Chronic Kidney Disease Patients Stages Research Articles

Prevalence of Vertebral Fractures and Their Prognostic Significance in the Survival in Patients with Chronic Kidney Disease Stages 3‒5 Not on Dialysis.

Background: The prevalence of vertebral fractures (VF) and their association with clinical risk factors and outcomes are poorly documented in chronic kidney disease (CKD) cohorts. The aim of the study was to evaluate the prevalence of VF in patients with non-dialysis dependent CKD (NDD-CKD), their value in predicting mortality and its correlation with parameters of bone mineral metabolism and vascular calcification. Materials and Methods: 612 NDD 3‒5 stage CKD patients participating in the OSERCE-2 study, a prospective, multicenter, cohort study, were prospectively evaluated and categorized into two groups according to presence or absence of VF at enrollment. VF were assessed with lateral radiographs and Genant semi-quantitative method was applied. Three radiologists specialized in musculoskeletal radiology performed consensual reading of individual images obtained using a Raim DICOM Viewer and a Canon EOS 350 camera to measure with Java Image software in those who had traditional acetate X-ray. Factors related to VF were assessed by logistic regression analysis. Association between VF and death over a 3-year follow-up was assessed by Kaplan-Meier survival curves and Cox-proportional hazard models. Results: VF were detected in 110 patients (18%). Serum phosphate levels (OR 0.719, 95% CI 0.532 to 0.972, p = 0.032), ankle-brachial index < 0.9 (OR 1.694, 95% CI 1.056‒2.717, p = 0.029) and treatment with bisphosphonates (OR 5.636, 95% CI 1.876‒16.930, p = 0.002) were independently related to the presence of VF. After a median follow-up of 35 months (IQR: 17‒37 months), 62 patients (10%) died. The causes of death were cardiovascular (n = 21, 34%) and infectious (n = 11, 18%). In the crude analysis, fractured patients group had poorer survival (log-rank test, p = 0.02). After multivariate adjustment for age, MDRD, albumin, diabetes mellitus, comorbidity, Adragao Score > 3 and serum phosphate, the presence of VF (HR 1.983, 95% CI 1.009‒3.898, p = 0.047) were an independent predictor of all-cause mortality. Conclusions: In our study 18% of patients with NDD-CKD have VF. Factors associated with VF were age, low serum phosphate levels and peripheral vascular disease. The presence of VF was an independent risk factor for mortality in stages 3‒5 NDD-CKD patients. Clinical trials are needed to confirm whether this relationship is causal and reversible with treatment for osteoporosis.

Hormonal and Mineral Imbalance Effect on Bone Resorption in Predialysis Iraqi Patients with Chronic Kidney Disease

Introduction: Chronic kidney disease mineral bone disorder is a metabolic bone disease present in almost all uremic patients. The aim of this research to indicate the stage of chronic kidney disease (CKD) that affect the bone metabolism that leading to the mineral and hormonal imbalance by studying the relationship among osteocalcin , glomerular filtration rate (GFR), parathyroid hormone, calcium and phosphorus levels in the blood. Method: The study included 52 patients with predialysis chronic kidney disease stage 3-5 and 40 apparently healthy relatives accompanying the patients. Glomerular filtration rate (GFR) was calculated for each patient. Renal function tests, including serum levels of urea, creatinine, a biochemical marker of bone metabolism: osteocalcin (OSN), calcium, phosphorus, and parathyroid hormone (PTH), were measured for each participant. Results: Serum urea and creatinine levels were significantly higher in CKD patients Than that of apparently healthy control. There is significantly higher serum parathyroid hormone, serum phosphorus, serum osteocalcin (P&lt;0.01, P&lt;0.01, P&lt;0.01 respectively) in CKD patients than that of the healthy control group. While low serum calcium level in CKD patients as compared to the corresponding group (P&lt;0.01). Conclusion: Hyperphosphatemia and hypocalcemia in the end stage of predialysis CKD patients lead to increase parathyroid hormone secretion, which causes high bone turnover characterized by significantly high serum osteocalcin in these patients. Parathyroid hormone and osteocalcin were used as a biomarker for the development of bone and mineral disorders in predialysis CKD patients.

