to reduce cardiovascular risk and risk for CKD progression.

  5. Retarding chronic kidney disease (CKD progression: a practical nutritional approach for non-dialysis CKD

    Directory of Open Access Journals (Sweden)

    Vincenzo Bellizzi

    2016-10-01

    Full Text Available This is a case report on a patient with non-dialysis chronic kidney disease (CKD in whom several nutritional issues are briefly discussed from a practical point of view. The article is accompanied by an editorial published in this Journal in relation to the 2nd International Conference of the European Renal Nutrition working group at ERA-EDTA—“Retarding CKD progression: readily available through comprehensive nutritional management?”—and focuses on several practical topics associated with the nutritional approach for the conservative treatment of non-dialysis CKD. The article is divided into 3 sections—basic nutritional assessment, nutritional targets, and nutritional follow-up in non-dialysis CKD—linked to 3 consecutive steps of the clinical follow-up of the patient and the related nutritional concerns and intervention. First visit: Baseline nutritional assessment and basic nutritional considerations in non-dialysis chronic kidney disease (CKD • What nutritional assessment/monitoring for protein-energy wasting (PEW should be employed? • Is a body mass index (BMI of 21 kg/m2 adequate? • What phosphate target should be pursued? • What are the nutritional habits in patients with incident CKD? • What protein needs and amount of dietary protein should be pursued? • Does the quality of protein matter? • What amount of dietary salt should be employed? How should this be obtained? • How should normal serum phosphate be achieved? • What diet should be recommended? Is a vegetarian diet an option? Second visit: Major nutritional targets in non-dialysis CKD • Consequences of unintentional weight loss • What is the role of the renal dietitian in helping the patient adhere to a renal diet? Intermediate visits: Nutritional follow-up in non-dialysis CKD • What treatment for calcium/parathyroid hormone (PTH will affect CKD progression? Final visits: • Would a dietary recall/intensive dietary education improve adherence with

  6. CKD-induced wingless/integration1 inhibitors and phosphorus cause the CKD-mineral and bone disorder.

    Science.gov (United States)

    Fang, Yifu; Ginsberg, Charles; Seifert, Michael; Agapova, Olga; Sugatani, Toshifumi; Register, Thomas C; Freedman, Barry I; Monier-Faugere, Marie-Claude; Malluche, Hartmut; Hruska, Keith A

    2014-08-01

    In chronic kidney disease, vascular calcification, renal osteodystrophy, and phosphate contribute substantially to cardiovascular risk and are components of CKD-mineral and bone disorder (CKD-MBD). The cause of this syndrome is unknown. Additionally, no therapy addresses cardiovascular risk in CKD. In its inception, CKD-MBD is characterized by osteodystrophy, vascular calcification, and stimulation of osteocyte secretion. We tested the hypothesis that increased production of circulating factors by diseased kidneys causes the CKD-MBD in diabetic mice subjected to renal injury to induce stage 2 CKD (CKD-2 mice). Compared with non-CKD diabetic controls, CKD-2 mice showed increased renal production of Wnt inhibitor family members and higher levels of circulating Dickkopf-1 (Dkk1), sclerostin, and secreted klotho. Neutralization of Dkk1 in CKD-2 mice by administration of a monoclonal antibody after renal injury stimulated bone formation rates, corrected the osteodystrophy, and prevented CKD-stimulated vascular calcification. Mechanistically, neutralization of Dkk1 suppressed aortic expression of the osteoblastic transcription factor Runx2, increased expression of vascular smooth muscle protein 22-α, and restored aortic expression of klotho. Neutralization of Dkk1 did not affect the elevated plasma levels of osteocytic fibroblast growth factor 23 but decreased the elevated levels of sclerostin. Phosphate binder therapy restored plasma fibroblast growth factor 23 levels but had no effect on vascular calcification or osteodystrophy. The combination of the Dkk1 antibody and phosphate binder therapy completely treated the CKD-MBD. These results show that circulating Wnt inhibitors are involved in the pathogenesis of CKD-MBD and that the combination of Dkk1 neutralization and phosphate binding may have therapeutic potential for this disorder.

  7. [Treatment of CKD-MBD targeting the parathyroid gland].

    Science.gov (United States)

    Isozaki, Yudai; Komaba, Hirotaka

    2016-06-01

    Secondary hyperparathyroidism is a major component of chronic kidney disease-mineral and bone disorder (CKD-MBD) and has a considerable impact on morbidity and mortality through the development of high-turnover bone disease and vascular calcification. Thus, management of secondary hyperparathyroidism is important for improving the outcomes of CKD patients. Because there is a fundamental difference in the pathogenesis of secondary hyperparathyroidism between predialysis and dialysis patients, different therapeutic approach should be considered for each condition. In this article, we summarize the treatment of CKD-MBD for managing secondary hyperparathyroidism, with a particular focus on the difference between predialysis and dialysis stages of CKD.

  8. CKD of Uncertain Etiology: A Systematic Review.

    Science.gov (United States)

    Lunyera, Joseph; Mohottige, Dinushika; Von Isenburg, Megan; Jeuland, Marc; Patel, Uptal D; Stanifer, John W

    2016-03-07

    Epidemics of CKD of uncertain etiology (CKDu) are emerging around the world. Highlighting common risk factors for CKD of uncertain etiology across various regions and populations may be important for health policy and public health responses. We searched PubMed, Embase, Scopus and Web of Science databases to identify published studies on CKDu. The search was generated in January of 2015; no language or date limits were used. We used a vote-counting method to evaluate exposures across all studies. We identified 1607 articles, of which 26 met inclusion criteria. Eighteen (69%) were conducted in known CKDu-endemic countries: Sri Lanka (38%), Nicaragua (19%), and El Salvador (12%). The other studies were from India, Japan, Australia, Mexico, Sweden, Tunisia, Tanzania, and the United States. Heavy metals, heat stress, and dietary exposures were reported across all geographic regions. In south Asia, family history, agrochemical use, and heavy metal exposures were reported most frequently, whereas altitude and temperature were reported only in studies from Central America. Across all regions, CKDu was most frequently associated with a family history of CKDu, agricultural occupation, men, middle age, snake bite, and heavy metal exposure. Studies examining etiologies of CKDu have reported many exposures that are heterogeneous and vary by region. To identify etiologies of CKDu, designing consistent and comparative multisite studies across high-risk populations may help elucidate the importance of region-specific versus global risk factors. Copyright © 2016 by the American Society of Nephrology.

  9. CKD-MBD: an endless story.

    Science.gov (United States)

    Brancaccio, Diego; Cozzolino, Mario

    2011-01-01

    Renal failure is a growing problem that involves a large part of the population and has a great social impact, with often incapacitating complications, mainly related to mineral bone disorders (MBD) and cardiovascular diseases. Analysis of the recent scientific literature confirms that a large number of chronic kidney disease (CKD) patients develop an early derangement of the parameters of Ca-P metabolism in which phosphate homeostasis and a reduced endogenous synthesis of calcitriol play a critical role. Recent findings from several large observational studies have also suggested that the benefits of vitamin D receptor activators may extend beyond the traditional parathyroid hormone-lowering effect, and could result in direct cardiovascular and metabolic benefits. Treatment of secondary hyperparathyroidism has become even more complex with the arrival of the calcium-sensing receptor agonist cinacalcet hydrochloride and with the uncovering of novel mechanisms responsible for secondary hyperparathyroidism. The aim of this review is the analysis of some of the recent contributions in the field of CKD-MBD, to update the understanding of the pathogenetic mechanisms and possibly the most appropriate therapeutic approach in this field.

  10. Simultaneous reconstruction of emission activity and attenuation coefficient distribution from TOF data, acquired with external transmission source.

    Science.gov (United States)

    Panin, V Y; Aykac, M; Casey, M E

    2013-06-07

    The simultaneous PET data reconstruction of emission activity and attenuation coefficient distribution is presented, where the attenuation image is constrained by exploiting an external transmission source. Data are acquired in time-of-flight (TOF) mode, allowing in principle for separation of emission and transmission data. Nevertheless, here all data are reconstructed at once, eliminating the need to trace the position of the transmission source in sinogram space. Contamination of emission data by the transmission source and vice versa is naturally modeled. Attenuated emission activity data also provide additional information about object attenuation coefficient values. The algorithm alternates between attenuation and emission activity image updates. We also proposed a method of estimation of spatial scatter distribution from the transmission source by incorporating knowledge about the expected range of attenuation map values. The reconstruction of experimental data from the Siemens mCT scanner suggests that simultaneous reconstruction improves attenuation map image quality, as compared to when data are separated. In the presented example, the attenuation map image noise was reduced and non-uniformity artifacts that occurred due to scatter estimation were suppressed. On the other hand, the use of transmission data stabilizes attenuation coefficient distribution reconstruction from TOF emission data alone. The example of improving emission images by refining a CT-based patient attenuation map is presented, revealing potential benefits of simultaneous CT and PET data reconstruction.

  11. Secondary flow and heat transfer coefficient distributions in the developing flow region of ribbed turbine blade cooling passages

    Science.gov (United States)

    Forsyth, Peter; McGilvray, Matthew; Gillespie, David R. H.

    2017-01-01

    This paper reports an experimental and numerical study of the development and coupling of aerodynamic flows and heat transfer within a model ribbed internal cooling passage to provide insight into the development of secondary flows. Static instrumentation was installed at the end of a long smooth passage and used to measure local flow features in a series of experiments where ribs were incrementally added upstream. This improves test turnaround time and allows higher-resolution heat transfer coefficient distributions to be captured, using a hybrid transient liquid crystal technique. A composite heat transfer coefficient distribution for a 12-rib-pitch passage is reported: notably the behaviour is dominated by the development of the secondary flow in the passage throughout. Both the aerodynamic and heat transfer test data were compared to numerical simulations developed using a commercial computational fluid dynamics solver. By conducting a number of simulations it was possible to interrogate the validity of the underlying assumptions of the experimental strategy; their validity is discussed. The results capture the developing size and strength of the vortical structures in secondary flow. The local flow field was shown to be strongly coupled to the enhancement of heat transfer coefficient. Comparison of the experimental and numerical data generally shows excellent agreement in the level of heat transfer coefficient predicted, though the numerical simulations fail to capture some local enhancement on both the ribbed and smooth surfaces. Where this was the case, the coupled flow and heat transfer measurements were able to identify missing velocity field characteristics.

  12. Uric Acid as a Target of Therapy in CKD

    Science.gov (United States)

    Jalal, Diana I.; Chonchol, Michel; Chen, Wei; Targher, Giovanni

    2012-01-01

    The prevalence of chronic kidney disease (CKD) has risen and will continue to rise in the United States and worldwide. This is alarming considering that CKD remains an irreversible condition and patients who progress to chronic kidney failure suffer reduced quality of life and high mortality rates. As such, it is imperative to identify modifiable risk factors to develop strategies to slow CKD progression. One such factor is hyperuricemia. Recent observational studies have associated hyperuricemia with kidney disease. In addition, hyperuricemia is largely prevalent in patients with CKD. Data from experimental studies have revealed several potential mechanisms by which hyperuricemia may contribute to the development and progression of CKD. In this manuscript we offer a critical review of the experimental evidence linking hyperuricemia to CKD, we highlight the gaps in our knowledge on the topic as it stands today, and we review the observational and interventional studies that have examined the potential nephro-protective effect of lowering uric acid in CKD patients . While uric acid may also be linked to cardiovascular disease and mortality in patients with CKD, this review will focus only on uric acid as a potential therapeutic target to prevent kidney disease onset and progression. PMID:23058478

  13. Epidemiology of CKD Regression in Patients under Nephrology Care.

    Science.gov (United States)

    Borrelli, Silvio; Leonardis, Daniela; Minutolo, Roberto; Chiodini, Paolo; De Nicola, Luca; Esposito, Ciro; Mallamaci, Francesca; Zoccali, Carmine; Conte, Giuseppe

    2015-01-01

    Chronic Kidney Disease (CKD) regression is considered as an infrequent renal outcome, limited to early stages, and associated with higher mortality. However, prevalence, prognosis and the clinical correlates of CKD regression remain undefined in the setting of nephrology care. This is a multicenter prospective study in 1418 patients with established CKD (eGFR: 60-15 ml/min/1.73m²) under nephrology care in 47 outpatient clinics in Italy from a least one year. We defined CKD regressors as a ΔGFR ≥0 ml/min/1.73 m2/year. ΔGFR was estimated as the absolute difference between eGFR measured at baseline and at follow up visit after 18-24 months, respectively. Outcomes were End Stage Renal Disease (ESRD) and overall-causes Mortality.391 patients (27.6%) were identified as regressors as they showed an eGFR increase between the baseline visit in the renal clinic and the follow up visit. In multivariate regression analyses the regressor status was not associated with CKD stage. Low proteinuria was the main factor associated with CKD regression, accounting per se for 48% of the likelihood of this outcome. Lower systolic blood pressure, higher BMI and absence of autosomal polycystic disease (PKD) were additional predictors of CKD regression. In regressors, ESRD risk was 72% lower (HR: 0.28; 95% CI 0.14-0.57; pCKD stage. CKD regression occurs in about one-fourth patients receiving renal care in nephrology units and correlates with low proteinuria, BP and the absence of PKD. This condition portends better renal prognosis, mostly in earlier CKD stages, with no excess risk for mortality.

  14. Quality of Life and Outcomes in African Americans with CKD

    Science.gov (United States)

    Fischer, Michael J.; Wang, Xuelei; Brooks, Deborah; Bruce, Marino; Charleston, Jeanne; Cleveland, William H.; Dowie, Donna; Faulkner, Marquetta; Gassman, Jennifer; Hiremath, Leena; Kendrick, Cindy; Kusek, John W.; Norris, Keith C.; Thornley-Brown, Denyse; Greene, Tom; Lash, James P.

    2014-01-01

    Low health-related quality of life (HRQOL) has been associated with increased risk for hospitalization and death in ESRD. However, the relationship of HRQOL with outcomes in predialysis CKD is not well understood. We evaluated the association between HRQOL and renal and cardiovascular (CV) outcomes in 1091 African Americans with hypertensive CKD enrolled in the African American Study of Kidney Disease and Hypertension (AASK) trial and cohort studies. Outcomes included CKD progression (doubling of serum creatinine/ESRD), CV events/CV death, and a composite of CKD progression or death from any cause (CKD progression/death). We assessed HRQOL, including mental health composite (MHC) and physical health composite (PHC), using the Short Form-36 survey. Cox regression analyses were used to assess the relationship between outcomes and five-point decrements in MHC and PHC scores using measurements at baseline, at the most recent annual visit (time-varying), or averaged from baseline to the most recent visit (cumulative). During approximately 10 years of follow-up, lower mean PHC score was associated with increased risk of CV events/CV death and CKD progression/death across all analytic approaches, but only time-varying and cumulative decrements were associated with CKD progression. Similarly, lower mean MHC score was associated with increased risk of CV events/CV death regardless of analytic approach, while only time-varying and cumulative decrements in mean MHC score was associated with CKD progression and CKD progression or death. In conclusion, lower HRQOL is associated with a range of adverse outcomes in African Americans with hypertensive CKD. PMID:24700865

  15. Arterial and Cellular Inflammation in Patients with CKD.

    Science.gov (United States)

    Bernelot Moens, Sophie J; Verweij, Simone L; van der Valk, Fleur M; van Capelleveen, Julian C; Kroon, Jeffrey; Versloot, Miranda; Verberne, Hein J; Marquering, Henk A; Duivenvoorden, Raphaël; Vogt, Liffert; Stroes, Erik S G

    2017-04-01

    CKD associates with a 1.5- to 3.5-fold increased risk for cardiovascular disease. Both diseases are characterized by increased inflammation, and in patients with CKD, elevated C-reactive protein level predicts cardiovascular risk. In addition to systemic inflammation, local arterial inflammation, driven by monocyte-derived macrophages, predicts future cardiovascular events in the general population. We hypothesized that subjects with CKD have increased arterial and cellular inflammation, reflected by (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography computed tomography (PET/CT) of the arterial wall and a migratory phenotype of monocytes. We assessed (18)F-FDG uptake in the arterial wall in 14 patients with CKD (mean±SD age: 59±5 years, mean±SD eGFR: 37±12 ml/min per 1.73 m(2)) but without cardiovascular diseases, diabetes, or inflammatory conditions and in 14 control subjects (mean age: 60±11 years, mean eGFR: 86±16 ml/min per 1.73 m(2)). Compared with controls, patients with CKD showed increased arterial inflammation, quantified as target-to-background ratio (TBR) in the aorta (TBRmax: CKD, 3.14±0.70 versus control, 2.12±0.27; P=0.001) and the carotid arteries (TBRmax: CKD, 2.45±0.65 versus control, 1.66±0.27; Pinflammation, observed in patients with CKD but without overt atherosclerotic disease and with few traditional risk factors, may contribute to the increased cardiovascular risk associated with CKD. The concomitant elevation of monocyte activity may provide novel therapeutic targets for attenuating this inflammation and thereby preventing CKD-associated cardiovascular disease. Copyright © 2017 by the American Society of Nephrology.

  16. Heat transfer coefficient distribution over the inconel plate cooled from high temperature by the array of water jets

    Science.gov (United States)

    Malinowski, Z.; Telejko, T.; Cebo-Rudnicka, A.; Szajding, A.; Rywotycki, M.; Hadała, B.

    2016-09-01

    The industrial rolling mills are equipped with systems for controlled water cooling of hot steel products. A cooling rate affects the final mechanical properties of steel which are strongly dependent on microstructure evolution processes. In case of water jets cooling the heat transfer boundary condition can be defined by the heat transfer coefficient. In the present study one and three dimensional heat conduction models have been employed in the inverse solution to heat transfer coefficient. The inconel plate has been heated to about 900oC and then cooled by one, two and six water jets. The plate temperature has been measured by 30 thermocouples. The heat transfer coefficient distributions at plate surface have been determined in time of cooling.

  17. Management of hypertension in CKD: beyond the guidelines.

    Science.gov (United States)

    Judd, Eric; Calhoun, David A

    2015-03-01

    Hypertension (HTN) and CKD are closely associated with an intermingled cause and effect relationship. Blood pressure (BP) typically rises with declines in kidney function, and sustained elevations in BP hasten progression of kidney disease. This review addresses current management issues in HTN in patients with CKD including altered circadian rhythm of BP, timing of antihypertensive medication dosing, BP targets, diagnostic challenges in evaluating secondary forms of HTN, and the role of salt restriction in CKD. HTN in patients with CKD is often accompanied by a decrease in the kidney's ability to remove salt. Addressing this salt sensitivity is critical for the management of HTN in CKD. In addition to the well-established use of an ACEI or angiotensin receptor blocker, dietary salt restriction and appropriate diuretic therapy make up the mainstay of HTN treatment in patients with CKD. Bedtime dosing of antihypertensive medications can restore nocturnal dips in BP, and future clinical practice guidelines may recommend bedtime dosing of 1 or more antihypertensive medications in patients with CKD.

  18. Bisphophonates in CKD Patients with Low Bone Mineral Density

    Directory of Open Access Journals (Sweden)

    Wen-Chih Liu

    2013-01-01

    Full Text Available Patients with chronic kidney disease-mineral and bone disorder (CKD-MBD have a high risk of bone fracture because of low bone mineral density and poor bone quality. Osteoporosis also features low bone mass, disarranged microarchitecture, and skeletal fragility, and differentiating between osteoporosis and CKD-MBD in low bone mineral density is a challenge and usually achieved by bone biopsy. Bisphosphonates can be safe and beneficial for patients with a glomerular filtration rate of 30 mL/min or higher, but prescribing bisphosphonates in advanced CKD requires caution because of the increased possibility of low bone turnover disorders such as osteomalacia, mixed uremic osteodystrophy, and adynamic bone, even aggravating hyperparathyroidism. Therefore, bone biopsy in advanced CKD is an important consideration before prescribing bisphosphonates. Treatment also may induce hypocalcemia in CKD patients with secondary hyperparathyroidism, but vitamin D supplementation may ameliorate this effect. Bisphosphonate treatment can improve both bone mineral density and vascular calcification, but the latter becomes more unlikely in patients with stage 3-4 CKD with vascular calcification but no decreased bone mineral density. Using bisphosphonates requires considerable caution in advanced CKD, and the lack of adequate clinical investigation necessitates more studies regarding its effects on these patients.

  19. Modification of diet in renal disease (MDRD study and CKD epidemiology collaboration (CKD-EPI equations for Taiwanese adults.

    Directory of Open Access Journals (Sweden)

    Ling-I Chen

    Full Text Available Estimated glomerular filtration rate (eGFR using the Modification of Diet in Renal Disease (MDRD study or the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI equations may not be accurate for Asians; thus, we developed modified eGFR equations for Taiwanese adults.This cross-sectional study compared the Taiwanese eGFR equations, the MDRD study, and the CKD-EPI equations with inulin clearance (Cin. A total of 695 adults including 259 healthy volunteers and 436 CKD patients were recruited. Participants from the Kaohsiung Medical University Hospital were used as the development set (N = 556 to develop the Taiwanese eGFR equations, whereas participants from the National Taiwan University Hospital were used as the validation set (N = 139 for external validation.The Taiwanese eGFR equations were developed by using the extended Bland-Altman plot in the development set. The Taiwanese MDRD equation was 1.309 × MDRD0.912, Taiwanese CKD-EPI was 1.262×CKD-EPI0.914 and Taiwanese four-level CKD-EPI was 1.205 × four-level CKD-EPI0.914. In the validation set, the Taiwanese equations had the lowest bias, the Taiwanese equations and the Japanese CKD-EPI equation had the lowest RMSE, whereas the Taiwanese and the Japanese equations had the best precision and the highest P30 among all equations. However, the Taiwanese MDRD equation had higher concordance correlation than did the Taiwanese CKD-EPI, the Taiwanese four-level CKD-EPI and the Japanese equations. Moreover, only the Taiwanese equations had no proportional bias among all of the equations. Finally, the Taiwanese MDRD equation had the best diagnostic performance in terms of ordinal logistic regression among all of the equations.The Taiwanese MDRD equation is better than the MDRD, CKD-EPI, Japanese, Asian, Thai, Taiwanese CKD-EPI, and Taiwanese four-level CKD-EPI equations for Taiwanese adults.

  20. Effects of dietary interventions on incidence and progression of CKD.

    Science.gov (United States)

    Jain, Nishank; Reilly, Robert F

    2014-12-01

    Traditional strategies for management of patients with chronic kidney disease (CKD) have not resulted in any change in the growing prevalence of CKD worldwide. A historic belief that eating healthily might ameliorate kidney disease still holds credibility in the 21(st) century. Dietary sodium restriction to dietary net acid load could be beneficial in patients with CKD, but the supremacy of any particular diet has yet to be established. More trials of dietary interventions are needed, especially in diabetic nephropathy, before evidence-based recommendations can be made. In the meantime, nephrologists should discuss healthy dietary habits with their patients and provide individualized care aimed at maximizing the potential benefits of dietary intervention, reducing the incidence of CKD and delaying its progression to end-stage renal disease. Keeping in mind the lack of data on hard outcomes, dietary recommendations should take into account barriers to adherence and be tailored to different cultures, ethnicities and geographical locations.

  1. Approach to the Treatment of Chronic Metabolic Acidosis in CKD.

    Science.gov (United States)

    Raphael, Kalani L

    2016-04-01

    Chronic metabolic acidosis is not uncommon in patients with chronic kidney disease (CKD). Clinical practice guidelines suggest that clinicians administer alkali to maintain serum bicarbonate level at a minimum of 22 mEq/L to prevent the effects of acidosis on bone demineralization and protein catabolism. Small interventional studies support the notion that correcting acidosis slows CKD progression as well. Furthermore, alkaline therapy in persons with CKD and normal bicarbonate levels may also preserve kidney function. Observational studies suggest that targeting a serum bicarbonate level near 28 mEq/L may improve clinical outcomes above and beyond targeting a value ≥ 22 mEq/L, yet values > 26 mEq/L have been reported to be associated with incident heart failure and mortality in the CRIC (Chronic Renal Insufficiency Cohort) Study. Furthermore, correcting acidosis may provoke vascular calcification. This teaching case discusses several uncertainties regarding the management of acidosis in CKD, such as when to initiate alkali treatment, potential side effects of alkali, and the optimum serum bicarbonate level based on current evidence in CKD. Suggestions regarding the maximum sodium bicarbonate dose to administer to patients with CKD to achieve the target serum bicarbonate concentration are offered.

  2. Epidemiology of CKD Regression in Patients under Nephrology Care.

    Directory of Open Access Journals (Sweden)

    Silvio Borrelli

    Full Text Available Chronic Kidney Disease (CKD regression is considered as an infrequent renal outcome, limited to early stages, and associated with higher mortality. However, prevalence, prognosis and the clinical correlates of CKD regression remain undefined in the setting of nephrology care. This is a multicenter prospective study in 1418 patients with established CKD (eGFR: 60-15 ml/min/1.73m² under nephrology care in 47 outpatient clinics in Italy from a least one year. We defined CKD regressors as a ΔGFR ≥0 ml/min/1.73 m2/year. ΔGFR was estimated as the absolute difference between eGFR measured at baseline and at follow up visit after 18-24 months, respectively. Outcomes were End Stage Renal Disease (ESRD and overall-causes Mortality.391 patients (27.6% were identified as regressors as they showed an eGFR increase between the baseline visit in the renal clinic and the follow up visit. In multivariate regression analyses the regressor status was not associated with CKD stage. Low proteinuria was the main factor associated with CKD regression, accounting per se for 48% of the likelihood of this outcome. Lower systolic blood pressure, higher BMI and absence of autosomal polycystic disease (PKD were additional predictors of CKD regression. In regressors, ESRD risk was 72% lower (HR: 0.28; 95% CI 0.14-0.57; p<0.0001 while mortality risk did not differ from that in non-regressors (HR: 1.16; 95% CI 0.73-1.83; p = 0.540. Spline models showed that the reduction of ESRD risk associated with positive ΔGFR was attenuated in advanced CKD stage. CKD regression occurs in about one-fourth patients receiving renal care in nephrology units and correlates with low proteinuria, BP and the absence of PKD. This condition portends better renal prognosis, mostly in earlier CKD stages, with no excess risk for mortality.

  3. Cause-Specific Deaths in Non-Dialysis-Dependent CKD.

    Science.gov (United States)

    Navaneethan, Sankar D; Schold, Jesse D; Arrigain, Susana; Jolly, Stacey E; Nally, Joseph V

    2015-10-01

    CKD is associated with higher risk of death, but details regarding differences in cause-specific death in CKD are unclear. We examined the leading causes of death among a non-dialysis-dependent CKD population using an electronic medical record-based CKD registry in a large healthcare system and the Ohio Department of Health mortality files. We included 33,478 white and 5042 black patients with CKD who resided in Ohio between January 2005 and September 2009 and had two measurements of eGFRCauses of death (before ESRD) were classified into cardiovascular, malignancy, and non-cardiovascular/non-malignancy diseases and non-disease-related causes. During a median follow-up of 2.3 years, 6661 of 38,520 patients (17%) with CKD died. Cardiovascular diseases (34.7%) and malignant neoplasms (31.8%) were the leading causes of death, with malignancy-related deaths more common among those with earlier stages of kidney disease. After adjusting for covariates, each 5 ml/min per 1.73 m(2) decline in eGFR was associated with higher risk of death due to cardiovascular disease (hazard ratio [HR], 1.10; 95% confidence interval [95% CI], 1.08 to 1.12) and non-cardiovascular/non-malignancy diseases (HR, 1.12; 95% CI, 1.09 to 1.14) but not to malignancy. In the adjusted models, blacks had overall-mortality hazard ratios similar to those of whites but higher hazard ratios for cardiovascular deaths. Further studies to confirm these findings and explain the mechanisms for differences are warranted. In addition to lowering cardiovascular burden in CKD, efforts to target known risk factors for cancer at the population level are needed.

  4. [Clinicopathological study of chronic kidney diseases (CKD)].

    Science.gov (United States)

    Yoshida, Haruyoshi

    2012-02-01

    up-to-date information and techniques in clinical nephrology. From this hospital, I published a paper in Kidney International entitled, "Mesangiolytic glomerulopathy in severe congestive heart failure", based on the autopsy cases collected at the Pathology Department. This paper became a milestone in starting to study the role of chronic hypoxia in CKD. In 1999, I was elected as a professor of the Department of Clinical Laboratories, Faculty of Medicine, University of Fukui. In Fukui, I could extend my hypoxia study to cellular levels and diabetic mouse experiments in collaboration with Dr. Kimura, Dr. Li, Dr. Takahashi and many other doctors and technicians. When overviewing my research history, I realize that I was fortunate to be involved at the starting point of every laboratory with energetic mood and that I was supported and helped by many people.

  5. The Role of Physical Activity in the CKD Setting

    Directory of Open Access Journals (Sweden)

    Filippo Aucella

    2014-07-01

    Full Text Available A sedentary lifestyle contributes to the development of cardiovascular disease, hypertension, diabetes and probably cancer in the general population; this cluster of disease may be defined the diseasome of physical inactivity. Also in CKD/ESRD patients physical activity is strikingly low. As a result of growing evidence suggestive of cardiovascular benefit among the CKD population with exercise, the National Kidney Foundation recommended counseling by nephrologists to increase patients' levels of physical activity in their guideline about management of cardiovascular disease. Therefore, to maintain the well-being and functional capacity of renal patients attention should be directed toward maintaining strength and aerobic fitness as well as focusing on renal function and anemia or other comorbidities. All CKD/ESRD patients should be counseled and regularly encouraged by nephrology and dialysis staff to increase their level of physical activity.

  6. Risk Prediction in CKD: The Rational Alignment of Health Care Resources in CKD 4/5 Care.

    Science.gov (United States)

    Wojciechowski, Peter; Tangri, Navdeep; Rigatto, Claudio; Komenda, Paul

    2016-07-01

    CKD is a well-recognized global epidemic with consequences on patient morbidity, mortality, and health care resources. In the United States and Canada, a financial premium is often paid to programs and providers for caring for patients with Stage 4 to 5 CKD (not on dialysis) and is justified by the intensive care required by these patients, particularly in preparation for dialysis. About half of all patients with CKD Stages 3 and 4 never progress to kidney failure, and more than a quarter of them have stable kidney function for years. Among patients with Stage 3 CKD, even fewer progresses to kidney failure but small subpopulations with certain characteristics (eg, younger age, higher levels of proteinuria) have a more predictable trajectory. Clearly, a more robust method of screening patients for nephrology referral and subsequent enrollment into multidisciplinary clinics is needed to provide better efficiency within the health care system. The Kidney Failure Risk Equation is a generalizable CKD risk prediction model that has been externally validated and allows for the efficient risk-based triaging of nephrology referrals with a significant benefit to decreasing wait times. It is also efficiently used in a multidisciplinary kidney disease clinic with aiding timing in modality planning and frequency of follow-ups. The overall potential benefit of this system should allow for appropriate allocation of human resources to those at highest risk to yield optimal care in the most cost-effective manner to the health care system.

  7. Chronic kidney disease (CKD) special interest group (SIG) networking session.

    Science.gov (United States)

    Campoy, Sally

    2005-01-01

    The issue of reimbursement for NP is not an issue in the VA system, although it can be a barrier for the private sector. How to make this cost-effective was discussed during the networking session and will continue to be explored. The nephrology nurse is in a key position to participate in CKD clinics/programs. By virtue of his/her nursing expertise in assessment, incorporation of psychosocial factors, and patient education, the nurse can play a pivotal role in successful management of persons with CKD.

  8. Genomics in CKD: Is This the Path Forward?

    Science.gov (United States)

    Nadkarni, Girish N; Horowitz, Carol R

    2016-03-01

    Recent advances in genomics and sequencing technology have led to a better understanding of genetic risk in CKD. Genetics could account in part for racial differences in treatment response for medications including antihypertensives and immunosuppressive medications due to its correlation with ancestry. However, there is still a substantial lag between generation of this knowledge and its adoption in routine clinical care. This review summarizes the recent advances in genomics and CKD, discusses potential reasons for its underutilization, and highlights potential avenues for application of genomic information to improve clinical care and outcomes in this particularly vulnerable population.

  9. Protein: Tips for People with Chronic Kidney Disease (CKD)

    Science.gov (United States)

    ... grits, cereals l Pasta, noodles, rice l Rice milk (not enriched) Why Is Protein Important for People with CKD? When your body ... Dairy foods: A portion is ½ cup of milk or yogurt, or one slice of cheese. ■ Plant proteins should make up the rest of the protein ...

  10. Glycemic management in ESRD and earlier stages of CKD.

    Science.gov (United States)

    Williams, Mark E; Garg, Rajesh

    2014-02-01

    The management of hyperglycemia in patients with kidney failure is complex, and the goals and methods regarding glycemic control in chronic kidney disease (CKD) are not clearly defined. Although aggressive glycemic control seems to be advantageous in early diabetic nephropathy, outcome data supporting tight glycemic control in patients with advanced CKD (including end-stage renal disease [ESRD]) are lacking. Challenges in the management of such patients include therapeutic inertia, monitoring difficulties, and the complexity of available treatments. In this article, we review the alterations in glucose homeostasis that occur in kidney failure, current views on the value of glycemic control and issues with its determination, and more recent approaches to monitor or measure glycemic control. Hypoglycemia and treatment options for patients with diabetes and ESRD or earlier stages of CKD also are addressed, discussing the insulin and noninsulin agents that currently are available, along with their indications and contraindications. The article provides information to help clinicians in decision making in order to provide individualized glycemic goals and appropriate therapy for patients with ESRD or earlier stages of CKD.

  11. Relating illness complexity to reimbursement in CKD patients

    Directory of Open Access Journals (Sweden)

    Bessette RW

    2011-09-01

    Full Text Available Russell W Bessette1, Randy L Carter2,3 1Department of Health Sciences, Institute for Healthcare Informatics, 2Department of Biostatistics, 3Population Health Observatory, University at Buffalo, State University of New York, Buffalo, NY, USA Background: Despite significant investments of federal and state dollars to transition patient medical records to an all-electronic system, a chasm still exists between health care quality and payment for it. A major reason for this gap is the difficulty in evaluating health care outcomes based on claims data. Since both payers and patients may not appreciate how illness complexity impacts treatment outcomes, it is difficult to determine fair provider compensation. Objectives: Chronic kidney disease (CKD typifies these problems and is often associated with comorbidities that impact cost, health, and work productivity. Thus, the objective of this study was to evaluate an illness complexity score (ICS based on a linear regression of select blood values that might assist in predicting average monthly reimbursements in CKD patients. A second objective was to compare the results of this ICS prediction to results obtained by prediction of average monthly reimbursement using CKD stage. A third objective was to analyze the relationship between the change in ICS, estimated glomerular filtration rate (eGFR, and CKD stage over time to average monthly reimbursement. Methods: We calculated parsimonious values for select variables associated with CKD patients and compared the ICS to ordinal staging of renal disease. Data from 177 de-identified patients over 13 months was collected, which included 15 blood chemistry observations along with complete claims data for all medical expenses. To test for the relationship between average blood chemistry values, stages of CKD, age, and average monthly reimbursement, we modeled an association through a linear regression function of age, eGFR, and the Z-scores calculated from average

  12. Bone mass and microarchitecture in CKD patients with fracture.

    Science.gov (United States)

    Nickolas, Thomas L; Stein, Emily; Cohen, Adi; Thomas, Valerie; Staron, Ronald B; McMahon, Donald J; Leonard, Mary B; Shane, Elizabeth

    2010-08-01

    Patients with predialysis chronic kidney disease (CKD) have increased risk for fracture, but the structural mechanisms underlying this increased skeletal fragility are unknown. We measured areal bone mineral density (aBMD) by dual-energy x-ray absorptiometry at the spine, hip, and radius, and we measured volumetric BMD (vBMD), geometry, and microarchitecture by high-resolution peripheral quantitative computed tomography (HR-pQCT) at the radius and tibia in patients with CKD: 32 with fracture and 59 without fracture. Patients with fracture had lower aBMD at the spine, total hip, femoral neck, and the ultradistal radius, the last having the strongest association with fracture. By HR-pQCT of the radius, patients with fracture had lower cortical area and thickness, total and trabecular vBMD, and trabecular number and greater trabecular separation and network heterogeneity. At the tibia, patients with fracture had significantly lower cortical area, thickness, and total and cortical density. Total vBMD at both radius and tibia most strongly associated with fracture. By receiver operator characteristic curve analysis, patients with longer duration of CKD had area under the curve of >0.75 for aBMD at both hip sites and the ultradistal radius, vBMD and geometry at the radius and tibia, and microarchitecture at the tibia. In summary, patients with predialysis CKD and fractures have lower aBMD by dual-energy x-ray absorptiometry and lower vBMD, thinner cortices, and trabecular loss by HR-pQCT. These density and structural differences may underlie the increased susceptibility to fracture among patients with CKD.

  13. Progression of CKD form pre-dialysis : natural course, risk factors, and outcomes

    NARCIS (Netherlands)

    Appeldoorn- de Jager, Dina Jezina (Dinanda) van

    2012-01-01

    Chronic kidney disease (CKD) is a progressive disease associated with increased morbidity and mortality. Different therapeutic interventions in the course of CKD are shown to be effective in slowing or preventing disease progression. This thesis focused on the progression of CKD from pre-dialysis to

  14. Conservation laws and self-consistent sources for a super-CKdV equation hierarchy

    Energy Technology Data Exchange (ETDEWEB)

    Li Li, E-mail: li07099@163.co [College of Maths and Systematic Science, Shenyang Normal University, Shenyang 110034 (China)

    2011-03-14

    From the super-matrix Lie algebras, we consider a super-extension of the CKdV equation hierarchy in the present Letter, and propose the super-CKdV hierarchy with self-consistent sources. Furthermore, we establish the infinitely many conservation laws for the integrable super-CKdV hierarchy.

  15. Placental Growth Factor as a Predictor of Cardiovascular Events in Patients with CKD from the NARA-CKD Study.

    Science.gov (United States)

    Matsui, Masaru; Uemura, Shiro; Takeda, Yukiji; Samejima, Ken-Ichi; Matsumoto, Takaki; Hasegawa, Ayako; Tsushima, Hideo; Hoshino, Ei; Ueda, Tomoya; Morimoto, Katsuhiko; Okamoto, Keisuke; Okada, Sadanori; Onoue, Kenji; Okayama, Satoshi; Kawata, Hiroyuki; Kawakami, Rika; Maruyama, Naoki; Akai, Yasuhiro; Iwano, Masayuki; Shiiki, Hideo; Saito, Yoshihiko

    2015-11-01

    Placental growth factor (PlGF) contributes to atherogenesis through vascular inflammation and plaque destabilization. High levels of PlGF may be associated with mortality and cardiovascular disease, but the relationship between PlGF level and adverse outcomes in patients with CKD is unclear. We conducted a prospective cohort study of 1351 consecutive participants with CKD enrolled in the Novel Assessment of Risk management for Atherosclerotic diseases in CKD (NARA-CKD) study between April 1, 2004, and December 31, 2011. During a median follow-up of 3 years, 199 participants died and 383 had cardiovascular events, defined as atherosclerotic disease or heart failure requiring hospitalization. In adjusted analyses, mortality and cardiovascular risk increased in each successive quartile of serum PlGF level; hazard ratios (HRs) (95% confidence intervals [95% CIs]) for mortality and cardiovascular risk, respectively, were 1.59 (0.83 to 3.16) and 1.55 (0.92 to 2.66) for the second quartile, 2.97 (1.67 to 5.59) and 3.39 (2.20 to 5.41) for the third quartile, and 3.87 (2.24 to 7.08) and 8.42 (5.54 to 13.3) for the fourth quartile. The composite end point of mortality and cardiovascular events occurred during the study period in 76.4% of patients in both the highest PlGF quartile (≥19.6 pg/ml) and the lowest eGFR tertile (cause mortality and cardiovascular events in patients with CKD.

  16. Timing of onset of CKD-related metabolic complications.

    Science.gov (United States)

    Moranne, Olivier; Froissart, Marc; Rossert, Jerome; Gauci, Cedric; Boffa, Jean-Jacques; Haymann, Jean Philippe; M'rad, Mona Ben; Jacquot, Christian; Houillier, Pascal; Stengel, Benedicte; Fouqueray, Bruno

    2009-01-01

    Chronic kidney disease (CKD) guidelines recommend evaluating patients with GFR acidosis from 2 to 39%, and hyperkalemia from 2 to 42%. Factors most strongly associated with metabolic complications, independent of mGFR, were younger age for acidosis and hyperphosphatemia, presence of diabetes for acidosis, diabetic kidney disease for anemia, and both male gender and the use of inhibitors of the renin-angiotensin system for hyperkalemia. mGFR thresholds for detecting complications with 90% sensitivity were 50, 44, 40, 39, and 37 ml/min per 1.73 m(2) for hyperparathyroidism, anemia, acidosis, hyperkalemia, and hyperphosphatemia, respectively. Analysis using estimated GFR produced similar results. In summary, this study describes the onset of CKD-related complications at different levels of GFR; anemia and hyperparathyroidism occur earlier than acidosis, hyperkalemia, and hyperphosphatemia.

  17. Prevalence, Predictors, and Outcomes of Pulmonary Hypertension in CKD.

    Science.gov (United States)

    Navaneethan, Sankar D; Roy, Jason; Tao, Kelvin; Brecklin, Carolyn S; Chen, Jing; Deo, Rajat; Flack, John M; Ojo, Akinlolu O; Plappert, Theodore J; Raj, Dominic S; Saydain, Ghulam; Sondheimer, James H; Sood, Ruchi; Steigerwalt, Susan P; Townsend, Raymond R; Dweik, Raed A; Rahman, Mahboob

    2016-03-01

    Pulmonary hypertension (PH) is associated with poor outcomes in the dialysis and general populations, but its effect in CKD is unclear. We evaluated the prevalence and predictors of PH measures and their associations with long-term clinical outcomes in patients with nondialysis-dependent CKD. Chronic Renal Insufficiency Cohort (CRIC) Study participants who had Doppler echocardiography performed were considered for inclusion. PH was defined as the presence of estimated pulmonary artery systolic pressure (PASP) >35 mmHg and/or tricuspid regurgitant velocity (TRV) >2.5 m/s. Associations between PH, PASP, and TRV and cardiovascular events, renal events, and all-cause mortality were examined using Cox proportional hazards models. Of 2959 eligible participants, 21% (n=625) had PH, with higher rates among those with lower levels of kidney function. In the multivariate model, older age, anemia, lower left ventricular ejection fraction, and presence of left ventricular hypertrophy were associated with greater odds of having PH. After adjusting for relevant confounding variables, PH was independently associated with higher risk for death (hazard ratio, 1.38; 95% confidence interval, 1.10 to 1.72) and cardiovascular events (hazard ratio, 1.23; 95% confidence interval, 1.00 to 1.52) but not renal events. Similarly, TRV and PASP were associated with death and cardiovascular events but not renal events. In this study of patients with CKD and preserved left ventricular systolic function, we report a high prevalence of PH. PH and higher TRV and PASP (echocardiographic measures of PH) are associated with adverse outcomes in CKD. Future studies may explain the mechanisms that underlie these findings. Copyright © 2016 by the American Society of Nephrology.

  18. Nurse practitioner care improves renal outcome in patients with CKD.

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    Peeters, Mieke J; van Zuilen, Arjan D; van den Brand, Jan A J G; Bots, Michiel L; van Buren, Marjolijn; Ten Dam, Marc A G J; Kaasjager, Karin A H; Ligtenberg, Gerry; Sijpkens, Yvo W J; Sluiter, Henk E; van de Ven, Peter J G; Vervoort, Gerald; Vleming, Louis-Jean; Blankestijn, Peter J; Wetzels, Jack F M

    2014-02-01

    Treatment goals for patients with CKD are often unrealized for many reasons, but support by nurse practitioners may improve risk factor levels in these patients. Here, we analyzed renal endpoints of the Multifactorial Approach and Superior Treatment Efficacy in Renal Patients with the Aid of Nurse Practitioners (MASTERPLAN) study after extended follow-up to determine whether strict implementation of current CKD guidelines through the aid of nurse practitioners improves renal outcome. In total, 788 patients with moderate to severe CKD were randomized to receive nurse practitioner support added to physician care (intervention group) or physician care alone (control group). Median follow-up was 5.7 years. Renal outcome was a secondary endpoint of the MASTERPLAN study. We used a composite renal endpoint of death, ESRD, and 50% increase in serum creatinine. Event rates were compared with adjustment for baseline serum creatinine concentration and changes in estimated GFR were determined. During the randomized phase, there were small but significant differences between the groups in BP, proteinuria, LDL cholesterol, and use of aspirin, statins, active vitamin D, and antihypertensive medications, in favor of the intervention group. The intervention reduced the incidence of the composite renal endpoint by 20% (hazard ratio, 0.80; 95% confidence interval, 0.66 to 0.98; P=0.03). In the intervention group, the decrease in estimated GFR was 0.45 ml/min per 1.73 m(2) per year less than in the control group (P=0.01). In conclusion, additional support by nurse practitioners attenuated the decline of kidney function and improved renal outcome in patients with CKD.

  19. [Kidney Disease and Laboratory Examinations--Opening Remarks: For Better Understanding of CKD].

    Science.gov (United States)

    Yoshida, Haruyoshi; Wada, Takashi

    2015-02-01

    Chronic kidney diseases (CKD) have been cited as major risk factors not only for endstage renal failure, but also for the development of cardiovascular diseases and death. In the former criteria for CKD diagnosis (NKF K/DOQI, 2002), estimation of the severity of CKD was simply based on GFR, in order for it to be widely and easily understood by general physicians and patients. Therefore, the use of the CKD guideline without information on the causes and grades of albuminuria was limited for estimation of the prognosis. The revised guideline for CKD diagnosis (KDIGO CKD guideline 2012), with the disease category specified for diabetes mellitus and the different scoring system of microalbuminuria, is presently being effectively utilized by nephrologists as well as general physicians. In this symposium, to advice understanding of the causes and evaluation methods of CKD, speakers were invited to discuss topics in kidney pathology, urine sample examination, urinary biomarkers, and GFR.

  20. Marijuana and Cannabinoids in ESRD and Earlier Stages of CKD.

    Science.gov (United States)

    Rein, Joshua L; Wyatt, Christina M

    2017-08-12

    Marijuana is the most commonly used recreational drug in the United States, and legal recreational and medicinal use has gained public acceptance during the last decade. Twenty-nine US states have established medical marijuana programs, 8 of which have also legalized recreational marijuana, and Canada is expected to legalize recreational marijuana in 2018. Advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) are chronic conditions with significant associated morbidity and mortality. Patients experience substantial symptom burden that is frequently undertreated due to adverse medication side effects. This article reviews the available evidence for the use of medical marijuana to manage chronic pain, nausea/vomiting, anorexia/cachexia, and pruritus, all of which are frequently reported by patients with advanced CKD or ESRD. Potential adverse health effects of medical and recreational marijuana use are also discussed. Regardless of personal, social, and political beliefs, marijuana use is becoming mainstream, and nephrologists should be aware of the potential impact on our patient population. Further research is warranted to investigate the renal endocannabinoid system, the impact of marijuana use on kidney disease outcomes, and the risks and benefits of medical marijuana use on symptoms of advanced CKD and ESRD. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  1. Skin Sodium Concentration Correlates with Left Ventricular Hypertrophy in CKD.

    Science.gov (United States)

    Schneider, Markus P; Raff, Ulrike; Kopp, Christoph; Scheppach, Johannes B; Toncar, Sebastian; Wanner, Christoph; Schlieper, Georg; Saritas, Turgay; Floege, Jürgen; Schmid, Matthias; Birukov, Anna; Dahlmann, Anke; Linz, Peter; Janka, Rolf; Uder, Michael; Schmieder, Roland E; Titze, Jens M; Eckardt, Kai-Uwe

    2017-06-01

    The pathogenesis of left ventricular hypertrophy in patients with CKD is incompletely understood. Sodium intake, which is usually assessed by measuring urinary sodium excretion, has been inconsistently linked with left ventricular hypertrophy. However, tissues such as skin and muscle may store sodium. Using (23)sodium-magnetic resonance imaging, a technique recently developed for the assessment of tissue sodium content in humans, we determined skin sodium content at the level of the calf in 99 patients with mild to moderate CKD (42 women; median [range] age, 65 [23-78] years). We also assessed total body overhydration (bioimpedance spectroscopy), 24-hour BP, and left ventricular mass (cardiac magnetic resonance imaging). Skin sodium content, but not total body overhydration, correlated with systolic BP (r=0.33, P=0.002). Moreover, skin sodium content correlated more strongly than total body overhydration did with left ventricular mass (r=0.56, Pskin sodium content is a strong explanatory variable for left ventricular mass, unaffected by BP and total body overhydration. In conclusion, we found skin sodium content to be closely linked to left ventricular mass in patients with CKD. Interventions that reduce skin sodium content might improve cardiovascular outcomes in these patients. Copyright © 2017 by the American Society of Nephrology.

  2. CKD-EPI方程估算肾小球滤过率的评价%Assessment of CKD-EPI equation for estimating glomerular filtration rate

    Institute of Scientific and Technical Information of China (English)

    王宏斌; 夏先考; 吴建华

    2011-01-01

    Objective To compare the applicability of CKD-EPI equation with MDRD equation in predicting glomerular filtration rate(GFR)in patients with chronic kidney disease(CKD) and healthy controls, and the relative risk factor of the decrease of GFR was analyzed by CKD-EPI equation. Methods GFR of 91 cases of hospitalized patients with CKD and 198 cases of healthy controls were estimated by CKD-FPI and MDRD equation respectively[denoted as GFR( CKD-EPI) and GFR( MDRD) ]. Correlation and consistency between GFR (CKD-FPI) and GFR ( MDRD) were analyzed by Person correlation analysis and Bland-Altman analytic process. CKD stage of subj ects was assessed according to GFR( MDRD) . Scr, GFR( MDRD) and GFR(CKDEPI) of each stage were compared. Correlation between GFR(CKD-FPI) and other items were also analyzed. Results There was no significant difference of age,Scr,GFR(MDRD)and GFR(CKDEPI) between male an female group(P<O. 05). There was fine correlation between GFR ( MDRD) and GFR( CKD-FPI) [GFR( MDRD) = 0. 944×GFR( CKD-FPI) +0. 612 , r2 = 0. 960 ( P<O. 001) ]. BlandAltman analytic process indicated that there was fine consistency between GFR( MDRD) and GFR(CKD-EPI). All subjects were classified into 5 CKD stages according to GFR(MDRD). Compared with GFR( MDRD) ,.mean of GFR(CKD-EPI) in CKD Ⅰ、 Ⅱ、Ⅲ stage increased 0. 15,7. 34 and l. 60 mL. min-1 . (1. 73 m2 )-1 respectively, mean of GFR(CKD-FPI) in CKD Ⅳ、Ⅴ stage decreased 0. 25 and 0. 41 mL. min-1 ( 1. 73 m2) -1 respectively. GFR ( CKD-EPI) was negatively correlative to age , systolic blood pressure ( SBP) , diastolic blood pressure( DBP) ,serum creatinine( Scr) , serum uric acid( SUA) , fasting blood glucose( FBG) , urine protein( UP) and urine protein-to-creatinine ratio( UP/Ucr) , was positively correlative to total cholesterol( TC) and urine uric acid ( P<O. 05) , but was not correlative to gender and triglyceride(P>O. 05). Conclusion The application of CKD-FPI equation to estimate GFR could reduce

  3. [Kidney and bone update : the 5-year history and future of CKD-MBD. Disorders of musculoskeletal system in CKD ; bone fracture and periarticular calcification].

    Science.gov (United States)

    Yamada, Shunsuke; Taniguchi, Masatomo

    2012-07-01

    Chronic kidney disease-mineral and bone disorder (CKD-MBD) affects life expectancy through vascular calcification, and impairs patient's activity of daily living (ADL) and quality of life (QOL) through bone fracture and periarticular calcification. In CKD patients, vitamin D deficiency and secondary hyperparathyroidism impairs bone strength, and muscle dysfunction related to vitamin D deficiency also causes easy fall, leading to the high risk of bone fracture. Bone fracture not only aggravates ADL and QOL but increases the risk of mortality. Periarticular calcification such as tumoral calcinosis in relation to CKD-MBD causes restricted range of articular motion, leading to the deterioration of patient's ADL and QOL. Because bone fragility and tumoral calcinosis occurs in relation to CKD-MBD, the appropriate management of CKD-MBD is madatory.

  4. Chronic Kidney Disease Japan Cohort (CKD-JAC) study: design and methods.

    Science.gov (United States)

    Imai, Enyu; Matsuo, Seiichi; Makino, Hirofumi; Watanabe, Tsuyoshi; Akizawa, Tadao; Nitta, Kosaku; Iimuro, Satoshi; Ohashi, Yasuo; Hishida, Akira

    2008-06-01

    The prevalence and incidence of end-stage renal disease (ESRD) in Japan are the highest and the third highest, respectively, in the world, while the incidence of cardiac death in Japan is the lowest among developed countries. A recent study showed that the prevalence of chronic kidney disease (CKD), defined as an estimated glomerular filtration rate (GFR) of less than 60 mL/min/1.73 m(2), is extremely high in Japan, about 20% of the adult population. However, the risk of ESRD and cardiovascular disease (CVD) in the CKD population has not been determined nationwide. For this observational study, we will establish a Chronic Kidney Disease Japan Cohort (CKD-JAC) by enrolling 3,000 patients with CKD in 17 clinical centers around Japan, which will be used to determine the incidence of ESRD and CVD in Japanese CKD patients. Risk factors associated with the development of CVD will also be examined. Comorbidity of diabetes in CKD patients will be analyzed to determine whether it is a risk for rapid progression of CKD and high incidence of CVD. In addition, we will study whether the burden of CKD decreases the QOL of patients, and increases hospitalization or health resource utilization. Insights from the CKD-JAC study will provide a basis for future interventional trials focused on reducing the burden of ESRD and CVD in patients with CKD in Japan.

  5. Homocysteine and C-Reactive Protein as Useful Surrogate Markers for Evaluating CKD Risk in Adults

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    Chung-Hsun Chuang

    2013-10-01

    Full Text Available Background/Aims: This study aimed to evaluate the effectiveness of homocysteine and C-reactive protein (CRP as potential markers for chronic kidney disease (CKD in adults in Taiwan, and to identify associations between these factors and CKD, stratifying by gender. Methods: This cross-sectional study analyzed multi-center data retrospectively. Data were collected from 22,043 adult Taiwanese at Chang-Gung Memorial Hospital from 2005 to 2011. Smoking/drinking history, personal medical/medication history, pregnancy, fasting times as well as laboratory parameters, including homocysteine and CRP were measured and analyzed. Results: Significant differences were observed between four homocysteine and CRP quartiles in eGFR and CKD. For males, only one model showed significant associations between plasma homocysteine and CKD, while in females, all three models showed significant associations with CKD. On the contrary, the gender difference in the case of CRP was opposite. Combined homocysteine and CRP were associated with CKD in males but not in females. Conclusion: Among Taiwanese adults, plasma homocysteine is associated with CKD in females and plasma hsCRP is associated with CKD in males. High hsCRP/high homocysteine is associated with elevated CKD risk in male. Our results suggest that homocysteine and hsCRP may be useful surrogate markers for evaluating CKD risk in adults.

  6. The chronic kidney disease - Mineral bone disorder (CKD-MBD): Advances in pathophysiology.

    Science.gov (United States)

    Hruska, Keith A; Sugatani, Toshifumi; Agapova, Olga; Fang, Yifu

    2017-01-21

    The causes of excess cardiovascular mortality associated with chronic kidney disease (CKD) have been attributed in part to the CKD-mineral bone disorder syndrome (CKD-MBD), wherein, novel cardiovascular risk factors have been identified. New advances in the causes of the CKD-MBD are discussed in this review. They demonstrate that repair and disease processes in the kidneys release factors to the circulation that cause the systemic complications of CKD. The discovery of WNT inhibitors, especially Dickkopf 1 (Dkk1), produced during renal repair as participating in the pathogenesis of the vascular and skeletal components of the CKD-MBD implied that additional pathogenic factors are critical. This lead to the discovery that activin A is a second renal repair factor circulating in increased levels during CKD. Activin A derives from peritubular myofibroblasts of diseased kidneys, wherein it stimulates fibrosis, and decreases tubular klotho expression. Activin A binds to the type 2 activin A receptor, ActRIIA, which is variably affected by CKD in the vasculature. In diabetic/atherosclerotic aortas, specifically in vascular smooth muscle cells (VSMC), ActRIIA signaling is inhibited and contributes to CKD induced VSMC dedifferentiation, osteogenic transition and neointimal atherosclerotic calcification. In nondiabetic/nonatherosclerotic aortas, CKD increases VSMC ActRIIA signaling, and vascular fibroblast signaling causing the latter to undergo osteogenic transition and stimulate vascular calcification. In both vascular situations, a ligand trap for ActRIIA prevented vascular calcification. In the skeleton, activin A is responsible for CKD stimulation of osteoclastogenesis and bone remodeling increasing bone turnover. These studies demonstrate that circulating renal repair and injury factors are causal of the CKD-MBD and CKD associated cardiovascular disease.

  7. CKD hotspots around the world: where, why and what the lessons are. A CKJ review series.

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    Martín-Cleary, Catalina; Ortiz, Alberto

    2014-12-01

    Chronic kidney disease (CKD) is one of the three causes of death that has had the highest increase in the last 20 years. The increasing CKD burden occurs in the context of lack of access of most of the world population to adequate healthcare and an incomplete understanding of the pathogenesis of CKD. However, CKD is not homogeneously distributed. CKD hotspots are defined as countries, region, communities or ethnicities with higher than average incidence of CKD. Analysis of CKD hotspots has the potential to provide valuable insights into the pathogenesis of kidney disease and to improve the life expectancy of the affected communities. Examples include ethnicities such as African Americans in the USA or Aboriginals in Australia, regions such as certain Balkan valleys or Central America and even groups of people sharing common activities or interests such as young women trying to lose weight in Belgium. The study of these CKD hotspots has identified underlying genetic factors, such as ApoL1 gene variants, environmental toxins, such as aristolochic acid and socioeconomic factors leading to nutritional deprivation and inflammation/infection. The CKD hotspots series of CKJ reviews will explore the epidemiology and causes in CKD hotspots, beginning with Australian Aboriginals in this issue. An online map of CKD hotspots around the world will feature the reviewed hotspots, highlighting known or suspected causes as well as ongoing projects to unravel the cause and providing a directory of public health officials, physicians and basic scientists involved in these efforts. Since the high prevalence of CKD in a particular region or population may only be known to local physicians, we encourage readers to propose further CKD hotspots to be reviewed.

  8. Integrative biology identifies shared transcriptional networks in CKD.

    Science.gov (United States)

    Martini, Sebastian; Nair, Viji; Keller, Benjamin J; Eichinger, Felix; Hawkins, Jennifer J; Randolph, Ann; Böger, Carsten A; Gadegbeku, Crystal A; Fox, Caroline S; Cohen, Clemens D; Kretzler, Matthias

    2014-11-01

    A previous meta-analysis of genome-wide association data by the Cohorts for Heart and Aging Research in Genomic Epidemiology and CKDGen consortia identified 16 loci associated with eGFR. To define how each of these single-nucleotide polymorphisms (SNPs) could affect renal function, we integrated GFR-associated loci with regulatory pathways, producing a molecular map of CKD. In kidney biopsy specimens from 157 European subjects representing nine different CKDs, renal transcript levels for 18 genes in proximity to the SNPs significantly correlated with GFR. These 18 genes were mapped into their biologic context by testing coregulated transcripts for enriched pathways. A network of 97 pathways linked by shared genes was constructed and characterized. Of these pathways, 56 pathways were reported previously to be associated with CKD; 41 pathways without prior association with CKD were ranked on the basis of the number of candidate genes connected to the respective pathways. All pathways aggregated into a network of two main clusters comprising inflammation- and metabolism-related pathways, with the NRF2-mediated oxidative stress response pathway serving as the hub between the two clusters. In all, 78 pathways and 95% of the connections among those pathways were verified in an independent North American biopsy cohort. Disease-specific analyses showed that most pathways are shared between sets of three diseases, with closest interconnection between lupus nephritis, IgA nephritis, and diabetic nephropathy. Taken together, the network integrates candidate genes from genome-wide association studies into their functional context, revealing interactions and defining established and novel biologic mechanisms of renal impairment in renal diseases.

  9. Medication Adherence and Growth in Children with CKD

    Science.gov (United States)

    Schneider, Michael F.; Mulqueen, Lucy; Brooks, Ellen R.; Langman, Craig B.; Greenbaum, Larry A.; Furth, Susan L.; Moxey-Mims, Marva; Warady, Bradley A.; Kaskel, Frederick J.; Skversky, Amy L.

    2014-01-01

    Background and objectives Poor growth is a consequence of CKD, but can often be partially or fully prevented or corrected with the use of a number of medications. The extent of nonadherence with medications used to treat or mitigate growth failure in CKD has not been examined prospectively in children with CKD. Design, setting, participants, & measurements The prevalence of both prescription of and nonadherence to recombinant human growth hormone (rhGH), phosphate binders, alkali, active vitamin D, nutritional vitamin D, iron, and erythrocyte-stimulating agents was summarized over the first seven visits of the Chronic Kidney Disease in Children cohort study. The association between self-reported nonadherence to each medication group and the mean annual change in age- and sex-specific height z score was quantified using seven separate linear regression models with generalized estimating equations. Results Of 834 participants, 597 reported use of at least one of these medication groups and had adherence data available. Nonadherence ranged from 4% over all visits for erythrocyte-stimulating agents to 22% over all visits for nutritional vitamin D. Of the study participants, 451 contributed data to at least one of the analyses of adherence and changes in height z score. Children nonadherent to rhGH had no change in height z score, whereas those adherent to rhGH had a significant improvement of 0.16 SDs (95% confidence interval, 0.05 to 0.27); the effect size was slightly larger and remained significant after adjustment. Among participants with height≤3rd percentile and after adjustment, adherence to rhGH was associated with a 0.33 SD (95% confidence interval, 0.10 to 0.56) greater change in height z score. Nonadherence with other medication groups was not significantly associated with a change in height z score. Conclusions Self-reported nonadherence to rhGH was associated with poorer growth velocity in children with CKD, suggesting an opportunity for intervention and

  10. Diagnosis and Prediction of CKD Progression by Assessment of Urinary Peptides

    Science.gov (United States)

    Schanstra, Joost P.; Alkhalaf, Alaa; Argiles, Angel; Bakker, Stephan J.L.; Beige, Joachim; Bilo, Henk J.G.; Chatzikyrkou, Christos; Dakna, Mohammed; Dawson, Jesse; Delles, Christian; Haller, Hermann; Haubitz, Marion; Husi, Holger; Jankowski, Joachim; Jerums, George; Kleefstra, Nanne; Kuznetsova, Tatiana; Maahs, David M.; Menne, Jan; Mullen, William; Ortiz, Alberto; Persson, Frederik; Rossing, Peter; Ruggenenti, Piero; Rychlik, Ivan; Serra, Andreas L.; Siwy, Justyna; Snell-Bergeon, Janet; Spasovski, Goce; Staessen, Jan A.; Vlahou, Antonia; Mischak, Harald; Vanholder, Raymond

    2015-01-01

    Progressive CKD is generally detected at a late stage by a sustained decline in eGFR and/or the presence of significant albuminuria. With the aim of early and improved risk stratification of patients with CKD, we studied urinary peptides in a large cross-sectional multicenter cohort of 1990 individuals, including 522 with follow-up data, using proteome analysis. We validated that a previously established multipeptide urinary biomarker classifier performed significantly better in detecting and predicting progression of CKD than the current clinical standard, urinary albumin. The classifier was also more sensitive for identifying patients with rapidly progressing CKD. Compared with the combination of baseline eGFR and albuminuria (area under the curve [AUC]=0.758), the addition of the multipeptide biomarker classifier significantly improved CKD risk prediction (AUC=0.831) as assessed by the net reclassification index (0.303±−0.065; P<0.001) and integrated discrimination improvement (0.058±0.014; P<0.001). Correlation of individual urinary peptides with CKD stage and progression showed that the peptides that associated with CKD, irrespective of CKD stage or CKD progression, were either fragments of the major circulating proteins, suggesting failure of the glomerular filtration barrier sieving properties, or different collagen fragments, suggesting accumulation of intrarenal extracellular matrix. Furthermore, protein fragments associated with progression of CKD originated mostly from proteins related to inflammation and tissue repair. Results of this study suggest that urinary proteome analysis might significantly improve the current state of the art of CKD detection and outcome prediction and that identification of the urinary peptides allows insight into various ongoing pathophysiologic processes in CKD. PMID:25589610

  11. Assessing physical function and physical activity in patients with CKD.

    Science.gov (United States)

    Painter, Patricia; Marcus, Robin L

    2013-05-01

    Patients with CKD are characterized by low levels of physical functioning, which, along with low physical activity, predict poor outcomes in those treated with dialysis. The hallmark of clinical care in geriatric practice and geriatric research is the orientation to and assessment of physical function and functional limitations. Although there is increasing interest in physical function and physical activity in patients with CKD, the nephrology field has not focused on this aspect of care. This paper provides an in-depth review of the measurement of physical function and physical activity. It focuses on physiologic impairments and physical performance limitations (impaired mobility and functional limitations). The review is based on established frameworks of physical impairment and functional limitations that have guided research in physical function in the aging population. Definitions and measures for physiologic impairments, physical performance limitations, self-reported function, and physical activity are presented. On the basis of the information presented, recommendations for incorporating routine assessment of physical function and encouragement for physical activity in clinical care are provided.

  12. Analysis of the spatial layer discrete cosine transform coefficient distribution and its application to rate model for H.264/SVC encoder

    Directory of Open Access Journals (Sweden)

    Szu-Wei Lee

    2014-03-01

    Full Text Available Knowledge of the discrete cosine transform coefficient distribution (DCT-DIST is important for the encoder design. For example, rate control relies on this knowledge to estimate a possible bit rate and then decide proper coding parameters before the actual encoding task is performed. Therefore the rate control performance is fairly dependent on how accurately the DCT-DIST is modelled. The spatial enhancement layer (SL DCT-DIST for H.264 scalable video coding (SVC is studied in this Letter. SL DCT-DIST knowledge is furthermore used to derive a novel rate model. Our results can help design a proper rate control module for the H.264/SVC encoder.

  13. Older Patients' Perspectives on Managing Complexity in CKD Self-Management.

    Science.gov (United States)

    Bowling, C Barrett; Vandenberg, Ann E; Phillips, Lawrence S; McClellan, William M; Johnson, Theodore M; Echt, Katharina V

    2017-04-03

    Patients with CKD are asked to perform self-management tasks including dietary changes, adhering to medications, avoiding nephrotoxic drugs, and self-monitoring hypertension and diabetes. Given the effect of aging on functional capacity, self-management may be especially challenging for older patients. However, little is known about the specific challenges older adults face maintaining CKD self-management regimens. We conducted an exploratory qualitative study designed to understand the relationship among factors facilitating or impeding CKD self-management in older adults. Six focus groups (n=30) were held in August and September of 2014 with veterans≥70 years old with moderate-to-severe CKD receiving nephrology care at the Atlanta Veterans Affairs Medical Center. Grounded theory with a constant comparative method was used to collect, code, and analyze data. Participants had a mean age (range) of 75.1 (70.1-90.7) years, 60% were black, and 96.7% were men. The central organizing concept that emerged from these data were managing complexity. Participants typically did not have just one chronic condition, CKD, but a number of commonly co-occurring conditions. Recommendations for CKD self-management therefore occurred within a complex regimen of recommendations for managing other diseases. Participants identified overtly discordant treatment recommendations across chronic conditions (e.g., arthritis and CKD). Prioritization emerged as one effective strategy for managing complexity (e.g., focusing on BP control). Some patients arrived at the conclusion that they could group concordant recommendations to simplify their regimens (e.g., protein restriction for both gout and CKD). Among older veterans with moderate-to-severe CKD, multimorbidity presents a major challenge for CKD self-management. Because virtually all older adults with CKD have multimorbidity, an integrated treatment approach that supports self-management across commonly occurring conditions may be

  14. The role of bone in CKD-mediated mineral and vascular disease.

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    Khouzam, Nadine M; Wesseling-Perry, Katherine; Salusky, Isidro B

    2015-09-01

    Cardiovascular disease is the leading cause of death in pediatric patients with chronic kidney disease (CKD), and vascular calcifications start early in the course of CKD. Based on the growing body of evidence that alterations of bone and mineral metabolism and the therapies designed to treat the skeletal consequences of CKD are linked to cardiovascular calcifications, the Kidney Disease, Improving Global Outcomes (KDIGO) working group redefined renal osteodystrophy as a systemic disorder of mineral and bone metabolism due to CKD, and this newly defined disorder is now known as "chronic kidney disease-mineral bone disorder (CKD-MBD)". Elevated fibroblast growth factor 23 (FGF23), a bone-derived protein, is the first biochemical abnormality to be associated with CKD-MBD, and high FGF23 levels correlate with increased cardiovascular morbidity and mortality, suggesting that bone is central to both initiating and perpetuating the abnormal mineral metabolism and vascular disease in CKD. The current standard therapies for CKD-MBD affect FGF23 levels differently; non-calcium-based binders with or without concurrent use of dietary phosphate restriction reduce FGF23 levels, while calcium-based binders seem to either increase or have no effect on FGF23 levels. Active vitamin D sterols increase FGF23 levels, whereas therapy with calcimimetics decreases FGF23 levels. Thus, the appropriate therapy that will minimize the rise in FGF23 and prevent cardiovascular morbidity remains to be defined.

  15. Chronic Kidney Disease Guideline Implementation in Primary Care: A Qualitative Report from the TRANSLATE CKD Study.

    Science.gov (United States)

    Vest, Bonnie M; York, Trevor R M; Sand, Jessica; Fox, Chester H; Kahn, Linda S

    2015-01-01

    Primary care physicians (PCPs) are optimally situated to identify and manage early stage chronic kidney disease (CKD). Nonetheless, studies have documented suboptimal PCP understanding, awareness, and management of early CKD. The TRANSLATE CKD study is an ongoing national, mixed-methods, cluster randomized control trial that examines the implementation of evidence-based guidelines for CKD into primary care practice. As part of the mixed-methods process evaluation, semistructured interviews were conducted by phone with 27 providers participating in the study. Interviews were audio-taped and transcribed. Thematic content analysis was used to identify themes. Themes were categorized according to the 4 domains of Normalization Process Theory (NPT). Identified themes illuminated the complex work undertaken to manage CKD in primary care practices. Barriers to guideline implementation were identified in each of the 4 NPT domains, including (1) lack of knowledge and understanding around CKD (coherence), (2) difficulties engaging providers and patients in CKD management (cognitive participation), (3) limited time and competing demands (collective action), and (4) challenges obtaining and using data to monitor progress (reflexive monitoring). Addressing the barriers to implementation with concrete interventions at the levels at which they occur, informed by NPT, will ultimately improve the quality of CKD patient care. © Copyright 2015 by the American Board of Family Medicine.

  16. The lingering dilemma of arterial pressure in CKD : what do we know, where do we go?

    NARCIS (Netherlands)

    Agarwal, Rajiv; Martinez-Castelao, Alberto; Wiecek, Andrzej; Massy, Ziad; Suleymanlar, Gultekin; Ortiz, Alberto; Blankestijn, Peter J.; Covic, Adrian; Dekker, Friedo W.; Jager, Kitty J.; Lindholm, Bengt; Goldsmith, David; Fliser, Danilo; London, Gerard; Zoccali, Carmine

    2011-01-01

    Despite many advances in the management of hypertensive chronic kidney disease (CKD) patients, both on and off dialysis, there exist several gaps in our knowledge. Although the modern techniques to measure blood pressure (BP) indirectly have been available for a long time, among those with CKD, how

  17. Systematic review of structural and functional neuroimaging findings in children and adults with CKD.

    Science.gov (United States)

    Moodalbail, Divya G; Reiser, Kathryn A; Detre, John A; Schultz, Robert T; Herrington, John D; Davatzikos, Christos; Doshi, Jimit J; Erus, Guray; Liu, Hua-Shan; Radcliffe, Jerilynn; Furth, Susan L; Hooper, Stephen R

    2013-08-01

    CKD has been linked with cognitive deficits and affective disorders in multiple studies. Analysis of structural and functional neuroimaging in adults and children with kidney disease may provide additional important insights into the pathobiology of this relationship. This paper comprehensively reviews neuroimaging studies in both children and adults. Major databases (PsychLit, MEDLINE, WorldCat, ArticleFirst, PubMed, Ovid MEDLINE) were searched using consistent search terms, and studies published between 1975 and 2012 were included if their samples focused on CKD as the primary disease process. Exclusion criteria included case reports, chapters, and review articles. This systematic process yielded 43 studies for inclusion (30 in adults, 13 in children). Findings from this review identified several clear trends: (1) presence of cerebral atrophy and cerebral density changes in patients with CKD; (2) cerebral vascular disease, including deep white matter hyperintensities, white matter lesions, cerebral microbleeds, silent cerebral infarction, and cortical infarction, in patients with CKD; and (3) similarities in regional cerebral blood flow between patients with CKD and those with affective disorders. These findings document the importance of neuroimaging procedures in understanding the effect of CKD on brain structure, function, and associated behaviors. Results provide a developmental linkage between childhood and adulthood, with respect to the effect of CKD on brain functioning across the lifespan, with strong implications for a cerebrovascular mechanism contributing to this developmental linkage. Use of neuroimaging methods to corroborate manifest neuropsychological deficits or perhaps to indicate preventive actions may prove useful to individuals with CKD.

  18. Diagnosis and Prediction of CKD Progression by Assessment of Urinary Peptides

    NARCIS (Netherlands)

    Schanstra, Joost P.; Zuerbig, Petra; Alkhalaf, Alaa; Argiles, Angel; Bakker, Stephan J. L.; Beige, Joachim; Bilo, Henk J. G.; Chatzikyrkou, Christos; Dakna, Mohammed; Dawson, Jesse; Delles, Christian; Haller, Hermann; Haubitz, Marion; Husi, Holger; Jankowski, Joachim; Jerums, George; Kleefstra, Nanne; Kuznetsova, Tatiana; Maahs, David M.; Menne, Jan; Mullen, William; Ortiz, Alberto; Persson, Frederik; Rossing, Peter; Ruggenenti, Piero; Rychlik, Ivan; Serra, Andreas L.; Siwy, Justyna; Snell-Bergeon, Janet; Spasovski, Goce; Staessen, Jan A.; Vlahou, Antonia; Mischak, Harald; Vanholder, Raymond

    2015-01-01

    Progressive CKD is generally detected at a late stage by a sustained decline in eGFR and/or the presence of significant albuminuria. With the aim of early and improved risk stratification of patients with CKD, we studied urinary peptides in a large cross-sectional multicenter cohort of 1990 individu

  19. Diagnosis and Prediction of CKD Progression by Assessment of Urinary Peptides

    DEFF Research Database (Denmark)

    Schanstra, Joost P; Zürbig, Petra; Alkhalaf, Alaa

    2015-01-01

    Progressive CKD is generally detected at a late stage by a sustained decline in eGFR and/or the presence of significant albuminuria. With the aim of early and improved risk stratification of patients with CKD, we studied urinary peptides in a large cross-sectional multicenter cohort of 1990 indiv...

  20. Telehealth Applications to Enhance CKD Knowledge and Awareness Among Patients and Providers.

    Science.gov (United States)

    Tuot, Delphine S; Boulware, L Ebony

    2017-01-01

    CKD affects 13% of the US adult population, causes excess mortality, and is associated with significant sociodemographic disparities. Optimal CKD management slows progression of disease and reduces cardiovascular-related outcomes. Resources for patients and primary care providers, major stakeholders in preventive CKD care, are critically needed to enhance understanding of the disease and to optimize CKD health, particularly because of the asymptomatic nature of kidney disease. Telehealth is defined as the use of electronic communication and telecommunications technology to support long-distance clinical health care, patient and professional health-related education, and public health and health administration. It provides new opportunities to enhance awareness and understanding among these important stakeholders. This review will examine the role of telehealth within existing educational theories, identify telehealth applications that can enhance CKD knowledge and behavior change among patients and primary care providers, and examine the advantages and disadvantages of telehealth vs usual modalities for education.

  1. Filling the gap in CKD: The health care workforce and faculty development.

    Science.gov (United States)

    Becker, Bryan N

    2011-02-01

    Given limited resources, adding another chronic illness to the panoply of chronic disease care is problematic. Nevertheless, chronic kidney disease (CKD) is increasing in recognition and prevalence across the world, and a management strategy for this growing population is necessary. A diverse group of health care professionals interacts with patients with CKD and their family members, including nurses, nurse practitioners, dieticians, social workers, pharmacists, physicians, physical therapists, physician assistants, and public health workers. All these individuals have the opportunity to reinforce CKD management. This potentially would bring a broader health care workforce to bear on CKD, reducing the impact of the nephrology workforce shortage. To realize such a strategy, it is necessary to bolster CKD awareness and knowledge in the diverse health care workforce. A faculty development program that extends CKD awareness to existing health care workers also has the possibility of migrating into the learner curriculum in health professional schools. This approach would expand CKD education, creating a skilled diverse health care workforce. Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  2. The chronic kidney disease self-efficacy (CKD-SE) instrument: development and psychometric evaluation.

