Chronic Kidney Disease Participants Research Articles

The relationship between serum 1,5-anhydroglucitol and adverse outcomes in acute coronary syndrome with and without chronic kidney disease patients

PurposeIndividuals with chronic kidney disease (CKD) face an elevated residual risk of cardiovascular events, but the relationship between this residual risk and 1,5-anhydroglucitol (1,5-AG) is uncertain. Our study aimed to examine the effect of 1,5-AG on major adverse cardiovascular events (MACEs) and all-cause mortality in acute coronary syndrome (ACS) individuals. Methods1253 ACS participants hospitalized were enrolled at Beijing Hospital between March 2017 and March 2020. All participants were classified into 2 groups based on their eGFR (60 ml/min/1.73 m2). The link between 1,5-AG and adverse outcome was investigated in non-CKD and CKD participants. ResultsCKD patients had reduced concentrations of 1,5-AG than those without CKD. Throughout a median follow-up duration of 43 months, 1,5-AG was an autonomous hazard factor for MACEs and all-cause mortality. 1,5-AG<14 μg/ml participants had greater MACEs and all-cause mortality risk than those with 1,5-AG≥14 μg/ml, regardless of renal function. Furthermore, concomitant reduced concentrations of 1,5-AG and CKD portended a dismal prognosis in ACS patients. Conclusions1,5-AG was autonomously linked to MACEs and all-cause mortality in ACS participants with both non-CKD and CKD. Co-presence of reduced concentrations of 1,5-AG and CKD may portend adverse clinical outcomes.

Association between blood methylmalonic acid and chronic kidney disease in the general US population: insights from multi-cycle National Health and Nutrition Examination Survey (NHANES).

Chronic kidney disease (CKD) is significantly influenced by mitochondrial dysfunction (MD). Previous research suggests that methylmalonic acid (MMA) is involved in MD. Consequently, we aimed to investigate associations between blood MMA level and the prevalence of CKD as well as mortality in patients with CKD. The study included 23,587 individuals from National Health and Nutrition Examination Survey (NHANES). The NHANES datasets from 1999-2004 and 2011-2014 were utilized as separate primary and validation subsets. There were 3,554 patients with CKD. The association of blood MMA level with the prevalence of CKD was investigated using weighted logistic regression. Meanwhile, we employed weighted Cox regression models to evaluate the association between blood MMA level and all-cause mortality in patients with CKD. Blood MMA levels had a significant positive association with urinary albumin-to-creatinine ratio (β=45.29, P=0.01) and negative association with estimated glomerular filtration rate (β=-15.27, P<0.001) in CKD patients. Blood MMA level exhibited a significant increase in participants with CKD compared with those without CKD (7.60±0.86 vs. 7.03±0.62, P<0.001). The level of blood MMA was significantly associated with the prevalence of CKD [odds ratio (OR): 1.32, 95% confidence interval (CI): 1.05-1.64, P=0.01]. In addition, blood MMA level was significantly associated with all-cause mortality in CKD participants [hazard ratio (HR): 1.26, 95% CI: 1.11-1.43, P<0.001] after adjusting for other potential predictors. Increased blood MMA levels were associated with more severe kidney impairment and increased risk of both the prevalence of CKD and mortality in participants with CKD.

#842 Validation of the excessive salt intake screening questionnaire in CKD patients

