Chronic Kidney Disease Stage Research Articles

Depression and associated factors in chronic kidney disease patients in southern Nigeria: a cross-sectional study

Background The most common psychological problem encountered in patients with chronic kidney disease (CKD) is depression. However, it is often undiagnosed and undertreated in this group of patients. The prevalence of depression in pre-dialysis CKD patients and its associated factors were determined in this study Patients and methods This was a cross-sectional study that determined the prevalence of depression in pre-dialysis CKD patients using the Hamilton-Depression rating scale. Associated factors with depression were determined by logistic regression. P value less than 0.05 was taken as a significant Results A total of 250 CKD patients with a mean age of 52.3 ± 16.0 years were studied. They comprised of 116 (46.4%) males. Fifty-six (22.4%) of the study participants had depressive symptoms. Depression was significantly more common in those who were unmarried (38.3% vs. 18.7%; P= 0.002) and those whose duration of CKD was less than 6 months (26.6% vs. 15.2%; P= 0.026). Depression was significantly associated CKD stage (P=0.002). The significant factors associated with depression in the CKD patients were being unmarried (adjusted odds ratio: 2.54; confidence interval: 1.19–5.42; P= 0.02) and CKD stage (adjusted odds ratio:3.81; confidence interval: 1.50–9.83; P=0.01). Conclusion Depression is common in the pre-dialysis CKD population and its screening should be included in the evaluation and management of all pre-dialysis CKD patients.

Early Versus Late Initiation of Dialysis in CKD Stage 5: Time for a Consensus

Chronic kidney disease (CKD), a major global public health problem, emerged as one of the leading causes of death, affecting over 800 million individuals worldwide, with significant burden to patients and their caregivers, and may lead to end-stage kidney disease (ESKD). The decision on optimal initiation of chronic dialysis is a common problem faced by nephrologists, patients and caregivers due to lack of adequate data. Determining the ideal time to initiate maintenance dialysis for individuals struggling with ESKD has remained a puzzle.Currently, there is no consensus among guidelines as to the best time to initiate dialysis. Discrepancies in guidelines stem from lack of adequate data, necessitating larger randomized controlled trials to fill this major gap and come to a universal acceptance by the nephrology community about the optimal time to initiate dialysis for patients with advanced CKD. The fact that there has been only one randomized controlled trial that addressed early vs. late dialysis initiation is inadequate to convincingly answer such as critical clinical decision making.In this review, we will analyze the available literature and try to come with recommendations for further studies to guide nephrologist to the best time to initiate dialysis for patient approaching ESKD.

CLINICAL ASSESSMENT OF ANTIBIOTICS USED IN CHRONIC KIDNEY DISEASE: A LONGITUDINAL OBSERVATIONAL STUDY

Objective: The study was conducted to clinically evaluate the safety and efficacy of antibiotic drug consumption based on laboratory data, specifically White Blood Cells(WBC) and Glomerular Filtration Rate (GFR) before and after antibiotic use in patients with chronic kidney disease. Methods: This retro-prospective longitudinal study was conducted on 115 patients with Chronic Kidney Disease (CKD) based on 6 mo of data at a tertiary care teaching institute, Geetanjali Medical College and Hospital, in Udaipur, Rajasthan. Inclusion criteria were all the patients who were admitted in the nephrology department and were above 18 y, who were receiving antibiotics, and Creatine Clearance (CrCl) was ≤ 60 ml/min were included into this study. Exclusion criteria patients with renal replacement and lacking information of laboratory data (WBC, CrCl) and those who were below the age of 18 were excluded from the study. The data were analysed using descriptive analysis. Results: The mean age of the CKD patients was 50.10 (standard deviation=17.47) y. Males were found in greater numbers than that of females with 66 (58%) and 49(42%) respectively. Patients admitted with stage 5 CKD (66%) were greater than the patients with stage 4 CKD. 10 different types of antibiotics were provided to CKD patients, of which seven had irrational doses. Piptaz, Meropenem, and Teicoplanin have the highest irrational doses incidence. Conclusion: Patients with CKD Stages 4 and 5 were given systemic antibiotics at unreasonable dosages, most frequently in the forms of piptaz, aztreonam, and meropenem injections. The incidence of irrational antibiotic dosages provided to the CKD patients was still high.

