Overall survival with beraprost in dogs with IRIS stage 2 chronic kidney disease

334 Predictive Value of Cardiac Computed Tomography and the Impact of Renal Function on All Cause Mortality in Confirm: Coronary Computed Tomography Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry

BackgroundThe aim of this double-blind, placebo-controlled study was to investigate the effect of vitamin E supplementation as an addition to a commercial renal diet on survival time of cats with different stages of chronic kidney disease (CKD). In addition, we were interested whether vitamin E supplementation affects selected oxidative stress and clinical parameters. Thirty-four cats with CKD and 38 healthy cats were included in the study. Cats with CKD were classified according to the IRIS Guidelines; seven in IRIS stage 1, 15 in IRIS stage 2, five in IRIS stage 3 and seven in IRIS stage 4. Cats with CKD were treated according to IRIS Guidelines. Cats with CKD were randomly assigned to receive vitamin E (100 IU/cat/day) or placebo (mineral oil) for 24 weeks in addition to standard therapy. Plasma malondialdehyde (MDA) and protein carbonyl (PC) concentrations, DNA damage of peripheral lymphocytes and plasma vitamin E concentrations were measured at baseline and four, eight, 16 and 24 weeks thereafter. Routine laboratory analyses and assessment of clinical signs were performed at each visit.ResultsVitamin E supplementation had no effect on the survival time and did not reduce the severity of clinical signs. Before vitamin E supplementation, no significant differences in vitamin E, MDA and PC concentrations were found between healthy and CKD cats. However, plasma MDA concentration was statistically significantly higher (p = 0.043) in cats with early CKD (IRIS stages 1 and 2) than in cats with advanced CKD (IRIS stages 3 and 4). Additionally, DNA damage was statistically significantly higher in healthy cats (p ≤ 0.001) than in CKD cats. Plasma vitamin E concentrations increased statistically significantly in the vitamin E group compared to the placebo group four (p = 0.013) and eight (p = 0.017) weeks after the start of vitamin E supplementation. During the study and after 24 weeks of vitamin E supplementation, plasma MDA and PC concentrations and DNA damage remained similar to pre-supplementation levels in both the placebo and vitamin E groups.ConclusionsVitamin E supplementation as an addition to standard therapy does not prolong survival in feline CKD.

Simple SummaryChronic kidney disease (CKD) is a major cause of morbidity and mortality in cats. Despite the increasing worldwide interest in feline CKD, the specific role of systemic inflammation in these patients remains poorly defined. The aim of the present prospective study was to assess serum amyloid A (SAA) and erythrocyte sedimentation rate (ESR) levels as markers of inflammation in cats diagnosed with CKD at IRIS stages 2–4. The results indicate a systemic inflammatory state associated with feline CKD, as both markers showed significantly higher levels in affected animals than in healthy ones. Compared to SAA, the rise in ESR appears to be more closely linked to advanced stages of the disease and could, therefore, correlate with the uremic condition.This prospective study aimed to evaluate inflammatory status in cats affected by chronic kidney disease (CKD) at IRIS stages 2–4, using serum amyloid A (SAA) and the erythrocyte sedimentation rate (ESR) as inflammatory markers. Thirty-two cats with CKD and ten clinically healthy cats (i.e., control group) were enrolled. The recording of signalment data, complete physical examinations, and abdominal ultrasonography were performed for each animal. Additionally, ESR levels, complete blood count, clinical chemistry (including SAA determination), serum protein electrophoresis, and complete urinalysis were executed. This study’s results showed that mean ESR and SAA concentrations in cats with CKD were statistically higher compared to those of the control group (p = 0.0005 and p = 0.007, respectively). The SAA concentration was significantly increased at IRIS stages 2, 3, and 4 compared to the control group. Meanwhile, the ESR was significantly higher in cats at IRIS stages 3 and 4 (p = 0.0003 and p = 0.0007, respectively), but not at IRIS stage 2, compared to the control group. These results provide evidence that feline CKD is associated with a systemic inflammatory status. Moreover, the rise in ESR appears to be more linked to advanced stages of the disease and could, therefore, correlate with the uremic condition.