Abstract Background and Aims Excessive salt intake is implicated in the progression of hypertension, chronic kidney disease (CKD), diabetic nephropathy, cardiovascular diseases, cerebrovascular diseases, and increased mortality. In Japan, average salt consumption surpasses the levels recommended by national guidelines and the WHO. However, individuals seldom have the chance to gauge their salt intake accurately. This study aimed to validate a screening tool initially developed by Sasaki et al. to identify individuals with excessive salt intake using health check-up data from Asahi City, Chiba Prefecture, Japan. Method This study was conducted as a part of the Cities Changing Diabetes (CCD). CCD is Novo Nordisk's commitment to drive action against type 2 diabetes and obesity in cities globally. It is a partnership program to accelerate the prevention of diabetes and obesity by addressing the systemic change in urban environments. Participants of this study were drawn from specific health examinations in Asahi City. Consent was obtained, and dialysis patients were excluded. Spot urine samples were analyzed for sodium and creatinine to estimate daily salt intake via Tanaka's formula. The screening tool incorporated risk factors such as age, gender, Body Mass Index (obesity), hypertension (use of antihypertensive drugs), frequency of soup intake, saltiness of home-cooked meals compared to restaurants, efforts to reduce salt intake, and frequency of dining out. The primary outcome was excessive salt intake, defined as an intake exceeding one standard deviation above the mean. Discrimination was assessed using the Area Under the Curve (AUC), while calibration was evaluated with a calibration plot and the Hosmer-Lemeshow test. Results Of the 1532 CKD participants, the mean age was 76.3 years, with males comprising 46%. The average daily salt intake was 9.3 g (SD: 2.39), and the estimated Glomerular Filtration Rate (GFR) was 50.6 ml/min/1.73 m² (SD: 14.5). The distribution of CKD stages included 1198 stage 3a, 285 stage 3b, 43 stage 4, and 5 stage 5 patients. The AUC of screening tool was 0.65 (95% CI: 0.61 to 0.69), and its calibration slope (with an intercept) was 0.98 (95% CI: 0.72 to 1.25). The Hosmer-Lemeshow test yielded a p-value of 0.626. Conclusion The predictive capability of the existing model for excessive salt intake was limited in the CKD population, which may suggest a need for a screening method distinct from that used in the general population. Factors such as changes in sodium excretion due to reduced renal function and the effects of diuretics should also be considered when interpreting these results. Integrating this questionnaire into routine health check-ups could enhance dietary monitoring and intervention, potentially attenuating the progression of CKD and its associated complications. There remains scope for further refinement of the tool's accuracy by incorporating additional predictors.

Cerebrovascular Carbon Dioxide Reactivity Is Intact in Chronic Kidney Disease

Introduction: Chronic Kidney Disease (CKD) is associated with a substantially elevated risk of stroke. One factor that might contribute to this heightened risk is an impairment in cerebrovascular carbon dioxide reactivity (CVR), the mechanism through which cerebral vessels dilate and constrict in response to fluctuations in arterial carbon dioxide tension (PaCO2). CVR is known to be impaired in other chronic disease states associated with stroke risk; thus, we aimed to determine if CVR is also impaired in patients with moderate to severe CKD (stages III-IV). We hypothesized that CKD patients would exhibit impaired CVR compared to a control group (CON) matched for age, hypertension, and diabetes status. Methods: 9 CKD participants (age=56 ± 17y, eGFR=39 ± 4 mL/min/1.73m2), and 9 CON participants (age=61 ± 6y) underwent a single experimental protocol in which PaCO2 was manipulated via 2-min of hypercapnia (5% CO2) followed by 2-min hypocapnia (voluntary hyperventilation) while heart rate (via ECG), blood pressure (via finger photoplethysmography), middle cerebral artery blood velocity (MCAv; via transcranial Doppler ultrasonography), and end-tidal carbon dioxide (etCO2) were measured continuously. CVR was quantified as the slope of the linear relationship between breath-by-breath etCO2 and MCAv while accounting for blood pressure as a covariate. Hyper-, hypo- and, integrated (hyper + hypo) CVR was compared between groups via a 2-tailed, unpaired T-test. Results: We observed no differences in CVR between groups. Hypercapnic CVR: CKD = 1.4 ± 1.0 cm/s/mmHg, CON = 1.5 ± 0.8 cm/s/mmHg, Hypocapnic CVR: CKD = 1.5 ± 0.8 cm/s/mmHg, CON = 1.5 ± 0.8 cm/s/mmHg, Integrated CVR: CKD = 1.7 ± 1.2 cm/s/mmHg, CON = 1.7 ± 0.6 cm/s/mmHg, P ≥ 0.90. Conclusions: Contrary to our hypothesis, CVR remains intact in CKD stages III-IV. These findings suggest that other mechanisms contribute to the elevated stroke risk observed in this population. Funding: This work was supported by the American Heart Association (Career Development Award #929040, PI: Sprick), and NIH grants R01HL135183 and R33AT010457. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