Baseline Characteristics of Frailty and Disease Stage in Older People Living With CKD

IntroductionThe GOAL trial, a cluster-randomised controlled trial, investigated the effect of comprehensive geriatric assessment (CGA) on frail older people with chronic kidney disease (CKD). This paper describes (1) participant baseline characteristics, and (2) their relationship with CKD stage and frailty severity. MethodsSixteen kidney outpatient clinics (clusters) were randomly allocated 1:1 to CGA or usual care. Enrolled frail older people with CKD (Frailty Index >0.25; aged ≥65 years or ≥55 if First Nations people) received the intervention allocated to their cluster. CKD was defined as moderate (stages 3/4) or severe (stage 5/5D), and frailty categorised as moderate (>0.25 to <0.36), severe (0.36 to <0.45) or very severe (≥0.45). Participant characteristics were analysed using descriptive statistics. Statistical methods appropriate for type of outcome were used to describe the association of frailty and CKD categories with participant characteristics. ResultsOver a 27-month period, 240 people were recruited (55.7% male, 82.9% white/European). Mean age was 76.9 (SD: 6.6) and median FI was 0.39 (IQR: 0.32 – 0.47). The median EQ-5D-5L quality of life index score was worse in those with very severe frailty (0.57, IQR: 0.28 – 0.83) compared to severe frailty (0.85, IQR: 0.67 – 0.92) and moderate frailty (0.90, IQR: 0.82 – 0.93) (overall P <0.001). Median EQ-5D-5L was also worse in those with severe CKD (0.79, IQR: 0.40 – 0.89), compared to moderate CKD (median 0.87, IQR: 0.73 – 0.92; P 0.001). ConclusionThis cohort demonstrated poorer quality of life scores in those with more severe frailty and more advanced CKD.

The effect of a low potential renal acid load diet on metabolic acidosis in patients with chronic kidney disease stage 4 and 5

The effect of a low potential renal acid load diet on metabolic acidosis in patients with chronic kidney disease stage 4 and 5

The effect of reduced L-glutathione supplementation on TNF-α, hs-CRP, and neutrophil-lymphocyte ratio in maintenance hemodialysis patients.

Cardiovascular disease is the main cause of mortality in patients with chronic kidney disease stage 5 on dialysis (CKD-5D). High sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), and neutrophil-lymphocyte ratio (NLR) are several inflammatory parameters associated with high cardiovascular events in CKD-5D. The main aim of this study was to evaluate the effect of reduced L-glutathione supplementation on serum hs-CRP, TNF-α, and NLR in patients with CKD-5D. This study is a quasi-experimental research with one group pretest-posttest design. Subjects included were patients with CKD-5D who routinely underwent hemodialysis therapy two times a week in Hasan Sadikin General Hospital. Serum hs-CRP, TNF-α, and NLR levels were obtained before and after the intervention of reduced L-glutathione supplementation dosing of one thousand milligrams a day for four weeks. Statistical analysis was then conducted using the Wilcoxon test. There were 26 hemodialysis patients included in the study, with a median age of 43 years and a male predominance. There was a significant decrease in serum TNF-α level after reduced L-glutathione supplementation for 4 weeks, 5.40 (-10.80-0.00) pg/mL, p = 0.002. However, there was no statistically significant decrease in either serum hs-CRP level, 0.40 (-0.70-0.80) mg/L (p = 0.656), or NLR with a difference of 0.55 (0.30-1.00) p = 0.055. Exogenous oral reduced glutathione supplementation for four weeks significantly reduced TNF-α level, but no significant decrease in hs-CRP level and NLR in patients with CKD-5D.

