Chronic Kidney Disease Patients Stages Research Articles

Wireless Detection of Trace Ammonia: A Chronic Kidney Disease Biomarker.

Elevated levels of ammonia in breath can be linked to medical complications, such as chronic kidney disease (CKD), that disturb the urea balance in the body. However, early stage CKD is usually asymptomatic, and mass screening is hindered by high instrumentation and operation requirements and accessible and reliable detection methods for CKD biomarkers, such as trace ammonia in breath. Enabling methods would have significance in population screening for early stage CKD patients. We herein report a method to effectively immobilize transition metal selectors in close proximity to a single-walled carbon nanotube (SWCNT) surface using pentiptycene polymers containing metal-chelating backbone structures. The robust and modular nature of the pentiptycene metallopolymer/SWCNT complexes creates a platform that accelerates sensor discovery and optimization. Using these methods, we have identified sensitive, selective, and robust copper-based chemiresistive ammonia sensors that display low parts per billion detection limits. We have added these hybrid materials to the resonant radio frequency circuits of commercial near-field communication (NFC) tags to achieve robust wireless detection of ammonia at physiologically relevant levels. The integrated devices offer a noninvasive and cost-effective approach for early detection and monitoring of CKD.

Denosumab for osteoporosis in patients suffering from chronic kidney disease; a review on current data

Osteoporosis is one of the complications that affects patients with chronic kidney disease (CKD). To treat this complication, denosumab is one of the prescription drugs. We investigated articles with the keywords of "CKD" OR "Chronic Kidney Disease" AND "Denosumab" in the title in PubMed database. Evidence shows the advantages of using denosumab over bisphosphonate in CKD patients. Also, some studies stated that this drug does not have a negative effect on kidney function and its effectiveness is the same in people with different kidney function. The common complication of taking this drug is hypocalcemia, which can be controlled with appropriate approaches in these patients. It is also important to pay attention to adherence and continuity of medication. Some studies also stated that this drug is contraindicated in CKD patients (stage 4 and 5).

A new approach for cognitive impairment pattern in chronic kidney disease.

Chronic kidney disease (CKD) is associated with an elevated risk of neurocognitive disorders (NCDs). It remains unclear whether CKD-related NCDs have a specific cognitive pattern or are earlier-onset phenotypes of the main NCDs (vascular NCDs and Alzheimer's disease). We used the Mini Mental State Examination score (MMSE) to assess cognitive patterns in 3003 CKD patients (stage 3-4) followed up over 5 years in the Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort. After normalizing MMSE scores to a 0-to-100 scale, the associations between the baseline estimated glomerular filtration rate (eGFR, using the Chronic Kidney Disease Epidemiology Collaboration creatinine formula) and changes in each MMSE domain score were assessed in linear mixed models. Patients (age: 67±13years old; males: 65%, mean eGFR: 33± 12mL/min/1.73m2) had a good baseline cognitive functions: the mean MMSE score was 26.9/30±2.9. After adjustment for age, sex, educational level, depression (past or present), cardiovascular risk factors and cerebrovascular disease, a lower baseline eGFR (per 10mL/min/1.73m2) was associated with a 0.53-point decrement [P<.001; 95% confidence interval (CI) (-0.98, -0.08)] for orientation, a 1.04-point decrement [P=.03; 95% CI (-1.96, -0.13)] for attention and calculation, a 0.78-point decrement [P=.003; 95% CI (-1.30, -0.27)] for language, and a 0.94-point decrement [P=.02; 95% CI (-1.75, -0.13)] for praxis. Baseline eGFR was not, however, associated with significant changes over time in MMSE domain scores. A lower eGFR in CKD patients was associated with early impairments in certain cognitive domains: praxis, language and attention domains before an obvious cognitive decline. Early detection of NCD in CKD patients must be performed before clinically cognitive decline using preferably tests assessing executive, attentional functions and language, rather than memory tests. This early cognitive screening could lead to a better management of cognitive impairment and their consequences on CKD management.

Progressive alterations of left atrial and ventricular volume and strain across chronic kidney disease stages: a speckle tracking echocardiography study.