ASSOCIATION BETWEEN LOW LEVEL BLOOD LEAD EXPOSURE AND MORTALITY IN US ADULTS WITH CHRONIC KIDNEY DISEASE

Objective: This study aimed to explore the association between blood lead and both chronic kidney disease (CKD) and cardiovascular and all-cause mortality among participants with or without CKD in the US adults. Design and method: Date from the National Health and Nutrition Examination Survey (2007-20018) was used and all participants were followed up regularly until December 31, 2019. CKD was defined as an eGFR &lt;60 ml/min/1.73 m2 and/or a urine albumin and creatinine ratio &gt;= 30 mg/g. Logistic regression models were constructed to explore the associations between blood lead and CKD. The Kaplan–Meier analysis with a log-rank test was performed to estimate the cumulative incidence of mortality between groups. Cox proportional-hazards models were used to explore the associations between blood lead and cardiovascular and all-cause mortality. Results: Totally, this study enrolled 22,951 participants, including 4,078 CKD participants. Multivariable logistic regression analysis showed that higher level of blood lead (&gt;=1.82 vs. &lt;0.73) was associated with the increased risk of CKD (OR:1.35, 95% CI: 1.13–1.62, p=0.001). During a mean follow-up duration of 85.21±43.58 months, a total of 2,139 all-cause mortality and 525 cardiovascular mortality were recorded. In multivariable Cox model, compared with the lowest quartiles, highest blood lead level (&gt;=1.82 vs. &lt; 0.73) was associated with a higher risk of cardiovascular mortality (HR:3.36, 95% CI: 1.32–8.53) and all-cause mortality (HR:1.85, 95% CI: 1.18–2.90) in participants with CKD. Conclusions: In conclusion, in this US cohort, low level blood lead exposure may also be a predictive factor for CKD, and increasing blood lead concentrations significantly contributed to enhanced risk of cardiovascular and all-cause mortality in CKD patients. Hence, the reduce of blood lead exposure may reduce risk of mortality in high-risk individuals with CKD.

Triglyceride-glucose index and mortality risk in individuals with or without chronic kidney disease: Insights from a national survey of United States adults, 1999–2018

Background and aimsThe Triglyceride-Glucose Index (TyG) has been proposed as a predictor to mortality, yet its association remains incompletely understood for individuals with or without chronic kidney disease (CKD). Methods and resultsWe analyzed data from the National Health and Nutrition Examination Survey spanning the years 1999–2018. CKD was defined as eGFR level <60 ml/min/1.73 m2 or urinary albumin creatinine ratio ≥30 mg/g. We employed the Cox proportional-hazards model to evaluate the incident risk of mortality associated with TyG among both non-CKD and CKD individuals. In the current analysis, 19,426 individuals were without CKD, while 2975 individuals had CKD. The overall mean TyG was 8.65, with significant difference between non-CKD and CKD individuals (8.60 vs 8.95, P < 0.001). The TyG index exhibited linear associations with incident cardiovascular disease (CVD) mortality and all-cause mortality among non-CKD and CKD individuals, respectively. A per-unit increase in the TyG index was significantly associated with CVD mortality for both non-CKD (HR = 1.24, 95%CI = 1.09–1.41) and CKD participants (HR = 1.19, 95%CI = 1.04–1.36), with no significant difference in the associations between the two groups (P = 0.091). For both non-CKD and CKD participants, TyG index was significantly associated with CVD mortality and all-cause mortality among those with age <65, but not for those with age ≥65. ConclusionsOur findings underscore the TyG index's as a valuable predictive tool for assessing the risk of all-cause and CVD mortality in both individuals with and without CKD.