Persistent Renal Dysfunction After Acute Kidney Injury Among STEMI Patients Undergoing Primary Coronary Intervention: Prevalence and Predictors.

Acute kidney injury (AKI) is a common and serious complication of ST-elevation myocardial infarction (STEMI). AKI and chronic kidney disease (CKD) are highly heterogeneous, leaving a wide gap between them. Therefore, the term acute kidney disease (AKD) was implemented, describing prolonged renal injury between 7 and 90 days. We aimed to evaluate the prevalence and predictors of AKD among STEMI patients. This retrospective observational study included 2940 consecutive patients admitted with STEMI between 2008 and 2022. Renal function was assessed upon admission and routinely thereafter. Renal outcomes were evaluated according to KDIGO criteria, with AKD defined as persistent renal injury of between 7 and 90 days. Two hundred and fifty-two subjects with STEMI and AKI were included; of them, 117 (46%) developed AKD. Among baseline CKD patients, higher rates of AKD were observed (60% vs. 46%). KDIGO index ≥ 2 was an independent predictor for AKD in in subjects without baseline CKD (AOR 2.63, 95% CI 1.07-6.53). In subjects with baseline CKD, older age and higher creatinine were independent predictors for AKD. Subjects with AKD had a higher 1-year mortality rate (HR 3.39, 95% CI 1.71-6.72, p < 0.01). This trend was mainly driven by the CKD subpopulation where higher mortality rates for AKD on CKD were observed (HR 5.26, 95% CI 1.83-15.1, p < 0.01). AKD is common among STEMI patients with AKI. The presence of CKD and higher KDIGO stage should prompt strict monitoring for early diagnosis, treatment, and prevention of renal function deterioration.

Development of an evaluation system for rational drug use in patients with chronic kidney disease using the Delphi method.

Chronic kidney disease (CKD) stages 3-4 present a significant clinical challenge due to the absence of a systematic approach to managing associated medication-related problems (MRPs). This lack of a structured framework hinders the timely identification and effective intervention for these complications, potentially compromising patient safety and prognosis. This study aims to leverage the Delphi method to establish an evaluation index for a rational drug use evaluation system dedicated to CKD patients in stages 3-4. This system will function as a platform for the continuous identification and management of MRPs, ultimately contributing to improved medication safety and patient outcomes. This research uses the modified Delphi technique to develop an evaluation system for rational drug use in patients with chronic kidney disease. The initial questionnaire was developed by literature review for patients with chronic kidney disease. Twenty-six senior experts formed a panel in order to evaluate items across two Delphi rounds. Consensus was defined as at least 95% agreement (first round) and 85% agreement (second round), agreeing with an average score of at least 4.5 (first round) and 4.0 (second round). Items that fulfill the stipulated criteria are eligible for inclusion in the consensus list. All experts participated in both rounds (100% response rate). Consensus was achieved on three patient-related items in the first round of 34 items. Based on expert feedback, 18 revised items were included in the second round after refining, restructuring, and removing some elements. Following two rounds of consultation, 20 items achieved consensus, encompassing aspects such as drug selection, dosage assessment, treatment duration, prescription and dispensing practices, patient-related factors, and other relevant considerations. This study has successfully identified 20 key evaluation indicators for a rational drug use evaluation system specifically designed for CKD patients in stages 3 and 4. This system will serve as a tool for continuous MRP identification and timely intervention, ultimately enhancing medication safety and patient prognosis.

