Advanced Chronic Kidney Disease Research Articles

Reduction in ambient PM2.5 associated with decreased risk of dialysis and mortality among patients with advanced chronic kidney disease: A population-based retrospective cohort study in Taiwan.

Reduction in ambient PM2.5 associated with decreased risk of dialysis and mortality among patients with advanced chronic kidney disease: A population-based retrospective cohort study in Taiwan.

The role of oxidative balance score in Cardiovascular-Kidney-Metabolic syndrome progression and mortality: insights from NHANES 1999–2020

AimsCardiovascular-Kidney-Metabolic Syndrome (CKM) is a significant public health issue. This research explored the link between oxidative balance score (OBS) and the advancement of CKM, and assessed mortality risks across CKM stages in a U. S. cohort.MethodsData from 10 NHANES cycles (1999–2020) were analyzed, including 19,433 participants for primary analysis and 16,467 for survival analysis. Multinomial regression, Cox models, survival analysis and mediation analysis were employed to evaluate the relationships.ResultsThe OBS was robustly associated with CKM stages, with each increment reducing the odds of CKM stages 1–4 (OR 0.93–0.90, all p < 0.001). The highest OBS quartile (Q4) lowered advanced CKM odds (OR 0.77, 95% CI 0.59–0.99, p = 0.045). Higher OBS values were associated with a lower risk of all-cause mortality (HR 0.97, 95%CI 0.95–0.99, p < 0.001) and cardiovascular disease (CVD) mortality (HR 0.96, 95% CI 0.93–0.99, p = 0.012) in individuals with non-advanced chronic kidney disease (CKD), and with a lower risk of CVD mortality (HR 0.97, 95% CI 0.94–0.99, p = 0.014) in those with advanced CKD. Kaplan–Meier curves showed better survival in higher OBS quartiles, especially for non-advanced CKM. Inflammatory markers (Ln-WBC and Ln-SUA) mediated 26.08 and 15.17% of the total effect in advanced CKM.ConclusionImproving oxidative balance may mitigate CKM progression and mortality risks. Additional studies are required to clarify the mechanisms and public health significance of OBS in CKM.

Loss of p300 in proximal tubular cells reduces renal fibrosis and endothelial-mesenchymal transition.

Chronic kidney disease (CKD) has a high prevalence worldwide and is typically accompanied by severe fibrosis. However, the exact pathogenesis of renal fibrosis and effective treatments have yet to be identified. In this study, we found that expression of the histone-acetyltransferase p300 was increased in focal segmental glomerulosclerosis patients and several distinct mouse models of renal fibrosis. Moreover, we showed that the AKT-mediated phosphorylation of Ser-1834 of p300 increased the stability of p300 upon renal fibrosis induction, and conversely, PPM1K specifically dephosphorylated p300 at Ser-1834, resulting in a significant reduction in p300 stability and renal fibrosis. Interestingly, increased p300 in proximal tubular cells (PTCs) promoted renal fibrosis development by mediating the endothelial to mesenchymal transition (EndMT) via upregulation of the mesenchymal-transition-related secreted proteins POSTN, FSTL1, and FSCN1. Both EndMT and renal fibrosis were significantly diminished by either PTC-specific deletion of p300 gene or selective inhibitors of p300. Collectively, our results demonstrate the role of p300 in the development of renal fibrosis, and suggest that p300 is a promising target for treatment of advanced CKD.

The Impact of a 10-Month Synbiotic Intake on eGFR, Uremic Toxins, Oxidative Stress, and Inflammatory Markers in Non-Dialysis Chronic Kidney Disease Patients: A Prospective, Non-Randomized, Placebo-Controlled Study