Association of Baseline Chronic Kidney Disease Stage With Short- and Long-Term Outcomes After Fenestrated Endovascular Aneurysm Repair

BACKGROUND: About 5-10% of coronavirus disease 2019 (COVID-19) infected patients require critical care hospitalization and a variety of respiratory support, including invasive mechanical ventilation. Several nationwide studies from Saudi Arabia have identified common comorbidities but none were focused on mechanically ventilated patients in the Al-Ahsa region of Saudi Arabia.OBJECTIVES: Identify characteristics and risk factors for mortality in mechanically ventilated COVID-19 patients.DESIGN: Retrospective chart reviewSETTING: Two general hospitals in the Al-Ahsa region of Saudi ArabiaPATIENTS AND METHODS: We included mechanically ventilated COVID-19 patients (>18 years old) admitted between 1 May and 30 November 2020, in two major general hospitals in the Al-Ahsa region, Saudi Arabia. Descriptive statistics were used to characterize patients. A multivariable Cox proportional hazards (CPH) model was used exploratively to identify hazard ratios (HR) of predictors of mortality.MAIN OUTCOME MEASURES: Patient characteristics, mortality rate, extubation rate, the need for re-intubation and clinical complications during hospitalization.SAMPLE SIZE AND CHARACTERISTICS: 154 mechanically ventilated COVID-19 patients with median (interquartile range) age of 60 (22) years; 65.6% male.RESULTS: Common comorbidities were diabetes (72.2%), hypertension (67%), cardiovascular disease (14.9%) and chronic kidney disease (CKD) (14.3%). In the multivariable CPH model, age >60 years old (HR=1.83, 95% CI 1.2-2.7, P=.002), CKD (1.61, 95% CI 0.9-2.6, P=.062), insulin use (HR=0.65, 95% CI 0.35-.08, P<.001), and use of loop diuretics (HR=0.51, 95% CI 0.4, P=.037) were major predictors of mortality.CONCLUSION: Common diseases in mechanically ventilated COVID-19 patients from the Al-Ahsa region were diabetes, hypertension, other cardiovascular diseases, and CKD in this exploratory analysis.LIMITATIONS: Retrospective, weak CPH model performance.CONFLICTS OF INTEREST: None.

Background: The use of prescription diets for cats with chronic kidney disease (CKD) is one of the main management approach of this disease in cats, and is considered a renoprotective strategy that may promote increased survival and/or improve quality of life, according to the stage of CKD. Besides that, nutritional assessment is important to monitor the maintenance of quality of life of the patients and their response to disease, especially those with chronic conditions. The aim of this study was to follow the clinical and nutritional status of cats with chronic kidney disease (CKD) IRIS stages II, III and IV fed with a renal prescription diet, followed for 12 months. Materials, Methods &amp; Results: Patients were fed exclusively with a dry renal prescription diet and medications for the management of CKD were prescribed when needed. Exclusion criteria were cats that already received a renal prescription diet or medications for the treatment of CKD. Cats were evaluated every 2 months, considering body weight (BW), body condition score (BCS), muscle mass score (MMS), clinical and laboratory parameters. In all assessments, a complete blood count and biochemistry were performed by conventional methods with the patient fasted for 12 h. In addition, urinalysis, urinary protein:creatinine ratio (UPC) and urine culture were performed from a urine sample collected by cystocentesis. The quantitative variables were tested for their stability on consecutive assessments using the non-parametric Friedman test, and did not present significant variation during follow-up, except for systolic blood pressure (SBP). Eight cats with a diagnosis of CKD were included in the study and 6 of them remained in the same CKD stage during follow-up. On cat died due to an unrelated CKD cause. Regarding nutritional assessment, 5 of 7 cats maintained BW during the 12 months. Of these, 4 also maintained MMS and BCS. Three of 7 cats presented a decrease in MMS, 2 of which presented also a decreased BW and one maintained BW.Discussion: IRIS staging results combined with Friedman’s analysis demonstrated that the diet and the clinical management were effective in the non-progression of CKD in this study. As renal injury is not expected to be reversed in CKD, the maintenance of cats in the same IRIS stages and the minimum variation of the parameters is considered a positive result in this study. Hypertensive cats started on antihypertensive therapy during the study, achieving adequate control of SBP in most cases, what can justify the variation of this clinical parameter over the 12 months. Hyperphosphatemia was a frequent alteration, included stage II cats, and presented a positive response to nutritional and medical therapy. Despite CKD staging progression was not observed in most cats using serum creatinine as a single parameter, some cats presented BW and MMS reduction, which may have influenced this result. Weight loss and muscle wasting may have occurred by several reasons, including periods of hyporexia, presence of concomitant diseases, aging process or reduced protein content on renal prescription diets. This study enhances the importance of the association of clinical and nutritional management in the maintenance of cats with CKD. We suggest that other studies are done during longer periods of time and with a larger sample to support the results found. We also suggest new studies to evaluate the protein requirements for cats with CKD.

