Chronic Kidney Disease With Related Oral Health Problems and Alterations in the Tongue Microbiome Illustrated by a 15-Year-Old Girl: A Case Report.

Severe aortic stenosis and chronic kidney disease: Outcomes and impact of aortic valve replacement

BackgroundThe prognostic significance of chronic kidney disease (CKD) in severe aortic stenosis is poorly understood and no studies have yet evaluated the effect of aortic‐valve replacement (AVR) versus conservative management on long‐term mortality by stage of CKD.Methods and ResultsWe included 4119 patients with severe aortic stenosis. The population was divided into 4 groups according to the baseline estimated glomerular filtration rate: no CKD, mild CKD, moderate CKD, and severe CKD. The 5‐year survival rate was 71±1% for patients without CKD, 62±2% for those with mild CKD, 54±3% for those with moderate CKD, and 34±4% for those with severe CKD (P<0.001). By multivariable analysis, patients with moderate or severe CKD had a significantly higher risk of all‐cause (hazard ratio [HR] [95% CI]=1.36 [1.08–1.71]; P=0.009 and HR [95% CI]=2.16 [1.67–2.79]; P<0.001, respectively) and cardiovascular mortality (HR [95% CI]=1.39 [1.03–1.88]; P=0.031 and HR [95% CI]=1.69 [1.18–2.41]; P=0.004, respectively) than patients without CKD. Despite more symptoms, AVR was less frequent in moderate (P=0.002) and severe CKD (P<0.001). AVR was associated with a marked reduction in all‐cause and cardiovascular mortality versus conservative management for each CKD group (all P<0.001). The joint‐test showed no interaction between AVR and CKD stages (P=0.676) indicating a nondifferentialeffect of AVR across stages of CKD. After propensity matching, AVR was still associated with substantially better survival for each CKD stage relative to conservative management (all P<0.0017).ConclusionsIn severe aortic stenosis, moderate and severe CKD are associated with increased mortality and decreased referral to AVR. AVR markedly reduces all‐cause and cardiovascular mortality, regardless of the CKD stage. Therefore, CKD should not discourage physicians from considering AVR.

Funding Acknowledgements Type of funding sources: None. Background Patients with chronic kidney disease (CKD) are at high risk for cardiovascular disease compared to the general population. Classic echocardiographic indices of left ventricular (LV) function may not be sensitive enough in detecting early myocardial deterioration in CKD patients while LV speckle tracking (2DSTE) analysis has shown promising results. Dipyridamole stress echocardiography (DIPSE), mostly used to measure coronary flow reserve (CFR), assesses coronary macrovascular and/or microvascular dysfunction in a non-invasive way. Purpose To investigate differences in classic, 2DSTE-related indices, CFR and other DIPSE-induced changes in various echocardiographic parameters between 1) healthy controls and age-matched (younger) CKD patients, 2) younger versus older CKD patients with similar clinical characteristics. Methods We prospectively evaluated 30 healthy controls and 60 consecutive CKD patients 40-75 years old who were followed-up at the CKD outpatient clinic of a University Hospital in Western Greece. A standard echocardiographic analysis including 2DSTE analysis was performed in all subjects before and after dipyridamole infusion. CFR in left anterior descending artery was also assessed. Results The median age of the CKD patients was 63 years and most of them were males (70%). Younger patients with CKD (i.e. &amp;lt;60 years old) had higher E/e" ratio (7.80 ± 2.71 vs 6.06 ± 1.37, p = 0.019), LVMI (114.7 ± 41.1 vs 89.6 ± 21.2, p = 0.017) and relative wall thickness (0.47 ± 0.08 vs 0.40 ± 0.06, p = 0.031) and lower E" (10.6 ± 2.6 vs 2.3 ± 2.9 cm/s, p = 0.045) compared to age and gender-matched healthy controls. Older CKD patients had lower E/A (0.80 ± 0.19 vs 1.03 ± 0.33, p = 0.007) and E" (8.5 ± 1.8 vs 10.6 ± 2.6 cm/s, p = 0.003) compared to younger CKD patients. CFR was higher in healthy controls compared to both younger (3.93 ± 1.25 versus 3.1 ± 0.75, p = 0.009) and older CKD patients (3.93 ± 1.25 versus 2.89 ± 0.88, p &amp;lt; 0.001); no significant difference in CFR was observed between younger and older CKD patients. Dipyridamole-induced changes in other studied echocardiographic indices did not differ significantly among groups. Conclusions In the current study, impaired coronary microcirculation, LV diastolic function and increased LV mass with concentric remodeling were shown to be the principal findings early in the process of CKD. These results may have pathophysiological implications for cardiorenal syndrome type 4 and targeted cardiac assessment in CKD patients. Future studies are needed to assess whether any therapeutic efforts aiming to delay or reverse these changes may have an impact on the cardiovascular prognosis in CKD patients.