Background and Objectives: The worldwide prevalence of chronic kidney disease (CKD) continues to increase, representing a major concern for public health systems. CKD is associated with gut microbiota dysbiosis, which may exacerbate disease progression by increasing the levels of uremic toxins, systemic inflammation, and oxidative stress. Modulation of the gut microbiota through biotic supplementation has been proposed as a potential therapeutic strategy to slow CKD progression and mitigate its complications. This study aimed to evaluate the effect of 10-month synbiotic supplementation on estimated glomerular filtration rate (eGFR), circulating concentrations of indoxyl sulfate (IS), p-cresyl sulfate (p-CS), interleukin-6 (IL-6), and malondialdehyde (MDA) in patients with stage IV–V CKD not receiving dialysis, in comparison to placebo. Materials and Methods: Fifty non-dialysis CKD IV–V patients were assigned (n = 25 each) via matched, non-randomized allocation (age, sex, and primary disease) to synbiotic or placebo. This single-blind, placebo-controlled trial blinded participants and laboratory personnel. The synbiotic group received daily capsules containing Lactobacillus acidophilus La-14 (2 × 1011 CFU/g) + fructooligosaccharides; controls received identical placebo. Adherence was monitored monthly (pill counts, diaries), with < 80% over two visits resulting in withdrawal. The eGFR, IS, p-CS, IL-6, and MDA were measured at baseline and month 10. Results: Forty-two patients (21/arm) completed the study; eight withdrew (4 per arm). At 10 months, the change in eGFR was −1.2 ± 2.5 mL/min/1.73 m2 (synbiotic) vs. −3.5 ± 3.0 mL/min/1.73 m2 (placebo); between-group difference in change was 2.3 mL/min/1.73 m2 (95% CI: 0.5–4.1; p = 0.014; adjusted p = 0.07). IS decreased by −15.4 ± 8.2 ng/L vs. −3.1 ± 6.5 ng/L; between-group difference in change was −12.3 ng/L (95% CI: −17.8 to −6.8; p < 0.001; adjusted p = 0.005). No significant differences were observed for p-CS, IL-6, or MDA after correction. Conclusions: Synbiotic supplementation over a 10-month period resulted in a trend toward decreased serum IS levels in patients with advanced CKD, suggesting potential benefits of microbiota-targeted therapies. However, no significant effects were observed on renal function, inflammatory, or oxidative stress markers. Further large-scale studies are warranted to confirm these findings and explore the long-term impact of synbiotics in CKD management.

Acute Kidney Injury After Peripheral Interventions Using Carbon Dioxide Angiography—Risk Factors Beyond Iodinated Contrast Media

Contrast-associated acute kidney injury (CA-AKI) is a known complication of endovascular procedures using an iodinated contrast medium (ICM), especially in patients with peripheral artery disease (PAD) and chronic kidney disease (CKD). This retrospective study evaluated the incidence and risk factors of AKI in patients with PAD and CKD undergoing diagnostic angiography or endovascular intervention using carbon dioxide (CO2) as the primary contrast medium, with optional bailout ICM use. We included 340 patients who underwent peripheral angiography or intervention between September 2014 and December 2020. CO2 was used as the primary contrast medium for all patients, as the majority were classified with advanced CKD stages 3–5 according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Bailout ICM was used in 80% of cases (mean 21.23 ± 14.09 mL). Postinterventional AKI occurred in 13.2% of patients, with over 70% classified as stage 1. Seven patients required new dialysis within 7 days. Multivariate analysis identified hypertension, heart failure, and coronary artery disease as independent AKI risk factors. Statin or Renin–Angiotensin–Aldosteron System (RAAS) inhibitor use and higher pre-interventional GFR were protective. AKI remains common in patients undergoing CO2-guided peripheral procedures. Further studies are needed to explore underlying mechanisms and outcomes.

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as prognostic biomarkers of proteinuria and CKD severity: A cross-sectional study

Objectives: Chronic kidney disease (CKD) is characterized by a prolonged decline in kidney function, defined by an estimated glomerular filtration rate (eGFR) below 60 ml/min/1.73 m² for over 3 months. Persistent, low-grade systemic inflammation is critical to CKD progression and associated with higher mortality. This study aims to evaluate the role of Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte ratio (PLR) as hematological inflammatory biomarkers across different stages of CKD to observe their trends in relation to proteinuria and assess CKD severity. Materials and Methods: This cross-sectional study was conducted at a Tertiary Care Hospital, with 188 patients who presented with CKD, between May 2024 and September 2024. Laboratory data included absolute neutrophil count, absolute lymphocyte count, absolute platelet count, urinary protein, urinary creatinine, urinary protein-creatinine ratio (PCR), serum creatinine and eGFR. Results: Among the studied patients, male were 60%, and female were 40%, mean age of 40.1 and a range of 14-30 years. The distribution of CKD stages among the patients was as follows: 36.7% in stage 1, 16% in stage 2, 14.9% in stage 3A, 9% in stage 3B, 10.1% in stage 4 and 13.3% in stage 5. Both PLR and NLR correlated positively with proteinuria, with NLR emerging as a stronger predictor of inflammation than PLR, with data showing a stage-wise increase in NLR values, particularly higher in patients in advanced CKD stages. Conclusion: NLR and PLR can be used as biomarkers for assessing inflammation and monitoring CKD severity. These biomarkers demonstrate a stage-wise increase across different CKD stages in various patients, with higher values observed in advanced stages, thus helping identify those at risk.