A Mendelian randomization study: physical activities and chronic kidney disease

Increasing evidence has shown that physical activity is related to a lower risk of chronic kidney disease (CKD), thus indicating a potential target for prevention. However, the causality is not clear; specifically, physical activity may protect against CKD, and CKD may lead to a reduction in physical activity. Our study examined the potential bidirectional relationship between physical activity and CKD by using a genetically informed method. Genome-wide association studies from the UK Biobank baseline data were used for physical activity phenotypes and included 460,376 participants. For kidney function (estimated Glomerular Filtration Rate (eGFR) and CKD, with eGFR < 60 mL/min/1.73 m2), CKDGen Consortium data were used, which included 480,698 CKD participants of European ancestry. Mendelian randomization (MR) analysis was used to determine the causal relationship between physical activities and kidney function. Two-sample MR genetically predicted that heavy DIY (do it yourself) (e.g., weeding, lawn mowing, carpentry, and digging) decreased the risk of CKD (odds ratio [OR] = 0.287, 95% CI = 0.117–0.705, p = 0.0065) and improved the level of eGFR (β = 0.036, 95% CI = 0.005–0.067, p = 0.021). The bidirectional MR showed no reverse causality. It is worth noting that other physical activities, such as walking for pleasure, strenuous sports, light DIY (e.g., pruning and watering the lawn), and other exercises (e.g., swimming, cycling, keeping fit, and bowling), were not significantly correlated with CKD and eGFR. This study used genetic data to provide reliable and robust causal evidence that heavy physical activity (e.g., weeding, lawn mowing, carpentry, and digging) can protect kidney function and further lower the risk of CKD.

The association between appendicular skeletal muscle index and bone mineral density in children and adolescents with chronic kidney disease: A cross-sectional study.

Chronic kidney disease (CKD), a pervasive public health concern, can lead to complications like sarcopenia and reduced bone mineral density (BMD). However, it is still unclear exactly how muscle mass correlates with BMD in youngsters and adolescents with CKD. We aimed to investigate the association between appendicular skeletal muscle index (ASMI) and BMD among children and adolescents with CKD. In our research, we utilized data from the National Health and Nutrition Examination Survey (NHANES) collected between 2011 and 2014 to investigate the association of ASMI with BMD among this population. The association linking ASMI with total BMD was examined through multivariate linear regression models. Furthermore, fitted smoothing curves were employed, as well as generalized additive models. Our analysis finally included 503 CKD participants aged between 8 and 19 years. We found a significant association linking ASMI with total BMD among children and adolescents with CKD. The connection persisted even after accounting for covariates. Upon subgroup analysis, there was a statistically significant association of ASMI with total BMD for both males and females, as well as for Mexican-American and non-Hispanic White populations. However, no significant association was observed in other Hispanic, non-Hispanic Black, or populations of other races. We discovered a positive correlation linking the ASMI and the total BMD in children and teenagers with CKD. In CKD patients, maintaining skeletal muscle mass may be crucial for managing and preventing renal osteodystrophy.

Relationship between immune nutrition index and all-cause and cause-specific mortality in U.S. adults with chronic kidney disease.

The available evidence regarding the association of immune nutrition status with chronic kidney disease (CKD) is limited. Thus, the present study examined whether immunonutrition indices were associated with renal function and mortality among CKD individuals. This study enrolled 6,099 U.S. adults with CKD from the NHANES 2005-2018 database. Participants were matched with National Death Index records until 31 December 2019 to determine mortality outcomes. The time-dependent receiver operating characteristic was utilized to identify the most effective index among the prognostic nutritional index (PNI), system inflammation score (SIS), Naples prognostic score (NPS), and controlling nutritional status (CONUT) for predicting mortality. Cox regression models were employed to evaluate the associations of immunonutrition indices with mortality in participants with CKD. The PNI exhibited the strongest predictive power among the four indices evaluated and the restricted cubic spline analysis revealed a cutoff value of 51 for the PNI in predicting mortality. During a median follow-up of 72 months (39-115 months), a total of 1,762 (weighted 24.26%) CKD participants died from all causes. The Kaplan-Meier curve demonstrated a reduced risk of death for the subjects with a higher PNI compared to those in the lower group. Besides, after adjusting for multiple potential confounders, a higher PNI remained an independent predictor for lower risks of all-cause mortality (HR 0.80, 95%CI: 0.71-0.91, p < 0.001) and cardiovascular disease (CVD) mortality (HR 0.69, 95%CI: 0.55-0.88, p = 0.002) in individuals with CKD. In CKD, a higher PNI level was significantly associated with lower mortality from all causes and CVD. Thus, the clinical utility of this immunonutrition indicator may facilitate risk stratification and prevent premature death among patients with CKD.

COVID-19 disease among children and young adults enrolled in the North American Pediatric Renal Trials and Collaborative Studies registry.

