Understanding and Treatment Strategies of Hypertension and Hyperkalemia in Chronic Kidney Disease.

Nutrition interventions to address cardiovascular outcomes in chronic kidney disease

Relationship Between Serum Carnitine, Acylcarnitines, and Renal Function in Patients With Chronic Renal Disease

Background and Aims Chronic kidney disease (CKD) affects 8%–10% of the French population, posing considerable problems to healthcare systems due to its high morbidity and resource demands. However, less is known about healthcare utilization patterns among CKD patients compared to non-CKD patients. This study aims to compare healthcare utilization between these groups to identify differences in healthcare needs. Method This retrospective observational study included data from all hospitalized patients in several teaching hospitals of the west region of France between January 1, 2015, and December 31, 2018, our study period. Patients’ clinical data were extracted from hospitals’ clinical data warehouses (CDWs) and linked to the National Health Data System (SNDS). The SNDS is a comprehensive database maintained by the French Social Security system that contains all reimbursed outpatient care and inpatient care in France. We identified CKD patients using CDWs’ data. We defined CKD as having an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m² measured at least 90 days apart or a documented CKD diagnosis. Patients were stratified by CKD stages (3, 4, or 5). Non-CKD patients were identified as having eGFR values consistently ≥90 mL/min/1.73 m² within study period. Using the SNDS data, healthcare utilization in 2015 was assessed in terms of inpatient care (nephrology-related and unrelated hospitalizations) and outpatient care (consultations with general practitioners (GP), nephrologists, cardiologists, and endocrinologists). Care utilization rates were calculated by age groups and CKD stages. Results We identified 292,559 non-CKD patients (mean age 53.3 years, 54.7% female) and 26,125 CKD patients (mean age 75.2 years; 36% female). Among those, 53.5% were stage 3, 27% stage 4 and 19.5% stage 5. Hospitalization duration increased with both age and CKD severity, with the longest stays observed in advanced CKD stages (mean duration 7–10 days) among older patients (≥75 years). Nephrology-related hospitalization rates decreased with age beyond 50, while unrelated-nephrology hospitalization rate increased with both age and CKD stages. Patients aged >85 years with stage 5 CKD showed the highest rates of unrelated-nephrology hospitalizations (2000 per 1000 person-years) compared to stage 3 CKD (800) and non-CKD patients (790). Minimal differences in hospitalization rates were observed between non-CKD and stage 3 CKD patients as age increased. GP consultation rates increased with age and CKD severity, peaking in stage 5 patients aged >85 years (over 9000 per 1000 person-years). Nephrologist consultations were mainly observed in stage 5 patients, with higher rates in younger age groups (over 3000 per 1000 person-years for age ≤50). Consultation rates with cardiologists increased with age, peaking in stage 4 CKD among patients aged 75–85 years, at approximately 600 per 1000 person-years. Patients over 85 years old had the lowest consultation rates with endocrinologists, regardless of CKD status. Conclusion This is the first study in France to compare healthcare utilization between CKD and non-CKD patients. As age increased, CKD patients' rates of nephrologist consultations and related-nephrology hospitalizations decreased, suggesting a shift toward hospitalizations and consultations for comorbidities associated with CKD. Additionally, the results showed that hospitalization rates were similar at older ages, while GP consultation rates were comparable at younger ages between CKD and non-CKD patients. Further analysis will explore gender differences and adherence to French national care guidelines to identify areas of improvement in CKD care.

KDOQI US Commentary on the 2012 KDIGO Clinical Practice Guideline for Anemia in CKD

Fruit and vegetable intake is commonly discouraged in children with chronic kidney disease (CKD) to avoid hyperkalemia. However, direct evidence in support of this widespread practice is lacking. Furthermore, the resultant restricted fiber exposure may deprive CKD patients from potential health benefits associated with the latter. Therefore, we investigated associations between dietary potassium intake, fiber intake, and serum potassium levels in pediatric CKD. This study is a longitudinal analysis of a 2-year, prospective, multi-institutional study, following children with CKD at 3-month intervals. At each visit, dietary potassium and fiber intake were assessed, using 24-h recalls and 3-day food records. On the same occasion, serum potassium concentrations were determined. Associations between dietary potassium intake, dietary fiber intake, and serum potassium concentrations were determined using linear mixed models. Fifty-two CKD patients (7 transplant recipients, none on dialysis) aged 9 [4;14] years with an estimated glomerular filtration rate (eGFR) of 49 [25;68] mL/min/1.73 m2 were included. For every g/day decrease in dietary potassium intake, the estimated mean daily fiber intake was 5.1g lower (95% confidence interval (CI), 4.3-5.9g/day; p < 0.001). Neither dietary potassium intake (p = 0.40) nor dietary fiber intake (p = 0.43) was associated with circulating potassium in a model adjusted for time point, eGFR, treatment with a renin-angiotensin-aldosterone system blocker, serum bicarbonate concentration, and body surface area. Dietary potassium and fiber intake are closely related but were not associated with circulating potassium levels in pediatric CKD. A higher-resolution version of the graphical abstract is available as Supplementary information.