    Science.gov (United States)

    Lin, Chiu-Chu; Wu, Chia-Chen; Anderson, Robert M; Chang, Chao-Sung; Chang, Shu-Chen; Hwang, Shang-Jyh; Chen, Hung-Chun

    2012-10-01

    Self-management has been associated with positive health outcomes among adults with chronic kidney disease (CKD). Perceived disease-related self-efficacy (DSE) is considered a critical component in the successful self-management of chronic disease. A valid and reliable instrument for measuring CKD patients' self-efficacy is needed. This study aims to develop and test a new instrument to measure the DSE of patients with early stage CKD. A total of 594 Taiwanese patients with early stage CKD recruited from two medical centers and one regional hospital in southern Taiwan completed the questionnaire. The CKD self-efficacy (CKD-SE) was evaluated using exploratory factor analyses (EFA) and measures of reliability. EFA identified four distinct factors with loadings ranging from 0.557 to 0.970: autonomy, self-integration, problem solving and seeking social support, accounting for 64.348% of the total variance. Cronbach's alpha coefficients for the subscales ranged from 0.843 to 0.901. This promising 25-item CKD-SE instrument can be used for the early identification of patients with low DSE, thus allowing the development of interventions to help these patients attain an appropriate level of DSE.

  3. Association of eGFR-Related Loci Identified by GWAS with Incident CKD and ESRD.

    Directory of Open Access Journals (Sweden)

    Carsten A Böger

    2011-09-01

    Full Text Available Family studies suggest a genetic component to the etiology of chronic kidney disease (CKD and end stage renal disease (ESRD. Previously, we identified 16 loci for eGFR in genome-wide association studies, but the associations of these single nucleotide polymorphisms (SNPs for incident CKD or ESRD are unknown. We thus investigated the association of these loci with incident CKD in 26,308 individuals of European ancestry free of CKD at baseline drawn from eight population-based cohorts followed for a median of 7.2 years (including 2,122 incident CKD cases defined as eGFR <60ml/min/1.73m(2 at follow-up and with ESRD in four case-control studies in subjects of European ancestry (3,775 cases, 4,577 controls. SNPs at 11 of the 16 loci (UMOD, PRKAG2, ANXA9, DAB2, SHROOM3, DACH1, STC1, SLC34A1, ALMS1/NAT8, UBE2Q2, and GCKR were associated with incident CKD; p-values ranged from p = 4.1e-9 in UMOD to p = 0.03 in GCKR. After adjusting for baseline eGFR, six of these loci remained significantly associated with incident CKD (UMOD, PRKAG2, ANXA9, DAB2, DACH1, and STC1. SNPs in UMOD (OR = 0.92, p = 0.04 and GCKR (OR = 0.93, p = 0.03 were nominally associated with ESRD. In summary, the majority of eGFR-related loci are either associated or show a strong trend towards association with incident CKD, but have modest associations with ESRD in individuals of European descent. Additional work is required to characterize the association of genetic determinants of CKD and ESRD at different stages of disease progression.

  4. Association of eGFR-Related Loci Identified by GWAS with Incident CKD and ESRD.

    Directory of Open Access Journals (Sweden)

    Carsten A Böger

    2011-09-01

    Full Text Available Family studies suggest a genetic component to the etiology of chronic kidney disease (CKD and end stage renal disease (ESRD. Previously, we identified 16 loci for eGFR in genome-wide association studies, but the associations of these single nucleotide polymorphisms (SNPs for incident CKD or ESRD are unknown. We thus investigated the association of these loci with incident CKD in 26,308 individuals of European ancestry free of CKD at baseline drawn from eight population-based cohorts followed for a median of 7.2 years (including 2,122 incident CKD cases defined as eGFR <60ml/min/1.73m(2 at follow-up and with ESRD in four case-control studies in subjects of European ancestry (3,775 cases, 4,577 controls. SNPs at 11 of the 16 loci (UMOD, PRKAG2, ANXA9, DAB2, SHROOM3, DACH1, STC1, SLC34A1, ALMS1/NAT8, UBE2Q2, and GCKR were associated with incident CKD; p-values ranged from p = 4.1e-9 in UMOD to p = 0.03 in GCKR. After adjusting for baseline eGFR, six of these loci remained significantly associated with incident CKD (UMOD, PRKAG2, ANXA9, DAB2, DACH1, and STC1. SNPs in UMOD (OR = 0.92, p = 0.04 and GCKR (OR = 0.93, p = 0.03 were nominally associated with ESRD. In summary, the majority of eGFR-related loci are either associated or show a strong trend towards association with incident CKD, but have modest associations with ESRD in individuals of European descent. Additional work is required to characterize the association of genetic determinants of CKD and ESRD at different stages of disease progression.

  5. Implication of global nephrology guidelines in Asia and 'Asian CKD Best Practice Guidelines'.

    Science.gov (United States)

    Tsukamoto, Yusuke

    2010-06-01

    By establishing Kidney Diseases: Improving Global Outcome (KDIGO), nephrology has taken an important step towards developing global clinical practice guidelines (CPG). KDIGO published its first CPG on 'Hepatitis C in CKD' in 2008 and has since published two new CPG ('CKD-MBD' and 'Kidney Transplant Recipient') in 2009. A major obstacle to implement CPG is the lack of both high-quality evidence for regionally-specific areas of medicine and a lack of resources in many countries in our region. However, an endeavor by the Asian Forum of CKD Initiative (AFCKDI) may make it possible to overcome these obstacles. By developing regionally-specific CKD guidelines, the AFCKDI might identify relevant evidence gaps and by using specific expertise develop a standard of patient care appropriate to the Asia-Pacific region. This can be accomplished only by engaging a group of international experts who fully represent the Asia-Pacific area.

  6. How to Read a Food Label: Tips for People with Chronic Kidney Disease (CKD)

    Science.gov (United States)

    ... How to Read a Tips for People with Chronic Kidney Disease (CKD) National Kidney Disease Education Program If you ... and Human Services National Institutes of Health National Kidney Disease Education Program 2

  7. Study on the E-commerce Ordering Platform of CKD/IKD

    Institute of Scientific and Technical Information of China (English)

    YIN Xiaoqing; LIU Wei

    2006-01-01

    CKD/IKD is a new technology management method which should be used instead of commerce mode of CBU. In the international trade, as to the products with fast update, complex structure, mass variety, complicated sales states and multimode configuration, when they are exported to enterprises without independent technology of products design from the OEM suppliers in the form of CKD/IKD. The all-around intellectualized management of CKD/IKD customization, purchase and supply will be realized by transforming automatically between CKD/IKD orders and parts orders in ERP systems through KD virtual collaborative center, combining the e-commerce sales system, ERP, SCM, CRM, PDM and export management system.

  8. The French Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort study

    Science.gov (United States)

    Stengel, Bénédicte; Combe, Christian; Jacquelinet, Christian; Briançon, Serge; Fouque, Denis; Laville, Maurice; Frimat, Luc; Pascal, Christophe; Herpe, Yves-Edouard; Deleuze, Jean-François; Schanstra, Joost; Pisoni, Ron L.; Robinson, Bruce M.; Massy, Ziad A.

    2014-01-01

    Background While much has been learned about the epidemiology and treatment of end-stage renal disease (ESRD) in the last 30 years, chronic kidney disease (CKD) before the end-stage has been less investigated. Not enough is known about factors associated with CKD progression and complications, as well as its transition to ESRD. We designed the CKD-renal epidemiology and information network (REIN) cohort to provide a research platform to address these key questions and to assess clinical practices and costs in patients with moderate or advanced CKD. Methods A total of 46 clinic sites and 4 renal care networks participate in the cohort. A stratified selection of clinic sites yields a sample that represents a diversity of settings, e.g. geographic region, and public versus for-profit and non-for-profit private clinics. In each site, 60–90 patients with CKD are enrolled at a routine clinic visit during a 12-month enrolment phase: 3600 total, including 1800 with Stage 3 and 1800 with Stage 4 CKD. Follow-up will continue for 5 years, including after initiation of renal replacement therapy. Data will be collected from medical records at inclusion and at yearly intervals, as well as from self-administered patient questionnaires and provider-level questionnaires. Patients will also be interviewed at baseline, and at 1, 3 and 5 years. Healthcare costs will also be determined. Blood and urine samples will be collected and stored for future studies on all patients at enrolment and at study end, and at 1 and 3 years in a subsample of 1200. Conclusions The CKD-REIN cohort will serve to improve our understanding of the biological, clinical and healthcare system determinants associated with CKD progression and adverse outcomes as well as of international variations in collaboration with the CKD Outcome and Practice Pattern Study (CKDopps). It will foster CKD epidemiology and outcomes research and provide evidence to improve the health and quality of life of patients with CKD and

  9. Pulmonary hypertension: epidemiology in different CKD stages and its association with cardiovascular morbidity.

    Directory of Open Access Journals (Sweden)

    Zhilian Li

    Full Text Available Pulmonary hypertension (PH was recently recognized as a common complication of end-stage renal disease (ESRD that causes an increased risk of mortality. Epidemiological data for this disorder in earlier stages of chronic kidney disease (CKD and its association with cardiovascular (CV morbidity are scarce.We retrospectively analyzed 2,351 Chinese CKD patients with complete clinical records and echocardiography data between Jan 2008 and May 2012. The patients were divided into the following 6 groups: CKD Stages 1-4; Stage 5 for those not on or initiated on hemodialysis for <3 months; and Stage 5D for the patients undergoing hemodialysis for ≥3 months. The prevalence of PH and CV morbidity was investigated, and their association was evaluated with a logistic regression model.PH was detected in 426 patients (18.1%. Mild, moderate and severe PH was diagnosed in 12.1%, 4.9% and 1.1% of the patients, respectively. Severe PH was detected in CKD Stages 5 and 5D. CV morbidity was found in 645 patients (27.4%. Compared with the non-PH group, the PH group had a higher risk for cardiac disease but not for cerebrovascular disease risk. PH severity was associated with cardiac morbidity risk [odds ratio (95% CI for mild PH: 1.79 (1.30-2.47; moderate PH: 2.75 (1.73-4.37; severe PH: 3.90 (1.46-10.42].Our study showed for the first time the epidemiology profile of PH across the spectrum of CKD. Mild-to-moderate PH occurs with more frequency in advanced CKD, and severe PH is scarce in non-ESRD CKD. PH in CKD is associated with cardiac but not cerebrovascular disease, with increasing cardiac morbidity seen with increasing PH severity. Evidence from prospective studies addressing PH in this population is needed to predict cardiac events.

  10. Vegan-vegetarian low-protein supplemented diets in pregnant CKD patients: fifteen years of experience.

    Science.gov (United States)

    Attini, Rossella; Leone, Filomena; Parisi, Silvia; Fassio, Federica; Capizzi, Irene; Loi, Valentina; Colla, Loredana; Rossetti, Maura; Gerbino, Martina; Maxia, Stefania; Alemanno, Maria Grazia; Minelli, Fosca; Piccoli, Ettore; Versino, Elisabetta; Biolcati, Marilisa; Avagnina, Paolo; Pani, Antonello; Cabiddu, Gianfranca; Todros, Tullia; Piccoli, Giorgina B

    2016-09-20

    Pregnancy in women with advanced CKD becoming increasingly common. However, experience with low-protein diets in CKD patients in pregnancy is still limited. Aim of this study is to review the results obtained over the last 15 years with moderately restricted low-protein diets in pregnant CKD women (combining: CKD stages 3-5, proteinuria: nephrotic at any time, or > =1 g/24 at start or referral; nephrotic in previous pregnancy). CKD patients on unrestricted diets were employed for comparison. January, 2000 to September, 2015: 36 on-diet pregnancies (31 singleton deliveries, 3 twin deliveries, 1 pregnancy termination, 1 miscarriage); 47 controls (42 singleton deliveries, 5 miscarriages). The diet is basically vegan; since occasional milk and yoghurt are allowed, we defined it vegan-vegetarian; protein intake (0.6-0.8 g/Kg/day), keto-acid supplementation, protein-unrestricted meals (1-3/week) are prescribed according to CKD stage and nutritional status. Statistical analysis was performed as implemented on SPSS. Patients and controls were similar (p: ns) at baseline with regard to age (33 vs 33.5), referral week (7 vs 9), kidney function (CKD 3-5: 48.4 % vs 64.3 %); prevalence of hypertension (51.6 % vs 40.5 %) and proteinuria >3 g/24 h (16.1 % vs 12.2 %). There were more diabetic nephropathies in on-diet patients (on diet: 31.0 % vs controls 5.3 %; p 0.007 (Fisher)) while lupus nephropathies were non-significantly higher in controls (on diet: 10.3 % vs controls 23.7 %; p 0.28 (Fisher)). The incidence of preterm delivery was similar (vegan-vegetarian supplemented diet is confirmed as a safe option in the management of pregnant CKD patients.

  11. Symptom Management in Patients with Stage 5 CKD Opting for Conservative Management.

    Science.gov (United States)

    Johnston, Sheila

    2016-09-22

    Chronic kidney disease (CKD) stages 3-5 now affects 8.5% of adults in the United Kingdom; with 4% of patients expected to reach stage 5 CKD. Increasing numbers of older patients are contributing to the growth of demand of kidney services. With the exception of transplantation, dialysis has been the main form of renal replacement therapy (RRT) for advanced CKD. This elderly population is usually too frail and has many other co-existing medical complaints or co morbidities to undergo transplantation. Dialysis is an invasive treatment, and some frail elderly patients can experience many dialysis related symptoms. An alternative option for these patients is to choose conservative management (CM) of their stage 5 CKD. These patients often have complex supportive and palliative care needs. The frequency, severity and distress caused by symptoms related to stage 5 CKD are often under recognized and under treated. There is a need for early identification and management of symptoms as they present in patients with stage 5 CKD being managed conservatively. Symptom assessment should be focused on anticipating, identifying and alleviating any symptoms. This needs to be incorporated into the regular practice of those managing CM patients.

  12. Estrogen Deficiency Leads to Further Bone Loss in the Mandible of CKD Mice.

    Directory of Open Access Journals (Sweden)

    Yuchen Guo

    Full Text Available Chronic kidney disease (CKD has been regarded as a grave public health problem. Estrogen is a critical factor for both renal protection and bone remodeling. Our previous study demonstrated that CKD impairs the healing of titanium implants. The aim of this study was to investigate the effects of estrogen deficiency on the mandibular bone in CKD mice.Forty eleven-week-old female C57BL mice were used in this study. Uremia and estrogen deficiency were induced by 5/6 nephrectomy and ovariectomy (OVX, respectively. After 8 weeks, the mice were sacrificed, and their mandibles were collected for micro-CT analysis and histological examination.All the mice survived the experimental period. Serum measurements confirmed a significant increase in BUN in the CKD group that was further increased by OVX. OVX led to significant decreases in both the BV/TV and cortical thickness of the mandibular bone in CKD mice.In summary, our findings indicate that estrogen deficiency leads to further mandibular bone loss in CKD mice.

  13. Uremic retention solute indoxyl sulfate level is associated with prolonged QTc interval in early CKD patients.

    Science.gov (United States)

    Tang, Wei-Hua; Wang, Chao-Ping; Chung, Fu-Mei; Huang, Lynn L H; Yu, Teng-Hung; Hung, Wei-Chin; Lu, Li-Fen; Chen, Po-Yuan; Luo, Ching-Hsing; Lee, Kun-Tai; Lee, Yau-Jiunn; Lai, Wen-Ter

    2015-01-01

    Total mortality and sudden cardiac death is highly prevalent in patients with chronic kidney disease (CKD). In CKD patients, the protein-bound uremic retention solute indoxyl sulfate (IS) is independently associated with cardiovascular disease. However, the underlying mechanisms of this association have yet to be elucidated. The relationship between IS and cardiac electrocardiographic parameters was investigated in a prospective observational study among early CKD patients. IS arrhythmogenic effect was evaluated by in vitro cardiomyocyte electrophysiological study and mathematical computer simulation. In a cohort of 100 early CKD patients, patients with corrected QT (QTc) prolongation had higher IS levels. Furthermore, serum IS level was independently associated with prolonged QTc interval. In vitro, the delay rectifier potassium current (IK) was found to be significantly decreased after the treatment of IS in a dose-dependent manner. The modulation of IS to the IK was through the regulation of the major potassium ion channel protein Kv 2.1 phosphorylation. In a computer simulation, the decrease of IK by IS could prolong the action potential duration (APD) and induce early afterdepolarization, which is known to be a trigger mechanism of lethal ventricular arrhythmias. In conclusion, serum IS level is independently associated with the prolonged QTc interval in early CKD patients. IS down-regulated IK channel protein phosphorylation and the IK current activity that in turn increased the cardiomyocyte APD and QTc interval in vitro and in the computer ORd model. These findings suggest that IS may play a role in the development of arrhythmogenesis in CKD patients.

  14. Phosphate Metabolism in CKD Stages 3–5: Dietary and Pharmacological Control

    Directory of Open Access Journals (Sweden)

    Markus Ketteler

    2011-01-01

    Full Text Available When compared to the available information for patients on dialysis (CKD stage 5D, data on the epidemiology and appropriate treatment of calcium and phosphate metabolism in the predialysis stages of chronic kidney disease (CKD are quite limited. Perceptible derangements of calcium and phosphate levels start to become apparent when GFR falls below 30 mL/min in some, but not all, patients. However, hyperphosphatemia may be a significant morbidity and mortality risk predictor in predialysis CKD stages. The RIND study, evaluating progression of coronary artery calcification in incident hemodialysis patients, indirectly demonstrated that vascular calcification processes start to manifest in CKD patients prior to the dialysis stage, which may be closely linked to early and invisible derangements in calcium and phosphate homeostasis. Novel insights into the pathophysiology of calcium and phosphate handling such as the discovery of FGF23 and other phosphatonins suggest that a more complex assessment of phosphate balance is warranted, possibly including measurements of fractional phosphate excretion and phosphatonin levels in order to appropriately evaluate disordered metabolism in earlier stages of kidney disease. As a consequence, early and preventive treatment approaches may have to be developed for patients in CKD stages 3-5 to halt progression of CKD-MBD.

  15. Dietary fiber intake is associated with chronic kidney disease (CKD) progression and cardiovascular risk, but not protein nutritional status, in adults with CKD.

    Science.gov (United States)

    Lu, Lu; Huang, Yan-Feng; Wang, Ming-Qing; Chen, De-Xiu; Wan, Heng; Wei, Lian-Bo; Xiao, Wei

    Evidence suggests that dietary fiber benefits patients with chronic kidney disease (CKD); however, this conclusion requires further validation. In this study, we examined the effects of dietary fiber on kidney function, inflammation, indoxyl sulfate, nutritional status, and cardiovascular risk in patients with advanced CKD. We performed linear regressions to assess the association between dietary fiber intake and CKD parameters. The aforementioned parameters were compared over an 18-month follow- up period. Kaplan-Meier analysis was used to investigate the association between fiber intake and Cardiac vascular disease (CVD). In total, 157 patients were included in this study. Dietary fiber and inflammatory indices were associated (interleukin [IL]-6: β=-0.024, p=0.035). The differential estimated glomerular filtration rate (ΔeGFR) as well as levels of C-reactive protein, IL-6, indoxyl sulfate, and serum cholesterol in the higher fiber intake (>=25 g/day) group were lower than those in the lower fiber intake (Dietary fiber intake may be a protective factor associated with CVD (hazard ratio=0.537 and 0.305- 0.947). The protein nutritional status was not different between the two groups (p>0.05). Our results suggest that increasing fiber intake can retard the decrease in the eGFR; can reduce the levels of proinflammatory factors, indoxyl sulfate, and serum cholesterol; and is negatively associated with cardiovascular risk, but does not disrupt the nutritional status of patients with CKD.

  16. Practical approach to the diagnosis and treatment of anemia associated with CKD in elderly.

    Science.gov (United States)

    Agarwal, Anil K

    2006-11-01

    Anemia is a frequent complication of chronic kidney disease (CKD). Inadequate production of erythropoietin by the failing kidneys leads to decreased stimulation of the bone marrow to produce red blood cells (RBCs). Anemia of CKD develops early and worsens with progressive renal insufficiency. Although over 40% of patients with CKD are anemic, anemia in this population is under-recognized and undertreated. Of considerable importance, anemia is a risk factor for cardiovascular disease and is associated with higher rates of hospitalization and mortality. Despite the availability of erythropoiesis-stimulating proteins (ESPs) to stimulate RBC production in CKD patients, approximately three fourths of patients initiating dialysis have a hemoglobin CKD begins with an estimation of glomerular filtration rate (GFR), which can be far lower than a normal serum creatinine might suggest, especially in the elderly and in those with poor nutrition and muscle mass. If GFR is cause of anemia should be investigated in these individuals; this can range from erythropoietin deficiency due to CKD, to deficiency of vitamin B(12) and/or folate, iron deficiency, blood loss, inflammation, malignancy, and aluminum intoxication. After other causes of anemia have been excluded, CKD is the most likely etiology, and it should be treated with an ESP. Currently, epoetin alfa and darbepoetin alfa are the only 2 ESPs approved for use in the United States. Extended dosing of ESP has potential advantages for the patient and may also improve resource utilization. Consequently, both agents have been tested for dosing at extended intervals. Adequate iron stores--defined as transferrin saturation >20% and ferritin >100 mg--as well as ESP administration are needed to produce an appropriate increase in hemoglobin. Poor response to treatment with ESP can be due to many factors, including presence of iron deficiency, inflammation, continued blood loss, and hemoglobinopathy.

  17. Myocardial dysfunction occurs prior to changes in ventricular geometry in mice with chronic kidney disease (CKD).

    Science.gov (United States)

    Winterberg, Pamela D; Jiang, Rong; Maxwell, Josh T; Wang, Bo; Wagner, Mary B

    2016-03-01

    Uremic cardiomyopathy is responsible for high morbidity and mortality rates among patients with chronic kidney disease (CKD), but the underlying mechanisms contributing to this complex phenotype are incompletely understood. Myocardial deformation analyses (ventricular strain) of patients with mild CKD have recently been reported to predict adverse clinical outcome. We aimed to determine if early myocardial dysfunction in a mouse model of CKD could be detected using ventricular strain analyses. CKD was induced in 5-week-old male 129X1/SvJ mice through partial nephrectomy (5/6Nx) with age-matched mice undergoing bilateral sham surgeries serving as controls. Serial transthoracic echocardiography was performed over 16 weeks following induction of CKD. Invasive hemodynamic measurements were performed at 8 weeks. Gene expression and histology was performed on hearts at 8 and 16 weeks. CKD mice developed decreased longitudinal strain (-25 ± 4.2% vs. -29 ± 2.3%; P = 0.01) and diastolic dysfunction (E/A ratio 1.2 ± 0.15 vs. 1.9 ± 0.18; P ventricular hypertrophy was not apparent until 4 weeks. Hearts from CKD mice developed progressive fibrosis at 8 and 16 weeks with gene signatures suggestive of evolving heart failure with elevated expression of natriuretic peptides. Uremic cardiomyopathy in this model is characterized by early myocardial dysfunction which preceded observable changes in ventricular geometry. The model ultimately resulted in myocardial fibrosis and increased expression of natriuretic peptides suggestive of progressive heart failure.

  18. JS ISH-ISN-3 OPTIMAL TARGETS FOR BP CONTROL IN CKD.

    Science.gov (United States)

    Wheeler, David

    2016-09-01

    Hypertension is the most prevalent complication of chronic kidney disease (CKD). Lowering high blood pressure slows progressive loss of kidney function and may also reduce the associated risk of cardiovascular complications, a common cause of premature death in CKD patients.Current International Guidelines produced by Kidney Disease: Improving Global Outcomes (KDIGO) acknowledges that no single BP target is optimal for all CKD patients, and encourages individualization of treatment depending on age, the severity of albuminuria and comorbidities. When published in 2012, the available evidence indicated that in CKD patients without albuminuria, the target BP should be ≤140 mmHg systolic and ≤90 mmHg diastolic. However, in most patients with an albumin excretion rate of ≥30 mg/24 h (i.e., those with both micro- and macroalbuminuria), a lower target of ≤130 mmHg systolic and ≤80 mmHg diastolic was suggested. In achieving BP control, the value of lifestyle changes and the need for multiple pharmacological agents was acknowledged. Use of agents that block the renin-angiotensin-aldosterone system was recommended or suggested in all patients with an albumin excretion rate of ≥30 mg/24 h. Recommendations are almost identical in CKD patients with and without diabetes.Recent data from SPRINT (which included CKD patients) and other clinical trials has led nephrologists to ask whether targets lower than those recommend by KDIGO are appropriate and the guidelines are currently undergoing an update. Controversies remain around discontinuation of ACE/ARB in patients with stage 4-5 CKD and dual renin-angiotensin-aldosterone system blockade.

  19. Decreased microRNA is involved in the vascular remodeling abnormalities in chronic kidney disease (CKD.

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    Neal X Chen

    Full Text Available Patients with CKD have abnormal vascular remodeling that is a risk factor for cardiovascular disease. MicroRNAs (miRNAs control mRNA expression intracellularly and are secreted into the circulation; three miRNAs (miR-125b, miR-145 and miR-155 are known to alter vascular smooth muscle cell (VSMC proliferation and differentiation. We measured these vascular miRNAs in blood from 90 patients with CKD and found decreased circulating levels with progressive loss of eGFR by multivariate analyses. Expression of these vascular miRNAs miR-125b, miR-145, and miR-155 was decreased in the thoracic aorta in CKD rats compared to normal rats, with concordant changes in target genes of RUNX2, angiotensin II type I receptor (AT1R, and myocardin. Furthermore, the expression of miR-155 was negatively correlated with the quantity of calcification in the aorta, a process known to be preceded by vascular de-differentiation in these animals. We then examined the mechanisms of miRNA regulation in primary VSMC and found decreased expression of miR-125b, 145, and 155 in VSMC from rats with CKD compared to normal littermates but no alteration in DROSHA or DICER, indicating that the low levels of expression is not due to altered intracellular processing. Finally, overexpression of miR-155 in VSMC from CKD rats inhibited AT1R expression and decreased cellular proliferation supporting a direct effect of miR-155 on VSMC. In conclusion, we have found ex vivo and in vitro evidence for decreased expression of these vascular miRNA in CKD, suggesting that alterations in miRNAs may lead to the synthetic state of VSMC found in CKD. The decreased levels in the circulation may reflect decreased vascular release but more studies are needed to confirm this relationship.

  20. Prevalence and risk factors of CKD in Chinese patients with periodontal disease.

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    Kejin Liu

    Full Text Available BACKGROUND: Periodontal disease is common among adults and is associated with an increasing risk of chronic kidney disease (CKD. We aimed to investigate the prevalence and risk factors of CKD in patients with periodontal disease in China. METHODS: In the current cross-sectional study, patients with periodontal disease were included from Guangdong Provincial Stomatological Hospital between March 2011 and August 2011. CKD was defined as estimated glomerular filtration rate (eGFR <60 mL/min/1.73 m(2, the presence of albuminuria, or hematuria. All patients with periodontal disease underwent a periodontal examination, including periodontal probing pocket depth, gingival recession, and clinical attachment level by Florida Probe. They completed a questionnaire and had blood and urine samples taken. The adjusted prevalence of indicators of kidney damage was calculated and risk factors associated with CKD were analyzed. RESULTS: A total of 1392 patients with periodontal disease were invited to participate this study and 1268 completed the survey and examination. After adjusting for age and sex, the prevalence of reduced eGFR, albuminuria, and hematuria was 2.7% (95% CI 1.7-3.7, 6.7% (95% CI 5.5-8.1 and 10.9% (95% CI 9.2-12.5, respectively. The adjusted prevalence of CKD was 18.2% (95% CI 16.2-20.3. Age, male, diabetes, hypertension, history of CKD, hyperuricemia, and interleukin-6 levels (≥7.54 ng/L were independent risk factors for reduced eGFR. Female, diabetes, hypertension, history of CKD, hyperuricemia, high level of cholesterol, and high sensitivity C-reactive protein (hsCRP (≥ 1.03 mg/L and TNF-α levels (≥ 1.12 ng/L were independently associated with an increased risk of albuminuria. Female, lower education (CKD were independent risk factors for hematuria. CONCLUSIONS: 18.2% of Chinese patients with periodontal disease have proteinuria, hematuria, or reduced eGFR, indicating the presence of kidney damage

  1. Sleep quality, mood, alertness and their variability in CKD and ESRD.

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    Roumelioti, Maria-Eleni; Argyropoulos, Christos; Buysse, Daniel J; Nayar, Harry; Weisbord, Steven D; Unruh, Mark L

    2010-01-01

    Little is known about the association of chronic kidney disease (CKD) with sleep quality, mood, and alertness. In this report, we assessed these symptoms among patients with advanced CKD (stages 4-5) and those with end-stage renal disease (ESRD) and compared them to healthy controls without known kidney disease. Patients were recruited from local dialysis units, outpatient nephrology clinics and the Thomas E. Starzl Transplant Institute. Healthy control subjects matched for age, gender and race were drawn from an archival database. Daily symptoms of sleep quality, mood, and alertness were assessed by visual analogue scales of the Pittsburgh Sleep Diary. Health-related quality of life was assessed by the Short Form-36 instrument. Sixty-nine dialysis patients and 23patients with advanced CKD demonstrated worse scores in sleep quality, mood, and alertness (p < 0.001) than controls. In adjusted analyses, European-American race, dialysis dependency, younger age, and physical performance SF-36 components were significantly associated with poor sleep quality, mood and alertness (p < 0.05). The dialysis population demonstrated higher day-to-day variability in scores than either the advanced CKD patients or the controls. Advanced CKD and dialysis dependency are associated with impaired and highly variable sleep quality, mood, and alertness. Copyright 2010 S. Karger AG, Basel.

  2. What Would You Like to Eat, Mr CKD Microbiota? A Mediterranean Diet, please!

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    Eustacchio Montemurno

    2014-07-01

    Full Text Available In this review we elucidate the role of gut microbiota as the plausible missing link between food and health, focusing on chronic kidney disease (CKD. Microbiota, the microbial community harboured in the large intestine, is considered a symbiotic “supplementary organ”. It contributes to digestion, mainly through two catabolic pathways: saccharolytic (fermentation or proteolytic (putrefaction. It also interacts with host influencing immunity, metabolism, and health status. It is believed that a balanced healthy microbiota is primarily saccharolytic and diet has a deep effect on its composition. Mediterranean Diet, UNESCO “Intangible Cultural Heritage of Humanity”, prevents cardiovascular and metabolic systemic diseases, thanks to the high supply of fibres and antioxidants. Mediterranean Diet also favours the prevalence of saccharolytic species, while Western Diet promotes the shift towards a proteolytic profile (dysbiosis. Emerging evidences highlight the association between a wide range of diseases and dysbiosis. In CKD a vicious circle exists, in which proteolytic-derived microbial metabolites (p-cresol and indoxyl sulphate, represent the main circulating uremic toxins: their accumulation worsens dysbiosis and promotes CKD progression. Gut microbiota shaping through non-pharmacologic nutritional treatments, based on Mediterranean Diet, represents an innovative approach in CKD, potentially restoring microbiota balance, ameliorating CKD conditions and slowing down disease progression.

  3. What would you like to eat, Mr CKD Microbiota? A Mediterranean Diet, please!

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    Montemurno, Eustacchio; Cosola, Carmela; Dalfino, Giuseppe; Daidone, Giuseppe; De Angelis, Maria; Gobbetti, Marco; Gesualdo, Loreto

    2014-01-01

    In this review we elucidate the role of gut microbiota as the plausible missing link between food and health, focusing on chronic kidney disease (CKD). Microbiota, the microbial community harboured in the large intestine, is considered a symbiotic "supplementary organ". It contributes to digestion, mainly through two catabolic pathways: saccharolytic (fermentation) or proteolytic (putrefaction). It also interacts with host influencing immunity, metabolism, and health status. It is believed that a balanced healthy microbiota is primarily saccharolytic and diet has a deep effect on its composition. Mediterranean Diet, UNESCO "Intangible Cultural Heritage of Humanity", prevents cardiovascular and metabolic systemic diseases, thanks to the high supply of fibres and antioxidants. Mediterranean Diet also favours the prevalence of saccharolytic species, while Western Diet promotes the shift towards a proteolytic profile (dysbiosis). Emerging evidences highlight the association between a wide range of diseases and dysbiosis. In CKD a vicious circle exists, in which proteolytic-derived microbial metabolites (p-cresol and indoxyl sulphate), represent the main circulating uremic toxins: their accumulation worsens dysbiosis and promotes CKD progression. Gut microbiota shaping through non-pharmacologic nutritional treatments, based on Mediterranean Diet, represents an innovative approach in CKD, potentially restoring microbiota balance, ameliorating CKD conditions and slowing down disease progression.

  4. Longitudinal changes of cardiac structure and function in CKD (CASCADE study).

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    Cai, Qi-Zhe; Lu, Xiu-Zhang; Lu, Ye; Wang, Angela Yee-Moon

    2014-07-01

    Little is known regarding the natural longitudinal changes in cardiac structure and function in CKD. We hypothesized that baseline CKD stage is associated with progressive worsening in cardiac structure and function. We conducted a prospective longitudinal study, recruiting 300 patients with stages 3-5 CKD from a major regional tertiary center and university teaching hospital in Hong Kong. Baseline CKD stages were studied in relation to natural longitudinal changes in echocardiographic and tissue Doppler imaging-derived parameters. Over 1 year, the prevalence of left ventricular (LV) hypertrophy increased from 40.3% to 48.9%, median left atrial volume index increased 4.8 (interquartile range [IQR], 2.1, 7.7) ml/m(2) (Pcardiac structure and function and predicted greater longitudinal progression in LV mass index (odds ratio [OR], 3.02; 95% confidence interval [95% CI], 1.39 to 6.58), volume index (OR, 2.58; 95% CI, 1.18 to 5.62), and left atrial volume index (OR, 2.61; 95% CI, 1.20 to 5.69) and worse diastolic dysfunction grade (OR, 3.17; 95% CI, 1.16 to 8.69) compared with stage 3a in the fully adjusted analysis. In conclusion, more advanced CKD at baseline may be associated with larger longitudinal increases in LV mass and volume and greater deterioration in diastolic function.

  5. Research Priorities in CKD: Report of a National Workshop Conducted in Australia.

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    Tong, Allison; Crowe, Sally; Chando, Shingisai; Cass, Alan; Chadban, Steve J; Chapman, Jeremy R; Gallagher, Martin; Hawley, Carmel M; Hill, Sophie; Howard, Kirsten; Johnson, David W; Kerr, Peter G; McKenzie, Anne; Parker, David; Perkovic, Vlado; Polkinghorne, Kevan R; Pollock, Carol; Strippoli, Giovanni F M; Tugwell, Peter; Walker, Rowan G; Webster, Angela C; Wong, Germaine; Craig, Jonathan C

    2015-08-01

    Research aims to improve health outcomes for patients. However, the setting of research priorities is usually performed by clinicians, academics, and funders, with little involvement of patients or caregivers and using processes that lack transparency. A national workshop was convened in Australia to generate and prioritize research questions in chronic kidney disease (CKD) among diverse stakeholder groups. Patients with CKD (n=23), nephrologists/surgeons (n=16), nurses (n=8), caregivers (n=7), and allied health professionals and researchers (n=4) generated and voted on intervention questions across 4 treatment categories: CKD stages 1 to 5 (non-dialysis dependent), peritoneal dialysis, hemodialysis, and kidney transplantation. The 5 highest ranking questions (in descending order) were as follows: How effective are lifestyle programs for preventing deteriorating kidney function in early CKD? What strategies will improve family consent for deceased donor kidney donation, taking different cultural groups into account? What interventions can improve long-term post-transplant outcomes? What are effective interventions for post hemodialysis fatigue? How can we improve and individualize drug therapy to control post-transplant side effects? Priority questions were focused on prevention, lifestyle, quality of life, and long-term impact. These prioritized research questions can inform funding agencies, patient/consumer organizations, policy makers, and researchers in developing a CKD research agenda that is relevant to key stakeholders.

  6. HDL Cholesterol, LDL Cholesterol, and Triglycerides as Risk Factors for CKD: A Mendelian Randomization Study.

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    Lanktree, Matthew B; Thériault, Sébastien; Walsh, Michael; Paré, Guillaume

    2017-07-26

    High-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride concentrations are heritable risk factors for vascular disease, but their role in the progression of chronic kidney disease (CKD) is unclear. 2-sample Mendelian randomization analysis of data derived from the largest published lipid and CKD studies. Effect of independent genetic variants significantly associated with lipid concentrations was obtained from the Global Lipids Genetics Consortium (n=188,577), and the effect of these same variants on estimated glomerular filtration rate (eGFR), CKD (defined as eGFRGenetics Consortium (n=133,814). Using conventional, multivariable, and Egger Mendelian randomization approaches, we assessed the causal association between genetically determined lipid concentrations and kidney traits. eGFR, dichotomous eGFRGenetically higher triglyceride concentrations appeared associated with higher eGFRs, but this finding was driven by a single pleiotropic variant in the glucokinase regulator gene (GCKR). After exclusion, genetically higher triglyceride concentration was not associated with any kidney trait. Individual patient-level phenotype and genotype information were unavailable. 2-sample Mendelian randomization analysis of data from the largest lipid and CKD cohorts supports genetically higher HDL cholesterol concentration as causally associated with better kidney function. There was no association between genetically altered LDL cholesterol or triglyceride concentration and kidney function. Further analysis of CKD outcomes in HDL cholesterol intervention trials is warranted. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  7. Curcumin and Chronic Kidney Disease (CKD: Major Mode of Action through Stimulating Endogenous Intestinal Alkaline Phosphatase

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    Siddhartha S. Ghosh

    2014-12-01

    Full Text Available Curcumin, an active ingredient in the traditional herbal remedy and dietary spice turmeric (Curcuma longa, has significant anti-inflammatory properties. Chronic kidney disease (CKD, an inflammatory disease, can lead to end stage renal disease resulting in dialysis and transplant. Furthermore, it is frequently associated with other inflammatory disease such as diabetes and cardiovascular disorders. This review will focus on the clinically relevant inflammatory molecules that play a role in CKD and associated diseases. Various enzymes, transcription factors, growth factors modulate production and action of inflammatory molecules; curcumin can blunt the generation and action of these inflammatory molecules and ameliorate CKD as well as associated inflammatory disorders. Recent studies have shown that increased intestinal permeability results in the leakage of pro-inflammatory molecules (cytokines and lipopolysaccharides from gut into the circulation in diseases such as CKD, diabetes and atherosclerosis. This change in intestinal permeability is due to decreased expression of tight junction proteins and intestinal alkaline phosphatase (IAP. Curcumin increases the expression of IAP and tight junction proteins and corrects gut permeability. This action reduces the levels of circulatory inflammatory biomolecules. This effect of curcumin on intestine can explain why, despite poor bioavailability, curcumin has potential anti-inflammatory effects in vivo and beneficial effects on CKD.

  8. FGF23 signaling impairs neutrophil recruitment and host defense during CKD.

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    Rossaint, Jan; Oehmichen, Jessica; Van Aken, Hugo; Reuter, Stefan; Pavenstädt, Hermann J; Meersch, Melanie; Unruh, Mark; Zarbock, Alexander

    2016-03-01

    Chronic kidney disease (CKD) has been associated with impaired host response and increased susceptibility to infections. Leukocyte recruitment during inflammation must be tightly regulated to protect the host against pathogens. FGF23 levels are increased in blood during CKD, and levels of this hormone have been associated with a variety of adverse effects in CKD patients. Here, we have shown that CKD impairs leukocyte recruitment into inflamed tissue and host defense in mice and humans. FGF23 neutralization during CKD in murine models restored leukocyte recruitment and host defense. Intravital microscopy of animals with chronic kidney failure showed that FGF23 inhibits chemokine-activated leukocyte arrest on the endothelium, and downregulation of FGF receptor 2 (FGFR2) on PMNs rescued host defense in these mice. In vitro, FGF23 inhibited PMN adhesion, arrest under flow, and transendothelial migration. Mechanistically, FGF23 binding to FGFR2 counteracted selectin- and chemokine-triggered β2 integrin activation on PMNs by activating protein kinase A (PKA) and inhibiting activation of the small GTPase Rap1. Moreover, knockdown of PKA abolished the inhibitory effect of FGF23 on integrin activation. Together, our data reveal that FGF23 acts directly on PMNs and dampens host defense by direct interference with chemokine signaling and integrin activation.

  9. Association between absolute blood eosinophil count and CKD stages among cardiac patients.

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    Ishii, Rui; Fujita, Shu-Ichi; Kizawa, Shun; Sakane, Kazushi; Morita, Hideaki; Ozeki, Michishige; Sohmiya, Koichi; Hoshiga, Masaaki; Ishizaka, Nobukazu

    2016-02-01

    Elevated eosinophil count was shown to be associated with the development of cholesterol embolization syndrome, a potentially life-threatening condition, after catheter-based procedures. We investigated the association between stages of chronic kidney disease (CKD) and the absolute eosinophil count (AEC) among cardiac patients. CKD stages were determined solely on the estimated glomerular filtration rate or requirement for hemodialysis. Eosinophilia is defined as an eosinophil count exceeding 500/μL. A total of 1022 patients were enrolled in the current study, and eosinophil counts (/μL) in the first through fourth eosinophil count quartiles were blood pressure, and total white blood cell count. Similarly, after adjustment for the same variables, eosinophilia was associated with severe renal dysfunction with an odds ratio of 2.60 (95 % confidence interval, 1.08-6.26, P count was positively associated with higher CKD stages among cardiology patients, some fraction of which might be related to subclinical cholesterol embolization.

  10. IκB Kinase Inhibitor Attenuates Sepsis-Induced Cardiac Dysfunction in CKD.

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    Chen, Jianmin; Kieswich, Julius E; Chiazza, Fausto; Moyes, Amie J; Gobbetti, Thomas; Purvis, Gareth S D; Salvatori, Daniela C F; Patel, Nimesh S A; Perretti, Mauro; Hobbs, Adrian J; Collino, Massimo; Yaqoob, Muhammad M; Thiemermann, Christoph

    2017-01-01

    Patients with CKD requiring dialysis have a higher risk of sepsis and a 100-fold higher mortality rate than the general population with sepsis. The severity of cardiac dysfunction predicts mortality in patients with sepsis. Here, we investigated the effect of preexisting CKD on cardiac function in mice with sepsis and whether inhibition of IκB kinase (IKK) reduces the cardiac dysfunction in CKD sepsis. Male C57BL/6 mice underwent 5/6 nephrectomy, and 8 weeks later, they were subjected to LPS (2 mg/kg) or sepsis by cecal ligation and puncture (CLP). Compared with sham operation, nephrectomy resulted in significant increases in urea and creatinine levels, a small (Psepsis or endotoxemia in mice; this effect may be caused by increased cardiac NF-κB activation and iNOS expression. Copyright © 2016 by the American Society of Nephrology.

  11. The effect of sodium bicarbonate on cytokine secretion in CKD patients with metabolic acidosis.

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    Ori, Yaacov; Zingerman, Boris; Bergman, Michael; Bessler, Hanna; Salman, Hertzel

    2015-04-01

    The incidence of acidosis increases with the progression of chronic kidney disease (CKD). Correction of acidosis by sodium bicarbonate may slow CKD deterioration. Inflammation, which is common in CKD, may be related to acidosis. Whether the slower rate of GFR decline following the correction of acidosis is related to changes in inflammatory markers is unknown. The current study examined whether correcting CKD-acidosis affected inflammatory cytokines secretion. Thirteen patients with CKD 4-5 and acidosis were tested for cytokines secretion from peripheral-blood mononuclear cells at baseline and after one month of oral sodium bicarbonate. Following treatment with sodium bicarbonate there was no change in weight, blood pressure, serum creatinine, albumin, sodium, calcium, phosphate, PTH, hemoglobin and CRP. Serum urea decreased (134±10-116±8 mg/dl, P=0.002), potassium decreased (5.1±0.4-4.8±0.1 mequiv./l, P=0.064), pH increased (7.29±0.01-7.33±0.01, P=0.008), and serum bicarbonate increased (18.6±0.4 mequiv./l to 21.3±0.3 mequiv./l, P=0.001). The secretion of the anti-inflammatory cytokine IL-10 decreased (2.75±0.25 ng/ml to 2.29±0.21 ng/ml, P=0.041). There was no significant change in the secretion of the other pro-inflammatory and anti-inflammatory cytokines, including IL-1β, IL-2, IL-6, TNFα, IFNγ, IL-1ra. Thus, correcting acidosis in CKD with bicarbonate decreases IL-10 secretion. Its significance needs to be further investigated.

  12. Genome-Wide Association of CKD Progression: The Chronic Renal Insufficiency Cohort Study.

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    Parsa, Afshin; Kanetsky, Peter A; Xiao, Rui; Gupta, Jayanta; Mitra, Nandita; Limou, Sophie; Xie, Dawei; Xu, Huichun; Anderson, Amanda Hyre; Ojo, Akinlolu; Kusek, John W; Lora, Claudia M; Hamm, L Lee; He, Jiang; Sandholm, Niina; Jeff, Janina; Raj, Dominic E; Böger, Carsten A; Bottinger, Erwin; Salimi, Shabnam; Parekh, Rulan S; Adler, Sharon G; Langefeld, Carl D; Bowden, Donald W; Groop, Per-Henrik; Forsblom, Carol; Freedman, Barry I; Lipkowitz, Michael; Fox, Caroline S; Winkler, Cheryl A; Feldman, Harold I

    2017-03-01

    The rate of decline of renal function varies significantly among individuals with CKD. To understand better the contribution of genetics to CKD progression, we performed a genome-wide association study among participants in the Chronic Renal Insufficiency Cohort Study. Our outcome of interest was CKD progression measured as change in eGFR over time among 1331 blacks and 1476 whites with CKD. We stratified all analyses by race and subsequently, diabetes status. Single-nucleotide polymorphisms (SNPs) that surpassed a significance threshold of P<1×10(-6) for association with eGFR slope were selected as candidates for follow-up and secondarily tested for association with proteinuria and time to ESRD. We identified 12 such SNPs among black patients and six such SNPs among white patients. We were able to conduct follow-up analyses of three candidate SNPs in similar (replication) cohorts and eight candidate SNPs in phenotype-related (validation) cohorts. Among blacks without diabetes, rs653747 in LINC00923 replicated in the African American Study of Kidney Disease and Hypertension cohort (discovery P=5.42×10(-7); replication P=0.039; combined P=7.42×10(-9)). This SNP also associated with ESRD (hazard ratio, 2.0 (95% confidence interval, 1.5 to 2.7); P=4.90×10(-6)). Similarly, rs931891 in LINC00923 associated with eGFR decline (P=1.44×10(-4)) in white patients without diabetes. In summary, SNPs in LINC00923, an RNA gene expressed in the kidney, significantly associated with CKD progression in individuals with nondiabetic CKD. However, the lack of equivalent cohorts hampered replication for most discovery loci. Further replication of our findings in comparable study populations is warranted.

  13. Australian general practitioners’ current practice for chronic kidney disease (CKD detection and management

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    Marie Ludlow

    2017-06-01

    Full Text Available Background Guidelines for early detection of chronic kidney disease (CKD emphasise regular testing of kidney health in high-risk individuals. However, evidence suggests that CKD is not being adequately detected or appropriately managed in primary care. Aims Assess Australian general practitioners’ (GP current practice in relation to CKD detection and management. Methods This was a cross-sectional study utilising a random sample of GPs identified by interrogation of the national online telephone directory, and stratified by geographical location. Data collection occurred between October 2014 and January 2015. Of 2,815 eligible contacts, the final response rate was 23 per cent. Results Of the 656 respondents, over 90 per cent assessed kidney health at least annually in people with diabetes or high blood pressure, and 71 per cent correctly assessed kidney health every 3–6 months in a patient with Stage 3b CKD. The tests most commonly used to assess kidney health were serum creatinine (with eGFR, blood pressure and urine albumin creatinine ratio. The most commonly reported CKD management strategies were ‘blood pressure reduction using pharmacological agents’ (81 per cent and ‘glycaemic control if diabetes present’ (64 per cent. Knowledge testing highlighted that 32 per cent of respondents were not able to correctly identify how to properly assess absolute cardiovascular risk, and this was significantly more common in more experienced GPs (p=0.003. Conclusion The results indicate that Australian GPs are mainly practising in accordance with current guidelines for detection and management of patients with CKD, but with room for improvement in some areas

  14. A new modified CKD-EPI equation for Chinese patients with type 2 diabetes.

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    Xun Liu

    Full Text Available OBJECTIVE: To improve the performance of glomerular filtration rate (GFR estimating equation in Chinese type 2 diabetic patients by modification of the CKD-EPI equation. DESIGN AND PATIENTS: A total of 1196 subjects were enrolled. Measured GFR was calibrated to the dual plasma sample 99mTc-DTPA-GFR. GFRs estimated by the re-expressed 4-variable MDRD equation, the CKD-EPI equation and the Asian modified CKD-EPI equation were compared in 351 diabetic/non-diabetic pairs. And a new modified CKD-EPI equation was reconstructed in a total of 589 type 2 diabetic patients. RESULTS: In terms of both precision and accuracy, GFR estimating equations all achieved better results in the non-diabetic cohort comparing with those in the type 2 diabetic cohort (30% accuracy, P≤0.01 for all comparisons. In the validation data set, the new modified equation showed less bias (median difference, 2.3 ml/min/1.73 m2 for the new modified equation vs. ranged from -3.8 to -7.9 ml/min/1.73 m2 for the other 3 equations [P<0.001 for all comparisons], as was precision (IQR of the difference, 24.5 ml/min/1.73 m2 vs. ranged from 27.3 to 30.7 ml/min/1.73 m2, leading to a greater accuracy (30% accuracy, 71.4% vs. 55.2% for the re-expressed 4 variable MDRD equation and 61.0% for the Asian modified CKD-EPI equation [P = 0.001 and P = 0.02]. CONCLUSION: A new modified CKD-EPI equation for type 2 diabetic patients was developed and validated. The new modified equation improves the performance of GFR estimation.

  15. Uremic retention solute indoxyl sulfate level is associated with prolonged QTc interval in early CKD patients.

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    Wei-Hua Tang

    Full Text Available Total mortality and sudden cardiac death is highly prevalent in patients with chronic kidney disease (CKD. In CKD patients, the protein-bound uremic retention solute indoxyl sulfate (IS is independently associated with cardiovascular disease. However, the underlying mechanisms of this association have yet to be elucidated. The relationship between IS and cardiac electrocardiographic parameters was investigated in a prospective observational study among early CKD patients. IS arrhythmogenic effect was evaluated by in vitro cardiomyocyte electrophysiological study and mathematical computer simulation. In a cohort of 100 early CKD patients, patients with corrected QT (QTc prolongation had higher IS levels. Furthermore, serum IS level was independently associated with prolonged QTc interval. In vitro, the delay rectifier potassium current (IK was found to be significantly decreased after the treatment of IS in a dose-dependent manner. The modulation of IS to the IK was through the regulation of the major potassium ion channel protein Kv 2.1 phosphorylation. In a computer simulation, the decrease of IK by IS could prolong the action potential duration (APD and induce early afterdepolarization, which is known to be a trigger mechanism of lethal ventricular arrhythmias. In conclusion, serum IS level is independently associated with the prolonged QTc interval in early CKD patients. IS down-regulated IK channel protein phosphorylation and the IK current activity that in turn increased the cardiomyocyte APD and QTc interval in vitro and in the computer ORd model. These findings suggest that IS may play a role in the development of arrhythmogenesis in CKD patients.

  16. Homotopic Approximate Solutions for the Perturbed CKdV Equation with Variable Coefficients

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    Dianchen Lu

    2014-01-01

    Full Text Available This work concerns how to find the double periodic form of approximate solutions of the perturbed combined KdV (CKdV equation with variable coefficients by using the homotopic mapping method. The obtained solutions may degenerate into the approximate solutions of hyperbolic function form and the approximate solutions of trigonometric function form in the limit cases. Moreover, the first order approximate solutions and the second order approximate solutions of the variable coefficients CKdV equation in perturbation εun are also induced.

  17. High Mobility Group Box Protein-1 correlates with renal function in chronic kidney disease (CKD).

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    Bruchfeld, Annette; Qureshi, Abdul Rashid; Lindholm, Bengt; Barany, Peter; Yang, Lihong; Stenvinkel, Peter; Tracey, Kevin J

    2008-01-01

    Chronic kidney disease (CKD) is associated with inflammation and malnutrition and carries a markedly increased risk of cardiovascular disease (CVD). High Mobility Group Box Protein-1 (HMGB-1) is a 30-kDa nuclear and cytosolic protein known as a transcription and growth factor, recently identified as a proinflammatory mediator of tissue injury. Recent data implicates HMGB-1 in endotoxin lethality, rheumatoid arthritis, and atherosclerosis. The aim of this post-hoc, cross-sectional study was to determine whether HMGB-1 serum levels are elevated in CKD patients. The study groups were categorized as follows: 110 patients starting dialysis defined as CKD 5; 67 patients with moderately to severely reduced renal function or CKD 3-4; and 48 healthy controls. High-sensitivity C-reactive-protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor (TNF), serum-albumin (S-albumin), hemoglobin A(1c) (HbA(1c)), hemoglobin, subjective global nutritional assessment (SGA), and glomerular filtration rate (GFR) were analyzed. Kruskal-Wallis test was used to compare groups and Spearman's rank correlation test was used for continuous variables. HMGB-1, measured by Western blot, was significantly (P < 0.001) elevated in CKD 5 (146.7 +/- 58.6 ng/mL) and CKD 3-4 (85.6 +/- 31.8) compared with controls (10.9 +/- 10.5). HMGB-1 levels were correlated positively with TNF (Rho = 0.52; P < 0.001), hs-CRP (Rho = 0.38; P < 0.001), IL-6 (Rho = 0.30; P < 0.001), HbA(1c) (Rho = 0.14; P = 0.02) and SGA (Rho = 0.21; P = 0.002) and negatively correlated with GFR (Rho = -0.69; P = 0.0001), Hb (Rho = -0.60; P < 0.001), S-albumin (Rho = -0.31; P < 0.001). The current study has revealed that HMGB-1 is elevated significantly in CKD patients and correlates with GFR as well as markers of inflammation and malnutrition. Future studies may delineate whether HMGB-1 is also a marker of disease activity and severity as well as a predictor of outcome in CKD.

  18. Effects of Vitamin D Receptor Activation and Dietary Sodium Restriction on Residual Albuminuria in CKD: The ViRTUE-CKD Trial.

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    Keyzer, Charlotte A; van Breda, G Fenna; Vervloet, Marc G; de Jong, Maarten A; Laverman, Gozewijn D; Hemmelder, Marc H; Janssen, Wilbert M T; Lambers Heerspink, Hiddo J; Kwakernaak, Arjan J; Bakker, Stephan J L; Navis, Gerjan; de Borst, Martin H

    2017-04-01

    Reduction of residual albuminuria during single-agent renin-angiotensin-aldosterone blockade is accompanied by improved cardiorenal outcomes in CKD. We studied the individual and combined effects of the vitamin D receptor activator paricalcitol (PARI) and dietary sodium restriction on residual albuminuria in CKD. In a multicenter, randomized, placebo (PLAC)-controlled, crossover trial, 45 patients with nondiabetic CKD stages 1-3 and albuminuria >300 mg/24 h despite ramipril at 10 mg/d and BPsodium (LS) or regular sodium (RS) diet. We analyzed the treatment effect by linear mixed effect models for repeated measurements. In the intention-to-treat analysis, albuminuria (geometric mean) was 1060 (95% confidence interval, 778 to 1443) mg/24 h during RS + PLAC and 990 (95% confidence interval, 755 to 1299) mg/24 h during RS + PARI (P=0.20 versus RS + PLAC). LS + PLAC reduced albuminuria to 717 (95% confidence interval, 512 to 1005) mg/24 h (Psodium restriction substantially reduced residual albuminuria during fixed dose angiotensin-converting enzyme inhibition. The additional effect of PARI was small and nonsignificant.

  19. Is chronic kidney disease-mineral bone disorder (CKD-MBD) really a syndrome?

    Science.gov (United States)

    Cozzolino, Mario; Ureña-Torres, Pablo; Vervloet, Marc G; Brandenburg, Vincent; Bover, Jordi; Goldsmith, David; Larsson, Tobias E; Massy, Ziad A; Mazzaferro, Sandro

    2014-10-01

    The concept of chronic kidney disease-mineral bone disorder (CKD-MBD) does not appear to fulfil the requirements for a syndrome at first glance, but its definition has brought some clear-cut benefits for clinicians and patients, including wider and more complex diagnostic and therapeutic approaches to the management of this challenging set of issues. Admittedly, not all components of CKD-MBD are present in all patients at all times, but these are highly interrelated, involving mineral and bone laboratory abnormalities, clinical and histological bone disease and finally, cardiovascular disease. The presence of typical biological bone ossification processes in an ectopic anatomical location in CKD has helped to define the existence of an unprecedented bone-vascular relationship, extending its interest even to other medical specialities. For now, we believe that CKD-MBD does not reach full criteria to be defined as a syndrome. However, this novel concept has clearly influenced current clinical guidelines. The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF/KDOQI™) guidelines in 2003 for instance recommended that calcium-based phosphate binders should be avoided to treat hyperphosphataemia in the presence of cardiovascular calcifications. In 2009, the KDIGO and other guidelines reinforced and extended this recommendation by stating that it is reasonable to choose oral phosphate binder therapy by taking into consideration other components of CKD-MBD. Similarly, it is also considered reasonable to use information on vascular/valvular calcification to guide the management of CKD-MBD. Our current assumption as a working group 'CKD-MBD' is that CKD-MBD has the potential to be defined a true syndrome, such as a constellation of concurrent signs and symptoms that suggest a common underlying mechanism for these components as opposed to the term disease. The term 'syndrome' also implies that in any patient at risk due to the presence of one or a few

  20. CKD and hypertension during long-term follow-up in children and adolescents previously treated with extracorporeal membrane oxygenation

    NARCIS (Netherlands)

    A.J.M. Zwiers (Alexandra); H. IJsselstijn (Hanneke); J.M. van Rosmalen (Joost); S.J. Gischler (Saskia); S.N. de Wildt (Saskia); D. Tibboel (Dick); K. Cransberg (Karlien)

    2014-01-01

    markdownabstract__Abstract__ Background and objectives Many children receiving extracorporeal membrane oxygenation develop AKI. If AKI leads to permanent nephron loss, it may increase the risk of developing CKD. The prevalence of CKD and hypertension and its predictive factors during long-term foll

  1. Obesity, smoking, and physical inactivity as risk factors for CKD: Are men more vulnerable?

    NARCIS (Netherlands)

    S. Hallan; R. de Mutsert; S. Carlsen; F.W. Dekker; K. Aasarod; J. Holmen

    2006-01-01

    Background: The incidence of end-stage renal disease is especially high in men, and some studies indicated that smoking is a risk factor for men only. We investigated associations between obesity, smoking, and physical inactivity and chronic kidney disease (CKD) in the general population and whether

  2. Starting together: a focus group for the organization of a CKD outpatient care unit.

    Science.gov (United States)

    Piccoli, Giorgina Barbara; Consiglio, Valentina; Deagostini, Maria Chiara; Manente, Elisa; Scarpa, Roberto Mario

    2010-01-01

    The growing interest in patient empowerment in chronic diseases underlines the importance of assessing patients' opinions in planning healthcare strategies. Focus groups are flexible tools for investigating innovative aspects of care. The aim of the study was to use a focus group to define the main requirements for a chronic kidney disease (CKD) outpatient care unit. The focus group met during the opening of a new CKD outpatient facility. It consisted of 12 patients with long-term experience of CKD, dialysis and transplantation; they had been followed previously by the senior physician, who moderated the discussion. The discussion was tape-recorded and the results were summarized and approved by all participants. The group made 10 major suggestions: 1. Therapeutic continuity in all disease phases, from pre-dialysis to transplantation; 2. Possibility to choose the reference physician; 3. Strict integration with the nursing activities; 4. Organizational flexibility, to adapt to the needs of daily life; 5. To be "fully" taken care of, with organizational support for blood tests, imaging and consultations; 6. Need for time with the reference physician in critical phases of the disease; 7. Identification of a network of consultants, in keeping with the need for continuity of care; 8. Educational sessions; 9. Meetings for critical discussion of organizational performances; 10. As a setting: a home for the disease and not a disease to take home. Continuity of care and flexibility of organization, allowing time for education and discussion, are the quality requirements of our CKD patients.

  3. A resistant starch fiber diet ameliorates oxidative stress, inflammation, and progression of chronic kidney disease (CKD)

    Science.gov (United States)

    Inflammation is a constant feature and a major mediator of CKD progression. It is, in part, driven by altered gut microbiome and disruption of intestinal epithelial barrier, events which are primarily caused by: 1- urea influx in the intestine resulting in dominance of urease-possessing bacteria; 2-...

  4. High amylose resistant starch diet ameliorates oxidative stress, inflammation, and progression of chronic kidney disease (CKD)

    Science.gov (United States)

    Patients with advanced CKD exhibit profound changes in the composition and function of the gut microbiome. This is, in part, mediated by: I- heavy influx of urea in the intestinal tract leading to the dominance of urease-possessing bacteria and II- dietary restriction of potassium-rich fruits and ve...

  5. Intravenous Iron Repletion Does Not Significantly Decrease Platelet Counts in CKD Patients with Iron Deficiency Anemia

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    Neville R. Dossabhoy

    2013-01-01

    Full Text Available Purpose. We sought to investigate the effect of IV iron repletion on platelet (PLT counts in CKD patients with iron deficiency anemia (IDA. Methods. We conducted a retrospective chart review, including all patients with CKD and IDA who were treated with iron dextran total dose infusion (TDI between 2002 and 2007. Patient demographics were noted, and laboratory values for creatinine, hemoglobin (Hgb, iron stores and PLT were recorded pre- and post-dose. Results. 153 patients received a total of 251 doses of TDI (mean ± SD = 971 ± 175 mg; age years and Creatinine  mg/dL. All CKD stages were represented (stage 4 commonest. Hgb and Fe stores improved post-TDI (. There was a very mild decrease in PLT (pre-TDI 255 versus post-TDI 244, . The mild reduction in PLT after TDI remained non-significant ( when data was stratified by molecular weight (MW of iron dextran used (low versus high, as well as by dose administered (<1000 versus ≥1000 mg. Linear regression analysis between pre-dose PLT and Tsat and Fe showed R2 of 0.01 and 0.04, respectively. Conclusion. Correction of iron deficiency did not significantly lower PLT in CKD patients, regardless of MW or dose used. Correlation of PLT to severity of iron deficiency was very weak.

  6. Educating Patients about CKD: The Path to Self-Management and Patient-Centered Care.

    Science.gov (United States)

    Narva, Andrew S; Norton, Jenna M; Boulware, L Ebony

    2016-04-07

    Patient education is associated with better patient outcomes and supported by international guidelines and organizations, but a range of barriers prevent widespread implementation of comprehensive education for people with progressive kidney disease, especially in the United States. Among United States patients, obstacles to education include the complex nature of kidney disease information, low baseline awareness, limited health literacy and numeracy, limited availability of CKD information, and lack of readiness to learn. For providers, lack of time and clinical confidence combine with competing education priorities and confusion about diagnosing CKD to limit educational efforts. At the system level, lack of provider incentives, limited availability of practical decision support tools, and lack of established interdisciplinary care models inhibit patient education. Despite these barriers, innovative education approaches for people with CKD exist, including self-management support, shared decision making, use of digital media, and engaging families and communities. Education efficiency may be increased by focusing on people with progressive disease, establishing interdisciplinary care management including community health workers, and providing education in group settings. New educational approaches are being developed through research and quality improvement efforts, but challenges to evaluating public awareness and patient education programs inhibit identification of successful strategies for broader implementation. However, growing interest in improving patient-centered outcomes may provide new approaches to effective education of people with CKD. Copyright © 2016 by the American Society of Nephrology.

  7. Tempol, a Superoxide Dismutase-Mimetic Drug, Ameliorates Progression of Renal Disease in CKD Mice

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    Wei Ding

    2015-07-01

    Full Text Available Background: Oxidative stress has been implicated in the pathogenesis of chronic kidney disease (CKD and antioxidants may ameliorate disease progression. We investigate the beneficial effect of Tempol, a superoxide dismutase-mimetic drug, on progression of disease in a mouse model of CKD. Methods: CKD was surgically induced in c57BL/6 mice by 5/6 nephrectomy. Mice were randomly divided into 3 groups: sham group, 5/6 nephrectomized group (Nx and Nx+Tempol (2 mmol/l in drinking water. Mice were sacrificed at the end of 12 weeks. Renal function, structure as well as expression of key molecules involved in the pathogenesis of inflammation, fibrosis and progression in mice were measured. Results: Reduced body weight and impaired renal function (elevation on serum creatinine, blood urea nitrogen, urine albumin, segmental sclerosis and tubulointerstitial damage was demonstrated in Nx mice but was significantly improved by Tempol administration. Nx animals exhibited significantly elevated proinflammatory and profibrotic factors, activation of NF-κB, increased expression of NADPH oxidase related subunits (p47phox, p67phox, gp91phox, and elevated activation of TGF-ß/Smad3, EGFR, MAPK signaling pathway. Tempol inhibited NF-κB mediated inflammation, TGF-ß/Smad3-induced renal fibrosis as well as EGFR and MAPK signaling pathway activation. Conclusions: Tempol administration attenuated renal injury in CKD mice through NF-κB, TGF-ß/Smad3, redox-senstive EGFR activation and c-Raf/MEK/ERK pathways.

  8. Hepcidin Response to Iron Therapy in Patients with Non-Dialysis Dependent CKD

    NARCIS (Netherlands)

    Gaillard, Carlo A.; Bock, Andreas H.; Carrera, Fernando; Eckardt, Kai-Uwe; Van Wyck, David B.; Bansal, Sukhvinder S.; Cronin, Maureen; Meier, Yvonne; Larroque, Sylvain; Roger, Simon D.; Macdougall, Iain C.

    2016-01-01

    Hepcidin is the key regulator of iron homeostasis but data are limited regarding its temporal response to iron therapy, and response to intravenous versus oral iron. In the 56-week, open-label, multicenter, prospective, randomized FIND-CKD study, 626 anemic patients with non-dialysis dependent

  9. Prevalence, awareness, and management of CKD and cardiovascular risk factors in publicly funded health care

    NARCIS (Netherlands)

    Verhave, J.C.; Troyanov, S.; Mongeau, F.; Fradette, L.; Bouchard, J.; Awadalla, P.; Madore, F.

    2014-01-01

    BACKGROUND AND OBJECTIVES: It is uncertain how many patients with CKD and cardiovascular risk factors in publicly funded universal health care systems are aware of their disease and how to achieve their treatment targets. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The CARTaGENE study evaluated B

  10. The community health promotion plan: a CKD prevention and management strategy.

    Science.gov (United States)

    Sinasac, Lisa

    2012-01-01

    Chronic kidney disease (CKD) is one of the top 10 causes of death. CKD is often caused by diabetes mellitus (DM) and hypertension (HTN). Both DM Type 2 and HTN are treatable and preventable and, yet, the population of individuals diagnosed with these two diseases is increasing. Millions of dollars are spent every year providing dialysis treatments for patients with CKD. This money only accounts for dialysis and does not include the millions spent on complications such as infections, medications, tests and procedures. The burden to society is tremendous and the quality of life for these people is often poor. Health promotion and early detection is a key factor in reducing the risk for and incidence of DM and HTN, thus reducing the incidence of CKD. Three-quarters of health problems are preventable. Educating and providing the community with resources about diet, exercise, regular physical examinations, medication, and smoking cessation can empower the population with the necessary knowledge to help prevent these diseases. Health promotion and access to health promotion activities can, therefore, provide an active and healthier life.

  11. INCREASED FAT INTAKE MAY STABILIZED CKD PROGRESSION IN LOW-FAT INTAKE PATIENTS

    Directory of Open Access Journals (Sweden)

    Min-Yu Chang

    2012-06-01

    Inadequate calories intake will induce excessive protein catabolism, which can cause accumulation of uremic toxins and acceleration of renal failure. Increasing fats intake is an easy way to achieve adequate calories acquirement and may stabilize the progression of CKD especially in low-fat intake patients.

  12. LDL cholesterol in CKD-to treat or not to treat?

    NARCIS (Netherlands)

    Massy, Ziad A.; de Zeeuw, Dick

    2013-01-01

    In the majority of patients with chronic kidney disease (CKD) the total and low-density lipoprotein (LDL) cholesterol are usually normal, with the exception of patients with nephrotic-range proteinuria and in peritoneal dialysis patients. Moreover, epidemiological evidence shows that the link betwee

  13. The effect of some medications given to CKD patients on vitamin D levels

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    Claudia Yuste

    2015-03-01

    Conclusions: CKD patients with vitamin D deficiency who received RAS inhibitors or Allopurinol treatment had higher 25-OH-D3 levels, however those with statins treatment had lower vitamin D levels. Randomized controlled trials are required to confirm these findings.

  14. Assessment of the anti-obesity effects of the TNP-470 analog, CKD-732.

    Science.gov (United States)

    Kim, Yoo Mee; An, Juan Ji; Jin, Yong-Jun; Rhee, Yumie; Cha, Bong Soo; Lee, Hyun Chul; Lim, Sung-Kil

    2007-04-01

    The systemic treatment with angiogenesis inhibitor has been shown to result in weight reduction and adipose tissue loss in various models of obesity. To verify the mechanism of CKD-732 (TNP-470 analog) against obesity, we evaluated CKD-732's peripheral and central anti-obesity effects. CKD-732 was injected subcutaneously (s.c.) for 7 days in various animal models and intracerebroventricularly (i.c.v.) in arcuate nucleus (ARC) lesion mice, ob/ob mice, and normal littermates. Modulation of the hypothalamic neuropeptide mRNAs after i.c.v. injection was evaluated in ARC lesion mice and normal littermates. A conditioned taste aversion (CTA) was performed using lithium chloride (LiCl) as a positive control agent in Long-Evans Tokushima Otsuka and Otsuka Long-Evans Tokushima fatty (OLETF) rats. As a result, 7 days of CKD-732 s.c. injection reduced the cumulative food intake and the body weight significantly in both treated obese (e.g. 114.8 +/- 13.4 g vs 170.7 +/- 20.6 g, 7.9 +/- 0.5% decrease vs 0.3 +/- 2.2% decrease; in treated OLETF rat versus control OLETF rat, P obese models. Epididymal and mesenteric fat pads, and the size of adipocytes were significantly decreased in treated rats. A single i.c.v. injection decreased food intake and body weight in ARC lesion mice and ob/ob mice but not in normal littermates. Unexpectedly, the hypothalamic neuropeptide mRNAs were not altered by single i.c.v. injection. CKD-732 also induced a dose-dependent CTA comparable with LiCl injection, which is a commonly used agent to produce a CTA. In conclusion, CKD-732 causes significant body weight and appetite reduction, possibly by decreasing adiposity directly and inducing central anorexia, which is partly explained by a CTA. These results should be carefully verified to assess the utility of CKD-732 as an anti-obesity drug.

  15. KDOQI US commentary on the 2013 KDIGO Clinical Practice Guideline for Lipid Management in CKD.

    Science.gov (United States)

    Sarnak, Mark J; Bloom, Roy; Muntner, Paul; Rahman, Mahboob; Saland, Jeffrey M; Wilson, Peter W F; Fried, Linda

    2015-03-01

    The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) guideline for management of dyslipidemia in chronic kidney disease (CKD) was published in 2003. Since then, considerable evidence, including randomized controlled trials of statin therapy in adults with CKD, has helped better define medical treatments for dyslipidemia. In light of the new evidence, KDIGO (Kidney Disease: Improving Global Outcomes) formed a work group for the management of dyslipidemia in patients with CKD. This work group developed a new guideline that contains substantial changes from the prior KDOQI guideline. KDIGO recommends treatment of dyslipidemia in patients with CKD primarily based on risk for coronary heart disease, which is driven in large part by age. The KDIGO guideline does not recommend using low-density lipoprotein cholesterol level as a guide for identifying individuals with CKD to be treated or as treatment targets. Initiation of statin treatment is no longer recommended in dialysis patients. To assist US practitioners in interpreting and applying the KDIGO guideline, NKF-KDOQI convened a work group to write a commentary on this guideline. For the most part, our work group agreed with the recommendations of the KDIGO guideline, although we describe several areas in which we believe the guideline statements are either too strong or need to be more nuanced, areas of uncertainty and inconsistency, as well as additional research recommendations. The target audience for the KDIGO guideline includes nephrologists, primary care practitioners, and non-nephrology specialists such as cardiologists and endocrinologists. As such, we also put the current recommendations into the context of other clinical practice recommendations for cholesterol treatment.

  16. Measured GFR Does Not Outperform Estimated GFR in Predicting CKD-related Complications

    Science.gov (United States)

    Propert, Kathleen; Xie, Dawei; Hamm, Lee; He, Jiang; Miller, Edgar; Ojo, Akinlolu; Shlipak, Michael; Teal, Valerie; Townsend, Raymond; Weir, Matthew; Wilson, Jillian; Feldman, Harold

    2011-01-01

    Although many assume that measurement of glomerular filtration rate (GFR) using a marker such as iothalamate (iGFR) is superior to equation-estimated GFR (eGFR), each of these methods has distinct disadvantages. Because physicians often use renal function to guide the screening for various CKD-associated complications, one method to compare the clinical utility of iGFR and eGFR is to determine the strength of their association with CKD-associated comorbidities. Using a subset of 1214 participants in the Chronic Renal Insufficiency Cohort (CRIC) Study, we determined the cross-sectional associations between known complications of CKD and iGFR, eGFR estimated from serum creatinine (eGFR_Cr), and eGFR estimated from cystatin C (eGFR_cysC). We found that none of the measures of renal function strongly associated with CKD complications and that the relative strengths of associations varied according to the outcome of interest. For example, iGFR demonstrated better discrimination than eGFR_Cr and eGFR_cysC for outcomes of anemia and hemoglobin concentration; however, both eGFR_Cr and eGFR_cysC demonstrated better discrimination than iGFR for outcomes of hyperphosphatemia and phosphorus level. iGFR and eGFR had similar strengths of association with hyperkalemia/potassium level and with metabolic acidosis/bicarbonate level. In conclusion, iothalamate measurement of GFR is not consistently superior to equation-based estimations of GFR in explaining CKD-related comorbidities. These results raise questions regarding the conventional view that iGFR is the “gold standard” measure of kidney function. PMID:21921144

  17. Risedronate, an effective treatment for glucocorticoid-induced bone loss in CKD patients with or without concomitant active vitamin D (PRIUS-CKD).

    Science.gov (United States)

    Fujii, Naohiko; Hamano, Takayuki; Mikami, Satoshi; Nagasawa, Yasuyuki; Isaka, Yoshitaka; Moriyama, Toshiki; Horio, Masaru; Imai, Enyu; Hori, Masatsugu; Ito, Takahito

    2007-06-01

    Recent post hoc analysis proved the efficacy and tolerability of risedronate in osteoporotic patients with renal impairment, but the combination of active vitamin D in chronic kidney disease (CKD) patients taking glucocorticoids remains unknown. We conducted a prospective study enrolling 114 CKD patients (creatinine clearance > or =30 ml/min/1.73 m(2)) receiving glucocorticoid therapy for > or =6 months. Eighty-eight subjects who had received active vitamin D (aVD) were randomly assigned to either a group treated with aVD only (group A), or to a group also receiving risedronate 2.5 mg/day (group B). The remaining patients (group C) received risedronate only. After 1 year 100 subjects were analysed. Risedronate was effective on the lumbar spine, but not on the femoral neck. The lumbar bone mineral density (BMD) significantly increased by 2.8 and 2.5% in groups B and C, respectively, but decreased by 1.0% in group A. Serum N-terminal telopeptides of type I collagen (S-NTX) and bone alkaline phosphatase (ALP) fell significantly in groups B and C at 3 and 6 months, respectively, while in group A S-NTX remained unchanged and bone ALP significantly increased. There was no significant difference between groups B and C regarding BMD and bone markers. The reduction rate of S-NTX (bone ALP) at 6 months predicted the increase in lumbar BMD at 1 year with a sensitivity of 73% (34%) and a specificity of 46.2% (100%). Risedronate is effective in increasing BMD with or without aVD in CKD patients receiving long-term glucocorticoid therapy. Bone markers are of some use in predicting the response to anti-resorptive therapy.