The aim of the present study was to investigate retrospectively the plasma concentration of alpha-tocopherol in dogs with naturally acquired chronic kidney disease (CKD), at different stages of severity. Forty dogs (CKD group) with different stages of CKD (IRIS 1 n=12, IRIS 2 n=8, IRIS 3 n=11, IRIS 4 n=9) and 20 clinically healthy dogs were considered. Plasma alpha-tocopherol was assessed in both groups through high performance liquid chromatography (HPLC). Dogs of CKD group showed significantly lower (p=0.0002) levels of plasma alpha-tocopherol compared with clinically healthy dogs. A significant difference (p<0.04) in the number of patients with plasma alpha-tocopherol > or ≤ 21.5 ppm was found in CKD patients at different stages of severity. No significant correlation between plasma levels of alpha-tocopherol and plasma creatinine was found. In the present study, dogs affected by spontaneous CKD showed significantly lower plasma concentrations of alpha-tocopherol compared with clinically healthy dogs. Plasma alpha-tocopherol deficiency seems to be more severe in IRIS stage 1 and 4, compared with IRIS stage 2 and 3. The finding of marked alpha-tocopherol deficiency in patients in IRIS stage 1 should encourage further studies on the early use of prescription renal diet and antioxidant in this group of patients.

Phosphodiesterase-3 (PDE3) inhibitors are widely used among patients with congestive heart failure (CHF). However, no studies have compared the cardiovascular outcomes between different PDE3 inhibitors in CHF management. In this report, we retrospectively compared the clinical benefits of two PDE3 inhibitors, milrinone and olprinone, to determine which better controls the progression of CHF. A total of 288 hospitalized patients who received PDE3 inhibitors [(milrinone; n = 77 and olprinone; n = 211, respectively)] for CHF were retrospectively enrolled. The primary endpoint was defined as having a major adverse cardiovascular and cerebrovascular event (MACCE) or cardiac death by day 60. Kaplan-Meier curves and multivariate Cox proportional models were used to compare the outcomes for patients treated with milrinone and olprinone. We found no significant differences in the baseline characteristics between the two groups. In patients treated with milrinone, a greater incidence of a MACCE or cardiac death was observed (log rank; P = 0.005 and P = 0.01, respectively). Milrinone-treated patients with ischemic heart disease and chronic kidney disease (CKD) at stage ≥ 4 presented with greater incidence of MACCE (log rank; P < 0.001 and P = 0.006, respectively). Similarly, these patients were significantly more likely to succumb to cardiac death (log rank; P < 0.001 and P = 0.02). Multivariate Cox proportional hazard models demonstrated that milrinone treatment was an independent predictor of MACCE [hazard ratio (HR) 3.17; 95% CI 1.64-6.10] and cardiac death (HR 2.64; 95% CI 1.42-4.91). Oral administration of a β-blocker at discharge occurred more often in the olprinone-treated patients than in the milrinone-treated patients (63% vs. 29%, P = 0.004). We compared the outcomes of milrinone and olprinone treatment in patients with CHF. Those treated with milrinone were more likely to succumb to a MACCE or cardiac death within 60days of treatment, which was especially true for patients with ischemic heart disease or CKD.

Is preoperative anemia a risk factor for upper tract urothelial carcinoma following radical nephroureterectomy?