Hematological Disorders during Chronic Kidney Disease Stages 3 to 5 Non-Dialysed in Cameroon

Introduction: Haematological disorders are common complications of chronic kidney disease (CKD) leading by anemia which increase with the severity of the disease. Objective: Assess the haematological profile of CKD patients stages 3 to 5 non-dialysed seen at the first nephrology consultation in Cameroon. Patients and Methods: A hospital-based cross-sectional study was conducted from February to July 2018 at the nephrology unit of the Yaounde University Teaching Hospital and Douala General Hospital. All adults’ (≥18 years old) patients who provided a written informed consent and attended their first nephrology consultation with a nephrologist diagnosis of CKD stages 3 to 5 non-dialysed were included. Clinical and paraclinical data (serum creatinine, full blood count, reticulocytes count, iron status, vitamin B12 and folates count, and bleeding time) were collected. Parametric, non-parametric and correlations tests were used to compare variables. Results: We included 105 (59% males) participants with a mean age of 55.2 ± 13.6 years divided into 20 (19%), 36 (34.3%) and 49 (46.7%) respectively in stage G3, G4 and G5 of CKD. The profile of hematological abnormalities was anemia (86.7%), leucopenia (15.2%), hyperleucocytosis (6.7%), thrombopenia (23.8%), thrombocytosis (3.8%) and prolonged bleeding time (13.3%) without any association with the stage of CKD (p > 0.05). The pattern of anemia was mainly normocytic and normochromic (59.3%) and aregenerative (92.3%) with iron deficiency found in 23 (21.9%) participants. There was no case of vitamin B12 and folates deficiency. Prolonged bleeding time was observed in 14 (13.3%) participants with a weak correlation between platelets count and bleeding time (r = 0.122). Conclusion: We observed that aregenerative normocytic normochromic anemia is the leading haematological abnormality during CKD in this setting. None of the full blood count parameters was associated with CKD stages and there was a week correlation between bleeding time and platelet count.

Gut microbiota composition and frailty in elderly patients with Chronic Kidney Disease.

BackgroundFrailty is common in older patients affected by chronic kidney disease (CKD). Since gut microbiota (gMB) may contribute to frailty, we explored possible associations between gMB and frailty in CKD.MethodsWe studied 64 CKD patients (stage 3b-4), categorized as frail (F, 38) and not frail (NF, 26) according to Fried criteria, and 15 controls (C), all older than 65 years. In CKD we assessed serum C-reactive protein, blood neutrophil/lymphocyte ratio, Malnutrition-inflammation Score (MIS); gMB was studied by denaturing gel gradient electrophoresis (DGGE), high-throughput sequencing (16S r-RNA gene), and quantitative real-time PCR (RT-PCR).ResultsNo differences in alpha diversity between CKD and C and between F and NF patients emerged, but high-throughput sequencing showed significantly higher abundance of potentially noxious bacteria (Citrobacter, Coprobacillus, etc) and lower abundance of saccharolytic and butyrate-producing bacteria (Prevotella spp., Faecalibacterium prausnitzii, Roseburia spp.), in CKD respect to C. Mogibacteriaceae family and Oscillospira genus abundance was positively related to inflammatory indices in the whole CKD cohort, while that of Akkermansia, Ruminococcus and Eubacterium genera was negatively related. Compared with NF, in F there was a higher abundance of some bacteria (Mogibacteriacee, Coriobacteriacee, Eggerthella, etc), many of which have been described as more abundant in other diseases.ConclusionsThese results suggest that inflammation and frailty could be associated to gMB modifications in CKD.

Dialysis therapy is associated with peripheral marginal zone B-cell augmentation

Chronic kidney disease stage 5 (CKD5) dialysis patients who stay long term in uremic environment often exhibit several, poorly defined, immune impairments. In this study, we assessed peripheral virus-specific effector/memory cells and subpopulations of T, B and DC cells using ELISPOT and FACS methods in 74 low-risk kidney transplant candidates without anti-HLA antibodies, prior to transplantation in pre-emptive (never experienced dialysis) and dialysis cohorts. There was difference in circulating marginal zone B cells (MZB) (IgDhighCD27high) between dialysis patients and those receiving kidney grafts pre-emptively (P = .002). Patients treated on dialysis >12 months had also 4.2-fold greater risk of increased absolute numbers of MZB (95%CI:1.6–11.2; P = .004). There were no other differences in B-, T- and DC-cell subsets. Numbers of effector/memory T cells reactive to major opportunistic virus-specific antigens (CMV, BKV and EBV) were not affected by dialysis. Non-sensitised dialysis-treated patients displayed significantly more circulating MZB compared to those CKD5 patients that had never undergone dialysis therapy.