  18. Association between Urine Creatinine Excretion and Arterial Stiffness in Chronic Kidney Disease: Data from the KNOW-CKD Study

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    Young Youl Hyun

    2016-08-01

    Full Text Available Background/Aims: Previous studies have shown that low muscle mass is associated with arterial stiffness, as measured by pulse wave velocity (PWV, in a population without chronic kidney disease (CKD. This link between low muscle mass and arterial stiffness may explain why patients with CKD have poor cardiovascular outcomes. However, the association between muscle mass and arterial stiffness in CKD patients is not well known. Methods: Between 2011 and 2013, 1,529 CKD patients were enrolled in the prospective Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD. We analyzed 888 participants from this cohort who underwent measurements of 24-hr urinary creatinine excretion (UCr and brachial-ankle PWV (baPWV at baseline examination. The mean of the right and left baPWV (mPWV was used as a marker of arterial stiffness. Results: The baPWV values varied according to the UCr quartile (1,630±412, 1,544±387, 1,527±282 and 1,406±246 for the 1st to 4th quartiles of UCr, respectively, PConclusion: Low muscle mass estimated by low UCr was associated high baPWV in pre-dialysis CKD patients in Korea. Further studies are needed to confirm the causal relationship between UCR and baPWV, and the role of muscle mass in the development of cardiovascular disease in CKD.

  19. Nonapnea Sleep Disorders in Patients Younger than 65 Years Are Significantly Associated with CKD: A Nationwide Population-Based Study.

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    Hugo You-Hsien Lin

    Full Text Available Nonapnea sleep disorders (NASD and sleep-related problems are associated with poor health outcomes. However, the association between NASD and the development and prognosis of chronic kidney disease (CKD has not been investigated thoroughly. We explored the association between CKD and NASD in Taiwan.We conducted a population-based study using the Taiwan National Health Insurance database with1,000,000 representative data for the period from January 1, 2000 to December 31, 2009. We investigated the incidence and risk of CKD in 7,006 newly diagnosed NASD cases compared with 21,018 people without NASD matched according to age, sex, index year, urbanization, region, and monthly income at a 1:3 ratio.The subsequent risk of CKD was 1.48-foldhigher in the NASD cohort than in the control cohort (95% confidence interval [CI] = 1.26-1.73, p< 0.001. Men, older age, type 2 diabetes mellitus, and gout were significant factors associated with the increased risk of CKD (p< 0.001. Among different types of NASDs, patients with insomnia had a 52% increased risk of developing CKD (95%CI = 1.23-1.84; P<0.01, whereas patients with sleep disturbance had a 49%increased risk of subsequent CKD (95% CI = 1.19-1.87; P<0.001. Younger women (aged < 65 years were at a high risk of CKD with NASD (adjusted hazard ratio, [HR] = 1.81; 95% CI = 1.35-2.40, p< 0.001.In this nationwide population-based cohort study, patients with NASD, particularly men of all ages and women aged younger than 65 years, were at high risk of CKD.

  20. MDRD or CKD-EPI for glomerular filtration rate estimation in living kidney donors.

    Science.gov (United States)

    Burballa, Carla; Crespo, Marta; Redondo-Pachón, Dolores; Pérez-Sáez, María José; Mir, Marisa; Arias-Cabrales, Carlos; Francés, Albert; Fumadó, Lluis; Cecchini, Lluis; Pascual, Julio

    2017-04-12

    The evaluation of the measured Glomerular Filtration Rate (mGFR) or estimated Glomerular Filtration Rate (eGFR) is key in the proper assessment of the renal function of potential kidney donors. We aim to study the correlation between glomerular filtration rate estimation equations and the measured methods for determining renal function. We analysed the relationship between baseline GFR values measured by Tc-(99)m-DTPA (diethylene-triamine-pentaacetate) and those estimated by the four-variable Modification of Diet in Renal Disease (MDRD4) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in a series of living donors at our institution. We included 64 donors (70.6% females; mean age 48.3±11 years). Baseline creatinine was 0.8±0.1 mg/dl and it was 1.1±0.2 mg/dl one year after donation. The equations underestimated GFR when measured by Tc(99)m-DTPA (MDRD4-9.4 ± 25ml/min, P<.05, and CKD-EPI-4.4 ± 21ml/min). The correlation between estimation equations and the measured method was superior for CKD-EPI (r=.41; P<.004) than for MDRD4 (r=.27; P<.05). eGFR decreased to 59.6±11 (MDRD4) and 66.2±14ml/min (CKD-EPI) one year after donation. This means a mean eGFR reduction of 28.2±16.7 ml/min (MDRD4) and 27.31±14.4 ml/min (CKD-EPI) at one year. In our experience, CKD-EPI is the equation that better correlates with mGFR-Tc(99)m-DTPA when assessing renal function for donor screening purposes. Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  1. Can we delay the progression of chronic kidney disease (CKD) by improving collaboration between renal units and primary care teams?

    Science.gov (United States)

    Thomas, N

    2005-01-01

    This paper will discuss why nephrology teams should collaborate with primary care teams in delaying the progression of chronic kidney disease (CKD), and explain how they can collaborate to improve the outcomes for patients who eventually need dialysis. The paper will describe the staging of CKD and will discuss evidence-based guidelines for the management of CKD in the community. Practical examples of how a specialist renal nurse can improve communication with primary care and can improve the outcome of patients with early kidney disease will be described.

  2. Hepatitis B Virus Infection and Anti-HBc (Total Positivity in CKD Patients before Dialysis

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    Fareha Jesmin Rabbi

    2016-09-01

    Full Text Available Background: CKD patients are associated with HBV infection both as a cause and complication of treatment. CKD patients before starting dialysis therapy are considered as a high risk group because of impaired immune response compared with healthy individuals and also other risk factors related with treatment and management. Only HBsAg marker does not always follow the presence or absence of HBV infection. Anti-HBc (total alone positivity indicates previous exposure to HBV infection, window period and even after reactivation of resolved HBV infection. In some cases only anti-HBc positivity is interpreted as possible chronic low dose HBV infection (chronic carriage. Predialytic CKD patients were tested with three serological markers [HBsAg, anti-HBc (total and anti-HBs] for screening HBV infection. Proper diagnosis before dialysis and knowing the infection status would help both the patient and doctor to choose proper treatment approach. Objective: This cross-sectional study was done in the CKD patients before starting dialysis therapy to find out the HBV infection and to evaluate the infection by minimal serological markers as for screening. Materials and Methods: A total of 211 patients with chronic kidney disease stage five (CKD-V before starting dialysis therapy were included as subjects of this cross-sectional study. Among the CKD patients HBsAg was tested to see the prevalence. Other serological markers, i.e., anti-HBc (total and anti-HBs were tested in combination with HBsAg in 89 randomly selected patients among the subjects. The patients were also tested for anti-HCV to assess co-infection. After collecting all the data of different test results analyses were done by SPSS version 15.0. Results: Among total study population 10 (4.7% patients were found HBsAg positive. No patient was found positive for both HBsAg and anti-HCV. Among the 89 CKD patients only 2 (2.2% patients were HBsAg positive, and only one patient (0.9% was found positive

  3. Relation of Serum Lipids and Lipoproteins with Progression of CKD: The CRIC Study

    Science.gov (United States)

    Yang, Wei; Akkina, Sanjeev; Alper, Arnold; Anderson, Amanda Hyre; Appel, Lawrence J.; He, Jiang; Raj, Dominic S.; Schelling, Jeffrey; Strauss, Louise; Teal, Valerie; Rader, Daniel J.

    2014-01-01

    Background and objectives Hyperlipidemia is common in patients with CKD. The objective of this study was to evaluate whether measures of plasma lipids and lipoproteins predict progression of kidney disease in patients with CKD. Design, setting, participants, & measurements Prospective cohort study in adults (n=3939) with CKD aged 21–74 years recruited between 2003 and 2008 and followed for a median of 4.1 years. At baseline, total cholesterol, triglycerides, very-low-density lipoprotein cholesterol (VLDL-C), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C), apoA-I , apoB, and lipoprotein(a) [Lp(a)] were measured. The outcomes were composite end point of ESRD or 50% decline in eGFR from baseline (rate of change of GFR). Results Mean age of the study population was 58.2 years, and the mean GFR was 44.9 ml/min per 1.73 m2; 48% of patients had diabetes. None of the lipid or lipoprotein measures was independently associated with risk of the composite end point or rate of change in GFR. However, there were significant (P=0.01) interactions by level of proteinuria. In participants with proteinuria0.2 g/d, neither LDL-C (HR, 0.98; 95% CI, 0.98 to 1.05) nor total cholesterol levels were associated with renal outcomes. Treatment with statins was reported in 55% of patients and was differential across lipid categories. Conclusions In this large cohort of patients with CKD, total cholesterol, triglycerides, VLDL-C, LDL-C, HDL-C, apoA-I, apoB, and Lp(a) were not independently associated with progression of kidney disease. There was an inverse relationship between LDL-C and total cholesterol levels and kidney disease outcomes in patients with low levels of proteinuria. PMID:24832097

  4. The effect of some medications given to CKD patients on vitamin D levels.

    Science.gov (United States)

    Yuste, Claudia; Quiroga, Borja; de Vinuesa, Soledad García; Goicoechea, Maria Angeles; Barraca, Daniel; Verdalles, Ursula; Luño, Jose

    2015-01-01

    Vitamin D deficiency and polypharmacy is a common problem over chronic kidney disease (CKD) population. To assess the clinical and analytical characteristics of CKD patients with 25-OH-D3 deficiency (<15 ng/mL), including the possible role of associated drugs. A single center observational review of 137 incident patients referred to our outpatient clinic with different stages of CKD and 25-OH-D3<15ng/mL (male gender 53.3%, mean age 70.8 [±16.1] years, mean GFR (MDRD-4) 43.6 [±25.5] ml/min/1.73 m²). 25-OH-D3 levels were collected in spring. Clinical and biochemical data and associated medications were recorded. Mean 25-OH-D3 levels were 8.23 [±4.03] ng/ml. Eighty-eight patients (64.7%) had 3 or more concomitant drugs. Only 7 patients (5.1%) were not receiving any medication. Patients were divided in three groups according the therapies into none (n=26), RAS inhibitors or allopurinol (n=81), and RAS inhibitors plus allopurinol (n=30); with the aim to study the influence of statin therapy. Patients under renin angiotensin (RAS) inhibitors or Allopurinol treatment presented significantly higher 25-OH-D3 levels (p=0.001 and p=0.01 respectively), however patients with Statins treatment had lower 25-OH-D3 level (p=0.039). Personal history of diabetes, cardiovascular events or other therapies did not modify 25-OH-D3 levels, adjusted by age and eGFR. CKD patients with vitamin D deficiency who received RAS inhibitors or Allopurinol treatment had higher 25-OH-D3 levels, however those with statins treatment had lower vitamin D levels. Randomized controlled trials are required to confirm these findings. Copyright © 2015. Published by Elsevier España, S.L.U.

  5. Phytoextraction of chloride from a cement kiln dust (CKD) contaminated landfill with Phragmites australis.

    Science.gov (United States)

    McSorley, Kaitlin; Rutter, Allison; Cumming, Robert; Zeeb, Barbara A

    2016-05-01

    Cement kiln dust (CKD) is a globally produced by-product from cement manufacturing that is stockpiled or landfilled. Elevated concentrations of chloride pose toxic threats to plants and aquatic communities, as the anion is highly mobile in water and can leach into surrounding water sources. Re-vegetation and in situ phytoextraction of chloride from a CKD landfill in Bath, ON, Canada, was investigated with the resident invasive species Phragmites australis (haplotype M). Existing stands of P. australis were transplanted from the perimeter of the site into the highest areas of contamination (5.9×10(3)μg/g). Accumulation in the shoots of P. australis was quantified over one growing season by collecting samples from the site on a bi-weekly basis and analyzing for chloride. Concentrations decreased significantly from early May (24±2.2×10(3)μg/g) until mid-June (15±2.5×10(3)μg/g), and then remained stable from June to August. Shoot chloride accumulation was not significantly affected by water level fluctuations at the site, however elevated potassium concentrations in the soil may have contributed to uptake. Based on shoot chloride accumulation and total biomass, it was determined that phytoextraction from the CKD landfill can remove 65±4kg/km(2) of chloride per season. Based on this extraction rate, removal of chloride present in the highly contaminated top 10cm of soil can be achieved in 3-9years. This is the first study to apply phytotechnologies at a CKD landfill, and to successfully demonstrate in situ phytoextraction of chloride.

  6. Clinical features of CKD-MBD in Japan: cohort studies and registry.

    Science.gov (United States)

    Hamano, Takayuki; Sakaguchi, Yusuke; Fujii, Naohiko; Isaka, Yoshitaka

    2017-03-01

    Randomized controlled trials (RCTs) are essential for evidence-based medicine; however, cohort studies and registries provide an important information about risk factors and, hence, shed light on the target of laboratory parameters. The uniqueness of the current Japanese CKD-MBD guidelines lies in the lower target range of intact parathyroid hormone levels than those used in other countries, which is based on analyses of the nationwide Japan Renal Data Registry. Cohort studies were also useful in exploring risk factors of renal outcome in predialysis patients. It was revealed that low vitamin D status (very prevalent in Japan) and high fibroblast growth factor 23 (FGF23) levels predict poor renal outcome. The reported association of FGF23 levels with left ventricular hypertrophy (LVH) and heart failure observed in cohort studies may support the idea of adding the 4th component of CKD-MBD, namely, "LVH" to the three original components. When it is not feasible to conduct RCTs regarding intervention, we have no choice but to rely on observational studies with sophisticated analysis methods, such as facility-level analysis and marginal structural model minimizing indication bias. Observational studies conducted in Japan revealed that the side effects of medications for CKD-MBD, resultant compliance, and effective doses in terms of hard outcome in Japanese patients were found to be different from those in other countries. For example, the MBD-5D study confirmed the benefit of cinacalcet in terms of mortality despite its median dose of only 25 mg/day. These data are very helpful for future guidelines specific to Japanese patients with CKD.

  7. High Mobility Group Box Protein-1 Correlates with Renal Function in Chronic Kidney Disease (CKD)

    OpenAIRE

    Bruchfeld, Annette; Qureshi, Abdul Rashid; Lindholm, Bengt; Barany, Peter; Yang, Lihong; Stenvinkel, Peter; Tracey, Kevin J.

    2007-01-01

    Chronic kidney disease (CKD) is associated with inflammation and malnutrition and carries a markedly increased risk of cardiovascular disease (CVD). High Mobility Group Box Protein-1 (HMGB-1) is a 30-kDa nuclear and cytosolic protein known as a transcription and growth factor, recently identified as a proinflammatory mediator of tissue injury. Recent data implicates HMGB-1 in endotoxin lethality, rheumatoid arthritis, and atherosclerosis. The aim of this post-hoc, cross-sectional study was to...

  8. Use of administrative databases for health-care planning in CKD.

    Science.gov (United States)

    Bello, Aminu; Hemmelgarn, Brenda; Manns, Braden; Tonelli, Marcello

    2012-10-01

    Good-quality information is required to plan healthcare services for patients with chronic diseases. Such information includes measures of disease burden, current care patterns and gaps in care based on quality-of-care indicators and clinical outcomes. Administrative data have long been used as a source of information for policy decisions related to the management of chronic diseases including cardiovascular disease, diabetes and hypertension. More recently, chronic kidney disease (CKD) has been acknowledged as a significant public health issue. Administrative data, particularly when supplemented by the use of routine laboratory data, have the potential to inform the development of optimal CKD care strategies, generate hypotheses about how to slow disease progression and identify risk factors for adverse outcomes. Available data may allow case identification and assessment of rates and patterns of disease progression, evaluation of risk and complications, including current gaps in care, and an estimation of associated costs. In this article, we use the example of the Alberta Kidney Disease Network to describe how researchers and policy makers can collaborate, using administrative data sources to guide health policy for the care of CKD patients.

  9. Alteration of the Intestinal Environment by Lubiprostone Is Associated with Amelioration of Adenine-Induced CKD.

    Science.gov (United States)

    Mishima, Eikan; Fukuda, Shinji; Shima, Hisato; Hirayama, Akiyoshi; Akiyama, Yasutoshi; Takeuchi, Yoichi; Fukuda, Noriko N; Suzuki, Takehiro; Suzuki, Chitose; Yuri, Akinori; Kikuchi, Koichi; Tomioka, Yoshihisa; Ito, Sadayoshi; Soga, Tomoyoshi; Abe, Takaaki

    2015-08-01

    The accumulation of uremic toxins is involved in the progression of CKD. Various uremic toxins are derived from gut microbiota, and an imbalance of gut microbiota or dysbiosis is related to renal failure. However, the pathophysiologic mechanisms underlying the relationship between the gut microbiota and renal failure are still obscure. Using an adenine-induced renal failure mouse model, we evaluated the effects of the ClC-2 chloride channel activator lubiprostone (commonly used for the treatment of constipation) on CKD. Oral administration of lubiprostone (500 µg/kg per day) changed the fecal and intestinal properties in mice with renal failure. Additionally, lubiprostone treatment reduced the elevated BUN and protected against tubulointerstitial damage, renal fibrosis, and inflammation. Gut microbiome analysis of 16S rRNA genes in the renal failure mice showed that lubiprostone treatment altered their microbial composition, especially the recovery of the levels of the Lactobacillaceae family and Prevotella genus, which were significantly reduced in the renal failure mice. Furthermore, capillary electrophoresis-mass spectrometry-based metabolome analysis showed that lubiprostone treatment decreased the plasma level of uremic toxins, such as indoxyl sulfate and hippurate, which are derived from gut microbiota, and a more recently discovered uremic toxin, trans-aconitate. These results suggest that lubiprostone ameliorates the progression of CKD and the accumulation of uremic toxins by improving the gut microbiota and intestinal environment.

  10. The "phosphorus pyramid": a visual tool for dietary phosphate management in dialysis and CKD patients.

    Science.gov (United States)

    D'Alessandro, Claudia; Piccoli, Giorgina B; Cupisti, Adamasco

    2015-01-20

    Phosphorus retention plays a pivotal role in the onset of mineral and bone disorders (MBD) in chronic kidney disease (CKD). Phosphorus retention commonly occurs as a result of net intestinal absorption exceeding renal excretion or dialysis removal. The dietary phosphorus load is crucial since the early stages of CKD, throughout the whole course of the disease, up to dialysis-dependent end-stage renal disease.Agreement exits regarding the need for dietary phosphate control, but it is quite challenging in the real-life setting. Effective strategies to control dietary phosphorus intake include restricting phosphorus-rich foods, preferring phosphorus sourced from plant origin, boiling as the preferred cooking procedure and avoiding foods with phosphorus-containing additives. Nutritional education is crucial in this regard.Based on the existing literature, we developed the "phosphorus pyramid", namely a novel, visual, user-friendly tool for the nutritional education of patients and health-care professionals. The pyramid consists of six levels in which foods are arranged on the basis of their phosphorus content, phosphorus to protein ratio and phosphorus bioavailability. Each has a colored edge (from green to red) that corresponds to recommended intake frequency, ranging from "unrestricted" to "avoid as much as possible".The aim of the phosphorus pyramid is to support dietary counseling in order to reduce the phosphorus load, a crucial aspect of integrated CKD-MBD management.

  11. Chronotherapy improves blood pressure control and reduces vascular risk in CKD.

    Science.gov (United States)

    Hermida, Ramón C; Ayala, Diana E; Smolensky, Michael H; Mojón, Artemio; Fernández, José R; Crespo, Juan J; Moyá, Ana; Ríos, María T; Portaluppi, Francesco

    2013-06-01

    In patients with chronic kidney disease (CKD), the prevalence of increased blood pressure during sleep and blunted sleep-time-relative blood pressure decline (a nondipper pattern) is very high and increases substantially with disease severity. Elevated blood pressure during sleep is the major criterion for the diagnoses of hypertension and inadequate therapeutic ambulatory blood pressure control in these patients. Substantial, clinically meaningful ingestion-time-dependent differences in the safety, efficacy, duration of action and/or effects on the 24 h blood pressure pattern of six different classes of hypertension medications and their combinations have been substantiated. For example, bedtime ingestion of angiotensin-converting-enzyme inhibitors and angiotensin-receptor blockers is more effective than morning ingestion in reducing blood pressure during sleep and converting the 24 h blood pressure profile into a dipper pattern. We have identified a progressive reduction in blood pressure during sleep--a novel therapeutic target best achieved by ingestion of one or more hypertension medications at bedtime--as the most significant predictor of decreased cardiovascular risk in patients with and without CKD. Recent findings suggest that in patients with CKD, ambulatory blood pressure monitoring should be used for the diagnosis of hypertension and assessment of cardiovascular disease risk, and that therapeutic strategies given at bedtime rather than on awakening are preferable for the management of hypertension.

  12. Preoperative Hemoglobin and Outcomes in Patients with CKD Undergoing Cardiac Surgery

    Science.gov (United States)

    Hitti, Sharbel; Silberman, Shuli; Tauber, Rachel; Merin, Ofer; Lifschitz, Meyer; Slotki, Itzchak; Bitran, Daniel; Fink, Daniel

    2014-01-01

    Background and objectives Preoperative anemia adversely affects outcomes of cardiothoracic surgery. However, in patients with CKD, treating anemia to a target of normal hemoglobin has been associated with increased risk of adverse cardiac and cerebrovascular events. We investigated the association between preoperative hemoglobin and outcomes of cardiac surgery in patients with CKD and assessed whether there was a level of preoperative hemoglobin below which the incidence of adverse surgical outcomes increases. Design, setting, participants, & measurements This prospective observational study included adult patients with CKD stages 3–5 (eGFR<60 ml/min per 1.73 m2) undergoing cardiac surgery from February 2000 to January 2010. Patients were classified into four groups stratified by preoperative hemoglobin level: <10, 10–11.9, 12–13.9, and ≥14 g/dl. The outcomes were postoperative AKI requiring dialysis, sepsis, cerebrovascular accident, and mortality. Results In total, 788 patients with a mean eGFR of 43.5±13.7 ml/min per 1.73 m2 were evaluated, of whom 22.5% had preoperative hemoglobin within the normal range (men: 14–18 g/dl; women: 12–16 g/dl). Univariate analysis revealed an inverse relationship between the incidence of all adverse postoperative outcomes and hemoglobin level. Using hemoglobin as a continuous variable, multivariate logistic regression analysis showed a proportionally greater frequency of all adverse postoperative outcomes per 1-g/dl decrement of preoperative hemoglobin (mortality: odds ratio, 1.38; 95% confidence interval, 1.23 to 1.57; P<0.001; sepsis: odds ratio, 1.31; 95% confidence interval, 1.14 to 1.49; P<0.001; cerebrovascular accident: odds ratio, 1.31; 95% confidence interval, 1.00 to 1.67; P=0.03; postoperative hemodialysis: odds ratio, 1.38; 95% confidence interval, 1.11 to 1.75; P<0.01). Moreover, preoperative hemoglobin<12 g/dl was an independent risk factor for postoperative mortality (odds ratio, 2.6; 95% confidence

  13. Soluble TWEAK and Major Adverse Cardiovascular Events in Patients with CKD

    Science.gov (United States)

    Fernández-Laso, Valvanera; Sastre, Cristina; Valdivielso, Jose M.; Betriu, Angels; Fernández, Elvira; Egido, Jesús; Martín-Ventura, Jose L.

    2016-01-01

    Background and objectives Soluble TNF–like weak inducer of apoptosis (sTWEAK) is a proinflammatory cytokine belonging to the TNF superfamily. sTWEAK concentrations have been associated with the presence of CKD and cardiovascular disease (CVD). We hypothesized that sTWEAK levels may relate to a higher prevalence of atherosclerotic plaques, vascular calcification, and cardiovascular outcomes observed in patients with CKD. Design, setting, participants, & measurements A 4-year prospective, multicenter, longitudinal study was conducted in 1058 patients with CKD stages 3–5D (mean age =58±13 years old; 665 men) but without any history of CVD from the NEFRONA Study (a study design on the prevalence of surrogate markers of CVD). Ankle-brachial index and B-mode ultrasound were performed to detect the presence of carotid and/or femoral atherosclerotic plaques together with biochemical measurements and sTWEAK assessment. Patients were followed for cardiovascular outcomes (follow-up of 3.13±1.15 years). Results Patients with more advanced CKD had lower sTWEAK levels. sTWEAK concentrations were independently and negatively associated with carotid intima-media thickness. sTWEAK levels were lower in patients with carotid atherosclerotic plaques but not in those with femoral plaques. After adjustment by confounders, the odds ratio (OR) for presenting carotid atherosclerotic plaques in patients in the lowest versus highest tertile of sTWEAK was 4.18 (95% confidence interval [95% CI], 2.89 to 6.08; P<0.001). Furthermore, sTWEAK levels were lower in patients with calcified carotid atherosclerotic plaques. The OR for presenting calcified carotid plaques was 1.77 (95% CI, 1.06 to 2.93; P=0.02) after multivariable adjustment. After the follow-up, 41 fatal and 68 nonfatal cardiovascular events occurred. In a Cox model, after controlling for potential confounding factors, patients in the lowest tertile of sTWEAK concentrations had a higher risk of fatal and nonfatal cardiovascular

  14. The influence of creatinine versus GFR on NSAID prescriptions in CKD

    Science.gov (United States)

    Patel, Krupa; Diamantidis, Clarissa; Zhan, Min; Hsu, Van Doren; Walker, Loreen D.; Gardner, James; Weir, Matthew R.; Fink, Jeffrey C.

    2012-01-01

    Background Non-steroidal anti-inflammatory drugs (NSAIDs), including cyclo-oxygenase-2 (COX-2) inhibitors, are generally contraindicated in chronic kidney disease (CKD). This investigation sought to identify the frequency of NSAID/COX2 prescription and determine the influence of serum Cr versus estimated GFR on this practice pattern. Methods An established Veterans Health Administration (VHA) CKD safety cohort (n = 70,154) was examined to determine the frequency of NSAID/COX2 in fiscal year 2005 (FY05) for up to 30 days preceding the index hospitalization and as many as 365 days during that year. Binomial regression was used to determine adjusted prevalence ratios for prescription of NSAID/COX2 with respect to continuous eGFR measurement and serum creatinine (Cr) categories. CKD was defined as eGFR < 60 ml/min/1.73m2. Results 15.4% of subjects had an NSAID/COX2 prescription during the observation period with the proportion prescribed these agents decreasing with declining renal function, but remained significant at any stage of CKD given the renal harm related to these medications. At specific GFR estimates, serum creatinine (Cr) remained a significant predictor of NSAID/COX prescription. At GFR set at 42 ml/min/1.73, the predicted proportion prescribed NSAID/COX2 was 0.29 (95% CI: 0.24,0.36); 0.23 (95% CI: 0.22,0.26); 0.20 (95%: 0.19,0,22); 0.12 (95% CI: 0.10,0.14) for Cr strata of ≤ 1.3 mg/dl, 1.4 – 1.6 mg/dl, 1.7 –2.1 mg/dl, ≥ 2.2 mg/dl, respectively (all p < 0.05). Conclusion A significant proportion of individuals with CKD continue to be prescribed NSAID/COX2 and serum Cr remains an influential guide to NSAID/COX2 prescription, even in GFR ranges where these agents are ill-advised. PMID:22699456

  15. Hypertension in CKD Pregnancy: a Question of Cause and Effect (Cause or Effect? This Is the Question).

    Science.gov (United States)

    Piccoli, Giorgina Barbara; Cabiddu, Gianfranca; Attini, Rossella; Parisi, Silvia; Fassio, Federica; Loi, Valentina; Gerbino, Martina; Biolcati, Marilisa; Pani, Antonello; Todros, Tullia

    2016-04-01

    Chronic kidney disease (CKD) is increasingly encountered in pregnancy, and hypertension is frequently concomitant. In pregnancy, the prevalence of CKD is estimated to be about 3%, while the prevalence of chronic hypertension is about 5-8%. The prevalence of hypertension and CKD in pregnancy is unknown. Both are independently related to adverse pregnancy outcomes, and the clinical picture merges with pregnancy-induced hypertension and preeclampsia. Precise risk quantification is not available, but risks linked to CKD stage, hypertension, and proteinuria are probably multiplicative, each at least doubling the rates of preterm and early preterm delivery, small for gestational age babies, and related outcomes. Differential diagnosis (based upon utero-placental flows, fetal growth, and supported by serum biomarkers) is important for clinical management. In the absence of guidelines for hypertension in CKD pregnancies, the ideal blood pressure goal has not been established; we support a tailored approach, depending on compliance, baseline control, and CKD stages, with strict blood pressure monitoring. The choice of antihypertensive drugs and the use of diuretics and of erythropoiesis-stimulating agents (ESAs) are still open questions which only future studies may clarify.

  16. CKD8S型内燃机车柴油机发电机组设计%CKD8S Diesel Locomotive Diesel Engine-generator Set Design

    Institute of Scientific and Technical Information of China (English)

    谷巧凤

    2015-01-01

    介绍了CKD8S型内燃机车柴油机发电机组的组成、各主要部件的技术性能参数及设计方案.该柴油机发电机组设计充分考虑了当地得气候特点,运用环境以及客户得使用要求,解决了以前同类机车柴油机发电机组的盖茨林格联轴节漏油、以及螺栓断裂等惯性质量问题,可靠性有了较大提高.

  17. Controversial issues in CKD clinical practice: position statement of the CKD-treatment working group of the Italian Society of Nephrology.

    Science.gov (United States)

    Bellizzi, Vincenzo; Conte, Giuseppe; Borrelli, Silvio; Cupisti, Adamasco; De Nicola, Luca; Di Iorio, Biagio R; Cabiddu, Gianfranca; Mandreoli, Marcora; Paoletti, Ernesto; Piccoli, Giorgina B; Quintaliani, Giuseppe; Ravera, Maura; Santoro, Domenico; Torraca, Serena; Minutolo, Roberto

    2017-04-01

    This position paper of the study group "Conservative treatment of Chronic Kidney Disease-CKD" of the Italian Society of Nephrology addresses major practical, unresolved, issues related to the conservative treatment of chronic renal disease. Specifically, controversial topics from everyday clinical nephrology practice which cannot find a clear, definitive answer in the current literature or in nephrology guidelines are discussed. The paper reports the point of view of the study group. Concise and practical advice is given on several common issues: renal biopsy in diabetes; dual blockade of the renin-angiotensin-aldosterone system (RAAS); management of iron deficiency; low protein diet; dietary salt intake; bicarbonate supplementation; treatment of obesity; the choice of conservative therapy vs. dialysis. For each topic synthetic statements, guideline-style, are reported.

  18. Kidney Disease Population Health Management in the Era of Accountable Care: A Conceptual Framework for Optimizing Care Across the CKD Spectrum.

    Science.gov (United States)

    Mendu, Mallika L; Waikar, Sushrut S; Rao, Sandhya K

    2017-01-23

    Since its passage in 2010, the Affordable Care Act has led to the creation of numerous accountable care organizations that face the challenge of transforming the traditional care delivery model to provide more patient-centered, high-quality, and low-cost care. Complex patients, including those with chronic kidney disease (CKD), present the most challenges and opportunities. CKD is a condition with significant morbidity, mortality, and cost and thought to be partly secondary to known gaps in care delivery. Successful population management for CKD requires consideration of the needs of patients at all phases of the disease. In this article, we offer a comprehensive framework for a population-based approach to CKD and examples of programs we are implementing in each area. These initiatives include the development and implementation of an electronic nephrology consult (e-consult) platform, CKD quality metrics, CKD registry, CKD collaborative care agreement, multidisciplinary care clinic for advanced CKD, end-stage renal disease care coordinator program, shared decision-making tools for renal replacement, CKD education videos, and a tablet-based CKD patient-reported outcome measures tool.

  19. Association between periodontal disease and mortality in people with CKD: a meta-analysis of cohort studies.

    Science.gov (United States)

    Zhang, Jian; Jiang, Hong; Sun, Min; Chen, Jianghua

    2017-08-16

    Periodontal disease occurs relatively prevalently in people with chronic kidney disease (CKD), but it remains indeterminate whether periodontal disease is an independent risk factor for premature death in this population. Interventions to reduce mortality in CKD population consistently yield to unsatisfactory results and new targets are necessitated. So this meta-analysis aimed to evaluate the association between periodontal disease and mortality in the CKD population. Pubmed, Embase, Web of Science, Scopus and abstracts from recent relevant meeting were searched by two authors independently. Relative risks (RRs) with 95% confidence intervals (CIs) were calculated for overall and subgroup meta-analyses. Statistical heterogeneity was explored by chi-square test and quantified by the I(2) statistic. Eight cohort studies comprising 5477 individuals with CKD were incorporated. The overall pooled data demonstrated that periodontal disease was associated with all-cause death in CKD population (RR, 1.254; 95% CI 1.046-1.503; P = 0.005), with a moderate heterogeneity, I(2) = 52.2%. However, no evident association was observed between periodontal disease and cardiovascular mortality (RR, 1.30, 95% CI, 0.82-2.06; P = 0.259). Besides, statistical heterogeneity was substantial (I(2) = 72.5%; P = 0.012). Associations for mortality were similar between subgroups, such as the different stages of CKD, adjustment for confounding factors. Specific to all-cause death, sensitivity and cumulative analyses both suggested that our results were robust. As for cardiovascular mortality, the association with periodontal disease needs to be further strengthened. We demonstrated that periodontal disease was associated with an increased risk of all-cause death in CKD people. Yet no adequate evidence suggested periodontal disease was also at elevated risk for cardiovascular death.

  20. Effect of paricalcitol on left ventricular mass and function in CKD--the OPERA trial.

    Science.gov (United States)

    Wang, Angela Yee-Moon; Fang, Fang; Chan, John; Wen, Yue-Yi; Qing, Shang; Chan, Iris Hiu-Shuen; Lo, Gladys; Lai, Kar-Neng; Lo, Wai-Kei; Lam, Christopher Wai-Kei; Yu, Cheuk-Man

    2014-01-01

    Vitamin D seems to protect against cardiovascular disease, but the reported effects of vitamin D on patient outcomes in CKD are controversial. We conducted a prospective, double blind, randomized, placebo-controlled trial to determine whether oral activated vitamin D reduces left ventricular (LV) mass in patients with stages 3-5 CKD with LV hypertrophy. Subjects with echocardiographic criteria of LV hypertrophy were randomly assigned to receive either oral paricalcitol (1 μg) one time daily (n=30) or matching placebo (n=30) for 52 weeks. The primary end point was change in LV mass index over 52 weeks, which was measured by cardiac magnetic resonance imaging. Secondary end points included changes in LV volume, echocardiographic measures of systolic and diastolic function, biochemical parameters of mineral bone disease, and measures of renal function. Change in LV mass index did not differ significantly between groups (median [interquartile range], -2.59 [-6.13 to 0.32] g/m(2) with paricalcitol versus -4.85 [-9.89 to 1.10] g/m(2) with placebo). Changes in LV volume, ejection fraction, tissue Doppler-derived measures of early diastolic and systolic mitral annular velocities, and ratio of early mitral inflow velocity to early diastolic mitral annular velocity did not differ between the groups. However, paricalcitol treatment significantly reduced intact parathyroid hormone (P<0.001) and alkaline phosphatase (P=0.001) levels as well as the number of cardiovascular-related hospitalizations compared with placebo. In conclusion, 52 weeks of treatment with oral paricalcitol (1 μg one time daily) significantly improved secondary hyperparathyroidism but did not alter measures of LV structure and function in patients with severe CKD.

  1. Randomized Clinical Trial of Sodium Polystyrene Sulfonate for the Treatment of Mild Hyperkalemia in CKD.

    Science.gov (United States)

    Lepage, Laurence; Dufour, Anne-Claude; Doiron, Jessica; Handfield, Katia; Desforges, Katherine; Bell, Robert; Vallée, Michel; Savoie, Michel; Perreault, Sylvie; Laurin, Louis-Philippe; Pichette, Vincent; Lafrance, Jean-Philippe

    2015-12-07

    Hyperkalemia affects up to 10% of patients with CKD. Sodium polystyrene sulfonate has long been prescribed for this condition, although evidence is lacking on its efficacy for the treatment of mild hyperkalemia over several days. This study aimed to evaluate the efficacy of sodium polystyrene sulfonate in the treatment of mild hyperkalemia. In total, 33 outpatients with CKD and mild hyperkalemia (5.0-5.9 mEq/L) in a single teaching hospital were included in this double-blind randomized clinical trial. We randomly assigned these patients to receive either placebo or sodium polystyrene sulfonate of 30 g orally one time per day for 7 days. The primary outcome was the comparison between study groups of the mean difference of serum potassium levels between the day after the last dose of treatment and baseline. The mean duration of treatment was 6.9 days. Sodium polystyrene sulfonate was superior to placebo in the reduction of serum potassium levels (mean difference between groups, -1.04 mEq/L; 95% confidence interval, -1.37 to -0.71). A higher proportion of patients in the sodium polystyrene sulfonate group attained normokalemia at the end of their treatment compared with those in the placebo group, but the difference did not reach statistical significance (73% versus 38%; P=0.07). There was a trend toward higher rates of electrolytic disturbances and an increase in gastrointestinal side effects in the group receiving sodium polystyrene sulfonate. Sodium polystyrene sulfonate was superior to placebo in reducing serum potassium over 7 days in patients with mild hyperkalemia and CKD. Copyright © 2015 by the American Society of Nephrology.

  2. INFLAMMATION IS ASSOCIATED WITH EXCESSIVE BODY ADIPOSITY IN NONDIALYSED CHRONIC KIDNEY DISEASE (CKD PATIENTS

    Directory of Open Access Journals (Sweden)

    Maria Inês Barreto-Silva

    2012-06-01

    Full Text Available The purpose of this study was to evaluate inflammation in non-dialysed CKD patients with normal and high body adiposity level. One hundred and thirty four CKD patients (male: 56%; age=65±12 years under treatment for 3.0±2.0 years were evaluated in a cross-sectional study. Glomerular filtration rate (eGFR was estimated by MDRD equation. Body adiposity was assessed by BMI and total body fat (BF; dual-energy X-ray absorptiometry. Laboratorial measurements were: albumin, pro-inflammatory cytokines by Multiplexed analysis: tumor necrosis factor-α, interferon-γ, high sensitive C reactive protein, monocyte chemotactic protein, inteleukine 6 and 8, intercellular adhesion molecule-1 and vascular adhesion molecule-1. The inflammation status was defined according to the median values for each studied pro-inflammatory cytokines: negative for inflammation (Infl- (< median, positive for inflammation (Infl+ (≥ median. The cytokines were compared between patients with normal BMI (<25kg/m2 (46%; BMI=22.2±1.9 and high BMI (≥25kg/m2 (BMI=28.8±2.8. Both groups showed similar eGFR and CKD stages distribution (stage 3:42%, 4: 37%, 5: 21%. BF and all cytokines were higher in high BMI group than in normal BMI (P<0.0001. BMI and BF were correlated (r= 0.74; P<0.0001. The Infl+ condition was more prevalent, for all cytokines, in the high BMI group (range:61–76% than in normal (24–38%. Multivariate logistic regression analysis, for all cytokines, showed that Infl+ condition was associated with high BMI (Odds Ratio range: 2.5–4.2; 95%CI: 1.1 - 9.6; P<0.01, even after adjusted for age, gender, diabetes and eGFR. In conclusion, CKD patients with high BMI and body adiposity are at higher risk for inflammation. Therefore, the excess of adiposity should be carefully treated in these patients.

  3. Pro-inflammatory cytokines and bone fractures in CKD patients. An exploratory single centre study

    Directory of Open Access Journals (Sweden)

    Panuccio Vincenzo

    2012-10-01

    Full Text Available Abstract Background Pro-inflammatory cytokines play a key role in bone remodeling. Inflammation is highly prevalent in CKD-5D patients, but the relationship between pro-inflammatory cytokines and fractures in CKD-5D patients is unclear. We studied the relationship between inflammatory cytokines and incident bone fractures in a cohort of CKD-5D patients. Methods In 100 CKD-5D patients (66 on HD, 34 on CAPD; males:63, females:37; mean age: 61 ± 15; median dialysis vintage: 43 months belonging to a single renal Unit, we measured at enrolment bone metabolic parameters (intact PTH, bone and total alkaline phosphatase, calcium, phosphate and inflammatory cytokines (TNF-α, IL-6, CRP. Patients were followed-up until the first non traumatic fracture. Results During follow-up (median: 74 months; range 0.5 -84.0 18 patients experienced fractures. On categorical analysis these patients compared to those without fractures had significantly higher intact PTH (median: 319 pg/ml IQ range: 95–741 vs 135 pg/ml IQ: 53–346; p = 0.04 and TNF-α levels (median: 12 pg/ml IQ: 6.4-13.4 vs 7.8 pg/ml IQ: 4.6-11; p = 0.02. Both TNF-α (HR for 5 pg/ml increase in TNF-α: 1.62 95% CI: 1.05-2.50; p = 0.03 and intact PTH (HR for 100 pg/ml increase in PTH: 1.15 95% CI: 1.04-1.27; p = 0.005 predicted bone fractures on univariate Cox’s regression analysis. In restricted (bivariate models adjusting for previous fractures, age, sex and other risk factors both PTH and TNF-α maintained an independent association with incident fractures. Conclusions In our bivariate analyses TNF-α was significantly associated with incident fractures. Analyses in larger cohorts and with adequate number of events are needed to firmly establish the TNF α -fracture link emerged in the present study.

  4. Patterns of NSAIDs Use and Their Association with Other Analgesic Use in CKD.

    Science.gov (United States)

    Zhan, Min; St Peter, Wendy L; Doerfler, Rebecca M; Woods, Corinne M; Blumenthal, Jacob B; Diamantidis, Clarissa J; Hsu, Chi-Yuan; Lash, James P; Lustigova, Eva; Mahone, Erin B; Ojo, Akinlolu O; Slaven, Anne; Strauss, Louise; Taliercio, Jonathan J; Winkelmayer, Wolfgang C; Xie, Dawei; Fink, Jeffery C

    2017-08-15

    Avoiding nonsteroidal anti-inflammatory drugs is important for safe CKD care. This study examined nonsteroidal anti-inflammatory drug use patterns and their association with other analgesic use in CKD. The Chronic Renal Insufficiency Cohort Study is an observational cohort study that enrolled 3939 adults ages 21-74 years old with CKD between 2003 and 2008 using age-based eGFR inclusion criteria. Annual visits between June of 2003 and December of 2011 were organized into 15,917 visit-pairs (with an antecedent and subsequent visit) for 3872 participants with medication information. Demographics, kidney function, and clinical factors were ascertained along with report of nonsteroidal anti-inflammatory drug or other analgesic use in the prior 30 days. In our study, 24% of participants reported nonsteroidal anti-inflammatory drug use at baseline or at least one follow-up study visit. Having a 10 ml/min per 1.73 m(2) higher eGFR level at an antecedent visit was associated with higher odds of starting nonsteroidal anti-inflammatory drugs at a subsequent visit (odds ratio, 1.44; 95% confidence interval, 1.34 to 1.56). Seeing a nephrologist at the antecedent visit was associated with lower odds of starting or staying on nonsteroidal anti-inflammatory drugs at a subsequent visit (odds ratio, 0.70; 95% confidence interval, 0.56 to 0.87 and odds ratio, 0.61; 95% confidence interval, 0.46 to 0.81, respectively). Starting and stopping nonsteroidal anti-inflammatory drugs were both associated with higher odds of increasing the number of other analgesics (odds ratio, 1.52; 95% confidence interval, 1.25 to 1.85 and odds ratio, 1.78; 95% confidence interval, 1.39 to 2.28, respectively) and higher odds of increasing the number of opioid analgesics specifically (odds ratio, 1.92; 95% confidence interval, 1.48 to 2.48 and odds ratio, 1.46; 95% confidence interval, 1.04 to 2.03, respectively). Nonsteroidal anti-inflammatory drug use is common among patients with CKD but less so among

  5. Impact of late-stage CKD and aging on medical utilization in the elderly population: a closed-cohort study in Taiwan.

    Science.gov (United States)

    Lin, Ming-Yen; Hwang, Shang-Jyh; Mau, Lih-Wen; Chen, Hung-Chun; Hwang, Su-Chen; Wu, Ling-Chu; Chiu, Herng-Chia

    2010-10-01

    Taiwan has the highest incidence and prevalence of end-stage renal disease globally, especially in the elderly population. The elderly with chronic kidney disease (CKD) also had high mortality. However, population-based research on how the elderly with CKD utilize medical services is still unexplored. We aimed to examine the effects of CKD severity and aging on medical utilizations in the elderly population. This retrospective closed cohort study analysed 7868 elderly residents of Kaohsiung City, who participated in the government-sponsored annual physical examination in 1997. The information of medical services and expenses were obtained from the claimed data of the National Health Insurance from 1996 to 1999. CKD was grouped into five stages according to the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF K-DOQI) criteria with modifications. Late-stage CKD was defined as CKD Stages 3 to 5 [estimated glomerular filtration rate (eGFR) below 60 ml/min/1.73 m(2)]. Those subjects with eGFR above 60 ml/min/1.73 m(2) were treated as the reference group. After adjusting all covariates, the odds ratios of hospitalization for elderly subjects with CKD stages 3a, 3b and 4/5 were 1.19 (95% CI = 1.08-1.32), 1.48 (95% CI = 1.26-1.73) and 1.68 (95% CI = 1.21-2.33) compared with the reference group, respectively (P < 0.001). The autoregressive generalized estimating equation analysis revealed that CKD stage had linear associations with medical expenditures during the study period, especially for those elderly subjects with later stage CKD. Increases in medical utilizations and expenses were demonstrated in elderly CKD subjects, especially those with late stage CKD. Early prevention of CKD is necessary to lessen the financial impact on medical health care.

  6. Impact of the Triglycerides to High-Density Lipoprotein Cholesterol Ratio on the Incidence and Progression of CKD: A Longitudinal Study in a Large Japanese Population.

    Science.gov (United States)

    Tsuruya, Kazuhiko; Yoshida, Hisako; Nagata, Masaharu; Kitazono, Takanari; Iseki, Kunitoshi; Iseki, Chiho; Fujimoto, Shouichi; Konta, Tsuneo; Moriyama, Toshiki; Yamagata, Kunihiro; Narita, Ichiei; Kimura, Kenjiro; Kondo, Masahide; Asahi, Koichi; Kurahashi, Issei; Ohashi, Yasuo; Watanabe, Tsuyoshi

    2015-12-01

    The impact of the triglycerides to high-density lipoprotein cholesterol (TG:HDL-C) ratio on chronic kidney disease (CKD) is unclear. Longitudinal cohort study. 124,700 participants aged 39 to 74 years in the Japanese Specific Health Check and Guidance System, including 50,392 men, 74,308 women, 102,900 without CKD, and 21,800 with CKD. Quartiles of TG:HDL-C ratio. Changes in estimated glomerular filtration rate (eGFR) and urinary protein excretion during the 2-year study period. Incident CKD in participants without CKD, and progression of CKD in participants with CKD. In the entire study population, higher quartile of TG:HDL-C ratio at baseline was significantly associated with greater decline in eGFR and increase in urinary protein excretion during the 2-year study period, even after adjustment for confounding factors. A higher ratio was associated with higher risk of incident CKD in participants without CKD and higher risk of rapid decline in eGFR and increase in urinary protein excretion in participants with CKD. Higher TG:HDL-C ratio was more strongly associated with decline in eGFR (P for interaction = 0.002) and with incident CKD (P for interaction = 0.05) in participants with diabetes than without diabetes. Short observation period and single measurement of all variables. A higher TG:HDL-C ratio affects the decline in eGFR and incidence and progression of CKD in the Japanese population. Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  7. Difference between CKD-EPI and MDRD equations in calculating glomerular filtration rate in patients with cirrhosis

    Institute of Scientific and Technical Information of China (English)

    Yu-Wei Chen; Han-Hsiang Chen; Tsang-En Wang; Ching-Wei Chang; Chen-Wang Chang; Chih-Jen Wu

    2011-01-01

    AIM: To evaluate the difference between the performance of the (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations in cirrhotic patients. METHODS: From Jan 2004 to Oct 2008, 4127 cirrhotic patients were reviewed. Patients with incomplete data with respect to renal function were excluded; thus, a total of 3791 patients were included in the study. The glomerular filtration rate (GFR) was estimated by the 4-variable MDRD (MDRD-4), 6-variable MDRD (MDRD-6), and CKD-EPI equations. RESULTS: When serum creatinine was 0.7-6.8 mg/dL and 0.6-5.3 mg/dL in men and women, respectively, a significantly lower GFR was estimated by the MDRD-6 than by the CKD-EPI. Similar GFRs were calculated by both equations when creatinine was > 6.9 mg/dL and > 5.4 mg/dL in men and women, respectively. In predicting in-hospital mortality, estimated GFR obtained by the MDRD-6 showed better accuracy [81.72%; 95% confidence interval (CI), 0.94-0.95] than that obtained by the MDRD-4 (80.22%; 95%CI, 0.96-0.97), CKD-EPI (79.93%; 95%CI, 0.96-0.96), and creatinine (77.50%; 95%CI, 2.27-2.63). CONCLUSION: GFR calculated by the 6-variable MDRD equation may be closer to the true GFR than that calculated by the CKD-EPI equation.

  8. Establishment of a integrative multi-omics expression database CKDdb in the context of chronic kidney disease (CKD)

    Science.gov (United States)

    Fernandes, Marco; Husi, Holger

    2017-01-01

    Complex human traits such as chronic kidney disease (CKD) are a major health and financial burden in modern societies. Currently, the description of the CKD onset and progression at the molecular level is still not fully understood. Meanwhile, the prolific use of high-throughput omic technologies in disease biomarker discovery studies yielded a vast amount of disjointed data that cannot be easily collated. Therefore, we aimed to develop a molecule-centric database featuring CKD-related experiments from available literature publications. We established the Chronic Kidney Disease database CKDdb, an integrated and clustered information resource that covers multi-omic studies (microRNAs, genomics, peptidomics, proteomics and metabolomics) of CKD and related disorders by performing literature data mining and manual curation. The CKDdb database contains differential expression data from 49395 molecule entries (redundant), of which 16885 are unique molecules (non-redundant) from 377 manually curated studies of 230 publications. This database was intentionally built to allow disease pathway analysis through a systems approach in order to yield biological meaning by integrating all existing information and therefore has the potential to unravel and gain an in-depth understanding of the key molecular events that modulate CKD pathogenesis. PMID:28079125

  9. "Quadruple whammy"- a preventable newly described syndrome of post-operative AKI in CKD II and CKD III patients on combination "Triple whammy" medications: a Mayo Clinic Health System, Eau Claire, Wisconsin experience.

    Science.gov (United States)

    Onuigbo, M A; Agbasi, N

    2014-01-01

    The potential combination of diuretics- angiotensin-converting enzyme inhibitors- Non-steroidal anti-inflammatory drugs (diuretics-ACEIs-NSAIDs), the so-called 'triple whammy', to produce clinically significant nephrotoxicity in chronic kidney disease (CKD) is often unrecognized. In 2013, in the British Medical Journal, we described accelerated post-operative acute kidney injury (AKI) in CKD patients concurrently on 'triple whammy' medications, a new syndrome that we aptly named 'quadruple whammy'. Two case reports. I. A 59-year-old Caucasian male, hypertensive CKD III, serum creatinine (SCr) 1.42 mg/dL, developed accelerated oliguric AKI after elective right nephrectomy. Outpatient medications included Lisinopril-Hydrochlorothiazide and Nabumetone (NSAID). SCr rapidly more than doubled with metabolic acidosis and hyperkalemia within 24 hours, peaking at 4.02 mg/dL. 'Triple whammy' medications were promptly stopped and the hypotension was corrected. SCr was 1.64 mg/dL and stable, after three months. II. A 46-year-old Caucasian male, hypertensive CKD II, SCr 1.21 mg/dL, developed accelerated AKI after elective right hip arthroplasty. Outpatient medications included Lisinopril and Hydrochlorothiazide. Celecoxib (200 mg) was given pre-operatively. Within 36 hours, SCr rapidly more than doubled to 2.58 mg/dL, with metabolic acidosis. 'Triple whammy' medications were promptly stopped and the hypotension was corrected. SCr was 0.99 mg/dL, and stable, after one month. We have described two cases of preventable accelerated AKI following post-operative hypotension in CKD patients concurrently on 'triple whammy' medications. We dubbed this new syndrome "Quadruple Whammy". It is not uncommon. 'Renoprevention', the pre-emptive withholding of (potentially nephrotoxic) medications, including 'triple whammy' medications, pre-operatively, in CKD patients, together with the simultaneous avoidance of peri-operative hypotension would help reduce, if not eliminate such AKI - a call

  10. Altered intestinal microbial flora and impaired epithelial barrier structure and function in CKD: the nature, mechanisms, consequences and potential treatment.

    Science.gov (United States)

    Vaziri, Nosratola D; Zhao, Ying-Yong; Pahl, Madeleine V

    2016-05-01

    Chronic kidney disease (CKD) results in systemic inflammation and oxidative stress which play a central role in CKD progression and its adverse consequences. Although many of the causes and consequences of oxidative stress and inflammation in CKD have been extensively explored, little attention had been paid to the intestine and its microbial flora as a potential source of these problems. Our recent studies have revealed significant disruption of the colonic, ileal, jejunal and gastric epithelial tight junction in different models of CKD in rats. Moreover, the disruption of the epithelial barrier structure and function found in uremic animals was replicated in cultured human colonocytes exposed to uremic human plasma in vitro We have further found significant changes in the composition and function of colonic bacterial flora in humans and animals with advanced CKD. Together, uremia-induced impairment of the intestinal epithelial barrier structure and function and changes in composition of the gut microbiome contribute to the systemic inflammation and uremic toxicity by accommodating the translocation of endotoxin, microbial fragments and other noxious luminal products in the circulation. In addition, colonic bacteria are the main source of several well-known pro-inflammatory uremic toxins such as indoxyl sulfate, p-cresol sulfate, trimethylamine-N-oxide and many as-yet unidentified retained compounds in end-stage renal disease patients. This review is intended to provide an overview of the effects of CKD on the gut microbiome and intestinal epithelial barrier structure and their role in the pathogenesis of systemic inflammation and uremic toxicity. In addition, potential interventions aimed at mitigating these abnormalities are briefly discussed.

  11. Muscle atrophy in patients wirh ckd results from fgf23/klotho-mediated supression of insulin/igf-i signaling

    Directory of Open Access Journals (Sweden)

    Shinsuke Kido

    2012-06-01

    Full Text Available Muscle atrophy is a significant consequence of chronic kidney disease (CKD that increases a patient’s risk of mortality and decrease their quality of life. In CKD patients, the circulation levels of FGF23 are significantly increased, but the exact pathological significance of the increase and relationship between FGF23 and muscle atrophy are not clear. Because of Klohto, acts as a co-receptor of FGF23 is detectable in limited tissues including in kidney and brain, but not in skeletal muscles. In contrast, recently reports indicated that the extracellular domain of klohto is cleavage for some reason on the cell surface and detected in the blood in animals. In this study, we attempted to identify the causative factors responsible for the shedding of Klotho, and whether both FGF23 and Klohto induced muscle atrophy via reduction of insulin/IGF-I signaling. We first investigated by treating kidney cells with various factors related in pathological factors in CKD. As a result, we found that advanced glycation endproducts (AGEs, an accumulated in patients with CKD and diabetes mellitus, increases shedding of Klohto in kidney cells. It is common knowledge that insulin/IGF-I signaling is necessary for normal skeletal growth. As a result, we showed that both FGF23 and Klohto inhibited differentiation of cultured skeletal muscle cells through down-regulation of insulin/IGF-I signaling. These observations suggested a divergent role of FGF23 and soluble klohto in the regulation of skeletal muscle differentiation and thereby muscle atrophy under pathological conditioned in CKD patients. Our results further imply that FGF23/Klohto may serve a new therapeutic target for CKD-induced muscle atrophy.

  12. Prevalence of Metformin Use and the Associated Risk of Metabolic Acidosis in US Diabetic Adults With CKD

    Science.gov (United States)

    Kuo, Chin-Chi; Yeh, Hung-Chieh; Chen, Bradley; Tsai, Ching-Wei; Lin, Yu-Sheng; Huang, Chiu-Ching

    2015-01-01

    Abstract The use of metformin in chronic kidney disease (CKD) population has been intensely debated with conflicting evidence. Large population studies are needed to inform risk assessment and therapeutic decision-making. We evaluated the associations among metformin, metabolic acidosis, and CKD in a 10-year nationally representative noninstitutionalized civilian population in the United States. In this cross-sectional study, a total of 2279 diabetic adults aged 20 years or older in the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2012 were included and had measurements of serum bicarbonate, sodium, potassium, and chloride. The exposure was metformin use. The outcome was subclinical and severe metabolic acidosis defined by serum bicarbonate 16mEq/L and by serum bicarbonate 60 mL/min/1.73 m2 was also observed. In multiple linear regression analysis, metformin was significantly associated with decreased serum bicarbonate levels (β = −0.45, 95% CI: −0.73, −0.17) and increased serum anion gap levels (β = 0.40, 95% CI: 0.19, 0.61). The adjusted odds ratio of subclinical high anion gap and severe metabolic acidosis for metformin users was 1.68 (95% CI: 1.11, 2.55) and 1.31 (0.49, 3.47), respectively. The association between metformin and serum bicarbonate was significantly modified by CKD status. No interaction was found between metformin and CKD stages for serum anion gap and acidosis. Metformin is associated with subclinical metabolic acidosis but not with severe metabolic acidosis. The propensity of serum bicarbonate-lowering effect was intensified in advanced CKD; however, such tendency was not associated with the risk of clinically defined acidosis. Our findings highlight a potential of cautious expansion of metformin use among CKD-3b patients with diabetes meriting further investigations. PMID:26705203

  13. Application of MDRD and CKD-EPI equations in patients with peripheral arterial diseases%MDRD与CKD-EPI肾小球滤过率评估公式在外周动脉疾病患者中的应用

    Institute of Scientific and Technical Information of China (English)

    余思韵; 李觉; 张丽娟

    2015-01-01

    Objective To compare the performance of newly developed Chronic Kidney Disease Epideniology Collaboration (CKD-EPI) equation and Modification of Diet in Renal Disease (MDRD) equation in patients with peripheral arterial diseases (PAD).Methods A total of 841 patients with PAD were enrolled in this retrospective cohort study.Estimated glomerular filtration rate (eGFR), calculated by MDRD and CKD-EPI equation respectively, was analyzed by Spearman correlation analysis, Bland-Altman method and Kappa test for the evaluation of correlation and consistency.Net reclassification improvement (NRI) was adopted to compare the death risk assessment between these two equations.Results Although the eGFR was 4.33 ml· min-1 · (1.73 m2)-1 higher with MDRD equation than with CKD-EPI equation, there were still significant correlation and fine consistency between eGFRMDRD and eGFRCKD-EPI (Kappa: 0.749, r=0.991, P<0.05).The CKD-EPI equation re-classified 9 (1.1%) patients upward to higher eGFR category and 143 (17.0%) patients downward to lower eGFR category.Besides, the performance of risk assessment for all-cause death was better with CKD-EPI equation than with MDRD equation (NRI=0.059, P < 0.05), which was not the case for cardiovascular death (NRI=0.022, P > 0.05).Conclusions There is no solid evidence suggesting that CKD-EPI equation performs better than MDRD equation.%目的 比较简化MDRD公式与慢性肾脏病学流行病学合作研究(CKD-EPI)公式在评估外周动脉疾病(peripheral arterial disease,PAD)患者肾小球滤过率(GFR)中的适用性.方法 采用回顾性队列研究,选择2005年在上海市和北京市8家医院被确诊为PAD的841例患者作为研究对象,分别利用MDRD与CKD-EPI公式估算肾小球滤过率(eGFR),应用Spearman相关性检验、Bland-Ahman曲线和Kappa检验比较两种方程估算GFR的相关性和一致性,并利用净重新分类指数(net re-classification improvement,NRI)比较2个公式对死

  14. Occupational lead exposure and severe CKD: a population-based case-control and prospective observational cohort study in Sweden.

    Science.gov (United States)

    Evans, Marie; Fored, Carl Michael; Nise, Gun; Bellocco, Rino; Nyrén, Olof; Elinder, Carl-Gustaf

    2010-03-01

    The role of low-level lead exposure in the cause of chronic kidney disease (CKD) is unsettled. Case-control study and prospective observational cohort study. 926 cases with incident severe CKD (serum creatinine > 3.4 mg/dL for men and > 2.8 mg/dL for women for the first time) and 998 population controls were included. Cases represented nearly all patients with incident severe CKD in Sweden during 2 years. Cases also were followed up prospectively for 7-9 years. Exposed and nonexposed cases were compared with regard to rate of change in estimated glomerular filtration rate (eGFR) and renal survival. Lead exposure was assessed using the expert rating method. Associations between lead exposure and risk of CKD, adjusted for factors associated with this outcome, were analyzed using multivariable logistic regression modeling, whereas links to the rate of change in eGFR were analyzed in mixed-effects multivariable models based on up to 6 measurements. Renal survival in relation to lead exposure was analyzed in a Cox proportional hazards model. The adjusted OR for incident severe CKD was 0.97 (95% CI, 0.68-1.38) in lead-exposed compared with nonexposed participants. The OR for individuals with the highest average exposure (>0.0075 mg/m(3)) was 1.09 (95% CI, 0.64-1.85). ORs for CKD caused by glomerulonephritis, nephrosclerosis, and diabetic nephropathy did not differ importantly. In patients with CKD ever exposed and most exposed to lead, eGFRs changed by -4.27 and -3.39 mL/min/1.73 m(2)/y compared with -4.55 mL/min/1.73 m(2)/y in nonexposed patients, respectively. Only native Swedes were included, which may limit generalizability. Blood lead was not measured to confirm the validity of the expert rating method. Our data provide no evidence of an important role of low-level occupational lead exposure in the cause or progression of severe CKD. Copyright 2010 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  15. The dysfunctional endothelium in CKD and in cardiovascular disease : mapping the origin(s) of cardiovascular problems in CKD and of kidney disease in cardiovascular conditions for a research agenda

    NARCIS (Netherlands)

    Fliser, Danilo; Wiecek, Andrzej; Suleymanlar, Gultekin; Ortiz, Alberto; Massy, Ziad; Lindholm, Bengt; Martinez-Castelao, Alberto; Agarwal, Rajiv; Jager, Kitty J.; Dekker, Friedo W.; Blankestijn, Peter J.; Goldsmith, David; Covic, Adrian; London, Gerard; Zoccali, Carmine

    2011-01-01

    Endothelial dysfunction resulting in disintegration of vascular structure and function is a key element in the progression of chronic kidney disease (CKD). Many risk factors-traditional and non-traditional-are thought to have a role in the progression and development of cardiovascular disease (CVD)

  16. A population-based screening for microalbuminuria among relatives of CKD patients : The Kidney Evaluation and Awareness Program in Sheffield (KEAPS)

    NARCIS (Netherlands)

    Bello, Aminu K.; Peters, Jean; Wight, Jeremy; de Zeeuw, Dick; El Nahas, Meguid

    2008-01-01

    Background: Microalbuminuria has been used to detect subjects at risk of cardiovascular disease and chronic kidney disease (CKD) in patients with diabetes, those with hypertension, and the general population. However, relatives of patients with CKD have not been investigated for microalbuminuria in

  17. CKD6B型内燃机车的研制与运用

    Institute of Scientific and Technical Information of China (English)

    刘吉晨

    2014-01-01

    CKD6B型机车是大连机车车辆有限公司针对印度ESL钢厂设计开发的高效、可靠的调车机车。从实践运用表明,该型机车设计合理,机车各部分采用的技术措施有效,适合印度当地的气候环境。介绍了改型机车的总体布置、主要技术参数和性能、技术特点等。

  18. Serum Calcification Propensity Predicts All-Cause Mortality in Predialysis CKD

    Science.gov (United States)

    Ford, Martin L.; Tomlinson, Laurie A.; Bodenham, Emma; McMahon, Lawrence P.; Farese, Stefan; Rajkumar, Chakravarthi; Holt, Stephen G.; Pasch, Andreas

    2014-01-01

    Medial arterial calcification is accelerated in patients with CKD and strongly associated with increased arterial rigidity and cardiovascular mortality. Recently, a novel in vitro blood test that provides an overall measure of calcification propensity by monitoring the maturation time (T50) of calciprotein particles in serum was described. We used this test to measure serum T50 in a prospective cohort of 184 patients with stages 3 and 4 CKD, with a median of 5.3 years of follow-up. At baseline, the major determinants of serum calcification propensity included higher serum phosphate, ionized calcium, increased bone osteoclastic activity, and lower free fetuin-A, plasma pyrophosphate, and albumin concentrations, which accounted for 49% of the variation in this parameter. Increased serum calcification propensity at baseline independently associated with aortic pulse wave velocity in the complete cohort and progressive aortic stiffening over 30 months in a subgroup of 93 patients. After adjustment for demographic, renal, cardiovascular, and biochemical covariates, including serum phosphate, risk of death among patients in the lowest T50 tertile was more than two times the risk among patients in the highest T50 tertile (adjusted hazard ratio, 2.2; 95% confidence interval, 1.1 to 5.4; P=0.04). This effect was lost, however, after additional adjustment for aortic stiffness, suggesting a shared causal pathway. Longitudinally, serum calcification propensity measurements remained temporally stable (intraclass correlation=0.81). These results suggest that serum T50 may be helpful as a biomarker in designing methods to improve defenses against vascular calcification. PMID:24179171

  19. Ketoanalogue-Supplemented Vegetarian Very Low-Protein Diet and CKD Progression.

    Science.gov (United States)

    Garneata, Liliana; Stancu, Alexandra; Dragomir, Diana; Stefan, Gabriel; Mircescu, Gabriel

    2016-07-01

    Dietary protein restriction may improve determinants of CKD progression. However, the extent of improvement and effect of ketoanalogue supplementation are unclear. We conducted a prospective, randomized, controlled trial of safety and efficacy of ketoanalogue-supplemented vegetarian very low-protein diet (KD) compared with conventional low-protein diet (LPD). Primary end point was RRT initiation or >50% reduction in initial eGFR. Nondiabetic adults with stable eGFRproteins and 1 cps/5 kg ketoanalogues per day) or continue LPD (0.6 g/kg per day) for 15 months. Only 14% of screened patients patients were randomized, with no differences between groups. Adjusted numbers needed to treat (NNTs; 95% confidence interval) to avoid composite primary end point in intention to treat and per-protocol analyses in one patient were 4.4 (4.2 to 5.1) and 4.0 (3.9 to 4.4), respectively, for patients with eGFR<30 ml/min per 1.73 m(2) Adjusted NNT (95% confidence interval) to avoid dialysis was 22.4 (21.5 to 25.1) for patients with eGFR<30 ml/min per 1.73 m(2) but decreased to 2.7 (2.6 to 3.1) for patients with eGFR<20 ml/min per 1.73 m(2) in intention to treat analysis. Correction of metabolic abnormalities occurred only with KD. Compliance to diet was good, with no changes in nutritional parameters and no adverse reactions. Thus, this KD seems nutritionally safe and could defer dialysis initiation in some patients with CKD.

  20. Association between cardiac biomarkers and the development of ESRD in patients with type 2 diabetes mellitus, anemia, and CKD

    DEFF Research Database (Denmark)

    Desai, Akshay S; Toto, Robert; Jarolim, Petr

    2011-01-01

    In patients with chronic kidney disease (CKD), as in other populations, elevations in cardiac biomarker levels predict increased risk of cardiovascular events. We examined the value of troponin T (TnT) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) in assessing the risk of developing e...

  1. Hematological profile of chronic kidney disease (CKD patients in Iran, in pre-dialysis stages and after initiation of hemodialysis

    Directory of Open Access Journals (Sweden)

    Afshar Reza

    2010-01-01

    Full Text Available Anemia is a common sequealae of chronic kidney disease (CKD, associated with significant morbidity. A cross-sectional study was conducted on 100 CKD patients (54 hemodia-lyzed, 46 pre-dialyzed. Data including, complete blood count, BUN, creatinine, creatinine clea-rance, underlying diseases and hemodialysis duration were collected by a questionnaire. The most frequent morphologic features were normochromic-normocytic (80%, hypochromic-microcytic (15% and macrocytic (5%. The frequency of anemia in hemodialyzed and pre-dialyzed patients (with mean Hgb level of 10.27 and 11.11 g/dL were 85% and 75%. Hemoglobin concentration was positively correlated to calculated creatinine clearance (P < 0.001. The severity of anemia among hemodialyzed patients was mild (Hgb > 10 g/dL in 5%, moderate in 70% and severe (Hgb < 7 g/dL in 25%, while in pre-dialyzed was mild in 45% and moderate in 55%. There was no correlation between the anemia and CKD causes or hemodialysis duration. In conclusion, data shows that anemia in our patients with CKD is a predominant manifestation, with high frequency but of moderate degree. The most likely cause is inadequate erythropoietin production.

  2. CKD screening and management in the Veterans Health Administration: the impact of system organization and an innovative electronic record.

    Science.gov (United States)

    Patel, Thakor G; Pogach, Leonard M; Barth, Robert H

    2009-03-01

    At the beginning of this decade, Healthy People 2010 issued a series of objectives to "reduce the incidence, morbidity, mortality and health care costs of chronic kidney disease." A necessary feature of any program to reduce the burden of kidney disease in the US population must include mechanisms to screen populations at risk and institute early the aspects of management, such as control of blood pressure, management of diabetes, and, in patients with advanced chronic kidney disease (CKD), preparation for dialysis therapy and proper vascular access management, that can retard CKD progression and improve long-term outcome. The Department of Veterans Affairs and the Veterans Health Administration is a broad-based national health care system that is almost uniquely situated to address these issues and has developed a number of effective approaches using evidence-based clinical practice guidelines, performance measures, innovative use of a robust electronic medical record system, and system oversight during the past decade. In this report, we describe the application of this systems approach to the prevention of CKD in veterans through the treatment of risk factors, identification of CKD in veterans, and oversight of predialysis and dialysis care. The lessons learned and applicability to the private sector are discussed.

  3. A Comparison of Treating Metabolic Acidosis in CKD Stage 4 Hypertensive Kidney Disease with Fruits and Vegetables or Sodium Bicarbonate

    Science.gov (United States)

    Goraya, Nimrit; Simoni, Jan; Jo, Chan-Hee

    2013-01-01

    Summary Background and objectives Current guidelines recommend Na+-based alkali for CKD with metabolic acidosis and plasma total CO2 (PTCO2) fruits and vegetables with oral NaHCO3 (HCO3) regarding the primary outcome of follow-up estimated GFR (eGFR) and secondary outcomes of improved metabolic acidosis and reduced urine indices of kidney injury. Design, setting, participants, & measurements Individuals with stage 4 (eGFR, 15–29 ml/min per 1.73 m2) CKD due to hypertensive nephropathy, had a PTCO2 level fruits and vegetables dosed to reduce dietary acid by half (n=36). Results Plasma cystatin C–calculated eGFR did not differ at baseline and 1 year between groups. One-year PTCO2 was higher than baseline in the HCO3 group (21.2±1.3 versus 19.5±1.5 mM; Pfruits and vegetables group (19.9±1.7 versus 19.3±1.9 mM; Pfruits and vegetable group (Pfruits and vegetables or NaHCO3 in individuals with stage 4 CKD yielded eGFR that was not different, was associated with higher-than-baseline PTCO2, and was associated with lower-than-baseline urine indices of kidney injury. The data indicate that fruits and vegetables improve metabolic acidosis and reduce kidney injury in stage 4 CKD without producing hyperkalemia. PMID:23393104

  4. Comparison of risk prediction using the CKD-EPI equation and the MDRD study equation for estimated glomerular filtration rate.

    NARCIS (Netherlands)

    Matsushita, K.; Mahmoodi, B.K.; Woodward, M.; Emberson, J.R.; Jafar, T.H.; Jee, S.H.; Polkinghorne, K.R.; Shankar, A.; Smith, D.H.; Tonelli, M.; Warnock, D.G.; Wen, C.P.; Coresh, J.; Gansevoort, R.T.; Hemmelgarn, B.R.; Levey, A.S.; Wetzels, J.F.

    2012-01-01

    CONTEXT: The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation more accurately estimates glomerular filtration rate (GFR) than the Modification of Diet in Renal Disease (MDRD) Study equation using the same variables, especially at higher GFR, but definitive evidence of its risk

  5. Hemoglobin A(1c) and fructosamine for assessing glycemic control in diabetic patients with CKD stages 3 and 4.

    Science.gov (United States)

    Chen, Harn-Shen; Wu, Tzu-En; Lin, Hong-Da; Jap, Tjin-Shing; Hsiao, Li-Chuan; Lee, Shen-Hung; Lin, Shu-Hsia

    2010-05-01

    Hemoglobin A(1c) (HbA(1c)) and fructosamine can be used to monitor glycemic control in diabetic patients with normal kidney function, but their validity in patients with chronic kidney disease (CKD) has not been evaluated. In this study, we evaluated the correlation and accuracy of these 2 measures of glycemic control in type 2 diabetic patients with CKD stages 3-4. Diagnostic test study. Type 2 diabetic patients with normal (n = 30) and abnormal kidney function (n = 30) were recruited in Taipei Veterans General Hospital, Taiwan. HbA(1c) and fructosamine. Self-monitoring of blood glucose levels. Blood glucose measurements consisted of 6 preprandial, 6 postprandial, and 2 bedtime assessments in a week with a cycle of 4-week intervals for 12 weeks. Correlation coefficients between HbA(1c) level or fructosamine-albumin ratio and mean blood glucose levels were 0.836 and 0.645 in participants with normal kidney function and 0.813 and 0.649 in participants with CKD stages 3-4, respectively. In patients with CKD stages 3-4, mean blood glucose levels in weeks 1-12 were 21.9 mg/dL (95% CI, 11.6-32.5) higher than estimated average glucose (eAG) levels calculated from HbA(1c) levels in participants with normal kidney function. In patients with CKD stages 3-4, mean blood glucose levels in weeks 10-12 were 15.5 mg/dL (95% CI, 5.2-30.5) higher than eAG levels calculated from fructosamine levels in participants with normal kidney function, but without statistical significance when eAG calculated from fructosamine level was corrected for serum albumin level (difference of 5.6 mg/dL; 95% CI, -8.6 to 19.8). Relatively small number of participants with limited amount of blood glucose measurement data. Our data show that eAG calculated from HbA(1c) and fructosamine levels might underestimate mean blood glucose levels in patients with CKD stages 3-4. References ranges may need to be modified when interpreting results of measurements of glycemic control in type 2 diabetic patients with

  6. The effect of lowering salt intake on ambulatory blood pressure to reduce cardiovascular risk in chronic kidney disease (LowSALT CKD study: protocol of a randomized trial

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    McMahon Emma J

    2012-10-01

    Full Text Available Abstract Background Despite evidence implicating dietary sodium in the pathogenesis of cardiovascular disease (CVD in chronic kidney disease (CKD, quality intervention trials in CKD patients are lacking. This study aims to investigate the effect of reducing sodium intake on blood pressure, risk factors for progression of CKD and other cardiovascular risk factors in CKD. Methods/design The LowSALT CKD study is a six week randomized-crossover trial assessing the effect of a moderate (180 mmol/day compared with a low (60 mmol/day sodium intake on cardiovascular risk factors and risk factors for kidney function decline in mild-moderate CKD (stage III-IV. The primary outcome of interest is 24-hour ambulatory blood pressure, with secondary outcomes including arterial stiffness (pulse wave velocity, proteinuria and fluid status. The randomized crossover trial (Phase 1 is supported by an ancillary trial (Phase 2 of longitudinal-observational design to assess the longer term effectiveness of sodium restriction. Phase 2 will continue measurement of outcomes as per Phase 1, with the addition of patient-centered outcomes, such as dietary adherence to sodium restriction (degree of adherence and barriers/enablers, quality of life and taste assessment. Discussion The LowSALT CKD study is an investigator-initiated study specifically designed to assess the proof-of-concept and efficacy of sodium restriction in patients with established CKD. Phase 2 will assess the longer term effectiveness of sodium restriction in the same participants, enhancing the translation of Phase 1 results into practice. This trial will provide much-needed insight into sodium restriction as a treatment option to reduce risk of CVD and CKD progression in CKD patients. Trial registration Universal Trial Number: U1111-1125-2149. Australian New Zealand Clinical Trials Registry Number: ACTRN12611001097932

  7. Telemedicine to Promote Patient Safety: Use of Phone-Based Interactive Voice-Response System to Reduce Adverse Safety Events in Pre-dialysis CKD.