The mean dietary protein intake at different stages of chronic kidney disease is higher than current guidelines

Nutrition interventions to address cardiovascular outcomes in chronic kidney disease

A Decade After the KDOQI CKD Guidelines: Impact on the United States and Global Public Policy

BackgroundAcute kidney injury (AKI) requiring renal replacement therapy (RRT) is a serious complication in the ICU that results in increased mortality and risk of chronic kidney disease (CKD). Some studies suggest RRT modality may have an impact on long-term renal recovery after AKI. However, other predictive factors of severe long-term CKD in ICU patients with AKI requiring RRT are unknown.MethodsWe performed an ancillary study of the multicenter ELVIS trial in the population with AKI requiring RRT. Patients alive 3 months after RRT initiation were eligible. Serum creatinine levels available at 3, 6 and 12 months and 3 and 5 years were recorded. CKD stage was determined according to the glomerular filtration rate as estimated by the CKD-EPI formula. At each timepoint, two groups of patients were compared, a no/mild CKD group with normal or mildly to moderately decreased renal function (stages 1, 2 and 3 of the international classification) and a severe CKD group (stages 4 and 5). Our objective was to identify predictive factors of severe long-term CKD.ResultsOf the 287 eligible patients, 183 had follow-up at 3 months, 136 (74.3%) from the no/mild CKD group and 47 (25.7%) from the severe CKD group, and 122 patients at 5 years comprising 96 (78.7%) from the no/mild CKD group and 26 (21.3%) from the severe CKD group. Multivariate analysis showed that a long RRT period was associated with severe CKD up to 12 months (ORM12 = 1.03 95% CI [1.02–1.05] per day) and that a high SOFA score at the initiation of RRT was not associated with severe CKD up to 5 years (ORM60 = 0.85 95% CI [0.77–0.93] per point).ConclusionSevere long-term CKD was found in 21% of ICU survivors who underwent RRT for AKI. The duration of the RRT in AKI patients was identified as a new predictive factor for severe long-term CKD. This finding should be taken into consideration in future studies on the prognosis of ICU patients with AKI requiring RRT.Trial registration ELVIS trial was registered with ClinicalTrials.gov, number: NCT00875069 (June 16, 2014), and this ancillary study was registered with ClinicalTrials.gov, number: NCT03302624 (October 6, 2017).

Background: The chronic kidney disease (CKD) epidemic continues to grow, and cardiovascular disease (CVD) is the leading cause of death. To modify CVD risk, CKD patients are asked to engage in health promoting behaviors. However, older patients with CKD likely face challenges to engage in healthy behaviors due to social and health factors. This study examined the relationship of social and health factors to health promoting behaviors among younger and older CKD patients and the association of these behaviors with CVD events, death, and CKD progression. Methods: Data from the Chronic Renal Insufficiency Cohort (CRIC) Study were analyzed using latent class analysis (LCA) to identify health promoting behavior clusters, stratified by &lt;65 and ≥65 years of age. LCA was based on: BMI of &gt;20 and ≤25kg/m 2 vs. other, healthy diet vs. not, physical activity ≥150min/week vs. not, blood pressure ≤140/90mmHg vs. greater, never/past smoker vs. current, and &lt;7.0% hemoglobin A1c vs. greater. Social factors (self-efficacy, social support, education, income, insurance) and health factors (depressive symptoms, cognition, co-morbidities) were measured by validated surveys and self-report. Logistic regression assessed the association of social and health factors to the behavior clusters. Cox proportional hazards models estimated risk of clusters to CVD events (myocardial infarction/revascularization, peripheral arterial disease, or stroke), CKD progression (incident end-stage renal disease or 50% decline in eGFR), and death from any cause. Results: All social and health factors significantly differed between age groups. Three clusters with varying levels of engagement in health promoting behaviors were identified separately among &lt;65 and ≥65 years of age. Among &lt;65 years, the cluster with the highest level of engagement in healthy behaviors was associated with more self-efficacy and lower depressive symptoms. In this age group, in multivariable adjusted models, the clusters with less healthy behavior engagement had a statistically significant increased risk of CVD events (32-81%), death (29-78%), and CKD progression (32-38%). Among ≥65 years, the cluster with the highest level of engagement in healthy behaviors was associated with higher self-efficacy, social support, cognition, and less depressive symptoms. In this age group, in multivariable adjusted models, the clusters with less healthy behaviors had a statistically significant 49% increased risk of death. Conclusion: This study demonstrated three clusters of health promoting behaviors that distinguish risk for CVD and other outcomes among older and younger CKD patients. These clusters could identify high-risk groups and be targeted for aggressive management. Clusters with less health promoting behaviors were associated with self-efficacy and depressive symptoms, which could serve as potential targets for intervention.

