Elevated Serum Levels of Galectin-3 and Kidney Injury Molecule-1 as Potential Biomarkers for Early Detection and Staging of Chronic Kidney Disease in Iraqi Population.

Urinary Tubular Biomarkers of Kidney Damage: Potential Value in Clinical Practice

Non-traditional risk factors predict coronary calcification in chronic kidney disease in a population-based cohort

Clostridioides difficile Infection in Chronic Kidney Disease/End-Stage Renal Disease.

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

Impact of preoperative chronic kidney disease on short- and long-term outcomes after transcatheter aortic valve implantation: A Pooled-RotterdAm-Milano-Toulouse In Collaboration Plus (PRAGMATIC-Plus) initiative substudy

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.

Neutrophil Gelatinase-Associated Lipocalin (NGAL) and Kidney Injury Molecule 1 (KIM-1) as Predictors of Incident CKD Stage 3: The Atherosclerosis Risk in Communities (ARIC) Study

Anemia is a common complication of chronic kidney disease (CKD) and is associated with adverse patient outcomes. However, data on the prevalence of anemia in CKD patients is sparse, particularly in resource-limited settings. Therefore, this study aimed to assess the prevalence of anemia and its predictors among patients with CKD admitted to the Jimma medical center, southwest Ethiopia. A hospital-based prospective cross-sectional study was conducted from September 1 to November 30, 2020. All adult patients with CKD aged ≥18 years who fulfilled the inclusion criteria were consecutively recruited into the study. Data were entered into the Epi data manager version 4.4.1 and then exported to SPSS version 22 (IBM Corp., Armonk, NY) for analysis. The predictors of anemia were determined using multivariable logistic regression analysis. Statistical significance was set at P < .05. A total of 150 patients were included in this study. Of these, 64.67% were male, 56.67% had stage 5 CKD, 78% had a CKD duration of less than 1 year, and 74% had proteinuria. Hypertension (40.7%) and diabetes (14.7%) were the common causes of CKD. The prevalence of anemia was 85.33%. Of the patients, 28.67%, 40.67%, and 16% had mild, moderate, and severe anemia, respectively. On multivariate logistic regression, stage 4 CKD (adjusted odds ratio [AOR] 3.2, confidence interval [CI]: 1.78-12.91, P = .025), stage 5 CKD (AOR 4.03, CI: 1.17-13.73, P = .016), and CKD duration of less than 1 year (AOR 3, CI: 1.19-9.11, P = .007) were significantly associated with anemia. The prevalence of anemia among stage 3 to 5 CKD patients was very high. Anemia was significantly associated with the severity and duration of CKD. Therefore, serial follow-up of patients with a long duration and advanced stages of CKD may help prevent anemia and its adverse consequences.

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

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

Approaching the End of the Homocysteine Hype?

Renal tubular lesions play an important role in the development and progression of chronic kidney disease (CKD). There has been only one cohort retrospective study of the prevalence of CКD in children with juvenile idiopathic arthritis (JIA). Therefore, early diagnosis of kidney damage using renal biomarkers is important. Purpose - to determine the frequency and risk factors for the development of structural tubular lesions by studying the level of kidney injury molecule-1 (KIM-1) in the urine of children with JIA, depending on the characteristics of the clinical course of the disease, use of nonsteroidal anti-inflammatory drugs (NSAIDs). Materials and methods. 80 children from JIA were examined. To measure the marker KIM-1 in urine samples, an enzyme-linked immunosorbent assay was used. Results. The indicator of the urinary marker KIM-1 in the examined children was 0.997±0.1662 (0.98; 0.90-1.12) ng/ml. High activity of JIA affects the level of urinary KIM-1 - among children with high activity of the disease, 20% had a high level of KIM-1. Involvement of ≥6 joints almost 3-fold increased the in CIdence of elevated urinary KIM-1 levels (OR=5.00; 95% CI: 1.65-15.15; p&lt;0.006). Risk factors for structural tubular kidney lesions in children with JIA were identified: high JIA activity (OR=7.25; 95% CI: 1.22-43.22; p&lt;0.04), arthritis ≥6 joints (OR=5.00; 95% CI: 1.65-15.15; p&lt;0.006), arthritis of the small joints of the hands (OR=4.85; 95% CI: 1.39-16.87; p&lt;0.02), arthritis of the wrist joints (OR=3.78; 95% CI: 1.21-11.83; p&lt;0.03), arthritis of the hip joints (OR=10.41; 95% CI: 1.02-106.7; p&lt;0.05). The level of urinary biomarker KIM-1 was negatively affected by long-term use of NSAIDs (ρ=0.60, p&lt;0.004). An increased level of KIM-1 in urine is associated with hypertension (OR=12.43; 95% CI: 2.26-68.27; p&lt;0.003) and reduced Estimated Glomerular Filtration Rate (eGFR) according to the Hoek formula (OR=15.58; 95% CI: 4.02-60.36; p&lt;0.001), which suggests the presence of CKD in children with JIA as a result of tubular lesions. Conclusions. Structural damage of the renal tubules, which was established by studying the biomarker KIM-1 in the urine and the relationship with reduced eGFR according to the Hoek formula, suggests the presence of CKD in children with JIA as a result of tubular lesions. Urine KIM-1 testing should be included in the JIA screening plan for early diagnosis of renal disease. The study was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution specified in the work. Informed consent was obtained from the parents of the children for the research. The authors declare no conflicts of interest. Key words: juvenile idiopathic arthritis, tubular biomarker KIM-1, children.