    Science.gov (United States)

    Weiner, Shoshana; Fink, Jeffery C

    2017-01-01

    CKD patients have several features conferring on them a high risk of adverse safety events, which are defined as incidents with unintended harm related to processes of care or medications. These characteristics include impaired kidney function, polypharmacy, and frequent health system encounters. The consequences of such events in CKD can include new or prolonged hospitalization, accelerated kidney function loss, acute kidney injury, ESRD, and death. Health information technology administered via telemedicine presents opportunities for CKD patients to remotely communicate safety-related findings to providers for the purpose of improving their care. However, many CKD patients have limitations that hinder their use of telemedicine and access to the broad capabilities of health information technology. In this review, we summarize previous assessments of the pre-dialysis CKD populations' proficiency in using telemedicine modalities and describe the use of interactive voice-response system to gauge the safety phenotype of the CKD patient. We discuss the potential for expanded interactive voice-response system use in CKD to address the safety threats inherent to this population.

  8. [Vascular Calcification - Pathological Mechanism and Clinical Application - . Vascular calcification in chronic kidney disease-mineral and bone disorder (CKD-MBD)].

    Science.gov (United States)

    Omata, Momoyo; Fukagawa, Masafumi; Kakuta, Takatoshi

    2015-05-01

    Chronic kidney disease-mineral and bone disorder (CKD-MBD), is sequential pathophysiology that starts in the very early stages of CKD. Three major aspects of CKD-MBD are laboratory abnormalities, bone abnormalities and vascular calcification. In dialysis patients, the prevalence of death due to cardiovascular disease accounts for more than 40% of all-cause mortality. Therefore, arteriosclerosis with vascular calcification may be an important pathophysiological mechanism in the development of cardiovascular disease. Vascular calcification is known to be an important risk factor influencing mortality in CKD patients. A number of studies have suggested a close association between serum FGF23 concentration and the risks of mortality, cardiovascular disease vascular calcification as well as CKD progression. Renal insufficiency leads to decline in klotho level and impaired phosphate excretion. However serum phosphate levels are maintained in the normal range by up regulation of FGF23 and PTH in early CKD stage. Early treatment intervention is necessary to improve the prognosis of the CKD patient.

  9. Anti-inflammatory effect of white wine in CKD patients and healthy volunteers.

    Science.gov (United States)

    Migliori, Massimiliano; Panichi, Vincenzo; de la Torre, Rafael; Fitó, Montserrat; Covas, Maribel; Bertelli, Alberto; Muñoz-Aguayo, Daniel; Scatena, Alessia; Paoletti, Sabrina; Ronco, Claudio

    2015-01-01

    Mediterranean-style diet has been considered for its important beneficial effects on the progression of CV disease. Wine is an important component of the Mediterranean diet, and moderate wine drinkers have lower mortality rates than nondrinkers and heavy drinkers in epidemiologic studies. The beneficial effects of red wine are thought to be dependent on the polyphenol compounds such as resveratrol that exhibit potent antioxidant activity. However, white wine, although lacking polyphenols, contains simple phenols, such as tyrosol (Tyr) and hydroxytyrosol (OH-Tyr), characteristic also of extra-virgin olive oil, which may share similar antioxidant and inflammatory properties. The effect of white wine and extra-virgin olive oil on inflammatory markers was evaluated in 10 healthy volunteers and in 10 patients with CKD (chronic kidney disease) K-DOQI stage III-IV in a prospective, single blind, randomized, cross-over trial. After two weeks of wash-out from alcoholic beverages, subjects were randomized to a cross-over design A-B or B-A of a 2-week treatment with white wine (4 ml/kg body weight, 0.48 g/kg of alcohol 12%, corresponding to 2-3 glasses/daily) and extra-virgin olive oil (treatment A) or extra-virgin olive oil alone (treatment B). The two study periods were separated by a two-week wash-out period. At baseline and at the end of each treatment, plasma levels of inflammatory markers C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), and interleukin-8 (IL-8) concentration were determined. Urinary levels of Tyr, OH-Tyr, and their metabolites were measured at the same time. During combined consumption of white wine and extra-virgin olive oil (treatment A), plasma levels of CRP and IL-6 decreased from 4.1 ± 1.8 to 2.4 ± 1.9 mg/l (p patients. CRP decreased from 2.6 ± 1.2 to 1.9 ± 0.9 mg/l (p chronic inflammation were significantly reduced in CKD patients during the combined consumption of white wine and olive oil, suggesting a

  10. Rate of change in kidney function and the risk of death: the case for incorporating the rate of kidney function decline into the CKD staging system.

    Science.gov (United States)

    Al-Aly, Ziyad; Cepeda, Oscar

    2011-01-01

    Chronic kidney disease (CKD) is associated with increased risk of death. A wave of recent studies used longitudinal data to examine the effect of the rate of decline of kidney function on the risk of death. The results from these studies show that there is an independent and graded association between the rate of kidney function decline and the risk of death. There is a need to incorporate the rate of decline in the definition of CKD. This redefinition of CKD will transform a static definition into a dynamic one that more accurately describes the disease state in an individual patient.

  11. Confounding and control of confounding in nonexperimental studies of medications in patients with CKD.

    Science.gov (United States)

    Bradbury, Brian D; Gilbertson, David T; Brookhart, M Alan; Kilpatrick, Ryan D

    2012-01-01

    Confounding is an important source of bias in nonexperimental studies, arising when the effect of an exposure on the occurrence of an outcome is distorted by the effect of some other factor. In nonexperimental studies of patients with CKD or who are on chronic dialysis, confounding is a significant concern owing to the high burden of comorbid disease, extent of required clinical management, and high frequency of adverse clinical events in this patient population. Confounding can be addressed in both the design stage (restriction, accurate measurement of confounders) and analysis stage (stratification, multivariable adjustment, propensity scores, marginal structural models, instrumental variable) of a study. Time-dependent confounding and confounding by indication are 2 special cases of confounding that can arise in studies of treatment effects and may require more sophisticated analytic techniques to adequately address. The availability and expanded use of large health care databases have ensured greater precision and have now placed the focus on validity. Addressing the major threats to validity, such as confounding, should be a first-order concern.

  12. Cardiac troponin I concentration is commonly increased in nondialysis patients with CKD: experience with a sensitive assay.

    Science.gov (United States)

    Lamb, Edmund J; Kenny, Claire; Abbas, Nasir A; John, R Ian; Webb, Michelle C; Price, Christopher P; Vickery, Susan

    2007-04-01

    Cardiac troponin (cTn) concentrations commonly are increased in patients with chronic kidney disease (CKD) in the absence of an acute coronary syndrome. cTn T (cTnT) concentration reportedly is increased more commonly than cTn I (cTnI). Using a sensitive cTnI assay, we studied cTnI concentrations in predialysis patients with CKD who did not have an acute coronary event. Observational cohort study. Nondialysis patients with CKD attending an outpatient clinic. Plasma cTnI was measured using the cTnI-Ultra assay (Bayer HealthCare LLC, Diagnostics Division, Tarrytown, NY), the same manufacturer's standard cTnI assay, and a cTnT assay (Roche Diagnostics PLC, East Sussex, UK). Prevalence of increased cTn concentration, effect of clinical variables on cTnI-Ultra concentration, and independent associations between cTn assays and all-cause mortality by using multiple regression modeling. Plasma cTnI-Ultra concentration exceeded the upper limit of normal in 33% of patients compared with 18% with the cTnI-standard assay and 43% with the cTnT assay. Age, vascular disease, parathyroid hormone concentration, and left ventricular mass, but not kidney function, had independent effects on plasma cTnI-Ultra concentrations. There were 39 deaths during follow-up. Survival was decreased in patients with baseline cTnI-Ultra concentrations of 0.040 ng/mL or greater (54% versus 83%; P sensitive assay, we found that the prevalence of increased cTnI concentrations in patients with CKD is similar to that observed for cTnT. cTnT concentration, but not cTnI, was independently associated with death.

  13. [Comparison of the cardiovascular predictive value of MDRD and CKD-EPI in estimating chronic kidney disease].

    Science.gov (United States)

    Cinza-Sanjurjo, S; Calvo-Gómez, C; Hermida-Ameijeiras, A; López-Paz, J E; González-Juanatey, J R

    2016-01-01

    To assess predictive value of the cardiovascular prognosis by comparing the two most used formulas for the estimation of glomerular filtration rate in hypertensive patients. A retrospective cohort study was designed that included 405 patients diagnosed with essential hypertension. The patients were referred from Primary Care to the Hypertension and Vascular Risk Unit between January 1, 1998 and August 31, 1999. Blood pressure measurements, blood and urine analysis, and echocardiography were simultaneously performed. They were followed up for 12.5 years (mean [± IQR]: 10.61 [± 3.11] years) and 174 events were recorded. The study included 405 patients (53.8% women), with a mean age of 55.5 years. The estimated glomerular filtration rate according to the MDRD and CKD-EPI equations was 73.9±2.6 mL/min/1.73m(2) and 76.9±2.2 mL/min/1.73m(2), respectively. The prevalence of chronic kidney disease was 31.6% and 23.9%, respectively. Using the CKD-EPI equation led to the re-classification of 22.9% of patients. The incidence rate ratio (IRR [95%CI] for chronic kidney disease identified by the MDRD equation was 2.4 [1.8-3.3], and for the CKD-EPI calculation it was 2.5 [1.8 to 3.3]). Both equations estimate similar magnitudes of renal function, although the CKD-EPI equation has less false positives, and both have similar prognostic values in patients at high cardiovascular risk as well those at low risk. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Thematic synthesis of qualitative studies on patient and caregiver perspectives on end-of-life care in CKD.

    Science.gov (United States)

    Tong, Allison; Cheung, Katharine L; Nair, Sumi Sukumaran; Kurella Tamura, Manjula; Craig, Jonathan C; Winkelmayer, Wolfgang C

    2014-06-01

    Although dialysis prolongs life for patients with end-stage kidney disease, 20% of deaths in this population are preceded by dialysis therapy withdrawal. Recently, there has been more focus on conservative (nondialytic) care as a legitimate option, particularly for elderly patients. This study aims to describe patients' and caregivers' perspectives on conservative treatment and end-of-life care in chronic kidney disease (CKD). Systematic review and thematic synthesis of qualitative studies. Patients with CKD and caregivers. MEDLINE, Embase, PsycINFO, CINAHL, and reference lists were searched to May 2013. Thematic synthesis was used to analyze the findings. 26 studies involving more than 711 patients (non-dialysis dependent [n=41], hemodialysis [n=544], peritoneal dialysis [n=9]; unspecified dialysis modality [n=31], conservative management [n=86]) and 178 caregivers were included. We identified 5 themes: invasive suffering (bodily deterioration, loss of freedom and independence, unyielding fatigue and pain, resignation, treatment burden and harm, financial strain), personal vulnerability (imminence of death, misunderstanding and judgment, autonomy and dignity, medical abandonment, trust and safety), relational responsibility (being a burden, demonstrating loyalty, protecting others from grief), negotiating existential tensions (accepting natural course of life, disrupted aging, worthlessness, living on borrowed time, respecting sanctity of life, life satisfaction, preserving self-identity), and preparedness (decisional clarity, informational power, spirituality and hope). Non-English articles were excluded; therefore, the transferability of findings to other populations is unclear. Some patients with CKD experience physical and psychosocial frailty and feel ambivalent about prolonging life. Some caregivers believe in providing relief from suffering, but are uncertain about making decisions regarding dialysis therapy initiation and discontinuation. We suggest that

  15. Extreme Elevations in Blood Pressure and All-Cause Mortality in a Referred CKD Population: Results from the CRISIS Study.

    Science.gov (United States)

    Ritchie, James; Rainone, Francesco; Green, Darren; Alderson, Helen; Chiu, Diana; Middleton, Rachel; O'Donoghue, Donal; Kalra, Philip A

    2013-01-01

    Hypertension frequently complicates chronic kidney disease (CKD), with studies showing clinical benefit from blood pressure lowering. Subgroups of patients with severe hypertension exist. We aimed to identify patients with the greatest mortality risk from uncontrolled hypertension to define the prevalence and phenotype of patients who might benefit from adjunctive therapies. 1691 all-cause CKD patients from the CRISIS study were grouped by baseline blood pressure-target (extreme (>190 and/or 100 mmHg). Groups were well matched for age, eGFR, and comorbidities. 77 patients had extreme hypertension at recruitment but no increased mortality risk (HR 0.9, P = 0.9) over a median follow-up period of 4.5 years. The 1.2% of patients with extreme hypertension at recruitment and at 12-months had a significantly increased mortality risk (HR 4.3, P = 0.01). This association was not seen in patients with baseline extreme hypertension and improved 12-month blood pressures (HR 0.86, P = 0.5). Most CKD patients with extreme hypertension respond to pharmacological blood pressure control, reducing their risk for death. Patients with extreme hypertension in whom blood pressure control cannot be achieved have an approximate prevalence of 1%. These patients have an increased mortality risk and may be an appropriate group to consider for further therapies, including renal nerve ablation.

  16. Validation of Indonesian Version of FACIT Fatigue Scale Questionnaire in Chronic Kidney Disease (CKD Patients with Routine Hemodialysis

    Directory of Open Access Journals (Sweden)

    Jhonson P. Sihombing

    2016-12-01

    Full Text Available Anemia is common in Chronic Kidney Disease (CKD. One of anemia consequences is fatigue which can lead to decrease in quality of life. Functional Assessment Chronic Illness Therapy (FACIT Fatigue Scale is an instrument to measure patient’s score of fatigue. This questionnaire is not validated yet in Indonesia. The aim of this study is to validate Indonesian version of Functional Assessment Chronic Illness Therapy (FACIT Fatigue Scale as an instrument for patient’s quality of life. FACIT Fatigue Scale was translated into Indonesian and administrated to CKD patients with routine homodialysis in an academic hospital in Yogyakarta on May until October 2015. The validity was evaluated by Pearson correlation test and the reliability was evaluated by Cronbach’s alpha test. Validity test showed that all of the questions were valid because r count was bigger than r table=0,279 and reliable because r11=0,646>0,6. In conclusion, Indonesian version of FACIT Fatigue Scale was a brief and valid to monitor important symptom and its effect on CKD patients with routine hemodialysis.

  17. Survey of attitudes of physicians toward the current evaluation and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD

    Directory of Open Access Journals (Sweden)

    Souqiyyeh Muhammad

    2010-01-01

    Full Text Available We aimed in this study to determine the opinion of the medical directors of dialysis centers in the Kingdom of Saudi Arabia (KSA about the updates of strategies for evaluation and treatment of chronic kidney disease-mineral and bone Disorder (CKD-MBD. A questionnaire was sent to medical directors of 174 dialysis centers in the KSA between July and November 2009. The questionnaire was opinion based and comprised the prevalence of the CKD-MBD, strategies of therapy and indications of cinacalcet, a new therapy in the CKD patients. A total of 154 medical directors of the 174 (88.5%, who are the therapeutic decision-makers for 10100 (89% dialysis patients, answered the questionnaire. There were 84 respondents (54% who believed that the parathormone (PTH blood levels initially increase at a glomerular filtration rate (GFR < 30%. There were 80 (53% respondents who believed that changes of phosphorus (PO4 and cal-cium (Ca blood levels are initially observed at GFR < 30 mL/min. The majority of respondents, 115 (77%, 116 (80%, 95 (66%, and 134 (90% currently have observed increased prevalence of vascular calcifications, adynamic bone disease, PTH > 500 pmol/L, and elevated Ca blood levels, respectively, only in the minority of advanced CKD. However, 88 (58% respondents observed increased prevalence of elevated PO4 blood levels in the majority of new dialysis and advanced CKD patients. There were 137 (89% respondents who believed from the current published evi-dence that CKD-MBD may result in increased morbidity (e.g. fractures and mortality (e.g. cardiovascular in advanced CKD and new dialysis patients. However, only 41 (27% respondents follow the PTH levels in their patients every 2-3 months, while 81(53% follow it every 6 months. There were 127 (83%, 129 (84%, 114 (75% respondents who would start vitamin D (vit D in dialysis and CKD patients for hypocalcemia, high PTH, and vit D 1,25 deficiency, respectively. However, only 51 (34% respondents would

  18. Gibt es neben der Prähypertonie auch ein Vorstadium der chronischen Niereninsuffizienz (Prä-CKD ?

    Directory of Open Access Journals (Sweden)

    Ribitsch W

    2011-01-01

    Full Text Available Die Prävalenz der chronischen Niereninsuffizienz (CKD wird in den nächsten Jahren weiter zunehmen und aller Voraussicht deutlich auf einen Anteil 10 % der Gesamtbevölkerung ansteigen. Sie ist mit wesentlichen negativen Auswirkungen inklusive erhöhter kardiovaskulärer Morbidität und Mortalität assoziiert. Die wichtigsten traditionellen Risikofaktoren für die Entwicklung einer chronischen Niereninsuffizienz beinhalten Adipositas, arterielle Hypertonie und Diabetes mellitus. Bisherige Definitionen der arteriellen Hypertonie und des Diabetes mellitus wurden aufgrund von Studien erweitert, die zeigten, dass bereits Blutdruckwerte und Blutzuckerspiegel unterhalb der Normbereichsgrenze mit einem erhöhten kardiovaskulären Risiko einhergehen. Diese Erkenntnisse führten zur Einführung der Begriffe „Prähypertonie“ und „Prädiabetes“. Prähypertonie beschreibt einen Blutdruck zwischen 130–139/85– 90 mmHg, während ein Prädiabetes durch eine gestörte Nüchternglukose bzw. das Vorliegen einer gestörten Glukosetoleranz definiert ist. Patienten beider Entitäten unterliegen der Gefahr einer Krankheitsprogression und damit einhergehend einer erhöhten kardiovaskulären Morbidität und Mortalität. Der Begriff einer Prä-CKD war in der Nephrologie bislang noch nicht etabliert. In der jüngeren Vergangenheit mehrten sich jedoch Hinweise, wonach bereits bei normaler und leicht eingeschränkter Nierenfunktion eine Assoziation zwischen Phosphatspiegel und kardiovaskulärem Risiko besteht. Diese Beobachtungen lenkten die Aufmerksamkeit der Nephrologen auf die frühen Stadien der Niereninsuffizienz, wobei vor allem das „Phosphatonin Fibroblast Growth Factor 23“ (FGF-23 im komplexen System des Phosphatstoffwechsels ein vielversprechender Parameter zu sein scheint. FGF- 23 steigt bereits früh im Verlauf einer chronischen Niereninsuffizienz an, wenn der Patient üblicherweise noch keinem Nephrologen vorgestellt wird. Aufgrund der limitierten

  19. Individuals with a family history of ESRD are a high-risk population for CKD: implications for targeted surveillance and intervention activities.

    Science.gov (United States)

    McClellan, William M; Satko, Scott G; Gladstone, Elisa; Krisher, Jenna O; Narva, Andrew S; Freedman, Barry I

    2009-03-01

    Activities intended to improve the detection, treatment, and control of chronic kidney disease (CKD) should be incorporated into existing health care systems and targeted to high-risk populations to avoid redundancy and waste of resources. One high-risk population consists of first- or second-degree family members of patients with end-stage renal disease (ESRD), who are 2 to 3 times as likely to have incident ESRD, have high rates of impaired kidney function and undetected and uncontrolled high blood pressure, and are more likely to be obese. These individuals usually are unaware of their underlying CKD and may discount their own risk of ESRD. The ESRD Network 6 Family History Project shows that the ESRD Networks, which constitute a national CKD surveillance system for patients with stage 5 CKD, may be an existing resource that can be used to identify relatives of incident patients with ESRD and provide these families with information about CKD. Nationally available resources have been developed by the National Kidney Disease Education Program for use with these at-risk families. Individuals interested in population-based CKD control activities should be aware of and use these resources.

  20. Serum Testosterone Levels and Mortality in Men With CKD Stages 3–4

    Science.gov (United States)

    Khurana, Kiranpreet K.; Navaneethan, Sankar D.; Arrigain, Susana; Schold, Jesse D.; Nally, Joseph V.; Shoskes, Daniel A.

    2014-01-01

    Background Hypogonadism in men (total testosterone level testosterone measured for-cause between January 1, 2005 and October 31, 2011 at a tertiary care center in Cleveland, Ohio. Predictors Total testosterone measured using an immunoassay measurement in 3 forms: a) categorized as low or testosterone replacement therapy versus normal, b) continuous log testosterone, and c) quintiles (100–226, 227–305, 306–392, 393–511, 512–3153 ng/dL). Outcomes Factors associated with low total testosterone, and association between low total testosterone and all-cause mortality were evaluated using logistic regression, Cox proportional hazard models, and Kaplan-Meier survival curves. Results Hypogonadism was found in 1288/2419 (53%) of men. In a multivariable logistic regression analysis, African American ethnicity and higher eGFR were associated with lower odds of having hypogonadism. Diabetes and higher body mass index were associated with higher odds of having hypogonadism. 357/2419 (15%) patients died during a median follow up of 2.3 years. In the multivariate Cox model, testosterone testosterone replacement therapy were not associated with mortality. In a multivariable model also adjusted for testosterone supplementation, higher log testosterone was associated with significantly lower mortality (HR per 1 log unit, 0.70; 95% CI, 0.55–0.89). When compared to the highest quintile, the second lowest quintile of testosterone was associated with higher mortality (HR, 1.53; 95% CI, 1.09–2.16). Limitations Single center study, timing of testosterone testing, lack of adjustment for proteinuria, and sampling bias. Conclusions Low total testosterone may be associated with higher mortality in men with CKD stages 3–4 but more studies are needed. PMID:24726629

  1. The QICKD study protocol: a cluster randomised trial to compare quality improvement interventions to lower systolic BP in chronic kidney disease (CKD in primary care

    Directory of Open Access Journals (Sweden)

    du Bois Elizabeth

    2009-07-01

    Full Text Available Abstract Background Chronic kidney disease (CKD is a relatively newly recognised but common long-term condition affecting 5 to 10% of the population. Effective management of CKD, with emphasis on strict blood pressure (BP control, reduces cardiovascular risk and slows the progression of CKD. There is currently an unprecedented rise in referral to specialist renal services, which are often located in tertiary centres, inconvenient for patients, and wasteful of resources. National and international CKD guidelines include quality targets for primary care. However, there have been no rigorous evaluations of strategies to implement these guidelines. This study aims to test whether quality improvement interventions improve primary care management of elevated BP in CKD, reduce cardiovascular risk, and slow renal disease progression Design Cluster randomised controlled trial (CRT Methods This three-armed CRT compares two well-established quality improvement interventions with usual practice. The two interventions comprise: provision of clinical practice guidelines with prompts and audit-based education. The study population will be all individuals with CKD from general practices in eight localities across England. Randomisation will take place at the level of the general practices. The intended sample (three arms of 25 practices powers the study to detect a 3 mmHg difference in systolic BP between the different quality improvement interventions. An additional 10 practices per arm will receive a questionnaire to measure any change in confidence in managing CKD. Follow up will take place over two years. Outcomes will be measured using anonymised routinely collected data extracted from practice computer systems. Our primary outcome measure will be reduction of systolic BP in people with CKD and hypertension at two years. Secondary outcomes will include biomedical outcomes and markers of quality, including practitioner confidence in managing CKD. A small

  2. CKD6E5000型混合动力交流传动内燃调车机车的研制%Development of the Type CKD6E5000 Hybrid Power Shunting Diesel Locomotive with AC Drive

    Institute of Scientific and Technical Information of China (English)

    孟玉发; 彭长福; 王选民; 刘顺国; 任聪

    2011-01-01

    从内燃调车机车工作特点、国家产业政策出发,分析了混合动力调车机车与传统调车机车的优势比较和发展前景,详细介绍了CKD6E5000型混合动力交流传动内燃调车机车的总体方案设计和取得的成果,并提出了混合动力机车的进一步研究方向和目标.

  3. Serum uric acid level as an indicator for CKD regression and progression in patients with type 2 diabetes mellitus-a 4.6-year cohort study.

    Science.gov (United States)

    Chang, Yu-Hung; Lei, Chen-Chou; Lin, Kun-Chen; Chang, Dao-Ming; Hsieh, Chang-Hsun; Lee, Yau-Jiunn

    2016-09-01

    To investigate the association of serum uric acid level with renal function change in patients with type 2 diabetes mellitus (T2DM). T2DM patients who had been followed-up for at least 3 years were included. Participants were categorized into stable, progression, or regression groups according to their change in chronic kidney disease (CKD) stage. During the follow-up period, all numeric values of metabolic factors, including the uric acid level and the medication possession rate, were calculated in order to investigate their associations with CKD development. Multivariate Cox regression analyses were used to identify independent factors associated with change in CKD. A total of 2367 T2DM patients were enrolled in this study and followed-up for a mean of 4.6 years. The numbers of patients in the stable, progression and regression groups were 1133 (47.9%), 487 (20.6%), and 747 (31.5%), respectively. The progression group had the highest serum uric acid level (6.9 ± 1.8 mg/dL), and the regression group had the lowest uric acid level (5.4 ± 1.5 mg/dL). In addition, we found that the serum uric acid level was an independent factor associated with CKD progression when the value exceeded 6.3 mg/dL. A lower uric acid level could be beneficial for CKD improvement in T2DM patients with stage 3-5 CKD. Our data indicated that the serum uric acid level is associated with CKD regression and progression and suggested that a high normal serum uric acid level should be closely monitored in patients with T2DM. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  4. Correction of iron deficiency anaemia using IV CosmoFer in CKD patients with asthma: a prospective study.

    Science.gov (United States)

    Syed, A; Bhandari, S

    2016-03-01

    Intravenous (IV) iron is commonly used for correcting iron deficiency anaemia in patients with chronic kidney disease (CKD). There remains a concern for its use in patients with asthma as it may trigger an acute exacerbation. Pre-treatment with a single dose of parenteral hydrocortisone may obviate this risk. We carried out a prospective study of known asthmatic patients with CKD requiring single-dose iron repletion therapy. We analysed the efficacy and safety of IV CosmoFer (low molecular weight iron dextran). Twenty non-dialysis CKD patients with iron deficiency anaemia and a history of asthma were enrolled. Severity of asthma and level of control were recorded as per British Thoracic Society Guidelines and Royal Collage of Physician questionnaire, respectively. All patients received IV hydrocortisone 30 min before the test dose of CosmoFer followed by the remaining total dose. Patients were monitored for adverse reactions. Haemoglobin, serum ferritin levels and estimated glomerular filtration rate were measured pre and 6-weeks post-infusion. All patients were followed up until 6 weeks to assess the control of their asthma. All 20 patients completed the study. No patient experienced acute hypersensitivity or infusion reactions. At 6 weeks follow-up, no patient reported worsening of their asthma. There was an increase in mean haemoglobin from 10.1 to 11.1 g/dl and mean ferritin from 93.5 to 302.6 ng/ml. This study demonstrates that IV CosmoFer may be administered safely in asthmatics by administering a single 50 mg dose of hydrocortisone pre-infusion. © The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  5. Report on the Workshop and Regular Meeting of the Imode-CKD and Bcmolmed Marie Curie Training and Research Programs.

    Science.gov (United States)

    Krochmal, Magdalena; Cisek, Katryna; Markoska, Katerina; Spasovski, Goce; Vlahou, Antonia

    2015-01-01

    A Workshop and Regular Meeting of the Marie Curie Training and Research Programs iMODECKD (Identification of the Molecular Determinants of established Chronic Kidney Disease) and BCMolMed (Molecular Medicine for Bladder Cancer) was held from 20-22 March at the Macedonian Academy of Science and Arts (MASA). The meeting was hosted by the participating center University of Skopje (SKO) - Goce Spasovski and MASA - Momir Polenakovic (R. Macedonia). The representative from MASA proteomic research center - Katerina Davalieva (R. Macedonia) had presentation on proteomic research in prostate cancer (PCa). 40 researchers from 13 different countries participated at the meeting. The Workshop was devoted on "Chronic Kidney Disease: Clinical Management issues", and consisted of 15 oral presentations given by nephrologists and experts in the field of CKD. Raymond Vanholder (Belgium) - past president of ERA-EDTA had a keynote lecture on "CKD: Questions that need to be answered and are not (or at least not entirely)". The workshop continued in four sessions with lectures from Alberto Ortiz (Spain), Olivera Stojceva-Taneva (R. Macedonia), Dimitrios Goumenos (Greece), Joachim Beige (Germany), Marian Klinger (Poland), Goce Spasovski (R. Macedonia), Joachim Jankowski (Germany), Adalbert Schiller (Romania), Robert Johnson (USA), Franco Ferrario (Italy), Ivan Rychlik (Czech Republic), Fulvio Magni (Italy) and Giovambattista Capasso (Italy), all covering a training theme. Within the meeting there were two lectures on complimentary skills for ethics in science and career advancement from two principal investigators - Goce Spasovski (R. Macedonia) and Joost Schanstra (France). During the Regular Meeting, 13 PhD students i.e. Early Stage Researchers and one Experienced Researcher from both Programs presented their work and progress within iMODE-CKD and BCMolMed projects. This meeting was a great opportunity to exchange experience and ideas in the field of systems biology approaches and

  6. Patient INformation about Options for Treatment (PINOT): a prospective national study of information given to incident CKD Stage 5 patients.

    Science.gov (United States)

    Morton, Rachael L; Howard, Kirsten; Webster, Angela C; Snelling, Paul

    2011-04-01

    Informed decision-making requires the presentation of all possible courses of action; however, it is unclear what proportion of Stage 5 chronic kidney disease (CKD) patients are routinely informed of all their treatment options. The aim of this study was to determine the effect of patient and unit characteristics on the type and timing of information provided. A prospective national multi-centre study of information was given to incident pre-emptive transplant, dialysis and conservatively managed patients in Australian renal units, over a 3-month period. Sixty-six of 73 renal units participated in the study. Seven hundred and twenty-one incident CKD Stage 5 patients including 102 who chose not to dialyse were identified. Of these, 603 (84%) were presented with information about their options prior to commencing treatment. Three quarters (n = 543) were presented with home dialysis, one-third (n = 230) pre-emptive transplantation and 65% (n = 470) were informed about conservative care as an option. Patients were more likely to receive information prior to commencing treatment if they were known to a nephrologist for more than 3 months (OR 7.29, 95% CI 3.86-13.79) or were treated in small units with < 100 dialysis patients (OR 2.40, 95% CI 1.26-4.60). The mean estimated glomerular filtration rate at the time information was first presented was 13.3 mL/min/1.73 m(2) (95% CI 12.7-13.8) and mean serum creatinine was 449 μmol/L (95% CI 431-467). Most Australian patients were informed of their treatment options prior to starting treatment, albeit in late stage CKD. Earlier education and support for informed decision-making may help optimize the uptake of pre-emptive transplantation and home dialysis therapies.

  7. Dietary Patterns and Risk of Death and Progression to ESRD in Individuals With CKD: A Cohort Study

    Science.gov (United States)

    Gutiérrez, Orlando M.; Muntner, Paul; Rizk, Dana V.; McClellan, William M.; Warnock, David G.; Newby, P.K.; Judd, Suzanne E.

    2014-01-01

    Background Nutrition is strongly linked with health outcomes in chronic kidney disease (CKD). However, few studies have examined relationships between dietary patterns and health outcomes in persons with CKD. Study Design Observational cohort study. Setting & Participants 3,972 participants with CKD (defined as an estimated glomerular filtration rate < 60 ml/min/1.73 m2 or an albumin-creatinine ratio ≥30 mg/g at baseline) from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a prospective cohort study of 30,239 black and white adults at least 45 years of age. Predictors Five empirically derived dietary patterns identified via factor analysis: “Convenience” (Chinese and Mexican foods, pizza, other mixed dishes), “Plant-Based” (fruits, vegetables), “Sweets/Fats” (sugary foods), “Southern” (fried foods, organ meats, sweetened beverages), and “Alcohol/Salads” (alcohol, green-leafy vegetables, salad dressing). Outcomes All-cause mortality and end-stage renal disease (ESRD). Results A total of 816 deaths and 141 ESRD events were observed over approximately 6 years of follow-up. There were no statistically significant associations of Convenience, Sweets/Fats or Alcohol/Salads pattern scores with all-cause mortality after multivariable adjustment. In Cox regression models adjusted for sociodemographic factors, energy intake, co-morbidities, and baseline kidney function, higher Plant-Based pattern scores (indicating greater consistency with the pattern) were associated with lower risk of mortality (HR comparing fourth to first quartile, 0.77; 95%CI, 0.61–0.97) whereas higher Southern pattern scores were associated with greater risk of mortality (HR comparing fourth to first quartile, 1.51; 95%CI, 1.19–1.92). There were no associations of dietary patterns with incident ESRD in multivariable-adjusted models. Limitations Missing dietary pattern data, potential residual confounding from lifestyle factors. Conclusions A

  8. Early Holocene volcanism in CKD (Kamchatka) as a mechanical probe of the stress level in the crust.

    Science.gov (United States)

    Simakin, Alexander; Shaposhnikova, Olga

    2016-04-01

    The last (late Pleistocene) glaciation in Kluychevskaya group of volcanoes (KGV) can be considered as a large scale mechanical experiment allowing evaluation of the level of the global geodynamic stresses in the crust of North Kamchatka. KGV is located in the Central Kamchatka depression (CKD). Formation of the CKD can be connected with accretion of Kronotsky paleoarc to the Kamchatka edge c.a. 5 Mys ago. At the compression stage zone of the contact was thickened so that lower part can reach PT parameters of basalt-eclogite transition. Suggested carbonates contamination of the mantle wedge during accretion (Simakin et al., 2015) can became a source of CO2 facilitating eclogite formation. Dense eclogitic keel and trench retreat following accretion can be the driving forces of the CKD rift formation. Extension is partially accommodated (several mm/yr eastward motion) on the eastern border of CKD in the zone of the normal faulting (Kozhurin et al., 2006). And partially extension is accommodated by the formation of the series of dykes of submeridional direction marked by monogenic cones on the surface. At the last phase of the Pleistocene glaciation KGV was covered by the ice cap with 80 km diameter and above 1000 m maximum thickness on the slopes. After the fast deglaciation surface uplift has produced horizontal compression (Simakin and Muravyev, 2015; Pagli and Sigmundsson, 2008). Addition of the deglacial compression to the geodynamic extension turns s1 direction to the horizontal latitudinal one. Due to the horizontal compression areal of eruptions was expanded towards edges of the former glacier. Numerical modeling demonstrates that maximum level of the glacial stress is proportional to the ice gravity load and is estimated to be 5.8-7.5 MPa. Initially principle compressive stress due to the deglaciation was higher than geodynamic one abs(s1,glac) > abs(s1,geod). Time of the volcanism return to the basic submeridional direction marked the moment of viscous

  9. Electric Drive and Control System of CKD6E Hybrid Power Locomotive%CKD6E混合动力机车电传动及控制系统

    Institute of Scientific and Technical Information of China (English)

    何良; 姚晓阳

    2012-01-01

    对我国研制的首台节能环保型混合动力机车——CKD6E机车进行了介绍,对机车电传动电路、控制系统、工作方式进行了设计说明,提出了机车开发调试过程中的关键问题及解决措施,总结了混合动力机车区别于传统机车的特点,并提出了改进建议.%CKD6E locomotive, the China's first developed hybrid power locomotive with energy conservation and environmental protection, was introduced, and electric drive circuit, control system and working methods were illuminated. Key issues and solutions measures of the locomotive development and debugging process were proposed. In addition, hybrid power locomotive features different from the traditional were summarized, and improving countermeasures were proposed.

  10. Retinopathy and CKD as Predictors of All-Cause and Cardiovascular Mortality: National Health and Nutrition Examination Survey (NHANES) 1988–1994

    Science.gov (United States)

    Ricardo, Ana C.; Grunwald, Juan E.; Parvathaneni, Sharmila; Goodin, Sean; Ching, Alice; Lash, James P.

    2014-01-01

    Background Retinopathy is associated with increased mortality risk in general populations. We evaluated the joint effect of retinopathy and chronic kidney disease (CKD) on mortality in a representative sample of US adults. Study Design Prospective cohort study. Setting & Participants 7,640 adults from the National Health and Nutrition Examination Survey (NHANES) 1988–1994 with mortality linkage through 12/31/2006. Predictors CKD, defined as low estimated glomerular filtration rate (eGFR; <60 ml/min/1.73 m2) or albuminuria (urine protein-creatinine ratio ≥30mg/g), and retinopathy, defined as presence of microaneurysms, hemorrhages, exudates, microvascular abnormalities, or other evidence of diabetic retinopathy by fundus photograph. Outcomes All-cause and cardiovascular mortality. Measurements Multivariable-adjusted Cox proportional hazards. Results Overall, 4.6% of participants had retinopathy and 15% had CKD. Mean age was 56 years, 53% were women and 81% non-Hispanic white. Prevalence of retinopathy in CKD was 11%. We identified 2,634 deaths during 14.5 years’ follow-up. In multivariable analyses, compared with individuals with neither CKD nor retinopathy, the HRs for all-cause mortality were 1.02 (95% CI, 0.75–1.38), 1.52 (95% CI, 1.35–1.72), and 2.39 (95% CI, 1.77–3.22) for individuals with retinopathy only, for those with CKD only, and for those with both CKD and retinopathy, respectively. Corresponding HRs for cardiovascular mortality were 0.96 (95% CI, 0.50–1.84), 1.72 (95% CI, 1.47–2.00) and 2.96 (95% CI, 2.11–4.15), respectively. There was a significant synergistic interaction between retinopathy and CKD on all-cause mortality (p=0.04). Limitations Presence of retinopathy was evaluated only once. Small sample size of some of the subpopulations studied. Conclusions In the presence of CKD, retinopathy is a strong predictor of mortality in this adult population. PMID:24656452

  11. Effects of the Use of Non-Calcium Phosphate Binders in the Control and Outcome of Vascular Calcifications: A Review of Clinical Trials on CKD Patients

    Directory of Open Access Journals (Sweden)

    Piergiorgio Bolasco

    2011-01-01

    Full Text Available Vascular calcifications produce a high impact on morbidity and mortality rates in patients affected by chronic kidney disease and mineral bone disorder (CKD-MBD. Effects are manifested from the more advanced stages of CKD (stages 3-4, particularly in patients undergoing dialysis (CKD5D. In recent years, a large number of therapeutic options have been successfully used in the treatment of secondary hyperparathyroidism (SHPT, despite eliciting less marked effects on nonbone calcifications associated with CKD-MBD. In addition to the use of Vitamin D and analogues, more recently treatment with calcimimetic drugs has also been undertaken. The present paper aims to analyze comparative and efficacy studies undertaken to assess particularly the impact on morbidity and mortality rates of non-calcium phosphate binders. Moreover, the mechanism of action underlying the depositing of calcium and phosphate along blood vessel walls, irrespective of the specific contribution provided in reducing the typical phosphate levels observed in CKD largely at more advanced stages of the disease, will be investigated. The aim of this paper therefore is to evaluate which phosphate binders are characterised by the above action and the mechanisms through which these are manifested.

  12. Prevalence of Metformin Use and the Associated Risk of Metabolic Acidosis in US Diabetic Adults With CKD: A National Cross-Sectional Study.

    Science.gov (United States)

    Kuo, Chin-Chi; Yeh, Hung-Chieh; Chen, Bradley; Tsai, Ching-Wei; Lin, Yu-Sheng; Huang, Chiu-Ching

    2015-12-01

    The use of metformin in chronic kidney disease (CKD) population has been intensely debated with conflicting evidence. Large population studies are needed to inform risk assessment and therapeutic decision-making. We evaluated the associations among metformin, metabolic acidosis, and CKD in a 10-year nationally representative noninstitutionalized civilian population in the United States.In this cross-sectional study, a total of 2279 diabetic adults aged 20 years or older in the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2012 were included and had measurements of serum bicarbonate, sodium, potassium, and chloride. The exposure was metformin use. The outcome was subclinical and severe metabolic acidosis defined by serum bicarbonate 16mEq/L and by serum bicarbonate 60 mL/min/1.73 m was also observed. In multiple linear regression analysis, metformin was significantly associated with decreased serum bicarbonate levels (β = -0.45, 95% CI: -0.73, -0.17) and increased serum anion gap levels (β = 0.40, 95% CI: 0.19, 0.61). The adjusted odds ratio of subclinical high anion gap and severe metabolic acidosis for metformin users was 1.68 (95% CI: 1.11, 2.55) and 1.31 (0.49, 3.47), respectively. The association between metformin and serum bicarbonate was significantly modified by CKD status. No interaction was found between metformin and CKD stages for serum anion gap and acidosis.Metformin is associated with subclinical metabolic acidosis but not with severe metabolic acidosis. The propensity of serum bicarbonate-lowering effect was intensified in advanced CKD; however, such tendency was not associated with the risk of clinically defined acidosis. Our findings highlight a potential of cautious expansion of metformin use among CKD-3b patients with diabetes meriting further investigations.

  13. Enzymatic creatinine assays allow estimation of glomerular filtration rate in stages 1 and 2 chronic kidney disease using CKD-EPI equation.

    Science.gov (United States)

    Kuster, Nils; Cristol, Jean-Paul; Cavalier, Etienne; Bargnoux, Anne-Sophie; Halimi, Jean-Michel; Froissart, Marc; Piéroni, Laurence; Delanaye, Pierre

    2014-01-20

    The National Kidney Disease Education Program group demonstrated that MDRD equation is sensitive to creatinine measurement error, particularly at higher glomerular filtration rates. Thus, MDRD-based eGFR above 60 mL/min/1.73 m² should not be reported numerically. However, little is known about the impact of analytical error on CKD-EPI-based estimates. This study aimed at assessing the impact of analytical characteristics (bias and imprecision) of 12 enzymatic and 4 compensated Jaffe previously characterized creatinine assays on MDRD and CKD-EPI eGFR. In a simulation study, the impact of analytical error was assessed on a hospital population of 24084 patients. Ability using each assay to correctly classify patients according to chronic kidney disease (CKD) stages was evaluated. For eGFR between 60 and 90 mL/min/1.73 m², both equations were sensitive to analytical error. Compensated Jaffe assays displayed high bias in this range and led to poorer sensitivity/specificity for classification according to CKD stages than enzymatic assays. As compared to MDRD equation, CKD-EPI equation decreases impact of analytical error in creatinine measurement above 90 mL/min/1.73 m². Compensated Jaffe creatinine assays lead to important errors in eGFR and should be avoided. Accurate enzymatic assays allow estimation of eGFR until 90 mL/min/1.73 m² with MDRD and 120 mL/min/1.73 m² with CKD-EPI equation.

  14. Screening of chronic kidney disease (CKD in general population on world kidney day on three consecutive years: A single day data

    Directory of Open Access Journals (Sweden)

    Pradeep Kumar Rai

    2014-04-01

    Full Text Available Objective: Chronic kidney disease (CKD is increasingly recognized as a global public health problem. There is now convincing evidence that CKD can be detected using simple laboratory tests, and that treatment can prevent or delay complications of decreased kidney function, slow the progression of kidney disease and reduce the risk of cardiovascular disease (CVD. Currently, screening for CKD is accepted practice only in patients with hypertension or diabetes, but more widespread screening is increasingly proposed. We screened a sample of population on World Kidney Day on three consecutive years for detecting patients with CKD and to describe the natural course of the disease. Materials and Methods: Everyone aged ≥18 was invited to participate. The study population was general population from Varanasi were screened in OPAL hospital. The survey comprised an extensive questionnaire and a brief clinical examination, including analysis of serum creatinine concentration in all participants. We screened all the participants who had at least one risk factor for CKD (including hypertension, diabetes mellitus, or a family history of CKD. Urine dipstick tests were done and blood sample was obtained to detect proteinuria and measure serum creatinine concentration, respectively. Results: A total of 547 participants were enrolled of which all 547 subjects were included in the analyses. The mean serum creatinine was 0.9525 mg/dL (0.900 to 1.0050. A high serum creatinine level was demonstrated in 16 participants (2.92 %, and 191 (34.91 % were demonstrated to have proteinuria. There was a significant correlation between CKD and age, DM, urine protein and serum creatinine. There was no significant correlation between serum creatinine level and urinary protein excretion (P = .001. There were no significant differences between CKD and gender. Conclusion: The study demonstrates that increasing age, diabetes mellitus, Serum creatinine and urinary protein were found

  15. Estimating glomerular filtration rate using the new CKD-EPI equation and other equations in patients with autosomal dominant polycystic kidney disease

    DEFF Research Database (Denmark)

    Orskov, Bjarne; Strandgaard, Svend; Ørskov, Bjarne;

    2010-01-01

    (CKD-EPI) equation, the Cockcroft-Gault equation adjusted for body surface area and the MDRD equation with cystatin C. Performance was evaluated by mean bias, precision and accuracy. RESULTS: The MDRD equation with cystatin C had 97% of GFR estimates within 30% of measured GFR (accuracy). Both the CKD......-EPI and Cockcroft-Gault equations had an accuracy of 90% whereas the MDRD equation had an accuracy of 83%. This difference of accuracy was especially marked with GFR >60 ml/min/1.73 m(2). CONCLUSION: For estimating GFR in ADPKD patients the MDRD equation with cystatin C incorporated had the best performance...

  16. Prevalence of chronic kidney disease (CKD) in the Japanese general population predicted by the MDRD equation modified by a Japanese coefficient.

    Science.gov (United States)

    Imai, Enyu; Horio, Masaru; Iseki, Kunitoshi; Yamagata, Kunihiro; Watanabe, Tsuyoshi; Hara, Shigeko; Ura, Nobuyuki; Kiyohara, Yutaka; Hirakata, Hideki; Moriyama, Toshiki; Ando, Yasuhiro; Nitta, Kosaku; Inaguma, Daijo; Narita, Ichiei; Iso, Hiroyasu; Wakai, Kenji; Yasuda, Yoshinari; Tsukamoto, Yusuke; Ito, Sadayoshi; Makino, Hirofumi; Hishida, Akira; Matsuo, Seiichi

    2007-06-01

    The number of patients with end-stage renal disease (ESRD) in Japan has continuously increased in the past three decades. In 2005, 36,063 patients whose average age was 66 years entered a new dialysis program. This large number of ESRD patients could be just the tip of the iceberg of an increasing number of patients with chronic kidney disease (CKD). However, to date, a nationwide epidemiological study has not been conducted yet to survey the CKD population. Data for 527,594 (male, 211,034; female, 316,560) participants were obtained from the general adult population aged over 20 years who received annual health check programs in 2000-2004, from seven different prefectures in Japan: Hokkaido, Fukushima, Ibaraki, Tokyo, Osaka, Fukuoka, and Okinawa prefectures. The glomerular filtration rate (GFR) for each participant was estimated from the serum creatinine values, using the abbreviated Modification of Diet in Renal Disease (MDRD) study equation modified by the Japanese coefficient. The prevalences of CKD stage 3 in the study population, stratified by age groups of 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, and 80-89 years, were 1.4%, 3.6%, 10.8%, 15.9%, 31.8%, 44.0%, and 59.1%, respectively, predicting 19.1 million patients with stage 3 CKD in the Japanese general adult population of 103.2 million in 2004. CKD stage 4 + 5 was predicted in 200,000 patients in the Japanese general adult population. Comorbidity of hypertension, diabetes, and proteinuria increased as the estimated GFR (eGFR) decreased. The prevalence of concurrent CKD was significantly higher in hypertensive and diabetic populations than in the study population overall when CKD was defined as being present with an eGFR of less than 40 ml/min per 1.73 m(2) instead of less than 60 ml/min per 1.73 m(2). About 20% of the Japanese adult population (i.e., approximately 19 million people) are predicted to have stage 3 to 5 CKD, as defined by a GFR of less than 60 ml/min per 1.73 m(2).

  17. Report of the Asian Forum of Chronic Kidney Disease Initiative (AFCKDI) 2007. "Current status and perspective of CKD in Asia": diversity and specificity among Asian countries.

    Science.gov (United States)

    Tsukamoto, Yusuke; Wang, HaiYan; Becker, Gavin; Chen, Hung-Chun; Han, Dae-Suk; Harris, David; Imai, Enyu; Jha, Vivekanand; Li, Philip K T; Lee, Evan J C; Matsuo, Seiichi; Tomino, Yasuhiko; Tungsanga, Kriang; Yamagata, Kunihiro; Hishida, Akira

    2009-06-01

    The Japanese Society of Nephrology (JSN) sponsored the Asian Forum of CKD Initiative (AFCKDI) 2007 with the support of the International Society of Nephrology-Commission for Global Advancement in Nephrology (ISN-COMGAN), Asian Pacific Society of Nephrology (APSN), the Kidney Disease: Improving Global Outcome (KDIGO) and other national societies of nephrology in the Asian Pacific region on 27-28 May 2007 in Hamamatsu City, Japan. An international organising committee was established by leading experts of the CKD initiative. The main objective of this forum was to clarify the current status and perspectives of CKD and to promote coordination, collaboration and integration of initiatives in the Asian Pacific region. The forum received 56 papers from 16 countries; it began with the symposium "A Challenge to CKD in the world" and was followed by the ISN-COMGAN affiliated workshop "Current status and perspective of CKD in Asia". The second day was dedicated to discussion on the evaluation, surveillance and intervention in CKD in this area. At the end of the forum, we decided on the future plan as follows: (1) The AFCKDI will provide opportunities annually or biannually for every person who promotes CKD initiatives in the Asian Pacific region to join together and build consensus for action; (2) the second forum will be held in Kuala Lumpur on 4 May 2008 at the time of the 11th Asian Pacific Congress of Nephrology (APCN). Zaki Morad, President of the 11th APCN, will host the second forum; (3) the International Organising Committee (IOC) of the 1st AFCKDI will continue its function by adding other experts, including the organisers of the APCN; (4) the AFCKDI is not an organisation by itself, nor does it belong to any society, but is organised by each host national society of nephrology. The IOC will assist the domestic committee for the success of the forum and will assure the continuation of the mission; (5) in order to organise the forum and promote CKD initiatives in the

  18. Chronic Kidney Disease-Mineral Bone Disorder in Korean Patients: a Report from the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD).

    Science.gov (United States)

    Kim, Chang Seong; Bae, Eun Hui; Ma, Seong Kwon; Han, Seung Hyeok; Lee, Kyu Beck; Lee, Joongyub; Oh, Kook Hwan; Chae, Dong Wan; Kim, Soo Wan

    2017-02-01

    This study examined the characteristics of biochemical parameters, bone diseases, and vascular calcification in Korean patients with chronic kidney disease (CKD) not yet on dialysis. Serum levels of fibroblast growth factor 23 (FGF23), intact parathyroid hormone (iPTH), 25-hydroxyvitamin D3 (25D), and 1,25-dihydroxyvitamin D3 (1,25D); lumbar spine, total hip, and femur neck bone mineral densities; and brachial-to-ankle pulse wave velocity (baPWV) representing vascular calcification were measured at baseline for 2,238 CKD patients in the KoreaN Cohort Study for Outcomes in Patients With CKD (KNOW-CKD). Increases in serum FGF23 and iPTH preceded changes in serum calcium and phosphate, similar to Western populations. However, the 25D and 1,25D levels decreased earlier than serum FGF23 or iPTH increased, with a decreased estimated glomerular filtration rate (eGFR) in Korean CKD patients. Vitamin D deficiency occurred in 76.7% of patients with CKD stage 1. Bone mineral densities were lowest in CKD stage 5 (lumbar spine, -0.64 ± 1.67; total hip, -0.49 ± 1.21; femur neck, -1.02 ± 1.25). Osteoporosis was more prevalent in patients with higher CKD stages. The mean baPWV, abdominal aortic calcification (AAC), and coronary calcium score also increased, with declined eGFR. In conclusion, a decline in serum vitamin D levels was observed in early CKD stages before significant increases of FGF23 and iPTH in the Korean CKD population compared with that in Western populations. Increased bone disease and vascular calcification occurred in early-stage CKD.

  19. Hypertension Awareness, Treatment, and Control in Adults With CKD: Results From the Chronic Renal Insufficiency Cohort (CRIC) Study

    Science.gov (United States)

    Muntner, Paul; Anderson, Amanda; Charleston, Jeanne; Chen, Zhen; Ford, Virginia; Makos, Gail; O’Connor, Andrew; Perumal, Kalyani; Rahman, Mahboob; Steigerwalt, Susan; Teal, Valerie; Townsend, Raymond; Weir, Matthew; Wright, Jackson T

    2010-01-01

    Background A low rate of blood pressure control has been reported among patients with chronic kidney disease (CKD). These data were derived from population-based samples with a low rate of CKD awareness. Study Design Cross-sectional Setting & Participants Data from the baseline visit of the Chronic Renal Insufficiency Cohort (CRIC) study (n=3612) were analyzed. Participants with an estimated glomerular filtration rate of 20 to 70 ml/min/1.73m2 were identified from physician offices and review of laboratory databases. Outcomes Prevalence and awareness of hypertension, treatment patterns, control rates and factors associated with hypertension control. Measurements Following a standardized protocol, blood pressure was measured three times by trained staff and hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg and/or self-reported antihypertensive medication use. Patients’ awareness and treatment of hypertension were defined using self-report and two levels of hypertension control were evaluated: systolic/diastolic blood pressure <140/90 mmHg and <130/80 mmHg. Results The prevalence of hypertension was 85.7%, and 98.9% of CRIC participants were aware of this diagnosis, 98.3% were treated with medications while 67.1% and 46.1% had their hypertension controlled to <140/90 mmHg and <130/80 mmHg, respectively. Of CRIC participants with hypertension, 15%, 25%, 26% and 32% were taking one, two, three and four or more antihypertensive medications, respectively. After multivariable adjustment, older patients, blacks, those with higher urinary albumin excretion were less likely while participants taking ACE-inhibitors and angiotensin receptor blockers were more likely to have controlled their hypertension to <140/90 mmHg and <130/80 mmHg. Limitations Data were derived from a single study visit. Conclusions Despite almost universal hypertension awareness and treatment in this cohort of patients with CKD, rates of

  20. The clinical the rapeutic effect of Chinese Caterpilar Fungus on treaing Chronic kidney disease(CKD3)%人工虫草治疗慢性肾脏病(CKD3期)的临床观察

    Institute of Scientific and Technical Information of China (English)

    孙健; 王胜蓝

    2014-01-01

    目的:探讨人工虫草(金水宝胶囊)治疗慢性肾脏病(CKD3期)的临床疗效。方法:将65例患者随机分为常规治疗组(对照组)和金水宝治疗组(治疗组),疗程8周,观察治疗前后肌酐清除率(Ccr)、血尿酸(UA)、低密度脂蛋白(LDL-C)、尿蛋白定量(Upr)。结果:金水宝治疗组Ccr、UA、LDL-C、Upr较常规治疗组都有下降(p<0.05).结论:人工虫草可减少尿蛋白排泄,调脂、降低血尿酸,改善肾功能。%To investigate the clinical effect of Chinese Caterpilar Fungus(Jin shui capsule) on treaing Chronic kidney disease(CKD3).Methods:adopt 65 copd patient is divided into the conventional treatment group (control group) and the Jin shui capsule treatment group (treatment group) at random. The course of treatment was 8 weeks. They were observed before and after treatment that were creatinine clearance rate (Ccr), blood uric acid (UA), low density lipoprotein (LDL-C), urinary protein ration (Upr).Resute:The Jin shui capsule treatment group Ccr, UA, LDL-C, Upr than the conventional treatment group are down (p<0.05).Conclusion:Chinese Caterpilar Fungus can decrease the excretion of urine protein, lipid, decreasing blood uric acid, renal function.

  1. Renoprotection and the Bardoxolone Methyl Story - Is This the Right Way Forward A Novel View of Renoprotection in CKD Trials: A New Classification Scheme for Renoprotective Agents

    Directory of Open Access Journals (Sweden)

    Macaulay Onuigbo

    2013-04-01

    Full Text Available In the June 2011 issue of the New England Journal of Medicine, the BEAM (Bardoxolone Methyl Treatment: Renal Function in CKD/Type 2 Diabetes trial investigators rekindled new interest and also some controversy regarding the concept of renoprotection and the role of renoprotective agents, when they reported significant increases in the mean estimated glomerular filtration rate (eGFR in diabetic chronic kidney disease (CKD patients with an eGFR of 20-45 ml/min/1.73 m2 of body surface area at enrollment who received the trial drug bardoxolone methyl versus placebo. Unfortunately, subsequent phase IIIb trials failed to show that the drug is a safe alternative renoprotective agent. Current renoprotection paradigms depend wholly and entirely on angiotensin blockade; however, these agents [angiotensin converting enzyme (ACE inhibitors and angiotensin receptor blockers (ARBs] have proved to be imperfect renoprotective agents. In this review, we examine the mechanistic limitations of the various previous randomized controlled trials on CKD renoprotection, including the paucity of veritable, elaborate and systematic assessment methods for the documentation and reporting of individual patient-level, drug-related adverse events. We review the evidence base for the presence of putative, multiple independent and unrelated pathogenetic mechanisms that drive (diabetic and non-diabetic CKD progression. Furthermore, we examine the validity, or lack thereof, of the hyped notion that the blockade of a single molecule (angiotensin II, which can only antagonize the angiotensin cascade, would veritably successfully, consistently and unfailingly deliver adequate and qualitative renoprotection results in (diabetic and non-diabetic CKD patients. We clearly posit that there is this overarching impetus to arrive at the inference that multiple, disparately diverse and independent pathways, including any veritable combination of the mechanisms that we examine in this review

  2. Effects of different phosphate lowering strategies in patients with CKD on laboratory outcomes: A systematic review and NMA

    Science.gov (United States)

    Angeliki Veroniki, Argie; Thabane, Lehana; Busse, Jason W.; Akhtar-Danesh, Noori; Iorio, Alfonso; Cruz Lopes, Luciane; Guyatt, Gordon H.

    2017-01-01

    Background Chronic kidney disease-mineral and bone disorder (CKD-MBD), a complication of chronic kidney disease, has been linked to reduced quality and length of life. High serum phosphate levels that result from CKD-MBD require phosphate-lowering agents, also known as phosphate binders. The objective of this systematic review is to compare the effects of available phosphate binders on laboratory outcomes in patients with CKD-MBD. Methods Data sources included MEDLINE and EMBASE from January 1996 to April 2016, and the Cochrane Register of Controlled Trials up to April 2016. Teams of two reviewers, independently and in duplicate, screened titles and abstracts and potentially eligible full text reports to determine eligibility, and subsequently abstracted data and assessed risk of bias in eligible randomized controlled trials (RCTs). Eligible trials enrolled patients with CKD-MBD and randomized them to receive calcium-based phosphate binders (delivered as calcium acetate, calcium citrate or calcium carbonate), non-calcium-based phosphate binders (NCBPB) (sevelamer hydrochloride, sevelamer carbonate, lanthanum carbonate, sucroferric oxyhydroxide and ferric citrate), phosphorus restricted diet (diet), placebo or no treatment and reported effects on serum levels of phosphate, calcium and parathyroid hormone. We performed Bayesian network meta-analyses (NMA) to calculate the effect estimates (mean differences) and 95% credible intervals for serum levels of phosphate, calcium and parathyroid hormone. We calculated direct, indirect and network meta-analysis estimates using random-effects models. We applied the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach to rate the quality of evidence for each pairwise comparison. Results Our search yielded 1108 citations; 71 RCTs were retrieved for full review and 16 proved eligible. Including an additional 13 studies from a previous review, 29 studies that enrolled 8335 participants proved

  3. Cost-benefit analysis of supplemented very low-protein diet versus dialysis in elderly CKD5 patients.

    Science.gov (United States)

    Scalone, Luciana; Borghetti, Francesca; Brunori, Giuliano; Viola, Battista Fabio; Brancati, Barbara; Sottini, Laura; Mantovani, Lorenzo Giovanni; Cancarini, Giovanni

    2010-03-01

    Dialysis increases patient life expectancy but is associated with clinically severe and costly complications. Health and economic benefits could derive from postponing dialysis with a supplemented very low-protein diet (sVLPD). An economic evaluation was conducted to compare benefits and costs of sVLPD versus dialysis in elderly CKD5 patients. Data from 57 patients aged >or=70 years, with glomerular filtration rate (GFR) 5-7 mL/min, previously participating in a clinical trial demonstrating non-inferior mortality and morbidity of starting sVLPD compared to dialysis treatment, were analysed: 30 patients were randomized to dialysis and 27 to sVLPD. A cost-benefit analysis was conducted, in the perspective of the National Health Service (NHS). Direct medical and non-medical benefits and costs occurring in 3.2 mean years of follow-up were quantified: time free from dialysis, cost of dialysis treatment, hospitalization, drugs, laboratory/instrumental tests, medical visits and travel and energy consumption to receive dialysis. Prices/tariffs valid in 2007 were used, with an annual discount rate of 5% applied to benefits and costs occurring after the first year. Sensitivity analyses were conducted to identify how estimates could vary in different contexts of applications. Results are reported as net benefit, expressed as mean euro/patient (patient-year). The opportunity to safely postpone initiation of dialysis of 1 year/patient on average translated into an economic benefit to the NHS, corresponding to 21 180 euro/patient in the first, 6500 euro/patient in the second and 682 euro/patient in the third year of treatment, with a significant net benefit in favour of sVLPD even in a worst-case hypothesis. The initiation of sVLPD in elderly CKD5 subjects is a safe and beneficial strategy for these patients and allows them to gain economic resources that can be allocated to further health care investments.

  4. Healthy Dietary Patterns and Risk of Mortality and ESRD in CKD: A Meta-Analysis of Cohort Studies.

    Science.gov (United States)

    Kelly, Jaimon T; Palmer, Suetonia C; Wai, Shu Ning; Ruospo, Marinella; Carrero, Juan-Jesus; Campbell, Katrina L; Strippoli, Giovanni F M

    2017-02-07

    Patients with CKD are advised to follow dietary recommendations that restrict individual nutrients. Emerging evidence indicates overall eating patterns may better predict clinical outcomes, however, current data on dietary patterns in kidney disease are limited. This systematic review aimed to evaluate the association between dietary patterns and mortality or ESRD among adults with CKD. Medline, Embase, and reference lists were systematically searched up to November 24, 2015 by two independent review authors. Eligible studies were longitudinal cohort studies reporting the association of dietary patterns with mortality, cardiovascular events, or ESRD. A total of seven studies involving 15,285 participants were included. Healthy dietary patterns were generally higher in fruit and vegetables, fish, legumes, cereals, whole grains, and fiber, and lower in red meat, salt, and refined sugars. In six studies, healthy dietary patterns were consistently associated with lower mortality (3983 events; adjusted relative risk, 0.73; 95% confidence interval, 0.63 to 0.83; risk difference of 46 fewer (29-63 fewer) events per 1000 people over 5 years). There was no statistically significant association between healthy dietary patterns and risk of ESRD (1027 events; adjusted relative risk, 1.04; 95% confidence interval, 0.68 to 1.40). Healthy dietary patterns are associated with lower mortality in people with kidney disease. Interventions to support adherence to increased fruit and vegetable, fish, legume, whole grain, and fiber intake, and reduced red meat, sodium, and refined sugar intake could be effective tools to lower mortality in people with kidney disease. Copyright © 2017 by the American Society of Nephrology.

  5. Association of CKD-MBD Markers with All-Cause Mortality in Prevalent Hemodialysis Patients: A Cohort Study in Beijing

    Science.gov (United States)

    Li, Duo; Zhang, Ling; Zuo, Li; Jin, Cheng Gang; Li, Wen Ge; Chen, Jin-Bor

    2017-01-01

    The relationships between all-cause mortality and serum intact parathyroid hormone (iPTH), calcium, and phosphate are fairly diverse in patients on maintenance hemodialysis according to prior studies. This study evaluated the association of chronic kidney disease-mineral and bone disorder (CKD-MBD) markers with all-cause mortality in prevalent hemodialysis patients from 2007 to 2012 in Beijing, China. A cohort, involving 8530 prevalent hemodialysis patients who had undergone a 6–70 months follow-up program (with median as 40 months) was formed. Related data was recorded from the database in 120 hemodialysis centers of Beijing Health Bureau (2007 to 2012). Information regarding baseline demographics, blood CKD-MBD markers and all-cause mortality was retrospectively reviewed. By using multivariate Cox regression model analysis, patients with a low iPTH level at baseline were found to have greater risk of mortality (<75pg/ml, HR = 1.36, 95% confidence interval (CI) 1.16–1.60) than those with a baseline iPTH level within 150–300 pg/ml. Similarly, death risk showed an increase when the baseline serum calcium presented a low level (<2.1mmol/L, HR = 1.54; 95% CI 1.37–1.74). Levels of baseline serum phosphorus were not associated with the risk of death. Similar results appeared through the baseline competing risks regression analysis. Patients with a lower level of serum iPTH or calcium are at a higher risk of all-cause mortality compared with those within the range recommended by Kidney Disease Outcome Quality Initiative (KDOQI) guidelines. PMID:28045985

  6. Cost-effectiveness of Simvastatin plus Ezetimibe for Cardiovascular Prevention in CKD : Results of the Study of Heart and Renal Protection (SHARP)

    NARCIS (Netherlands)

    Mihaylova, Borislava; Schlackow, Iryna; Herrington, William; Lozano-Kuehne, Jingky; Kent, Seamus; Emberson, Jonathan; Reith, Christina; Haynes, Richard; Cass, Alan; Craig, Jonathan; Gray, Alastair; Collins, Rory; Landray, Martin J.; Baigent, Colin; de Zeeuw, Dick

    2016-01-01

    Background Simvastatin, 20 mg, plus ezetimibe, 10 mg, daily (simvastatin plus ezetimibe) reduced major atherosclerotic events in patients with moderate to severe chronic kidney disease (CKD) in the Study of Heart and Renal Protection (SHARP), but its cost-effectiveness is unknown. Study Design Cost-

  7. Changes in fat mass correlate with changes in soluble sCD163, a marker of mature macrophages, in patients with CKD

    DEFF Research Database (Denmark)

    Axelsson, Jonas; Møller, Holger Jon; Witasp, Anna

    2006-01-01

    BACKGROUND: Recently, adipose tissue was shown to contain macrophages capable of contributing to systemic inflammation and cardiovascular disease (CVD). Here, we investigate this putative relationship in patients with chronic kidney disease (CKD) by using the novel macrophage marker soluble (s)CD...

  8. Designing a web-application to support home-based care of childhood CKD stages 3-5: qualitative study of family and professional preferences.

    Science.gov (United States)

    Swallow, Veronica M; Hall, Andrew G; Carolan, Ian; Santacroce, Sheila; Webb, Nicholas J A; Smith, Trish; Hanif, Noreen

    2014-02-18

    There is a lack of online, evidence-based information and resources to support home-based care of childhood CKD stages 3-5. Qualitative interviews were undertaken with parents, patients and professionals to explore their views on content of the proposed online parent information and support (OPIS) web-application. Data were analysed using Framework Analysis, guided by the concept of Self-efficacy. 32 parents, 26 patients and 12 professionals were interviewed. All groups wanted an application that explains, demonstrates, and enables parental clinical care-giving, with condition-specific, continously available, reliable, accessible material and a closed communication system to enable contact between families living with CKD. Professionals advocated a regularly updated application to empower parents to make informed health-care decisions. To address these requirements, key web-application components were defined as: (i) Clinical care-giving support (information on treatment regimens, video-learning tools, condition-specific cartoons/puzzles, and a question and answer area) and (ii) Psychosocial support for care-giving (social-networking, case studies, managing stress, and enhancing families' health-care experiences). Developing a web-application that meets parents' information and support needs will maximise its utility, thereby augmenting parents' self-efficacy for CKD caregiving, and optimising outcomes. Self-efficacy theory provides a schema for how parents' self-efficacy beliefs about management of their child's CKD could potentially be promoted by OPIS.

  9. Cost-effectiveness of Simvastatin plus Ezetimibe for Cardiovascular Prevention in CKD : Results of the Study of Heart and Renal Protection (SHARP)

    NARCIS (Netherlands)

    Mihaylova, Borislava; Schlackow, Iryna; Herrington, William; Lozano-Kuehne, Jingky; Kent, Seamus; Emberson, Jonathan; Reith, Christina; Haynes, Richard; Cass, Alan; Craig, Jonathan; Gray, Alastair; Collins, Rory; Landray, Martin J.; Baigent, Colin; de Zeeuw, Dick

    Background Simvastatin, 20 mg, plus ezetimibe, 10 mg, daily (simvastatin plus ezetimibe) reduced major atherosclerotic events in patients with moderate to severe chronic kidney disease (CKD) in the Study of Heart and Renal Protection (SHARP), but its cost-effectiveness is unknown. Study Design

  10. Arterial aging and arterial disease : interplay between central hemodynamics, cardiac work, and organ flow-implications for CKD and cardiovascular disease

    NARCIS (Netherlands)

    London, Gerard; Covic, Adrian; Goldsmith, David; Wiecek, Andrzej; Suleymanlar, Gultekin; Ortiz, Alberto; Massy, Ziad; Lindholm, Bengt; Martinez-Castelao, Alberto; Fliser, Danilo; Agarwal, Rajiv; Jager, Kitty J.; Dekker, Friedo W.; Blankestijn, Peter J.; Zoccali, Carmine

    2011-01-01

    Cardiovascular disease is an important cause of morbidity and mortality in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). All epidemiological studies have clearly shown that accelerated arterial and cardiac aging is characteristic of these populations. Arterial premat

  11. The effect of magnesium supplementation on vascular calcification in chronic kidney disease-a randomised clinical trial (MAGiCAL-CKD)

    DEFF Research Database (Denmark)

    Bressendorff, Iain; Hansen, Ditte; Schou, Morten

    2017-01-01

    INTRODUCTION: Chronic kidney disease (CKD) is associated with an increased risk of cardiovascular disease and mortality, which is thought to be caused by increased propensity towards vascular calcification (VC). Magnesium (Mg) inhibits phosphate-induced VC in vitro and in animal models and serum ...

  12. Performance of the Cockcroft-Gault, MDRD, and New CKD-EPI Formulas in Relation to GFR, Age, and Body Size

    NARCIS (Netherlands)

    W.M. Michels; D.C. Grootendorst; M. Verduijn; E.G. Elliott; F.W. Dekker; R.T. Krediet

    2010-01-01

    Background and objectives: We compared the estimations of Cockcroft-Gault, Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations to a gold standard GFR measurement using I-125-iothalamate, within strata of GFR, gender, age, body weigh

  13. Development of a LC-MS/MS method for the determination of CKD-712 in rat plasma: Application to a pharmacokinetic study in rats.

    Science.gov (United States)

    Chae, Jung-Woo; Yun, Hwi-Yeol; Eom, Han Young; Jeong, Eun Ju; Koo, Tae-Sung; Kwon, Kwang-Il; Lee, Jong-Hwa

    2017-09-01

    CKD-712 is a potential treatment for sepsis, as it exhibits protective effects against lipopolysaccharide-mediated platelet aggregation, inducible nitric oxide synthase expression, and cecum-ligation puncture-induced septic mortality in mice. In this study, we develop a rapid and sensitive LC-MS/MS method for determining CKD-712 in rat plasma. CKD-712 and papaverine hydrochloride (an internal standard) were analyzed using an LC-MS/MS system consisting of an Agilent HPLC system (HP-1100) equipped with an Atlantis HILIC Silica (2.1×50mm, 3μm) column and a API 4000 (Applied Biosystems/MDS Sciex, USA) in a positive ESI mode. We utilized multiple reaction monitoring (MRM) at m/z transitions of 306.2-164.0 to analyze CKD-712, and 340.3-202.1 m/z for IS, with a mobile phase of acetonitrile (0.025% trifluoroacetic acid):20mM ammonium acetate (94:6, v/v) at a flow rate of 0.25mL/min. The lower limit of quantification (LLOQ) was 5ng/mL, with a linearity ranging from 5 to 1000ng/mL (r>0.999). Validation parameters including specificity, precision, accuracy, matrix effect, recovery, dilution effect and stability results were well within acceptance criteria, and applied successfully on a pharmacokinetic study in rats. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. 氯沙坦对伴血尿酸升高的早期 CKD 大鼠心脏病变影响%The influence of losartan on heart disease of early CKD rats with elevated serum uric acid

    Institute of Scientific and Technical Information of China (English)

    魏翠芳

    2015-01-01

    Objective To observe the influence of losartan on heart disease of early chronic kidney disease ( CKD) rats with elevated serum uric acid ( SUA) and explore the possible mechanism .Methods The experimental rats were divided into group A (sham operation group),group B ( CKD group),group C ( CKD with elevated SUA group,CKD+OXO),group D (CKD with elevated SUA,CKD+OXO+losartan),each of 15 cases.Prepared the male early CKD SD rats with elevated SUA model by right kidney resection and OXO continuous irrigation stomach method ,the dose of OXO was 800 mg/kg/time,2 times/d.The dose of losartan in group D was 20mg/kg/time,1 time/d.All the the rats were killed after 16 weeks.The serum creatinine (Scr),SUA,oxidized low density lipoprotein (ox LDL) and superoxide dismutase (SOD) were detected.The renal pathologic changes were observed by HE and PAS staining ,and the HE staining was used to observe cardiac pathological chan-ges too.The expression of myocardial collagen type I ( ColI) was determinated by immunohistochemical method .Results (1) There were no significant different of Scr between 4 groups.The SUA of group C was higher than that of the other 3 groups. Compared with group A,the other 3 groups had only mild mesangial proliferation in HE、PAS staining of the renal tissue.(2) There was no obvious morphological change in the HE staining of heart in group A ,and there was small amount deposition of myocardial ColI .In group B,a small amount of scattered inflammatory cells was between the myocardial cells .The deposition of myocardial ColI increased a little .A large number of inflammatory cells were infiltrated in group C ,and interstitial hyperemia , fibrosis;the fibroblast appeared in the wall of small vessels;The deposition of myocardial ColI increased significantly .The le-sions of Group D were similar to group C ,But the degree of lesion significantly reduced ,only a small amount of inflammatory cell infiltration ,occasionally seen inflammatory cells in the vascular

  15. Results of low-dose human atrial natriuretic peptide infusion in nondialysis patients with chronic kidney disease undergoing coronary artery bypass grafting: the NU-HIT (Nihon University working group study of low-dose HANP Infusion Therapy during cardiac surgery) trial for CKD

    National Research Council Canada - National Science Library

    Sezai, Akira; Hata, Mitsumasa; Niino, Tetsuya; Yoshitake, Isamu; Unosawa, Satoshi; Wakui, Shinji; Kimura, Haruka; Shiono, Motomi; Takayama, Tadateru; Hirayama, Atsushi

    2011-01-01

    ...). CKD is an important risk factor for cardiac surgery. This was a randomized controlled study of 303 patients with CKD who underwent CABG, and were divided into a group who received carperitide infusion and another group without carperitide...

  16. Baseline Cardiovascular Characteristics of Adult Patients with Chronic Kidney Disease from the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD).

    Science.gov (United States)

    Kim, Hyoungnae; Yoo, Tae Hyun; Choi, Kyu Hun; Oh, Kook Hwan; Lee, Joongyub; Kim, Soo Wan; Kim, Tae Hee; Sung, Suah; Han, Seung Hyeok

    2017-02-01

    Cardiovascular disease (CVD) is the most common cause of death in patients with chronic kidney disease (CKD). We report the baseline cardiovascular characteristics of 2,238 participants by using the data of the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD) study. The cohort comprises 5 subcohorts according to the cause of CKD: glomerulonephritis (GN), diabetic nephropathy (DN), hypertensive nephropathy (HTN), polycystic kidney disease (PKD), and unclassified. The average estimated glomerular filtration rate (eGFR) was 50.5 ± 30.3 mL/min⁻¹/1.73 m⁻² and lowest in the DN subcohort. The overall prevalence of previous CVD was 14.4% in all patients, and was highest in the DN followed by that in the HTN subcohort. The DN subcohort had more adverse cardiovascular risk profiles (higher systolic blood pressure [SBP], and higher levels of cardiac troponin T, left ventricular mass index [LVMI], coronary calcium score, and brachial-ankle pulse wave velocity [baPWV]) than the other subcohorts. The HTN subcohort exhibited less severe cardiovascular risk profiles than the DN subcohort, but had more severe cardiovascular risk features than the GN and PKD subcohorts. All these cardiovascular risk profiles were inversely correlated with eGFR. In conclusion, this study shows that the KNOW-CKD cohort exhibits high cardiovascular burden, as other CKD cohorts in previous studies. Among the subcohorts, the DN subcohort had the highest risk for CVD. The ongoing long-term follow-up study up to 10 years will further delineate cardiovascular characteristics and outcomes of each subcohort exposed to different risk profiles.