It has been a scarcity of evidence regarding differences in left ventricular (LV) and left atrial (LA) size and strain changes across stages of chronic kidney disease (CKD) and which echocardiographic parameters could be utilized to predict the decline of glomerular filtration rate (GFR). This study aimed to evaluate the alterations of LV and LA strain across the reduction of renal function and potential echocardiographic parameters which could be correlated with the GFR decline among patients with CKD. A cross-sectional study was conducted on 169 CKD patients at Bach Mai General Hospital, Hanoi, Vietnam from April to November 2022. Demographic, clinical and laboratory characteristics of patients were collected. Transthoracic echocardiography was performed to measure LV and LA size and strains. Jonckheere-Terpstra test was used to measure the tendency of change. Multivariate linear regression models were performed to find associations between different echocardiographic parameters and renal function reduction. The number of patients with CKD stages 1, 2, 3, 4, and 5 was 21 (12.4%), 28 (16.6%), 27 (16.0%), 22 (13.0%) and 71 (42.0%), respectively. CKD severity was positively associated with LV diastolic and systolic diameters, LV mass, E/e' ratio, and maximal tricuspid regurgitation velocity (TR max), and negatively correlated with the LV global longitudinal strain. Higher severity of CKD stage was associated with higher LA diameter, LA strain, and volume in four and two-chamber views, and lower LA reservoir and conduit function. Left ventricular mass (β = 0.068), ejection fraction (β = 0.112) and left atrial reservoir (β = -0.077) were associated with reduced GFR. Left ventricular mass, ejection fraction, and atrial longitudinal strain by STE should be done at the earlier stages of CKD patients for better follow-up of GFR decline.

Association of carbohydrate intake from different sources with all-cause and cardiovascular mortality among chronic kidney disease populations: assessment of 1999–2018 National Health and Nutrition Examination Survey participation

This study analysed the data from the NHANES (1999–2018) to examine how different sources of carbohydrate intake affected the all-cause and cardiovascular mortality of 11,302 chronic kidney disease (CKD) patients. The data were adjusted for other factors using various methods. The results showed that CKD patients (stages 1-2 and 3-5) who consumed more carbohydrates from whole grains, fruits, vegetables and less carbohydrates from fruit juice or sauces had lower mortality rates. Replacing fat intake with carbohydrates from whole grains (HR = 0.86[0.78–0.95]), fruits (raw) (HR = 0.79[0.70–0.88]) and non-starchy vegetables (HR = 0.82[0.70–0.96]), but not protein intake, was linked to lower all-cause mortality. The fibre content in carbohydrates might partly account for the benefits of selected carbohydrate intake. This study provided practical recommendations for optimising the carbohydrate sources in CKD patients.

The Effect of Sodium Bicarbonate Supplementation on Serum Alpha Klotho in Chronic Kidney Disease Patients Stage 3b to 4

Abstract Background Growing evidence suggests that the FGF–Klotho endocrine system also has a crucial role in the pathophysiology of ageing-related disorders, including diabetes, cancer, arteriosclerosis and chronic kidney disease. Aim of the Work The present study aimed to ascertain the potential significance of oral sodium bicarbonate supplementation on soluble α-Klotho serum levels in chronic kidney disease (stage 3b:4) according to CKD-EPI formula. Patients and Methods This was an uncontrolled clinical trial conducted on Inward and OPC patients at El-Demerdash Internal Medicine Hospital. The baseline values of plasma α-klotho were measured in 45 patients having CKD with an estimated glomerular filtration rate (eGFR) of (15:44) mL/min/1.73 m2 (according to CKD-EPI formula) with follow up plasma α-klotho after 3 months of taking sodium bicarbonate tabs orally 0.5 g/12 hrs. Results In our study, 14 (Fourteen) patients with Hypertension, 13 (Thirteen) patients Diabetes, 6 (Six) patients Glomerulus's nephritis, 6 (Six) patients Repeated urinary tract infection, 4 (Four) patient Recurrent stones, 4 (Four) patient Polycystic kidney and 2 (Two) patient Systemic lupus. The Klotho (pg/mL) Before ranged from 296.7 to 976.5 with mean 596.30 ± 202.89 and the Klotho (pg/mL) After ranged from 327.4 to 988.6 with mean 696.16 ± 185.32. The Hco3 before ranged from 17.6 to 22.5 with mean 19.74 ± 1.43 and the Hco3 After ranged from 15 to 28.3 with mean 23.63 ± 3.23. The current study showed that there was non statically significant correlation Between Klotho (pg/mL) and SPB, DPB, Pulse, Temperature, Respiratory rate. The present study showed that there was non statically significant correlation Between Klotho (pg/mL) and Platelets, Urea, Creat, U. creatinine, U. albumin, A/C Ratio, E-GFR, Na, K, Ca, Po4. There was Non statically significant correlation Between Klotho (pg/mL) and Hco3 Before, and there was statically significant Positive correlation Between Klotho (pg/mL)After and Hco3 After. Conclusion There was highly significant difference found between before and after sodium bicarbonate supplementation in terms of Klotho and Hco3 in chronic kidney disease patients stage 3b to 4.