ABSTRACTBackgroundSmall, dense low-density lipoprotein (sd-LDL) and glycated LDL (g-LDL) have been associated with cardiovascular disease (CVD) in chronic kidney disease (CKD) in patients >60 years of age. Since young adult and paediatric patients have shorter exposure to Framingham-type risk factors, our study aims to determine whether younger CKD patients exhibit the same sd-LDL and g-LDL pattern.MethodsAfter ethics board approval, this cross-sectional study was conducted at two universities with 44 patients (mean ± standard deviation age 12.6 ± 4.9, range 2–24 years) with CKD stage of 1–5. Laboratory parameters studied were Cystatin C (CysC), CysC estimated glomerular filtration rate (eGFR) (calculated from the Filler formula), sd-LDL, g-LDL and albumin. Lipid samples were measured for sd-LDL and g-LDL using ELISA. Non-linear correlation analysis was performed to determine the relationship between g-LDL, sd-LDL and eGFR. Clinical Trials Registration is at clinicaltrials.gov, NCT02126293, https://clinicaltrials.gov/ct2/show/NCT02126293.ResultsTriglycerides, but not total cholesterol and calculated LDL, were associated with CKD stages (ANOVA P = 0.0091). As in adults, sd-LDL was significantly associated with CKD stages (ANOVA P = 0.0133), CysC eGFR (r = −0.6495, P < 0.00001), and body mass index (r = −0.3895, P = 0.0189), but not with age. By contrast, there was no significant correlation between g-LDL and CKD stages or CysC eGFR (P = 0.9678).ConclusionsOur study demonstrates that only triglycerides and sd-LDL were associated with CKD stages in this young cohort without confounding Framingham-type CVD risk factors. While larger studies are needed, this study suggests that lowering sd-LDL levels may be a potential target to ameliorate the long-term CVD risks in paediatric CKD patients.

PurposeRed cell distribution width (RDW) has been evidenced to be related to various diabetes-associated macrovascular and microvascular complications. However, the studies on the association between RDW and diabetic chronic kidney disease (CKD) are still scarce. The aim of the study is to explore whether there is any association between RDW and the severity of diabetic CKD.Patients and MethodsThe study recruited 396 patients diagnosed with diabetic CKD at People’s Hospital of Gaochun from January 2006 to April 2021. Baseline characteristics were gathered and laboratory tests were performed to measure clinical indexes. Patients were also categorized into three groups based on their CKD stages. Correlation analysis and multivariate ordinal logistic regression were performed to investigate the association between RDW and the severity of diabetic CKD. The risk size was described as odds ratio (OR) and 95% confidence interval (CI).ResultsWe found a significant association between RDW and the severity of CKD, with a correlation coefficient of 0.32 (P < 0.01). We used three models for multivariate ordinal logistic regression to investigate the relationship between RDW and the severity of CKD. Results showed that RDW is an independent and significant risk factor of diabetic CKD after adjustment for demographic data, physiological indexes, and drug history [Model 3 OR (95% CI) = 1.225 (1.023–1.467)]. In subgroup analysis, RDW remained a significant risk factor in all three models for patients who had diabetes of 5–10 years [Model 3 OR (95% CI) = 1.480 (1.067–2.052)] and had a HbA1c level >7% [(Model 3 OR (95% CI) = 1.478 (1.184–1.845)].ConclusionRDW is significantly associated with the disease stages of diabetic CKD, and the risk is higher for people with 5–10 years of diabetes and for those who do not control the HbA1c level well. This study has implications for the diagnosis, monitoring, and timely treatment of the diabetic CKD.

PD44-03 SEVERE CHRONIC KIDNEY DISEASE IS ASSOCIATED WITH SEVERE NOCTURIA IN MEN

Muscle Oxygenation and Microvascular Reactivity Across Different Stages of CKD: A Near-Infrared Spectroscopy Study

Strengthening the Link Between Cardiovascular Disease and Sarcopenia in CKD

Chronic Kidney Disease Following Liver Transplantation: A South Australian Experience

Implementing KDOQI CKD Definition and Staging Guidelines in Southern California Kaiser Permanente