Coronavirus disease of 2019 (COVID-19) has disproportionately affected adults with kidney disease. Data regarding outcomes among children with kidney disease are limited. The North American Pediatric Renal Trials Collaborative Studies Registry (NAPRTCS) has followed children with chronic kidney disease (CKD) since 1987 at 87 participating centers. This study aimed to evaluate the impact of COVID-19 among participants enrolled in the three arms of the registry: CKD, dialysis, and transplant. This was a retrospective cohort study of COVID-19 among participants in the NAPRTCS CKD, dialysis, and transplant registries from 2020 to 2022. Where appropriate, t-tests, chi-square analyses, and univariate logistic regression were used to evaluate the data. The cohort included 1505 NAPRTCS participants with recent data entry; 260 (17%) had documented COVID-19. Infections occurred in all three registry arms, namely, 10% (n = 29) in CKD, 11% (n = 67) in dialysis, and 26% (n = 164) in transplant. The majority of participants (75%) were symptomatic. Hospitalizations occurred in 17% (n = 5) of participants with CKD, 27% (n = 18) maintenance dialysis participants, and 26% (n = 43) of transplant participants. Fourteen percent (n = 4) of CKD participants and 10% (n = 17) of transplant participants developed acute kidney injury (AKI), and a total of eight participants (one CKD, seven transplant) required dialysis initiation. Among transplant participants with moderate to severe illness, 40-43% developed AKI and 29-40% required acute dialysis. There were no reported deaths. COVID-19 was documented in 17% of active NAPRTCS participants. While there was no documented mortality, the majority of participants were symptomatic, and a quarter required hospitalization.

Higher urinary glyphosate exposure is associated with increased risk of liver dysfunction in adults: An analysis of NHANES, 2013-2016.

Glyphosate (GLY) exposure, both exogenous and endogenous, is a global concern. Multiple studies of model systems in vitro and in vivo have demonstrated the potential toxic effects of GLY exposure on human organs, particularly the liver and renal system. However, there is currently limited epidemiological evidence establishing a link between GLY exposure and hepatorenal function in the general population. In this study, a multivariable linear regression model and forest plots were employed to evaluate the connection between urinary GLY and biomarkers of hepatorenal function in 2241 participants from the National Health and Nutrition Examination Survey 2013-2016. Additionally, subgroup analyses were conducted based on age, gender, race, BMI, and chronic kidney disease (CKD). Alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), AST/ALT and fibrosis 4 score (FIB-4) all increased with elevated urinary GLY concentrations after adjusting for potential confounders, while albumin (ALB) exhibited the opposite trend, particularly among younger, female, non-Hispanic white, overweight, and CKD participants. Furthermore, individuals in the third tertile had a greater risk of liver dysfunction than those in the first tertile after categorizing urinary GLY concentrations. However, our study showed no proof that GLY exposure affects the ratio of urine albumin to creatinine (ACR) or serum creatinine levels. Overall, these results imply that GLY exposure may have adverse effects on human liver function.

Gender-specific risk factors and outcomes of hyperkalemia in CKD patients: smoking as a driver of hyperkalemia in men.

Hyperkalemia 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. We 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. Median 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.

Dietary fiber intake and cognitive impairment in older patients with chronic kidney disease in the United States: A cross-sectional study.

High-fiber diet has been associated with better cognitive performance. However, the association between dietary fiber intake and cognition in older patients with chronic kidney disease (CKD) remains unknown. Hence, this study aimed to investigate the effect of dietary fiber intake on cognition in older patients with CKD. This study included participants aged ≥60 years who provided data on social demography, cognitive tests (Consortium to Establish a Registry for Alzheimer's disease Word Learning [CERAD-WL], CERAD Delayed Recall [CERAD-DR], Animal Fluency Test [AFT], and Digit Symbol Substitution Test [DSST]), diet, and other potential cognition-related variables from the National Health and Nutrition Examination Survey 2011-2014. Fully-adjusted multivariate logistic regression subgroup models were performed, and multiple linear regression analyses were employed to examine the association between dietary fiber intake and cognition in patients with CKD. A total of 2461 older adults were included, with 32% who suffered from CKD. Participants with CKD scored lower in CERAD-WL, CERAD-DR, AFT, and DSST. Patients with CKD consuming low dietary fiber (≤25 g/day) had a higher risk of CERAD-WL and DSST impairments. High dietary fiber intake eliminated the differences in CERAD-WL and DSST impairments between the CKD and non-CKD participants. However, no associations were observed between CKD and CERAD-DR and AFT impairments regardless of dietary fiber intake. A positive linear relationship between dietary fiber intake and AFT score was observed in older patients with CKD. High dietary fiber intake may benefit cognitive function in older patients with CKD. High-fiber diet management strategies could potentially mitigate cognitive impairment in this group of patients.