Frailty in Patients With Chronic Kidney Disease Stage Five.

Aim To study the prevalence of frailty in patients with chronic kidney disease stage 5 (CKD5) and to assess coexisting factors associated with frailty in chronic kidney disease. Patients and methods We studied the prevalence of frailty in CKD5 patients from November 2021 to November 2022. CKD5 patients over 18 years of age were included. Patients on maintenance hemodialysis and CKD5 patients on pre-dialysis care were included. Patients with active infection and significant morbidity were excluded. We performed a history and clinical examination and recorded laboratory data. We performed frailty assessments using modified Fried's criteria. Frailty was defined based on previously validated Fried's criteria, which included 1. Slowness, 2. Weakness, 3. Unintentional weight loss, 4. Exhaustion, 5. Low physical activity. A patient is considered frail if three or more components are present. We evaluated the prevalence of frailty in pre-dialysis and dialysis care participants and the association of frailty with coexisting factors. Results Of the 139 patients, 84 were on thrice-weekly hemodialysis, and 55 were on pre-dialysis care. We found the prevalence of frailty to be 41%. The prevalence of frailty was similar in patients on pre-dialysis care and hemodialysis. The prevalence of frailty in hemodialysis patients and those in pre-dialysis care was 43% and 40%, respectively. The prevalence of frailty among the elderly (over 55) was 82%. The prevalence of frailty among diabetes patients was 75%. Factors with a statistically significant association with frailty included old age (p< 0.005), native kidney disease (p < 0.005), edema (p < 0.001), intradialytic hypotension (p = 0.002), and various comorbidities like diabetes (p < 0.001), heart failure (p < 0.001), coronary artery disease (p = 0.001), and cerebrovascular accidents (p = 0.016). We observed no significant association with the duration of chronic kidney disease (CKD) (p = 0.458), duration of dialysis (p = 0.838), or body mass index (BMI) (p = 0.267). The most commonly reported frailty components were exhaustion (61.9%), low physical activity (61.2%), and weak handgrip (55.4%). Conclusion Frailty is a marker of increased vulnerability to adverse outcomes. A significant proportion, 41% of CKD5 patients, are frail. Dialysis does not affect the prevalence of frailty in CKD5 patients. Old age, native kidney disease, edema, intradialytic hypotension, and comorbidities like diabetes, heart failure, coronary artery disease, and cerebrovascular accident are significantly associated with frailty in CKD5 patients. CKD patients with those conditions should receive special care to reduce the development of frailty.

Factors Associated with Accelerated Progression of Chronic Kidney Disease in Patients from the Colombian Caribbean Coast

Background: Chronic Kidney Disease (CKD) is a global public health problem with increasing prevalence and a substantial burden on healthcare systems. The characteristics of rapid progressors and factors that may predict accelerated CKD progression require further exploration, especially since there are no published studies about this topic in Colombia. Purpose: To identify the clinical and sociodemographic factors associated with the rapid progression of CKD in a large cohort of Colombian patients. Methods: This retrospective observational study included two cohorts of G1 to G4 stage CKD patients without dialysis from the Colombian North Coast. Follow-up was conducted for 18 months (n=14,420) and 24 months (n=10,042). Patients were divided into rapid progressors and stable progressors based on the glomerular filtration rate (GFR) slope &lt;?5 mL/min/1.73m2/year or ?-5 mL/min/1.73 m2/year, respectively. Results: 37.68% of the cohort was classified as rapid progressors at 24 months and 28.41% at 18 months. An R2=0.77 was found in both cohorts for GFR measurements, indicating a linear trend toward loss. Furthermore, accelerated progression was observed in younger patients and those with higher diastolic blood pressure values. Conclusion: In two large cohorts of renal patients, approximately 4 out of 10 patients were classified as rapid progressors at 24 months of follow-up and 3 out of 10 at 18 months of follow-up. It is important to identify patients at higher risk of accelerated CKD progression in the short term to provide them with personalized and effective care.