Chronic kidney disease (CKD) is a risk factor for embolic stroke, and many nonvalvular atrial fibrillation (NVAF) patients have concomitant CKD. Anticoagulation therapy can be challenging in CKD due to increased bleeding risk, and left atrial appendage occlusion (LAAO) may be a promising alternative. This systematic review aimed to consolidate current evidence on the safety and effectiveness of transcatheter LAAO in patients with CKD and end-stage renal disease (ESRD). Medline, Cochrane, and Embase databases were searched from inception to September 2, 2022. We conducted a meta-analysis if an outcome was evaluated in at least two similar studies. We included 15 studies with 77,780 total patients. Of the 15 studies, 11 had a cohort design (five prospective and six retrospective), and four were case series. Patients with CKD were older and had a higher prevalence of comorbidities than non-CKD patients. The two groups did not differ in procedural failure rate, vascular complications, or pericardial tamponade. CKD patients exhibited higher odds of in-hospital acute kidney injury (AKI) and bleeding, longer-term bleeding, and mortality than those without CKD. The risk of in-hospital and longer-term cardioembolic events was similar between CKD and non-CKD populations (odds ratio = 1.01 [95% CI 0.70-1.15] and 1.05 [95% CI 0.55-2.00], respectively). Patients with ESRD had higher odds of in-hospital mortality and cardioembolic events than non-ESRD patients, with no differences in risk of pericardial tamponade. Based on observational studies, LAAO may be an effective option to prevent cardioembolic events in CKD. However, CKD patients may have higher odds of AKI and in-hospital and long-term bleeding and mortality. The adverse clinical outcomes observed in CKD patients may be attributed to this population's high burden of comorbidities, especially among those with ERSD, rather than the LAAO procedure itself. To ensure maximum clinical benefit, careful patient selection, management, and surveillance involving multidisciplinary teams are essential for CKD patients undergoing LAAO.

ABSTRACTBackgroundHyperkalemia is common among patients with chronic kidney disease (CKD) but there is scarce information on differential risk factors and outcomes for men and women. For instance, smoking has been suggested to be a risk factor for hyperkalemia, but specific analysis of the sex-specific impact of smoking on hyperkalemia in CKD is lacking.MethodsWe studied serum potassium levels in 2891 participants from the NEFRONA cohort: 483 controls (47% women) and 2408 CKD patients (38% women) without prior cardiovascular disease (CVD), assessing whether smoking is a risk factor for hyperkalemia, and if hyperkalemia is associated with outcomes separately for men and women.ResultsMedian potassium levels and prevalence of hypo and hyperkalemia were higher in CKD participants than in controls. Serum potassium levels were higher and hyperkalemia and severe hyperkalemia more prevalent in men than in women with non-dialysis CKD (G3–G5). The highest prevalence of hyperkalemia for each gender was found in CKD G4-G5 and hemodialysis patients for men (46%) and in hemodialysis (54%) for women. Gender-specific etiological multivariate analysis identified current smoking as a risk factor for hyperkalemia only in men. Hyperkalemia was independently associated with stopping RAASi, an outcome which was more common in women. Hyperkalemia was also associated to higher risk of cardiovascular events within 4 years in men. In conclusion, hyperkalemia is common among men and women with CKD, but the prevalence, risk factors and outcomes may differ by gender. Specifically, current smoking is a driver of hyperkalemia in men.