Prevalence of Pulmonary Hypertension in Chronic Kidney Disease Patients at a Tertiary Hospital

Background:Pulmonary hypertension (PH) is a recognized cardiovascular complication in patients with chronic kidney disease (CKD), particularly in advanced stages. Its presence is associated with increased morbidity, hospitalizations, and mortality. Despite its clinical significance, data on PH prevalence in CKD patients in low-resource settings remain limited. Objective:To determine the prevalence of PH among patients with CKD presenting to a tertiary care nephrology department and to assess its association with demographic and clinical characteristics. Methods:This descriptive cross-sectional study was conducted at the Department of Nephrology, XXXX, from December 2020 to June 2021. A total of 194 patients aged 20–60 years with CKD stage III to V were included. PH was diagnosed using transthoracic echocardiography based on pulmonary artery systolic pressure >35 mmHg and tricuspid regurgitant velocity >3.4 m/s. Patient demographics, comorbidities (diabetes, hypertension), and disease duration were recorded. Statistical analysis was performed using SPSS version 22, with p ≤ 0.05 considered significant. Results:Among 194 patients, 118 (60.8%) were male and the mean age was 49.2 ± 7.14 years. PH was identified in 91 patients (46.9%). Significant associations were observed between PH and male gender (p=0.001), DM (p=0.002), smoking history (p=0.026), disease duration >1 year (p=0.015), and advanced CKD stage (p=0.001). No statistically significant relationship was found with hypertension or obesity. Conclusion:PH is highly prevalent in patients with CKD and correlates with several modifiable and disease-related factors. Routine screening for PH in high-risk CKD patients is recommended for early diagnosis and timely management to reduce cardiovascular complications and improve patient outcomes.

Impact of CKD/Kidney Failure on Angiodysplasia-Related Gastrointestinal Bleeding: Incidence, Outcomes, and Readmission Risk in a National Cohort.

Angiodysplasia-related gastrointestinal bleeding (AGIB) is an increasingly recognized cause of hospitalization, particularly among patients with chronic kidney disease (CKD). While AGIB has been linked to kidney failure (KF), its burden across CKD stages remains unclear. This study aimed to evaluate AGIB incidence, outcomes, and readmissions across CKD stages using the largest inpatient and readmission databases in the United States. We conducted a retrospective cohort study using the 2022 National Inpatient Sample (NIS) and Nationwide Readmissions Database (NRD). Adult patients hospitalized with AGIB were identified and stratified into five groups: non-CKD (NCKD), early CKD (ECKD, stage 3), advanced CKD (ACKD, stages 4-5 not on dialysis), kidney failure (KF, end-stage kidney disease requiring chronic dialysis) and others. The primary outcome was AGIB hospitalization incidence. Secondary outcomes included in-hospital mortality, disease severity, treatment interventions, healthcare utilization, and 30-day readmission. Multivariable regression models were used to identify independent risk. In 2022, 46,670 adults were hospitalized with AGIB (0.17% of all admissions). CKD/KF was an independent risk factor for AGIB hospitalization, with risk increasing progressively with worsening kidney function (aOR: 1.34 1.42 1.50 [ECKD], 1.72 1.89 2.07 [ACKD], 2.32 2.51 2.72 [KF]; all p < 0.001). The overall in-hospital mortality rate was 1.04%, higher among CKD patients. KF was independently associated with higher mortality (aOR: 1.06 1.87 3.27), lower rates of endoscopic evaluation (aOR: 0.43 0.53 0.65), and longer hospital stays. Endoscopy was associated with lower mortality (aOR: 0.32 0.54 0.92). The 30-day all-cause readmission rate was 22.3%, with recurrent AGIB as the leading cause. Readmission risk increased progressively with CKD stage. CKD progression is strongly associated with increased risk of AGIB hospitalization and readmission. KF and lack of endoscopic evaluation were independent mortality risk factors. These findings highlight the need for proactive management strategies in this high-risk population.