Prevalence of Hypertension and Diabetes in Chronic Kidney Disease: A Tertiary Care Hospital Based Cross-sectional Study in Mymensingh, Bangladesh

Background: Chronic kidney disease (CKD) is a worldwide public health problem. It is usually associated with hypertension (HTN) and diabetes mellitus (DM) and the prevalence of these complications increases progressively with worsening CKD. Objective: To find out the association of HTN and DM with different stages of CKD. Methods: This cross-sectional study was conducted at the Department of Physiology, Mymensingh Medical College, Bangladesh, for one year from January to December 2016. A total number of 73 diagnosed CKD patients and 73 non-CKD individuals were enrolled in the study. Blood pressure was measured by using a sphygmomanometer and stethoscope. Serum glucose concentrations were measured by using an auto-analyzer. Results: Hypertension and diabetes were more prevalent in CKD than in non-CKD individuals, which were statistically significant. Among 73 CKD patients, 42.5% were diagnosed as hypertensive, and 34.3% were diagnosed as diabetic. Conclusion: This study revealed that the prevalence of HTN and DM is common in all stages of CKD patients in Mymensingh, Bangladesh. It emphasizes the need for regular checking of blood pressure, blood glucose, serum creatinine and estimated glomerular filtration rate (eGFR) level in CKD patients and early referral to nephrologists. Mediscope 2023;10(2): 63-67

The effect of a ketogenic diet on weight loss in CKD: a randomized controlled trial in obese stage G1-3a CKD patients.

This study describes a multicentre randomized controlled trial comparing the effects of a ketogenic diet with a low-energy standard diet containing 0.8g/kg/day on weight loss and metabolic alterations in adult patients with mild-to-moderate non-diabetic chronic kidney disease (CKD) and mild-to-severe obesity. The study is being conducted to understand the impact of the ketogenic diet on weight loss in these patients, as the existing evidence on the ketogenic diet's effect in CKD patients is limited and inconclusive. The study will enrol mild-to moderate adult CKD patients (Stages G1-3a) with albumin to creatinine ratio ≥200mg/g, without diabetes, with obesity (body mass index ≥30kg/m2), and stable body weight and estimated glomerular filtration rate from at least 3months. The primary outcome will be weight loss at 6months, and secondary outcomes will include adherence to prescribed dietary regimens, body composition changes, changes in standardized blood pressure measurements, metabolic parameters, lipid profile, liver profile, mineral bone disease biomarkers, and changes in renal function and albuminuria. The findings of this study will contribute to a better understanding of the potential benefits and risks of the ketogenic diet in CKD patients with obesity. The results will help guide future research on the ketogenic diet and renal health.

24-h Urinary Calcium Excretion and Renal Outcomes in Hospitalized Patients with and without Chronic Kidney Disease.

This study investigated the impact of 24-h urinary calcium excretion (UCaE) on renal function decline in hospitalized patients with and without chronic kidney disease (CKD). This study enrolled 3815 CKD patients in stages 1-4 and 1133 non-CKD patients admitted to the First Center of the Chinese PLA General Hospital between January 2014 and July 2022. The primary outcome for CKD patients was a composite of CKD progression, defined as a 40% decline in estimated glomerular filtration rate (eGFR) or end-stage kidney disease. Annual eGFR change was the secondary outcome. For non-CKD patients, the primary outcome was an eGFR decline of ≥20% or CKD incidence, while annual eGFR change was the secondary outcome. The association between UCaE and kidney function decline was assessed using Cox proportional hazards and generalized linear models. Primary outcomes were observed in 813 CKD patients and 109 non-CKD patients over a median follow-up of 3.0 and 4.1 years, respectively. For CKD patients, every 1-mmol/d increase in UCaE was associated with a 15% decreased risk of CKD progression. The hazard ratio (HR) was 0.85, with a 95% confidence interval (CI) of 0.77-0.93. For non-CKD patients, the risk of renal function decline decreased by 11%. The multivariate models indicated that there was an annual decrease in eGFR in both CKD and non-CKD patients, with a reduction of 0.122 mL/min/1.73 m2/year (p < 0.001) and 0.046 mL/min/1.73 m2/year (p = 0.004), respectively, for every 1-mmol/d increase in UCaE. CKD experiences a decrease in 24-h UCaE as early as stage 1, with a significant decline in stage 4. CKD and non-CKD patients with lower UCaE levels are at an increased risk of renal decline, regardless of other variables.

In vivo evaluation of an innovative synbiotics on stage IIIb-IV chronic kidney disease patients.