Associations of periodontitis with risk of all-cause and cause-specific mortality among us adults with chronic kidney disease

ObjectivesTo investigate the associations of periodontitis with risk of all-cause and cause-specific mortality in a nationally representative sample of adults with chronic kidney disease (CKD) in the United States. MethodsThis prospective cohort study included 4,271 individuals aged ≥30 years at baseline with CKD participants in the National Health and Nutrition Examination Survey (NHANES) during 1988–1994, 1999–2004, and 2009–2014. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m2 and/or urinary albumin/creatinine ratio (uACR) ≥30 mg/g. Multivariate cox proportional hazards regression models were used to estimate the hazard ratios (HRs) and 95 % confidence intervals (CIs) of all-cause and cause-specific mortality in participants with CKD according to periodontitis. The associations of the quartiles of mean clinical attachment loss (CAL) and mean periodontal probing depth (PPD) levels with mortality were examined using the first quartile as the reference group. ResultsDuring a median of 8.67 years of follow-up, 2,146 deaths were documented. After multivariate adjustments, moderate/severe periodontitis was significantly associated with all-cause (HR:1.28; 95 % CI:1.11–1.47; P = 0.001) and cardiovascular disease (CVD)-related mortality (HR:1.44; 95 % CI:1.14–1.81; P = 0.002) in participants with CKD. Compared with the reference group of mean CAL and mean PPD levels, all-cause (CAL: HR, 1.58; 95 % CI, 1.32–1.89, P <0.001; PPD: HR, 1.35, 95 % CI, 1.09–1.67, P = 0.011) and CVD-related mortality (CAL: HR, 1.70, 95 % CI, 1.21–2.40, P = 0.001) were increased for participants in the highest quartile. ConclusionsThis study suggests that moderate/severe periodontitis and high levels of mean CAL and mean PPD are associated with an increased risk of all-cause mortality, and moderate/severe periodontitis and mean CAL associated with CVD-related mortality among adults with CKD in the US. Clinical SignificanceThis study details the association between periodontitis and the increased risk of all-cause mortality and CVD-related mortality in a large, representative sample of adults with CKD.

Novel Assessment of Viscoelastic Skeletal Muscle Properties in Chronic Kidney Disease: Association with Physical Functioning

Chronic kidney disease (CKD) is characterised by poor physical function. Mechanical muscle properties such as tone, elasticity, and stiffness influence the functional state of the muscle. Measuring these muscle mechanical properties is difficult and data on CKD are sparse. Using a novel myotonometer device, the aims of this study were to compare the viscoelastic muscle properties in CKD patients with previously reported data and to explore the association with muscle function. Non-dialysis-dependent CKD participants were recruited into a cross-sectional study conducted between 2018 and 2020. Muscle properties (tone, stiffness, elasticity) were assessed using a myotonometer (MyotonPRO). Muscle function was assessed using physical performance tests (sit-to-stand 5 and 60, timed up and go, short physical performance battery, gait speed, incremental shuttle walk, postural sway). General linear regression models were used to explore the association between muscle properties and physical function. Thirty-nine participants were included (age 64.2 (SD: 10.4) years; 51% male; eGFR 40.9 (SD: 20.0) mL/min/1.73 m2). Participants with CKD had reduced muscle tone, stiffness, and elasticity compared to previously reported studies. Muscle tone (B = −0.567, p = 0.003) and muscle stiffness (B = −0.368, p = 0.071) were greater in males than females. Increased BMI was associated with lower muscle tone (B = −0.528, p = 0.002) and muscle stiffness (B = −0.577, p = 0.002). No meaningful nor consistent associations were found between these properties and measures of muscle function and physical performance. In conclusion, using a novel handheld myotonometer, this study found that CKD patients exhibit a reduction in muscle tone, stiffness, and elasticity. In a passive state, these viscoelastic muscle properties showed no consistent associations with physical performance.