Study of the incidence of acute kidney injury in HCV infected patients receiving DAAs

Abstract Background Egypt had the highest burden of hepatitis C virus infection worldwide with genotype 4. The new direct-acting antivirals DAAs can target almost all steps of the HCV life cycle. The objective of our study was to detect AKI events during and on follow up after the end of treatment with combination DAAs. Aim of the work to study the incidence of acute kidney injury in HCV infected patients receiving IFN-free combination new DAAs. Patients and Methods A longitudinal prospective study that was conducted in the virology clinic in Kobry El-Koba Military Armed Forces Hospital on 63 male patients (&amp;gt;18years) who are HCV antibody and PCR positive, treatment-naïve, who received treatment with sofosbuvir, daclatasvir and ribavirin. They were divided into Group A: 33 patients with normal kidney functions stage I and Group B: 30 patients with chronic kidney disease (CKD) with estimated GFR (eGFR) &amp;gt;30 mL/min and &amp;lt; 90 mL/min stage II, III. The fluctuations in serum creatinine and eGFR were measured while on-therapy and for 3 months follow up after end of treatment. Results Sixty three male patients, treatment-naive were included. Thirty of them had eGFR of less than 90 mL/min/1.73 m2 (25 with eGFR = 60-89 mL/min) &amp; (5 with eGFR = 45-59 mL/min) of mean age 62.4 ± 7.4. These were compared to thirty-three patients with eGFR of more than 90 mL/min/1.73 m2 of mean age 53.8 ± 11 (P = 0.001). Our included treatment regimen was daclatasvir/sofosbuvir/RBV. A total of 54% had liver cirrhosis, 62/63 (98.5%) of the patients achieved SVR at 12th week; One CKD stage II patient continued treatment for 6 months because he had a detectable HCV RNA after 1st month of starting treatment. All other patients completed the treatment for 3 months. There is a statistical difference between different readings of serum creatinine in both groups on therapy and on follow up during the next 3 months after the end of therapy with a P value of 0.001 in group A and a P value of 0.005 in group B. There is a rise in serum creatinine in group A during the three months of therapy with slight improvement during follow up after the end of therapy without reaching the baseline. In group B it was noticed that there is slight increase in serum creatinine after 1st month of start of therapy then there is significant improvement after 3rd and 4th months of start of therapy to come to a plateau by the end of 6th month. The incidence of AKI was more observed in patients with eGFR &amp;gt; 90 ml/min per 1.73 m2 by being 13.65% by the end of treatment but decreases to 6.1% by the end of the three months follow up after the end of treatment. This was compared to 3.3% in those with eGFR &amp;lt; 90 ml/min per 1.73 m2 and &amp;gt;45 ml/min per 1.73 m2 that was the same all through the follow up, but of no statistical significant difference. Conclusion daclatasvir/sofosbuvir/ribavirin antiviral therapy is effective in patients with stage 1-3 CKD with SVR of 98.5%. Although adverse effects are common, serious adverse effects and treatment discontinuations are rare. There were AKI events during and after the end of therapy especially in patients with normal baseline serum creatinine by 12.76% in comparison to 3.3% in already CKD patients stage 2 and 3. Patients with CKD stage 2 and 3 experienced improvement in their kidney functions during and after end of therapy . Future studies are needed to determine predictors of kidney recovery with HCV eradication and confirm the long-term effects of HCV eradication on kidney function.