Cost-effectiveness of treatment with finerenone in mild to advanced stage chronic kidney disease patients with type 2 diabetes from a societal perspective

ABSTRACTIntroductionOne in three patients with type 2 diabetes (T2D) suffers from any stage of chronic kidney disease (CKD), a chronic illness associated with a high global burden that impacts not only the healthcare system but also societal costs. Addition of finerenone to the standard of care (SoC) for patients with advanced CKD and T2D has been shown to be cost-effective by reducing healthcare and societal costs. This analysis explores the cost-effectiveness of finerenone in patients with CKD (stages 1–4 with albuminuria) associated with T2D from a societal perspective, as broader societal costs are a crucial consideration in managing chronic illnesses.Research design and methodsThe validated FINE-CKD model was populated with data from the pooled FIDELITY analysis (ie, a patient population with early-to-late stage CKD associated with T2D) to investigate the cost-effectiveness of the addition of finerenone to SoC compared with SoC alone, from a Dutch societal perspective. Sensitivity analyses were conducted to evaluate the impact of parameter uncertainty on the robustness of the model.ResultsOur analysis shows that by adding finerenone to SoC, patients with mild to severe stage CKD and T2D gain 0.14 quality-adjusted life years (QALYs) compared with SoC alone, mainly due to a reduction in renal and cardiovascular events. The societal costs of these events are considerable (ie, €8481 and €9799 per patient over a lifetime in the finerenone and SoC arm, respectively), showing the relevance of a societal perspective in chronic diseases. Overall, finerenone leads to savings of €2713 per patient over a lifetime. Therefore, the addition of finerenone to SoC emerges as the dominant treatment option when compared with SoC alone. The sensitivity analysis shows that finerenone has a 62.3% chance to be dominant and an 83.8% chance to be cost-effective, considering a willingness-to-pay threshold of €20 000/QALY.ConclusionsThis study highlights the burden that chronic diseases impose on healthcare systems and society, emphasising the relevance of incorporating a societal perspective in cost-effectiveness analyses. The analysis estimates that adding finerenone to SoC treatment for patients with mild to advanced CKD associated with is cost-effective from a healthcare and societal perspective.

Renal donation: Acceptance criteria and their influence at 5 and 10years after donation.

Renal donation: Acceptance criteria and their influence at 5 and 10years after donation.

838-P: Changes in Clinical Measures in U.S. Adults with Type 2 Diabetes (T2D) and Chronic Kidney Disease (CKD) Who Received Once-Weekly (OW) Semaglutide

Introduction and Objective: To assess changes in clinical measures in US adults with T2D and CKD treated with OW semaglutide. Methods: Adults with T2D and CKD who initiated OW semaglutide between Jan 1, 2019 and Jun 30, 2023 were selected from Optum’s de-identified Clinformatics® Data Mart Database. Clinical measures were compared before vs. during OW semaglutide treatment. Changes were described at Month 12, and trajectories were analyzed with mixed models in the overall cohort and subgroups: those 1) ineligible for sodium-glucose cotransporter-2 inhibitor (SGLT2i) due to advanced CKD stages, 2) for whom SGLT2is were suboptimal indicated by treatment switch or augmentation with OW semaglutide after SGLT2i use, and 3) with stage IV CKD or kidney failure. Results: Out of 49,683 patients, 67.6% were aged 65 or older and 56.7% were female. After OW semaglutide treatment, there was a decline in HbA1c (12-month mean change [95% confidence interval]: -1.2% [-1.3%, -1.2%]), increase in estimated glomerular filtration rate (1.6 mL/min/1.73 m2 [1.2, 2.0]), decline in body weight (-6.0 kg [-6.7, -5.4]), and decline in systolic blood pressure (SBP; -2.9 mmHg [-4.1, -1.7]). Similar trends were observed in all subgroups. Conclusion: Real-world patients with T2D and CKD treated with OW semaglutide had improved glycemic control and kidney function and reduced body weight and SBP. Disclosure J. Amamoo: Employee; Novo Nordisk. Y. Wang: Other Relationship; Analysis Group, Inc. H. Liu: Employee; Analysis Group, Inc. M. Sundar: Consultant; Novo Nordisk. Y. Song: Research Support; Novo Nordisk. L. Xie: None. S.J. Mehanna: None. J. Noone: Employee; Novo Nordisk. C. Swift: Employee; Novo Nordisk. Stock/Shareholder; Novo Nordisk. M.R. Weir: Advisory Panel; AstraZeneca, Bayer Pharmaceuticals, Inc, Novo Nordisk, Corcept Therapeutics, Vifor Pharma. Consultant; Intercept Pharmaceuticals, Inc.