Prevalence and outcome of Gastroduodenal lesion and H pylori Infection in Chronic kidney disease, pretransplant and End stage renal disease patients

Prevalence and outcome of Gastroduodenal lesion and H pylori Infection in Chronic kidney disease, pretransplant and End stage renal disease patients

Projecting the Population Level Burden of CKD Progression According to Urine Albumin-to-Creatinine Ratio Categories

IntroductionUrinary albumin-creatinine ratio (uACR) is an independent predictor of chronic kidney disease (CKD) progression, however there is limited evidence on the burden of CKD according to uACR categories at a population level. This study estimates future clinical and financial burden of CKD according to uACR categories using the Inside CKD microsimulation. MethodsThe Inside CKD model is an individual patient level microsimulation that emulates national populations based on demographic, epidemiological and economic data. The analysis estimates clinical and economic outcomes over time according to KDIGO uACR categories (A1–A3) at a population level for 31 countries and regions. ResultsCKD populations (diagnosed and undiagnosed individuals, stages G3-5) were projected to be predominantly within uACR categories A1 and A2 in 2022. Projected cumulative incidence of CKD stage transitions (disease progression) and cardio-renal complications (heart failure, myocardial infarction, stroke, and all-cause mortality) occurred mostly in uACR categories A1 and A2 between 2022–2027. Patients in uACR categories A1 and A2, who represent the largest proportion of patients with CKD, were projected to incur most of the healthcare costs associated with CKD management and cardio-renal complications for the diagnosed population (prevalence 2027). ConclusionThis study highlights the disproportionate population-level clinical and economic burden associated with individuals within KDIGO uACR categories A1 and A2, who represent most of the CKD population. This awareness will help healthcare decision makers to appropriately allocate resource and interventions to the CKD population, including those with mildly to moderately increased albuminuria, to reduce clinical and economic burden associated with CKD.

Impact of Age on Prescribing Patterns of Cardiovascular Medications in Older Japanese Patients with Non-Dialysis-Dependent Chronic Kidney Disease: A Cross-Sectional Study.

Older patients with chronic kidney disease (CKD) are more likely to be excluded from clinical trials. This exclusion affects the quality of cardiovascular disease (CVD) prevention in this population. Baseline data from the Fukuoka Kidney Disease Registry (FKR) cohort, which included 4476 adult patients with CKD stages G1-G5, were cross-sectionally analyzed to compare the use of recommended drugs for preventing CVD in each age group. Different prescribing patterns were observed according to age for the cardiovascular drug classes. Older patients with CKD were less likely to receive renin-angiotensin system (RAS) inhibitors and were more likely to receive calcium channel blockers. The proportion of anticoagulation prescriptions for patients with CKD and atrial fibrillation decreased in the older age group (≥ 75 years). However, the proportion of antiplatelet therapy in patients with ischemic CVD increased linearly with age, even in the very old group aged ≥ 85 years. These findings suggest a severe cardiovascular burden in patients with CKD. Notably, RAS inhibitor use was avoided in the older group despite a severe cardiovascular burden, such as a high prevalence of CVD history and massive albuminuria ＞300 mg/g creatinine. This finding indicates that an older age independently contributed to the non-use of RAS inhibitors, even after adjusting for other covariates. This study suggests that age is a potential barrier to the treatment of patients with CKD and highlights the need to establish individualized treatment strategies for cardiovascular protection in this population.

Safety and efficacy of direct oral anticoagulants in chronic kidney disease: a meta-analysis

BackgroundDirect oral anticoagulants (DOACs) have emerged as the first-line therapy for venous thromboembolism and stroke prophylaxis in atrial fibrillation. As DOACs are partially excreted renally, their safety in patients with chronic kidney disease (CKD) is unclear. ObjectivesTo synthesize primary evidence on the safety profile of DOACs in patients with CKD. MethodsWe searched MEDLINE and Embase from inception to June 2023 for randomized and nonrandomized cohort studies comparing DOACs with vitamin K antagonists (VKAs) in CKD patients. Screening and data collection were conducted in duplicate. The primary safety outcome was major bleeding, defined by International Society on Thrombosis and Haemostasis criteria, stratified by CKD severity. Meta-analysis was done using the Mantel–Haenszel random-effects model, presented as odds ratios (ORs) with corresponding 95% CIs. ResultsOf the 2355 articles captured in the literature search, 25 nonrandomized studies (n = 6832) and 6 randomized studies (n = 66,898) were included. DOACs reduced major bleeding compared with VKAs in all subgroups (stage 4: OR, 0.73; 95% CI, 0.58, 0.93; stage 5/renal replacement therapy: OR, 0.70; 95% CI, 0.50, 0.98; stage unspecified: OR, 0.72; 95% CI, 0.63, 0.83). Apixaban and rivaroxaban both reduced major bleeding in stage 5/renal replacement therapy patients (apixaban: OR, 0.66; 95% CI, 0.52, 0.85; rivaroxaban: OR, 0.58; 95% CI, 0.35, 0.94). ConclusionIn this meta-analysis, DOACs reduced major bleeding compared with VKAs in stage 4, stage 5/renal replacement therapy, and CKD stage unspecified patients. Future analysis should evaluate the impact of specific DOACs and dosage on safety and efficacy in this population.