High-sensitivity C-reactive Protein as a Marker of Future Cardiovascular Events in Chronic Kidney Disease Stage-5 Patients

Introduction: Chronic Kidney Disease (CKD) has been recognised as a worldwide health threat and understanding its complex patho-physiological mechanisms could go a long way in taking care of patients with CKD. One of the most important causes for mortality in End Stage Renal Disease (ESRD) patients is Cardiovascular Disease (CVD). ESRD is a low grade chronic inflammatory state, suspected to promote atherosclerosis. Aim: To determine, if there is any association between elevated High-sensitivity C-Reactive Protein (hs-CRP) and development of future cardiovascular events in stage-5 CKD patients. Materials and Methods: Forty-five CKD stage-5 patients were included in the study, after ruling out patients with established CVD. According to categorisation proposed by the American Heart Association for the cut-off value of hs-CRP-value (3 mg/L), patients were divided into two groups. Those who had hs-CRP more than 3 mg/L were considered to have ‘elevated hs-CRP’ and those who had a value 3 mg/L and below were considered to have ‘normal hs-CRP’ levels. These patients were followed-up monthly, for a period of one year to record any occurrence of cardiovascular events (coronary events/cerebrovascular accidents/peripheral occlusive vascular disease). Statistical Package for the Social Sciences (SPSS) 16.0 was used for analysis. Chi-square test and Mann-Whitney U-test were used for statistical comparison between the groups and a p-value of 0.05 or less was considered to be statistically significant. Receiver Operating Characteristic (ROC) curve was also plotted to determine the cut-off value for hs-CRP based on the occurrence of any cardiovascular event. Results: Baseline hs-CRP level was more than 3 mg/L in 42% of patients. Among those who had elevated hs-CRP, 78.9% of patients developed cardiovascular events during the follow-up period. This signifies a strong association between elevated hs-CRP and CVD in ESRD patients. The hs-CRP cut-off point of 3 mg/L was obtained from ROC curve. Conclusion: There was a significant association between elevated hs-CRP and development of cardiovascular events in ESRD patients. Hence, hs-CRP can be used as a marker of future cardiovascular events in CKD stage-5 patients.

Assessment of oral health status and inflammatory markers in end stage chronic kidney disease patients: A cross-sectional study

Aim:To assess the oral health status and inflammatory markers in end stage chronic kidney disease (CKD) patients.Objectives:To study and compare oral health status of end stage CKD patients with the control group (matched health individuals) and to study and compare inflammatory biomarkers in study and control groups.Materials and Methods:A cross-sectional study was conducted among 50 patients of end stage CKD and 50 matched healthy individual, who were taken as control in the study. Convenience sampling technique was used. Oral health status was recorded by using WHO proforma (2013). Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP ) were also measured in the both groups. These are inflammatory markers which show systemic inflammation. Statistical analysis was done by using IBM SPSS Statistics-version 21 (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.)Results:The study revealed that patients on dialysis going for transplantation have evidence of increased inflammation as indicated by raised CRP values.Conclusion:The present study concludes that the oral hygiene of the patients is deteriorated who are having chronic kidney disease. Good oral and dental care in CKD patients can improve the transplant outcomes.

Dietary Assessment of Korean Non-dialysis Chronic Kidney Disease Patients with or without Diabetes.

BackgroundDietary intervention at the early stage of chronic kidney disease (CKD) is important for preventing progression to the end-stage renal disease (ESRD). However, few studies have investigated dietary intake of CKD patients in non-dialysis stage. Therefore, we investigated the dietary intake of Korean non-dialysis CKD patients and aimed to establish baseline data for the development of dietary education and intervention strategies for CKD patients.MethodsThree hundred fifty CKD patients who visited Seoul National University Hospital outpatient clinic from February 2016 to January 2017 were recruited for this cross-sectional study. Subjects on dialysis and those who had undergone kidney transplantation were excluded. Dietary intake, demographic information, and biochemical characteristics of 256 subjects who completed three-day dietary records were analyzed. Subjects were divided into four groups based on diabetes mellitus (DM) (DM-CKD and Non-DM-CKD groups) and kidney function (Early-CKD and Late-CKD groups).ResultsTotal energy intake was lower in the Late-CKD group compared with the Early-CKD group. In men, carbohydrate intake was higher and protein and fat intakes tended to be lower in the Late-CKD group compared with the Early-CKD group. In women, carbohydrate intake tended to be lower in the DM-CKD group than the Non-DM-CKD group. Protein intake tended to be higher in the DM-CKD groups. Phosphorus and sodium intakes were higher in the DM-CKD groups compared with the Non-DM-CKD groups in women, and tended to be higher in the DM-CKD groups in men.ConclusionDM and kidney function affected energy and nutrient intakes. Subjects in the Late-CKD group consumed less energy than those in the Early-CKD group. Non-DM subjects seemed to restrict protein intake starting from the Early-CKD stage than subjects with DM. Subjects in this study had low energy and high sodium intakes compared with recommended levels. Protein intake was lower in advanced CKD patients, but their intake level was still higher than the recommendation. Dietary intervention strategies for non-dialysis CKD patients need to be customized depending on the presence of DM and kidney function.