Different Bacteriology and Prognosis of Thoracic Empyemas Between Patients With Chronic and End-Stage Renal Disease

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

Perceived knowledge among patients cared for by nephrologists about chronic kidney disease and end-stage renal disease therapies

Background and Aims Implementation of alternative therapies is a common practice in patients with chronic disease. Frequency in different countries is varying, highly dependant on local cultural habits. Furthermore, alternative therapy, especially if taken seriously, might be associated with reduced compliance to conventional interventions. Chronic Kidney disease (CKD) is a progressive chronic illness with a really high mortality, which ends up with renal replacement treatment. In CKD certain dietary restrictions are central part of conventional treatment. The scope of the presented study was to determine prevalence of self implementation of alternative therapies and its relationship with compliance to dietary restrictions in CKD patients in Greece. Respective epidemiological data are still totally missing. Method Consecutive patients of the Outpatient Nephrology Wards and all patients of the Peritoneal Dialysis (PD) and Haemodialysis (HD) Units of the University Hospital of Larissa, the General Hospital of Veria and the University Hospital Attikon in Athens (Greece) were studied after informed consent from June to December 2019. The international Complementary and Alternative Medicine questionnaire (I-CAM-Q), was applied. The questionnaire registers all visits to complementary or alternative health-care providers, the respective treatments, the use of herbals, of dietary supplements, and self-help practices. Patients’ 24h recollection data were used to calculate dietary intake of protein, sodium, potassium and phosphorus. Albumin, phosphate, sodium, potassium, creatinine and urea were determined with routine methods in the central Laboratory of the University Hospital of Larissa. Results Overall 261 patients (165 males, aged 66.1±13 years) witk CKD were included. Among them102 were on chronic haemodialysis and 59 on peritoneal dialysis treatment. The prevalence of alternative treatment practices was overall 45%, significantly higher in female patients (OR 1,494, ci 1,085-2,057, P = .015). The frequency in PD patients and in CKD patients was significantly higher than in HD patients (PD 69.5%, CKD 55% and HD 21.6%; p&amp;lt;0.01). There was no significant variation due to profession or education. The prayers and confession (31.1%) as well as the use of herbs (25.3%) were the most frequent alternative practices applied. In HD prayers (prevalence 8.9%) and the use of herbs (8.9%) are less frequently practiced than in the other groups. The dietary compliance was for phosporus about 24% and when all relevant diet parameters were considered 18%. Compliance to dietary restrictions was better in females (P = .024) but was independent of the patient's profession (P = .42) and educational status (P = .89). No significant influence of the alternative treatment practices application was determined on the compliance to diet of either CKD, PD or HD patients. Conclusion The autonomous implementation of alternative medical and other treatment and self-help practices is common among patients with CKD with a predominace of females. In Greece the most commonly applied practices are herbs and prayers or the confession. There is overall a lower prevalence of alternative practices n HD patients than CKD and PD patients. The initial hypothesis, namely that alternative therapy implementation might combine with reduced compliance of patients to conventional interventions was not confirmed at least as far as the dietary restrictions prescrıbed for CKD patients are concerned. The role alternative treatment practices in CKD and its relationship to the patients’ physical and mental health deserves further investigation.

Treatment with erythropoiesis-stimulating agents in chronic kidney disease patients with cancer

Hemodialysis reduces inhibitory effect of plasma ultrafiltrate on LDL oxidation and subsequent endothelial reactions

Today, it is universally acknowledged that, in hypertension, the kidney is both culprit and victim.1 Kidney malfunction causes hypertension, and hypertension, in turn, aggravates chronic kidney disease (CKD) and accelerates its progression. High blood pressure (frank hypertension and blood pressure values in the high normal range) are clearly correlated to progressive kidney injury, both in experimental2 and in clinical3 observations. All of the current guidelines4,5 recommend lowering of systolic blood pressure to 130 or 125 mm Hg in CKD, and even lower values are recommended if the target level of proteinuria of <1 g per 24 hours has not been achieved.4 There is good evidence of “renoprotection” by lowering blood pressure in patients with renal disease, at least in the presence of proteinuria.3 In CKD patients without proteinuria, eg, autosomal polycystic kidney disease, further renoprotection cannot be achieved by lowering blood pressure below the target blood pressure recommended in patients without CKD6; nevertheless, these patients have a markedly elevated cardiovascular risk, and more stringent lowering of blood pressure is desirable, because, eg, reduction of left ventricular hypertrophy as an index of cardiovascular risk had been documented in such patients.6 The worldwide problem of neglect of hypertension and of insufficient implementation of antihypertensive treatment in CKD patients prompted the International Society of Nephrology and the International Federation of Kidney Foundations to devote this year’s World Kidney Day (http://www.worldkidneyday.org) on March 12th to the issue …

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