Influence of Kidney Diseases on Lipid Profile in Patients Undergoing Conservative Managements and Hemodialysis

Kidney function gradually declines as a result of chronic kidney disease (CKD). The current study was conducted at Princess Iman Hospital in Muadi, Jordan from December to March 2024. It aimed to investigate the association between lipids and chronic renal failure (CRF), which refers to the advanced stages of CKD where kidney function has declined significantly, and to understand how dyslipidemia affects the development of CKD and general health outcomes. The study involved three groups of participants: patients with CRF who were on hemodialysis, those receiving conservative management for CRF, and healthy individuals as controls. According to the findings, CRF patients (hemodialysis and conservative management) had significantly higher lipid levels than the control group besides showing low indicators for kidney function (p&lt;0.001). In addition, triglyceride, cholesterol, low-density lipoprotein (LDL) levels, Cholesterol/high-density lipoprotein (HDL) ratio, and LDL/HDL ratio were also found to be significantly high in the hemodialysis group when compared to the conservative group (p&lt;0.001). In this population with CRFs, it was observed that lipid levels correlated positively with markers for kidney disease progression. Therefore, monitoring of lipids should be done regularly across all stages of CKDs to reduce cardiovascular complications associated with atherosclerosis. Hence, incorporating lipid evaluations into standard CKD care regimens, even during the initial phases, is vital for enhancing patient outcomes and lowering mortality risks. In essence, the results highlight the importance of proactive management of lipid levels in CKD individuals to tackle cardiovascular complications effectively. By understanding dyslipidemia's impact on CKD advancement, healthcare practitioners can customize interventions to enhance patient care and diminish related risks, ultimately improving prognosis and decreasing mortality rates among CKD cohorts.

N-terminal pro-B-type natriuretic peptide, eGFR, and progression of kidney disease in chronic kidney disease patients without heart failure.

Cardiorenal syndrome highlights the bidirectional relationship between kidney and heart dysfunction. N-terminal pro-B-type natriuretic peptide (NT-proBNP), which is the gold standard biomarker in heart failure (HF), may be an important biomarker for chronic kidney disease (CKD) progression. However, NT-proBNP is negatively related with estimated glomerular filtration rate (eGFR). In this study, we investigated the association of NT-proBNP, eGFR, and progression of kidney disease in CKD patients without HF. This multicentric retrospective cohort study recruited 23 860 CKD patients without HF, who had at least one NT-proBNP record from China Renal Data System database. Linear regression model evaluated the relationship between eGFR and NT-proBNP. Cox regression analysis assessed the association between NT-proBNP and CKD progression. Sensitivity analysis examined the robustness of the main findings. This study involved 23 860 CKD patients without HF, distributed across different CKD stages: 10 526 in stages G1-2, 4665 in G3a, 3702 in G3b, 2704 in G4, and 2263 in G5. NT-proBNP was negatively correlated with eGFR, particularly in stages 4-5 CKD. A 15-unit decrease in eGFR was associated with increases in log (NT-proBNP) levels by 1.04-fold, 1.27-fold, 1.29-fold, 1.80-fold, and 3.50-fold for stages 1-2, 3a, 3b, 4, and 5, respectively. After excluding patients who developed CKD progression within 1 year, the Cox regression analysis revealed that the relationship between NT-proBNP and CKD progression was not significant in stages 4 and 5. However, for stages 1-3, each standard deviation increase in log (NT-proBNP) was associated with a 26%, 36%, and 28% higher risk of CKD progression, with P interaction ≤.001. The hazard ratios were 1.26 (95% confidence intervals (CI), 1.18 to 1.35), 1.36 (95% CI, 1.22 to 1.51), and 1.28 (95% CI, 1.14 to 1.43) for stages 1-2, stage 3a, and stage 3b, respectively. Despite its strong inverse association with eGFR, NT-proBNP was positively associated with the risk of progression of kidney disease in CKD patients with stages 1-3 without HF. Future studies should investigate the effectiveness of NT-proBNP as a predictive biomarker for the progression of kidney disease across diverse racial groups and healthcare settings.