2005-LB: Changes in Clinical Measures among U.S. Adults with Type 2 Diabetes (T2D) and Chronic Kidney Disease (CKD) Receiving Once-Weekly Semaglutide (sema OW) vs. Oral Antidiabetic Medications (ADMs)

Introduction and Objective: This study compared changes in clinical measures among US adults with T2D and CKD treated with sema OW vs. select oral ADMs (SU, DPP4i, TZD). Methods: This observational study of adults with T2D and CKD initiating sema OW or oral ADMs (Jan 2019 -Jun2023) used data from Optum’s de-identified Clinformatics® Data Mart Database. Patients not indicated for SGLT2is due to advanced CKD stages or who had suboptimal treatment with SGLT2is indicated by treatment switching or augmentation after SGLT2i use were included in the study. Trajectories of changes in HbA1c, eGFR, body weight (BW), and SBP before vs. during index treatment were compared between the two cohorts. Results: A total of 16,646 and 33,197 patients were included in the OW semaglutide and oral ADM cohorts. In both cohorts, there was a decline in HbA1c and an initial increase in eGFR, with greater improvement observed in the sema OW cohort (12-month change in OW semaglutide minus oral ADM cohort [95% confidence interval] for HbA1c: -0.6% [-0.6%, -0.5%]; eGFR: 2.1 mL/min/1.73 m2 [1.7, 2.4]). Greater reduction in BW (-6.7 kg [-7.0, -6.3]) and SBP (-3.7 mmHg [-4.9, -2.5]) were observed in the sema OW cohort. Conclusion: Patients with T2D and CKD treated with sema OW had greater improvement in clinical measures than those treated with select oral ADMs. Disclosure J. Amamoo: Employee; Novo Nordisk. Y. Wang: Other Relationship; Analysis Group, Inc. Y. Song: Research Support; Novo Nordisk. M. Sundar: Consultant; Novo Nordisk. H. Liu: Employee; Analysis Group, Inc. M.R. Weir: Advisory Panel; AstraZeneca, Bayer Pharmaceuticals, Inc, Novo Nordisk, Corcept Therapeutics, Vifor Pharma. Consultant; Intercept Pharmaceuticals, Inc. L. Xie: None. S.J. Mehanna: None. J. Noone: Employee; Novo Nordisk. C. Swift: Employee; Novo Nordisk. Stock/Shareholder; Novo Nordisk.

Impact of Bariatric Metabolic Surgery on Cardiovascular, Kidney, and Mortality Outcomes Among Adults with Obesity and Chronic Kidney Disease Across Different Time Frames.