Borderline proteinuria is associated with decreased survival in cats with azotemic chronic kidney disease (CKD). Determine the clinical importance of borderline proteinuria in nonazotemic cats. A total of 201 healthy client-owned cats ≥7 years of age; 150 nonproteinuric (urinary protein : creatinine ratio [UPC] <0.2) and 51 borderline proteinuric (UPC 0.2-0.4). Prospective study. Cats were thoroughly screened and subsequently examined every 6 months for 2 years. Kaplan-Meier curves were compared between nonproteinuric and borderline proteinuric cats. Univariable and multivariable Cox models were fit to determine the relationship between development of renal disease and potential risk factors such as age, sex, breed, weight, dental disease, blood pressure, serum creatinine concentration (sCrea), serum symmetric dimethylarginine concentration (sSDMA), blood urea nitrogen concentration, urine specific gravity (USG), and UPC. Significantly more cats with borderline proteinuria at inclusion developed renal disease (International Renal Interest Society [IRIS] ≥ stage 2 CKD or renal proteinuria; log-rank P = .004) or died (log-rank P = .02) within 2 years, compared with nonproteinuric cats. In the multivariate analysis, IRIS stage 1 CKD (persistent USG <1.035 or sSDMA >14 μg/dL; hazard ratio [HR], 4.2; 95% confidence interval [CI], 2.0-8.8; P < .001), sCrea ≥1.6 mg/dL (≥140 μmol/L; HR, 2.6; 95% CI, 1.1-6.4; P = .04), borderline proteinuria (HR, 2.5; 95% CI, 1.2-5.2; P = .01), and age at inclusion (HR, 1.3; 95% CI, 1.2-1.5; P < .001) were significantly associated with diagnosis of renal disease 6 months later. Borderline proteinuria should receive more attention in healthy mature adult and senior cats because it is associated with renal disease and death.

Chronic kidney disease (CKD) is characterized by chronic inflammation, which mediates the progressive replacement of functional nephrons by fibrotic tissue. Hemogram-derived inflammatory markers are known to serve as markers of pathological conditions; however, their diagnostic value in feline CKD is still unknown. The aim of this retrospective study was to investigate selected hemogram-derived inflammatory markers (neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR) and the systemic immune-inflammatory index (SII)) in cats at different clinical stages of CKD. Eighty-eight client-owned cats with CKD and thirty-two healthy control cats were included. Cats with CKD were divided into two groups: early CKD (IRIS stage 1 and 2; 62 cats) and progressed CKD (IRIS stage 3 and 4; 26 cats). The values of inflammatory markers were compared between the two CKD groups and the control group. All investigated hemogram-derived inflammatory markers were significantly (p < 0.05) greater in cats with advanced CKD than in those in the other two groups. Additionally, we demonstrated a statistically significant weak to moderate correlation between serum urea, creatinine, selected hematologic and urinary parameters, and the investigated inflammatory markers in cats with CKD. Chronic inflammation can be easily and inexpensively assessed with hemogram-derived markers.

Aggressive blood pressure reduction and renin–angiotensin system blockade in chronic kidney disease: time for re-evaluation?

BackgroundEvidence regarding the relationship between thyroid hormone levels within the normal range and the incidence of chronic kidney disease (CKD) in adults is scarce. This study aimed to identify the association between thyrotropin (TSH) and free thyroxine (FT4) levels with the incidence of CKD in a large cohort study over long-term follow-up.MethodsThis prospective cohort study, with an 18-year follow-up, included 4118 adults without CKD from the Tehran thyroid Study (TTS). Participants were categorized by tertiles of normal TSH levels (low-normal, middle-normal, and high-normal) and abnormal TSH. The study outcome was incident CKD, defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) for CKD incidence based on thyroid hormone levels.ResultsThe HR for CKD development was 1.08 (95%CI: 1.01–1.15) per 1 SD increase in the TSH levels. Compared with participants with low-normal TSH levels, those with high-normal (HR:1.37; 95%CI: 1.03–1.84) and abnormal TSH (HR:1.24; 95%CI: 1.05–1.46) had a significantly higher risk of developing CKD. In subgroup analyses, the association between TSH level and CKD was significant in participants younger than 60 years, females, non-obese, non-smokers, and those without diabetes and hypertension. No association was observed between FT4 levels and incident CKD (HR: 0.92; 95%CI: 0.79–1.09). However, a significant association was observed between FT4 levels within the normal range and CKD development in those younger than 60 years old (HR: 0.77; 95% CI: 0.61–0.98).ConclusionIncreased TSH levels, even within the normal range, linearly increased the risk of CKD even after adjustment for important risk factors. As a result, TSH may potentially be an independent risk factor for incident CKD.