Association between renal function and fracture incidence during treatment with teriparatide or alendronate: an exploratory subgroup analysis of the Japanese Osteoporosis Intervention Trial-05.

Incidence rate of morphometric vertebral fracture was lower under treatment with once-weekly teriparatide (TPTD) followed by alendronate (ALN) than under treatment with ALN throughout the study among elderly Japanese women at high fracture risk in JOINT-05. This is an exploratory subgroup analysis according to chronic kidney disease (CKD) status at baseline. Participants received sequential therapy with TPTD for 72weeks, followed by ALN for 48weeks (TPTD-ALN group, N = 483) or ALN monotherapy for 120weeks (ALN group, N = 496). Baseline CKD status was classified by the estimated glomerular filtration rate (eGFR) and categorized as: CKD 1/2 (eGFR ≥ 60mL/min/1.73 m2), CKD 3a (eGFR 45-59mL/min/1.73 m2), or CKD 3b/4 (eGFR < 45mL/min/1.73 m2). Incidences of vertebral fractures including morphometric fractures, non-vertebral fractures, and all fractures were evaluated during follow-up. Baseline characteristics were not different between treatment groups. Higher stages of CKD were associated with age and number of prevalent vertebral fracture. In CKD 1/2 patients (N = 556 with 90 incidents of morphometric vertebral fracture), the incidence of vertebral fractures was lower in the TPTD-ALN group than in the ALN group (p = 0.01). In CKD 3b/4 patients (N = 112 with 10 incidents of non-vertebral fracture), the incidence of non-vertebral fractures was lower in the ALN group than in the TPTD-ALN group, although the number of fractures was small. In the ALN group, the incidences of vertebral fractures, non-vertebral fractures, and all fractures remained constant across CKD stages. This exploratory analysis showed that fracture incidence on ALN was constant regardless of renal function. It also suggested that the incidence of vertebral fractures on TPTD-ALN was lower than ALN monotherapy in CKD 1/2 patients. These results provide important information for drug selection in the clinical practice of osteoporosis.

Low-dose spironolactone and cardiovascular outcomes in moderate stage chronic kidney disease: a randomized controlled trial.