  17. Comparing Results of Five Glomerular Filtration Rate-Estimating Equations in the Korean General Population: MDRD Study, Revised Lund-Malmö, and Three CKD-EPI Equations

    Science.gov (United States)

    Ji, Misuk; Lee, Yoon-Hee; Kim, Hyesun; Cho, Han-Ik; Yang, Hyun Suk; Navarin, Silvia; Di Somma, Salvatore

    2016-01-01

    Background Estimated glomerular filtration rate (eGFR) is a widely used index of kidney function. Recently, new formulas such as the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations or the Lund-Malmö equation were introduced for assessing eGFR. We compared them with the Modification of Diet in Renal Disease (MDRD) Study equation in the Korean adult population. Methods The study population comprised 1,482 individuals (median age 51 [42-59] yr, 48.9% males) who received annual physical check-ups during the year 2014. Serum creatinine (Cr) and cystatin C (CysC) were measured. We conducted a retrospective analysis using five GFR estimating equations (MDRD Study, revised Lund-Malmö, and Cr and/or CysC-based CKD-EPI equations). Reduced GFR was defined as eGFR <60 mL/min/1.73 m2. Results For the GFR category distribution, large discrepancies were observed depending on the equation used; category G1 (≥90 mL/min/1.73 m2) ranged from 7.4-81.8%. Compared with the MDRD Study equation, the other four equations overestimated GFR, and CysC-based equations showed a greater difference (-31.3 for CKD-EPICysC and -20.5 for CKD-EPICr-CysC). CysC-based equations decreased the prevalence of reduced GFR by one third (9.4% in the MDRD Study and 2.4% in CKD-EPICysC). Conclusions Our data shows that there are remarkable differences in eGFR assessment in the Korean population depending on the equation used, especially in normal or mildly decreased categories. Further prospective studies are necessary in various clinical settings. PMID:27578504

  18. Hydro-epidemiology of Chronic Kidney Disease(CKD) in Sri Lanka and Its Similarities to the CKD Epidemic in Meso-America.Sarath Gunatilake M.D, Dr. P.H, Professor, California State University, Long Beach California

    Science.gov (United States)

    Illangasekera, T.; Gunatilake, S.

    2015-12-01

    Over 2000 years ago Sri Lanka was known as the granary of the east. This distinction was achieved with a massive rice production aided by an efficient irrigation system. The basic structural unit of this irrigation system -with thousands of man-made lakes- was a large reservoir collecting rain water from tributaries and redistributing it to a cascade of rice paddy farms. The rice cultivation used organic fertilizer and natural pesticides made from ancient Ayurvedic recipes. The sociopolitical changes initiated in the county in 1977 resulted in a modernized agricultural economy with the renovation of the old irrigation system. Heavy use of pesticides, mostly Glyphosate (brand name "Round Up") with government subsidized cheap synthetic fertilizer (mostly triple phosphate) contaminated with heavy metals, including Arsenic and Cadmium, became a common practice. As a result, the shallow aquifers in the lowest lying areas, recharged by the irrigation water, was contaminated with Calcium, Magnesium phosphates, and the heavy metals, rendering the drinking water from shallow wells in these areas, extremely hard and unpalatable. The practice of drinking water from the shallow wells in low lying areas, most of which are abandoned now, and the use and spraying of pesticides particularly Glyphosate (often without proper personal protective equipment) have been identified in a case control study, as the main risk factors responsible for a massive epidemic of Chronic Kidney Disease (CKD) affecting 450,000 young farmers, resulting in 23,000 deaths. It is hypothesized that the Glyphosate chelates heavy metals delivering it to the kidney, with contaminated drinking water and food, causing progressive kidney damage. The same irrigation system that contributed to past prosperity has now become a scourge within the realm of a modernized agriculture. Climatic variations, global warming and severe dehydration also have been identified as contributory factors. Similar CKD epidemic killing

  19. The transmission coefficient distribution of highly scattering sparse random media

    OpenAIRE

    Jin, Curtis; Nadakuditi, Raj Rao; Michielssen, Eric

    2015-01-01

    We consider the distribution of the transmission coefficients, i.e. the singular values of the modal transmission matrix, for 2D random media with periodic boundary conditions composed of a large number of point-like non-absorbing scatterers. The scatterers are placed at random locations in the medium and have random refractive indices that are drawn from an arbitrary, known distribution. We construct a randomized model for the scattering matrix that retains scatterer dependent properties ess...

  20. Cost-effectiveness of Simvastatin plus Ezetimibe for Cardiovascular Prevention in CKD: Results of the Study of Heart and Renal Protection (SHARP)

    Science.gov (United States)

    Mihaylova, Borislava; Schlackow, Iryna; Herrington, William; Lozano-Kühne, Jingky; Kent, Seamus; Emberson, Jonathan; Reith, Christina; Haynes, Richard; Cass, Alan; Craig, Jonathan; Gray, Alastair; Collins, Rory; Landray, Martin J.; Baigent, Colin; Collins, R.; Baigent, C.; Landray, M.J.; Bray, C.; Chen, Y.; Baxter, A.; Young, A.; Hill, M.; Knott, C.; Cass, A.; Feldt-Rasmussen, B.; Fellström, B.; Grobbee, D.E.; Grönhagen-Riska, C.; Haas, M.; Holdaas, H.; Hooi, L.S.; Jiang, L.; Kasiske, B.; Krairittichai, U.; Levin, A.; Massy, Z.A.; Tesar, V.; Walker, R.; Wanner, C.; Wheeler, D.C.; Wiecek, A.; Dasgupta, T.; Herrington, W.; Lewis, D.; Mafham, M.; Majoni, W.; Reith, C.; Emberson, J.; Parish, S.; Simpson, D.; Strony, J.; Musliner, T.; Agodoa, L.; Armitage, J.; Chen, Z.; Craig, J.; de Zeeuw, D.; Gaziano, J.M.; Grimm, R.; Krane, V.; Neal, B.; Ophascharoensuk, V.; Pedersen, T.; Sleight, P.; Tobert, J.; Tomson, C.

    2016-01-01

    Background Simvastatin, 20 mg, plus ezetimibe, 10 mg, daily (simvastatin plus ezetimibe) reduced major atherosclerotic events in patients with moderate to severe chronic kidney disease (CKD) in the Study of Heart and Renal Protection (SHARP), but its cost-effectiveness is unknown. Study Design Cost-effectiveness of simvastatin plus ezetimibe in SHARP, a randomized controlled trial. Setting & Population 9,270 patients with CKD randomly assigned to simvastatin plus ezetimibe versus placebo; participants in categories by 5-year cardiovascular risk (low, plus ezetimibe (2015 UK £1.19 per day) during 4.9 years’ median follow-up in SHARP; scenario analyses with high-intensity statin regimens (2015 UK £0.05-£1.06 per day). Outcomes Additional health care costs per major atherosclerotic event avoided and per quality-adjusted life-year (QALY) gained. Results In SHARP, the proportional reductions per 1 mmol/L of low-density lipoprotein (LDL) cholesterol reduction with simvastatin plus ezetimibe in all major atherosclerotic events of 20% (95% CI, 6%-32%) and in the costs of vascular hospital episodes of 17% (95% CI, 4%-28%) were similar across participant categories by cardiovascular risk and CKD stage. The 5-year reduction in major atherosclerotic events per 1,000 participants ranged from 10 in low-risk to 58 in high-risk patients and from 28 in CKD stage 3 to 36 in patients on dialysis therapy. The net cost per major atherosclerotic event avoided with simvastatin plus ezetimibe compared to no LDL-lowering regimen ranged from £157,060 in patients at low risk to £15,230 in those at high risk (£30,500-£39,600 per QALY); and from £47,280 in CKD stage 3 to £28,180 in patients on dialysis therapy (£13,000-£43,300 per QALY). In scenario analyses, generic high-intensity statin regimens were estimated to yield similar benefits at substantially lower cost. Limitations High-intensity statin-alone regimens were not studied in SHARP. Conclusions Simvastatin plus

  1. Cost-effectiveness of Simvastatin plus Ezetimibe for Cardiovascular Prevention in CKD: Results of the Study of Heart and Renal Protection (SHARP).

    Science.gov (United States)

    Mihaylova, Borislava; Schlackow, Iryna; Herrington, William; Lozano-Kühne, Jingky; Kent, Seamus; Emberson, Jonathan; Reith, Christina; Haynes, Richard; Cass, Alan; Craig, Jonathan; Gray, Alastair; Collins, Rory; Landray, Martin J; Baigent, Colin

    2016-04-01

    Simvastatin, 20mg, plus ezetimibe, 10mg, daily (simvastatin plus ezetimibe) reduced major atherosclerotic events in patients with moderate to severe chronic kidney disease (CKD) in the Study of Heart and Renal Protection (SHARP), but its cost-effectiveness is unknown. Cost-effectiveness of simvastatin plus ezetimibe in SHARP, a randomized controlled trial. 9,270 patients with CKD randomly assigned to simvastatin plus ezetimibe versus placebo; participants in categories by 5-year cardiovascular risk (low, plus ezetimibe (2015 UK £1.19 per day) during 4.9 years' median follow-up in SHARP; scenario analyses with high-intensity statin regimens (2015 UK £0.05-£1.06 per day). Additional health care costs per major atherosclerotic event avoided and per quality-adjusted life-year (QALY) gained. In SHARP, the proportional reductions per 1mmol/L of low-density lipoprotein (LDL) cholesterol reduction with simvastatin plus ezetimibe in all major atherosclerotic events of 20% (95% CI, 6%-32%) and in the costs of vascular hospital episodes of 17% (95% CI, 4%-28%) were similar across participant categories by cardiovascular risk and CKD stage. The 5-year reduction in major atherosclerotic events per 1,000 participants ranged from 10 in low-risk to 58 in high-risk patients and from 28 in CKD stage 3 to 36 in patients on dialysis therapy. The net cost per major atherosclerotic event avoided with simvastatin plus ezetimibe compared to no LDL-lowering regimen ranged from £157,060 in patients at low risk to £15,230 in those at high risk (£30,500-£39,600 per QALY); and from £47,280 in CKD stage 3 to £28,180 in patients on dialysis therapy (£13,000-£43,300 per QALY). In scenario analyses, generic high-intensity statin regimens were estimated to yield similar benefits at substantially lower cost. High-intensity statin-alone regimens were not studied in SHARP. Simvastatin plus ezetimibe prevented atherosclerotic events in SHARP, but other less costly statin regimens are

  2. Cinacalcet HCl prevents development of parathyroid gland hyperplasia and reverses established parathyroid gland hyperplasia in a rodent model of CKD.

    Science.gov (United States)

    Miller, Gerald; Davis, James; Shatzen, Edward; Colloton, Matthew; Martin, David; Henley, Charles M

    2012-06-01

    Secondary hyperparathyroidism (sHPT) represents an adaptive response to progressively impaired control of calcium, phosphorus and vitamin D in chronic kidney disease (CKD). It is characterized by parathyroid hyperplasia and excessive synthesis and secretion of parathyroid hormone (PTH). Parathyroid hyperplasia in uremic rats can be prevented by calcium-sensing receptor (CaSR) activation with the calcimimetic cinacalcet (Sensipar®/Mimpara®); however, it is unknown, how long the effects of cinacalcet persist after withdrawal of treatment or if cinacalcet is efficacious in uremic rats with established sHPT. We sought to determine the effect of cinacalcet discontinuation in uremic rats and whether cinacalcet was capable of influencing parathyroid hyperplasia in animals with established sHPT. Discontinuation of cinacalcet resulted in reversal of the beneficial effects on serum PTH and parathyroid hyperplasia. In rats with established sHPT, cinacalcet decreased serum PTH and mediated regression of parathyroid hyperplasia. The cinacalcet-mediated decrease in parathyroid gland size was accompanied by increased expression of the cyclin-dependent kinase inhibitor p21. Prevention of cellular proliferation with cinacalcet occurred despite increased serum phosphorus and decreased serum calcium. The animal data provided suggest established parathyroid hyperplasia can be reversed by modulating CaSR activity with cinacalcet and that continued treatment may be necessary to maintain reductions in PTH.

  3. KDOQI US Commentary on the 2012 KDIGO Clinical Practice Guideline for Management of Blood Pressure in CKD

    Science.gov (United States)

    Taler, Sandra J.; Agarwal, Rajiv; Bakris, George L.; Flynn, Joseph T.; Nilsson, Peter M.; Rahman, Mahboob; Sanders, Paul W.; Textor, Stephen C.; Weir, Matthew R.; Townsend, Raymond R.

    2014-01-01

    In response to the 2012 KDIGO (Kidney Disease: Improving Global Outcomes) guideline for blood pressure management in patients with chronic kidney disease not on dialysis, the National Kidney Foundation organized a group of US experts in hypertension and transplant nephrology to review the recommendations and comment on their relevancy in the context of current US clinical practice and concerns. The overriding message was the dearth of clinical trial evidence to provide strong evidence-based recommendations. For patients with CKD with normal to mildly increased albuminuria, goal blood pressure has been relaxed to ≤140/90 mm Hg for both diabetic and nondiabetic patients. In contrast, KDIGO continues to recommend goal blood pressure ≤130/80 mm Hg for patients with chronic kidney disease with moderately or severely increased albuminuria and for all renal transplant recipients regardless of the presence of proteinuria, without supporting data. The expert panel thought the KDIGO recommendations were generally reasonable but lacking in sufficient evidence support and that additional studies are greatly needed. PMID:23684145

  4. Cinacalcet HCl prevents development of parathyroid gland hyperplasia and reverses established parathyroid gland hyperplasia in a rodent model of CKD

    Science.gov (United States)

    Miller, Gerald; Davis, James; Shatzen, Edward; Colloton, Matthew; Martin, David

    2012-01-01

    Background. Secondary hyperparathyroidism (sHPT) represents an adaptive response to progressively impaired control of calcium, phosphorus and vitamin D in chronic kidney disease (CKD). It is characterized by parathyroid hyperplasia and excessive synthesis and secretion of parathyroid hormone (PTH). Parathyroid hyperplasia in uremic rats can be prevented by calcium-sensing receptor (CaSR) activation with the calcimimetic cinacalcet (Sensipar®/Mimpara®); however, it is unknown, how long the effects of cinacalcet persist after withdrawal of treatment or if cinacalcet is efficacious in uremic rats with established sHPT. Methods. We sought to determine the effect of cinacalcet discontinuation in uremic rats and whether cinacalcet was capable of influencing parathyroid hyperplasia in animals with established sHPT. Results. Discontinuation of cinacalcet resulted in reversal of the beneficial effects on serum PTH and parathyroid hyperplasia. In rats with established sHPT, cinacalcet decreased serum PTH and mediated regression of parathyroid hyperplasia. The cinacalcet-mediated decrease in parathyroid gland size was accompanied by increased expression of the cyclin-dependent kinase inhibitor p21. Prevention of cellular proliferation with cinacalcet occurred despite increased serum phosphorus and decreased serum calcium. Conclusions. The animal data provided suggest established parathyroid hyperplasia can be reversed by modulating CaSR activity with cinacalcet and that continued treatment may be necessary to maintain reductions in PTH. PMID:22036941

  5. Comparison of the Schwartz and CKD-EPI Equations for Estimating Glomerular Filtration Rate in Children, Adolescents, and Adults: A Retrospective Cross-Sectional Study.

    Science.gov (United States)

    Selistre, Luciano; Rabilloud, Muriel; Cochat, Pierre; de Souza, Vandréa; Iwaz, Jean; Lemoine, Sandrine; Beyerle, Françoise; Poli-de-Figueiredo, Carlos E; Dubourg, Laurence

    2016-03-01

    Estimating kidney glomerular filtration rate (GFR) is of utmost importance in many clinical conditions. However, very few studies have evaluated the performance of GFR estimating equations over all ages and degrees of kidney impairment. We evaluated the reliability of two major equations for GFR estimation, the CKD-EPI and Schwartz equations, with urinary clearance of inulin as gold standard. The study included 10,610 participants referred to the Renal and Metabolic Function Exploration Unit of Edouard Herriot Hospital (Lyon, France). GFR was measured by urinary inulin clearance (only first measurement kept for analysis) then estimated with isotope dilution mass spectrometry (IDMS)-traceable CKD-EPI and Schwartz equations. The participants' ages ranged from 3 to 90 y, and the measured GFRs from 3 to 160 ml/min/1.73 m2. A linear mixed-effects model was used to model the bias (mean ratio of estimated GFR to measured GFR). Equation reliability was also assessed using precision (interquartile range [IQR] of the ratio) and accuracy (percentage of estimated GFRs within the 10% [P10] and 30% [P30] limits above and below the measured GFR). In the whole sample, the mean ratio with the CKD-EPI equation was significantly higher than that with the Schwartz equation (1.17 [95% CI 1.16; 1.18] versus 1.08 [95% CI 1.07; 1.09], p Schwartz equation were closer to 1 than the mean ratios with the CKD-EPI equation whatever the age class (1.02 [95% CI 1.01; 1.03] versus 1.15 [95% CI 1.13; 1.16], p Schwartz equation had a better precision and was also more accurate than the CKD-EPI equation at GFR values under 60 ml/min/1.73 m2 (IQR: 0.32 [95% CI 0.28; 0.33] versus 0.40 [95% CI 0.36; 0.44]; P30: 81.4 [95% CI 78.1; 84.7] versus 63.8 [95% CI 59.7; 68.0]) and also at GFR values of 60-89 ml/min/1.73 m2. In all patients aged ≥65 y, the CKD-EPI equation performed better than the Schwartz equation (IQR: 0.33 [95% CI 0.31; 0.34] versus 0.40 [95% CI 0.38; 0.41]; P30: 77.6 [95% CI 75.7; 79

  6. Carboplatin dose calculation in lung cancer patients with low serum creatinine concentrations using CKD-EPI and Cockcroft-Gault with different weight descriptors.

    Science.gov (United States)

    Kaag, Dieter

    2013-01-01

    Carboplatin dosing using the Calvert and Cockcroft-Gault formulae in patients with low serum creatinine levels is discussed controversially. We conducted a retrospective analysis applying the CKD-EPI formula and the alternate size descriptors adjusted body weight and predicted normal weight in the Cockcroft-Gault equation for calculating the carboplatin dose. Data were collected retrospectively from 128 lung cancer patients with serum creatinine obese patients they were superior in reducing mean overdose from 24% to roughly 15% (predicted normal weight, CKD-EPI) and 10% (adjusted body weight) and from 25% to 9%, 8% and 4%, respectively. Best performed the combination of Cockcroft-Gault with adjusted body weight. The results show that application of the alternate size descriptor adjusted body weight in the Cockcroft-Gault equation can improve dosing accuracy especially in overweight and obese patients with low serum creatinine levels. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  7. Ozone therapy could attenuate tubulointerstitial injury in adenine-induced CKD rats by mediating Nrf2 and NF-κB

    Directory of Open Access Journals (Sweden)

    Gang Yu

    2016-10-01

    Full Text Available Objective(s: This study aims to determine the effects of ozone therapy on restoring impaired Nrf2 activation to ameliorate chronic tubulointerstitial injury in rats with adenine-induced CKD. Materials and Methods: Sprague–Dawley rats were fed with 0.75% adenine-containing diet to induce CKD and chronic tubulointerstitial injury. Ozone therapy was administered by rectal insufflation. After 4 weeks, serum and kidney samples were collected and analyzed. Renal function and systemic electrolyte level were detected. Pathological changes in kidney were assessed by hematoxylin–eosin staining and Masson trichrome staining. Nrf2 activation was detected by immunohistochemistry and Western blot analyses. The levels of SOD, CAT, GSH, PCO, and MDA were detected in the kidney. Immunohistochemistry, Western blot, and real-time PCR analyses were performed to evaluate the activation of the nuclear factor kappa B (NF-κB P65 pathway and inflammation infiltration in the tubulointerstitium of the rats. Results: Ozone therapy improved severe renal insufficiency and tubulointerstitial morphology injury as well as restored Nrf2 activation and inhibited the NF-κB pathway in rats with adenine-induced CKD. Ozone therapy also up-regulated anti-oxidation enzymes (SOD, CAT, and GSH and down-regulated oxidation products (PCO and MDA, as well as inflammatory cytokines (IL-1β, IL-6, TNF-α, and ICAM-1 in the kidney. Conclusion:These findings indicated that ozone therapy could attenuate tubulointerstitial injury in rats with adenine-induced CKD by mediating Nrf2 and NF-κB.

  8. Ozone therapy could attenuate tubulointerstitial injury in adenine-induced CKD rats by mediating Nrf2 and NF-κB

    Science.gov (United States)

    Yu, Gang; Liu, Xiuheng; Chen, Zhiyuan; Chen, Hui; Wang, Lei; Wang, Zhishun; Qiu, Tao; Weng, Xiaodong

    2016-01-01

    Objective(s): This study aims to determine the effects of ozone therapy on restoring impaired Nrf2 activation to ameliorate chronic tubulointerstitial injury in rats with adenine-induced CKD. Materials and Methods: Sprague–Dawley rats were fed with 0.75% adenine-containing diet to induce CKD and chronic tubulointerstitial injury. Ozone therapy was administered by rectal insufflation. After 4 weeks, serum and kidney samples were collected and analyzed. Renal function and systemic electrolyte level were detected. Pathological changes in kidney were assessed by hematoxylin–eosin staining and Masson trichrome staining. Nrf2 activation was detected by immunohistochemistry and Western blot analyses. The levels of SOD, CAT, GSH, PCO, and MDA were detected in the kidney. Immunohistochemistry, Western blot, and real-time PCR analyses were performed to evaluate the activation of the nuclear factor kappa B (NF-κB) P65 pathway and inflammation infiltration in the tubulointerstitium of the rats. Results: Ozone therapy improved severe renal insufficiency and tubulointerstitial morphology injury as well as restored Nrf2 activation and inhibited the NF-κB pathway in rats with adenine-induced CKD. Ozone therapy also up-regulated anti-oxidation enzymes (SOD, CAT, and GSH) and down-regulated oxidation products (PCO and MDA), as well as inflammatory cytokines (IL-1β, IL-6, TNF-α, and ICAM-1) in the kidney. Conclusion: These findings indicated that ozone therapy could attenuate tubulointerstitial injury in rats with adenine-induced CKD by mediating Nrf2 and NF-κB. PMID:27872711

  9. Clinical practice guidelines for the prevention, diagnosis, evaluation and treatment of mineral and bone disorders in chronic kidney disease (CKD-MBD) in adults.

    Science.gov (United States)

    Bellorin-Font, Ezequiel; Ambrosoni, Pablo; Carlini, Raúl G; Carvalho, Aluizio B; Correa-Rotter, Ricardo; Cueto-Manzano, Alfonso; Jara, Aquiles; Jorgetti, Vanda; Negri, Armando L; Negri, Armando; Olaizola, Inés; Salusky, Isidro; Slatopolsky, Eduardo; Weisinger, José R

    2013-01-01

    The clinical practice guidelines for the prevention, diagnosis, evaluation and treatment of chronic kidney disease mineral and bone disorders (CKD-BMD) in adults, of the Latin American Society of Nephrology and Hypertension (SLANH) comprise a set of recommendations developed to support the doctor in the management of these abnormalities in adult patients with stages 3-5 kidney disease. This excludes changes associated with renal transplantation. The topics covered in the guidelines are divided into four chapters: 1) Evaluation of biochemical changes, 2) Evaluation of bone changes, 3) Evaluation of vascular calcifications, and 4) Treatment of CKD-MBD. The guidelines are based on the recommendations proposed and published by the Kidney Disease: Improving Global Outcomes (KDIGO) for the prevention, diagnosis, evaluation and treatment of CKD-MBD (KDIGO Clinical practice guidelines for the diagnosis, evaluation, prevention and treatment of Chronic Kidney Disease Mineral and Bone Disorder [CKD-MBD]), adapted to the conditions of patients, institutions and resources available in Latin America, with the support of KDIGO. In some cases, the guidelines correspond to management recommendations directly defined by the working group for their implementation in our region, based on the evidence available in the literature. Each chapter contains guidelines and their rationale, supported by numerous updated references. Unfortunately, there are few controlled studies with statistically sufficient weight in Latin America to support specific recommendations for the region, and as such, most of the references used correspond to studies carried out in other regions. This highlights the need to plan research studies designed to establish the current status of mineral and bone metabolism disorders in Latin America as well as defining the best treatment options for our population.

  10. A Genetic Biomarker of Oxidative Stress, the Paraoxonase-1 Q192R Gene Variant, Associates with Cardiomyopathy in CKD: A Longitudinal Study

    Directory of Open Access Journals (Sweden)

    E. Dounousi

    2016-01-01

    Full Text Available Background. Oxidative stress is a hallmark of CKD and this alteration is strongly implicated in LV hypertrophy and in LV dysfunction. Methods and Patients. We resorted to the strongest genetic biomarker of paraoxonase-1 (PON1 activity, the Q192R variant in the PON1 gene, to unbiasedly assess (Mendelian randomization the cross-sectional and longitudinal association of this gene-variant with LV mass and function in 206 CKD patients with a 3-year follow-up. Results. The R allele of Q192R polymorphism associated with oxidative stress as assessed by plasma 8-isoPGF2α (P=0.03 and was dose-dependently related in a direct fashion to LVMI (QQ: 131.4 ± 42.6 g/m2; RQ: 147.7 ± 51.1 g/m2; RR: 167.3 ± 41.9 g/m2; P=0.001 and in an inverse fashion to systolic function (LV Ejection Fraction (QQ: 79 ± 12%; RQ: 69 ± 9%; RR: 65 ± 10% P=0.002. On longitudinal observation, this gene variant associated with the evolution of the same echocardiographic indicators [LVMI: 13.40 g/m2 per risk allele, P=0.005; LVEF: −2.96% per risk allele, P=0.001]. Multivariate analyses did not modify these associations. Conclusion. In CKD patients, the R allele of the Q192R variant in the PON1 gene is dose-dependently related to the severity of LVH and LV dysfunction and associates with the longitudinal evolution of these cardiac alterations. These results are compatible with the hypothesis that oxidative stress is implicated in cardiomyopathy in CKD patients.

  11. The Association Between Unhealthy Lifestyle Behaviors and the Prevalence of Chronic Kidney Disease (CKD in Middle-Aged and Older Men

    Directory of Open Access Journals (Sweden)

    Ryoma Michishita

    2016-07-01

    Full Text Available Background: This cross-sectional study evaluated the association between unhealthy lifestyle behaviors and the prevalence of chronic kidney disease (CKD in middle-aged and older men. Methods: The subjects included 445 men without a history of cardiovascular disease, stroke, or dialysis treatment, who were not taking medications. Unhealthy lifestyle behaviors were evaluated using a standardized selfadministered questionnaire and were defined as follows: 1 lack of habitual moderate exercise, 2 lack of daily physical activity, 3 slow walking speed, 4 fast eating speed, 5 late-night dinner, 6 bedtime snacking, and 7 skipping breakfast. The participants were divided into four categories, which were classified into quartile distributions based on the number of unhealthy lifestyle behaviors (0–1, 2, 3, and ≥4 unhealthy behaviors. Results: According to a multivariate analysis, the odds ratio (OR for CKD (defined as estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2 and/or proteinuria was found to be significantly higher in the ≥4 group than in the 0–1 group (OR 4.67; 95% confidence interval [CI], 1.51–14.40. Moreover, subjects’ lack of habitual moderate exercise (OR 3.06; 95% CI, 1.13–8.32 and presence of late-night dinner (OR 2.84; 95% CI, 1.40–5.75 and bedtime snacking behaviors (OR 2.87; 95% CI, 1.27–6.45 were found to be significantly associated with the prevalence of CKD. Conclusions: These results suggest that an accumulation of unhealthy lifestyle behaviors, especially those related to lack of habitual moderate exercise and presence of late-night dinner and bedtime snacking may be associated with the prevalence of CKD.

  12. Number of ablated spots in the course of renal sympathetic denervation in CKD patients with uncontrolled hypertension: EnligHTN vs. Standard irrigated cardiac ablation catheter.

    Science.gov (United States)

    Kiuchi, M G; Chen, S; Rodrigues Paz, L M; Pürerfellner, H

    2017-08-04

    Hypertension was both a mutual cause and the main concern of chronic kidney disease (CKD). Blood pressure control is more problematic in the company of CKD. This study compares the effects of renal sympathetic denervation (RSD) on 24-h ambulatory blood pressure measurements (ABPM) and renal function in individuals with CKD and uncontrolled hypertension by unlike a number of ablated spots using the EnligHTN catheter and the standard irrigated cardiac ablation catheter (SICAC), Flexability. The 112 subjects were randomly divided into two groups according to the catheter that would be used in the procedure EnligHTN (n=56) or Flexability (n=56). Into each group, we created 5 subgroups according to the number of ablated spots: 4, 8, 12, 16 and 20. All of them were followed for exactly 6 months to assess all the parameters measured in this investigation. Comparing the Δ 24-h systolic ABPM according to the number of ablated spots 4 and 20 for EnligHTN vs. Flexability, respectively, the differences were: -3.6±0.9 vs. -6.3±1.4mmHg (Prenal function in both groups. These effects were more marked and important in subgroups underwent a great number of ablated spots using the SICAC. Copyright © 2017 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. 怡肾丸治疗慢性肾衰竭(CKD2~4期)临床回顾性研究∗%Clinic Retrospective Study on Treating Chronic Renal Failure (CKD2~4) with Yishen Pills

    Institute of Scientific and Technical Information of China (English)

    彭亚军; 胡淑娟; 何泽云; 李旭华; 廖春来; 何雅琴

    2015-01-01

    目的::通过怡肾丸对慢性肾衰竭( CKD2~4期)临床治疗的回顾性研究,评价怡肾丸治疗慢性肾衰竭( CKD 2~4期)的临床疗效与安全性。方法:以2012年6月~2014年3月间,湖南中医药大学第一附属医院肾内科住院及门诊接受怡肾丸治疗的慢性肾衰竭( CKD2~4期)患者为研究对象,分别观察怡肾丸组与对照组治疗慢性肾衰竭( CKD2~4期)临床疗效、中医证候指标及安全性。结果:两组中医证候疗效、中医证候积分、西医疗效评定、肾功能及血红蛋白的影响比较中均较治疗前改善,且差异有统计学意义(P<0.05);在治疗后分别组间比较中,发现怡肾丸组在中医证候疗效、中医证候积分、西医疗效、肾功能及血红蛋白的影响中优于对照组,且差异有统计学意义(P<0.05),同时未发现不良反应。结论:怡肾丸可有效延缓慢性肾衰竭( CKD3~4期)进展,同时可改善患者临床症状,提高患者生活质量,且具有一定安全性。%Objective:Through the Yishen pills for chronic renal failure (CKD2~4) clinical retrospective study, evaluation of Yishen pills for the treatment of chronic renal failure ( CKD2 ~4 ) clinical efficacy and safety. Methods:In June 2012 ~March 2014, the First Affiliated Hospital of Hunan University of TCM Renal medical inpatient and outpatient accept Yishen pill treatment of patients with chronic renal failure (CKD2~4) as the research object, respectively to observe Yishen pill group and control group in the treatment of chronic renal failure (CKD2~4) clinical efficacy, TCM syndrome indicators, and security. Results:Two groups of TCM syndrome efficacy, TCM syndrome integral, western medicine curative effect evaluation, the influence of hemoglobin and renal function comparison was improved, the and the difference was statist ically significant (P<0. 05); After treatment, respectively, comparisons between groups, found Yishen pill group in TCM

  14. iConnect CKD - Virtual Medical Consulting: a web-based Chronic Kidney Disease, Hypertension and Diabetes Integrated Care Program.

    Science.gov (United States)

    Katz, Ivor J; Pirabhahar, Saiyini; Williamson, Paula; Raghunath, Vishwas; Brennan, Frank; O'Sullivan, Anthony; Youssef, George; Lane, Cathie; Jacobson, Gary; Feldman, Peter; Kelly, John

    2017-05-04

    Chronic kidney disease (CKD) patients overwhelm specialist services and can potentially be managed in the primary care (PC). Opportunistic screening of high risk (HR) patients and follow-up in PC is the most sustainable model of care. A 'virtual consultation' (VC) model instead of traditional face to face (F2F) consultations was used, aiming to assess efficacy and safety of the model. Seventy patients were recruited from PC sites and hospital clinics, and followed for one year. The HR patients (eGFR 30 mg/mmol/L) were randomised to either VC or F2F. Patients were monitored 6 monthly by a Clinical Nurse Specialist (CNS). The specialist team provided virtual or clinical support and included a Nephrologist, Endocrinologist, Cardiologist and Renal 'Palliative' Supportive Care. Sixty one (87%) patients were virtually tracked or consulted with 14 (23%) being HR. At 12 months there was no difference in outcomes between VC and F2F patients. All patients were successfully monitored. GPs reported high level of satisfaction and supported the model, but found software integration challenging. Patients found the system attractive and felt well managed. Specialist consults occurred within a week and if a second specialist opinion was required it took another two weeks. The program demonstrated safe, expedited and efficient follow up with a clinical and web based program. Support from the GPs and patients was encouraging, despite logistical issues. Ongoing evaluation of VC services will continue and feasibility to larger networks and more chronic diseases remains the long term goal. This article is protected by copyright. All rights reserved.

  15. Transcriptional analysis of kidneys during repair from AKI reveals possible roles for NGAL and KIM-1 as biomarkers of AKI-to-CKD transition.

    Science.gov (United States)

    Ko, Gang Jee; Grigoryev, Dmitry N; Linfert, Douglas; Jang, Hye Ryoun; Watkins, Tonya; Cheadle, Chris; Racusen, Lorraine; Rabb, Hamid

    2010-06-01

    Acute kidney injury (AKI) is being increasingly shown to be a risk factor for chronic kidney disease (CKD), but little is known about the possible mechanistic links. We hypothesized that analysis of the genomic signature in the repair stage after AKI would reveal pathways that could link AKI and CKD. Unilateral renal pedicle clamping for 45 min was performed in male C57BL/6J mice. Mice were euthanized at 3, 10, and 28 days after ischemia-reperfusion injury (IRI). Total RNA was isolated from kidney and analyzed using an Illumina mouse array. Among 24,600 tested genes, 242, 146, and 46 genes were upregulated at days 3, 10, and 28 after IRI, and 85, 35, and 0 genes were downregulated, respectively. Gene ontology analysis showed that gene expression changes were primarily related to immune and inflammatory pathways both early and late after AKI. The most highly upregulated genes late after AKI were hepatitis A virus cellular receptor 1 (Havcr1) and lipocalin 2 (Lcn2), which code for kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL), respectively. This was unexpected since they are both primarily potential biomarkers of the early stage of AKI. Furthermore, increases observed in gene expression in amiloride binding protein 1, vascular cell adhesion molecule-1, and endothelin 1 could explain the salt-sensitive hypertension that can follow AKI. These data suggested that 1) persistent inflammation and immune responses late after AKI could contribute to the pathogenesis of CKD, 2) late upregulation of KIM-1 and NGAL could be a useful marker for sustained renal injury after AKI, and 3) hypertension-related gene changes could underlie mechanisms for persistent renal and vascular injury after AKI.

  16. GFR decline as an end point for clinical trials in CKD: a scientific workshop sponsored by the National Kidney Foundation and the US Food and Drug Administration.

    Science.gov (United States)

    Levey, Andrew S; Inker, Lesley A; Matsushita, Kunihiro; Greene, Tom; Willis, Kerry; Lewis, Edmund; de Zeeuw, Dick; Cheung, Alfred K; Coresh, Josef

    2014-12-01

    The US Food and Drug Administration currently accepts halving of glomerular filtration rate (GFR), assessed as doubling of serum creatinine level, as a surrogate end point for the development of kidney failure in clinical trials of kidney disease progression. A doubling of serum creatinine level generally is a late event in chronic kidney disease (CKD); thus, there is great interest in considering alternative end points for clinical trials to shorten their duration, reduce sample size, and extend their conduct to patients with earlier stages of CKD. However, the relationship between lesser declines in GFR and the subsequent development of kidney failure has not been well characterized. The National Kidney Foundation and Food and Drug Administration sponsored a scientific workshop to critically examine available data to determine whether alternative GFR-based end points have sufficiently strong relationships with important clinical outcomes of CKD to be used in clinical trials. Based on a series of meta-analyses of cohorts and clinical trials and simulations of trial designs and analytic methods, the workshop concluded that a confirmed decline in estimated GFR of 30% over 2 to 3 years may be an acceptable surrogate end point in some circumstances, but the pattern of treatment effects on GFR must be examined, specifically acute effects on estimated GFR. An estimated GFR decline of 40% may be more broadly acceptable than a 30% decline across a wider range of baseline GFRs and patterns of treatment effects on GFR. However, there are other circumstances in which these end points could lead to a reduction in statistical power or erroneous conclusions regarding benefits or harms of interventions. We encourage careful consideration of these alternative end points in the design of future clinical trials.

  17. Contrast-Induced Nephropathy After Computed Tomography in Stable CKD Patients With Proper Prophylaxis: 8-Year Experience of Outpatient Prophylaxis Program.

    Science.gov (United States)

    Park, Sehoon; Kim, Myoung-Hee; Kang, Eunjeong; Park, Seokwoo; Jo, Hyung Ah; Lee, Hajeong; Kim, Sun Moon; Lee, Jung Pyo; Oh, Kook-Hwan; Joo, Kwon Wook; Kim, Yon Su; Kim, Dong Ki

    2016-05-01

    Conflicting data have been reported on the clinical significance of contrast-induced nephropathy after CT scan (CT-CIN). In addition, the epidemiologic characteristics and clinical outcomes of CT-CIN following proper prophylactic intervention remain elusive.We examined the incidence, risk factors, and outcomes of CT-CIN in stable chronic kidney disease (CKD) patients using data collected from our outpatient CT-CIN prophylaxis program conducted between 2007 and 2014. The program recruited patients with an estimated glomerular filtration rate (eGFR) pop-up alert system and provided an identical protocol of CIN prophylaxis to all patients.A total of 1666 subjects were included in this study, and 61 of the 1666 subjects (3.7%) developed CT-CIN. Multivariate analysis showed that baseline eGFR, diabetes mellitus, and low serum albumin were significant risk factors for CT-CIN. The generalized additive model analysis revealed a nonlinear relationship between the baseline eGFR and the risk of CT-CIN. In this analysis, the risk of CT-CIN began to increase below an eGFR threshold of 36.8 mL/min/1.73 m. To assess the outcomes of CT-CIN, patients with and without CT-CIN were compared after propensity score-based 1:2 matching. CT-CIN did not increase the mortality rate of patients. However, patients with CT-CIN were significantly more likely to start dialysis within 6 months of follow-up, but not after those initial 6 months.CT-CIN developed in only a small number of stable CKD patients who received proper prophylactic intervention, and the risk of CT-CIN was increased in patients with more advanced CKD. Despite the low incidence, CT-CIN conferred a non-negligible risk for the initiation of dialysis in the acute period, even after prophylaxis.

  18. Plant Protein Intake Is Associated with Fibroblast Growth Factor 23 and Serum Bicarbonate in Patients with CKD: The Chronic Renal Insufficiency Cohort Study

    Science.gov (United States)

    Scialla, Julia J.; Appel, Lawrence J; Wolf, Myles; Yang, Wei; Zhang, Xiaoming; Sozio, Stephen M.; Miller, Edgar R.; Bazzano, Lydia A.; Cuevas, Magdalena; Glenn, Melanie J.; Lustigova, Eva; Kallem, Radhakrishna R.; Porter, Anna C.; Townsend, Raymond R.; Weir, Matthew R.; Anderson, Cheryl A.M.

    2012-01-01

    Background Protein from plant, as opposed to animal, sources may be preferred in chronic kidney disease (CKD), due to lower bioavailability of phosphate and lower nonvolatile acid load. Study Design Observational cross-sectional study. Setting & Participants 2938 participants with chronic kidney disease and information on dietary intake at the baseline visit in the Chronic Renal Insufficiency Cohort Study. Predictors Percentage of total protein from plant sources (% plant protein) was determined by scoring individual food items from the National Cancer Institute Diet History Questionnaire (DHQ). Outcomes Metabolic parameters, including serum phosphate, bicarbonate (HCO3), potassium, and albumin, plasma fibroblast growth factor 23 (FGF23), and parathyroid hormone (PTH), and hemoglobin. Measurements We modeled the association between % plant protein and metabolic parameters using linear regression. Models were adjusted for age, sex, race, diabetes, body mass index, eGFR, income, smoking, total energy intake, total protein intake, 24 hour urinary sodium, use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers and use of diuretics. Results Higher % plant protein was associated with lower FGF23 (p=0.05) and higher HCO3 (p=0.01), but not with serum phosphate or PTH (p=0.9 and 0.5, respectively). Higher % plant protein was not associated with higher serum potassium (p=0.2), lower serum albumin (p=0.2) or lower hemoglobin (p=0.3). The associations of % plant protein with FGF23 and HCO3 did not differ by diabetes status, sex, race, CKD stage (2/3 vs. 4/5) or total protein intake (≤ 0.8 g/kg/d vs. >0.8 g/kg/d) (p-interaction > 0.10 for each). Limitations Cross-sectional study; Determination of % plant protein using the DHQ has not been validated. Conclusions Consumption of a higher percentage of protein from plant sources may lower FGF23 and raise HCO3 in patients with CKD. PMID:22480598

  19. In patients with chronic kidney disease (CKD kidney tissues PAI 1 clinical research%CKD患者肾组织中PAI-1的临床研究

    Institute of Scientific and Technical Information of China (English)

    李芊

    2012-01-01

    目的:观察CKD患者肾组织中PAI-1的临床研究.方法:设CKD组32例,对照组12例,取CKD组其肾穿刺标本及正常肾组织,采用免疫组化法检测中PAI-1的表达水平;比较对照组及不同分期的CKD组患者中PAI-1的表达差异,结果:PAI-1在CKD组患者不同分期的肾组织中,其表达明显高于对照组(P<0.05);PAI-1在CKD3肾组织的表达CKD1、2期明显增高(P<0.05).结论:PAI-1在CKD患者肾组织中的表达存在过度的现象,这种现象对于判断CKD患者的肾功能损害程度有很大的帮组,并能有效的防治慢性肾脏疾病.

  20. Statins decrease all-cause mortality only in CKD patients not requiring dialysis therapy--a meta-analysis of 11 randomized controlled trials involving 21,295 participants.

    Science.gov (United States)

    Barylski, Marcin; Nikfar, Shekoufeh; Mikhailidis, Dimitri P; Toth, Peter P; Salari, Pooneh; Ray, Kausik K; Pencina, Michael J; Rizzo, Manfredi; Rysz, Jacek; Abdollahi, Mohammad; Nicholls, Stephen J; Banach, Maciej

    2013-06-01

    The available studies have reported the benefits of statins on all-cause and cardiovascular mortality in chronic kidney disease (CKD) patients. However studies in end-stage renal disease patients on dialysis yielded conflicting results. Therefore, we performed a meta-analysis and provide the most reliable trial data to date on the impact of statin therapy on cardiovascular events and death from all causes in CKD patients. Data from PubMed, Web of Science, Cochrane Library, and Scopus for the years 1966 to October 2012 were searched. The final meta-analysis included 11 randomized controlled trials involving 21,295 participants with CKD. Among them 6857 were on dialysis. The use of statins in subjects with non-dialysis-dependent CKD resulted in a marked reduction in death from all causes (relative risk [RR]: 0.66; 95% confidence interval [CI]: 0.55-0.79; pcauses (RR: 0.69; 95%CI: 0.55-0.68; p=0.0012), cardiovascular events (RR: 0.55; 95%CI: 0.4-0.75; p=0.0001) and stroke (RR: 0.66; 95%CI: 0.5-0.88; p=0.0022). The use of statins in dialysis-dependent CKD patients resulted in a non-significant effect on death from all causes (RR: 0.99; 95%CI: 0.88-1.11; p=0.85) and stroke (RR: 1.31; 95%CI: 0.9-1.89; p>0.05), but had the effect of reducing death from cardiac causes (RR: 0.79; 95%CI: 0.64-0.98; pCKD. According to the very limited data the obtained results suggest caution in expecting a reduction in cardiovascular events in patients on dialysis.

  1. Quality of Reporting and Study Design of CKD Cohort Studies Assessing Mortality in the Elderly Before and After STROBE: A Systematic Review.

    Directory of Open Access Journals (Sweden)

    Anirudh Rao

    Full Text Available The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE statement was published in October 2007 to improve quality of reporting of observational studies. The aim of this review was to assess the impact of the STROBE statement on observational study reporting and study design quality in the nephrology literature.Systematic literature review.European and North American, Pre-dialysis Chronic Kidney Disease (CKD cohort studies.Studies assessing the association between CKD and mortality in the elderly (>65 years published from 1st January 2002 to 31st December 2013 were included, following systematic searching of MEDLINE & EMBASE.Time period before and after the publication of the STROBE statement.Quality of study reporting using the STROBE statement and quality of study design using the Newcastle Ottawa Scale (NOS, Scottish Intercollegiate Guidelines Network (SIGN and Critical Appraisal Skills Programme (CASP tools.37 papers (11 Pre & 26 Post STROBE were identified from 3621 potential articles. Only four of the 22 STROBE items and their sub-criteria (objectives reporting, choice of quantitative groups and description of and carrying out sensitivity analysis showed improvements, with the majority of items showing little change between the period before and after publication of the STROBE statement. Pre- and post-period analysis revealed a Manuscript STROBE score increase (median score 77.8% (Inter-quartile range [IQR], 64.7-82.0 vs 83% (IQR, 78.4-84.9, p = 0.05. There was no change in quality of study design with identical median scores in the two periods for NOS (Manuscript NOS score 88.9, SIGN (Manuscript SIGN score 83.3 and CASP (Manuscript CASP score 91.7 tools.Only 37 Studies from Europe and North America were included from one medical specialty. Assessment of study design largely reliant on good reporting.This study highlights continuing deficiencies in the reporting of STROBE items and their sub-criteria in cohort

  2. Quality of Reporting and Study Design of CKD Cohort Studies Assessing Mortality in the Elderly Before and After STROBE: A Systematic Review.

    Science.gov (United States)

    Rao, Anirudh; Brück, Katharina; Methven, Shona; Evans, Rebecca; Stel, Vianda S; Jager, Kitty J; Hooft, Lotty; Ben-Shlomo, Yoav; Caskey, Fergus

    2016-01-01

    The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement was published in October 2007 to improve quality of reporting of observational studies. The aim of this review was to assess the impact of the STROBE statement on observational study reporting and study design quality in the nephrology literature. Systematic literature review. European and North American, Pre-dialysis Chronic Kidney Disease (CKD) cohort studies. Studies assessing the association between CKD and mortality in the elderly (>65 years) published from 1st January 2002 to 31st December 2013 were included, following systematic searching of MEDLINE & EMBASE. Time period before and after the publication of the STROBE statement. Quality of study reporting using the STROBE statement and quality of study design using the Newcastle Ottawa Scale (NOS), Scottish Intercollegiate Guidelines Network (SIGN) and Critical Appraisal Skills Programme (CASP) tools. 37 papers (11 Pre & 26 Post STROBE) were identified from 3621 potential articles. Only four of the 22 STROBE items and their sub-criteria (objectives reporting, choice of quantitative groups and description of and carrying out sensitivity analysis) showed improvements, with the majority of items showing little change between the period before and after publication of the STROBE statement. Pre- and post-period analysis revealed a Manuscript STROBE score increase (median score 77.8% (Inter-quartile range [IQR], 64.7-82.0) vs 83% (IQR, 78.4-84.9, p = 0.05). There was no change in quality of study design with identical median scores in the two periods for NOS (Manuscript NOS score 88.9), SIGN (Manuscript SIGN score 83.3) and CASP (Manuscript CASP score 91.7) tools. Only 37 Studies from Europe and North America were included from one medical specialty. Assessment of study design largely reliant on good reporting. This study highlights continuing deficiencies in the reporting of STROBE items and their sub-criteria in cohort

  3. 慢性肾脏病患者耳鸣耳聋患病率及临床特点调查%The Research of Morbidity of Tinnitus and Deafness of CKD Patient and Clinical Characteristics

    Institute of Scientific and Technical Information of China (English)

    梁莹; 屈欢欢; 全春梅; 杨丛旭; 余仁欢

    2012-01-01

    Objective: Probe into the morbidity of tinnitus and deafness of CKD patient and clinical characteristics. Methods :Cross - sectional survey research methods is used, collecting CKD patientS information anf the properties and degree of tinnitus and deafness, to analyze the morbidity of tinnitus and deafness of CKD patient and clinical characteristics. ResultS:( 1 )CKD patients, tinnitus morbidity is 51. 6% , deafness prevalence is 44. 8% . Tinnitus frequency is mainly high - frequency, and deafness with mild hearing damage sensorineural neuropathic deafness accounts for a large number. ( 2 Jdeafness for increases with age, the prevalence of deafness is significantly rising trend. ( 3 Jsecondary kidney patients morbidity of deafness is higher than primary glomerular disease patients. (4 )ln the different clinical diagnosis, diabetic nephropathy and hypertensive renal disease are the main influence factors in the deafness morbidity of CKD patients.( 5 Jlncreasing with CKD stage, the morbidity of CKD patients with deafness is significantly rising trend. That improves the morbidity of CKD patients with deafness is closely related to the renal function state and glomerular filtration rate. Conclusion:( 1 )CKD patients, Tinnitus frequency is mainly high -frequency, and deafness with mild hearing damage sensorineural neuropathic deafness accounts for a large number. ( 2 Jlncreasing with the age or decreasing with the renal function state and glomerular filtration rate, the morbidity of CKD patients with deafness is significantly rising trend. ( 3 Jsecondary kidney disease patients morbidity of deafness is higher than primary glomerular disease patients. In Secondary kidney diseases, diabetic nephropathy and hypertensive renal disease are the main influence factors.%目的:探讨慢性肾脏病(CKD)患者耳鸣耳聋的患病率及其相关临床特点.方法:采用横断面的调查方法,收集CKD患者相关信息和耳鸣耳聋的性质及程度,对肾脏病患者耳

  4. New Insights into Dialysis Vascular Access: What Is the Optimal Vascular Access Type and Timing of Access Creation in CKD and Dialysis Patients?

    Science.gov (United States)

    Woo, Karen; Lok, Charmaine E

    2016-08-08

    Optimal vascular access planning begins when the patient is in the predialysis stages of CKD. The choice of optimal vascular access for an individual patient and determining timing of access creation are dependent on a multitude of factors that can vary widely with each patient, including demographics, comorbidities, anatomy, and personal preferences. It is important to consider every patient's ESRD life plan (hence, their overall dialysis access life plan for every vascular access creation or placement). Optimal access type and timing of access creation are also influenced by factors external to the patient, such as surgeon experience and processes of care. In this review, we will discuss the key determinants in optimal access type and timing of access creation for upper extremity arteriovenous fistulas and grafts.

  5. Epoetin beta pegol alleviates oxidative stress and exacerbation of renal damage from iron deposition, thereby delaying CKD progression in progressive glomerulonephritis rats.

    Science.gov (United States)

    Hirata, Michinori; Tashiro, Yoshihito; Aizawa, Ken; Kawasaki, Ryohei; Shimonaka, Yasushi; Endo, Koichi

    2015-12-01

    The increased deposition of iron in the kidneys that occurs with glomerulopathy hinders the functional and structural recovery of the tubules and promotes progression of chronic kidney disease (CKD). Here, we evaluated whether epoetin beta pegol (continuous erythropoietin receptor activator: CERA), which has a long half-life in blood and strongly suppresses hepcidin-25, exerts renoprotection in a rat model of chronic progressive glomerulonephritis (cGN). cGN rats showed elevated urinary total protein excretion (uTP) and plasma urea nitrogen (UN) from day 14 after the induction of kidney disease (day 0) and finally declined into end-stage kidney disease (ESKD), showing reduced creatinine clearance with glomerulosclerosis, tubular dilation, and tubulointerstitial fibrosis. A single dose of CERA given on day 1, but not on day 16, alleviated increasing uTP and UN, thereby delaying ESKD. In the initial disease phase, CERA significantly suppressed urinary 8-OHdG and liver-type fatty acid-binding protein (L-FABP), a tubular damage marker. CERA also inhibited elevated plasma hepcidin-25 levels and alleviated subsequent iron accumulation in kidneys in association with elevated urinary iron excretion and resulted in alleviation of growth of Ki67-positive tubular and glomerular cells. In addition, at day 28 when the exacerbation of uTP occurs, a significant correlation was observed between iron deposition in the kidney and urinary L-FABP. In our study, CERA mitigated increasing kidney damage, thereby delaying CKD progression in this glomerulonephritis rat model. Alleviation by CERA of the exacerbation of kidney damage could be attributable to mitigation of tubular damage that might occur with lowered iron deposition in tubules.

  6. Comparación entre las ecuaciones CKD-EPI y MDRD para la estimación del filtrado glomerular en pacientes con enfermedad renal crónica Comparison between CKD-EPI and MDRD-equations to estimate glomerular filtration rate in chronic kidney disease patients

    Directory of Open Access Journals (Sweden)

    Guillermo J. Rosa-Diez

    2011-08-01

    Full Text Available La ecuación MDRD para la estimación del índice de filtrado glomerular (IFG, es la estrategia más utilizada para evaluar pacientes con enfermedad renal crónica (ERC. Sin embargo, puede subestimar el IFG con el riesgo de asignar al paciente a estadios más avanzados de ERC. La nueva ecuación CKD-EPI, mejoraría la exactitud y precisión de las estimaciones. Sus autores sugieren que reemplace a la anterior. No habiendo comparaciones de estas ecuaciones aplicadas en un gran número de pacientes en nuestro país, nuestro objetivo fue realizarla en una amplia cohorte de pacientes. Se evaluó la concordancia de asignación en estadios de ERC entre ambas ecuaciones, tomando como referencia los datos surgidos de MDRD. Se calculó la media de las diferencias de los IFG obtenidos empleando ambas ecuaciones y se aplicó el análisis estadístico de Bland-Altman. Se estudió una cohorte de 9 319 pacientes con una media de creatinina sérica de 1.60 ± 1.03 mg/dl, 67% de sexo femenino y edad media 58 ± 20 años. En el grupo total, CKD-EPI presentó una media de IFG 0.61 ml/min/1.73 m² mayor que MDRD (p: NS. En los estadios 2 y 3A las medias del IFG fueron respectivamente 6.95 ± 4.76 y 3.21 ± 3.31, y la concordancia de 81 y 74%. El porcentaje de pacientes con un IFG menor de 60 ml/min/1.73 m², se redujo de 76.3% (MDRD a 70.1% (CKD-EPI. Por lo tanto, la nueva ecuación CKD-EPI disminuye el número de pacientes con IFG debajo de 60 ml/min/1.73 m² y asigna estadios de IFG más elevado a un número mayor de pacientes.The MDRD equation to estimate glomerular filtration rate (GFR is the most widely used strategy to assess chronic kidney disease. Nonetheless, for the individual patient the true GFR can be underestimated with the risk of diagnosing a more elevated CKD stage. This novel CKD-EPI equation would improve accuracy and precision of estimations, and several authors recommend this new equation replace the former. In our country there is only a

  7. Combination of low body mass index and serum albumin level is associated with chronic kidney disease progression: the chronic kidney disease-research of outcomes in treatment and epidemiology (CKD-ROUTE) study.

    Science.gov (United States)

    Kikuchi, Hiroaki; Kanda, Eiichiro; Mandai, Shintaro; Akazawa, Masanobu; Iimori, Soichiro; Oi, Katsuyuki; Naito, Shotaro; Noda, Yumi; Toda, Takayuki; Tamura, Teiichi; Sasaki, Sei; Sohara, Eisei; Okado, Tomokazu; Rai, Tatemitsu; Uchida, Shinichi

    2017-02-01

    The relationship between protein-energy wasting and chronic kidney disease (CKD) progression is unknown. In the present prospective cohort study, we evaluated the hypothesis that a combination of low body mass index (BMI) and serum albumin level is associated with rapid CKD progression. The study cohort comprised 728 predialysis Japanese patients with CKD (stages 2-5) enrolled from 2010 to 2011. Patients were categorized into four groups according to their serum albumin levels and BMI: group 1, low serum albumin level (BMI (BMI; group 3, low serum albumin level and high BMI (≥23.5 kg/m(2)); and group 4, high serum albumin level and high BMI. The primary outcome was a 30 % decline in estimated glomerular filtration rate (eGFR) or start of dialysis within 2 years. The secondary outcome was an annual GFR decline (mL/min/1.73 m(2)/year). Logistic regression analysis adjusted for baseline characteristics (reference, group 4) showed that only group 1 was associated with a significant risk of CKD progression, with adjusted odds ratio of 3.51 [95 % confidence interval (CI) (1.63, 7.56)]. A multivariate linear regression analysis adjusted for baseline characteristics showed a significant difference in annual eGFR decline between groups 1 and 4 [coefficients β (standard error) -2.62 (0.75), p = 0.001]. This study suggests that combined effects of low BMI (<23.5 kg/m(2)) and serum albumin level (<4 g/dL) are associated with CKD progression.

  8. Prognostic value of myocardial perfusion single photon emission computed tomography for major adverse cardiac cerebrovascular and renal events in patients with chronic kidney disease: results from first year of follow-up of the Gunma-CKD SPECT multicenter study

    Energy Technology Data Exchange (ETDEWEB)

    Kasama, Shu [Gunma University Graduate School of Medicine, Department of Medicine and Biological Science (Cardiovascular Medicine), Maebashi, Gunma (Japan); Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Department of Cardiovascular Medicine, Gunma (Japan); Toyama, Takuji [Department of Cardiovascular Medicine, Gunma Prefectural Cardiovascular Center, Maebashi (Japan); Sato, Makito [Gunma University Graduate School of Medicine, Department of Medicine and Biological Science (Cardiovascular Medicine), Maebashi, Gunma (Japan); Tatebayashi Kosei Hospital, Department of Internal Medicine, Gunma (Japan); Sano, Hirokazu [Gunma University Graduate School of Medicine, Department of Medicine and Biological Science (Cardiovascular Medicine), Maebashi, Gunma (Japan); Isesaki Municipal Hospital, Department of Cardiovascular Medicine, Isesaki (Japan); Ueda, Tetsuya [Fujioka General Hospital, Division of Cardiology, Fujioka (Japan); Sasaki, Toyoshi [Takasaki General Medical Center, Division of Cardiology, Takasaki (Japan); Nakahara, Takehiro; Kurabayashi, Masahiko [Gunma University Graduate School of Medicine, Department of Medicine and Biological Science (Cardiovascular Medicine), Maebashi, Gunma (Japan); Higuchi, Tetsuya; Tsushima, Yoshito [Gunma University Graduate School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Maebashi (Japan)

    2016-02-15

    Patients with chronic kidney disease (CKD) have an increased risk of adverse cardio-cerebrovascular events. We examined whether stress myocardial perfusion single photon emission computed tomography (SPECT) provides reliable prognostic markers for these patients. In this multicenter, prospective cohort trial from the Gunma-CKD SPECT study protocol, patients with CKD [estimated glomerular filtration rate (eGFR) < 60 min/ml per 1.73 m{sup 2}] undergoing stress {sup 99m}Tc-tetrofosmin SPECT for suspected or possible ischemic heart disease were initially followed for 1 year, with the following study endpoints: primary, the occurrence of cardiac deaths (CDs), and secondary, major adverse cardiac, cerebrovascular, and renal events (MACCREs). The summed stress score (SSS), summed rest score, and summed difference score (SDS) were estimated with the standard 17-segment, 5-point scoring model. Left ventricular end-diastolic volume, end-systolic volume (ESV), and ejection fraction were measured using electrocardiogram-gated SPECT. During the first year of follow-up, 69 of 299 patients experienced MACCREs (CD, n = 7; non-fatal myocardial infarction, n = 3; hospitalization for heart failure, n = 13; cerebrovascular accident, n = 1; need for revascularization, n = 38; and renal failure, i.e., hemodialysis initiation, n = 7). ESV and SSS were associated with CDs (p < 0.05), and eGFR and SDS were associated with MACCREs (p < 0.05), in multivariate logistic analysis. Patients with high ESV and high SSS had a significantly higher CD rate during the first year than the other CKD patient subgroups (p < 0.05). Patients with low eGFR and high SDS had a significantly higher MACCRE rate than the other subgroups (p < 0.05). Myocardial perfusion SPECT can provide reliable prognostic markers for patients with CKD. (orig.)

  9. The role of equation developed by CKD-EPI in evaluating the status of patients with chronic kidney disease%CKD-EPI 开发方程在评价慢性肾脏病患者病情中的作用

    Institute of Scientific and Technical Information of China (English)

    王汉敏; 饶珺; 赵妍; 韩四萍

    2015-01-01

    Objective To evaluate the role of equation developed by the chronic kidney disease (CKD) epidemic cooperation working group (CKD‐EPI) in evaluating the status of patients with CKD .Methods A total of 260 outpatients with CKD from Hu‐bei Provincial Hospital of TCM from January 2012 to April 2014 were recruited in this study .Glomerular filtration rate (GFR) was calculated by the equation developed by the CKD‐EPI(EPI‐GFR) ,and compared with serum creatinine (Cr) ,uric acid(UA ) ,albu‐mins (ALB) ,calcium(Ca) ,phosphorus(P) ,cystatin C (CysC) ,24 h urine protein (UP) ,hemoglobin(Hb) and other biochemical in‐dexes ,and also with the estimating GFR calculated by simplified MDRD equation(simplified‐GFR) and Chinese corrected MDRD e‐quation(corrected‐GFR) .Results The EPI‐GFR was negatively correlated with Cr ,UA ,CysC ,P and 24 h UP (P < 0 .05) ,and there was significant difference with Hb (P< 0 .05) which had a significant positive correlation .As the disease progresses ,GFR de‐creased gradually ,anemia was also gradually increase ,ALB ,Ca decreased in varying degrees .There was a good correlation between simplified‐GFR ,correction‐GFR and EPI‐GFR (r was 0 .997 and 0 .995 respectively ,P < 0 .05) .EPI‐GFR was higher than simpli‐fied‐GFR average about 0 .49 mL/(min × 1 .73 m2 ) but lower than correction‐GFR average about 0 .81 mL /(min × 1 .73 m2 ) .Con‐clusion The GFR calculated by CKD‐EPI development equation has good correlation and predictive ability to evaluate the renal function damage in patients with CKD which is easy to determine and also could remedy the defect of excessive treatment and degra‐dation diagnosis with other evaluation equations .It provides a great convenience and could be used widely in clinical routine renal function tests .%目的:分析评价美国慢性肾脏病(CKD)流行病合作工作组(CKD‐EPI)开发方程在 CKD 患者病情评估中的作用。方法2012年1月至2014年4月

  10. Combined Effects of GSTM1 Null Allele and APOL1 Renal Risk Alleles in CKD Progression in the African American Study of Kidney Disease and Hypertension Trial.

    Science.gov (United States)

    Bodonyi-Kovacs, Gabor; Ma, Jennie Z; Chang, Jamison; Lipkowitz, Michael S; Kopp, Jeffrey B; Winkler, Cheryl Ann; Le, Thu H

    2016-10-01

    Apolipoprotein L-1 (APOL1) high-risk alleles and the glutathione-S-transferase-μ1 (GSTM1) null allele have been shown separately to associate with CKD progression in the African American Study of Kidney Disease and Hypertension (AASK) trial participants. Here, we determined combined effects of GSTM1 null and APOL1 high-risk alleles on clinical outcomes in 682 AASK participants who were classified into four groups by GSTM1 null or active genotype and APOL1 high- or low-risk genotype. We assessed survival differences among these groups by log-rank test and Cox regression adjusted for important clinical variables for time to GFR event (change in GFR of 50% or 25-ml/min per 1.73 m(2) decline), incident ESRD, death, or composite outcomes. The groups differed significantly in event-free survival for incident ESRD and composite outcomes (P≤0.001 by log-rank test). Compared with the reference GSTM1 active/APOL1 low-risk group, other groups had these hazard ratios for the composite outcome of incident ESRD and change in GFR: GSTM1 active/APOL1 high-risk hazard ratio, 2.13; 95% confidence interval, 0.76 to 5.90 (P=0.15); GSTM1 null/APOL1 low-risk hazard ratio, 2.05; 95% confidence interval, 1.08 to 3.88 (P=0.03); and GSTM1 null/APOL1 high-risk hazard ratio, 3.0; 95% confidence interval, 1.51 to 5.96 (P=0.002). In conclusion, GSTM1 null and APOL1 high-risk alleles deleteriously affect CKD progression among blacks with hypertension, and subjects with both GSTM1 null and APOL1 high-risk genotypes had highest risk of adverse renal outcomes. Larger cohorts are needed to fully explore interactions of GSTM1 and APOL1 genotypes in other subgroups.

  11. Albuminuria as a Risk Factor for Anemia in Chronic Kidney Disease: Result from the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD.

    Directory of Open Access Journals (Sweden)

    Ji Suk Han

    Full Text Available Anemia is a common complication among patients with chronic kidney disease (CKD, and it is associated with unfavorable clinical outcomes in patients with CKD independent of the estimated glomerular filtration rate (eGFR. We assessed the association of the urinary albumin-to-creatinine ratio (ACR and eGFR with anemia in CKD patients.We conducted a cross-sectional study using baseline data from the KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD. Multiple regression analysis was performed to identify the independent association of albuminuria with anemia. Furthermore, odds ratios for anemia were calculated by cross-categorization of ACR and eGFR.Among 1,456 patients, the mean age was 53.5 ± 12.4 years, and the mean eGFR and ACR were 51.9 ± 30.5 mL/min per 1.73 m2 and 853.2 ± 1,330.3 mg/g, respectively. Anemia was present in 644 patients (40.5%. Multivariate analysis showed that the odds ratio of anemia increased according to ACR levels, after adjusting for age, sex, eGFR, body mass index, pulse pressure, cause of CKD, use of erythropoiesis stimulating agents, serum calcium and ferritin (ACR < 30 mg/g as a reference group; 30-299 mg/g, adjusted odds ratio (OR = 1.43, 95% confidence interval (CI = 0.88-2.33; ≥300 mg/g, adjusted OR = 1.86, 95% CI = 1.12-3.10. In addition, graded associations were observed in cross-categorized groups of a higher ACR and eGFR compared to the reference group with an ACR <30 mg/g and eGFR ≥60 mL/min per 1.73 m2.The present study demonstrated that albuminuria was a significant risk factor for anemia in CKD patients independent of the eGFR.

  12. Advances in the application of direct renin inhibitors (DRI) aliskiren to chronic kidney disease (CKD)%直接肾素抑制剂(DRI)阿利吉仑在慢性肾脏疾病(CKD)中的应用进展

    Institute of Scientific and Technical Information of China (English)

    韩蕊

    2012-01-01

    肾素一血管紧张素系统(renin-angiotensin system,RAS)在慢性肾脏疾病(chronic kidney disease,CKD)的发生、发展过程中起重要作用,目前广泛应用的RAS抑制剂血管紧张素转化酶抑制剂(angiotensin converting enzyme inhibitor,ACEI)和血管紧张素受体阻断剂(angiotensin receptor blocker,ARB)类药物不足以完全阻断肾脏局部的RAS激活.近年来研发成功的直接肾素抑制剂(direct renin inhibitor,DRI)阿利吉仑为更有效地阻断RAS系统提供了新的选择,许多基础和临床研究均证实了DRI在保护肾功能方面的独特优势,且耐受性好、安全性高,本文就这些研究作一综述.%Renin-angiotensin system (RAS) plays an important role in the development of chronic kidney disease (CKD). Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) which have been commonly used in clinical practice do not result in complete suppression of the RAS. Aliskiren, a direct renin inhibitor (DRI) , offers a new and novel approach to inhibit the RAS in chronic kidney disease. Many basic and clinical studies have proved that aliskiren is superior in protecting the renal function than ARBs or ACEIs. And aliskiren has higher safety and better tolerability. The focus of this review is to discuss recent researches about aliskiren on the prevention and management of chronic kidney disease.

  13. Calciphylaxis: Beyond CKD-MBD.

    Science.gov (United States)

    Fernández, María; Morales, Enrique; Gutierrez, Eduardo; Polanco, Natalia; Hernández, Eduardo; Mérida, Eva; Praga, Manuel

    2017-04-05

    Calcific uraemic arteriolopathy (CUA), also called calciphylaxis, is a rare but potentially fatal vascular disorder that almost exclusively affects patients with chronic renal failure. The objective of this study was to analyse various risk factors for developing CUA and its subsequent clinical course according to the treatment received. A retrospective study that included patients diagnosed with CUA from December 1999 to December 2015. Various risk factors, clinical course and treatment options were analysed. A total of 28 patients (53.6% females) with a mean age of 67.2±11.8 (38-88) years were included. At the time of diagnosis, 53.6% were on haemodialysis, 25% were kidney transplant patients and 21.4% had normal renal function. The use of steroids (100%, P=.001) was the main risk factor in renal transplant patients. Skin lesions resolved in 60.7% (especially in those receiving multitargeted therapy). Patient survival at 12 months was 29% in transplant patients, 57% in haemodialysis patients and 100% in normal renal function patients (log-rank 6.88, P=.032). Chronic renal failure (P=.03) and hypoalbuminaemia (P=.02) were the main risk factor for CUA mortality. Although the incidence of CUA remains low, CUA mortality is very high, Special attention to its occurrence in kidney transplant patients and «non-renal» CUA forms is required. Oral anticoagulants and steroids appear to be the main risk factors, CUA is a challenge; a registry of patients and determining standard therapy are required. Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  14. Comparing the association of GFR estimated by the CKD-EPI and MDRD study equations and mortality: the third national health and nutrition examination survey (NHANES III

    Directory of Open Access Journals (Sweden)

    Shafi Tariq

    2012-06-01

    Full Text Available Abstract Background The Chronic Kidney Disease Epidemiology Collaboration equation for estimation of glomerular filtration rate (eGFRCKD-EPI improves GFR estimation compared with the Modification of Diet in Renal Disease Study equation (eGFRMDRD but its association with mortality in a nationally representative population sample in the US has not been studied. Methods We examined the association between eGFR and mortality among 16,010 participants of the Third National Health and Nutrition Examination Survey (NHANES III. Primary predictors were eGFRCKD-EPI and eGFRMDRD. Outcomes of interest were all-cause and cardiovascular disease (CVD mortality. Improvement in risk categorization with eGFRCKD-EPI was evaluated using adjusted relative hazard (HR and Net Reclassification Improvement (NRI. Results Overall, 26.9% of the population was reclassified to higher eGFR categories and 2.2% to lower eGFR categories by eGFRCKD-EPI, reducing the proportion of prevalent CKD classified as stage 3–5 from 45.6% to 28.8%. There were 3,620 deaths (1,540 from CVD during 215,082 person-years of follow-up (median, 14.3 years. Among those with eGFRMDRD 30–59 ml/min/1.73 m2, 19.4% were reclassified to eGFRCKD-EPI 60–89 ml/min/1.73 m2 and these individuals had a lower risk of all-cause mortality (adjusted HR, 0.53; 95% CI, 0.34-0.84 and CVD mortality (adjusted HR, 0.51; 95% CI, 0.27-0.96 compared with those not reclassified. Among those with eGFRMDRD >60 ml/min/1.73 m2, 0.5% were reclassified to lower eGFRCKD-EPI and these individuals had a higher risk of all-cause (adjusted HR, 1.31; 95% CI, 1.01-1.69 and CVD (adjusted HR, 1.42; 95% CI, 1.01-1.99 mortality compared with those not reclassified. Risk prediction improved with eGFRCKD-EPI; NRI was 0.21 for all-cause mortality (p  Conclusions eGFRCKD-EPI categories improve mortality risk stratification of individuals in the US population. If eGFRCKD-EPI replaces eGFRMDRD in the US, it will likely

  15. 慢性肾脏病流行合作方程在老年慢性肾脏病患者中的适用性评价%Validation of the CKD-EPI equation in elderly patients with chronic kidney disease

    Institute of Scientific and Technical Information of China (English)

    李江涛; 蒋晓峰; 崔春黎; 王慧芳; 吴毅泰; 原爱红; 黄洁丽; 马骏

    2011-01-01

    Objective To compare the performance of the newly developed chronic kidney disease epidemiology collaboration (CKD-EPI) equation and the abbreviated MDRD equation in elderly patients with Chronic kidney disease (CKD). Methods 194 CKD patients with age ≥65 years were enrolled (100 women and 94 men) in the present study. We used the renal dynamic imaging method to measure the GFR and estimated the GFR with the new CKD-EPI equation and the abbreviated MDRD equation.99mTc-GFR was used as a reference standard GFR (Rgfr) for the comparison between the two equations. The overall performances of the two equations were assessed with the Bland-Altman method. Performance in bias, precision and accuracy of the two equations in subgroups were further investigated, [subgroups was defined by Rgfr, the level of Rgfr was categorized as Rgfr≥60 or 0.05). Similar results were observed in the group with a Rgfr 60 Ml·min' -(1.73 m2)'. For group with a Rgfr 0.05); (2)高rGFR组,CKD-EPI方程估测GFR的偏差[1.2mL·min-1·(1.73m2)-1vs-5.3mL·min-1·(1.73m2)-1 P0.05),(3)低rGFR组:二方程估测GFR的偏差、精确度及准确性相当.结论 相对简化MDRD方程而言,CKD-EPI方程在总体和高GFR老年CKD人群中的适用性均有不同程度改善.因此,CKD-EPI方程可作为评估老年CKD患者GFR的首选方程.

  16. Comparación entre las ecuaciones CKD-EPI y MDRD para la estimación del filtrado glomerular en pacientes con enfermedad renal crónica

    Directory of Open Access Journals (Sweden)

    Guillermo J. Rosa-Diez

    2011-08-01

    Full Text Available La ecuación MDRD para la estimación del índice de filtrado glomerular (IFG, es la estrategia más utilizada para evaluar pacientes con enfermedad renal crónica (ERC. Sin embargo, puede subestimar el IFG con el riesgo de asignar al paciente a estadios más avanzados de ERC. La nueva ecuación CKD-EPI, mejoraría la exactitud y precisión de las estimaciones. Sus autores sugieren que reemplace a la anterior. No habiendo comparaciones de estas ecuaciones aplicadas en un gran número de pacientes en nuestro país, nuestro objetivo fue realizarla en una amplia cohorte de pacientes. Se evaluó la concordancia de asignación en estadios de ERC entre ambas ecuaciones, tomando como referencia los datos surgidos de MDRD. Se calculó la media de las diferencias de los IFG obtenidos empleando ambas ecuaciones y se aplicó el análisis estadístico de Bland-Altman. Se estudió una cohorte de 9 319 pacientes con una media de creatinina sérica de 1.60 ± 1.03 mg/dl, 67% de sexo femenino y edad media 58 ± 20 años. En el grupo total, CKD-EPI presentó una media de IFG 0.61 ml/min/1.73 m² mayor que MDRD (p: NS. En los estadios 2 y 3A las medias del IFG fueron respectivamente 6.95 ± 4.76 y 3.21 ± 3.31, y la concordancia de 81 y 74%. El porcentaje de pacientes con un IFG menor de 60 ml/min/1.73 m², se redujo de 76.3% (MDRD a 70.1% (CKD-EPI. Por lo tanto, la nueva ecuación CKD-EPI disminuye el número de pacientes con IFG debajo de 60 ml/min/1.73 m² y asigna estadios de IFG más elevado a un número mayor de pacientes.

  17. Diffusion coefficient distribution from NMR-DOSY experiments using Hopfield neural network

    Science.gov (United States)

    Sebastião, Rita C. O.; Pacheco, Carlos N.; Braga, J. P.; Piló-Veloso, Dorila

    2006-09-01

    Diffusion ordered spectroscopy (DOSY) is a powerful two-dimensional NMR method to study molecular translation in various systems. The diffusion coefficients are usually retrieved, at each frequency, from a fit procedure on the experimental data, considering a unique coefficient for each molecule or mixture. However, the fit can be improved if one regards the decaying curve as a multiexponential function and the diffusion coefficient as a distribution. This work presents a computer code based on the Hopfield neural network to invert the data. One small-molecule binary mixture with close diffusion coefficients is treated with this approach, demonstrating the effectiveness of the method.

  18. A linear first-order hyperbolic equation with discontinuous coefficient: distributional shadows and propagation of singularities

    Directory of Open Access Journals (Sweden)

    Hideo Deguchi

    2011-06-01

    Full Text Available It is well-known that distributional solutions to the Cauchy problem for $u_t + (b(t,xu_{x} = 0$ with $b(t,x = 2H(x-t$, where H is the Heaviside function, are non-unique. However, it has a unique generalized solution in the sense of Colombeau. The relationship between its generalized solutions and distributional solutions is established. Moreover, the propagation of singularities is studied.

  19. Parathyroidectomy and serum leptin levels in stage 5 CKD patients%慢性肾脏病5期患者血清瘦素水平及甲状旁腺切除术的影响

    Institute of Scientific and Technical Information of China (English)

    张晶晶; 柏建岭; 张丽娜; 程晨; 杨光; 崔一尧; 曾鸣; 葛益飞; 孙彬

    2014-01-01

    目的:探讨慢性肾脏病(chronic kidney disease,CKD)5期患者血清瘦素变化以及与临床和血生化指标的关系,评估严重继发性甲状旁腺功能亢进患者行甲状旁腺切除术(parathyroidectomy,PTX)对上述指标的影响.方法:对1 13例CKD 5期患者和76例健康人进行横断面研究,并对PTX成功组(n=23)和PTX失败组(n=4)进行随访,记录其临床特征、血生化及血清瘦素水平.结果:在健康男性人群,血清瘦素水平与年龄和体质指数(body mass index,BMI)呈正相关,与血白蛋白(albumin,Alb)水平呈负相关;健康女性中,血清瘦素水平与BMI呈正相关.与健康人相比,CKD患者血清瘦素水平无明显差异.男性患者血清瘦素与BMI、血糖、甘油三酯(triglyceride,TG)和Alb呈正相关,与高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)和甲状旁腺激素(intact parathyroid hormone,iPTH)负相关;女性患者血清瘦素与BMI、血红蛋白(hemoglobin,Hb)、红细胞压积(hematocrit,Hct)和TG正相关,与HDL-C负相关.PTX成功组术后血瘦素升高值与增高的体重、Hb、Hct以及下降的血iPTH值呈正相关,手术未成功组无上述变化.结论:CKD 5期患者血清瘦素水平与健康人无差异,但与患者异常的骨矿物质代谢、造血和营养有关,成功的PTX使血清瘦素升高并与上述指标改善相关.