Urinary peptidomic liquid biopsy for non-invasive differential diagnosis of chronic kidney disease.

Specific urinary peptides hold information on disease pathophysiology, which, in combination with artificial intelligence, could enable non-invasive assessment of chronic kidney disease (CKD) aetiology. Existing approaches are generally specific for the diagnosis of single aetiologies. We present the development of models able to simultaneously distinguish and spatially visualize multiple CKD aetiologies. The urinary peptide data of 1850 healthy control (HC) and CKD [diabetic kidney disease (DKD), immunoglobulin A nephropathy (IgAN) and vasculitis] participants were extracted from the Human Urinary Proteome Database. Uniform manifold approximation and projection (UMAP) coupled to a support vector machine algorithm was used to generate multi-peptide models to perform binary (DKD, HC) and multiclass (DKD, HC, IgAN, vasculitis) classifications. This pipeline was compared with the current state-of-the-art single-aetiology CKD urinary peptide models. In an independent test set, the developed models achieved 90.35% and 70.13% overall predictive accuracies, respectively, for the binary and the multiclass classifications. Omitting the UMAP step led to improved predictive accuracies (96.14% and 85.06%, respectively). As expected, the HC class was distinguished with the highest accuracy. The different classes displayed a tendency to form distinct clusters in the 3D space based on their disease state. Urinary peptide data present an effective basis for CKD aetiology differentiation using machine learning models. Although adding the UMAP step to the models did not improve prediction accuracy, it may provide a unique visualization advantage. Additional studies are warranted to further validate the pipeline's clinical potential as well as to expand it to other CKD aetiologies and also other diseases.

Effect of Non-Surgical Periodontal Therapy on Renal Function Among Pre-Dialysis Chronic Kidney Disease Patients

Background: Association between chronic kidney disease (CKD) and periodontitis has been established. The aim of this study was to determine the effect of non-surgical periodontal therapy (NSPT) on renal function among pre-dialysis CKD patients. Methods: This is an intervention study involving 120 CKD participants. 60 CKD participants constituted the intervention group while 60 CKD participants constituted the control group. Blood samples were collected from all participants at baseline and after 3 months for the measurement of high sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), and serum creatinine for the estimation of glomerular filtration rate (eGFR). Periodontal clinical examination was performed in all participants at six sites per tooth by the researcher for the measurement of Probing Pocket Depth (PPD) and Clinical Attachment Loss (CAL). The intervention group received NSPT (scaling and root planning) and oral hygiene motivation while the control group received only oral hygiene motivation only. Re-evaluation was done after 3 months. Results: In this study, three months post NSPT, PPD reduced from 5.44mm to 3.17mm (P &lt; 0.01) and CAL from 6.29mm to 4.29mm (P &lt; 0.01) in the intervention group. There was also a statistically significant reduction in the mean values of hsCRP and IL-6 at 3 months post NSPT in the intervention group (p&lt;0.01). However, there was no reduction observed in the control group (p=0.59 and 0.66) respectively. Estimated GFR (eGFR) for the intervention group improved from 40.55 mL/min/1.73m2 to 43.22 mL/min/1.73m2 three months post NSPT (P &lt; 0.01). Conclusion: This study demonstrates the potential beneficial effects of NSPT on renal function among pre-dialysis CKD participants as estimated by improvement in eGFR.

Serum miRNA-146a and vitamin D values in chronic renal ailment with and without comorbid cardiovascular disease

ABSTRACT Chronic kidney disease (CKD) is a global concern and is a serious health issue that is closely associated with cardiovascular disease (CVD). Accordingly, there is a rising clinical demand for promoting the importance of the screening and diagnosis of CVD in CKD patients. The purpose of this research was to assess the effectiveness of blood microRNA-146a and vitamin D levels in CKD detection and cardiovascular complications prediction. When CKD participants, either complicated or not, were compared to the control group, plasma rates of Vascular adhesion molecule-1 (VCAM-1) and microRNA-146a were greater, while serum vitamin D values were markedly smaller. Hence, although blood miR-RNA146a quantities can be used as a reliable and particular CKD biomarker, they cannot be used to identify CVD in CKD patients since its level was not significantly different in CKD and CKD+CVD patients.

Ticagrelor or Clopidogrel as Antiplatelet Agents in Patients with Chronic Kidney Disease and Cardiovascular Disease: A Meta-analysis.