Microbiota unbalance has been proven to affect chronic kidney disease (CKD) patients and, noteworthy, microbiota composition and activity are implicated in CKD worsening. The progression of kidney failure implies an exceeding accumulation of waste compounds deriving from the nitrogenous metabolism in the intestinal milieu. Therefore, in the presence of an altered intestinal permeability, gut-derived uremic toxins, i.e., indoxyl sulfate (IS) and p-cresyl sulfate (PCS), can accumulate in the blood. In a scenario facing the nutritional management as adjuvant therapy, the present study assessed the effectiveness of an innovative synbiotics for its ability to modulate the patient gut microbiota and metabolome by setting a randomized, single-blind, placebo-controlled, pilot trial accounting for IIIb-IV stage CKD patients and healthy controls. Metataxonomic fecal microbiota and fecal volatilome were analyzed at the run-in, after 2 months of treatment, and after 1 month of wash out. Significant changes in microbiota profile, as well as an increase of the saccharolytic metabolism, in feces were found for those CKD patients that were allocated in the synbiotics arm. Noteworthy, the here analyzed data emphasized a selective efficacy of the present synbiotics on a stage IIIb-IV CKD patients. Nonetheless, a further validation of this trial accounting for an increased patient number should be considered. https://clinicaltrials.gov/, identifier NCT03815786.

#5864 EFFECT OF IV FERRIC CARBOXYMALTOSE ON PHYSICAL PERFORMANCE AND QOL IN PATIENTS WITH CKD NOT ON DIALYSIS, MILD ANEMIA AND IRON DEFICIENCY

Abstract Background and Aims Iron deficiency (ID) in patients with chronic kidney disease (CKD) is highly prevalent and contributes to a poorer quality of life. According to current guidelines, treatment with intravenous (IV) iron is limited to CKD patients with ID and anemia to avoid/delay the use of erythropoiesis-stimulating agents (ESAs) or the reduce the doses of ESA in patients treated with these drugs. Considering the effects of the correction of ID in other settings, we hypothetized that treatment with IV iron in patients with ID and borderline anemia can improve physical performance and their quality of life, independent of the effects on hemoglobin. Method Prospective, unicentric, single-arm study in CKD patients with ID, mild anemia and with-out heart failure. The inclusion criteria were: age ≥ 18 years, CKD patients stages 3–5 not on dialysis, iron deficiency (ferritin &amp;lt;100 ng/ml or ferritin &amp;lt;200 ng/ml if TSAT &amp;lt;20%), mild anaemia (Hb 10.5-11.5 g/dL). At the baseline visit, after all the studies were performed, iv ferric carboxymaltose was administered in a single dose, according to the degree of ID calculated by the Ganzoni´s formula. The co-primary outcome was the change in physical performance, evaluated through the 6 minute-walk test (6MWT) at one week and at four weeks. Secondary end-points: Patient's global assessment (PGA) and quality of life (EQ-5D), Piper's fatigue test, serum phosphorous at four week. Laboratory data, PGA, EQ-5D and Piper test questionnaires were evaluated at baseline, and at weeks 1 and 4 after receiving IV ferric carboximaltose. Results 41 patients completed the study. Primary end-point: the 6MWT increased significantly from 296 ± 101 m to 314 ± 106 m at week 1 (p&amp;lt;0.01), and to 325 ±111 meters at week 4 (p&amp;lt;0.01). at week 4 (p = 0.083). A significant improvement in the PGA test values was detected when compared baseline vs 4 weeks (adjusted p value = 0.031). No significant differences were found between the baseline and week 1 (adjusted p value = 0.083), and week 1 and week 4 visits (adjusted p value = 0.086). No significant differences were found between the initial, 1-week, and 4-week visits in the EQ-5D quality of life questionnaire nor Piper's fatigue test. Phosphorus levels decreased significantly at week 1 from baseline (3.16 ± 0.7 vs 3.72 ± 0.6) (adjusted p&amp;lt;0.001), with a partial recovery of serum levels in week 4 (3.57 ± 0.7 mg/dL). There were no significant increases in hemoglobin concentration between the different time periods. Conclusion IV ferric carboximaltose administration significantly improved the functional capacity of CKD patients with ID in short term. PGA also improved slightly but significantly. Effects that were independent of hemoglobin changes, suggesting a role of ID for a lower physical performance in CKD patients without heart failure, independent of the presence of anemia.