  20. Status and Method of Epidemiological Survey on Hematuria and Its Influence on Prognosis in CKD%血尿流行病学调查的现状和方法及其对肾病预后的影响

    Institute of Scientific and Technical Information of China (English)

    尹道馨; 王梅

    2011-01-01

    近年来终末期肾病(ESRD)呈现出上升趋势,我国ESRD的病因构成仍以慢性肾小球肾炎为首.部分单纯血尿患者病情可进展成蛋白尿和(或)肾功能不全.本文对慢性肾脏病(CKD)筛查中血尿的筛查方法、患病率及单纯血尿对肾病的影响进行综述.%The incidence and the prevalence of the end stage of renal disease ( ESRD ) is increasing. In China, the leading cause of ESRD is glomerulonephritis. Some studies suggested a part of isolated hematuria patients developed proteinuria or/and renal dysfuction. This paper reviews the advances in hematuria screening and the progression of isolated hematuria.

  1. Efficacy and safety of two fixed-dose combinations of S-amlodipine and telmisartan (CKD-828 versus S-amlodipine monotherapy in patients with hypertension inadequately controlled using S-amlodipine monotherapy: an 8-week, multicenter, randomized, double-blind, Phase III clinical study

    Directory of Open Access Journals (Sweden)

    Ihm SH

    2016-11-01

    Full Text Available Sang-Hyun Ihm,1 Hui-Kyung Jeon,1 Tae-Joon Cha,2 Taek-Jong Hong,3 Sang-Hyun Kim,4 Nae-Hee Lee,5 Jung Han Yoon,6 Namsik Yoon,7 Kyung-Kuk Hwang,8 Sang-Ho Jo,9 Ho-Joong Youn1 1Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, Seoul, 2Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, 3Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, 4Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, 5Department of Cardiology, Soonchunhyang University Hospital, Bucheon, 6Division of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, 7Department of Cardiology, Chonnam National University Hospital, Gwangju, 8Department of Internal Medicine, Chungbuk National University, College of Medicine, Cheongju, 9Division of Cardiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea Purpose: To evaluate the blood pressure (BP lowering efficacy and safety of CKD-828, a fixed-dose combination of S-amlodipine (the more active isomer of amlodipine besylate, which is calcium channel blocker and telmisartan (long acting angiotensin receptor blocker, in patients with hypertension inadequately controlled with S-amlodipine monotherapy.Patients and methods: Eligible patients (N=187 who failed to respond after 4-week S-amlodipine 2.5 mg monotherapy (sitting diastolic blood pressure [sitDBP] ≥90 mmHg to receive CKD-828 2.5/40 mg (n=63, CKD-828 2.5/80 mg (n=63, or S-amlodipine 2.5 mg (n=61 for 8 weeks. The primary efficacy endpoint, mean sitDBP change from baseline to Week 8, was compared between the combination (CKD-828 2.5/40 mg and CKD-828 2.5/80 mg and S-amlodipine monotherapy groups. The safety was assessed based on adverse events, vital signs, and physical examination findings.Results: After the 8

  2. 慢性肾脏病患者蛋白-能量消耗发生机制及干预的研究进展%Progress of research on pathogenesis and intervention of PEW in patients with CKD

    Institute of Scientific and Technical Information of China (English)

    王玲; 袁伟杰

    2014-01-01

    Patients with chronic kidney disease (CKD)are often associated with different levels of protein-energy wasting (PEW)whose main clinical manifestation is skeletal muscle atrophy,which can increase the risk of complications and mortality.The pathogenesis of PEW is multifactorial.Previous studies suggested that loss of appetite,activation of the ubiquitin-proteasome system,and damage to the insulin/insulin-like growth factor l/phosphatidylinositol kinase /protein kinase B pathway were the main cause of muscle atrophy.With a lot of in-depth studies being finished in recent years,it has been found that inflammation,metabolic acidosis,hormone metabolism disorder,and myostatin expression increase also played important roles in the development and progress of muscle atrophy.At present,effective treatment for PEW is to add nutrients to ensure adequate intake of calories and protein.In addition,exercise,correction of metabolic acidosis,and improvement of inflammation in time also play roles in prevention and treatment of skeletal muscle atrophy in patients with CKD.Use of short-term hormone drugs can improve the body′s protein storage,which lacks long-term researches on its efficacy and safety.It is still in the research stage to effectively block the catabolic pathways of skeletal muscle atrophy by targeting the ubiquitin proteasome system and myostatin signaling pathway,etc.A large number of experimental studies are still needed to explore effective measures for the prevention or treatment of PEW in patients with CKD.%慢性肾脏病(CKD)患者常伴有不同程度的蛋白-能量消耗(PEW),主要临床表现为骨骼肌萎缩,可增加患者并发症和死亡风险。PEW 的发病机制是多因素的。研究认为食欲减退、泛素-蛋白酶体系(UPS)活化及细胞内胰岛素/胰岛素样生长因子-1(IGF-1)/磷脂酰肌醇激酶(P13K)/蛋白激酶 B 信号通路受损是导致肌萎缩的主要原因。然而随着近年大量

  3. Impact of creatinine production on the agreement between glomerular filtration rate estimates using cystatin C-derived, and 4- and 6-variable Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations

    Science.gov (United States)

    Hermida-Cadahia, Esperanza F.; Lampon, Natalia

    2012-01-01

    Background. It has recently been reported that patient selection has a strong impact on the agreement between glomerular filtration rate (GFR) estimates from serum cystatin C and creatinine. The aim of our study was to evaluate the effect of creatinine production rate (CPR) on this subject. Material and methods. GFR was estimated from serum cystatin C and from creatinine using the 4- and 6-variable Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in 50 healthy subjects, 43 patients with renal failure, 794 kidney and 104 liver transplant recipients, 61 patients with heart failure, 59 patients with biliary obstruction, and 113 critically ill patients. Results. In the 295 patients with impaired CPR ( 900 mg/24 h/1.73 m2), greater discordances than 40% between GFRMDRD4 and GFRcystatinC were observed in 8% of cases, between GFRMDRD6 and GFRcystatinC in 9%, and between GFRCKD-EPI and GFRcystatinC in 7% (in the major part of cases due to GFR overestimation from cystatin C). Conclusion. The main source of differences of more than 40% between GFR estimates from serum creatinine and cystatin C is a GFR overestimation in patients with low CPR and GFR underestimation in patients with high CPR by the creatinine-derived equations. PMID:22746300

  4. 肾小球固有细胞模型在糖尿病慢性肾脏疾病中的研究进展%Glomerular cell models and their application in the studies on chronic kidney disease in diabetes (CKD)

    Institute of Scientific and Technical Information of China (English)

    逄冰; 赵林华; 郭允; 刘阳; 仝小林

    2013-01-01

    Chronic kidney disease in diabetes (CKD) is the main complication of diabetes and the main cause of death of diabetics. The cell model of diabetic nephropathy is an important tool for the studies on its pathogenesis, intervening measures, and treatment methods. At present, the cell models established included mainly three kinds: the models of glomeruli endothelial cells, podocytes, and glomeruli mesangial cells.%糖尿病慢性肾脏疾病(CKD)是糖尿病的主要并发症之一,也是糖尿病致死的主要原因之一.CKD细胞模型是研究其发病机制、干预措施及治疗方法的重要工具,目前建立的细胞模型,主要为肾小球内皮细胞、肾小球足细胞、肾小球系膜细胞3类.

  5. 肌肉特异性糖皮质激素受体基因敲除对慢性肾脏病骨骼肌消耗的影响%Muscle specific glucocorticoids receptor gene knockout rescue muscle atrophy induced by CKD

    Institute of Scientific and Technical Information of China (English)

    王会玲; 丁婷婷; 许烨; 张金元

    2012-01-01

    Objective: The endogenous glucocorticoids ( GC) is required for activation of muscle protein degradation in chronic kidney disease (CKD) related protein energy wasting. We studied the muscle wasting in a muscle specific glucocorticoids receptor knockout mouse ( MGRKO) with CKD model. We hypothesis the MGRKO could suppress muscle atrophy. Methodology: MGRKO and lox/lox mice CKD model was made by 5/6 nephroctomy, and the sham was regarded as control (CTL). The serum corticosteroid hormone was measured by ELISA. The bodyweight and Tibia Anterior (TA) muscle weight were measured. The TA muscle size of was observed under microscope and calculated with software. The expression of Atrogin-1 ( Muscle Atrophy Fbox-1) and MuRF-1 ( Muscle RING finger 1) was measured by Q-PCR and western blot. We also analyzed the signaling pathway of Akt/FoxOl. Results: The levels of serum BUN and corticosteroids were increased dramatically in lox/lox-CKD and MGRKO-CKD, but no differences between two groups. The bodyweight and TA muscle weight in the lox/lox-CKD was lower than that in the lox/lox- CTL L; but no difference between the MGKO-CTL and MGKO-CKD. The cross-sectional area of muscle fibers in the MGRKO-CKD was smaller, and the shrinkages of fibers sizes caused leftward shift in fiber size distribution was obvious in lox/lox-CKD, but only mild change in ' MGRKO + CKD mice's muscle. The level of Atrogin-1 and MuRF-1 was increased dramatically, and the Akt/FoxOlsignaling pathway was abnormal which showed the level of phosphorylated Akt/FoxOl repressive simultaneously in lox/lox-CKD (P< 0.001). Whereas, the Atrogin-1 mRNA showed a mild higher ( P < 0. 05 ), the MuRF-1 mRNA 'showed no difference, and the Akt/FoxOl signaling abnormal was unconspicuous in the MGKO-CKD, which showed suppresses insulin/ IGF-1 stimulation of Akt/FoxOl activities. The MGRKO could resist to this abnormal, hence, ameliorate CKD induced muscle wasting. Conclusion: Endogenous Glucocorticoids ( GC) may play an

  6. 慢性肾脏病(CKD4期)中医证治方案临床研究%Clinical Research on TCM Treatment of Chronic Kidney Disease in Ⅳ Stage

    Institute of Scientific and Technical Information of China (English)

    范军; 车树强

    2012-01-01

    Objective: To observe the clinical effect of series of prescription and acupuncture on chronic kidney disease in Ⅳ stage and to work out the therapy with characteristic of Chinese medicine. Methods: One hundred and twenty patients were randomly divided into two groups: treated group(60 cases) and controlled group(60 cases). The patients of two groups were received the same basic treatment. Treated group was given treantment with Shenshuai series of prescription and acupuncture;controlled group was given treantment with Niaoduqing granule. The treatment course was eight weeks,there were three courses in two groups. The diversification of symptom in both of two groups before and after treatment was observed. The diversification of the data about liver and kidney function,the proteinuria numbers of 24hours,trace protein,total cholesterol, total riglyceride,high density lipoprotein hemoglobin and hemorheology were observed and compared. Meanwhile we assessed the treating effects. Results: There was evident effect in treated group. The total effective rate was 93. 3% in treated group.it was better than that in the controlled group(46. 7% ) (P <0. 05 ). Meanwhile treated group can not only obviously improve clinical symptoms and enhance glomerular filtration rate but also decline blood urine nitrogen serum dreatinine.the proteinuria numbers of 24hours,trace protein,Total cholesterol,total riglyceride, high density lipoprotein, Hemoglobin, Hemorheology. There was statistical difference not only before and after treatment ( P <0. 05) but also between two groups(P<0. 05). Conclusion:Through the results of clinical research we can conclute that Chinese treating therapy can effectively treat patients of chronic kidney disease in Ⅳ stage. The treatment effects and safety of Chinese treating therapy are fine, it is worthy of in-depth study and clinical application.%目的:观察肾衰系列方配合针刺治疗慢性肾脏病(CKD4期)的疗效;制订体现中医特色的

  7. A review of albumin binding in CKD.

    Science.gov (United States)

    Meijers, Björn K I; Bammens, Bert; Verbeke, Kristin; Evenepoel, Pieter

    2008-05-01

    Hypoalbuminemia is associated with excess mortality in patients with kidney disease. Albumin is an important oxidant scavenger and an abundant carrier protein for numerous endogenous and exogenous compounds. Several specific binding sites for anionic, neutral, and cationic ligands were described. Overall, the extent of binding depends on the ligand and albumin concentration, albumin-binding affinity, and presence of competing ligands. Chronic kidney disease affects all these determinants. This may result in altered pharmacokinetics and increased risk of toxicity. Renal clearance of albumin-bound solutes mainly depends on tubular clearance. Dialytic clearance by means of conventional hemodialysis/hemofiltration and peritoneal dialysis is limited. Other epuration techniques combining hemodialysis with adsorption have been developed. However, the benefit of these techniques remains to be proved.

  8. Micardis可有效治疗CKD

    Institute of Scientific and Technical Information of China (English)

    王吉云(摘)

    2005-01-01

    ESPRIT(替米沙坦治疗肾功能不全患者的有效性和安全性)试验是一项公开标签的多中心临床研究。人选82名轻、中度高血压[舒张压(DBP)在90—109mmHg之间]合并CKD(慢性肾病)的患者,旨在评价药物的降压疗效和对肾功能的影响,以及药物的耐受性。

  9. Integrating guidelines, CKD, multimorbidity, and older adults.

    Science.gov (United States)

    Stevens, Paul E; Lamb, Edmund J; Levin, Adeera

    2015-03-01

    Clinical practice guidelines provide guidance in decision making relating to diagnosis, management, and treatment in specific areas of health care. They play an essential role in the evaluation and synthesis of an ever-expanding evidence base and are of increasing importance in aging societies with a high prevalence of overlapping disease comorbid conditions. Integration of chronic disease guidance is essential, particularly in older people, in order to understand critical disease interactions and the potential adverse effects that individual guideline statements may engender in different disease areas. This requires a need for flexibility that not only recognizes the differences in patients' characteristics, but also their preferences for medical interventions and health outcomes. The question is how this can be achieved. In this article, we look at the standardization of clinical practice guidelines from the chronic kidney disease standpoint and consider how tools for integrating guidelines, such as the ADAPTE process and the knowledge-to-action cycle, can be used to guide appropriate decision making and take account of patient choice in older adults with multimorbidity.

  10. Effects of Outpatient Nursing Management Mode on uality of Life of Patients With CKD%门诊护理管理模式对慢性肾脏病患者进入肾替代治疗时间的影响

    Institute of Scientific and Technical Information of China (English)

    陈慧; 刘静梅; 李雪莲; 王春燕

    2016-01-01

    Objective Study the outpatient nursing management model is established to chronic kidney disease ( Chronic kidney diseases, Chronic kidney disease ( CKD) ) in renal replacement therapy in patients with time. Methods The object of study for a September 2013 to April 2011 in Mianyang, sichuan 4 0 4 hospital diagnosed with chronic kidney disease stage 3 kidney disease clin-ics, 120 cases of patients with chronic kidney disease (CKD) (each patient in renal replacement therapy (in CKD stage 5) stop re-search) , were randomly divided into experimental group and control group. Experimental group kidney disease outpatient management system of the education and management, the control group by outpatient doctor make a diagnosis and give treatment and health educa-tion. In renal replacement therapy in patients with two groups of time. Results Into the renal replacement therapy group 16. 39±4. 54, 11. 16±3. 04 control group, the difference is significant(P<0. 05). Conclusion Build into patients with chronic kidney disease out-patient nursing management mode can delay the time of renal replacement therapy, so as to slow disease progression.%目的:研究建立门诊护理管理模式对慢性肾脏病( Chronic kidney disease, CKD)患者进入肾替代治疗时间的影响。方法对2011年至2013年四川绵阳四○四医院肾脏病门诊确诊为慢性肾脏病第3期以上CKD患者120例,随机分为实验组和对照组。实验组由肾脏病门诊管理小组进行系统的教育和管理,对照组由门诊医生进行诊治和健康教育。对两组患者的进入肾替代治疗时间进行比较。结果进入肾替代治疗时间实验组16.39±4.54月,对照组11.16±3.04月,差异有统计学意义(P<0.05)。结论建立慢性肾脏病门诊护理管理模式可以提高患者依从性,从而延缓患者进入肾替代治疗时间,延缓疾病进展。

  11. Early Detection of Malnutritional Status in Non-dialysis CKD Patients by Bioimpedance Analysis%生物电阻抗法人体成分测量对慢性肾脏病非透析患者营养状态评估

    Institute of Scientific and Technical Information of China (English)

    高春娟; 崔俊; 王好; 龚德华; 季大玺

    2011-01-01

    Objective:To explore the role of bioimpedance analysis ( BIA ) in assessing nutritional status in non - dialysis patients with chronic kidney disease ( CKD ). Methods: According to the CKD classification criteria, 64 non - diabetic patients with CKD stage 2 to 4 due to primary glomerulonephritis were included in the study. Exclusion criteria was overt proteinuria, hematuria, requiring erythropoietin or immunosuppressant treatment, being fever, bleeding, steroid treatment within one month prior to enrollment. BIA, direct anthropometric measurements and blood biochemical test was used to assess the nutritional status of these patients. Results: According to body mass index ( BMI ), 11 % of the patients were below normal. Blood biochemical test showed that no one of the patients had a level of serum albumin, pre - albumin, globumin, cholesterol below normal. , the percentage of patients with level of total protein, transferring, hemoglobin, triglyceride below normal was 2% ,2% ,17% and 2% , respectively. BIA showed that 52% patients had lean weight below normal; 86% patients had dry lean weight below normal. BIA detected significantly more patients below normal than other methods. Conclusion: BIA is a non - invasive and reproducible convenient method being able to earlier detect malnutrition status in non - diabetic CKD patients than standard methods.%目的:探讨生物电阻抗法人体成分测量在评价慢性肾脏病非透析患者营养状态中的作用.方法:选取门诊随访的原发病为肾小球肾炎的慢性肾脏病2~4期患者64例,排除糖尿病、大量蛋白尿、血尿、需要促红细胞生成素或免疫抑制剂治疗,以及近1月内有发热、消化道出血、使用类固醇激素者,采用人体生物电阻抗法人体成分测量、体重指数(BMI)和实验室检查等指标评价患者营养状态.结果:BMI显示11%的患者存在营养不良;实验室检查白蛋白均在正常范围内,球蛋白、前白蛋白与胆固醇均

  12. 肌酐实验室分析变异对估算肾小球滤过率及慢性肾脏病分期的影响%Effects of analytic variations in creatinine measurement on estimated glomerular filtration rate and the classification of CKD

    Institute of Scientific and Technical Information of China (English)

    史德宝; 吕礼应

    2016-01-01

    目的:探讨血清肌酐(sCr)实验室分析变异对估算肾小球滤过率(eGFR)及慢性肾脏病(CKD)分期的影响。方法收集就诊并检测 sCr 者,年龄20~89岁,sCr 介于参考区间上限(URL)±12%×URL 之间的人群共13157例,其中男9886例,女3271例。将 sCr 检测结果分别递增或递减4%、8%、12%及原始结果,共分为7组,观察不同程度 sCr实验室分析变异对 eGFR 及 CKD 分期的影响。结果sCr在 URL ±12%URL 范围内,随着年龄的增加,sCr 呈上升趋势;而 eGFR 随着年龄的增加而逐渐降低(P <0.05)。 eGFR结果较原始结果的平均偏倚随着 sCr 检测结果的实验室变异增大而增大,sCr 检测结果负向偏倚12%时,eGFR 结果的正向偏倚达16.73%。当 sCr 结果正向偏倚达12%时,男性患者 CKD 分期 G3期(eGFR 在30~59 ml/min/1.73 m 2)所占比例可增加20%,而女性患者可增加近30%;当 sCr 负偏倚达12%时,女性 G3期患者所占比例由38.56%减少至10.42%,而男性患者则减少近7%。结论sCr 实验室分析变异在允许范围内的改变,即可引起 eGFR 较大的偏倚,从而导致患者 CKD 分期的改变,eGFR 的正确报告关键在于sCr 的准确检测。%Objective To evaluate the effects of analytic variations in creatintine measurements on estimated glo -merular filtration rate (eGFR) and the classification of chronic kidney disease ( CKD).Methods A total of 13 157 patients, including inpatients, outpatients and health individual , were enrolled, whose creatinine range from upper reference limit (URL) -12% ×URL to URL +12% ×URL.There were 9 886 males and 3 271 fe-males with an age range of 20 ~89 years.The results of sCr incremented or decremented 4%, 8%, 12% and orig-inal results were divided into 7 groups.The effects of different degree of analytic variation in sCr measurement on eGFR and classification of CKD using eGFR were

  13. 成纤维细胞生长因子-23与慢性肾病患者钙磷代谢的相关性研究%The Relationship Between Serum Level of Fibroblast Growth Factor 23 and Phosphorus and Calcium Metabolism in CKD Patients

    Institute of Scientific and Technical Information of China (English)

    江蕾; 简桂花; 汪年松; 李青; 薛勤; 陈海冰; 高许萍; 贾伟平

    2011-01-01

    Objective:To determine the serum level of fibroblast growth factor 23( FGF -23 ) in CKD patients and explore the relationship bewteen FGF - 23 and phosphorus and calcium metabloism. Methods: Serum FGF - 23 level was determined by enzyme - linked immunosorbent assay( ELISA ) in CKD patients and twenty healthy controls. The levels of serum iPTH and 25( OH )D3 were measured by radioimmunology. At the same time, some other paremeters including serun creatinine, calcium, phosphorus, albumin, hemoglobin and c -reactive protein were measured in patients and healthy volunteers. Results :( 1 )The levels of serum FGF -23 in CKD group were significantly higher than that in normal controls( P < 0.01 ). ( 2 )In non - dialysis group, the level of serum FGF - 23 by Pearson relativity analysis was significantly correlated positively with intact parathomone( r= 0.619 ,P < 0.01 ), calcium - phosphorus product product( r= 0.533,P < 0.01 ), albumin( r= 0.312, P < 0.05 ) and c - reactive protein( r= 0.306,P < 0.05 ). The level of serum FGF -23 by Pearson relativity analysis was significantly correlated negatively with serum phosphorus( r= -0.621, P <0.01 ), corrected calcium( r= - 0.415, P < 0.01 ), eGFR( r= - 0.602, P < 0.01 ) and hemoglobin( r= - 0.628, P < 0.01 ) in non -dialysis group. In MHD group, the level of serum FGF -23 by Pearson relativity analysis was significantly correlated positively with intact parathormone( r= 0.390, P < 0.01 ) and c - reactive protein( r= 0.458,P < 0.01 ). In non - dialysis group, serum phosphorus, intact parathormone and creatinine clearance rate were found to be three variables independently that influence the level of serum FGF - 23 by multiple regression model. ( 3 )The regression equation is as follow: Y( FGF - 23 ) = 1.700 + 0.106( P ) + 0.048( LogPTH ) - 0.003( Ccr ). In MHD group, intact parathormone and c - reactive protein were significant variables that influenced the level of serum FGF- 23 in multiple regression

  14. 慢性肾脏病3~5期患者营养门诊复诊依从性及影响因素研究%Analysis of the follow-up compliance of patients with CKD stage 3-5 in the nutrition clinic

    Institute of Scientific and Technical Information of China (English)

    常立阳; 徐佳美; 张红梅

    2015-01-01

    目的:调查慢性肾脏病(Chronic Kidney Disease,CKD)3~5期患者营养门诊复诊依从性,分析其影响因素,以改进护理工作质量,更好地发挥饮食营养治疗在CKD患者康复中的作用.方法:回顾分析 2007年1月至2012年12月我院肾病营养门诊建档患者(468例)资料,总结其结局及复诊情况.用Logistic回归探索患者建档时的人口学资料、家庭支持、基础肾功能情况以及血清白蛋白水平对复诊依从性的影响;并对依从性差者的主观原因进行分析.结果:468例CKD3~5期患者中,仍在接受随访的213例患者资料纳入统计分析,年龄(47.16±13.79)岁,随访时间为(26.85±22.37)个月.其中复诊依从性好者64例,占30.05%.Logistic回归显示,家庭支持(OR=2.448,P<0.001)、建档时的eGFR(OR=0.638,P=0.038)和Alb(OR=0.932,P=0.043)纳入方程,家庭支持越高者,复诊依从性越好;eGFR和Alb与家庭支持呈负相关,建档时肾小球滤过率及血清白蛋白情况越差的患者,随访依从性相对越好.通过与依从性差者的沟通,得到8个影响复诊依从性的主题,可见依从性差的CKD患者缺乏饮食营养监测及长期管理意识.结论:CKD3~5期患者饮食营养门诊复诊依从性有待提高.护理工作中应加强家属教育,着重提高患者及家属的饮食管理和营养监测意识和家庭支持力度,并结合患者的肾功能和营养情况,分级分层管理,加强肾病饮食营养门诊在CKD患者管理中的作用,有效预防营养不良的发生.%Objective: To evaluate follow-up compliance of patients with CKD stage 3-5 in the nutrition clinic, and explore its related factors. Methods: The data of 468 patients with CKD stage 3-5 who got nutrition ifles created from January 2007 to December 2012 were retrospectively analyzed. Logistic regression was used to analyze the inlfuencing factors of follow-up compliance. Patients' demographic data, family support, baseline renal function and serum albumin level

  15. Comparison of the Antialbuminuric Effects of Benidipine and Hydrochlorothiazide in Renin-Angiotensin System (RAS) Inhibitor-Treated Hypertensive Patients with Albuminuria: the COSMO-CKD (COmbination Strategy on Renal Function of Benidipine or Diuretics TreatMent with RAS inhibitOrs in a Chronic Kidney Disease Hypertensive Population) Study

    Science.gov (United States)

    Ando, Katsuyuki; Nitta, Kosaku; Rakugi, Hiromi; Nishizawa, Yoshiki; Yokoyama, Hitoshi; Nakanishi, Takeshi; Kashihara, Naoki; Tomita, Kimio; Nangaku, Masaomi; Takahashi, Katsutoshi; Isshiki, Masashi; Shimosawa, Tatsuo; Fujita, Toshiro

    2014-01-01

    Objective: This study evaluated the non-inferiority of renoprotection afforded by benidipine versus hydrochlorothiazide in hypertensive patients with chronic kidney disease (CKD). Methods: In this prospective, multicenter, open-labeled, randomized trial, the antialbuminuric effects of benidipine and hydrochlorothiazide were examined in renin-angiotensin system (RAS) inhibitor-treated patients with blood pressure (BP) readings of ≥ 130/80 mmHg and ≤ 180/110 mmHg, a urinary albumin to creatinine ratio (UACR) of ≥ 300 mg/g, and an estimated glomerular filtration rate (eGFR) of ≥ 30 ml/min/1.73m2. Patients received benidipine (n = 176, final dose: 4.8 mg/day) or hydrochlorothiazide (n = 170, 8.2 mg/day) for 12 months. Results: Benidipine and hydrochlorothiazide exerted similar BP- and eGFR-decreasing actions. The UACR values for benidipine and hydrochlorothiazide were 930.8 (95% confidence interval: 826.1, 1048.7) and 883.1 (781.7, 997.7) mg/g at baseline, respectively. These values were reduced to 790.0 (668.1, 934.2) and 448.5 (372.9, 539.4) mg/g at last observation carried forward (LOCF) visits. The non-inferiority of benidipine versus hydrochlorothiazide was not demonstrated (benidipine/hydrochlorothiazide ratio of LOCF value adjusted for baseline: 1.67 (1.40, 1.99)). Conclusions: The present study failed to demonstrate the non-inferiority of the antialbuminuric effect of benidipine relative to that of hydrochlorothiazide in RAS inhibitor-treated hypertensive patients with macroalbuminuria. PMID:25013370

  16. 肾病生命网对慢性肾脏病1~3期患者健康行为的影响%Effects of the life net work of health education for CKD on health behavior in patients with 1 to 3 stage of chronic kidney diseases

    Institute of Scientific and Technical Information of China (English)

    谢素芸; 范丽红

    2014-01-01

    Objective To explore the effects of the life net work of health education on health behavior in patients with 1 to 3 stage of chronic kidney diseases ( CKD ) .Methods The study used an experimental design, and 98 patients were randomly allocated to the control group or the intervention group .The patients in the control group received routine nursing care .The patients in the intervention group received individual , systematic and continued CKD health education . The intervention time span was three months . Two questionnaires were used for data collection , which were a general information sheet of patients and health behavior questionnaire .Results Before the intervention , the health behaviors between groups had no significant differences (P>0.05).The average score on health behavior and the scores of healthy sense of responsibility , nutrition, interpersonal relations , physical activity , mental health and stress management of the control group were (149.31 ±5.68), (20.45 ±3.71), (27.87 ±7.56), (26.37 ±1.54), (24.54 ±3.58), (23.55 ± 7.21) and (28.35 ±4.82), respectively.Those scores of the control group were (97.54 ±2.85), (16.35 ± 5.11), (15.79 ±2.97), (17.82 ±4.98), (15.76 ±6.72),(12.39 ±2.18) and (19.37 ±1.14).There were significant differences between groups (P<0.01).Conclusions The life net work of health education for CKD patients can enhance patients ’ health behavior and then improve patients ’ quality of life .%目的:探讨通过肾病生命网健康教育对慢性肾脏病1~3期患者的健康行为的影响。方法将98例慢性肾脏病1~3期患者采用随机抽样法分为干预组48例和对照组50例,对照组患者采用一般健康教育,干预组患者进行个体性、系统性、连贯性、重复性的生命网健康教育。干预时间为3个月,干预前后采用个人一般资料调查表、健康行为量表进行问卷调查。结果干预前,两组患者的健康行为评分

  17. Comparison of two AC DCT coefficient distribution models%两种DCT交流系数分布模型的比较

    Institute of Scientific and Technical Information of China (English)

    孙水发; 潘翔; 仇佩亮

    2004-01-01

    针对离散余弦变换(DCT)系数分布模型类型存在的异议,研究并比较了拉普拉斯模型和广义高斯模型.对于给定的样本,利用最大似然法估计两种模型的参数,同时采用X2检验和KS检验对估计结果进行检验.检验时对样本数据进行了预处理,包括舍弃极少数严重偏离检验范围的奇异点和选取适当的样本划分精度.检验结果表明,广义高斯模型比拉普拉斯模型更准确地反映了DCT交流系数的分布.

  18. The relationship between multilevel models and non-parametric multilevel mixture models: Discrete approximation of intraclass correlation, random coefficient distributions, and residual heteroscedasticity.

    Science.gov (United States)

    Rights, Jason D; Sterba, Sonya K

    2016-11-01

    Multilevel data structures are common in the social sciences. Often, such nested data are analysed with multilevel models (MLMs) in which heterogeneity between clusters is modelled by continuously distributed random intercepts and/or slopes. Alternatively, the non-parametric multilevel regression mixture model (NPMM) can accommodate the same nested data structures through discrete latent class variation. The purpose of this article is to delineate analytic relationships between NPMM and MLM parameters that are useful for understanding the indirect interpretation of the NPMM as a non-parametric approximation of the MLM, with relaxed distributional assumptions. We define how seven standard and non-standard MLM specifications can be indirectly approximated by particular NPMM specifications. We provide formulas showing how the NPMM can serve as an approximation of the MLM in terms of intraclass correlation, random coefficient means and (co)variances, heteroscedasticity of residuals at level 1, and heteroscedasticity of residuals at level 2. Further, we discuss how these relationships can be useful in practice. The specific relationships are illustrated with simulated graphical demonstrations, and direct and indirect interpretations of NPMM classes are contrasted. We provide an R function to aid in implementing and visualizing an indirect interpretation of NPMM classes. An empirical example is presented and future directions are discussed. © 2016 The British Psychological Society.

  19. Stego-images Recognition Based on DCT Coefficients Distributing%基于DCT系数分布的含密图像识别算法

    Institute of Scientific and Technical Information of China (English)

    刘一均; 柴毅; 柏森; 郭茂耘

    2007-01-01

    A fast and effective stego-images recognition method based on statistical distributions of DCT coefficients is proposed.The approach can distinguish stego-image and cover-image.The method is tested on a diverse set of test images that include both raw and processed images in the JPEG and BMP formats.Experiment results show the superiority of our approach over other stego-images recognition techniques.%提出了一种基于DCT系数统计分布的含密图像(stego-images)和掩护图像(cover-images)的识别算法.实验表明:该算法能快速识别各种JPEG和BMP格式的基于变换域和空间域的含密图像和非含密图像,并且优于其他含密图像识别方法.

  20. Uranium-Radium Equilibrium Coefficient Distribution in Pingxiashui Area%坪下水地区铀矿石铀镭平衡系数变化特征

    Institute of Scientific and Technical Information of China (English)

    王家跃

    2014-01-01

    Uranium-radium equilibrium coefficient is an important parameter in uranium exploration. Correctly measuring and analyzing the parameter is significance to guide the uranium exploration and research of uranium metal ogenic regularity. Used of analyze data of dril core samples in PINGXIASHUI area analyzing distribution characteristics of U-Ra equilibrium coefficient that could providing references for uranium exploration in this area.%铀镭平衡系数是铀矿勘查的重要参数,正确测量、分析该参数,对指导铀矿勘查、研究铀成矿规律有重要意义,利用坪下水地区钻探岩矿心样品分析结果,综合分析研究该地区铀镭平衡系数分布特征,为坪下水地区今后铀矿勘查提供参考。

  1. Sodium: Tips for People with Chronic Kidney Disease (CKD)

    Science.gov (United States)

    ... l Fresh meat, poultry, seafood l Low-fat, low-sodium cheese l Unsalted nuts l Low- and reduced- ... for foods labeled: sodium free, salt free, very low sodium, low sodium, reduced or less sodium, light in ...

  2. Advance care planning in CKD/ESRD: an evolving process.

    Science.gov (United States)

    Holley, Jean L

    2012-06-01

    Advance care planning was historically considered to be simply the completion of a proxy (health care surrogate designation) or instruction (living will) directive that resulted from a conversation between a patient and his or her physician. We now know that advance care planning is a much more comprehensive and dynamic patient-centered process used by patients and families to strengthen relationships, achieve control over medical care, prepare for death, and clarify goals of care. Some advance directives, notably designated health care proxy documents, remain appropriate expressions of advance care planning. Moreover, although physician orders, such as do-not-resuscitate orders and Physician Orders for Life-Sustaining Treatment, may not be strictly defined as advance directives, their completion, when appropriate, is an integral component of advance care planning. The changing health circumstances and illness trajectory characteristic of ESRD mandate that advance care planning discussions adapt to a patient's situation and therefore must be readdressed at appropriate times and intervals. The options of withholding and withdrawing dialysis add ESRD-specific issues to advance care planning in this population and are events each nephrologist will at some time confront. Advance care planning is important throughout the spectrum of ESRD and is a part of nephrology practice that can be rewarding to nephrologists and beneficial to patients and their families.

  3. Qualitative research in CKD: an overview of methods and applications.

    Science.gov (United States)

    Tong, Allison; Winkelmayer, Wolfgang C; Craig, Jonathan C

    2014-09-01

    There recently has been a paradigm shift in health care policies and research toward greater patient centeredness. A core tenet of patient-centered care is that patients' needs, values, and preferences are respected in clinical decision making. Qualitative research methods are designed to generate insights about patients' priorities, values, and beliefs. However, in the past 5 years (2008-2013), only 23 (0.4%) of the 6,043 original articles published in the top 5 nephrology journals (assessed by impact factor) were qualitative studies. Given this observation, it seems important to promote awareness and better understanding within the nephrology community about qualitative research and how the findings can contribute to improving the quality and outcomes of care for patients with chronic kidney disease. This article outlines examples of how qualitative research can generate insight into the values and preferences of patients with chronic kidney disease, provides an overview of qualitative health research methods, and discusses practical applications for research, practice, and policy.

  4. Predicting hospital cost in CKD patients through blood chemistry values

    Directory of Open Access Journals (Sweden)

    Bessette Russell W

    2011-12-01

    Full Text Available Abstract Background Controversy exists in predicting costly hospitalization in patients with chronic kidney disease and co-morbid conditions. We therefore tested associations between serum chemistry values and the occurrence of in-patient hospital costs over a thirteen month study period. Secondarily, we derived a linear combination of variables to estimate probability of such occurrences in any patient. Method We calculated parsimonious values for select variables associated with in-patient hospitalization and compared sensitivity and specificity of these models to ordinal staging of renal disease. Data from 1104 de-identified patients which included 18 blood chemistry observations along with complete claims data for all medical expenses. We employed multivariable logistic regression for serum chemistry values significantly associated with in-patient hospital costs exceeding $3,000 in any single month and contrasted those results to other models by ROC area curves. Results The linear combination of weighted Z scores for parathyroid hormone, phosphorus, and albumin correlated with in-patient hospital care at p Conclusion Further study is justified to explore indices that predict costly hospitalization. Such metrics could assist Accountable Care Organizations in evaluating risk adjusted compensation for providers.

  5. Complications of Diabetes: Chronic Kidney Disease (CKD) and Diabetic Nephropathy

    OpenAIRE

    iyabet Dunyagoz Hospitals G

    2014-01-01

    Today, almost half of the patients who are on chronic kidney replacement therapy have diabetes. The enormous worldwide rise in these cases pose potential economic burden for every country and therefore monitoring kidney function should be a practice provided in outpatient settings. Poorly controlled diabetes will not only result in chronic renal failure, but also patients with chronic renal disease will have some metabolic abnormalities that will increase both morbidity and mortality of the p...

  6. CKD increases the risk of age-related macular degeneration.

    Science.gov (United States)

    Liew, Gerald; Mitchell, Paul; Wong, Tien Yin; Iyengar, Sudha K; Wang, Jie Jin

    2008-04-01

    Age-related macular degeneration is the leading cause of irreversible blindness in the United States and often coexists with chronic kidney disease. Both conditions share common genetic and environmental risk factors. A total of 1183 participants aged 54+ were examined in the population-based, prospective cohort Blue Mountains Eye Study (Australia) to determine if chronic kidney disease increases the risk of age-related macular degeneration. Moderate chronic kidney disease (estimated glomerular filtration rate macular degeneration was 3.9% in participants with no/mild chronic kidney disease (35 of 897) and 17.5% in those with moderate chronic kidney disease (50 of 286). After adjusting for age, sex, cigarette smoking, hypertension, complement factor H polymorphism, and other risk factors, persons with moderate chronic kidney disease were 3 times more likely to develop early age-related macular degeneration than persons with no/mild chronic kidney disease (odds ratio = 3.2; 95% confidence interval, 1.8 to 5.7, P macular degeneration (odds ratio = 2.0; 95% confidence interval, 1.5 to 2.8, P chronic kidney disease have a higher risk of early age-related macular degeneration, suggesting the possibility of shared pathophysiologic mechanisms between the two conditions.

  7. CKD Increases the Risk of Age-Related Macular Degeneration

    OpenAIRE

    Liew, Gerald; Mitchell, Paul; Wong, Tien Yin; Iyengar, Sudha K; Wang, Jie Jin

    2008-01-01

    Age-related macular degeneration is the leading cause of irreversible blindness in the United States and often coexists with chronic kidney disease. Both conditions share common genetic and environmental risk factors. A total of 1183 participants aged 54+ were examined in the population-based, prospective cohort Blue Mountains Eye Study (Australia) to determine if chronic kidney disease increases the risk of age-related macular degeneration. Moderate chronic kidney disease (estimated glomerul...

  8. Iron Treatment Strategies in Dialysis-Dependent CKD.

    Science.gov (United States)

    Pandey, Richa; Daloul, Reem; Coyne, Daniel W

    2016-03-01

    Iron deficiency is common in patients on chronic dialysis, and most require iron-replacement therapy. In addition to absolute iron deficiency, many patients have functional iron deficiency as shown by a suboptimal response to the use of erythropoietin-stimulating agents. Both absolute and functional iron-deficiency anemia have been shown to respond to intravenous (IV) iron replacement. Although parenteral iron is an efficacious method and superior to standard doses of oral iron in patients on hemodialysis, there are ongoing safety concerns about repeated exposure potentially enhancing infection risk and cardiovascular disease. Each IV iron product is composed of an iron core with a carbohydrate shell. The avidity of iron binding and the type of carbohydrate shell play roles in the safe maximal dose and the frequency and severity of acute infusion reactions. All IV iron products are taken up into the reticuloendothelial system where the shell is metabolized and the iron is stored within tissue ferritin or exported to circulating transferrin. IV iron can be given as large intermittent doses (loading therapy) or in smaller doses at frequent intervals (maintenance dosing regimen). Limited trial data and observational data suggest that a maintenance dosing regimen is more efficacious and possibly safer than loading therapy. There is no consensus regarding the preferred method of iron repletion in patients on peritoneal dialysis, although small studies comparing oral and parenteral iron regimens in these patients have shown the latter to be more efficacious. Use of IV iron in virtually all hemodialysis and many peritoneal dialysis patients remains the standard of care.

  9. Preventive and therapeutic effects of calcium polystyrene sulfonate on hyperkalemia caused by RAAS-Ⅰ in patients with CKD%聚苯乙烯磺酸钙对CKD患者RAAS-Ⅰ所致高钾血症的防治作用

    Institute of Scientific and Technical Information of China (English)

    梁建忠; 姚筱; 李宁

    2014-01-01

    目的:探讨聚苯乙烯磺酸钙对慢性肾脏病(CKD)患者服用肾素·血管紧张素·醛固酮系统抑制剂(RAAS-Ⅰ)所致高钾血症的防治作用.方法:选取73例已服用RAAS-Ⅰ制剂1个月的CKD患者,随机将其分为两组(观察组和对照组),观察组(37例)给予聚苯乙烯磺酸钙散剂;对照组(36例)未给予聚苯乙烯磺酸钙散剂,比较RAAS-Ⅰ服药前后血肌酐、血钾水平变化,并比较两组患者给聚苯乙烯磺酸钙后1、2、3、6、12个月血钾水平变化和高钾血症发生率.结果:RAAS-Ⅰ服药1个月后,24 h尿蛋白定量改善优于RAAS-Ⅰ服药前,差异具有统计学意义(P<0.05);血钾水平明显升高,高血钾发生率为8.22%.聚苯乙烯磺酸钙用药前,两组患者高钾血症发生率和血钾水平比较,差异无统计学意义(P>0.05),用药后,观察组给药后1、2、3、6、12个月血钾水平均明显低于对照组,差异有统计学意义(P<0.05),且观察组仅发生1例高钾血症,明显少于对照组(P<0.05).结论:高钾血症是RAAS-Ⅰ在CKD治疗中应用受到限制的主要原因,聚苯乙烯磺酸钙在RAAS-Ⅰ所致高钾血症的防治中具有重要作用.

  10. 晨尿蛋白/尿肌酐比值评估CKD患者尿蛋白排泄临床应用评价%Morning spot urine protein-creatinine ratio assent urine protein excretion and their clinical evaluation among CKD patients

    Institute of Scientific and Technical Information of China (English)

    兰雷; 汪鹏; 任伟

    2012-01-01

    Objectives To evalute the clinical application of total protein-to-creatinine ratio in spot urine specimens as a predictor of urine protein exeretion among the CKD patients.Methods One hundred and thirty apecimens of 24-hour urine collection,first morning urine specimend from 136 impatients were collected.The correlations between Protein-to-creatinine ratio in first morning urine specimens and urinary protein excretion in 24-hour collections were analyzed.Influence about collections between p/c and tpu of factors such as GFR、sex、age and BMI were analyzed.The cutoff values of Protein-to-creatinine ratio in first morning urine specimens for screening urinary proten excretion of 0.15 g 、1.00g and 3.00g in 24-hour collection were detedmined by receiver operating characteristics ( ROC ) curve.Results There was a significant positive correlation between the urinary protein exeretion in 24-hour collections and Protein-to-creatinine ratio in first morning urine specimens.Such factors GFR 、sex 、age and BMI have nothing to do with the collection between p/c and tpu.urine protein exeretion in 24-hour collections ≥0.15 g,urine protein exeretion in 24-hour collections ≥ 1.00g and urine protein exeretion in 24-hour collections ≥ 3.00g.coresponding Protein-to-creatinine ratio clinical diagnosis best sensitive and specific spot:Protein-to-creatinine ratio ≥0.20g/gcr,Protein-to-creatinine ratio ≥0.95g/gcr,Protein-to-creatinine ratio ≥2.92 g/gct.Conclusions The Protein-to-creatinine ratio in spot urine samples can used as an alternative to urine protein excertion in 24-hour collections in patients.%目的 探讨晨尿蛋白/尿肌酐比值评估CKD患者尿蛋白排泄的临床价值.方法 选取住院慢性肾脏病患者136例,检测晨尿蛋白/尿肌酐和24h尿蛋白定量并进行相关性分析;分析GFR、性别、年龄、体重指数对二者相关性的影响,绘制ROC曲线分析确定晨尿蛋白/尿肌酐比值相对于24h尿蛋白定量≥0

  11. Prevalence of CKD-MBD in pre-dialysis patients using biochemical ...

    African Journals Online (AJOL)

    % ... decrease in serum calcium levels of patients compared to controls. .... diastolic blood pressure (DBP), serum creatinine, se- .... likely to have lower daily intake of dairy products and ... varies inversely with age.27 Similar to this index study,.

  12. Albuminuria Is an Appropriate Therapeutic Target in Patients with CKD : The Pro View

    NARCIS (Netherlands)

    Lambers Heerspink, Hiddo; Gansevoort, Ron T.

    2015-01-01

    The presence of elevated levels of albuminuria is associated with an increased risk of progressive renal function loss over time. This association is found in various pathophysiological conditions, including diabetic nephropathy, hypertensive nephropathy, and various primary renal diseases, but also

  13. Evaluating the Contribution of the Cause of Kidney Disease to Prognosis in CKD

    DEFF Research Database (Denmark)

    Haynes, Richard; Staplin, Natalie; Emberson, Jonathan

    2014-01-01

    BACKGROUND: The relevance of the cause of kidney disease to prognosis among patients with chronic kidney disease is uncertain. STUDY DESIGN: Observational study. SETTINGS & PARTICIPANTS: 6,245 nondialysis participants in the Study of Heart and Renal Protection (SHARP). PREDICTOR: Baseline cause......, whose adjusted risk of death was 2-fold higher than that of the cystic kidney disease group (relative risk, 2.35 [95% CI, 1.73-3.18]). LIMITATIONS: Exclusion of patients with prior myocardial infarction or coronary revascularization. CONCLUSIONS: The cause of kidney disease has substantial prognostic...

  14. Patient Education and Support During CKD Transitions: When the Possible Becomes Probable.

    Science.gov (United States)

    Green, Jamie A; Boulware, L Ebony

    2016-07-01

    Patients transitioning from kidney disease to kidney failure require comprehensive patient-centered education and support. Efforts to prepare patients for this transition often fail to meet patients' needs due to uncertainty about which patients will progress to kidney failure, nonindividualized patient education programs, inadequate psychosocial support, or lack of assistance to guide patients through complex treatment plans. Resources are available to help overcome barriers to providing optimal care during this time, including prognostic tools, educational lesson plans, decision aids, communication skills training, peer support, and patient navigation programs. New models are being studied to comprehensively address patients' needs and improve the lives of kidney patients during this high-risk time.

  15. Gastrointestinal phosphate handling in CKD and its association with cardiovascular disease.

    Science.gov (United States)

    Weinman, Edward J; Light, Paul D; Suki, Wadi N

    2013-11-01

    Increases in serum concentrations of parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF-23) and ultimately phosphate and decreases in 1,25-dihydroxyvitamin D level are thought to play a central role in the progressive nature of kidney disease and the development of cardiovascular disease in patients with chronic kidney disease. The initial changes in PTH and FGF-23 levels are adaptive to maintain serum phosphate concentration and phosphate load within defined levels by increasing urinary excretion of phosphate. Less well appreciated is the unanticipated finding that absorption of phosphate from the gastrointestinal tract is not downregulated in chronic kidney disease. This maladaptive response maintains higher levels of phosphate absorption, thereby contributing to the phosphate burden. Moreover, in response to a low-phosphate diet, as often is prescribed to such patients, gut phosphate absorption may be enhanced, undermining the potential beneficial effects of this intervention. Given the poor response to limiting phosphate intake and the use of phosphate binders, we suggest that research efforts be oriented toward better understanding of the factors that affect phosphate absorption in the gastrointestinal tract and the development of agents that directly inhibit phosphate transporters in the small intestine and/or their associated binding proteins.

  16. Low-protein diets in CKD: how can we achieve them? A narrative, pragmatic review

    Science.gov (United States)

    Piccoli, Giorgina Barbara; Vigotti, Federica Neve; Leone, Filomena; Capizzi, Irene; Daidola, Germana; Cabiddu, Gianfranca; Avagnina, Paolo

    2015-01-01

    Low-protein diets (LPDs) have encountered various fortunes, and several questions remain open. No single study, including the famous Modification of Diet in Renal Disease, was conclusive and even if systematic reviews are in favour of protein restriction, at least in non-diabetic adults, implementation is lagging. LPDs are considered difficult, malnutrition is a threat and compliance is poor. LPDs have been reappraised in this era of reconsideration of dialysis indications and timing. The definition of a normal-adequate protein diet has shifted in the overall population from 1 to 1.2 to 0.8 g/kg/day. Vegan–vegetarian diets are increasingly widespread, thus setting the groundwork for easier integration of moderate protein restriction in Chronic Kidney Disease. There are four main moderately restricted LPDs (0.6 g/kg/day). Two of them require careful planning of quantity and quality of food: a ‘traditional’ one, with mixed proteins that works on the quantity and quality of food and a vegan one, which integrates grains and legumes. Two further options may be seen as a way to simplify LPDs while being on the safe side for malnutrition: adding supplements of essential amino and keto acids (various doses) allows an easier shift from omnivorous to vegan diets, while protein-free food intake allows for an increase in calories. Very-low-protein diets (vLPDs: 0.3 g/kg/day) combine both approaches and usually require higher doses of supplements. Moderately restricted LPDs may be adapted to virtually any cuisine and should be tailored to the patients' preferences, while vLPDs usually require trained, compliant patients; a broader offer of diet options may lead to more widespread use of LPDs, without competition among the various schemas. PMID:25713712

  17. Comparison of CKD-EPI versus MDRD and Cockcroft-Gault ...

    African Journals Online (AJOL)

    2016-12-15

    Dec 15, 2016 ... INTRODUCTION. Sickle cell anaemia (SCA) is a disorder of the blood ... has a prevalence of 20 per 1000 births in Nigeria, therefore. 150,000 children ... proteinuria which may progress to chronic renal failure in 20% of cases.

  18. Comparison of CKD-EPI versus MDRD and Cockcroft-Gault ...

    African Journals Online (AJOL)

    2016-12-15

    Dec 15, 2016 ... proteinuria which may progress to chronic renal failure in 20% of cases. ... infusion urinary clearance of exogenous inulin is widely regarded as the .... age has been identified as a socio‑demographic factor. [Downloaded free ...

  19. Hydration Characteristics and Immobilization of Cr (VI) in Slag Cement-CKD Pastes under Hydrothermal Treatment

    Institute of Scientific and Technical Information of China (English)

    M R Shatat; Gomaa A M Ali; M A Tantawy

    2015-01-01

    The effect of hydrothermal curing regimes on the hydration characteristics of slag cement containing different ratios of cement kiln dust has been studied. The samples for this study were combination of slag cement and cement kiln dust (5%-25%) without and with immobilization of 5% Cr (VI) by mass. Pastes were hydrothermally treated at 180℃ for different periods (2-24 h) in well closed stainless steel capsule. The hydration characteristics of these pastes were studied by measuring the compressive strength, bulk density, total porosity and combined water content. The findings were further supported by XRD and SEM analysis. The results indicated that the hydration characteristics of slag cement paste containing cement kiln dust 10% by mass were enhanced, especially at later ages (24 h) of hydration. That is due to the hydrothermal curing regimes of immobilized pastes accelerating hydration reactions and precipitation of CaCrO4, indicating that Cr (VI) can be solidiifed in the cement paste. This precipitation leads to pore formation in hydrated slag cement pastes.

  20. Canadian Society of Nephrology commentary on the KDIGO clinical practice guideline for CKD evaluation and management.

    Science.gov (United States)

    Akbari, Ayub; Clase, Catherine M; Acott, Phil; Battistella, Marisa; Bello, Aminu; Feltmate, Patrick; Grill, Allan; Karsanji, Meena; Komenda, Paul; Madore, Francois; Manns, Braden J; Mahdavi, Sara; Mustafa, Reem A; Smyth, Andrew; Welcher, E Sohani

    2015-02-01

    We congratulate the KDIGO (Kidney Disease: Improving Global Outcomes) work group on their comprehensive work in a broad subject area and agreed with many of the recommendations in their clinical practice guideline on the evaluation and management of chronic kidney disease. We concur with the KDIGO definitions and classification of kidney disease and welcome the addition of albuminuria categories at all levels of glomerular filtration rate (GFR), the terminology of G categories rather than stages to describe level of GFR, the division of former stage 3 into new G categories 3a and 3b, and the addition of the underlying diagnosis. We agree with the use of the heat map to illustrate the relative contributions of low GFR and albuminuria to cardiovascular and renal risk, though we thought that the highest risk category was too broad, including as it does people at disparate levels of risk. We add an albuminuria category A4 for nephrotic-range proteinuria and D and T categories for patients on dialysis or with a functioning renal transplant. We recommend target blood pressure of 140/90mm Hg regardless of diabetes or proteinuria, and against the combination of angiotensin receptor blockers with angiotensin-converting enzyme inhibitors. We recommend against routine protein restriction. We concur on individualization of hemoglobin A1c targets. We do not agree with routine restriction of sodium intake to 3.3g/d). We suggest screening for anemia only when GFR is 60mg/mmol or proteinuria with protein excretion > 1g/d as the referral threshold for proteinuria.

  1. Sodium Restriction in Patients With CKD: A Randomized Controlled Trial of Self-management Support.

    Science.gov (United States)

    Meuleman, Yvette; Hoekstra, Tiny; Dekker, Friedo W; Navis, Gerjan; Vogt, Liffert; van der Boog, Paul J M; Bos, Willem Jan W; van Montfrans, Gert A; van Dijk, Sandra

    2017-05-01

    To evaluate the effectiveness and sustainability of self-managed sodium restriction in patients with chronic kidney disease. Open randomized controlled trial. Patients with moderately decreased kidney function from 4 hospitals in the Netherlands. Regular care was compared with regular care plus an intervention comprising education, motivational interviewing, coaching, and self-monitoring of blood pressure (BP) and sodium. Primary outcomes were sodium excretion and BP after the 3-month intervention and at 6-month follow-up. Secondary outcomes were protein excretion, kidney function, antihypertensive medication, self-efficacy, and health-related quality of life (HRQoL). At baseline, mean sodium excretion rate was 163.6±64.9 (SD) mmol/24 h; mean estimated glomerular filtration rate was 49.7±25.6mL/min/1.73m(2); median protein excretion rate was 0.8 (IQR, 0.4-1.7) g/24 h; and mean 24-hour ambulatory systolic and diastolic BPs were 129±15 and 76±9mmHg, respectively. Compared to regular care only (n=71), at 3 months, the intervention group (n=67) showed reduced sodium excretion rate (mean change, -30.3 [95% CI, -54.7 to -5.9] mmol/24 h), daytime ambulatory diastolic BP (mean change, -3.4 [95% CI, -6.3 to -0.6] mmHg), diastolic office BP (mean change, -5.2 [95% CI, -8.4 to -2.1] mmHg), protein excretion (mean change, -0.4 [95% CI, -0.7 to -0.1] g/24h), and improved self-efficacy (mean change, 0.5 [95% CI, 0.1 to 0.9]). At 6 months, differences in sodium excretion rates and ambulatory BPs between the groups were not significant, but differences were detected in systolic and diastolic office BPs (mean changes of -7.3 [95% CI, -12.7 to -1.9] and -3.8 [95% CI, -6.9 to -0.6] mmHg, respectively), protein excretion (mean changes, -0.3 [95% CI, -0.6 to -0.1] g/24h), and self-efficacy (mean change, 0.5 [95% CI, 0.0 to 0.9]). No differences in kidney function, medication, and HRQoL were observed. Nonblinding, relatively low response rate, and missing data. Compared to regular care only, this self-management intervention modestly improved outcomes, although effects on sodium excretion and ambulatory BP diminish over time. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  2. Sodium Restriction in Patients With CKD : A Randomized Controlled Trial of Self-management Support

    NARCIS (Netherlands)

    Meuleman, Yvette; Hoekstra, Tiny; Dekker, Friedo W.; Navis, Gerjan; Vogt, Liffert; van der Boog, Paul J. M.; Bos, Willem Jan W.; van Montfrans, Gert A.; van Dijk, Sandra

    Background: To evaluate the effectiveness and sustainability of self-managed sodium restriction in patients with chronic kidney disease. Study Design: Open randomized controlled trial. Setting & Participants: Patients with moderately decreased kidney function from 4 hospitals in the Netherlands.

  3. Management of patients with diabetes and CKD: conclusions from a "Kidney Disease: Improving Global Outcomes" (KDIGO) Controversies Conference.

    Science.gov (United States)

    Perkovic, Vlado; Agarwal, Rajiv; Fioretto, Paola; Hemmelgarn, Brenda R; Levin, Adeera; Thomas, Merlin C; Wanner, Christoph; Kasiske, Bertram L; Wheeler, David C; Groop, Per-Henrik

    2016-12-01

    The prevalence of diabetes around the world has reached epidemic proportions and is projected to increase to 642 million people by 2040. Diabetes is already the leading cause of end-stage kidney disease (ESKD) in most developed countries, and the growth in the number of people with ESKD around the world parallels the increase in diabetes. The presence of kidney disease is associated with a markedly elevated risk of cardiovascular disease and death in people with diabetes. Several new therapies and novel investigational agents targeting chronic kidney disease patients with diabetes are now under development. This conference was convened to assess our current state of knowledge regarding optimal glycemic control, current antidiabetic agents and their safety, and new therapies being developed to improve kidney function and cardiovascular outcomes for this vulnerable population.

  4. Low-Protein Diets in Diabetic Chronic Kidney Disease (CKD) Patients: Are They Feasible and Worth the Effort?

    Science.gov (United States)

    Piccoli, Giorgina B.; Ventrella, Federica; Capizzi, Irene; Vigotti, Federica N.; Mongilardi, Elena; Grassi, Giorgio; Loi, Valentina; Cabiddu, Gianfranca; Avagnina, Paolo; Versino, Elisabetta

    2016-01-01

    Low-protein diets (LPDs) are often considered as contraindicated in diabetic patients, and are seldom studied. The aim of this observational study was to provide new data on this issue. It involved 149 diabetic and 300 non-diabetic patients who followed a LPD, with a personalized approach aimed at moderate protein restriction (0.6 g/day). Survival analysis was performed according to Kaplan–Meier, and multivariate analysis with Cox model. Diabetic versus non-diabetic patients were of similar age (median 70 years) and creatinine levels at the start of the diet (2.78 mg/dL vs. 2.80 mg/dL). There was higher prevalence of nephrotic proteinuria in diabetic patients (27.52% vs. 13.67%, p = 0.002) as well as comorbidity (median Charlson index 8 vs. 6 p = 0.002). Patient survival was lower in diabetic patients, but differences levelled off considering only cases with Charlson index > 7, the only relevant covariate in Cox analysis. Dialysis-free survival was superimposable in the setting of good compliance (Mitch formula: 0.47 g/kg/day in both groups): about 50% of the cases remained dialysis-free 2 years after the first finding of e-GFR (estimated glomerular filtration rate) < 15 mL/min, and 1 year after reaching e-GFR < 10 mL/min. In patients with type 2 diabetes, higher proteinuria was associated with mortality and initiation of dialysis. In conclusion, moderately restricted LPDs allow similar results in diabetic and non non-diabetic patients with similar comorbidity. PMID:27775639

  5. Diagnosis and Management of Iron Deficiency in CKD: A Summary of the NICE Guideline Recommendations and Their Rationale.

    Science.gov (United States)

    Ratcliffe, Laura E K; Thomas, Wayne; Glen, Jessica; Padhi, Smita; Pordes, Ben A J; Wonderling, David; Connell, Roy; Stephens, Suzanne; Mikhail, Ashraf I; Fogarty, Damian G; Cooper, Jan K; Dring, Belinda; Devonald, Mark A J; Brown, Chris; Thomas, Mark E

    2016-04-01

    The UK-based National Institute for Health and Care Excellence (NICE) has updated its guidance on iron deficiency and anemia management in chronic kidney disease. This report outlines the recommendations regarding iron deficiency and their rationale. Serum ferritin alone or transferrin saturation alone are no longer recommended as diagnostic tests to assess iron deficiency. Red blood cell markers (percentage hypochromic red blood cells, reticulocyte hemoglobin content, or reticulocyte hemoglobin equivalent) are better than ferritin level alone at predicting responsiveness to intravenous iron. When red blood cell markers are not available, a combination of transferrin saturation iron status testing and treatment strategies, using percentage hypochromic red blood cells > 6% was the most cost-effective strategy for both hemodialysis and nonhemodialysis patients. A trial of oral iron replacement is recommended in people not receiving an erythropoiesis-stimulating agent (ESA) and not on hemodialysis therapy. For children receiving ESAs, but not treated by hemodialysis, oral iron should be considered. In adults and children receiving ESAs and/or on hemodialysis therapy, intravenous iron should be offered. When giving intravenous iron, high-dose low-frequency administration is recommended. For all children and for adults receiving in-center hemodialysis, low-dose high-frequency administration may be more appropriate.

  6. Exploring the opinion of CKD patients on dialysis regarding end-of-life and Advance Care Planning.

    Science.gov (United States)

    Sánchez-Tomero, J A; Rodríguez-Jornet, A; Balda, S; Cigarrán, S; Herrero, J C; Maduell, F; Martín, J; Palomar, R

    2011-01-01

    Advance care planning (ACP) and the subsequent advance directive document (ADD), previously known as "living wills", have not been widely used in Spain. The Ethics Group from the Spanish Society of Nephrology has developed a survey in order to investigate the opinion of dialysis patients regarding the ADD and end-of-life care. Patients received documentation explaining ACP and filled out a survey about their familiarity with and approval of the ADD. Seven hospital dialysis centres participated in the study for a total of 416 active dialysis patients. Questionnaires were distributed to 263 patients, 154 of which answered (69.2% completed them without assistance). The rates for ADD implementation (7.9%) and designation of a representative person (6.6%) were very low. Most of the patients clearly expressed their wishes about irreversible coma, vegetative state, dementia and untreatable disease. More than 65% did not want mechanical ventilation, chronic dialysis, tube feeding or resuscitation if cardiorespiratory arrest occurred. They reported that an ADD could be done before starting dialysis but most thought that it should be offered only to those who requested it (65% vs 34%). In conclusion, patients have clear wishes about end-of-life care, although these desires had not been documented due to the very low implementation of the ADD.

  7. Low-Protein Diets in Diabetic Chronic Kidney Disease (CKD) Patients: Are They Feasible and Worth the Effort?

    Science.gov (United States)

    Piccoli, Giorgina B; Ventrella, Federica; Capizzi, Irene; Vigotti, Federica N; Mongilardi, Elena; Grassi, Giorgio; Loi, Valentina; Cabiddu, Gianfranca; Avagnina, Paolo; Versino, Elisabetta

    2016-10-21

    Low-protein diets (LPDs) are often considered as contraindicated in diabetic patients, and are seldom studied. The aim of this observational study was to provide new data on this issue. It involved 149 diabetic and 300 non-diabetic patients who followed a LPD, with a personalized approach aimed at moderate protein restriction (0.6 g/day). Survival analysis was performed according to Kaplan-Meier, and multivariate analysis with Cox model. Diabetic versus non-diabetic patients were of similar age (median 70 years) and creatinine levels at the start of the diet (2.78 mg/dL vs. 2.80 mg/dL). There was higher prevalence of nephrotic proteinuria in diabetic patients (27.52% vs. 13.67%, p = 0.002) as well as comorbidity (median Charlson index 8 vs. 6 p = 0.002). Patient survival was lower in diabetic patients, but differences levelled off considering only cases with Charlson index > 7, the only relevant covariate in Cox analysis. Dialysis-free survival was superimposable in the setting of good compliance (Mitch formula: 0.47 g/kg/day in both groups): about 50% of the cases remained dialysis-free 2 years after the first finding of e-GFR (estimated glomerular filtration rate) diabetes, higher proteinuria was associated with mortality and initiation of dialysis. In conclusion, moderately restricted LPDs allow similar results in diabetic and non non-diabetic patients with similar comorbidity.

  8. Low-Protein Diets in Diabetic Chronic Kidney Disease (CKD Patients: Are They Feasible and Worth the Effort?

    Directory of Open Access Journals (Sweden)

    Giorgina B. Piccoli

    2016-10-01

    Full Text Available Low-protein diets (LPDs are often considered as contraindicated in diabetic patients, and are seldom studied. The aim of this observational study was to provide new data on this issue. It involved 149 diabetic and 300 non-diabetic patients who followed a LPD, with a personalized approach aimed at moderate protein restriction (0.6 g/day. Survival analysis was performed according to Kaplan–Meier, and multivariate analysis with Cox model. Diabetic versus non-diabetic patients were of similar age (median 70 years and creatinine levels at the start of the diet (2.78 mg/dL vs. 2.80 mg/dL. There was higher prevalence of nephrotic proteinuria in diabetic patients (27.52% vs. 13.67%, p = 0.002 as well as comorbidity (median Charlson index 8 vs. 6 p = 0.002. Patient survival was lower in diabetic patients, but differences levelled off considering only cases with Charlson index > 7, the only relevant covariate in Cox analysis. Dialysis-free survival was superimposable in the setting of good compliance (Mitch formula: 0.47 g/kg/day in both groups: about 50% of the cases remained dialysis-free 2 years after the first finding of e-GFR (estimated glomerular filtration rate < 15 mL/min, and 1 year after reaching e-GFR < 10 mL/min. In patients with type 2 diabetes, higher proteinuria was associated with mortality and initiation of dialysis. In conclusion, moderately restricted LPDs allow similar results in diabetic and non non-diabetic patients with similar comorbidity.

  9. [CKD-MBD (Chronic Kidney Disease-Mineral and Bone Disorder). Effect of vitamin D on kidney and cardiovascular system].

    Science.gov (United States)

    Fujii, Hideki

    2010-07-01

    Recently, many investigators have reported that treatment with vitamin D improves outcomes of patients with chronic kidney disease. Though the detailed mechanisms have remained unclear, it has been speculated that such a treatment may prevent progression of chronic kidney disease and cardiovascular disease. It has been reported that Vitamin D may attenuate renal injury and ameliorate renal function and proteinuria. In addition, several studies have shown that vitamin D may prevent progression of atherosclerosis, vascular calcification and left ventricular hypertrophy. The emerging experimental and clinical evidence has suggested that vitamin D may protect kidney and cardiovascular system.

  10. Acute Kidney Disease Due to Excessive Vitamin C Ingestion and Remote Roux-en-Y Gastric Bypass Surgery Superimposed on CKD.

    Science.gov (United States)

    Sunkara, Vasu; Pelkowski, Timothy D; Dreyfus, Darren; Satoskar, Anjali

    2015-10-01

    A 69-year-old woman presented with acute kidney failure of unknown cause that ultimately required dialysis. Kidney biopsy revealed the diagnosis of oxalate nephropathy. In retrospect, the patient had several risk factors for this entity, including excessive vitamin C intake, a remote history of Roux-en-Y gastric bypass for weight loss, and chronic kidney disease. This presentation of multiple risk factors for oxalate nephropathy is especially relevant to patients and physicians considering the increase in the United States of vitamin C supplementation use and gastric bypass surgery. It is important for physicians to maintain an awareness of this diagnosis and its risk factors.

  11. Race/Ethnicity and Cardiovascular Outcomes in Adults With CKD: Findings From the CRIC (Chronic Renal Insufficiency Cohort) and Hispanic CRIC Studies.

    Science.gov (United States)

    Lash, James P; Ricardo, Ana C; Roy, Jason; Deo, Rajat; Fischer, Michael; Flack, John; He, Jiang; Keane, Martin; Lora, Claudia; Ojo, Akinlolu; Rahman, Mahboob; Steigerwalt, Susan; Tao, Kaixiang; Wolf, Myles; Wright, Jackson T; Go, Alan S

    2016-10-01

    Non-Hispanic blacks and Hispanics with end-stage renal disease have a lower risk for death than non-Hispanic whites, but data for racial/ethnic variation in cardiovascular outcomes for non-dialysis-dependent chronic kidney disease are limited. Prospective cohort. 3,785 adults with entry estimated glomerular filtration rates of 20 to 70mL/min/1.73m(2) enrolled in the CRIC (Chronic Renal Insufficiency Cohort) Study. Race/ethnicity (non-Hispanic white, non-Hispanic black, and Hispanic). Cardiovascular outcomes (atherosclerotic events [myocardial infarction, stroke, or peripheral arterial disease] and heart failure) and a composite of each cardiovascular outcome or all-cause death. Multivariable Cox proportional hazards. During a median follow-up of 6.6 years, we observed 506 atherosclerotic events, 551 heart failure events, and 692 deaths. In regression analyses, there were no significant differences in atherosclerotic events among the 3 racial/ethnic groups. In analyses stratified by clinical site, non-Hispanic blacks had a higher risk for heart failure events (HR, 1.59; 95% CI, 1.29-1.95), which became nonsignificant after adjustment for demographic factors and baseline kidney function. In contrast, Hispanics had similar risk for heart failure events as non-Hispanic whites. In analyses stratified by clinical site, compared with non-Hispanic whites, non-Hispanic blacks were at similar risk for atherosclerotic events or death. However, after further adjustment for cardiovascular risk factors, medications, and mineral metabolism markers, non-Hispanic blacks had 17% lower risk for the outcome (HR, 0.83; 95% CI, 0.69-0.99) than non-Hispanic whites, whereas there was no significant association with Hispanic ethnicity. Hispanics were largely recruited from a single center, and the study was underpowered to evaluate the association between Hispanic ethnicity and mortality. There were no significant racial/ethnic differences in adjusted risk for atherosclerotic or heart failure outcomes. Future research is needed to better explain the reduced risk for atherosclerotic events or death in non-Hispanic blacks compared with non-Hispanic whites. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  12. [CKD-MBD (Chronic Kidney Disease-Mineral and Bone Disorder). Lanthanum carbonate and new phosphate binders in patients with chronic kidney disease].

    Science.gov (United States)

    Negi, Shigeo; Shigematsu, Takashi

    2010-07-01

    Hyperphosphatemia is a serious complication which has been linked with an increased risk of cardiovascular mortality in patients with chronic kidney disease. Lanthanum carbonate is a novel non-calcium, non-aluminum phosphate-binding agent, and has approved for clinical use in patients on hemodialysis in Japan on March in 2009. Compared to calcium carbonate and sevelamer hydrochloride, lanthanum carbonate is a powerful phosphate binder. There is no evidence of bone toxicity and neurotoxicity of lanthanum carbonate previously reported for aluminium hydroxide. However, further studies are needed to address the longer term toxic effect on bone and other organs.

  13. New Organ Allocation System for Combined Liver-Kidney Transplants and the Availability of Kidneys for Transplant to Patients with Stage 4-5 CKD.

    Science.gov (United States)

    Asch, William S; Bia, Margaret J

    2016-12-27

    A new proposal has been created for establishing medical criteria for organ allocation in recipients receiving simultaneous liver-kidney transplants. In this article, we describe the new policy, elaborate on the points of greatest controversy, and offer a perspective on the policy going forward. Although we applaud the fact that simultaneous liver-kidney transplant activity will now be monitored and appreciate the creation of medical criteria for allocation in simultaneous liver-kidney transplants, we argue that some of the criteria proposed, especially those for allocating a kidney to a liver recipient with AKI, are too liberal. We call on the nephrology community to follow the consequences of this new policy and push for a re-examination of the longstanding policy of allocating kidneys to multiorgan transplant recipients before all other candidates. The charge to protect our system of equitable organ allocation is very challenging, but it is a challenge that we must embrace.

  14. Improvement of Physical Decline Through Combined Effects of Muscle Enhancement and Mitochondrial Activation by a Gastric Hormone Ghrelin in Male 5/6Nx CKD Model Mice.

    Science.gov (United States)

    Tamaki, Masanori; Hagiwara, Aika; Miyashita, Kazutoshi; Wakino, Shu; Inoue, Hiroyuki; Fujii, Kentaro; Fujii, Chikako; Sato, Masaaki; Mitsuishi, Masanori; Muraki, Ayako; Hayashi, Koichi; Doi, Toshio; Itoh, Hiroshi

    2015-10-01

    Because a physical decline correlates with an increased risk of a wide range of disease and morbidity, an improvement of physical performance is expected to bring significant clinical benefits. The primary cause of physical decline in 5/6 nephrectomized (5/6Nx) chronic kidney disease model mice has been regarded as a decrease in muscle mass; however, our recent study showed that a decrease in muscle mitochondria plays a critical role. In the present study, we examined the effects of a gastric hormone ghrelin, which has been reported to promote muscle mitochondrial oxidation, on the physical decline in the chronic kidney disease model mice, focusing on the epigenetic modulations of a mitochondrial activator gene, peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α). Ghrelin treatment improved a decline in exercise endurance of 5/6Nx mice, associated with an increase in both of the muscle mass and mitochondrial amount. The expression level of PGC-1α was decreased in the skeletal muscle of 5/6Nx mice, which was associated with an increase in the methylation ratio of the cytosine residue at 260 base pairs upstream of the initiation point. Conversely, ghrelin treatment de-methylated the cytosine residue and increased the expression of PGC-1α. A representative muscle anabolic factor, IGF-1, did not affect the expression of PGC-1α and muscle mitochondrial amount, although it increased muscle mass. As a result, IGF-1 treatment in 5/6Nx mice did not increase the decreased exercise endurance as effectively as ghrelin treatment did. These findings indicate an advantage of ghrelin treatment for a recovery of physical decline.

  15. Effect of an Educational Program on Adherence to Therapeutic Regimen among Chronic Kidney Disease Stage5 (CKD5) Patients under Maintenance Hemodialysis

    Science.gov (United States)

    Deif, Hala I. Abo; Elsawi, Khiria; Selim, Mohga; NasrAllah, Mohamed M.

    2015-01-01

    The burden of chronic disease on health care services worldwide is growing and the increased development of educational interventions which help patients to better manage their conditions is evident internationally. It has been recognized that poor adherence can be a serious risk to the health and wellbeing of patients. Adherence to fluid…

  16. The FIND-CKD study-a randomized controlled trial of intravenous iron versus oral iron in non-dialysis chronic kidney disease patients : background and rationale

    NARCIS (Netherlands)

    Macdougall, Iain C.; Bock, Andreas; Carrera, Fernando; Eckardt, Kai-Uwe; Gaillard, Carlo; Van Wyck, David; Roubert, Bernard; Cushway, Timothy; Roger, Simon D.

    2014-01-01

    Background. Rigorous data are sparse concerning the optimal route of administration and dosing strategy for iron therapy with or without concomitant erythropoiesis-stimulating agent (ESA) therapy for the management of iron deficiency anaemia in patients with non-dialysis dependent chronic kidney dis

  17. Urine Neutrophil Gelatinase-Associated Lipocalin and Risk of Cardiovascular Disease and Death in CKD: Results From the Chronic Renal Insufficiency Cohort (CRIC) Study

    Science.gov (United States)

    Liu, Kathleen D.; Yang, Wei; Go, Alan S.; Anderson, Amanda H.; Feldman, Harold I.; Fischer, Michael J.; He, Jiang; Kallem, Radhakrishna R.; Kusek, John W.; Master, Stephen R.; Miller, Edgar R.; Rosas, Sylvia E.; Steigerwalt, Susan; Tao, Kaixiang; Weir, Matthew R.; Hsu, Chi-yuan

    2015-01-01

    Background Chronic kidney disease is common and associated with increased cardiovascular disease risk. Currently, markers of renal tubular injury are not used routinely to describe kidney health and little is known about risk of cardiovascular events and death associated with these biomarkers independent of glomerular filtration—based markers (such as serum creatinine or albuminuria). Study Design Cohort study, Chronic Renal Insufficiency Cohort (CRIC) Study. Setting & Participants 3386 participants with estimated glomerular filtration rate of 20-70 mL/min/1.73 m2 enrolled from June 2003 through August 2008. Predictor Urine neutrophil gelatinase-associated lipocalin (NGAL) concentration. Outcomes Adjudicated heart failure event, ischemic atherosclerotic event (myocardial infarction, ischemic stroke or peripheral artery disease) and death through March 2011. Measurements Urine NGAL concentration measured at baseline with a two-step assay using chemiluminescent microparticle immunoassay technology on an ARCHITECT i2000SR (Abbott Laboratories). Results There were 428 heart failure events (during 16383 person-years of follow-up), 361 ischemic atherosclerotic events (during 16584 person-years of follow-up) and 522 deaths (during 18214 person-years of follow-up). In Cox regression models adjusted for estimated glomerular filtration rate, albuminuria, demographics, traditional cardiovascular disease risk factors and cardiac medications, higher urine NGAL levels remained independently associated with ischemic atherosclerotic events (adjusted HR for the highest [>49.5 ng/ml] vs. lowest [≤6.9 ng/ml] quintile, 1.83 [95% CI, 1.20-2.81]; HR, per 0.1-unit increase in log urine NGAL, 1.012 [95% CI, 1.001-1.023]), but not heart failure events or deaths. Limitations Urine NGAL was measured only once. Conclusions Among patients with chronic kidney disease, urine levels of NGAL, a marker of renal tubular injury, were independently associated with future ischemic atherosclerotic events but not with heart failure events or deaths. PMID:25311702

  18. Overview of Kidney Diseases in Children

    Science.gov (United States)

    ... Kidney Disease (CKD) What Is Chronic Kidney Disease? Causes of CKD Tests & Diagnosis Managing CKD Eating Right Preventing CKD ... or may go away completely once the underlying cause has been treated. Chronic kidney disease (CKD) does not go away with treatment and ...