Women exhibit a lower cardiovascular risk and longer life expectancy compared with men in the general population. However, this advantage is diminished in dialysis and transplant patients, suggesting greater excess risk, i.e. risk above the general population, in women with kidney failure. Yet, data on excess risk in chronic kidney disease (CKD) populations, using those without CKD as the reference, are lacking. In this retrospective cohort study, we analyzed de-identified, patient-level data from electronic medical records within the TriNetX database. Adults aged 18-90years with an eGFR ≥15mL/min/1.73 m2 without maintenance dialysis or kidney transplantation were included. Primary outcomes were all-cause mortality and cardiovascular composite outcome. Analyses were adjusted for age, sociodemographic factors, cardiovascular risk factors, laboratory measurements, medications and history of CVD, using multivariable Cox proportional hazards models. Of 328 431 eligible individuals, 43 830 were women with CKD, 45 173 men with CKD, 127 383 women without CKD and 112 045 men without CKD. In individuals without CKD, women displayed a reduced risk of all-cause mortality [hazard ratio (HR) 0.53; 95% confidence interval (CI) 0.49-0.58] and cardiovascular events (HR 0.70; 95% CI 0.68-0.71) compared with men. However, this risk reduction in women compared with men was significantly attenuated in individuals with CKD both for all-cause mortality (HR 0.73; 95% CI 0.69-0.77) and for cardiovascular events (HR 0.80; 95% 0.78-0.82). Consequently, CKD conferred significantly greater excess risk of mortality and cardiovascular events in women compared with men, consistent across different levels of kidney function, age and systolic blood pressure. The cardiovascular and survival advantage observed in women compared with men in the general population is significantly reduced in individuals with CKD, confining an increased excess risk in women with CKD.

ABSTRACTBackgroundHeart failure (HF) and chronic kidney disease (CKD) are common comorbidities among patients undergoing coronary angiography. Both conditions are associated with increased risk of adverse cardiovascular outcomes and mortality. However, the joint prognostic impact of HF and CKD in this patient population remains unclear.AimsWe aimed to evaluate the separate and combined associations of HF and CKD with all‐cause mortality in patients undergoing coronary angiography.MethodsWe analyzed data from the KARDIO registry, an ongoing real‐life clinical database of patients undergoing coronary angiography. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all‐cause mortality.ResultsOver a median follow‐up of 5.5 years, 11,896 all‐cause deaths were recorded. In multivariable‐adjusted analyses, a history of HF was associated with a higher risk of mortality compared to no HF (HR: 2.19; 95% CI: 2.04−2.34), as was a history of CKD compared to no CKD (HR: 2.06; 95% CI: 1.94−2.19). The associations persisted on mutual adjustment for each exposure. When assessed jointly, and using patients with neither condition (No HF‐No CKD) as the reference group, the adjusted HRs (95% CI) for mortality were 2.18 (2.01−2.36) for HF only, 2.04 (1.90−2.20) for CKD only, and 3.09 (2.77−3.46) for patients with both HF and CKD. Interaction analyses revealed that the associations of HF and CKD with mortality were significantly modified by each other, with the highest risk observed among individuals with both conditions. Subgroup analyses showed consistent directions of association across most categories, although the prognostic impact of HF and CKD varied by age, sex, and cardiovascular disease history.ConclusionsIn patients undergoing coronary angiography, HF and CKD were each independently associated with a twofold increased risk of all‐cause mortality. Interaction effects suggest that the co‐occurrence of HF and CKD synergistically amplifies this risk. These findings highlight the importance of identifying and managing cardiorenal comorbidity to improve outcomes in this high‐risk population.