#5619 THE ASSOCIATION BETWEEN THE LEVELS OF URIC ACID AND RENAL OUTCOMES IN EARLY CKD PATIENTS: A MULTI-CENTER REAL-WORLD DATA ANALYSIS

Abstract Background and Aims It is well known that serum uric acid (SUA) plays an important role both in patients with and without chronic kidney disease (CKD). However, the effect of SUA on renal outcomes of CKD patients, especially with asymptomatic hyperuricemia, remains controversial. Therefore, our study explores the relationship between SUA and adverse events in early CKD (stage 1-3) patients in a real-world setting. Method This multi-center real-world study analyzed the data from Chinese Renal Data System (CRDS). Eligible CKD patients (eGFR) (estimated glomerular filtration rate≥30 mL/min/1.73 m2) were enrolled. The primary endpoint is the decline of renal function defined as at least 40% decrease in eGFR. The secondary endpoints include onset of composite cardiovascular events and all-cause mortality. A multivariable cox regression model were used and the associations between levels of mean SUA and all endpoints were evaluated on a continuous scale with restricted cubic spline (RCS) curves based on Cox proportional hazards models. Kaplan-Meier survival curves were used to illustrate the ability of SUA to predict the end points. Results 25,202 adults (mean [SD] age, 52.59 [17.90] years, 8,212 male [46.1%], 9,604 female [53.9%]) were included in this study. During a median follow-up period of 2.61 years, 3,451 (15.9%) at least 40% decreased in eGFR. After adjustment for confounders, higher uric acid concentrations were independently associated with the higher risk for the decline of renal function [Per SD increment adjusted hazard ratio [aHR]: 1.41, 95%CI 1.36-1.47]; composite cardiovascular events [Per SD increment [aHR]: 1.04, 95%CI 1.01-1.07], all-cause mortality [Per SD increment [aHR]:1.32, 95%CI 1.14-1.54]. RCS curves showed that HRs for renal function progression, all-cause mortality and composite cardiovascular events increased significantly with the increase of SUA concentration in CKD patients. Results were consistent in stratified analyses. The KM curves suggested that patients with asymptomatic hyperuricemia had a substantially worse survival rate for renal function. Conclusion SUA is an independent risk factor for the decline of renal function, cardiovascular events and all-cause mortality in early CKD patients (stage 1-3). Treatment of asymptomatic hyperuricemia may be a potential avenue to improve outcomes in CKD patients.

#6124 INTERACTIONS BETWEEN FIBROBLAST GROWTH FACTOR 23 AND SYSTEMIC INFLAMMATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Abstract Background and Aims In patients with Chronic Kidney Disease (CKD), serum concentration of Fibroblast Growth Factor 23 (FGF23) is inversely correlated with Glomerular Filtration Rate (eGFR), as an adaptive mechanism to counterbalance the alterations of mineral metabolism. Transcription, secretion and cleavage from the intact form (iFGF23) to the c-terminal fraction (cFGF23) are regulated by several mechanisms among which inflammatory mediators seem to play a significant role. We investigated whether there was any correlation between FGF23 and several inflammatory mediators. Method In the present study we evaluated cross sectionally the correlation between FGF23 (iFGF23 and c-FGF23) and some pro-inflammatory (IL-6, TNFα, MCP-1)) and anti-inflammatory (IL-10) cytokines in a cohort of 111 prevalent CKD patients stages III-V not yet on dialysis. We excluded patients with infections or chronic inflammatory diseases in the last 3 months, neoplasia or under immunosuppressive therapy. FGF23 and cytokines were dosed by ELISA. Results Descriptive characteristics of the cohort are reported in Table 1. We found an increase in inflammation as eGFR declines: IL6 (r = -0,315, p&amp;lt;0,001), TNFa (r = -0,202, p = 0,033) and MCP1 (r = -0,278, p = 0,003). Furthermore, the ratio between C-terminal FGF23 to intact FGF23 (c/iFGF23) was directly related to eGFR, even if it did not reach statistical significance (r = 0,127, p = 0,113). The correlations between FGF23 and markers of osteo-mineral metabolism and inflammation are reported in Table 2. We found positive correlations of iFGF23 with: IL-6 (r = 0,465, p&amp;lt;0,001), TNFα (r = 0,241, p = 0,009) and IL-10 (r = 0,198, p = 0,044) Conversely, cFGF23 only correlated with MCP-1 (r = 0,264, p = 0,005). c/iFGF23 resulted inversely correlated with IL-6 (-0,326, p&amp;lt;0,001) and positively with MCP-1 (r = 0,178, p = 0,061). After the adjustment for eGFR, iFGF23 maintained his correlations only with IL-6 (r = 0,370, p &amp;lt; 0,001) and TNFα (r = 0,163, p = 0,044) while c/iFGF23 was negatively correlated with IL-6 (r -0,251, p = 0,008) and positively with MCP-1 (r = 0,204, p = 0,032). Conclusion Our data confirm that in CKD patients, as the renal function declines, there is an important increase of inflammatory cytokines and a tendency to an impaired cleavage of FGF23 from the intact to the c-terminal form. Furthermore, we observed strong correlations of iFGF23 with several inflammatory cytokines (IL-6, TNFα, IL-10) that seem to be independent of eGFR. On the contrary we did not find any correlation of cFGF23 with inflammatory mediators, except for MCP-1. Therefore, we believe that overall our results suggest that inflammatory markers are differently associated with cFGF23 and iFGF23, as if inflammation may independently influence FGF23 turnover (i.e, c/iFGF23 ratio).