  19. Henoch-Schönlein Purpura

    Science.gov (United States)

    ... Kidney Disease (CKD) What Is Chronic Kidney Disease? Causes of CKD Tests & Diagnosis Managing CKD Eating Right Preventing CKD ... adults, HSP can lead to chronic kidney disease (CKD) and kidney failure, described as ... are the causes of HSP? Henoch-Schönlein purpura is caused by ...

  20. Kidney Disease Statistics for the United States

    Science.gov (United States)

    ... High blood pressure and diabetes are the main causes of CKD. Almost half of individuals with CKD also have ... without CKD. However, rates of both overall and cause-specific admissions increased with advancing stages of CKD. Hospitalizations increased among CKD patients with the presence ...

  1. Acquired Cystic Kidney Disease

    Science.gov (United States)

    ... Kidney Disease (CKD) What Is Chronic Kidney Disease? Causes of CKD Tests & Diagnosis Managing CKD Eating Right Preventing CKD ... as polycystic kidney disease (PKD), another disease that causes the kidneys to ... chronic kidney disease (CKD)—a condition that develops over many years ...

  2. Chronic Kidney Disease

    Science.gov (United States)

    ... of the feet and ankles Causes & Risk FactorsWhat causes CKD?The most common causes of CKD are high blood pressure, diabetes and heart disease. ... caused by CKD.How else is CKD treated?Chronic kidney disease can cause other problems. Talk with your doctor about how ...

  3. Predictors of advanced chronic kidney disease and end-stage renal disease in HIV-positive persons

    DEFF Research Database (Denmark)

    Nielsen, Lene Ryom; Mocroft, Amanda; Kirk, Ole

    2014-01-01

    Whilst several antiretroviral drugs have been associated with moderate chronic kidney disease (CKD), their contribution to advanced CKD and end-stage renal disease (ESRD) remain unknown.......Whilst several antiretroviral drugs have been associated with moderate chronic kidney disease (CKD), their contribution to advanced CKD and end-stage renal disease (ESRD) remain unknown....

  4. Novel biomarkers for progression of chronic kidney disease

    Institute of Scientific and Technical Information of China (English)

    LIU Bi-cheng; L(U) Lin-li

    2010-01-01

    @@ CHARACTERISTICS OF THE PROGRESSION OF CHRONIC KIDNEY DISEASE (CKD) Although there are different initiators of CKD, it is generally recognized that the secondary pathological pathway is quite common to all CKD. CKD may inevitably progress to end stage renal disease (ESRD) due to a vicious cycle of nephron destruction by progressive glomerulosclerosis and tubulointerstitial fibrosis.

  5. Kidney Infection (Pyelonephritis)

    Science.gov (United States)

    ... Disease Chronic Kidney Disease (CKD) What Is Chronic Kidney Disease? Causes of CKD Tests & Diagnosis Managing CKD Eating Right Preventing CKD What If My Kidneys Fail? Clinical Trials Anemia High Blood Pressure Heart ... Nephropathy Kidney Disease in Children Childhood Nephrotic Syndrome Hemolytic ...

  6. Renal Tubular Acidosis

    Science.gov (United States)

    ... Disease Chronic Kidney Disease (CKD) What Is Chronic Kidney Disease? Causes of CKD Tests & Diagnosis Managing CKD Eating Right Preventing CKD What If My Kidneys Fail? Clinical Trials Anemia High Blood Pressure Heart ... Nephropathy Kidney Disease in Children Childhood Nephrotic Syndrome Hemolytic ...

  7. Solitary Kidney

    Science.gov (United States)

    ... Disease Chronic Kidney Disease (CKD) What Is Chronic Kidney Disease? Causes of CKD Tests & Diagnosis Managing CKD Eating Right Preventing CKD What If My Kidneys Fail? Clinical Trials Anemia High Blood Pressure Heart ... Nephropathy Kidney Disease in Children Childhood Nephrotic Syndrome Hemolytic ...

  8. Anemia and bone disease of chronic kidney disease: pathogenesis, diagnosis, and management.

    Science.gov (United States)

    Shemin, Douglas

    2014-12-02

    Anemia and metabolic bone disease accompany chronic kidney disease (CKD), and worsen as CKD progresses. It is likely that both processes contribute to the increased morbidity and mortality seen in CKD. This paper briefly reviews the pathogenesis and diagnosis of anemia and bone disease in CKD, and summarizes recent consensus guidelines for treatment.

  9. Arterial stiffness & Sri Lankan chronic kidney disease of unknown origin

    OpenAIRE

    Fiona Gifford; Robert Kimmitt; Chula Herath; Webb, David J.; Vanessa Melville; Sisira Siribaddana; Michael Eddleston; Neeraj Dhaun

    2016-01-01

    Chronic kidney disease (CKD) is common and independently associated with cardiovascular disease (CVD). Arterial stiffness contributes to CVD risk in CKD. In many developing countries a considerable proportion of CKD remains unexplained, termed CKDu. We assessed arterial stiffness in subjects with Sri Lankan CKDu, in matched controls without CKD and in those with defined CKD. Aortic blood pressure (BP), pulse wave velocity (PWV) and augmentation index (AIx) were assessed in 130 subjects (50 wi...

  10. Urinary F2?Isoprostanes in Cats with International Renal Interest Society Stage 1?4 Chronic Kidney Disease

    OpenAIRE

    Whitehouse, W; Quimby, J.; Wan, S.; Monaghan, K.; Robbins, R; Trepanier, L.A.

    2017-01-01

    Background F2?isoprostanes, a biomarker of oxidant injury, increase with advancing chronic kidney disease (CKD) in humans. In cats, the relationship between CKD and oxidative stress is poorly understood. Objectives To determine whether cats with advancing CKD have increasing urinary F2?isoprostanes. Animals Control cats without evidence of CKD (?6 years old; n = 11), and cats with IRIS stage 1 (n = 8), 2 (n = 38), 3 (n = 21), and 4 (n = 10) CKD. Methods This was a prospective observational st...

  11. Recent advances in understanding of chronic kidney disease [version 1; referees: 3 approved

    Directory of Open Access Journals (Sweden)

    Junna Yamaguchi

    2015-11-01

    Full Text Available Chronic kidney disease (CKD is defined as any condition that causes reduced kidney function over a period of time. Fibrosis, tubular atrophy and interstitial inflammation are the hallmark of pathological features in CKD. Regardless of initial insult, CKD has some common pathways leading CKD to end-stage kidney disease, including hypoxia in the tubulointerstitium and proteinuria. Recent advances in genome editing technologies and stem cell research give great insights to understand the pathogenesis of CKD, including identifications of the origins of renal myofibroblasts and tubular epithelial cells upon injury. Environmental factors such as hypoxia, oxidative stress, and epigenetic factors in relation to CKD are also discussed.

  12. Arterial stiffness &Sri Lankan chronic kidney disease of unknown origin.

    Science.gov (United States)

    Gifford, Fiona; Kimmitt, Robert; Herath, Chula; Webb, David J; Melville, Vanessa; Siribaddana, Sisira; Eddleston, Michael; Dhaun, Neeraj

    2016-09-02

    Chronic kidney disease (CKD) is common and independently associated with cardiovascular disease (CVD). Arterial stiffness contributes to CVD risk in CKD. In many developing countries a considerable proportion of CKD remains unexplained, termed CKDu. We assessed arterial stiffness in subjects with Sri Lankan CKDu, in matched controls without CKD and in those with defined CKD. Aortic blood pressure (BP), pulse wave velocity (PWV) and augmentation index (AIx) were assessed in 130 subjects (50 with CKDu, 45 with CKD and 35 without CKD) using the validated TensioMed™ Arteriograph monitor. Brachial and aortic BP was lower in controls than in CKDu and CKD subjects but no different between CKDu and CKD. Controls had a lower PWV compared to subjects with CKDu and CKD. Despite equivalent BP and renal dysfunction, CKDu subjects had a lower PWV than those with CKD (8.7 ± 1.5 vs. 9.9 ± 2.2 m/s, p CKDu vs. CKD: 6.7 ± 0.9 vs. 8.7 ± 1.5 vs. 10.4 ± 1.5 m/s, p CKDu is associated with less arterial stiffening than defined causes of CKD. Whether this translates to lower cardiovascular morbidity and mortality long term is unclear and should be the focus of future studies.

  13. Association between plasma soluble RAGE and renal function is unaffected by medication usage and enzymatic antioxidants in chronic kidney disease with type 2 diabetes.

    Science.gov (United States)

    Wong, Foo Nian; Tan, Jin Ai Mary Anne; Keng, Tee Chau; Ng, Kok Peng; Chua, Kek Heng; Kuppusamy, Umah Rani

    2016-01-30

    This study aimed to investigate the relationship between soluble RAGE and estimated glomerular filtration rate (eGFR) in patients with chronic kidney disease (CKD) after controlling for the potential confounding factors such as medication usage and enzymatic antioxidants. A total of 222 CKD patients whose eGFR is less than 60ml/min/1.73m(2) and 111 non-CKD individuals were recruited. The study subjects were classified based on their diabetes status. The plasma glutathione peroxidase (GPx) and superoxide dismutase (SOD) activities as well as plasma soluble RAGE level were measured. The plasma GPx and SOD activities were significantly lower and the plasma soluble RAGE level was significantly higher in the CKD patients than in the non-CKD individuals, regardless of the diabetes status. Soluble RAGE was significantly correlated with eGFR in both diabetic CKD (D-CKD) and non-diabetic CKD (ND-CKD) patients. The association between soluble RAGE and eGFR remained largely unaffected by the confounding factors in D-CKD patients. However, the confounding effect of enzymatic antioxidants in the relationship between eGFR and soluble RAGE was observed in ND-CKD patients. The increased plasma level of soluble RAGE is a better indicator of renal function decline in diabetic CKD patients instead of non-diabetic CKD patients. Copyright © 2015 Elsevier B.V. All rights reserved.

  14. Oral conditions, periodontal status and periodontal treatment need of chronic kidney disease patients

    Directory of Open Access Journals (Sweden)

    Modupeoluwa Omotunde Soroye

    2016-01-01

    Conclusion: Majority of the CKD patients reviewed had poor periodontal status with code 2 TN. We, therefore, recommend nonsurgical periodontal treatment for all CKD patients to improve their oral health and forestall the systemic effects of periodontal pathology.

  15. Epidemiology and Clinicopathologic Outcome of Pediatric Chronic ...

    African Journals Online (AJOL)

    Methods: We retrospectively analyzed the records of 154 CKD children and ... Hypertension, heart failure (HF), malnutrition, anemia, acute-on-CKD, need for dialysis, ... Keywords: Chronic Kidney Disease; Glomerular Disease; Mortality Risk ...

  16. Sleep disorders in children with chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Amira H. Darwish

    2016-09-01

    Conclusions: Sleep disturbances are very common among children with CKD. Sleep disturbances in patients with CKD include restless legs syndrome (RLS, excessive daytime sleepiness (EDS, sleep-disordered breathing (SDB, behavioral insomnias, and parasomnias.

  17. Development of intestinal ischemia/reperfusion-induced acute kidney injury in rats with or without chronic kidney disease: Cytokine/chemokine response and effect of α-melanocyte-stimulating hormone

    Directory of Open Access Journals (Sweden)

    Martin Skott

    2014-06-01

    Conclusion: Both the functional parameters and the cytokine/chemokine response are as dramatic when AKI is superimposed onto CKD as onto non-CKD. No convincing protective effect of α-MSH was detected.

  18. Mineral and Bone Disorder in Children with Chronic Kidney Disease Stage I to V (Predialysis

    Directory of Open Access Journals (Sweden)

    Joo Hoon Lee

    2014-06-01

    Conclusion: As CKD progressed, hyperphosphatemia, hyperparathyroidism and 1,25D3 deficiency increased, serum FGF-23 level increased and urinary phosphorus excretion decreased in children with CKD stage I to V predialysis.

  19. Eplerenone attenuates pulse wave reflection in chronic kidney disease stage 3-4--a randomized controlled study

    DEFF Research Database (Denmark)

    Boesby, Lene; Elung-Jensen, Thomas; Strandgaard, Svend

    2013-01-01

    Patients with chronic kidney disease (CKD) have high cardiovascular mortality and morbidity associated with increased arterial stiffness. Plasma aldosterone levels are increased in CKD, and aldosterone has been found to increase vascular inflammation and fibrosis. It was hypothesized...

  20. Download this PDF file

    African Journals Online (AJOL)

    2009-03-12

    Mar 12, 2009 ... Global Outreach Programs has made the fight against. CKD one of its major ... Undiagnosed Hypertension and Proteinuria in a Market Population in Ile-Ife, Nigeria .... shown to be associated with CKD, these include, ageing,.

  1. Features of ambulatory blood pressure in 540 patients with chronic kidney disease

    Institute of Scientific and Technical Information of China (English)

    王成

    2013-01-01

    Objective To explore the features and influencing factors of ambulatory blood pressure in chronic kidney disease(CKD)patients.Methods A total of 540 CKD patients from May 2010 to May 2012 in our department

  2. The Prevalence of Chronic Kidney Disease and Associated Factors ...

    African Journals Online (AJOL)

    2016-06-27

    Jun 27, 2016 ... CKD mainly affects young, reproductive adults between ..... to the direct effect of HIV on the renal system as CKD .... improve efficiency among sugarcane workers in El Salvador: Phase 1. ... Climate change and the emergent.

  3. Eating Right for Kidney Health

    Science.gov (United States)

    Eating Right for Kidney Health Tips for People with Chronic Kidney Disease (CKD) National Kidney Disease Education Program hat ... eat healthier. These tips will help you eat right as you manage your CKD. The First Steps ...

  4. Impaired vascular reactivity in patients with chronic kidney disease

    DEFF Research Database (Denmark)

    Tetzner, Fabian; Scholze, Alexandra; Wittstock, Antje

    2008-01-01

    Patients with chronic kidney disease (CKD) show increased cardiovascular morbidity. We hypothesized that vascular properties which can be routinely evaluated noninvasively are related to different stages of CKD and their clinical and biochemical characteristics.......Patients with chronic kidney disease (CKD) show increased cardiovascular morbidity. We hypothesized that vascular properties which can be routinely evaluated noninvasively are related to different stages of CKD and their clinical and biochemical characteristics....

  5. Tobacco exposure in children and adolescents with chronic kidney disease: parental behavior and knowledge. A study from the Midwest Pediatric Nephrology Consortium

    OpenAIRE

    Omoloja, Abiodun; Stolfi, Adrienne; Chand, Deepa; Laskin, Benjamin; Gipson, Debbie; Patel, Hiren; Smith, Jane Anne; Chishti, Aftab

    2014-01-01

    Aim: The incidence of cardiovascular disease (CVD) in children with chronic kidney disease (CKD) is high. Exposure to second hand smoke (SHS) is a known risk factor for CVD. Due to a recent report of high incidence of SHS in children with CKD, we sought to investigate via questionnaire the smoking behaviors of caregivers of children with CKD. Material and methods: A cross sectional study was conducted in which caregivers of children and adolescents with CKD were asked to complete a single ano...

  6. Effect of Redox Modulating NRF2 Activators on Chronic Kidney Disease

    OpenAIRE

    Bo-hyun Choi; Kyung-Shin Kang; Mi-Kyoung Kwak

    2014-01-01

    Chronic kidney disease (CKD) is featured by a progressive decline of kidney function and is mainly caused by chronic diseases such as diabetes mellitus and hypertension. CKD is a complex disease due to cardiovascular complications and high morbidity; however, there is no single treatment to improve kidney function in CKD patients. Since biological markers representing oxidative stress are significantly elevated in CKD patients, oxidative stress is receiving attention as a contributing factor ...

  7. Advanced chronic kidney disease, end-stage renal disease and renal death among HIV-positive individuals in Europe

    DEFF Research Database (Denmark)

    Nielsen, Lene Ryom; Kirk, O; Lundgren, J D

    2013-01-01

    Knowledge about advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) in HIV-positive persons is limited. The aim of this study was to investigate incidence, predictors and outcomes for advanced CKD/ESRD and renal death.......Knowledge about advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) in HIV-positive persons is limited. The aim of this study was to investigate incidence, predictors and outcomes for advanced CKD/ESRD and renal death....

  8. Efficacy of Statin Treatment in Early-Stage Chronic Kidney Disease

    OpenAIRE

    Cho, Eun Yeong; Myoung, Chana; Park, Hong-Suk; Kim, Ae Jin; Ro, Han; Chang, Jae Hyun; Lee, Hyun Hee; Chung, Wookyung; Jung, Ji Yong

    2017-01-01

    Chronic kidney disease (CKD) represents a major medical challenge and frequently coexists with cardiovascular disease (CVD), which can be treated by statin trerapy. However, whether statin treatment affects renal progression and outcomes in CKD patients remains unclear. We retrospectively reviewed CKD patients at Gachon University Gil Medical Center from 2003–2013. From a total of 14,497 CKD patients, 858 statin users were paired with non-users and analyze with propensity score matching was p...

  9. Outcomes after percutaneous coronary interventions in patients with chronic kidney disease

    Institute of Scientific and Technical Information of China (English)

    Tan Huay Cheem

    2005-01-01

    @@ Introduction Chronic kidney disease (CKD) is a significant contributor to cardiovascular morbidity and mortality.Patients with CKD are known to have a greater prevalence of cardiovascular disease than the general population,1 and patients with concurrent CKD and coronary artery disease (CAD) have greater mortality than patients without CKD.2-4 The rate of cardiovascular mortality is approximately 50%,five to 10 times higher than the general population.

  10. Improving the diagnostic accuracy of acute myocardial infarction with the use of high-sensitive cardiac troponin T in different chronic kidney disease stages

    Science.gov (United States)

    Yang, Hongliu; Liu, Jing; Luo, Han; Zeng, Xiaoxi; Tang, Xi; Ma, Liang; Mai, Hongxia; Gou, Shenju; Liu, Fang; Fu, Ping

    2017-01-01

    High-sensitive cardiac troponin T (hs-TnT) is a critical biomarker in diagnosis of acute myocardial infarction (AMI). However, CKD individuals usually have elevated hs-TnT even in the absence of AMI. Our study aimed to explore the optimal cutoff-value of hs-TnT and further to improve diagnostic accuracy of AMI in CKD patients. Clinical data of 489 patients were collected from the maintained database between September 2010 and June 2014. CKD patients with AMI were assigned to CKD+AMI group and CKD patients without AMI were assigned to CKD group. Receiver operating characteristic curves were utilized to derive the optimal cutoff-value. In CKD+STEMI and CKD group, hs-TnT was increased with descending eGFR. In CKD+NSTEMI group, hs-TnT showed an upward trend with increasing SYNTAX Score. In patients with CKD+STEMI, hs-TnT was significantly correlated with SYNTAX Score in CKD stage 2, stage 4 and in total. In CKD patients, the optimal cutoff-value of hs-TnT for diagnosis of AMI was 129.45 ng/l with 75.2% sensitivity and 83.2% specificity. The cutoff-value appeared to be hs-TnT level of 99.55ng/l in CKD stage 3, 129.45 ng/l in CKD stage 4, 105.50 ng/l in CKD stage 5 and 149.35 ng/l in dialysis patients, respectively. In different stages of CKD, eGFR-range-specific optimal cutoff-values should be considered. PMID:28145489

  11. Optimization of graded multilayer designs for astronomical x-ray telescopes

    DEFF Research Database (Denmark)

    Mao, P.H.; Harrison, F.A.; Windt, D.L.

    1999-01-01

    We developed a systematic method for optimizing the design of depth-graded multilayers for astronomical hard-x-ray and soft-gamma-ray telescopes based on the instrument's bandpass and the field of view. We apply these methods to the design of the conical-approximation Wolter I optics employed...... by the balloon-borne High Energy Focusing Telescope, using W/Si as the multilayer materials. In addition, we present optimized performance calculations of mirrors, using other material pairs that are capable of extending performance to photon energies above the W K-absorption edge (69.5 keV), including Pt/C, Ni...

  12. Former Smoking Is a Risk Factor for Chronic Kidney Disease After Lung Transplantation

    NARCIS (Netherlands)

    Hellemons, M. E.; Agarwal, P. K.; van der Bij, W.; Verschuuren, E. A. M.; Postmus, D.; Erasmus, M. E.; Navis, G. J.; Bakker, S. J. L.

    2011-01-01

    Chronic kidney disease (CKD) is a common complication after lung transplantation (LTx). Smoking is a risk factor for many diseases, including CKD. Smoking cessation for >6 months is required for LTx enlistment. However, the impact of smoking history on CKD development after LTx remains unclear. We i

  13. Slowing Kidney Disease

    Science.gov (United States)

    ... takes years of daily use for NSAIDs to cause CKD. But, once CKD is present, NSAIDs can make ... in the wrong places can “oxidize” and cause damage, a lot like rust. Antioxidants ... Fish oil can help slow CKD that is caused by a disease called IgA ...

  14. Epidemiology of chronic kidney disease in a Sri Lankan population: Experience of a tertiary care center

    Directory of Open Access Journals (Sweden)

    Eranga S Wijewickrama

    2011-01-01

    Full Text Available Chronic kidney disease (CKD is a growing problem in Sri Lanka. Diabetes and hypertension are the main contributors to the disease burden. A new form of CKD of uncertain etiology (CKD-u is the predominant form of CKD in certain parts of Sri Lanka, threatening to reach epidemic proportions. A cross-sectional descriptive study was carried out over a three-month period at the National Hospital of Sri Lanka to identify the underlying etiologic factors for the disease in a cohort of patients with CKD. A total of 200 patients were studied with a mean age of 50.57 years. Of them, 108 (54% were in CKD stage V. Majority of the patients were from the western province (137, 68.5% with only five (2.5% from provinces with high prevalence of CKD-u. The most common underlying causes of CKD were diabetes (88, 44% and hypertension (34, 17%. However, in patients younger than 40 years of age the most common cause was glomerulonephritis (20, 42.6%. Diabetes was the most common cause of CKD among patients from the western province (74, 54%. The prevalence of CKD-u was twice as high in patients from areas outside the western province compared with patients from this province (P > 0.05. The low prevalence of CKD-u in the study population could be the result of poor representation of patients from provinces with high prevalence of CKD-u.

  15. Resistant starch alters gut microbiota and reduces uremic retention solutes in rats with adenine-induced chronic kidney disease

    Science.gov (United States)

    Chronic kidney disease (CKD) is characterized by the reduced ability to void urine, leading to accumulation of waste products in the body. Recently, it has been observed that patients with CKD have an altered gut microbiome. This may in part be due to reduced fiber intake. Patients with CKD are ofte...

  16. Repeat testing is essential when estimating chronic kidney disease prevalence and associated cardiovascular risk.

    Science.gov (United States)

    Brook, M O; Bottomley, M J; Mevada, C; Svistunova, A; Bielinska, A-M; James, T; Kalachik, A; Harden, P N

    2012-03-01

    Investigations into chronic kidney disease (CKD) and cardiovascular disease in the CKD population may be misleading as they are often based on a single test of kidney function. To determine whether repeat testing at 3 months to confirm a diagnosis of CKD impacts on the estimated prevalence of CKD and the estimated 10-year general cardiovascular risk of the CKD population. Blood and urine samples from presumed healthy volunteers were analysed for evidence of CKD on recruitment and again 3 months later. Estimated 10-year cardiovascular risk was calculated using criteria determined by the Framingham study. Preliminary study: 512 volunteers were screened for CKD. Of the initial results, 206 indicated CKD or eGFR within one standard deviation of abnormal, and 142 (69%) of these were retested. Validation study: 528 volunteers were recruited and invited to return for repeat testing. A total of 214 (40.5%) participants provided repeat samples. A single test indicating CKD had a positive predictive value of 0.5 (preliminary) and 0.39 (validation) for repeat abnormalities 3 months later. Participants with CKD confirmed on repeat testing had a significant increase in estimated 10-year cardiovascular risk over the population as a whole (preliminary: 16.5 vs. 11.9%, P risk. Repeat testing for CKD after 3 months significantly reduces the estimated prevalence of disease and identifies a population with true CKD and a cardiovascular risk significantly in excess of the general population.

  17. Bone Density Is Directly Associated With Glomerular Filtration and Metabolic Acidosis but Do Not Predict Fragility Fractures in Men With Moderate Chronic Kidney Disease.

    Science.gov (United States)

    Lima, Guilherme Alcantara Cunha; de Paula Paranhos-Neto, Francisco; Silva, Luciana Colonese; de Mendonça, Laura Maria Carvalho; Delgado, Alvimar Gonçalves; Leite, Maurilo; Gomes, Carlos Perez; Farias, Maria Lucia Fleiuss

    2016-01-01

    Hyperparathyroidism, vitamin D deficiency, increased fibroblast growth factor-23 (FGF-23), and metabolic acidosis promote bone fragility in chronic kidney disease (CKD). Although useful in predicting fracture risk in the general population, the role of dual-energy X-ray absorptiometry (DXA) in CKD remains uncertain. This cross-sectional study included 51 men aged 50-75 yr with moderate CKD. The stage 4 CKD patients had higher levels of parathyroid hormone (pmetabolic acidosis for bone impairment and to the inadequacy of DXA to evaluate bone fragility in CKD patients.

  18. Oxidative stress and chronic kidney disease.

    Science.gov (United States)

    Brown, Scott A

    2008-01-01

    Slowing the rate of progression of chronic kidney disease (CKD) is a critical part of the management of affected dogs and cats. Renal oxidant stress is a previously unrecognized factor in the progression of canine CKD and is likely to be similarly important in feline CKD. Renin-angiotensin antagonism, calcium channel antagonism, n-3 polyunsaturated fatty acid, and antihypertensive and antiproteinuric therapy are commonly recommended for dogs and cats with CKD. These therapies would be expected to reduce renal oxidant stress by decreasing reactive oxygen species generation. Newer data indicate that dietary supplementation with specific antioxidants is an important consideration for limiting renal oxidant stress and progression of CKD.

  19. l-Carnitine improves cognitive and renal functions in a rat model of chronic kidney disease.

    Science.gov (United States)

    Abu Ahmad, Nur; Armaly, Zaher; Berman, Sylvia; Jabour, Adel; Aga-Mizrachi, Shlomit; Mosenego-Ornan, Efrat; Avital, Avi

    2016-10-01

    Over the past decade, the prevalence of chronic kidney disease (CKD) has reached epidemic proportions. The search for novel pharmacological treatment for CKD has become an area of intensive clinical research. l-Carnitine, considered as the "gatekeeper" responsible for admitting long chain fatty acids into cell mitochondria. l-Carnitine synthesis and turnover are regulated mainly by the kidney and its levels inversely correlate with serum creatinine of normal subjects and CKD patients. Previous studies showed that l-carnitine administration to elderly people is improving and preserving cognitive function. As yet, there are no clinical intervention studies that investigated the effect of l-carnitine administration on cognitive impairment evidenced in CKD patients. Thus, we aimed to investigate the effects of l-carnitine treatment on renal function and on the cognitive performance in a rat model of progressive CKD. To assess the role of l-carnitine on CKD condition, we estimated the renal function and cognitive abilities in a CKD rat model. We found that all CKD animals exhibited renal function deterioration, as indicated by elevated serum creatinine, BUN, and ample histopathological abnormalities. l-Carnitine treatment of CKD rats significantly reduced serum creatinine and BUN, attenuated renal hypertrophy and decreased renal tissue damage. In addition, in the two way shuttle avoidance learning, CKD animals showed cognitive impairment which recovered by the administration of l-carnitine. We conclude that in a rat model of CKD, l-carnitine administration significantly improved cognitive and renal functions.

  20. Building the chronic kidney disease management team.

    Science.gov (United States)

    Spry, Leslie

    2008-01-01

    The need to be efficient and the demands for performance-based service are changing how nephrologists deliver care. Chronic kidney disease (CKD) occurs in patients with complex medical and social problems. CKD management requires that multidisciplinary professionals provide patient education, disease management, and psychosocial support. To remain cost-efficient, many physicians are training and supervising midlevel practitioners in the delivery of specialized health care. Specialized care that meets present CKD patient needs is best delivered in a CKD clinic. Three models of CKD clinic are identified: (1) anemia management CKD clinic, (2) the basic CKD clinic, and (3) the comprehensive CKD clinic. Each clinic model is based on critical elements of staffing, billable services, and patient-focused health care. Billable services are anemia-management services, physician services that may be provided by midlevel practitioners, and medical nutrition therapy. In some cases, social worker services may be billable. Building a patient-focused clinic that offers CKD management requires planning, familiarity with federal regulations and statutes, and skillful practitioners. Making services cost-efficient and outcome oriented requires careful physician leadership, talented midlevel practitioners, and billing professionals who understand the goals of the CKD clinic. As Medicare payment reforms evolve, a well-organized CKD program can be well poised to meet the requirements of payers and congressional mandates for performance-based purchasing.

  1. ARTERIAL STIFFNESS AND CHRONIC KIDNEY DISEASE: CAUSES AND CONSEQUENCES

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    J. D. Kobalava

    2015-09-01

    Full Text Available Chronic kidney disease (CKD is associated with increased cardiovascular risk. CKD is characterized by accelerated aging of vessels in which the age-related arterial stiffness increase is exacerbated by a number of uremia-related processes. Increased arterial stiffness is associated with structural and functional disorders, as well as with the increase in cardiovascular mortality in patients with CKD. Increased arterial stiffness is diagnosed at an early stage of CKD. Modern understanding of the mechanisms of increased risk of cardiovascular complications in CKD, the factors contributing to the loss of elasticity of the arteries, arterial stiffness increase consequences are analyzed. Data illustrating the twoway interaction between CKD and arterial stiffness and mechanisms of accelerated progression of arterial stiffness in CKD are presented.

  2. Awareness of Chronic Kidney Disease among Patients and Providers

    Science.gov (United States)

    Plantinga, Laura C.; Tuot, Delphine S.; Powe, Neil R.

    2010-01-01

    Earlier recognition of chronic kidney disease (CKD) could slow progression, prevent complications, and reduce cardiovascular-related outcomes. However, current estimates of CKD awareness indicate that both patient- and provider-level awareness remain unacceptably low. Many of the factors that are possibly associated with CKD awareness, which could help guide implementation of awareness efforts, have yet to be fully examined. Also, little is known regarding whether increased patient or provider awareness improves clinical outcomes or whether there are possible negative consequences of awareness for CKD patients. Further research is necessary to continue to design and refine awareness campaigns aimed at both patients and providers, but there is an immediate need for dissemination of basic CKD information, given both the high prevalence of CKD and its risk factors and the low estimated awareness of CKD. PMID:20439091

  3. Effect of bicarbonate supplementation on renal function and nutritional indices in predialysis advanced chronic kidney disease.

    Science.gov (United States)

    Jeong, Jiwon; Kwon, Soon Kil; Kim, Hye-Young

    2014-12-01

    Current practice guidelines recommend alkali therapy in patients with chronic kidney disease (CKD) and metabolic acidosis to prevent complications. This study aims to investigate the effect of oral sodium bicarbonate supplementation on the progression of renal function and nutritional indices in patients with predialysis advanced CKD. Forty patients with predialysis stage 5 CKD(estimated glomerular filtration rate, eGFR total lymphocyte count (TLC), and Ondodera's prognostic nutritional index (OPNI) during the study between the two groups. In stage 5 CKD, there were significant differences in the changes of TLC and OPNI between the two groups. In conclusion, our results demonstrate that bicarbonate supplementation slows the rate of decline of renal function in stage 4 CKD and improves nutritional indices in stage 5 CKD. Alkali therapy in advanced CKD may have beneficial effect on renal function and malnutrition.

  4. THE EXPRESSION PROFILING OF INTESTINAL NUTRIENT TRANSPORTER GENES IN RATS WITH RENAL FAILURE

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    Hironori Yamamoto

    2012-06-01

    has been still unclear how different of the intestinal function in CKD. In this study, we demonstrated the microarray analysis of global gene expression in intestine of adenine-induced CKD rat. DNA microarray analysis using Affymextrix rat gene chip revealed that CKD caused great changes in gene expression in the rat duodenum: about 400 genes exhibited more than a two-fold change in expression level. Gene ontology analysis showed that a global regulation of genes by CKD involved in iron ion binding, alcoholic, organic acid and lipid metabolism. Furthermore, we found markedly changes of a number of intestinal transporters gene expression related to iron metabolism. These results suggest that CKD may alter some nutrient metabolism in the small intestine by modifying the expression of specific genes. The intestinal transcriptome database of CKD might be useful to develop the novel drugs or functional foods for CKD patients.

  5. Chronic kidney disease in Nigeria: an evaluation of the spatial accessibility to healthcare for diagnosed cases in Edo State

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    Osaretin Oviasu

    2016-05-01

    Full Text Available Chronic kidney disease (CKD is a growing problem in Nigeria, presenting challenges to the nation’s health and economy. This study evaluates the accessibility to healthcare in Edo State of CKD patients diagnosed between 2006 and 2009. Using cost analysis techniques within a geographical information system, an estimated travel time to the hospital was used to examine the spatial accessibility of diagnosed patients to available CKD healthcare in the state. The results from the study indicated that although there was an annual rise in the number of diagnosed cases, there were no significant changes in the proportion of patients that were diagnosed at the last stage of CKD. However, there were indications that the travel time to the hospital for CKD treatment might be a contributing factor to the number of diagnosed CKD cases. This implies that the current structure for CKD management within the state might not be adequate.

  6. Study on high quality spectral materials for emitted soft X-ray. Special study on inorganic materials between FY 1991 and FY 1995; Hoshako nan X sen`yo bunko zairyo no kohinshitsuka ni kansuru kenkyu. 1991 nendo - 1995 nendo muki zaishitsu tokubetsu kenkyu

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-11-28

    This is No.93 report of National Institute for Research in Inorganic Materials. Single crystal growth of YB66 was investigated to develop the single crystal of YB66 as a spectral material for synchrotron emitted soft X-ray. The emitted light is white light including from visible radiation to hard X-ray. Usually, it is used as homogeneous light through spectra. There are K-absorption edges of Mg and Si in the region ranging from 1 to 2 keV, which is significant for material science. There has been no proper spectral elemental device for application of the emitted spectra. The YB66 is the most suitable for this purpose. For the single crystal growth of high crystalline YB66, high frequency indirect heating floating method has been developed. For the growth furnace, a mechanism has been developed, by which pressurized gas atmosphere can be sealed with magnetic fluid. At the same time, the growth axis can be driven in high accuracy. From evaluation of the elemental device, energy resolution of 0.5{times}10{sup -3} was obtained as expected. By using this spectral device, accurate measurements of XAFS and EXAFS can be conducted with excellent operability for K-absorption edges of Mg and Si. 15 refs., 54 figs., 1 tab.

  7. Effects of unfractionated heparin on renal osteodystrophy and vascular calcification in chronic kidney disease rats.

    Science.gov (United States)

    Meng, Yan; Zhang, Hao; Li, Yingbin; Li, Qingnan; Zuo, Li

    2014-01-01

    Unfractionated heparin (UFH) is the most widely used anticoagulant in hemodialysis for chronic kidney disease (CKD) patients. Many studies have verified that UFH can induce bone loss in subjects with normal bone, but few have focused on its effect on renal osteodystrophy. We therefore investigated this issue in adenine-induced CKD rats. As CKD also impairs mineral metabolism systemically, we also studied the impacts of UFH on serum markers of CKD-mineral and bone disorder (CKD-MBD) and vascular calcification. We administered low and high doses of UFH (1U/g and 2U/g body weight, respectively) to CKD rats and compared them with CKD controls. At sacrifice, the serum markers of CKD-MBD did not significantly differ among the two UFH CKD groups and the CKD control group. The mean bone mineral densities (BMDs) of the total femur and a region of interest (ROI) constituted of trabecular and cortical bone were lower in the high-dose UFH (H-UFH) CKD group than in the CKD control group (P<0.05 and P<0.01, respectively). The BMD of the femoral ROI constituted of cortical bone did not differ between the H-UFH CKD group and the CKD control group. Histomorphometrical changes in the CKD rats indicated secondary hyperparathyroidism, and the femoral trabecular bone volume, but not cortical bone volume, significantly decreased with increasing UFH dose. The same decreasing trend was found in osteoblast parameters, and an increasing trend was found in osteoclast parameters; however, most differences were not significant. Moreover, no distinct statistical differences were found in the comparison of vascular calcium or phosphorus content among the CKD control group and the two UFH CKD groups. Therefore, we concluded that UFH could induce bone loss in CKD rats with secondary hyperparathyroidism, mainly by reducing the trabecular volume and had little effect on cortical bone volume. The underlying mechanism might involve inhibition of osteoblast activity and promotion of osteoclast activity

  8. Malnutrition in pre-dialysis chronic kidney disease patients in a teaching hospital in Southern Nigeria.

    Science.gov (United States)

    Oluseyi, Adejumo; Enajite, Okaka

    2016-03-01

    Malnutrition is a complication in chronic kidney disease (CKD) known to affect quality of life and prognosis although not often diagnosed. It is associated with rapid progression to end stage renal disease (ESRD) and mortality. Early identification and treatment will slow down progression to ESRD and mortality. To determine the prevalence and pattern of malnutrition in pre-dialysis CKD patients in Southern Nigeria. One hundred and twenty consecutive pre-dialysis CKD and 40 control subjects without CKD were studied. Data obtained from participants were demographics, body mass index (BMI), and aetiology of CKD. Indices used to assess presence of malnutrition were low BMI, hypocholesterolaemia and hypoalbuminaemia. Statistical significance was taken at 0.05 level. The mean age of the CKD subjects was 48.8±16.6years with a male: female ratio of 1.7:1. Prevalence of malnutrition in the CKD subjects was 46.7%, higher than 27.5% observed in the controls (p=0.033). Prevalence of malnutrition increased significantly across CKD stages 2 to 5 (p=0.020). It was significantly commoner in elderly patients (p=0.047) but not significantly different between males and females(p=0.188). Malnutrition is common in pre-dialysis CKD patients even in early CKD stages. Prevalence of malnutrition increases with worsening kidney function and increasing age.

  9. Illness representations and coping processes of Taiwanese patients with early-stage chronic kidney disease.

    Science.gov (United States)

    Lin, Chiu-Chu; Chen, Mei-Chun; Hsieh, Hsiu-Fang; Chang, Shu-Chen

    2013-06-01

    Chronic kidney disease (CKD) is a public health problem worldwide with an increasing incidence and prevalence and high cost. The role of illness perceptions in understanding health-related behavior has received little attention in patients with early-stage CKD. This qualitative study aimed to describe the illness representation and coping process experience of patients with early-stage CKD in Taiwan. A qualitative content analysis approach was used to analyze semistructured, open-ended, one-on-one interviews with 15 patients with early-stage CKD. Purposive sampling was used to recruit patients diagnosed with early-stage CKD from the nephrology departments of two medical centers in Taiwan. Trustworthiness of the study was evaluated using four criteria suggested by Lincoln and Guba. Six themes emerged from the analysis: experiencing early symptoms, self-interpreting the causes of having CKD, realizing CKD as a long-term disease, believing CKD could be controlled by following doctors' orders, anticipating the consequences of having CKD, and adopting coping strategies to delay the progress of CKD. Findings from this study compared with previous studies reveal that education can effectively change patient illness representations as an approach to improve coping behavior. This finding offers healthcare professionals insight into the health education necessary to assess patient illness representation to provide culturally sensitive interventions.

  10. [Assessment and characteristics of chronic renal insufficiency in France].

    Science.gov (United States)

    Bongard, V; Dallongeville, J; Arveiler, D; Ruidavets, J-B; Cottel, D; Wagner, A; Ferrières, J

    2012-08-01

    Chronic kidney disease (CKD) is a major public health issue. In France, few studies have evaluated CKD prevalence. The objective of the MONA LISA study was to estimate and to characterize CKD in three representative cross-sectional surveys in subjects aged 35-74.9 years. CKD was defined as subjects having MDRD glomerular filtration rate lower than 60 mL/min/1.73 m(2). Prevalence of CKD in MONA LISA was standardized according to the French population. A multiple logistic regression analysis was performed in order to find independent factors associated to CKD. The French estimate of CKD prevalence was 8.2% (95% confidence interval: 7.4-8.9%), that is 2,454,548 (95% confidence interval: 2,215,080-2,664,082) subjects aged 35-74.9 years. Factors significantly and independently associated to CKD were older age, hypertension and dyslipidemias. In conclusion, the MONA LISA study evaluated for the first time in France CKD prevalence in subjects aged 35-74.9 years. This prevalence probably underestimates the real CKD size due to selection bias present in every representative cross-sectional survey. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  11. Arterial stiffness and enlargement in mild-to-moderate chronic kidney disease.

    Science.gov (United States)

    Briet, M; Bozec, E; Laurent, S; Fassot, C; London, G M; Jacquot, C; Froissart, M; Houillier, P; Boutouyrie, P

    2006-01-01

    Chronic kidney disease (CKD) is associated with an increased risk of cardiovascular morbidity and mortality. Arterial stiffness and remodeling have been well documented in patients with end-stage renal disease, but little is known about arterial phenotype in CKD patients with moderate reduction in glomerular filtration rate (GFR). In total, 95 patients (58+/-15 years, mean+/-s.d.) with CKD and GFR measured by renal clearance of (51)Cr-ethylenediaminetetraacetate were compared to 121 hypertensive patients without CKD (59+/-11 years), and 57 normotensive subjects (56+/-6 years). Common carotid artery diameter, intima-media thickness (IMT), distensibility, and Young's elastic modulus were noninvasively determined with a high-definition echotracking system. Patients with CKD had a significantly larger carotid internal diameter than in hypertensives and normotensives (6.32+/-1.05, 5.84+/-0.74, and 5.50+/-0.64 m x 10(-3), respectively; Pelastic modulus did not significantly differ between CKD and hypertensives; normotensives had significantly higher distensibility and lower elastic modulus than CKD and hypertensive patients. Carotid-femoral pulse wave velocity was significantly higher in CKD patients than in hypertensives and normotensives. In multivariate analyses either involving the entire population or restricted to CKD patients, GFR was independently and strongly related to carotid diameter and elastic modulus. Arterial enlargement and increased arterial stiffness occur in parallel with the decline in renal function in patients with mild-to-moderate CKD.

  12. Excess mortality attributable to chronic kidney disease. Results from the PIRP project.

    Science.gov (United States)

    Gibertoni, Dino; Mandreoli, Marcora; Rucci, Paola; Fantini, Maria Pia; Rigotti, Angelo; Scarpioni, Roberto; Santoro, Antonio

    2016-10-01

    Although chronic kidney disease (CKD) has a high mortality rate, the estimation of CKD mortality burden in the general population may be challenging because CKD is not always listed as a cause of death in mortality registries. To overcome this limitation, relative survival was used to estimate the excess mortality attributable to CKD as compared to the general population using data of patients registered in the Prevenzione Insufficienza Renale Progressiva (PIRP) registry since 2005 and were followed up until 2013. Relative survival was the ratio of survival observed in CKD patients to the expected survival of the general population. Multivariate parametric survival analysis was used to identify factors predicting excess mortality. The relative survival of CKD patients at 9 years was 0.708. Survival was significantly lower in CKD patients with cardiovascular comorbidities, proteinuria, diabetes, anemia and high phosphate levels and in advanced CKD stages, males, older patients and those who underwent dialysis. Relative survival is a viable method to determine mortality attributable to CKD. Study limitations are that patients are representative only of CKD patients followed by nephrologists and that our follow-up duration may be relatively short as a model for mortality.

  13. Possible involvement of microRNAs in vascular damage in experimental chronic kidney disease.

    Science.gov (United States)

    Taïbi, Fatiha; Metzinger-Le Meuth, Valérie; M'Baya-Moutoula, Eléonore; Djelouat, Mohamed seif el Islam; Louvet, Loïc; Bugnicourt, Jean-Marc; Poirot, Sabrina; Bengrine, Abderrahmane; Chillon, Jean-Marc; Massy, Ziad A; Metzinger, Laurent

    2014-01-01

    Chronic kidney disease (CKD) is associated with vascular calcifications and atherosclerosis. There is a need for novel predictors to allow earlier diagnosis of these disorders, predict disease progression, and improve assessment of treatment response. We focused on microRNAs since they are implicated in a variety of cellular functions in cardiovascular pathology. We examined changes of microRNA expression in aortas of CKD and non-CKD wild type mice and apolipoprotein E knock-out mice, respectively. Both vascular smooth muscle-specific miR-143 and miR-145 expressions were decreased in states of atherosclerosis and/or CKD or both, and the expression level of protein target Myocardin was increased. The inflammatory miR-223 was increased in more advanced stages of CKD, and specific protein targets NFI-A and GLUT-4 were dramatically decreased. Expression of miR-126 was markedly increased and expression of protein targets VCAM-1 and SDF-1 was altered during the course of CKD. The drug sevelamer, commonly used in CKD, corrected partially these changes in microRNA expression, suggesting a direct link between the observed microRNA alterations and uremic vascular toxicity. Finally, miR-126, -143 and -223 expression levels were deregulated in murine serum during the course of experimental CKD. In conclusion, these miRNAs could have role(s) in CKD vascular remodeling and may therefore represent useful targets to prevent or treat complications of CKD.

  14. The prevalence and classification of chronic kidney disease in cats randomly selected within four age groups and in cats recruited for degenerative joint disease studies

    Science.gov (United States)

    Marino, Christina L; Lascelles, B Duncan X; Vaden, Shelly L; Gruen, Margaret E; Marks, Steven L

    2015-01-01

    Chronic kidney disease (CKD) and degenerative joint disease are both considered common in older cats. Information on the co-prevalence of these two diseases is lacking. This retrospective study was designed to determine the prevalence of CKD in two cohorts of cats: cats randomly selected from four evenly distributed age groups (RS group) and cats recruited for degenerative joint disease studies (DJD group), and to evaluate the concurrence of CKD and DJD in these cohorts. The RS group was randomly selected from four age groups from 6 months to 20 years, and the DJD group comprised cats recruited to four previous DJD studies, with the DJD group excluding cats with a blood urea nitrogen and/or serum creatinine concentration >20% (the upper end of normal) for two studies and cats with CKD stages 3 and 4 for the other two studies. The prevalence of CKD in the RS and DJD groups was higher than expected at 50% and 68.8%, respectively. CKD was common in cats between 1 and 15 years of age, with a similar prevalence of CKD stages 1 and 2 across age groups in both the RS and DJD cats, respectively. We found significant concurrence between CKD and DJD in cats of all ages, indicating the need for increased screening for CKD when selecting DJD treatments. Additionally, this study offers the idea of a relationship and causal commonality between CKD and DJD owing to the striking concurrence across age groups and life stages. PMID:24217707

  15. Mesenchymal stem cells from rats with chronic kidney disease exhibit premature senescence and loss of regenerative potential.

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    Barbara Mara Klinkhammer

    Full Text Available Mesenchymal stem cell (MSC transplantation has the potential for organ repair. Nevertheless, some factors might lessen the regenerative potential of MSCs, e.g. donor age or systemic disease. It is thus important to carefully assess the patient's suitability for autologous MSC transplantation. Here we investigated the effects of chronic kidney disease (CKD on MSC function. We isolated bone marrow MSCs from remnant kidney rats (RK with CKD (CKD-RK-MSC and found signs of premature senescence: spontaneous adipogenesis, reduced proliferation capacity, active senescence-associated-β-galactosidase, accumulation of actin and a modulated secretion profile. The functionality of CKD-RK-MSCs in vivo was tested in rats with acute anti-Thy1.1-nephritis, where healthy MSCs have been shown to be beneficial. Rats received healthy MSCs, CKD-RK-MSC or medium by injection into the left renal artery. Kidneys receiving healthy MSCs exhibited accelerated healing of glomerular lesions, whereas CKD-RK-MSC or medium exerted no benefit. The negative influence of advanced CKD/uremia on MSCs was confirmed in a second model of CKD, adenine nephropathy (AD. MSCs from rats with adenine nephropathy (CKD-AD-MSC also exhibited cellular modifications and functional deficits in vivo. We conclude that CKD leads to a sustained loss of in vitro and in vivo functionality in MSCs, possibly due to premature cellular senescence. Considering autologous MSC therapy in human renal disease, studies identifying uremia-associated mechanisms that account for altered MSC function are urgently needed.

  16. Effects of clopidogrel on mortality, cardiovascular and bleeding outcomes in patients with chronic kidney disease - data from Taiwan acute coronary syndrome full spectrum registry.

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    Tsung-Hsien Lin

    Full Text Available BACKGROUND: The efficacy of clopidogrel is inconclusive in the chronic kidney disease (CKD population with acute coronary syndrome (ACS. Furthermore, CKD patients are prone to bleeding with antiplatelet therapy. We investigated the efficacy and safety of clopidogrel in patients with ACS and CKD. METHODS: In a Taiwan national-wide registry, 2819 ACS patients were enrolled. CKD is defined as an estimated glomerular filtration rate of less than 60 ml/min per 1.73 m(2. The primary endpoints are the combined outcomes of death, non-fatal myocardial infarction and stroke at 12 months. RESULTS: Overall 949 (33.7% patients had CKD and 2660 (94.36% patients received clopidogrel treatment. CKD is associated with increased risk of the primary endpoint at 12 months (HR 2.39, 95% CI 1.82 to 3.15, p<0.01. Clopidogrel use is associated with reduced risk of the primary endpoint at 12 months (HR 0.42, 95% CI: 0.29-0.60, p<0.01. Cox regression analysis showed that clopidogrel reduced death and primary endpoints for CKD population (HR 0.35, 95% CI: 0.21-0.61 and HR 0.48, 95% CI: 0.30-0.77, respectively, both p<0.01. Patients with clopidogrel(-/CKD(-, clopidogrel(+/CKD(+ and clopidogrel(-/CKD(+ have 2.4, 3.0 and 10.4 fold risk to have primary endpoints compared with those receiving clopidogrel treatment without CKD (all p<0.01. Clopidogrel treatment was not associated with increased in-hospital Thrombolysis In Myocardial Infarction (TIMI bleeding in CKD population. CONCLUSION: Clopidogrel could decrease mortality and improve cardiovascular outcomes without increasing risk of bleeding in ACS patients with CKD.

  17. Is chronic kidney disease an adverse factor in lung cancer clinical outcome? A propensity score matching study

    Science.gov (United States)

    Lu, Ming‐Shian; Chen, Miao‐Fen; Lin, Chien‐Chao; Tseng, Yuan‐Hsi; Huang, Yao‐Kuang; Liu, Hui‐Ping

    2017-01-01

    Background Comorbidity has a great impact on lung cancer survival. Renal function status may affect treatment decisions and drug toxicity. The survival outcome in lung cancer patients with coexisting chronic kidney disease (CKD) has not been fully evaluated. We hypothesized that CKD is an independent risk factor for mortality in patients with lung cancer. Methods A retrospective, propensity‐matched study of 434 patients diagnosed between June 2004 and May 2012 was conducted. CKD was defined as estimated glomerular filtration rate cancer and coexisting CKD patients were matched 1:1 to patients with lung cancer without CKD. Results Age, gender, smoking status, histology, and lung cancer stage were not statistically significantly different between the CKD and non‐CKD groups. Kaplan–Meier survival analysis demonstrated a median survival of 7.26 months (95% confidence interval [CI] 6.06–8.46) in the CKD group compared with 7.82 months (95% CI 6.33–9.30) in the non‐CKD group (P = 0.41). Lung cancer stage‐specific survival is not affected by CKD. Although lung cancer patients with CKD presented with an increased risk of death of 6%, this result was not statistically significant (hazard ratio 1.06, 95% CI 0.93–1.22; P = 0.41). Conclusion According to our limited experience, CKD is not an independent risk factor for survival in lung cancer patients. Clinicians should not be discouraged to treat lung cancer patients with CKD. PMID:28207203

  18. Increased Blood Pressure Variability Prior to Chronic Kidney Disease Exacerbates Renal Dysfunction in Rats

    Directory of Open Access Journals (Sweden)

    Frederico Felipe Costa Tebas Freitas

    2016-09-01

    Full Text Available Increased blood pressure variability (BPV, which can be experimentally induced by sinoaortic denervation (SAD, has emerged as a new marker of the prognosis of cardiovascular and renal outcomes. Considering that increased BPV can lead to organ-damage, the goal of the present study was to evaluate the effects of SAD on renal function in an experimental model of chronic kidney disease (CKD. SAD was performed in male Wistar rats 2 weeks before 5/6 nephrectomy and the animals were evaluated 4 weeks after the induction of CKD. Our data demonstrated that BPV was increased in SAD and CKD animals and that the combination of both conditions (SAD+CKD exacerbated BPV. The baroreflex sensitivity index was diminished in the SAD and CKD groups; this reduction was more pronounced when SAD and CKD were performed together. 5/6 nephrectomy led to hypertension, which was higher in SAD+CKD animals. Regarding renal function, the combination of SAD and CKD resulted in reduced renal plasma and blood flow, increased renal vascular resistance and augmented uraemia when compared to CKD animals. Glomerular filtration rate and BPV were negatively correlated in SAD, CKD and SAD+CKD animals. Moreover, SAD+CKD animals presented a higher level of glomerulosclerosis when compared to all other groups. Cardiac and renal hypertrophy, as well as oxidative stress, was also further increased when SAD and CKD were combined. These results show that SAD prior to 5/6 nephrectomy exacerbates renal dysfunction, suggesting that previous augmented BPV should be considered as an important factor to the progression of renal diseases.

  19. Increased Blood Pressure Variability Prior to Chronic Kidney Disease Exacerbates Renal Dysfunction in Rats

    Science.gov (United States)

    Freitas, Frederico F. C. T.; Araujo, Gilberto; Porto, Marcella L.; Freitas, Flavia P. S.; Graceli, Jones B.; Balarini, Camille M.; Vasquez, Elisardo C.; Meyrelles, Silvana S.; Gava, Agata L.

    2016-01-01

    Increased blood pressure variability (BPV), which can be experimentally induced by sinoaortic denervation (SAD), has emerged as a new marker of the prognosis of cardiovascular and renal outcomes. Considering that increased BPV can lead to organ-damage, the goal of the present study was to evaluate the effects of SAD on renal function in an experimental model of chronic kidney disease (CKD). SAD was performed in male Wistar rats 2 weeks before 5/6 nephrectomy and the animals were evaluated 4 weeks after the induction of CKD. Our data demonstrated that BPV was increased in SAD and CKD animals and that the combination of both conditions (SAD+CKD) exacerbated BPV. The baroreflex sensitivity index was diminished in the SAD and CKD groups; this reduction was more pronounced when SAD and CKD were performed together. 5/6 nephrectomy led to hypertension, which was higher in SAD+CKD animals. Regarding renal function, the combination of SAD and CKD resulted in reduced renal plasma and blood flow, increased renal vascular resistance and augmented uraemia when compared to CKD animals. Glomerular filtration rate and BPV were negatively correlated in SAD, CKD, and SAD+CKD animals. Moreover, SAD+CKD animals presented a higher level of glomerulosclerosis when compared to all other groups. Cardiac and renal hypertrophy, as well as oxidative stress, was also further increased when SAD and CKD were combined. These results show that SAD prior to 5/6 nephrectomy exacerbates renal dysfunction, suggesting that previous augmented BPV should be considered as an important factor to the progression of renal diseases. PMID:27721797

  20. Arterial stiffness & Sri Lankan chronic kidney disease of unknown origin

    Science.gov (United States)

    Gifford, Fiona; Kimmitt, Robert; Herath, Chula; Webb, David J.; Melville, Vanessa; Siribaddana, Sisira; Eddleston, Michael; Dhaun, Neeraj

    2016-09-01

    Chronic kidney disease (CKD) is common and independently associated with cardiovascular disease (CVD). Arterial stiffness contributes to CVD risk in CKD. In many developing countries a considerable proportion of CKD remains unexplained, termed CKDu. We assessed arterial stiffness in subjects with Sri Lankan CKDu, in matched controls without CKD and in those with defined CKD. Aortic blood pressure (BP), pulse wave velocity (PWV) and augmentation index (AIx) were assessed in 130 subjects (50 with CKDu, 45 with CKD and 35 without CKD) using the validated TensioMed™ Arteriograph monitor. Brachial and aortic BP was lower in controls than in CKDu and CKD subjects but no different between CKDu and CKD. Controls had a lower PWV compared to subjects with CKDu and CKD. Despite equivalent BP and renal dysfunction, CKDu subjects had a lower PWV than those with CKD (8.7 ± 1.5 vs. 9.9 ± 2.2 m/s, p groups (controls vs. CKDu vs. CKD: 6.7 ± 0.9 vs. 8.7 ± 1.5 vs. 10.4 ± 1.5 m/s, p < 0.001 for all). Sri Lankan CKDu is associated with less arterial stiffening than defined causes of CKD. Whether this translates to lower cardiovascular morbidity and mortality long term is unclear and should be the focus of future studies.

  1. Comparison of Two Creatinine-Based Equations for Predicting Decline in Renal Function in Type 2 Diabetic Patients with Nephropathy in a Korean Population

    Directory of Open Access Journals (Sweden)

    Eun Young Lee

    2013-01-01

    Full Text Available Aim. To compare two creatinine-based estimated glomerular filtration rate (eGFR equations, the chronic kidney disease epidemiology collaboration (CKD-EPI and the modification of diet in renal disease (MDRD, for predicting the risk of CKD progression in type 2 diabetic patients with nephropathy. Methods. A total of 707 type 2 diabetic patients with 24 hr urinary albumin excretion of more than 30 mg/day were retrospectively recruited and traced until doubling of baseline serum creatinine (SCr levels was noted. Results. During the follow-up period (median, 2.4 years, the CKD-EPI equation reclassified 10.9% of all MDRD-estimated subjects: 9.1% to an earlier stage of CKD and 1.8% to a later stage of CKD. Overall, the prevalence of CKD (eGFR < 60 mL/min/1.73 m2 was lowered from 54% to 51.6% by applying the CKD-EPI equation. On Cox-regression analysis, both equations exhibited significant associations with an increased risk for doubling of SCr. However, only the CKD-EPI equation maintained a significant hazard ratio for doubling of SCr in earlier-stage CKD (eGFR ≥ 45 mL/min/1.73 m2, when compared to stage 1 CKD (eGFR ≥ 90 mL/min/1.73 m2. Conclusion. In regard to CKD progression, these results suggest that the CKD-EPI equation might more accurately stratify earlier-stage CKD among type 2 diabetic patients with nephropathy than the MDRD study equation.

  2. Chronic kidney disease and the skeleton.

    Science.gov (United States)

    Miller, Paul D

    2014-01-01

    Fractures across the stages of chronic kidney disease (CKD) could be due to osteoporosis, some form of renal osteodystrophy defined by specific quantitative histomorphometry or chronic kidney disease-mineral and bone disorder (CKD-MBD). CKD-MBD is a systemic disease that links disorders of mineral and bone metabolism due to CKD to either one or all of the following: abnormalities of calcium, phosphorus, parathyroid hormone or vitamin D metabolism; abnormalities in bone turnover, mineralization, volume, linear growth or strength; or vascular or other soft-tissue calcification. Osteoporosis, as defined by the National Institutes of Health, may coexist with renal osteodystrophy or CKD-MBD. Differentiation among these disorders is required to manage correctly the correct disorder to reduce the risk of fractures. While the World Health Organization (WHO) bone mineral density (BMD) criteria for osteoporosis can be used in patients with stages 1-3 CKD, the disorders of bone turnover become so aberrant by stages 4 and 5 CKD that neither the WHO criteria nor the occurrence of a fragility fracture can be used for the diagnosis of osteoporosis. The diagnosis of osteoporosis in stages 4 and 5 CKD is one of the exclusion-excluding either renal osteodystrophy or CKD-MBD as the cause of low BMD or fragility fractures. Differentiations among the disorders of renal osteodystrophy, CKD-MBD or osteoporosis are dependent on the measurement of specific biochemical markers, including serum parathyroid hormone (PTH) and/or quantitative bone histomorphometry. Management of fractures in stages 1-3 CKD does not differ in persons with or without CKD with osteoporosis assuming that there is no evidence for CKD-MBD, clinically suspected by elevated PTH, hyperphosphatemia or fibroblast growth factor 23 due to CKD. Treatment of fractures in persons with osteoporosis and stages 4 and 5 CKD is not evidence-based, with the exception of post-hoc analysis suggesting efficacy and safety of specific

  3. Hepatitis B and C co-infection are independent predictors of progressive kidney disease in HIV-positive, antiretroviral-treated adults

    DEFF Research Database (Denmark)

    Mocroft, Amanda; Neuhaus, Jacqueline; Peters, Lars

    2012-01-01

    Chronic kidney disease (CKD) is an important cause of morbidity and mortality in HIV-positive individuals. Hepatitis C (HCV) co-infection has been associated with increased risk of CKD, but prior studies lack information on potential mechanisms. We evaluated the association between HCV or hepatitis...... B (HBV) co-infection and progressive CKD among 3,441 antiretroviral-treated clinical trial participants. Progressive CKD was defined as the composite of end-stage renal disease, renal death, or significant glomerular filtration rate (eGFR) decline (25% decline to eGFR 800,000 IU/ml had increased...... odds (OR 3.07; 95% CI 1.60-5.90). Interleukin-6, hyaluronic acid, and the FIB-4 hepatic fibrosis index were higher among participants who developed progressive CKD, but were no longer associated with progressive CKD after adjustment. Future studies should validate the relationship between HCV viremia...

  4. Use of Lithium and Anticonvulsants and the Rate of Chronic Kidney Disease

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Gerds, Thomas Alexander; Feldt-Rasmussen, Bo

    2015-01-01

    IMPORTANCE: Lithium is the main mood stabilizing drug for bipolar disorder. However, it is controversial whether long-term maintenance treatment with lithium or other drugs for bipolar disorder causes chronic kidney disease (CKD). OBJECTIVE: To compare rates of CKD and in particular rates of end......-stage CKD among individuals exposed to successive prescriptions of lithium, anticonvulsants, or other drugs used for bipolar disorder. DESIGN, SETTING, AND PARTICIPANTS: This is a Danish nationwide population-based study of 2 cohorts. Cohort 1 comprised a randomly selected sample of 1.5 million individuals...... included the subgroup of 10 591 patients diagnosed as having bipolar disorder. MAIN OUTCOMES AND MEASURES: Possible CKD, definite CKD, and end-stage CKD (defined as long-term dialysis or renal transplantation). RESULTS: A total of 14 727 (0.8%), 18 762 (1.0%), and 3407 (0.2%) in cohort 1 and 278 (2...

  5. Image Annotation and Topic Extraction Using Super-Word Latent Dirichlet Allocation

    Science.gov (United States)

    2013-09-01

    requiring approximation techniques that are negatively affected by outliers. Some models are sensitive to probabilistic islands [138] caused by high...and ck,•,•,γs for Iter = 1→MaxIter do for all word/super-word tokens in the corpus do if token is a word wd,e then Exclude token from ckd ,e,d,•,•, ckd ...e,•,w,γw , ckd ,e,•,•,γw Sample new topic kd,e using Equation 5.3 Insert token in ckd ,e,d,•,•, ckd ,e,•,w,γw , ckd ,e,•,•,γw else if token is a super

  6. Clinical Signs, Causes, and Risk Factors of Pediatric Chronic Kidney Diseases: a Hospital-based Case-control Study

    Directory of Open Access Journals (Sweden)

    Parsa Yousefichaijan

    2016-06-01

    Full Text Available Background This retrospective study aimed to determine the epidemiologic characteristics and risk factors of chronic kidney diseases (CKD in patients < 18 years old at a single referral center. Materials and Methods In a hospital-based case control study, 66 CKD patients less than 18 years old were compared to 81 control patients (also under 18 without CKD. A patient was defined as a CKD case with renal injury and/or had a glomerular filtration rate (GFR of Results Fever, chills, and urinary tract infections were the most common clinical signs in the referred patients. Urinary tract infection (39.5% and growth failure (12.9% were the most important causes in referred pediatric CKD. After controlling the effect of confounding variables, household income, using packed water for drinking, percentile of body mass index (BMI, and gestational age were the significant predictors of pediatric CKD (P

  7. Genome-wide association studies in pediatric chronic kidney disease.

    Science.gov (United States)

    Gupta, Jayanta; Kanetsky, Peter A; Wuttke, Matthias; Köttgen, Anna; Schaefer, Franz; Wong, Craig S

    2016-08-01

    The genome-wide association study (GWAS) has become an established scientific method that provides an unbiased screen for genetic loci potentially associated with phenotypes of clinical interest, such as chronic kidney disease (CKD). Thus, GWAS provides opportunities to gain new perspectives regarding the genetic architecture of CKD progression by identifying new candidate genes and targets for intervention. As such, it has become an important arm of translational science providing a complementary line of investigation to identify novel therapeutics to treat CKD. In this review, we describe the method and the challenges of performing GWAS in the pediatric CKD population. We also provide an overview of successful GWAS for kidney disease, and we discuss the established pediatric CKD cohorts in North America and Europe that are poised to identify genetic risk variants associated with CKD progression.

  8. Elevated body mass index as a risk factor for chronic kidney disease: current perspectives

    Directory of Open Access Journals (Sweden)

    Garl

    2014-07-01

    Full Text Available Jocelyn S Garland Department of Medicine, Queen's University, Kingston, ON, Canada Abstract: Chronic kidney disease (CKD is defined by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative as the presence of reduced kidney function or kidney damage for a period of 3 months or greater. Obesity is considered a risk factor for CKD development, but its precise role in contributing to CKD and end stage kidney disease is not fully elucidated. In this narrative review, the objectives are to describe the pathogenesis of CKD in obesity, including the impact of altered adipokine secretion in obesity and CKD, and to provide an overview of the clinical studies assessing the risk of obesity and CKD development. Keywords: obesity, chronic renal disease, adipokine

  9. Calcium Regulation and Bone Mineral Metabolism in Elderly Patients with Chronic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Vickram Tejwani

    2013-05-01

    Full Text Available The elderly chronic kidney disease (CKD population is growing. Both aging and CKD can disrupt calcium (Ca2+ homeostasis and cause alterations of multiple Ca2+-regulatory mechanisms, including parathyroid hormone, vitamin D, fibroblast growth factor-23/Klotho, calcium-sensing receptor and Ca2+-phosphate product. These alterations can be deleterious to bone mineral metabolism and soft tissue health, leading to metabolic bone disease and vascular calcification and aging, termed CKD-mineral and bone disorder (MBD. CKD-MBD is associated with morbid clinical outcomes, including fracture, cardiovascular events and all-cause mortality. In this paper, we comprehensively review Ca2+ regulation and bone mineral metabolism, with a special emphasis on elderly CKD patients. We also present the current treatment-guidelines and management options for CKD-MBD.

  10. Role of Vitamin D in Cognitive Function in Chronic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Zhen Cheng

    2016-05-01

    Full Text Available Both vitamin D deficiency and cognitive impairment are common in patients with chronic kidney disease (CKD. Vitamin D exerts neuroprotective and regulatory roles in the central nervous system. Hypovitaminosis D has been associated with muscle weakness and bone loss, cardiovascular diseases (hypertension, diabetes and hyperlipidemia, inflammation, oxidative stress, immune suppression and neurocognitive impairment. The combination of hypovitaminosis D and CKD can be even more debilitating, as cognitive impairment can develop and progress through vitamin D-associated and CKD-dependent/independent processes, leading to significant morbidity and mortality. Although an increasingly recognized comorbidity in CKD, cognitive impairment remains underdiagnosed and often undermanaged. Given the association of cognitive decline and hypovitaminosis D and their deleterious effects in CKD patients, determination of vitamin D status and when appropriate, supplementation, in conjunction with neuropsychological screening, should be considered integral to the clinical care of the CKD population.

  11. Diagnosis and management of atherosclerotic cardiovascular disease in chronic kidney disease: a review.

    Science.gov (United States)

    Mathew, Roy O; Bangalore, Sripal; Lavelle, Michael P; Pellikka, Patricia A; Sidhu, Mandeep S; Boden, William E; Asif, Arif

    2016-12-28

    Patients with chronic kidney disease (CKD) have a high prevalence of atherosclerotic cardiovascular disease, likely reflecting the presence of traditional risk factors. A greater distinguishing feature of atherosclerotic cardiovascular disease in CKD is the severity of the disease, which is reflective of an increase in inflammatory mediators and vascular calcification secondary to hyperparathyroidism of renal origin that are unique to patients with CKD. Additional components of atherosclerotic cardiovascular disease that are prominent in patients with CKD include microvascular disease and myocardial fibrosis. Therapeutic interventions that minimize cardiovascular events related to atherosclerotic cardiovascular disease in patients with CKD, as determined by well-designed clinical trials, are limited to statins. Data are lacking regarding other available therapeutic measures primarily due to exclusion of patients with CKD from major trials studying cardiovascular disease. Data from well-designed randomized controlled trials are needed to guide clinicians who care for this high-risk population in the management of atherosclerotic cardiovascular disease to improve clinical outcomes.

  12. Animal models of pediatric chronic kidney disease. Is adenine intake an appropriate model?

    Directory of Open Access Journals (Sweden)

    Débora Claramunt

    2015-11-01

    Full Text Available Pediatric chronic kidney disease (CKD has peculiar features. In particular, growth impairment is a major clinical manifestation of CKD that debuts in pediatric age because it presents in a large proportion of infants and children with CKD and has a profound impact on the self-esteem and social integration of the stunted patients. Several factors associated with CKD may lead to growth retardation by interfering with the normal physiology of growth plate, the organ where longitudinal growth rate takes place. The study of growth plate is hardly possible in humans and justifies the use of animal models. Young rats made uremic by 5/6 nephrectomy have been widely used as a model to investigate growth retardation in CKD. This article examines the characteristics of this model and analyzes the utilization of CKD induced by high adenine diet as an alternative research protocol.

  13. Compromised Diet Quality is Associated with Decreased Renal Function in Children with Chronic Kidney Disease

    OpenAIRE

    Kim, Hyerang; Lim, Hyunjung; Choue, Ryowon

    2014-01-01

    Nutritional status of children with chronic kidney disease (CKD) is important since it affects growth and development. This study was to investigate overall diet quality measured by nutrient intake adequacy, nutrient density, and several dietary habits in children with CKD and its relationship with clinical parameters according to glomerular filtration rate (GFR). Assessment of nutritional status and diet quality was conducted in nineteen children with CKD. Average Z-scores of height, weight ...

  14. Diabetes Care and Treatment

    Science.gov (United States)

    2007-09-01

    Assessment Tool (BAT) Diabetes mellitus is a significant cause of morbidity and mortality in the United States.1 Clinical and scientific evidence...April. The status of the Chronic Kidney Disease ( CKD ) Clinics was updated. The CKD Clinics are a pilot program for the identification of early...chronic kidney disease patients by primary care providers in the state. Once identified, patients are recruited for enrollment in a CKD where they are

  15. The effect of naturally occurring chronic kidney disease on the micro-structural and mechanical properties of bone.

    Directory of Open Access Journals (Sweden)

    Anna Shipov

    Full Text Available Chronic kidney disease (CKD is a growing public health concern worldwide, and is associated with marked increase of bone fragility. Previous studies assessing the effect of CKD on bone quality were based on biopsies from human patients or on laboratory animal models. Such studies provide information of limited relevance due to the small size of the samples (biopsies or the non-physiologic CKD syndrome studied (rodent models with artificially induced CKD. Furthermore, the type, architecture, structure and biology of the bone of rodents are remarkably different from human bones; therefore similar clinicopathologic circumstances may affect their bones differently. We describe the effects of naturally occurring CKD with features resembling human CKD on the skeleton of cats, whose bone biology, structure and composition are remarkably similar to those of humans. We show that CKD causes significant increase of resorption cavity density compared with healthy controls, as well as significantly lower cortical mineral density, cortical cross-sectional area and cortical cross-sectional thickness. Young's modulus, yield stress, and ultimate stress of the cortical bone material were all significantly decreased in the skeleton of CKD cats. Cancellous bone was also affected, having significantly lower trabecular thickness and bone volume over total volume in CKD cats compared with controls. This study shows that naturally occurring CKD has deleterious effects on bone quality and strength. Since many similarities exist between human and feline CKD patients, including the clinicopathologic features of the syndrome and bone microarchitecture and biology, these results contribute to better understanding of bone abnormalities associated with CKD.

  16. Announcing the Standard for Key Management Using ANSI X9.17

    Science.gov (United States)

    2007-11-02

    computer system, or b. cause a major adverse financial impact on the operator which is not offset by Governmentwide savings...acquire keys (and optionally an IV) and send the keys (and IV) in a KSM. Implementations which assume the role of Party A in the CKD ...environment requests keys (and an IV) from a CKD (see Option 23). Implementations which assume the role of Party A in the CKT or CKD

  17. Discriminative kernel feature extraction and learning for object recognition and detection

    DEFF Research Database (Denmark)

    Pan, Hong; Olsen, Søren Ingvor; Zhu, Yaping

    2015-01-01

    Feature extraction and learning is critical for object recognition and detection. By embedding context cue of image attributes into the kernel descriptors, we propose a set of novel kernel descriptors called context kernel descriptors (CKD). The motivation of CKD is to use the spatial consistency...... codebook and reduced CKD are discriminative. We report superior performance of our algorithm for object recognition on benchmark datasets like Caltech-101 and CIFAR-10, as well as for detection on a challenging chicken feet dataset....

  18. Prevalence, awareness, treatment and control of hypertension in adults with chronic kidney disease in Turkey: results from the CREDIT study.

    Science.gov (United States)

    Altun, Bülent; Süleymanlar, Gültekin; Utaş, Cengiz; Arınsoy, Turgay; Ateş, Kenan; Ecder, Tevfik; Camsarı, Taner; Serdengeçti, Kamil

    2012-01-01

    In the Chronic REnal Disease in Turkey-CREDIT Study, a large populationbased study on 10,748 adults, the prevalence of chronic kidney disease (CKD) and relationship between CKD and other cardiovascular risk factors had been studied. This report presents the results of CREDIT study on the prevalence, awareness, treatment, and control of hypertension among CKD patients. The prevalence and awareness of hypertension in CREDIT population was 32.7% and 48.6%, respectively. Of the patients with hypertension, 31.5% were under treatment, and 16.4% had hypertension under control. Prevalence of CKD was 25.3% in patients with hypertension. Among CKD patients (15.7% of the CREDIT study population), 56.3% had hypertension. The prevalence of hypertension was 34.8% at stage 1, 79.8% at stage 3, and 92.3% at stage 5 CKD. Only 13.4% of patients with CKD have optimal blood pressure. Among CKD patients, 61.9% were aware of hypertension, and 44.2% were under treatment. Overall control rate of hypertension in subjects with CKD was 16.3% with the lowest rate at stage 1 (12.3%) and highest rate at stage 4 (40%). The control rate increased to 28.8% for CKD patients under treatment for hypertension. As a conclusion, hypertension is highly prevalent in subjects with CKD in Turkey with suboptimal awareness, treatment, and control rates. Appropriate health strategies should be implicated to improve prevention, early diagnosis, and treatment of hypertension, which is one of the leading causes of CKD. Copyright © 2012 S. Karger AG, Basel.