Bariatric metabolic surgery (BMS) is an effective intervention for obesity, with proven benefits in reducing cardiovascular events and mortality. However, its impact on patients with chronic kidney disease (CKD) remains unclear. This study aims to evaluate the long-term outcomes of BMS compared to nonsurgical management in CKD patients with obesity, focusing on major adverse cardiovascular events (MACE), major adverse kidney events (MAKE), and all-cause mortality. We conducted a retrospective cohort study using the TriNetX database, including adult patients with CKD and obesity. Patients who underwent BMS (Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy) were compared to those receiving lifestyle interventions. Propensity score matching (PSM) was applied to balance baseline characteristics. The primary outcome was a composite of all-cause mortality, MACE, and MAKE. Secondary outcomes included individual components of the primary outcome. Cox proportional hazards models and Kaplan-Meier survival analyses were used to assess outcomes across short-term (1month-1year), intermediate (up to 3years), and long-term (up to 5years) follow-up periods. Subgroup analyses were conducted by CKD stage (1-3 vs. 4-5) to evaluate effect heterogeneity across different levels of kidney function. After matching, 5,221 patients were included in each group. Over a 5-year follow-up, BMS was associated with significantly lower risk of the primary composite outcome (HR 0.75, 95% CI 0.70-0.81; p < 0.001). Subgroup analyses showed that this protective effect was observed across all CKD stages, with a more pronounced reduction in MAKE among patients with advanced CKD (stages 4-5) compared to early-stage CKD (stages 1-3). BMS was also associated with greater preservation of eGFR over time compared to controls. Among adults with obesity and CKD, BMS was associated with lower risks of mortality, MACE, and MAKE, as well as slower decline in kidney function. The benefits were consistent across CKD stages and appeared particularly pronounced in patients with advanced CKD (stages 4-5), highlighting the potential role of BMS in high-risk kidney populations. Further randomized trials are needed to validate these results and refine patient selection criteria.

The Influence of Renal Function on Safety and Effectiveness of Oral Anticoagulant Treatment Among Frail Elderly Patients with Non- Valvular Atrial Fibrillation and Chronic Kidney Disease.

The effectiveness and safety of oral anticoagulants (OAC) in patients with chronic kidney disease (CKD) and non-valvular atrial fibrillation (NVAF) in Frail Elderly patients has not been fully established. To determine the safety and effectiveness related to OACs in Frail Elderly patients with AF and CKD stage II and III. Frail Elderly patients ≥65 years with AF and CKD who received OAC from January 2022 to June 2024 were retrospectively identified. Primary endpoints were composite of ischemic stroke and systemic embolism (IS/SE), and composite of intracranial bleeding (ICH) and/or gastrointestinal (GI) bleeding. Secondary endpoints included any bleeding. The study enrolled 365 patients, of whom 141 (38.6%) initiated warfarin therapy and 224 (61.3%) initiated DOACs. CHA2DS2-VASc score was non-significant, (2.6±1.01 vs 2.8±0.89, p value 0.054), for GFR ≥ 60 and GFR < 60 mL/min/1.73m² patients respectively. HAS-BLED score (1.9±0.67 vs 2.3±0.70, p value 0.071) for GFR ≥ 60 and GFR < 60 mL/min/1.73m² patients respectively. While the observed incidence of ICH/GI bleeding was numerically higher in patients with GFR <60 mL/min/1.73m², Cox proportional hazards regression did not demonstrate a statistically significant difference in hazard between the groups. The incidence of composite IS/SE was 8.5% in GFR ≥60 mL/min/1.73m² vs. 8.7% in GFR <60 mL/min/1.73m² (HR 1.02, 95% CI 0.60-1.74, p=0.24). Composite ICH/GI bleeding occurred in 7.1% vs. 9.3% (HR 0.89, 95% CI 0.45-2.72, p=0.41). In this study comparing Frail Elderly patients with NVAF and CKD stage II versus stage III receiving OACs, we observed No significant difference in the risk of IS/SE or ICH/GI bleeding between groups. These findings suggest that within moderate CKD (eGFR 30-89 mL/min), renal function stage may not independently influence OAC-related outcomes when anticoagulation is well-managed. Our results may not generalize to less frail populations or those with advanced CKD. Further prospective studies with larger sample size are needed to provide clearer guidance on the optimal use of OACs in this challenging clinical scenario.