#4102 THE IMPACT OF MOBILE HEALTH ON HOME BLOOD PRESSURE AND HEALTH LITERACY IN CHRONIC KIDNEY DISEASE

Abstract Background and Aims Mobile health (mHealth) management is an emerging therapeutic strategy for chronic diseases. mHealth has been considered to improve self-care management and assist in detecting a worsening health status early. However, the effect of mHealth management on the blood pressure (BP) of patients with chronic kidney disease (CKD) has not been well-studied. This study aimed to access the association between mHealth management and BP control in CKD. We also investigated the association between mHealth and health literacy(HL) in CKD. Method Kaohsiung Medical University Hospital designed and developed a new healthcare mobile application called iCKD. The application has several major features, including BP monitoring, alarms, and a warning system. We randomly assigned 122 CKD patients stages 1-5 to utilize iCKD or paper records (control group) for BP management. The primary outcome was the portion of reaching the target goal, defined as office BP less than 130/80 mmHg, during the 6-month study. Trained nurses interviewed CKD patients using structured questionnaires to evaluate HL. Results Baseline kidney function and BP were not significantly different between iCKD and control groups. During the study period, 11 participants had withdrawal.42.3% of the iCKD group (22/52) had the BP control reaching the target goal, while only 22.4% (11/49) in the control group(p = 0.03). Regarding HL, CKD patients with BP reaching the target goal had higher total scores than those without. The score for iCKD group, ranging from 29.29 to 32.85, were higher than the control group, ranging from 28.94 to 31.03. (p = 0.01). Conclusion The iCKD group had a higher proportion of reaching the BP target goal and better HL score than the control group. This study demonstrates that mHealth can improve the CKD population's health literacy and BP management.

Serum malondialdehyde in different stages of chronic renal disorder

Background: Chronic kidney disease (CKD) is a widespread public health problem, which may have several adverse consequences such as renal failure, cardiovascular disease, and premature death. Kidney-related pathologies have increasing prevalence rates, produce a considerable financial burden, and are characterized by elevated levels of oxidative stress (OS). Several markers emerged as well-suited indicators of OS such as malondialdehyde (MDA) and lipid hydroperoxides. The reduced activities of antioxidant enzymes status and increased production of MDA in the CKD patients confirm the presence of OS. The alteration in antioxidant status and MDA in CKD patients supports the role of OS in CKD patient. Aims and Objectives: The aim of the study was to compare serum MDA in different stages of CKD with that of control. It is well known that inflammation has an important role in CKD and MDA is an oxidant biomarker. Materials and Methods: This was a cross-sectional study having 400 participants with 300 known cases of CKD and 100 healthy controls. Serum MDA levels were measured by thiobarbituric acid assay. Results: There was a significant difference between the groups regarding the MDA values (P&lt;0.001) with that of control. The mean MDA value in Stage III (5.64±1.93 Umol/L), Stage IV (6.14±1.584 Umol/L), and Stage V (10.761±3.347 U moL/L) of CKD patients were high in comparison to healthy control (1.88±0.181 U mol/L). Conclusion: We concluded that MDA is a useful biomarker in CKD patients. The correlations of serum MDA among different stages of CKD patients were significant. Larger studies focused on CKD severity and antioxidant/oxidant biomarkers are required.