  19. Prevalence and risk factors for chronic kidney disease in a rural region of Haiti.

    Science.gov (United States)

    Burkhalter, Felix; Sannon, Herriot; Mayr, Michael; Dickenmann, Michael; Ernst, Silvia

    2014-01-01

    In the Caribbean region chronic kidney disease (CKD) is an increasing challenge. High rates of non-communicable and infectious diseases and the rise in people suffering from diabetes and hypertension explain the observed and further expected increase of CKD. However, data about the magnitude of the problem are rare and in some countries such as Haiti completely lacking. The aim of our study was to generate data about the prevalence and risk factors for CKD in a rural region in Haiti. In this prospective cross-sectional study, adult patients visiting the medical outpatient clinic of the Hôpital Albert Schweitzer (HAS) in Deschapelles Haiti were included. CKD was assessed by estimated glomerular filtration rate (eGFR) and measurement of proteinuria by dipstick test. Risk factors for CKD were assessed by clinical examinations and questionnaires. Overall 608 patients were screened for CKD, of whom 27% had CKD. CKD stages 1 to 2 were found in 15.3% and stages 3 to 5 in 11.7%. The prevalence of hypertension and diabetes mellitus was 49.2% and 36.3%, respectively. Risk factors independently associated with CKD were hypertension (p = 0.0002) and HIV infection (p = 0.019) and age >60 years (p = 0.0052), whereas diabetes mellitus was not independently associated (p = 0.72). Our data show a high prevalence of CKD and traditional risk factors, and their association with CKD in Haiti. These findings have now to be confirmed in other regions in longitudinal analyses as a basic step to build up screening and prevention programmes for CKD.

  20. Pilgrim's Rest, Barley Hill, Westport, Mayo.

    LENUS (Irish Health Repository)

    Stack, Austin G

    2014-01-01

    Chronic Kidney Disease (CKD) is a major non-communicable chronic disease that is associated with adverse clinical and economic outcomes. Passive surveillance systems are likely to improve efforts for prevention of chronic kidney disease (CKD) and inform national service planning. This study was conducted to determine the overall prevalence of CKD in the Irish health system, assess period trends and explore patterns of variation as part of a novel surveillance initiative.

  1. Prevalence of herbal and dietary supplement usage in Thai outpatients with chronic kidney disease: a cross-sectional survey

    OpenAIRE

    Tangkiatkumjai, Mayuree; Boardman, Helen; Praditpornsilpa, Kearkiat; Walker, Dawn M.

    2013-01-01

    BACKGROUND:\\ud There are few studies of the prevalence and patterns of herbal and dietary supplement (HDS) use in patients with chronic kidney disease (CKD), although many researchers and health professionals worldwide have raised concern about the potential effects of HDS on patients with renal insufficiency. A survey was conducted to determine: the prevalence and patterns of HDS use in Thai patients with CKD; the demographic factors related to HDS use; the reasons why Thai patients with CKD...

  2. Nutritional assessment in children with chronic kidney disease.

    Science.gov (United States)

    Gupta, Aditi; Mantan, Mukta; Sethi, Monika

    2016-01-01

    Growth failure is a major problem in pediatric patients with chronic kidney disease (CKD), and the onset of the condition in infancy is more likely to have an adverse impact on growth than its development in later childhood. This study was aimed to assess nutritional intake and anthropometry of children presenting with CKD in a developing country. In this cross-sectional observational study, children (1-18 years) with CKD visiting the outpatient services were enrolled. The age of onset, cause of CKD, and anthropometry were recorded. Dietary intakes from three 24 h dietary recall (2 mid-week and 1 weekend day) were recorded. A blood sample was taken from all subjects for biochemical parameters. A total of 45 children (forty males and five females) with CKD underwent nutritional assessment. The median age at assessment was 108 months (13-167). Twenty-seven (60%) subjects had CKD stage 1, 2, or 3 while the remaining 40% had CKD stage 4 or 5. Of the 45 children, 27 (60%) had moderate to severe malnutrition at assessment. The mean weight and height (standard deviation scores) were -2.77 ± 2.07 and -2.30 ± 1.38, respectively. The prevalence of growth retardation was much higher in late stages of CKD; the difference was statistically significant (P iron (mean 48.9% deficit); deficient in calcium (mean -22.2%) and had excess phosphates (mean 18.3%). There was a progressive decrease in intake of nutrients in advanced stages of CKD. There was a high prevalence of malnutrition (60%) in children with CKD, especially in higher stages of CKD. An appropriate dietary assessment and nutritional counseling should be planned for all patients with CKD to prevent complications associated with malnutrition and anemia.

  3. [Kidney disease in Colombia: Priority for risk management].

    Science.gov (United States)

    Acuña, Lizbeth; Sánchez, Patricia; Soler, Luis Alberto; Alvis, Luisa Fernanda

    2016-08-01

    Objective To describe the demographic and clinical manifestations of patients with chronic kidney disease (CKD), arterial hypertension, and/or diabetes mellitus, and to determine the association between the presence of these pathologies and the development of CKD. Methods Analytic and cross-sectional study. The information, with a cutoff date of 30 June 2013, comes from the integrated database of CKD and patients with hypertension and diabetes, which the Colombian payer entities provided to the national fund for high-cost diseases (Cuenta de Alto Costo). A descriptive analysis was conducted and the prevalence of CKD and stage 5 CKD was determined. Crude odds ratios (OR) were used to determine the association between CKD and age, sex, and diabetes. Results 2,599,419 records were analyzed, of which 40% corresponded to people with CKD. Overall, 74.9% of the population had hypertension and 6.4% had diabetes. The prevalence of CKD was 2.81%, with 94.3% of patients in stages 1 to 3. In patients with diabetes, the risk of presenting CKD is 1.03 (confidence interval of 95% [CI95%] 1.016-1.043). Among persons over 60 years of age, the risk of CKD is 2.15 (CI95% 2.140-2.167). Conclusions 33.4% of patients with hypertension or diabetes have not been studied to determine the presence or absence of CKD. It is a priority to implement strategies for secondary and primary prevention in order to prevent the progression of CKD and reduce the prevalence of risk factors such as hypertension and diabetes.

  4. Relationship between serum adiopocyte fatty acid binding protein and atherosclerosis in chronic kidney disease

    Institute of Scientific and Technical Information of China (English)

    吴晶

    2014-01-01

    Objective To investigate the expression of serum adiopocyte fatty acid binding protein(A-FABP)in chronic kidney disease(CKD)and the role that A-FABP plays in CKD with atherosclerosis.Methods A total of 138 patients with CKD and 20 health control volunteers(HC)were involved in this study.The levels of serum AFABP,free fatty acid(FFA),interleukin-6(IL-6),

  5. Prevalence and variation of Chronic Kidney Disease in the Irish health system: initial findings from the National Kidney Disease Surveillance Programme.

    LENUS (Irish Health Repository)

    Stack, Austin G

    2014-01-01

    Chronic Kidney Disease (CKD) is a major non-communicable chronic disease that is associated with adverse clinical and economic outcomes. Passive surveillance systems are likely to improve efforts for prevention of chronic kidney disease (CKD) and inform national service planning. This study was conducted to determine the overall prevalence of CKD in the Irish health system, assess period trends and explore patterns of variation as part of a novel surveillance initiative.

  6. Oral health and kidney disease with emphasis on diabetic nephropathy

    OpenAIRE

    Vesterinen, Maarit

    2011-01-01

    Chronic kidney disease (CKD) is a worldwide health problem, with adverse outcomes of cardiovascular disease and premature death. The ageing of populations along with the growing prevalence of chronic diseases such as diabetes and hypertension is leading to worldwide increase in the number of CKD patients. It has become evident that inflammation plays an important role in the pathogenesis of atherosclerosis complications. CKD patients also have an increased risk of atherosclerosis complication...

  7. Effect of renal revascularization on the development of renal dysfunction in atherosclerotic ischemic nephropathy

    OpenAIRE

    Rodrigo Hagemann; Vanessa dos Santos Silva; Roberto Jorge da Silva Franco; Pasqual Barretti; Luis Cuadrado Martin

    2014-01-01

    Chronic kidney disease (CKD) is characterized by a progressive loss of renal function and its main causes are hypertension and diabetes mellitus. Among the causes of hypertension is atherosclerotic renal disease (ARD). The development of CKD in patients with ARD appears to be due not only to the involvement of the main renal arteries, but also of the renal microcirculation, which may explain the fact that the success of the procedure does not guarantee an improvement in the progression of CKD...

  8. The HUGE formula (hematocrit, urea, gender) for screening for chronic kidney disease in elderly patients: a study of diagnostic accuracy.

    Science.gov (United States)

    Musso, Carlos G; de Los Rios, Eduardo; Vilas, Manuel; Terrasa, Sergio; Bratti, Griselda; Varela, Federico; Diez, Guillermo Rosa; Jauregui, Jose; Luna, Daniel

    2017-04-01

    Chronically reduced glomerular filtration rate (GFR) in old people does not always mean that they suffer from chronic kidney disease (CKD) since their GFR can just be reduced by aging. The HUGE equation has been recently described and validated in Spain for screening CKD without taking into account the patient's GFR value. This equation is based on patient's hematocrit, plasma urea levels and gender. The present study documented that the HUGE equation had and acceptable performance for screening CKD in elderly Argentine patients.

  9. Incidence, determinants, and outcome of chronic kidney disease after adult heart transplantation in the United Kingdom.

    Science.gov (United States)

    Thomas, Helen L; Banner, Nicholas R; Murphy, Cara L; Steenkamp, Retha; Birch, Rhiannon; Fogarty, Damian G; Bonser, And Robert S

    2012-06-15

    We investigated the incidence of chronic kidney disease (CKD) in the United Kingdom heart transplant population, identified risk factors for the development of CKD, and assessed the impact of CKD on subsequent survival. Data from the UK Cardiothoracic Transplant Audit and UK Renal Registry were linked for 1732 adult heart transplantations, 1996 to 2007. Factors influencing time to CKD, defined as National Kidney Foundation CKD stage 4 or 5 or preemptive kidney transplantation, were identified using a Cox proportional hazards model. The effects of distinct CKD stages on survival were evaluated using time-dependent covariates. A total of 3% of patients had CKD at transplantation, 11% at 1-year and more than 15% at 6 years posttransplantation and beyond. Earlier transplantations, shorter ischemia times, female, older, hepatitis C virus positive, and diabetic recipients were at increased risk of developing CKD, along with those with impaired renal function pretransplantation or early posttransplantation. Significant differences between transplantation centers were also observed. The risk of death was significantly higher for patients at CKD stage 4, stage 5 (excluding dialysis), or on dialysis, compared with equivalent patients surviving to the same time point with CKD stage 3 or lower (hazard ratios of 1.66, 8.54, and 4.07, respectively). CKD is a common complication of heart transplantation in the UK, and several risk factors identified in other studies are also relevant in this population. By linking national heart transplantation and renal data, we have determined the impact of CKD stage and dialysis treatment on subsequent survival in heart transplant recipients.

  10. Assessment of DNA damage, oxidative stress and inflammation in chronic kidney disease patients - and a clinical study of a dietary supplement

    OpenAIRE

    Rodhe, Ylva

    2012-01-01

    Decreased kidney function is associated with higher levels of oxidative stress, inflammation and malnutrition. Chronic kidney disease (CKD) patients have a higher risk to develop cardiovascular disease, atherosclerosis and cancer compared to the general population. Cardiovascular disease is the major cause of death in CKD patients. Many CKD patients also report oral health problems including dry mouth symptoms, inflammation in the oral cavity and changes in the salivary constit...

  11. Delphi consensus on the diagnosis and management of dyslipidaemia in chronic kidney disease patients: A post hoc analysis of the DIANA study

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    Aleix Cases Amenós

    2016-11-01

    Conclusions: The consensus to analyse the lipid profile in CKD patients suggests acknowledgement of the high cardiovascular risk of this condition. However, the lack of consensus in considering renal function or albuminuria, both when selecting a statin and during follow-up, suggests a limited knowledge of the differences between statins in relation to CKD. Thus, it would be advisable to develop a guideline/consensus document on the use of statins in CKD.

  12. Dietary Energy Density, Renal Function, and Progression of Chronic Kidney Disease

    OpenAIRE

    2016-01-01

    Background. There is evidence of the association between dietary energy density and chronic diseases. However, no report exists regarding the relation between DED and chronic kidney disease (CKD). Objective. To examine the association between dietary energy density (DED), renal function, and progression of chronic kidney disease (CKD). Design. Cross-sectional. Setting. Three nephrology clinics. Subjects. Two hundred twenty-one subjects with diagnosed CKD. Main Outcome Measure. Dietary intake ...

  13. Medication safety and chronic kidney disease in older adults prescribed metformin: a cross-sectional analysis

    OpenAIRE

    Huang, Deborah L.; Abrass, Itamar B; Young, Bessie A.

    2014-01-01

    Background Medication safety in patients with chronic kidney disease (CKD) is a growing concern. This is particularly relevant in older adults due to underlying CKD. Metformin use is contraindicated in patients with abnormal kidney function; however, many patients are potentially prescribed metformin inappropriately. We evaluated the prevalence of CKD among older adults prescribed metformin for type 2 diabetes mellitus using available equations to estimate kidney function and examined demogra...

  14. Cardiovascular disease in patients with renal disease: the role of statins.

    Science.gov (United States)

    Fellström, Bengt; Holdaas, Hallvard; Jardine, Alan G; Svensson, Maria K; Gottlow, Mattis; Schmieder, Roland E; Zannad, Faiez

    2009-01-01

    Atherosclerosis is common in patients with chronic kidney disease (CKD), and cardiovascular disease (CVD) represents a major cause of death. The National Kidney Foundation guidelines favour the use of statin therapy for treatment of dyslipidaemia in patients with CKD. Much evidence supports statin therapy for reducing CVD and improving outcomes in the general population, but there is less evidence in patients with CKD. Consequently, prevention of CVD in CKD is based primarily on extrapolation from non-CKD trials. Significantly, in trials specifically designed to investigate patients with CKD, evidence is emerging for improved cardiovascular outcomes with statin therapy. This review describes available data relating to cardiovascular outcomes and the role of statins in patients with CKD, including pre-dialysis, dialysis, and renal transplant patients. The PubMed database was searched (1998-present) to ensure comprehensive identification of publications (including randomised clinical trials) relevant to CKD patients, patterns of cardiovascular outcome in such patients and their relationship to lipid profile, and the role of statins for the prevention and treatment of cardiovascular complications. There are conflicting data on the relationship between dyslipidaemia and cardiovascular outcomes, with one major study of statin therapy (4D--Deutsche Diabetes Dialyse Studie) providing equivocal results. Further studies, including AURORA (A study to evaluate the Use of Rosuvastatin in subjects On Regular haemodialysis: an Assessment of survival and cardiovascular events; NCT00240331) in patients receiving haemodialysis, and SHARP (Study of Heart And Renal Protection; NCT00125593) in patients with CKD including those on dialysis, should help to clarify the role of statin therapy in these populations. More studies are needed to elucidate the role of statins in improving cardiovascular outcomes for CKD patients. It is anticipated that ongoing clinical trials geared towards the

  15. Increased arterial inflammation in individuals with stage 3 chronic kidney disease

    Energy Technology Data Exchange (ETDEWEB)

    Takx, Richard A.P. [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Boston, MA (United States); University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); MacNabb, Megan H.; Emami, Hamed; Abdelbaky, Amr; Lavender, Zachary R. [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Boston, MA (United States); Singh, Parmanand [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Boston, MA (United States); New York Presbyterian Hospital, Weill Cornell Medical College, Division of Cardiology, New York, NY (United States); Di Carli, Marcelo; Taqueti, Viviany; Foster, Courtney [Brigham and Women' s Hospital and Harvard Medical School, Division of Radiology, Department of Medicine, Boston, MA (United States); Mann, Jessica; Comley, Robert A.; Weber, Chek Ing Kiu [F. Hoffmann-La Roche Ltd., Basel (Switzerland); Tawakol, Ahmed [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Boston, MA (United States); Massachusetts General Hospital and Harvard Medical School, Cardiology Division, Boston, MA (United States); Massachusetts General Hospital, Boston, MA (United States)

    2016-02-15

    While it is well known that patients with chronic kidney disease (CKD) are at increased risk for the development and progression of atherosclerosis, it is not known whether arterial inflammation is increased in mild CKD. The aim of this study was to compare arterial inflammation using {sup 18}F-FDG PET/CT in patients with CKD and in matched controls. This retrospective study included 128 patients undergoing FDG PET/CT imaging for clinical indications, comprising 64 patients with stage 3 CKD and 64 control patients matched by age, gender, and cancer history. CKD was defined according to guidelines using a calculated glomerular filtration rate (eGFR). Arterial inflammation was measured in the ascending aorta as FDG uptake on PET. Background FDG uptake (venous, subcutaneous fat and muscle) were recorded. Coronary artery calcification (CAC) was assessed using the CT images. The impact of CKD on arterial inflammation and CAC was then assessed. Arterial inflammation was higher in patients with CKD than in matched controls (standardized uptake value, SUV: 2.41 ± 0.49 vs. 2.16 ± 0.43; p = 0.002). Arterial SUV correlated inversely with eGFR (r = -0.299, p = 0.001). Venous SUV was also significantly elevated in patients with CKD, while subcutaneous fat and muscle tissue SUVs did not differ between groups. Moreover, arterial SUV remained significantly elevated in patients with CKD compared to controls after correcting for muscle and fat background, and also remained significant after adjusting for clinical risk factors. Further, CKD was associated with arterial inflammation (SUV) independent of the presence of subclinical atherosclerosis (CAC). Moderate CKD is associated with increased arterial inflammation beyond that of controls. Further, the increased arterial inflammation is independent of presence of subclinical atherosclerosis. Current risk stratification tools may underestimate the presence of atherosclerosis in patients with CKD and thereby the risk of

  16. Effects of 6 months yoga program on renal functions and quality of life in patients suffering from chronic kidney disease

    OpenAIRE

    Rajendra Kumar Pandey; Tung Vir Singh Arya; Amit Kumar; Ashish Yadav

    2017-01-01

    Aim: To study the effect of 6 months yoga program in patients suffering from chronic kidney disease (CKD). Materials and Methods: Fifty-four patients with CKD were studied and divided into two groups (yoga group and control group) to see the effect of yoga in CKD. Patients in the yoga group were offered yoga therapy along with other conventional treatment modalities, while the control group was only on conventional treatment. Subjects in yoga group were trained to perform specific yogic as...

  17. A case of biopsy-proven chronic kidney disease on progression from acute phosphate nephropathy

    Directory of Open Access Journals (Sweden)

    Woo Chul Joo

    2012-06-01

    Full Text Available Acute phosphate nephropathy (APhN following oral sodium phosphate solution (OSP ingestion as a bowel purgative has been frequently reported. It was recently suggested that APhN could progress to chronic kidney disease (CKD and a history of APhN might be considered as one of the causes of CKD. However, there are few reports proving APhN as a cause of CKD. Here, we report a case of APhN that progressed to CKD, as proven by renal biopsy.

  18. Rational selection and application of anti-hypertensive drugs in patients with chronic kidney disease%慢性肾脏病患者降压药物的合理选用

    Institute of Scientific and Technical Information of China (English)

    何娅妮; 林利容

    2016-01-01

    高血压作为心血管疾病传统的危险因素,在慢性肾脏病(CKD)的发展中起到了重要作用。它既是导致 CKD 的主要病因,也是 CKD 最常见的并发症。控制 CKD 患者血压达标不仅有利于延缓 CKD 进展,还可降低心血管事件发生。但 CKD 患者病因复杂、疾病阶段不一,降压药物的合理选用极为重要。%As a traditional risk factor for cardiovascular disease,hypertension plays a critical role in the progression of chronic kidney disease (CKD).Hypertension is not only one of the major causes of CKD, but the most common complication of it.Hypertension management can help to both delay the progression of CKD and reduce the incidence of cardiovascular events.Because the etiology and progression of CKD are complex,the rational selection and application of anti-hypertensive drugs are very important..

  19. Apolipoproteins: Good Markers for Cardiovacular Risk in Patients with Chronic Kidney Disease and Dyslipidemia

    Directory of Open Access Journals (Sweden)

    Tudor Mirela - Nicoleta

    2014-09-01

    Full Text Available Background and aims. Dyslipidemia (DLP is a common complication of chronic kidney disease (CKD and may accelerate its progression. Circulating lipoproteins and their constituent proteins, apolipoproteins, are risk factors for CKD and cardiovascular diseases (CVD. The aim of the study was to determine whether there is a correlation between apolipoproteins and estimated glomerular filtration rate (eGFR or between apolipoproteins and anthropometrical and laboratory parameters or between evaluated cardiovascular risk (CV and dyslipidemia/CKD. Material and methods. We performed a study on 51 subjects from the Nephrology Department of Emergency Clinical County Hospital of Craiova, from November 2011 to July 2013. Results. We found statistically significant correlations between eGFR and Apo A1. Also we found a linear correlation between C-reactive protein (CRP and Apo B. When we evaluated the CV risk using CRP, we found statistically significant differences between the groups (CKD and DLP, only CKD, only DLP and control group, patients with CKD and DLP showing the highest levels of CRP. Conclusions. Elevated levels of Apo A1 are associated with a low rate of CKD. DLP and chronic inflammation play an important role in the progression of CKD. Patients with CKD and DLP had a high cardiovascular risk.

  20. Gut microbiota in chronic kidney disease.

    Science.gov (United States)

    Cigarran Guldris, Secundino; González Parra, Emilio; Cases Amenós, Aleix

    The intestinal microflora maintains a symbiotic relationship with the host under normal conditions, but its imbalance has recently been associated with several diseases. In chronic kidney disease (CKD), dysbiotic intestinal microflora has been reported with an increase in pathogenic flora compared to symbiotic flora. An enhanced permeability of the intestinal barrier, allowing the passage of endotoxins and other bacterial products to the blood, has also been shown in CKD. By fermenting undigested products that reach the colon, the intestinal microflora produce indoles, phenols and amines, among others, that are absorbed by the host, accumulate in CKD and have harmful effects on the body. These gut-derived uraemic toxins and the increased permeability of the intestinal barrier in CKD have been associated with increased inflammation and oxidative stress and have been involved in various CKD-related complications, including cardiovascular disease, anaemia, mineral metabolism disorders or the progression of CKD. The use of prebiotics, probiotics or synbiotics, among other approaches, could improve the dysbiosis and/or the increased permeability of the intestinal barrier in CKD. This article describes the situation of the intestinal microflora in CKD, the alteration of the intestinal barrier and its clinical consequences, the harmful effects of intestinal flora-derived uraemic toxins, and possible therapeutic options to improve this dysbiosis and reduce CKD-related complications.

  1. The Gut as a Source of Inflammation in Chronic Kidney Disease.

    Science.gov (United States)

    Lau, Wei Ling; Kalantar-Zadeh, Kamyar; Vaziri, Nosratola D

    2015-01-01

    Chronic inflammation is a non-traditional risk factor for cardiovascular mortality in the chronic kidney disease (CKD) population. In recent years, the gastrointestinal tract has emerged as a major instigator of systemic inflammation in CKD. Postmortem studies previously discovered gut wall inflammation throughout the digestive tract in chronic dialysis patients. In CKD animals, colon wall inflammation is associated with breakdown of the epithelial tight junction barrier ('leaky gut') and translocation of bacterial DNA and endotoxin into the bloodstream. Gut bacterial DNA and endotoxin have also been detected in the serum from CKD and dialysis patients, whereby endotoxin levels increase with the CKD stage and correlate with the severity of systemic inflammation in the dialysis population. The CKD diet that is low in plant fiber and symbiotic organisms (in adherence with low potassium, low phosphorus intake) can alter the normal gut microbiome, leading to overgrowth of bacteria that produce uremic toxins such as cresyl and indoxyl molecules. The translocation of these toxins from the 'leaky gut' into the bloodstream further promotes systemic inflammation, adverse cardiovascular outcomes and CKD progression. Data are lacking on optimal fiber and yogurt consumption in CKD that would favor growth of a more symbiotic microbiome while avoiding potassium and phosphorus overload. Prebiotic and probiotic formulations have shown promise in small clinical trials, in terms of lowering serum levels of uremic toxins and improving quality of life. The evidence points to a strong relationship between intestinal inflammation and adverse outcomes in CKD, and more trials investigating gut-targeted therapeutics are needed.

  2. 17-Year-Old Boy with Renal Failure and the Highest Reported Creatinine in Pediatric Literature

    Directory of Open Access Journals (Sweden)

    Vimal Master Sankar Raj

    2015-01-01

    Full Text Available The prevalence of chronic kidney disease (CKD is on the rise and constitutes a major health burden across the world. Clinical presentations in early CKD are usually subtle. Awareness of the risk factors for CKD is important for early diagnosis and treatment to slow the progression of disease. We present a case report of a 17-year-old African American male who presented in a life threatening hypertensive emergency with renal failure and the highest reported serum creatinine in a pediatric patient. A brief discussion on CKD criteria, complications, and potential red flags for screening strategies is provided.

  3. Vitamin K status in chronic kidney disease.

    Science.gov (United States)

    McCabe, Kristin M; Adams, Michael A; Holden, Rachel M

    2013-11-07

    The purpose of this review is to summarize the research to date on vitamin K status in chronic kidney disease (CKD). This review includes a summary of the data available on vitamin K status in patients across the spectrum of CKD as well as the link between vitamin K deficiency in CKD and bone dynamics, including mineralization and demineralization, as well as ectopic mineralization. It also describes two current clinical trials that are underway evaluating vitamin K treatment in CKD patients. These data may inform future clinical practice in this population.

  4. Evaluation of arterial stiffness in nondiabetic chronic kidney disease patients

    Directory of Open Access Journals (Sweden)

    Bodanapu Mastanvalli

    2017-01-01

    Full Text Available Chronic kidney disease (CKD is a growing problem worldwide. Clinical and epidemiologic studies have shown that structural and functional changes that occur in major arteries are a major contributing factor to the high mortality in uremic patients. Recent studies have shown a stepwise increase of the carotid-femoral pulse wave velocity (cfPWV from CKD Stage 1 to Stage 5. We evaluated the cfPWV and augmentation index (AIx, as indirect markers of arterial stiffness in patients with nondiabetic CKD and compared the values with normal population; we also evaluated the relationship between various stages of CKD and arterial stiffness markers. This cross-sectional study was carried out in the Department of Nephrology for a duration of two years from January 15, 2012, to January 14, 2014. Fifty patients with nondiabetic CKD were studied along with 50 healthy volunteers who did not have CKD, who served as controls. Assessment of arterial stiffness (blood pressure, PWV, heart rate, aortic augmentation pressure, and AIx was performed using the PeriScope device. PWV positively correlated with systolic and diastolic blood pressure, mean aortic arterial pressure, serum creatinine, and serum uric acid and negatively correlated with estimated glomerular filtration rate. Arterial stiffness increased as CKD stage increased and was higher in nondiabetic CKD group than in the general population. Arterial stiffness progressed gradually from CKD Stage 2 to 5, and then abruptly, in dialysis patients. Measures to decrease the arterial stiffness and its influence on decreasing cardiovascular events need further evaluation.

  5. Optimizing outcomes in patients with cardiovascular disease and chronic kidney disease.

    Science.gov (United States)

    Marrs, Joel C

    2011-12-01

    Chronic kidney disease (CKD) is an independent risk factor for the development of cardiovascular disease (CVD). Often, CKD and CVD coexist, and patients warrant optimal pharmacotherapy to reduce the risk of future cardiovascular (CV) events. Randomized trials have evaluated the role of antihypertensive therapy and lipid-lowering therapy as means to reduce CVD in patients with CKD. Many clinical trials support the role of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in the CKD population. In addition, many clinical trials have evaluated the role of statin therapy in reducing CV events in early- and late-stage CKD. The struggle with interpreting results from these trials is that there are a number of different CV composite end points and a lack of consistency in defining CKD, especially in some post hoc subanalyses. Overall, ACEI/ARB therapy is supported by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) and the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) hypertension guidelines and statin therapy is supported by the Adult Treatment Panel (ATP) III and NKF KDOQI dyslipidemia guidelines to optimally manage patients with CKD and CV risk factors. Questions remain as to the optimal role of statin therapy in patients with CKD receiving dialysis. JNC 8 and ATP IV guidelines will be available in the next year, and it is expected that there will be specific recommendations on both hypertension and dyslipidemia management in the CKD population.

  6. Trefoil Factor 1 Excretion Is Increased in Early Stages of Chronic Kidney Disease.

    Directory of Open Access Journals (Sweden)

    Diana Lebherz-Eichinger

    Full Text Available Chronic kidney disease (CKD is associated with high morbidity and mortality. In many patients CKD is diagnosed late during disease progression. Therefore, the implementation of potential biomarkers may facilitate the early identification of individuals at risk. Trefoil factor family (TFF peptides promote restitution processes of mucous epithelia and are abundant in the urinary tract. We therefore sought to investigate the TFF peptide levels in patients suffering from CKD and their potential as biomarkers for CKD. We analysed TFF1 and TFF3 in serum and urine of 115 patients with CKD stages 1-5 without dialysis by ELISA. 20 healthy volunteers served as controls. Our results showed, that urinary TFF1 levels were significantly increased with the onset of CKD in stages 1-4 as compared to controls and declined during disease progression (p = 0.003, 0.8. In conclusion our results show increased levels of TFF1 and TFF3 in CKD patients with a pronounced elevation of urinary TFF1 in lower CKD stages. Furthermore, TFF1 and TFF3 seems to be differently regulated and show potential to predict various CKD stages, as shown by ROC curve analysis.

  7. Upper gastrointestinal bleeding as a risk factor for dialysis and all-cause mortality: a cohort study of chronic kidney disease patients in Taiwan

    OpenAIRE

    Liang, Chih-Chia; Chou, Che-Yi; Chang, Chiz-Tzung; Wang, I-Kuan; Huang, Chiu-Ching

    2016-01-01

    Objective Impaired renal function is associated with higher risk of upper gastrointestinal bleeding (UGIB) in patients with chronic kidney disease and not on dialysis (CKD-ND). It is unclear if UGIB increases risk of chronic dialysis. The aim of the study was to investigate risk of chronic dialysis in CKD-ND patients with UGIB. Setting All CKD-ND stage 3–5 patients of a CKD programme in one hospital between 2003 and 2009 were enrolled and prospectively followed until September 2012. Primary a...

  8. Treatment and Prevention of Common Complications of Chronic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Sheikh Salahuddin Ahmed

    2014-01-01

    Full Text Available Chronic kidney disease (CKD is a worldwide public health problem with an increasing incidence and prevalence. Outcomes of CKD include not only complications of decreased kidney function and cardiovascular disease but also kidney failure causing increased morbidity and mortality. Unfortunately, CKD is often undetected and undertreated because of its insidious onset, variable progression, and length of time to overt kidney failure. Diabetes is now the leading cause of CKD requiring renal replacement therapy in many parts of the world, and its prevalence is increasing disproportionately in the developing countries. This review article outlines the current recommendations from various clinical guidelines and research studies for treatment, prevention and delaying the progression of both CKD and its common complications such as hypertension, anemia, renal osteodystrophy, electrolyte and acid-base imbalance, and hyperlipidemia. Recommendations for nutrition in CKD and measures adopted for early diabetic kidney disease to prevent further progression have also been reviewed. There is strong evidence that early detection and management of CKD can prevent or reduce disease progression, decrease complications and improve outcomes. Evidence supports that achieving optimal glucose control, blood pressure, reduction in albuminuria with a multifactorial intervention slows the progression of CKD. Angiotensin-converting enzyme inhibitors and angiotensin-II receptor antagonists are most effective because of their unique ability to decrease proteinuria, a factor important for the progression of CKD.

  9. Using the diffusion of innovations theory to assess socio-technical factors in planning the implementation of an electronic health record alert across multiple primary care clinics

    Directory of Open Access Journals (Sweden)

    Ching-Pin Lin

    2016-04-01

    Conclusion: Understanding variation in organizational culture and infrastructure across primary care clinics is important in planning implementation of an intervention to reduce ADEs among patients with CKD.

  10. Antagonism of scavenger receptor CD36 by 5A peptide prevents chronic kidney disease progression in mice independent of blood pressure regulation.

    Science.gov (United States)

    Souza, Ana Carolina P; Bocharov, Alexander V; Baranova, Irina N; Vishnyakova, Tatyana G; Huang, Yuning G; Wilkins, Kenneth J; Hu, Xuzhen; Street, Jonathan M; Alvarez-Prats, Alejandro; Mullick, Adam E; Patterson, Amy P; Remaley, Alan T; Eggerman, Thomas L; Yuen, Peter S T; Star, Robert A

    2016-04-01

    Scavenger receptor CD36 participates in lipid metabolism and inflammatory pathways important for cardiovascular disease and chronic kidney disease (CKD). Few pharmacological agents are available to slow the progression of CKD. However, apolipoprotein A-I-mimetic peptide 5A antagonizes CD36 in vitro. To test the efficacy of 5A, and to test the role of CD36 during CKD, we compared wild-type to CD36 knockout mice and wild-type mice treated with 5A, in a progressive CKD model that resembles human disease. Knockout and 5A-treated wild-type mice were protected from CKD progression without changes in blood pressure and had reductions in cardiovascular risk surrogate markers that are associated with CKD. Treatment with 5A did not further protect CD36 knockout mice from CKD progression, implicating CD36 as its main site of action. In a separate model of kidney fibrosis, 5A-treated wild-type mice had less macrophage infiltration and interstitial fibrosis. Peptide 5A exerted anti-inflammatory effects in the kidney and decreased renal expression of inflammasome genes. Thus, CD36 is a new therapeutic target for CKD and its associated cardiovascular risk factors. Peptide 5A may be a promising new agent to slow CKD progression.

  11. Physicochemical characterization of cement kiln dust for potential reuse in acidic wastewater treatment

    Energy Technology Data Exchange (ETDEWEB)

    Mackie, A.; Boilard, S. [Department of Civil and Resource Engineering, Dalhousie University, 1360 Barrington St., Building D, Room D215, Halifax, Nova Scotia, B3J 1Z1 (Canada); Walsh, M.E., E-mail: mwalsh2@dal.ca [Department of Civil and Resource Engineering, Dalhousie University, 1360 Barrington St., Building D, Room D215, Halifax, Nova Scotia, B3J 1Z1 (Canada); Lake, C.B. [Department of Civil and Resource Engineering, Dalhousie University, 1360 Barrington St., Building D, Room D215, Halifax, Nova Scotia, B3J 1Z1 (Canada)

    2010-01-15

    Cement kiln dust (CKD) is a fine-grained material produced during the manufacture of cement. Current reuse options are limited and the bulk of CKD not reused in the cement manufacturing process is sent to landfills or stored on-site. Due to the calcium oxide (CaO) content of CKD, it has the potential to be used as a replacement for lime in treating acidic wastewaters such as acid rock drainage (ARD). This paper outlines the results of an examination of the physical and chemical properties of CKD samples collected from six cement plants. The CKD samples were analyzed for major oxides using X-ray diffraction (XRD), available lime, specific surface area, particle size, and morphology using scanning electron microscope (SEM) and compared with a commercial quicklime product. Conductivity, pH, and calcium concentrations of slaked CKD and quicklime solutions were used as indicators of reactivity of the CKD. Slaking of two of the CKD samples with the highest free lime contents (e.g., 34 and 37% free CaO) gave elevated pH values statistically comparable to those of the commercial quicklime sample that was characterized as having 87% available CaO. Acid neutralization trials indicate that even CKD samples with low free lime contents could be effective at neutralizing acidic wastewaters.

  12. Physicochemical characterization of cement kiln dust for potential reuse in acidic wastewater treatment.

    Science.gov (United States)

    Mackie, A; Boilard, S; Walsh, M E; Lake, C B

    2010-01-15

    Cement kiln dust (CKD) is a fine-grained material produced during the manufacture of cement. Current reuse options are limited and the bulk of CKD not reused in the cement manufacturing process is sent to landfills or stored on-site. Due to the calcium oxide (CaO) content of CKD, it has the potential to be used as a replacement for lime in treating acidic wastewaters such as acid rock drainage (ARD). This paper outlines the results of an examination of the physical and chemical properties of CKD samples collected from six cement plants. The CKD samples were analyzed for major oxides using X-ray diffraction (XRD), available lime, specific surface area, particle size, and morphology using scanning electron microscope (SEM) and compared with a commercial quicklime product. Conductivity, pH, and calcium concentrations of slaked CKD and quicklime solutions were used as indicators of reactivity of the CKD. Slaking of two of the CKD samples with the highest free lime contents (e.g., 34 and 37% free CaO) gave elevated pH values statistically comparable to those of the commercial quicklime sample that was characterized as having 87% available CaO. Acid neutralization trials indicate that even CKD samples with low free lime contents could be effective at neutralizing acidic wastewaters.

  13. Accounting for overdispersion when determining primary care outliers for the identification of chronic kidney disease: learning from the National Chronic Kidney Disease Audit.

    Science.gov (United States)

    Kim, Lois G; Caplin, Ben; Cleary, Faye; Hull, Sally A; Griffith, Kathryn; Wheeler, David C; Nitsch, Dorothea

    2017-04-01

    Early diagnosis of chronic kidney disease (CKD) facilitates best management in primary care. Testing coverage of those at risk and translation into subsequent diagnostic coding will impact on observed CKD prevalence. Using initial data from 915 general practitioner (GP) practices taking part in a UK national audit, we seek to apply appropriate methods to identify outlying practices in terms of CKD stages 3-5 prevalence and diagnostic coding. We estimate expected numbers of CKD stages 3-5 cases in each practice, adjusted for key practice characteristics, and further inflate the control limits to account for overdispersion related to unobserved factors (including unobserved risk factors for CKD, and between-practice differences in coding and testing). GP practice prevalence of coded CKD stages 3-5 ranges from 0.04 to 7.8%. Practices differ considerably in coding of CKD in individuals where CKD is indicated following testing (ranging from 0 to 97% of those with and glomerular filtration rate  Accounting for overdispersion is crucial in providing useful information about outlying practices for CKD prevalence.

  14. A propensity-matched comparison of perioperative complications and of chronic kidney disease between robot-assisted laparoscopic partial nephrectomy and radiofrequency ablative therapy

    Directory of Open Access Journals (Sweden)

    Sung Han Kim

    2015-07-01

    Conclusion: Despite the intraoperative renal ischemia and invasiveness of the procedure associated with RALPN, the incidence of perioperative complication and of CKD developing rates were statistically similar.

  15. Clinical characteristics and prevalence of complications of chronic kidney disease in children: the Taiwan Pediatric Renal Collaborative study.

    Science.gov (United States)

    Chou, Hsin-Hsu; Lin, Ching-Yuang; Chiou, Yee-Hsuan; Tain, You-Lin; Wang, Yi-Fan; Wang, Hsin-Hui; Chiou, Yuan-Yow

    2016-07-01

    Little information is available regarding the clinical characteristics and prevalence of complications in children with chronic kidney disease (CKD), especially in early disease stages. The objective of this study was to determine the clinical characteristics and prevalence of complications in children with predialytic CKD. This multicenter, cross-sectional study enrolled children at all stages of predialytic CKD. Children who were between the ages of 1 year and 18 years and who fulfilled the clinical criteria of CKD were included in the study. Baseline demographic data, previous history, clinical characteristics, and laboratory data were collected. A total of 757 children were included in the study. The median age at the time of enrollment was 10.6 years; 397 patients (52.4 %) were males. A total of 39.0 % of the patients were in CKD stage 1, 37.6 % were in stage 2, 14.8 % were in stage 3, 3.0 % were in stage 4, and 5.5 % were in stage 5. Nonglomerular renal diseases were the primary cause of CKD, comprising 51.9 % of the patients with CKD. The age at disease onset, gender, CKD stage distribution, and proportion of co-morbidities varied between the glomerular and nonglomerular CKD cases. Anemia, hyperlipidemia, hypocalcemia, and hyperphosphatemia were more prevalent in patients with glomerular CKD. The overall prevalence of complications was as follows: uncontrolled blood pressure, 44.1 %; anemia, 34.2 %; hyperlipidemia, 44.9 %; short stature, 10.3 %; and failure to thrive, 8.2 %. Uncontrolled blood pressure (BP), anemia, and hyperlipidemia were common, even in the early CKD stages. The prevalence of CKD complications generally increased with the worsening stage of CKD. This study reveals differences in CKD etiology and prevalence of specific complications according to the stage of CKD. Early recognition and awareness of complications are mandatory for clinicians during the follow-up visits of children with CKD.

  16. Effect of redox modulating NRF2 activators on chronic kidney disease.

    Science.gov (United States)

    Choi, Bo-hyun; Kang, Kyung-Shin; Kwak, Mi-Kyoung

    2014-08-20

    Chronic kidney disease (CKD) is featured by a progressive decline of kidney function and is mainly caused by chronic diseases such as diabetes mellitus and hypertension. CKD is a complex disease due to cardiovascular complications and high morbidity; however, there is no single treatment to improve kidney function in CKD patients. Since biological markers representing oxidative stress are significantly elevated in CKD patients, oxidative stress is receiving attention as a contributing factor to CKD pathology. Nuclear factor erythroid-2 related factor 2 (NRF2) is a predominant transcription factor that regulates the expression of a wide array of genes encoding antioxidant proteins, thiol molecules and their generating enzymes, detoxifying enzymes, and stress response proteins, all of which can counteract inflammatory and oxidative damages. There is considerable experimental evidence suggesting that NRF2 signaling plays a protective role in renal injuries that are caused by various pathologic conditions. In addition, impaired NRF2 activity and consequent target gene repression have been observed in CKD animals. Therefore, a pharmacological intervention activating NRF2 signaling can be beneficial in protecting against kidney dysfunction in CKD. This review article provides an overview of the role of NRF2 in experimental CKD models and describes current findings on the renoprotective effects of naturally occurring NRF2 activators, including sulforaphane, resveratrol, curcumin, and cinnamic aldehyde. These experimental results, coupled with recent clinical experiences with a synthetic triterpenoid, bardoxolone methyl, have brought a light of hope for ameliorating CKD progression by preventing oxidative stress and maintaining cellular redox homeostasis.

  17. The Economic Burden of Chronic Kidney Disease and End-Stage Renal Disease.

    Science.gov (United States)

    Wang, Virginia; Vilme, Helene; Maciejewski, Matthew L; Boulware, L Ebony

    2016-07-01

    The growing prevalence and progression of chronic kidney disease (CKD) raises concerns about our capacity to manage its economic burden to patients, caregivers, and society. The societal direct and indirect costs of CKD and end-stage renal disease are substantial and increase throughout disease progression. There is significant variability in the evidence about direct and indirect costs attributable to CKD and end-stage renal disease, with the most complete evidence concentrated on direct health care costs of patients with advanced to end-stage CKD. There are substantial gaps in evidence that need to be filled to inform clinical practice and policy.

  18. Effects of Long-Term Statin Therapy in Coronary Artery Disease Patients with or without Chronic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Huiling Huang

    2015-01-01

    Full Text Available Introduction. The effect of long-term statin therapy is essential for secondary prevention of adverse clinical outcomes of coronary artery disease (CAD patients. No study has compared the effects of long-term statin treatment in CAD patients with or without chronic kidney disease (CKD and CKD only patients. Methods. We compared the effects of long-term statin therapy (average follow-up time 5.79 years in terms of major adverse cardiovascular events (MACE, all-cause death, and cardiac death among 570 CAD patients with or without CKD and 147 CKD only patients. Results. The all-cause death and cardiac death of the patients with CAD and CKD (24.4% and 20.4% doubled those of CAD only patients (10.7% and 9.1% (P<0.001. Long-term statin therapy dramatically reduced the rates of both MACE and all-cause death/cardiac death (by 20.5% and 28.6%/27.7%, resp. in CAD and CKD patients. CKD only patients had no significant adverse clinical outcomes and were not responsive to long-term statin therapy. Conclusion. Chinese CAD patients with CKD had dramatically high rates of adverse clinical outcomes; for them, long-term statin therapies were exceptionally effective in improving morbidity and mortality. CKD patients who had no cardiovascular disease initially can prognose good clinical outcomes and do not require statin treatment.

  19. Effects of Long-Term Statin Therapy in Coronary Artery Disease Patients with or without Chronic Kidney Disease.

    Science.gov (United States)

    Huang, Huiling; Zeng, Chunmei; Ma, Yuedong; Chen, Yili; Chen, Cong; Liu, Chen; Dong, Yugang

    2015-01-01

    The effect of long-term statin therapy is essential for secondary prevention of adverse clinical outcomes of coronary artery disease (CAD) patients. No study has compared the effects of long-term statin treatment in CAD patients with or without chronic kidney disease (CKD) and CKD only patients. We compared the effects of long-term statin therapy (average follow-up time 5.79 years) in terms of major adverse cardiovascular events (MACE), all-cause death, and cardiac death among 570 CAD patients with or without CKD and 147 CKD only patients. The all-cause death and cardiac death of the patients with CAD and CKD (24.4% and 20.4%) doubled those of CAD only patients (10.7% and 9.1%) (P statin therapy dramatically reduced the rates of both MACE and all-cause death/cardiac death (by 20.5% and 28.6%/27.7%, resp.) in CAD and CKD patients. CKD only patients had no significant adverse clinical outcomes and were not responsive to long-term statin therapy. Chinese CAD patients with CKD had dramatically high rates of adverse clinical outcomes; for them, long-term statin therapies were exceptionally effective in improving morbidity and mortality. CKD patients who had no cardiovascular disease initially can prognose good clinical outcomes and do not require statin treatment.

  20. Effect of Redox Modulating NRF2 Activators on Chronic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Bo-hyun Choi

    2014-08-01

    Full Text Available Chronic kidney disease (CKD is featured by a progressive decline of kidney function and is mainly caused by chronic diseases such as diabetes mellitus and hypertension. CKD is a complex disease due to cardiovascular complications and high morbidity; however, there is no single treatment to improve kidney function in CKD patients. Since biological markers representing oxidative stress are significantly elevated in CKD patients, oxidative stress is receiving attention as a contributing factor to CKD pathology. Nuclear factor erythroid-2 related factor 2 (NRF2 is a predominant transcription factor that regulates the expression of a wide array of genes encoding antioxidant proteins, thiol molecules and their generating enzymes, detoxifying enzymes, and stress response proteins, all of which can counteract inflammatory and oxidative damages. There is considerable experimental evidence suggesting that NRF2 signaling plays a protective role in renal injuries that are caused by various pathologic conditions. In addition, impaired NRF2 activity and consequent target gene repression have been observed in CKD animals. Therefore, a pharmacological intervention activating NRF2 signaling can be beneficial in protecting against kidney dysfunction in CKD. This review article provides an overview of the role of NRF2 in experimental CKD models and describes current findings on the renoprotective effects of naturally occurring NRF2 activators, including sulforaphane, resveratrol, curcumin, and cinnamic aldehyde. These experimental results, coupled with recent clinical experiences with a synthetic triterpenoid, bardoxolone methyl, have brought a light of hope for ameliorating CKD progression by preventing oxidative stress and maintaining cellular redox homeostasis.

  1. Update on Medical Management of Clinical Manifestations of Chronic Kidney Disease.

    Science.gov (United States)

    Quimby, Jessica M

    2016-11-01

    Dysregulation of normal kidney functions in chronic kidney disease (CKD) leads to several pathophysiologic abnormalities that have the potential to significantly clinically affect the CKD patient. This article discusses the clinical impact of hypertension, hypokalemia, anemia, dysrexia, nausea/vomiting, and constipation in the CKD patient and therapies for these conditions. These clinical manifestations of disease may not occur in every patient and may also develop later during the progression of disease. Therefore, monitoring for, identifying, and addressing these factors is considered an important part of the medical management of CKD. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. The link between chronic kidney disease and cardiovascular disease.

    Science.gov (United States)

    Said, Sarmad; Hernandez, German T

    2014-07-01

    It is well known that patients with chronic kidney disease (CKD) have a strong risk of cardiovascular disease (CVD). However, the excess risk of cardiovascular disease in patients with CKD is only partially explained by the presence of traditional risk factors, such as hypertension and diabetes mellitus. Directory of Open Access Journals (DOAJ), Google Scholar, PubMed, EBSCO and Web of Science has been searched. Chronic kidney disease even in its early stages can cause hypertension and potentiate the risk for cardiovascular disease. However, the practice of intensive blood pressure lowering was criticized in recent systematic reviews. Available evidence is inconclusive but does not prove that a blood pressure target of less than 130/80 mmHg as recommended in the guidelines improves clinical outcomes more than a target of less than 140/90 mmHg in adults with CKD. The association between CKD and CVD has been extensively documented in the literature. Both CKD and CVD share common traditional risk factors, such as smoking, obesity, hypertension, diabetes mellitus, and dyslipidemia. However, cardiovascular disease remains often underdiagnosed und undertreated in patients with CKD. It is imperative that as clinicians, we recognize that patients with CKD are a group at high risk for developing CVD and cardiovascular events. Additional studies devoted to further understand the risk factors for CVD in patients with CKD are necessary to develop and institute preventative and treatment strategies to reduce the high morbidity and mortality in patients with CKD.

  3. Evaluation for association between urolithiasis and chronic kidney disease in cats.

    Science.gov (United States)

    Cléroux, Andréanne; Alexander, Kate; Beauchamp, Guy; Dunn, Marilyn

    2017-04-01

    OBJECTIVE To determine whether urolithiasis is associated with chronic kidney disease (CKD) in cats. DESIGN Retrospective case-control study. ANIMALS 126 cats (59 and 67 with and without urolithiasis, respectively). PROCEDURES Medical records from June 2006 to July 2013 were searched to identify cats that underwent abdominal or focal urinary tract ultrasonography and for which serum creatinine concentration and urine specific gravity data were obtained ≤ 14 days before or after the examination. In cats with (urolithiasis group) and without (control group) urolithiasis, the presence of CKD was determined according to International Renal Interest Society guidelines. Information recorded included signalment, body weight, serum creatinine concentration, and urine specific gravity; when present, the location and number of uroliths were noted. Differences between groups and associations between group and categorical variables were analyzed statistically. RESULTS Age, weight, sex, and breed did not differ between groups. The prevalence of CKD was significantly higher in cats with urolithiasis than in the control group. Among cats with urolithiasis, there was a negative association between CKD and presence of cystoliths. There was no association between urolithiasis and the stage of CKD or between presence of CKD and location of nephroliths in the kidney. CONCLUSIONS AND CLINICAL RELEVANCE Results confirmed a positive association between urolithiasis and CKD in the feline population studied and suggested that cats with urolithiasis should be evaluated for CKD. Further research is warranted to assess the nature of the relationship between CKD and urolithiasis in cats.

  4. Sympathetic Overactivity in Chronic Kidney Disease: Consequences and Mechanisms

    Directory of Open Access Journals (Sweden)

    Jasdeep Kaur

    2017-08-01

    Full Text Available The incidence of chronic kidney disease (CKD is increasing worldwide, with more than 26 million people suffering from CKD in the United States alone. More patients with CKD die of cardiovascular complications than progress to dialysis. Over 80% of CKD patients have hypertension, which is associated with increased risk of cardiovascular morbidity and mortality. Another common, perhaps underappreciated, feature of CKD is an overactive sympathetic nervous system. This elevation in sympathetic nerve activity (SNA not only contributes to hypertension but also plays a detrimental role in the progression of CKD independent of any increase in blood pressure. Indeed, high SNA is associated with poor prognosis and increased cardiovascular morbidity and mortality independent of its effect on blood pressure. This brief review will discuss some of the consequences of sympathetic overactivity and highlight some of the potential pathways contributing to chronically elevated SNA in CKD. Mechanisms leading to chronic sympathoexcitation in CKD are complex, multifactorial and to date, not completely understood. Identification of the mechanisms and/or signals leading to sympathetic overactivity in CKD are crucial for development of effective therapeutic targets to reduce the increased cardiovascular risk in this patient group.

  5. Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism

    National Research Council Canada - National Science Library

    Ikizler, T. Alp; Cano, Noël; Franch, Harold; Fouque, Denis; Himmelfarb, Jonathan; Kalantar-Zadeh, Kamyar; Kuhlmann, M. K; Stenvinkel, Peter; TerWee, Pieter; Teta, Daniel; Wang, Angela Yee-Moon; Wanner, Christoph

    2013-01-01

    Protein energy wasting (PEW) is common in patients with chronic kidney disease (CKD) and is associated with adverse clinical outcomes, especially in individuals receiving maintenance dialysis therapy...

  6. 慢性肾脏病患者贫血与铁代谢的相关性研究%Correlation between anemia and iron metabolism in patients with chronic kidney disease

    Institute of Scientific and Technical Information of China (English)

    张静; 杨俊伟

    2016-01-01

    目的:探讨慢性肾脏病(CKD)不同分期患者贫血和铁代谢紊乱程度及二者的相关性。方法选取2012年1月至2015年10月该院肾内科收治的240例初诊为CKD患者作为研究对象,根据肾小球滤过率估计值(eGFR)分为CKD 1~5期,收集患者血红蛋白(Hb)、红细胞(RBC)、血细胞比容(Hct)、血清铁(SI)、血清总铁结合力、转铁蛋白饱和度(TSAT)、血清铁蛋白等数据,并分析五组患者贫血检测指标与铁代谢检测指标的差异及其相关性。结果 CKD 1~5期患者均存在不同程度贫血,CKD 3~5期患者Hb、RBC、Hct与CKD 1、2期比较,差异均有统计学意义(P<0.05)。CKD 3期患者SI、TSAT较CKD 1期降低,CKD 4、5期患者SI、TSAT均较CKD 1、2期降低,差异均有统计学意义(P<0.05),CKD 3~5期患者SI、TSAT与Hb及Hct呈正相关(P<0.05)。结论 CKD 1~5期患者均存在不同程度贫血,CKD患者贫血与铁代谢密切相关,eGFR越低,贫血和铁代谢紊乱程度越重。%Objective To explore the degree of anemia and iron metabolism disorder in the patients with chronic kidney disease(CKD)and their relationship. Methods Totally 240 patients with initially diagnosed CKD in the nephrology department of our hospital from January 2012 to October 2015 were selected and divided into the CKD stage 1-5 according to the estimated value of glomerular filtration rate(eGFR). The data of hemoglobin(Hb),red blood cell count(RBC),hematokrit(Hct),serum iron (SI),total iron binding capacity(TIBC),serum transferrin saturation(TSAT) and serum ferritin(SF) were collected and the cor-relation between the anemia detection indicators with iron metabolic detection indicators was analyzed. Results The different degree of anemia existed among the CKD 5 stages. The Hb,RBC,Hct levels had statistical differences between the CKD stage 3-5 with the CKD stage 1-2(P<0.05). The SI and TSAT levels in the CKD stage 3 were

  7. Single shot near edge x-ray absorption fine structure spectroscopy in the laboratory

    Energy Technology Data Exchange (ETDEWEB)

    Mantouvalou, I., E-mail: ioanna.mantouvalou@tu-berlin.de; Witte, K.; Martyanov, W.; Jonas, A.; Grötzsch, D.; Kanngießer, B. [Institute for Optics and Atomic Physics, Technical University of Berlin, D-10623 Berlin (Germany); Streeck, C. [Physikalisch-Technische Bundesanstalt (PTB), D-10587 Berlin (Germany); Löchel, H.; Rudolph, I.; Erko, A. [Helmholtz-Zentrum Berlin, D-14109 Berlin (Germany); Stiel, H. [Max Born Institute for Nonlinear Optics and Short Pulse Spectroscopy, D-12489 Berlin (Germany)

    2016-05-16

    With the help of adapted off-axis reflection zone plates, near edge X-ray absorption fine structure spectra at the C and N K-absorption edge have been recorded using a single 1.2 ns long soft X-ray pulse. The transmission experiments were performed with a laser-produced plasma source in the laboratory rendering time resolved measurements feasible independent on large scale facilities. A resolving power of E/ΔE ∼ 950 at the respective edges could be demonstrated. A comparison of single shot spectra with those collected with longer measuring time proves that all features of the used reference samples (silicon nitrate and polyimide) can be resolved in 1.2 ns. Hence, investigations of radiation sensitive biological specimen become possible due to the high efficiency of the optical elements enabling low dose experiments.

  8. Chemical state speciation by resonant Raman scattering

    CERN Document Server

    Karydas, A G; Zarkadas, C; Paradelis, T; Kallithrakas-Kontos, N

    2002-01-01

    In the resonant Raman scattering (RRS) process the emitted photon exhibits a continuous energy distribution with a high energy cutoff limit. This cutoff energy depends on the chemical state of the element under examination. In the present work, the possibility of identifying the chemical state of V atoms by employing RRS spectroscopy with a semiconductor Si(Li) detector is investigated. A proton induced Cr K alpha x-ray beam was used as the incident radiation, having a fixed energy lower than the V K-absorption edge. The net RRS distributions extracted from the energy dispersive spectra of metallic V and its compound targets were simulated by an appropriate theoretical model. The results showed the possibility of employing RRS spectroscopy with a semiconductor detector for chemical speciation studies.

  9. Spatially Resolved Sulfur Speciation in Urban Soils

    Science.gov (United States)

    Brettholle, M.; Gleber, S.-C.; Mekiffer, B.; Legnini, D.; McNulty, I.; Vogt, S.; Wessolek, G.; Thieme, J.

    2011-09-01

    A combination of x-ray microscopy, elemental mapping, and XANES spectroscopy at the K-absorption edge of sulfur was used to analyze the elemental and particulate composition of an urban soil loaded with building rubble from WWII, exemplarily from Berlin, Germany. This combination of element specific high-resolution microscopy with high spectral resolution capabilities allows for the determination of elemental composition as well as chemical speciation and is therefore well suited for the analysis of highly heterogeneous environmental samples. Different soil and debris constituents could be assigned to elemental distribution patterns within collected fluorescence maps, allowing for a detailed analysis of the sulfur pool and release from war debris in subsequent studies. A detailed understanding of this sulfur lixiviation is central to preserve urban water quality.

  10. DAFS measurements using the image-plate Weissenberg method

    Energy Technology Data Exchange (ETDEWEB)

    Sugioka, N.; Matsumoto, K.; Sasaki, S. [Tokyo Inst. of Technology, Materials and Structures Lab., Yokohama (Japan); Tanaka, M.; Mori, T. [National Lab. for High Energy Physics, Photon Factory, Tsukuba (Japan)

    1998-05-01

    An instrumental technique for DAFS measurements which can provide site-specific information is proposed. The approach uses (i) focusing optics with parabolic mirrors and a double-crystal monochromator, (ii) the Laue and Bragg settings and (iii) data collection by the image-plate Weissenberg method. Six image exposures are recorded per plate at five intrinsic energies and one reference energy. The single-crystal measurements were performed at the Co K-absorption edge, and the 200, 220 and 311 reflections of CoO and 511 and 911 reflections of Co{sub 3}O{sub 4} were used for analysis. The regression analysis of {chi}(k), Fourier transforms of k{sup 3}{chi}(k) and back-Fourier filtering have been performed. 20 refs.

  11. DAFS measurements using the image-plate Weissenberg method.

    Science.gov (United States)

    Sugioka, N; Matsumoto, K; Tanaka, M; Mori, T; Sasaki, S

    1998-05-01

    An instrumental technique for DAFS measurements which can provide site-specific information is proposed. The approach uses (i) focusing optics with parabolic mirrors and a double-crystal monochromator, (ii) the Laue and Bragg settings and (iii) data collection by the image-plate Weissenberg method. Six image exposures are recorded per plate at five intrinsic energies and one reference energy. The single-crystal measurements were performed at the Co K-absorption edge, and the 200, 220 and 311 reflections of CoO and 511 and 911 reflections of Co(3)O(4) were used for analysis. The regression analysis of chi(k), Fourier transforms of k(3)chi(k) and back-Fourier filtering have been performed.

  12. Doping and bond length contributions to Mn K-edge shift in La1-SrMnO3 (=0-0.7) and their correlation with electrical transport properties

    Indian Academy of Sciences (India)

    S K Pandey; R Bindu; Ashwini Kumar; S Khalid; A V Pimpale

    2008-02-01

    The room temperature experimental Mn K-edge X-ray absorption spectra of La1-SrMnO3 ( = 0-0.7) are compared with the band structure calculations using spin polarized density functional theory. It is explicitly shown that the observed shift in the energy of Mn K-edge on substitution of divalent Sr on trivalent La sites corresponds to the shift in the center of gravity of the unoccupied Mn 4-band contributing to the Mn K-absorption edge region. This correspondence is then used to separate the doping and size contributions to the edge shift due to variation in the number of electrons in valence band and Mn-O bond lengths, respectively, when Sr is doped into LaMnO3. Such separation is helpful to find the localization behaviour of charge carriers and to understand the observed transport properties of these compounds.

  13. 慢性肾脏病的单中心横断面流行病学研究%Cross-sectional study of chronic kidney disease

    Institute of Scientific and Technical Information of China (English)

    刘迅; 唐骅; 彭晖; 石成钢; 陈珠江; 娄探奇

    2009-01-01

    目的 调查单中心肾内科门诊慢性肾脏病(CKD)患者的基础状况,判断CKD患者肾功能下降的危险因素.方法 对门诊就诊的CKD患者进行为期9个月的前瞻性横断面调查.结果 共有780例CKD病例入选.前4位CKD的病因分别为原发性肾小球疾病(59.0%),高血压肾病(7.6%),狼疮肾炎(6.4%),糖尿病肾病(6.3%).病例平均年龄41.9岁.CKD各期的分布为CKD 1期47.8%、2期18.7%、3期14.0%、4期8.1%、5期11.4%.多因素回归提示年龄、蛋白尿、高血压与CKD患者的肾功能下降独立相关.结论 目前针对中国CKD患者最大规模的单中心横断面调查,有助于确定CKD患者的基本状况,为进一步纵向随访奠定基础.%Objective To present the baseline characteristics of serum uric acid level in patients with chronic kidney disease(CKD)in single.centre nephrology clinic and judge the risk factor for decreased renal function of CKD Datients.Methods A cross-sectional study on CKD patients in clinic was carried out for 9 months.Results 780 CKD cases were enrolled in the study.The top four causes of CKD in these patients were primary glomerular disease(59.0%),essential hypertension(7.6%),lupus nephritis(6.4%)and diabetic nephropathy(6.3%).The average age was 41.9.The distribution of CKD stage was 47.8%of CKD1,18.7%of CKD2,14.0%of CKD3,8.1% of CKD4 and 11.4%of CKD5.Multivariate Logistic regression regression analysis indicated that age,proteinuria,hypertension were independently correlated with decreased renal function.Conclusion This is the largest cross-sectional study of CKD in China,which will help to determine the basic status of Chinese CKD patients,laying a basis for further followup.

  14. Insulin Resistance and Chronic Kidney Disease in Patients with Type 1 Diabetes Mellitus

    Science.gov (United States)

    Vladu, Mihaela; Clenciu, Diana; Efrem, Ion Cristian; Amzolini, Anca; Micu, Simona Tudorică; Moţa, Maria

    2017-01-01

    Background and Aims. Diabetes mellitus (DM) is a chronic disease which can evolve towards devastating micro- and macrovascular complications. DM is the most frequent cause of chronic kidney disease (CKD). Insulin resistance plays an important role in the natural history of type 1 diabetes. The purpose of the study was to determine the prevalence of CKD in T1DM and the correlation with insulin resistance (IR) in patients with CKD. Materials and Methods. The study was conducted over a period of three years (2010–2013) and included patients with DM registered in the Clinical Centre of Diabetes, Nutrition and Metabolic Diseases of Dolj county. The study design was an epidemiological, transversal, noninterventional type. Finally, the study group included 200 subjects with type 1 DM. Insulin resistance (IR) was estimated by eGDR. The subjects with eGDR ≤ 7.5 mg/kg/min were considered with insulin resistance. Results. CKD was found in 44% of the patients. Analyzing statistically the presence of CKD, we found highly significant differences between patients with CKD and those without CKD regarding age and sex of the patients, the duration of diabetes, glycosylated hemoglobin (HbA1c), the estimated glucose disposal rate (eGDR), and the presence of hypertension, dyslipidemia, and hyperuricaemia. In patients with CKD, age and diabetes duration are significantly higher than in those who do not have this complication. CKD is more frequent in males than in females (50.9% men versus 34.5% women, p = 0.022). From the elements of metabolic syndrome, high blood pressure, hyperuricemia, and dyslipidemia are significantly increased in diabetic patients with CKD. eGDR value (expressed as mg·kg−1·min−1) is lower in patients with CKD than in those without CKD (15.92 versus 6.42, p CKD show higher insulin resistance than those without CKD. Conclusions. This study has shown that insulin resistance is associated with an increased risk of CKD, but, due to the cross

  15. Plasma Pentosidine and Its Association with Mortality in Patients with Chronic Kidney Disease

    Science.gov (United States)

    Sun, Jia; Qureshi, Abdul Rashid; Isoyama, Naohito; Leurs, Paul; Anderstam, Björn; Heimburger, Olof; Barany, Peter; Stenvinkel, Peter; Lindholm, Bengt

    2016-01-01

    Background Circulating advanced glycated end-products (AGEs) including pentosidine accumulating in chronic kidney disease (CKD) patients due to retention and increased formation are thought to contribute to cardiovascular disease (CVD). Here we evaluated factors linked to increased plasma pentosidine and its association with mortality in patients with different stages of CKD and undergoing different treatments. Methods Plasma pentosidine, biomarkers of inflammation, oxidative stress and nutritional status were investigated in CKD 1–2 (n = 37), CKD 3–4 (n = 54), CKD 5 non-dialyzed (CKD5-ND; n = 386), peritoneal dialysis (PD; n = 74) and hemodialysis (HD; n = 195) patients. Factors predicting plasma pentosidine were analysed by multivariate regression analysis and mortality risk was assessed by GENMOD procedure. Results Plasma pentosidine levels, which were higher in CKD5-ND, PD and HD groups than in CKD 1–2 group, were significantly lower in PD than in HD patients, and not different between PD patients and CKD5-ND patients. Pentosidine associated inversely with glomerular filtration rate (GFR), and additionally in PD with 8-hydroxy-2‘-deoxyguanosine (8-OHdG), and interleukin 6 (IL-6); in HD with age, IL-6 and body mass index (BMI); in CKD5-ND with age, 8-OHdG, IL-6, high-sensitive C-reactive protein (hsCRP), and soluble vascular cell adhesion protein-1 (sVCAM-1); in CKD 3–4 with 8-OHdG and sVCAM-1; and in CKD 1–2 with age and sVCAM-1. In multivariate analysis, age (one standard deviation, 1-SD higher), malnutrition (subjective global assessment, SGA), oxidative stress (8-OHdG, 1-SD higher), and belonging to CKD5-ND, HD and PD cohorts associated with 1-SD higher pentosidine. In GENMOD, 1-SD higher pentosidine independently predicted all-cause mortality (relative risk, RR = 1.04; 95% confidence interval, CI, 1.01–1.08, p = 0.01) and CVD mortality (RR = 1.03; 95% CI, 1.01–1.06, p = 0.03) after adjusting for all confounders. Conclusions Plasma

  16. Associations Between Chronic Kidney Disease and Outcomes With Use of Prasugrel Versus Clopidogrel in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: A Report From the PROMETHEUS Study.

    Science.gov (United States)

    Baber, Usman; Chandrasekhar, Jaya; Sartori, Samantha; Aquino, Melissa; Kini, Annapoorna S; Kapadia, Samir; Weintraub, William; Muhlestein, Joseph B; Vogel, Birgit; Faggioni, Michela; Farhan, Serdar; Weiss, Sandra; Strauss, Craig; Toma, Catalin; DeFranco, Anthony; Baker, Brian A; Keller, Stuart; Effron, Mark B; Henry, Timothy D; Rao, Sunil; Pocock, Stuart; Dangas, George; Mehran, Roxana

    2017-07-27

    The study sought to compare clinical outcomes in a contemporary acute coronary syndrome (ACS) percutaneous coronary intervention (PCI) cohort stratified by chronic kidney disease (CKD) status. Patients with CKD exhibit high risks for both thrombotic and bleeding events, thus complicating decision making regarding antiplatelet therapy in the setting of ACS. The PROMETHEUS study was a multicenter observational study comparing outcomes with prasugrel versus clopidogrel in ACS PCI patients. Major adverse cardiac events (MACE) at 90 days and at 1 year were defined as a composite of death, myocardial infarction, stroke, or unplanned revascularization. Clinically significant bleeding was defined as bleeding requiring transfusion or hospitalization. Cox regression multivariable analysis was performed for adjusted associations between CKD status and clinical outcomes. Hazard ratios for prasugrel versus clopidogrel treatment were generated using propensity score stratification. The total cohort included 19,832 patients, 28.3% with and 71.7% without CKD. CKD patients were older with greater comorbidities including diabetes and multivessel disease. Prasugrel was less often prescribed to CKD versus non-CKD patients (11.0% vs. 24.0%, respectively; p < 0.001). At 1 year, CKD was associated with higher adjusted risk of MACE (1.27; 95% confidence interval: 1.18 to 1.37) and bleeding (1.46; 95% confidence interval: 1.24 to 1.73). Although unadjusted rates of 1-year MACE were lower with prasugrel versus clopidogrel in both CKD (18.3% vs. 26.5%, p < 0.001) and non-CKD (10.9% vs. 17.9%; p < 0.001) patients, associations were attenuated after propensity stratification. Similarly, unadjusted differences in 1-year bleeding with prasugrel versus clopidogrel (6.0% vs. 7.4%, p = 0.18 in CKD patients; 2.6% vs. 3.5%, p = 0.008 in non-CKD patients) were not significant after propensity score adjustment. Although risks for 1-year MACE were significantly higher in ACS PCI patients with

  17. Roles of Glycoproteins in the Diagnosis and Differential Diagnosis of Chronic and Latent Keshan Disease

    Directory of Open Access Journals (Sweden)

    Sen Wang

    2017-05-01

    Full Text Available We aimed to explore the roles of glycoproteins in the pathogenesis of chronic and latent Keshan disease (CKD and LKD, and screen the lectins as indicators of significant differences in glycoproteins of KD saliva and serum. Blood and saliva were collected from 50 CKD, 50 LKD patients and 54 normal individuals. Saliva and serum lectin microarrays and saliva and serum microarrays were used to screen and verify the differences in the levels of lectin among the three groups. In the male saliva lectin microarray, Solanum tuberosum (potato lectin (STL and other 9 lectins showed differences between CKD and normal; STL and other 9 lectins showed differences between LKD and normal; Aleuria aurantia lectin (AAL and other 15 lectins showed differences between CKD and LKD. In the female saliva microarray, Griffonia (Bandeiraea simplicifolia lectin I (GSL-I and other 9 lectins showed differences between CKD and normal; STL and other 7 lectins showed differences between LKD and normal; Maackia amurensis lectin I (MAL-I and Triticum vulgaris (WGA showed difference between CKD and LKD. In the male serum lectin microarray, Psophocarpus tetragonolobus lectin I (PTL-I and other 16 lectins showed differences between CKD and normal; Ulexeuropaeus agglutinin I (UEA-I and other 9 lectins showed differences between LKD and normal; AAL and other 13 lectins showed differences between CKD and LKD. In the female serum lectin microarray, WGA and other 13 lectins showed differences between CKD and normal; Euonymus europaeus lectin (EEL and other 6 lectins showed differences between LKD and normal; MAL-I and other 14 lectins showed differences between CKD and LKD. Carbohydrate chain GlcNAc and α-Gal may play crucial roles in the pathogenesis of KD. STL may be considered the diagnostic biomarker for male CKD and LKD, while WGA may be useful in distinguishing between the two stages. STL may be considered the diagnostic biomarker for female LKD.

  18. Hepatitis C Viremia and the Risk of Chronic Kidney Disease in HIV-Infected Individuals

    Science.gov (United States)

    Lucas, Gregory M.; Jing, Yuezhou; Sulkowski, Mark; Abraham, Alison G.; Estrella, Michelle M.; Atta, Mohamed G.; Fine, Derek M.; Klein, Marina B.; Silverberg, Michael J.; Gill, M. John; Moore, Richard D.; Gebo, Kelly A.; Sterling, Timothy R.; Butt, Adeel A.; Kirk, Gregory D.; Benson, Constance A.; Bosch, Ronald J.; Collier, Ann C.; Boswell, Stephen; Grasso, Chris; Mayer, Ken; Hogg, Robert S.; Harrigan, Richard; Montaner, Julio; Cescon, Angela; Brooks, John T.; Buchacz, Kate; Gebo, Kelly A.; Moore, Richard D.; Carey, John T.; Rodriguez, Benigno; Horberg, Michael A.; Silverberg, Michael J.; Horberg, Michael A.; Thorne, Jennifer E.; Goedert, James J.; Jacobson, Lisa P.; Klein, Marina B.; Rourke, Sean B.; Burchell, Ann; Rachlis, Anita R.; Rico, Puerto; Hunter-Mellado, Robert F.; Mayor, Angel M.; Gill, M. John; Deeks, Steven G.; Martin, Jeffrey N.; Patel, Pragna; Brooks, John T.; Saag, Michael S.; Mugavero, Michael J.; Willig, James; Eron, Joseph J.; Napravnik, Sonia; Kitahata, Mari M.; Crane, Heidi M.; Justice, Amy C.; Dubrow, Robert; Fiellin, David; Sterling, Timothy R.; Haas, David; Bebawy, Sally; Turner, Megan; Gange, Stephen J.; Anastos, Kathryn; Moore, Richard D.; Saag, Michael S.; Gange, Stephen J.; Kitahata, Mari M.; McKaig, Rosemary G.; Justice, Amy C.; Freeman, Aimee M.; Moore, Richard D.; Freeman, Aimee M.; Lent, Carol; Kitahata, Mari M.; Van Rompaey, Stephen E.; Crane, Heidi M.; Webster, Eric; Morton, Liz; Simon, Brenda; Gange, Stephen J.; Althoff, Keri N.; Abraham, Alison G.; Lau, Bryan; Zhang, Jinbing; Jing, Jerry; Golub, Elizabeth; Modur, Shari; Hanna, David B.; Rebeiro, Peter; Wong, Cherise; Mendes, Adell

    2013-01-01

    Background. The role of active hepatitis C virus (HCV) replication in chronic kidney disease (CKD) risk has not been clarified. Methods. We compared CKD incidence in a large cohort of HIV-infected subjects who were HCV seronegative, HCV viremic (detectable HCV RNA), or HCV aviremic (HCV seropositive, undetectable HCV RNA). Stages 3 and 5 CKD were defined according to standard criteria. Progressive CKD was defined as a sustained 25% glomerular filtration rate (GFR) decrease from baseline to a GFR < 60 mL/min/1.73 m2. We used Cox models to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Results. A total of 52 602 HCV seronegative, 9508 HCV viremic, and 913 HCV aviremic subjects were included. Compared with HCV seronegative subjects, HCV viremic subjects were at increased risk for stage 3 CKD (adjusted HR 1.36 [95% CI, 1.26, 1.46]), stage 5 CKD (1.95 [1.64, 2.31]), and progressive CKD (1.31 [1.19, 1.44]), while HCV aviremic subjects were also at increased risk for stage 3 CKD (1.19 [0.98, 1.45]), stage 5 CKD (1.69 [1.07, 2.65]), and progressive CKD (1.31 [1.02, 1.68]). Conclusions. Compared with HIV-infected subjects who were HCV seronegative, both HCV viremic and HCV aviremic individuals were at increased risk for moderate and advanced CKD. PMID:23904290

  19. Correlation of serum parathyroid hormone with mineral bone disease in chronic kidney disease patients

    Directory of Open Access Journals (Sweden)

    Rajeshwari S Vhora

    2015-01-01

    Full Text Available Background: Mineral bone disease (MBD is a systemic disorder of mineral and bone metabolism due to chronic kidney disease (CKD. Bone disease in CKD is due to secondary hyperparathyroidism. Serum intact parathyroid hormone (iPTH level estimation is a potential noninvasive method for the diagnosis of MBD at early stage. Aim: Treating renal bone disease should be one of the primary aims of therapy for CKD. Evaluation of the biochemical parameters of CKD-MBD (primarily phosphorus, calcium, parathyroid hormone, and Vitamin D levels as early as CKD stage 3, and an assessment of bone status (by the best means available, should be used to guide treatment decisions. The adverse effects of high phosphorus intake relative to renal clearance (including stimulation of hyperparathyroidism precede hyperphosphatemia, which presents late in CKD. Early reduction of phosphorus load may ameliorate these adverse effects. Evidence that calcium load may influence progression of vascular calcification with effects on mortality, should also be considered when choosing the type and dose of phosphate binder to be used. MBD in CKD has high morbidity and mortality and hence it is important to detect it at an early stage. iPTH levels can be highly sensitive and it is one of the useful noninvasive biochemical parameters to detect MBD in CKD. Materials and Methods: This was an observational study carried out in a tertiary care teaching hospital. The study involved 60 patients of CKD. Detailed history, physical examination, and biochemical parameters were assessed in all of them. Results: There was a significant association between hypertension, diabetes with nephropathy, and highly significant association between serum iPTH and raised blood urea levels in MBD group, however there was no significant association between duration of CKD, hemoglobin, creatinine, uric acid, phosphorous, calcium, and alkaline phosphatase with MBD. Conclusions: MBD in CKD can be detected at early

  20. Altitude and regional gradients in chronic kidney disease prevalence in Costa Rica: Data from the Costa Rican Longevity and Healthy Aging Study.

    Science.gov (United States)

    Harhay, Meera N; Harhay, Michael O; Coto-Yglesias, Fernando;