402-P: Relationship between Average Glucose and HbA1c across GFR Stages

Introduction and Objective: HbA1c’s accuracy and precision decline in advanced CKD, commonly attributed to anemia. Whether other CKD factors influence its relationship with glycemia in those with preserved GFR is unclear. We examined the relationship between CGM-derived average glucose and HbA1c across GFR stages. Methods: We conducted a retrospective cohort study linking Dexcom/Libre CGM data to EHR from a large academic health system. Adults with diabetes were included if they had: (1) HbA1c measurements, (2) ≥10 days of CGM data within the preceding 3 months, and (3) ≥1 creatinine within 6 months. Linear mixed-effects models with participant-specific random intercepts were used to examine the longitudinal association of CGM-derived average glucose and HbA1c, adjusting for age, sex, and race. Interactions with GFR and hemoglobin were tested. Results: We included 1,598 patients (692 GFR Stage G1, 532 G2, 285 G3, 89 G4-5) with 4,662 CGM periods. Mean age was 57, 45% female, 74% White, and mean HbA1c was 7.1%. Spearman correlations between average glucose and HbA1c declined from 0.7 (G1) to 0.44 (G4-5), and slopes flattened with advancing GFR stages (Fig). In adjusted models, the association between average glucose and HbA1c was modified by GFR (P-interaction=0.001), but not by hemoglobin (P-interaction=0.5). Conclusion: The association between CGM-derived mean glucose and HbA1c weakens as GFR declines, independent of hemoglobin levels. Disclosure M. Tang: Research Support; Dexcom, Inc., American Heart Association. M.S. Putman: Consultant; Anagram Therapeutics. Research Support; Dexcom, Inc. Other Relationship; Vertex Pharmaceuticals Incorporated. D.M. Nathan: Advisory Panel; Lexicon Pharmaceuticals, Inc. D.J. Wexler: Other Relationship; Novo Nordisk. H. Zheng: None. S. Sanzone: None. A. Doria: Research Support; Abbott, Lexicon Pharmaceuticals, Inc, Dexcom, Inc. I. de Boer: Consultant; Alnylam Pharmaceuticals, Inc, Jaeb Center for Health Research, Boehringer-Ingelheim, Lilly USA LLC, Dexcom, Inc. Research Support; Dexcom, Inc. Consultant; Lexicon Pharmaceuticals, Inc, Novo Nordisk. Research Support; Novo Nordisk. S. Kalim: Consultant; Fresenius. Speaker's Bureau; Vistera. Funding American Heart Association (AHA23POST1010825)

Tricuspid regurgitation and chronic kidney disease in patients with cardiogenic shock: Review of the literature and real-world experience from a single center

Tricuspid regurgitation and chronic kidney disease in patients with cardiogenic shock: Review of the literature and real-world experience from a single center

BP and Kidney Disease Progression in Advanced CKD: Findings from the Chronic Renal Insufficiency Cohort and KoreaN Cohort Study for Outcome in Patients with CKD Studies.

Blood pressure (BP) control is important in the management of chronic kidney disease (CKD). However, in patients with advanced CKD, the benefits of BP control in delaying the progression of CKD remain uncertain. We analyzed 2,939 participants with CKD G3b to G5 (estimated glomerular filtration rate [eGFR] <45 ml/min/1.73m2) without kidney replacement therapy from the Chronic Renal Insufficiency Cohort (CRIC) study and the KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD) (Phase I). The main predictors were baseline and time-updated systolic BP (SBP) and diastolic BP (DBP). The primary outcome was a composite kidney outcome of ≥50% decline in eGFR from baseline measurement or the initiation of kidney replacement therapy. In the analyses, multivariate cause-specific hazards models and marginal structural models were fitted for baseline and time-updated BPs, respectively. During 17,755 person-years of follow-up (median, 4.7 years), the composite outcome occurred 1,627 (55%) participants. Compared with baseline SBP <120 mmHg, the HRs (95% CIs) for 120-129, 130-139, and ≥140 mmHg were 1.33 (1.15-1.54), 1.48 (1.27-1.72), and 1.82 (1.58-2.10), respectively. This association was more evident in analysis with time-updated SBP, where the corresponding HRs (95% CIs) were 1.29 (1.09-1.54), 1.75 (1.46-2.10), and 2.79 (2.36-3.29), respectively. Furthermore, the slopes of eGFR decline were -1.20 (-1.36 to -1.04), -1.77 (-1.97 to -1.57), -2.11 (-2.35 to -1.88), and -2.48 (-2.70 to -2.27) mL/min/1.73m2 per year for respective baseline SBP categories. Additional analyses with DBP also showed similar results. In patients with advanced CKD, higher BP levels were associated with a higher risk of CKD progression.