Chronic kidney disease (CKD) is associated with a substantial risk of progression to end-stage renal disease and vascular events. The nonsteroidal mineralocorticoid receptor antagonist (MRA), finerenone, offers cardiorenal protection for people with CKD and diabetes, but there is uncertainty if the steroidal MRA, spironolactone, provides the same protection. In this prospective, randomized, open, blinded endpoint trial, we assessed the effectiveness of 25 mg spironolactone in addition to usual care or usual care alone for reducing cardiovascular outcomes in stage 3b CKD among an older community cohort (mean age = 74.8 years and s.d. = 8.1). We recruited 1,434 adults from English primary care, of whom 1,372 (96%) were included in the primary analysis. The primary outcome was time from randomization until the first occurrence of death, hospitalization for heart disease, stroke, heart failure, transient ischemic attack or peripheral arterial disease, or first onset of any condition listed not present at baseline. Across 3 years of follow-up, the primary endpoint occurred in 113 of 677 participants randomized to spironolactone (16.7%) and 111 of 695 participants randomized to usual care (16.0%) with no significant difference between groups (hazard ratio = 1.05, 95% confidence interval: 0.81-1.37). Two-thirds of participants randomized to spironolactone stopped treatment within 6 months, predominantly because they met prespecified safety stop criteria. The most common reason for stopping spironolactone was a decrease in the estimated glomerular filtration rate that met prespecified stop criteria (n = 239, 35.4%), followed by participants being withdrawn due to treatment side effects (n = 128, 18.9%) and hyperkalemia (n = 54, 8.0%). In conclusion, we found that spironolactone was frequently discontinued due to safety concerns, with no evidence that it reduced cardiovascular outcomes in people with stage 3b CKD. Spironolactone should not be used for people with stage 3b CKD without another explicit treatment indication. ClinicalTrials.gov registration: ISRCTN44522369 .

The Impact of Uric Acid-Lowering Therapy on the Progression of Non-dialysis Chronic Kidney Disease: A Prospective Cohort Study.

Background Hyperuricemia treatment can positively influence the progression of chronic kidney disease (CKD). This study aimed to evaluate the impact of uric acid-lowering therapy on the progression of CKD after three months. Materials and methods A prospective cohort study was conducted on 126 patients with non-dialysis CKD in Can Tho Central General Hospital, Vietnam, from December 2018 to December 2019. Adopting a questionnaire survey method to collect information, including demographic characteristics, body mass index (BMI), personal history, previous medical history, diet, and use of drugs with the potential to affect the uric acid levels in the blood. Participants also underwent necessary tests, such as serum uric acid, serum creatinine, and blood lipids. Data were analyzed using SPSS software version 26.0(IBM Corp., Armonk, NY). Results The prevalence of hyperuricemia in patients with non-dialysis CKD was 77.8%, and the average serum uric acid was 494.21 ± 131.57 µmol/L. Patients with a high-purine diet were about 18.85 times as likely to have hyperuricemia as those with a low-purine diet (p < 0.001, OR = 18.85, 95%CI: 4.233-83.938). BMI, stages of CKD, and hypertension were associated with the hyperuricemia rate (p < 0.05). After three months of treatment, 46.2% of patients achieved the serum uric acid target, and the patient group combined allopurinol with changing diet had a higher rate than the patient group changing diet only (p = 0.02). There was a moderate inverse correlation between the difference in serum uric acid and the difference in estimated glomerular filtration rate (eGFR) after treatment (r = -0.5, p = 0.001). Conclusions The effective management of hyperuricemia by combining nonpharmacological (changing diet) and/or pharmacological (allopurinol) therapies may meaningfully improve the glomerular filtration rate in non-dialysis CKD patients with hyperuricemia.

The Role of Healthcare Administration and Policy in Improving Access to Dialysis for ESRD Patients in CKD: Challenges and Solutions

End-Stage Renal Disease (ESRD) presents a critical challenge within the spectrum of Chronic Kidney Disease (CKD) and represents the final stage of CKD, necessitating timely and consistent access to dialysis for patient survival. However, access to dialysis remains significantly constrained in many regions due to a combination of systemic, financial, and infrastructural barriers. This article explores the pivotal role that healthcare administration and policy play in overcoming these challenges to enhance dialysis accessibility for ESRD patients. Multifaceted barriers are there regarding access to dialysis, including the economic burden of treatment, limited availability of dialysis centers, and disparities in healthcare delivery. The analysis then shifts to the policy landscape, discussing existing healthcare policies aimed at expanding dialysis services, as well as gaps that persist in current frameworks. The role of healthcare administration is also scrutinized, particularly in terms of resource allocation, service delivery optimization, and patient education. Through case studies and comparative analysis, it was identified that successful strategies from various regions that have effectively improved access to dialysis. These include public-private partnerships, subsidies, and advancements in telemedicine. The article concludes by offering policy recommendations and administrative strategies tailored to address the unique challenges faced by ESRD patients, emphasizing the need for a collaborative, patient-centered approach in healthcare planning and implementation. By highlighting these key areas, this article aims to provide actionable insights for policymakers, healthcare administrators, and other stakeholders committed to improving dialysis access and, ultimately, patient outcomes for those suffering from ESRD.