Background: Polyvascular disease (PolyVD) and chronic kidney disease (CKD) have been known to be independent risk factors for cardiovascular events. We evaluated the association between PolyVD and CKD through long-term cardiovascular outcomes after sirolimus-eluting stent (SES) implantation in patients with each stage of CKD. Methods: A total of 1797 patients with CKD except hemodialysis patients who had undergone SES implantation from November 2002 to January 2007 and 6-year follow up were enrolled in this study. Estimated glomerular filtration rate (eGFR) was classified into three stages: mild (eGFR 60-89), moderate (eGFR 30-59), and severe (eGFR < 30) CKD. The 1797 patients were divided into two groups: those with PolyVD (276) and those without PolyVD (1521). The number of patients with each stage (with PolyVD vs. without PolyVD) was as follows: mild 94 (34%) vs. 780 (51%), moderate 155 (56%) vs. 635 (42%), and severe 27 (10%) vs. 106 (7%). Results: The patients with PolyVD were older and had more cardiovascular risk factors. In the patients with moderate and severe CKD, the patients with PolyVD had a higher incidence of major adverse cardiovascular events (MACE: cardiovascular death, myocardial infarction, and target lesion revascularization) (hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.06-1.91, p=0.019) than those without PolyVD. Kaplan–Meier estimates for MACE stratified according to the CKD severity are shown in the figure. In the only patients with PolyVD, those with both moderate (HR 1.92, 95% CI 1.08-2.98) and severe CKD (HR 4.13, 95% CI 1.93-8.85) had higher incidence rates of MACE, as compared with those with mild CKD. Kaplan-Meier estimates of MACE Conclusion: The impact of CKD on the long-term cardiovascular outcomes after SES implantation was different between patients with and without PolyVD.

Kidney Injury Molecule-1 is a protein that increases in urine following tubular damage. Kidney Injury Molecule-1 levels were correlated with the level of chronic kidney disease secondary to diabetic nephropathy in patients with type 2 Diabetes Mellitus. Clinical and laboratory findings of 142 patients with diabetic nephropathy and 34 control subjects were analysed. Creatinine and HbA1c levels in blood samples and albumin, creatinine and Kidney Injury Molecule-1 levels in urine samples were assessed. Urinary Kidney Injury Molecule-1 levels were significantly increased both in subgroups of diabetic nephropathy (normo-/micro-/macro-albuminuria) and in chronic kidney disease (stage 2-4) compared with controls. Urinary Kidney Injury Molecule-1 levels in stage 2 chronic kidney disease patients were significantly higher than those of the patients with stage 3-4 chronic kidney disease. Urinary Kidney Injury Molecule-1 levels, along with urinary albumin excretion and the duration of diabetes, were found to be independent risk factors associated with low glomerular filtration rates. Urinary Kidney Injury Molecule-1 levels seems to predict renal injury secondary to diabetic nephropathy in early period independent of albuminuria, because urinary Kidney Injury Molecule-1 was elevated despite normal urinary albumin excretion in the normoalbuminuric subgroup. Urinary Kidney Injury Molecule-1 levels, which are elevated in primarily in stage 2, shows a gradual decrease in patients with chronic kidney disease stages 3 and 4; thus, urinary Kidney Injury Molecule-1 levels may be useful in tracking the progression of kidney disease.

Long-term growth in children with posterior urethral valves