Levels of FGF-23, C-Reactive Protein, Alkaline Phosphatase as A Risk Factor for Renal Osteodystrophy in Chronic Kidney Disease Patients Stage IV-V

The condition of CKD is closely related to the existence of systemic disorders that affect various organs, including organs that often experience effects are the kidneys and musculoskeletal. Cases of osteoporosis are often found in patients with CKD who are commonly known as having Renal Osteodystrophy, which is defined by the presence of disorders or pathological conditions in the bones associated with CKD conditions. FGF-23, CRP, ALP are markers that have been associated with the occurrence of a renal osteodystrophy. By conducting this research, it is expected to know the relationship between the three markers and the occurrence of renal osteodystrophy. This study used a case-control design with a cross-sectional method to determine the relationship between FGF-23, CRP, ALP and renal osteodystrophy. From the CKD population with or without renal osteodystrophy, the sample was selected by consecutive sampling. After that, statistical tests were carried out in the form of descriptive tests, normality tests, risk factor assessment using 2x2 cross-tabulations, and predictive analysis of proportions using logistic regression tests. FGF-23 levels &gt; 30 pg/ml (p-value &lt;0.001; CI = 1.4-6.7), CRP &gt; 3 mg/L (p-value &lt;0.001; CI = 1.3-4.8), ALP &gt; 120 U/L (p-value &lt;0.001; CI = 1.7-10.6) in patients with stage IV-V CKD significantly increased the risk of renal osteodystrophy. In the multivariate analysis, ALP had the most significant value compared to these three variables. Based on this study, increased serum ALP is the most influential risk factor for renal osteodystrophy, both based on bivariate and multivariate analysis.&#x0D;

Status of Serum Magnesium in Different Stages of CKD Patients: A Tertiary Care Hospital Study in Bangladesh

Background: In chronic kidney disease (CKD), renal regulatory mechanisms may be insufficient to balance intestinal magnesium absorption hence insufficient to maintain homeostasis. But related data are relatively sparse and not readily available, especially in Bangladesh context. Aim of the study: The aim of the study was to assess the pattern of serum magnesium level in different stages of CKD patients. Material Methods: This descriptive cross-sectional study was conducted in the Department of Medicine and the Department of Nephrology, Dhaka Medical College Hospital (DMCH) for nine months’ period. Approval for the study was taken from the ethical review committee of DMC before the commencement of the study. Diagnosed patients of chronic kidney disease (CKD) were approached for the inclusion of the study. Informed written consent was taken from each patient. All patients were subjected to detailed history taking, physical examination, and relevant investigations. For the study purpose, serum magnesium was done for all patients. Results: After compiling data from all participants, statistical analysis was performed using the statistical package for social science (SPSS) version 22 for windows, and a p &lt; 0.05 was considered statistically significant. Mean age of the patients was 53 years with male predominance (male 64% vs female 36%). Of all, 6.7% of cases had hypomagnesemia and 55.3% had hypermagnesemia. The mean serum magnesium level was 2.68±0.81 mg/dl. Assessment of serum magnesium in a different stages of CKD showed that hypermagnesemia is associated with higher staging (p&lt;0.05), and there is a negative correlation between lower e-GFR with serum magnesium ((r=-0.753, p&lt;0.01). Conclusion: Nearly two-third of CKD patients were found with altered magnesium level in the form of hypomagnesemia or hypermagnesemia in this study. Serum magnesium was found increased in higher stages of CKD. That means serum magnesium level increases along with higher stage of the disease. Urinary magnesium excretion also decreases when eGFR of patient decreased.

Renoprotective effect of febuxostat on contrast-induced acute kidney injury in chronic kidney disease patients stage 3: randomized controlled trial

IntroductionContrast-induced acute kidney injury (CI-AKI) is known to be a complication of using intravascular contrast injection. Unfortunately, it is associated with adverse outcomes such as prolonged length of hospitalization and increased burden of health care costs. So, we aimed to determine the efficacy of febuxostat in the prevention of contrast-induced acute kidney injury among patients with chronic kidney disease Stage 3 performing percutaneous coronary intervention (PCI).MethodsIn a randomized controlled trial we enrolled 120 CKD stage 3 Patients with acute coronary syndrome referred to the cardiology department Ain-Shams University hospital for performing PCI and stenting. Patients were randomly assigned to two arms: Group I (study group): Included 60 patients who received Febuxostat added to the traditional treatment (IV hydration and N-acetylcysteine). The patients received Feburic 80 mg within 6–18 h before and within 6–18 h after the coronary intervention (a time gap of 24 h between two doses). Group II (control group): included 60 patients who received only traditional treatment.ResultsThe incidence of AKI was higher in the control group with a statistically significant difference. We found that Independent Significant risk factors that led to AKI were febuxostate avoidance, DM, high urea level, high creatinine level, CKD stage 3B, high Mehran score and high AKI risk.ConclusionWe demonstrated that febuxostat has a Reno protective effect and it can help to reduce the incidence CI-AKI in CKD patients stage 3 performing PCI.