Risk Factors Associated with Hyporesponsiveness to Erythropoietin in Chronic Kidney Disease Patients on Hemodialysis Who Present Anemia: A Multicenter Case-Control Study

Background: Anemia represents a significant complication in patients with advanced chronic kidney disease (CKD) on hemodialysis, primarily caused by reduced renal erythropoietin production. Despite erythropoiesis-stimulating agents (ESAs) being the cornerstone of treatment, hyporesponsiveness to these agents remains a clinical challenge with implications for patient outcomes. Objective: To identify and quantify risk factors associated with hyporesponsiveness to erythropoietin in patients with CKD on hemodialysis who present with anemia. Methods: This multicenter case–control study analyzed data from 784 hemodialysis patients receiving erythropoietin therapy across six dialysis centers in Ecuador between January and December 2019. Hyporesponsiveness was defined as requiring ≥ 200 IU/kg/week of erythropoietin alfa for ≥3 consecutive months to maintain target hemoglobin levels (10–12 g/dL). Demographic, clinical, and laboratory parameters were compared between hyporesponsive cases (n = 123) and responsive controls (n = 661). Bivariate and multivariate logistic regression analyses were performed to identify independent risk factors. Results: The prevalence of erythropoietin hyporesponsiveness was 15.69%. A multivariate analysis identified female sex (adjusted OR = 1.96; 95% CI: 1.20–3.20; p &lt; 0.001), age &lt; 50 years (adjusted OR = 4.25; 95% CI: 2.42–7.47; p &lt; 0.001), serum albumin &lt; 4.0 g/dL (adjusted OR = 10.53; 95% CI: 6.53–16.98; p &lt; 0.001), ferritin ≥ 800 ng/mL (adjusted OR = 7.28; 95% CI: 4.22–12.57; p &lt; 0.001), transferrin saturation &lt; 20% (adjusted OR = 9.27; 95% CI: 5.47–15.69; p &lt; 0.001), parathyroid hormone ≥ 500 pg/mL (adjusted OR = 1.89; 95% CI: 1.16–3.09; p = 0.011), and use of renin–angiotensin system blockers (adjusted OR = 2.25; 95% CI: 1.36–3.71; p = 0.002) as independent risk factors for erythropoietin hyporesponsiveness. Conclusions: Multiple demographic, clinical, and laboratory factors independently contribute to erythropoietin hyporesponsiveness in hemodialysis patients. Identification of these risk factors may guide clinicians in developing individualized treatment approaches, optimizing erythropoietin dosing, and implementing targeted interventions to improve anemia management in this vulnerable population.

Risk of Post-polypectomy Bleeding After Colorectal Endoscopic Mucosal Resection in Patients with Chronic Kidney Disease: A Propensity-Matched Analysis of the US Collaborative Network.

Studies evaluating the risk of post-polypectomy bleeding (PPB) after colorectal endoscopic mucosal resection (EMR) in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) are limited. This retrospective cohort study utilized the U.S. Collaborative Network to assess the risk of PPB after colorectal EMR in patients with CKD compared to controls. Using one-to-one propensity score matching (PSM), the primary outcome measured was PPB within 30 days after colorectal EMR. The PPB risk was further stratified by CKD severity: non-advanced CKD and advanced CKD. After PSM, each cohort included 9,196 patients. Overall, CKD was associated with increased risk of PPB following colorectal EMR (5.4% vs. 3.8%, odds ratio [OR] 1.44, 95% confidence interval [CI] 1.25-1.66, p < 0.001). The PPB risk was significantly higher in patients with advanced CKD (8.1% vs. 4%, OR 2.09, 95% CI 1.65-2.65, p < 0.001), while those with non-advanced CKD showed modest increase in risk of PPB (4.7% vs. 4%, OR 1.20, 95% CI 1.01-1.41, p = 0.03). Patients with CKD had higher risk of PPB than patients without CKD. The PPB risk was notably increased in patients with advanced CKD. Optimizing patients with CKD, especially advanced CKD, before colorectal EMR and monitoring for post-procedure bleeding remains important.

Questions older people and caregivers ask about kidney therapies: A computer-assisted analysis.

Questions older people and caregivers ask about kidney therapies: A computer-assisted analysis.