The worldwide prevalence of chronic kidney disease (CKD) has significantly increased in the past decades. Scientific reports have shown CKD to be an enhancing risk factor for the development of cardiovascular disease (CVD), which is the leading cause of premature death in patients with CKD. Clinical practice guidelines are ambiguous in view of the use of antiplatelet drugs in patients with CKD because patients with moderate-to-severe CKD were often excluded from clinical trials evaluating the efficacy and safety of anticoagulants and antiplatelet agents. In this analysis, we aimed to systematically assess the adverse cardiovascular and bleeding outcomes that were observed with ticagrelor versus clopidogrel use in patients with CKD and cardiovascular disease. Electronic databases including Web of Science, Google Scholar, http://www. gov , Cochrane database, EMBASE, and MEDLINE were carefully searched for English-based articles comparing ticagrelor with clopidogrel in patients with CKD. Adverse cardiovascular outcomes and bleeding events were the endpoints in this study. The latest version of the RevMan software (version 5.4) was used to analyze the data. Risk ratios (RR) with 95% confidence intervals (CI) were used to represent the data post analysis. A total of 15,664 participants were included in this analysis, whereby 2456 CKD participants were assigned to ticagrelor and 13,208 CKD participants were assigned to clopidogrel. Our current analysis showed that major adverse cardiac events (MACEs) (RR: 0.85, 95% CI: 0.71-1.03; P = 0.09), all-cause mortality (RR: 0.82, 95% CI: 0.57- 1.18; P = 0.29), cardiovascular death (RR: 0.83, 95% CI: 0.56-1.23; P = 0.35), myocardial infarction (RR: 0.87, 95% CI: 0.70-1.07; P = 0.19), ischemic stroke (RR: 0.80, 95% CI: 0.58-1.11; P = 0.18), and hemorrhagic stroke (RR: 1.06, 95% CI: 0.38-2.99; P = 0.91) were not significantly different in CKD patients who were treated with ticagrelor versus clopidogrel. Thrombolysis in myocardial infarction (TIMI)-defined minor (RR: 0.89, 95% CI: 0.52-1.53; P = 0.68) and TIMI major bleeding (RR: 1.10, 95% CI: 0.69-1.76; P = 0.67) were also not significantly different. However, bleeding defined according to the academic research consortium (BARC) bleeding type 1 or 2 (RR: 1.95, 95% CI: 1.13-3.37; P = 0.02) and BARC bleeding type 3 or 5 (RR: 1.70, 95% CI: 1.17-2.48; P = 0.006) were significantly higher with ticagrelor. When compared with clopidogrel, even though ticagrelor was not associated with higher risk of adverse cardiovascular outcomes in these patients with CKD, it was associated with significantly higher BARC bleeding. Therefore, the safety outcomes of ticagrelor still require further evaluation in patients with CKD. Nevertheless, this hypothesis should only be confirmed with more powerful results that could usually only be achieved using large-scale randomized trials.

Determination of serum KIM-1 in patients with chronic kidney injury

Background: Chronic kidney disease (CKD) affects more than 800 million people worldwide and is one of the leading non-communicable causes of death. Despite being a latent issue, once renal damage has started, the disease can rapidly progress to an advanced stage. Aims and Objectives: Currently, the most commonly used markers for the diagnosis of renal disease are non-specific and insensitive. As a result, the goal of the current study is to investigate whether KIM-1 could be a precise and sensitive biomarker for identifying early kidney injury in CKD patients. Materials and Methods: This case–control study recruited 155 participants from the Index Medical College Hospital v Research Centre, Indore, Madhya Pradesh, based on inclusion and exclusion criteria. 150 non-CKD subjects matched for age and sex were also taken from the hospital. The levels of KIM-1 were compared between CKD and non-CKD participants. Serum creatinine, urea, and creatinine clearance were also measured. Results: The levels of KIM-1 were substantially higher in CKD patients than in non-CKD participants. In addition, a negative relationship between KIM-1 and creatinine clearance was observed with a P&lt;0.05. Conclusion: KIM-1 is a precise and sensitive kidney injury biomarker that can identify early kidney injury in CKD and contribute to the progression of interstitial fibrosis in kidney disease.