Lower extremity amputation rates in patients with chronic kidney disease: A database study comparing patients with and without diabetes mellitus

Lower extremity amputation (LEA) is one of the most feared consequences of diabetes mellitus (DM). The purpose of this study was to evaluate the impact of DM on LEA rates in patients at various stages of chronic kidney disease (CKD).A commercially available de-identified database was searched for patients undergoing LEA and for CKD patients, from 2010 to 2023. Patients with DM and patients without DM who were followed for at least 5 years were included. LEA rates were then compared for patients at all 5 CKD stages in patients with and without diabetes.Rates of all LEA were found to be significantly higher at all CKD stages for patients with diabetes (overall, minor and major LEA). Compared to patients without DM who have CKD stage 5 (end stage renal disease), patients with DM and CKD stage 5 have a 30 fold increased likelihood of undergoing overall LEA [OR 30.2 (24.48–37.19), p < 0.001], 29 fold increased likelihood of undergoing minor LEA [28.9i (22.91–36.35), p < 0.001] and 40 times fold increased likelihood of undergoing major LEA [40.1 (26.59–60.42), p < 0.001]. For all stages of CKD, independent of diabetes status, minor LEA were performed with greater frequency than major LEA. In patients with DM, LEA rates significantly increased with CKD progression between stages 2–5 with a substantial jump between stages 4 and 5 [OR 2.6 (CI 2.49–2.74), p < 0.001]. However, CKD progression between stages 1 and 2 was not significantly associated with increased LEA rates (OR 1.1 (CI 0.92–1.21), p = 0.24) in patients with diabetes.Patients with comorbid diabetes have elevated risk for LEA at all stages of CKD compared to those without diabetes.

Short- and long- term outcomes of mechanical thrombectomy in acute ischemic stroke patients with chronic kidney disease.

Chronic kidney disease (CKD) is a risk factor of acute ischemic stroke (AIS). Outcomes of treatment with mechanical thrombectomy (MT) in patients with CKD seem to be poorer than in the general population. Long‑term follow‑up studies are lacking. Our aim was to asses short- and long‑term outcomes (up to 365 days after stroke) in MT‑treated AIS patients with concomitant CKD. The study included all AIS patients treated with MT at the Comprehensive Stroke Center in Kraków, Poland, from 2019 to 2021. The patients were divided into the CKD group (best glomerular filtration rate [GFR] during hospitalization <60 ml/min/1.73 m2 or diagnosed CKD) and the controls. In‑hospital, 90‑day, and 365‑day mortality and rate of good functional outcomes (defined as modified Rankin Scale ≤2) were compared between the CKD patients and controls as well as between patients with CKD stages 1-3 (GFR ≥30 ml/min/1.73 m2) and 4-5 (GFR <30 ml/min/1.73 m2). Factors associated with the abovementioned outcomes were identified using univariable logistic regression analyses and then added to multivariable analyses. The CKD patients had higher 90- and 365‑day mortality and lower 90- and 365‑day good functional outcome rates than the controls. The patients with CKD stage 4-5 had significantly higher in‑hospital, 90‑day, and 365‑day mortality than the patients with CKD stage 1-3. Neither CKD nor its late stages (4-5) were independently associated with short- and long‑term mortality and functional outcomes of MT. MT outcomes in CKD patients are worse, especially in advanced stages of the disease, but CKD is not independently associated with poor prognosis. CKD alone should not be a contraindication for MT in otherwise eligible patients, although patients with impaired kidney function require more careful postprocedural monitoring.