Dietary intake of tyrosine and phenylalanine, and p-cresyl sulfate plasma levels in non-dialyzed patients with chronic kidney disease.

ABSTRACTBackground: Patients with chronic kidney disease (CKD) present an imbalance of the gut microbiota composition, leading to increased production of uremic toxins like p-cresyl sulfate (PCS), product from bacterial fermentation of the amino acids tyrosine (Tyr) and phenylalanine (Phe) from the diet. Thus, diet may be a determinant in the uremic toxins levels produced by the gut microbiota. The aim of this study was to evaluate the possible relationship between Tyr and Phe intake and PCS plasma levels in non-dialysis CKD patients.Methods: Twenty-seven non-dialysis CKD patients (stages 3 and 4) without previous nutritional intervention were evaluated. The dietary intake was evaluated using a 24-hour recall, 3-day food record and protein intake was also estimated by Protein Nitrogen Appearance (PNA). The plasma levels of PCS were measured using reverse phase high performance liquid chromatography.Results: The evaluated patients (GRF, 34.8 ± 12.4 mL/min, 54.2 ± 14.3 years, BMI, 29.3 ± 6.1 kg/m2) presented mean protein intake of 1.1 ± 0.5 g/kg/day), Tyr of 4.5 ± 2.4 g/day and Phe of 4.6 ± 2.5 g/day. PCS plasma levels (20.4 ± 15.5 mg/L) were elevated and positively associated with both, Tyr (r = 0.58, p = 0.002) and Phe intake (r = 0.53, p = 0.005), even after adjustments for eGFR and age.Conclusion: This study suggests that the diet is an important modulator of the uremic toxins plasma levels produced by the gut microbiota, in non-dialysis CKD patients.

Renal Syndromic Hearing Loss Is Common in Childhood-onset Chronic Kidney Disease.

BackgroundHearing loss (HL) in children may adversely affect their development. HL is more prevalent in patients with chronic kidney disease (CKD) than in the general population. This study evaluated the prevalence of HL and its underlying diseases in patients with childhood-onset in CKD.MethodsIn this retrospective study of a tertiary referral center, childhood-onset CKD patients (stage 2–5, age at onset of renal symptom < 18 years) were recruited. We referred to the “renal” syndromic HL as cases with genetic or syndromic diseases, or extra-renal anomalies in addition to HL and CKD.ResultsA total of 421 patients (male:female = 279:142) were reviewed according to the causes of CKD: congenital anomalies of the kidney and urinary tract (CAKUT; n = 184, 43.7%), glomerulopathies (GP; n = 105, 24.9%), cystic kidney diseases (CYST; n = 39, 9.3%), perinatal problems (PP; n = 29, 6.9%), and others (n = 64, 15.2%). HL was detected in 82 (19.5%) patients, including 51 (12.1%) patients with sensorineural hearing loss (SNHL), 30 (7.1%) with conductive hearing loss (CHL), and 1 patient with mixed HL. The prevalence of HL in each group was as follows: 16.8% in the CAKUT group, 28.6% in the GP group, 12.8% in the CYST group, 24.1% in the PP group, and 14.1% in the others group. HL was more common in higher CKD stages, especially CHL in end-stage renal disease. SNHL was more prevalent in CKD from GP. Of the 82 patients with HL, 50% had renal syndromic HL: 58.8% of SNHL and one-third of CHL were renal syndromic HL.ConclusionOne-fifth of the childhood-onset CKD had HL. Collectively, renal syndromic HL comprised half of the HL in this study. To improve the quality of life in patients with childhood-onset CKD, we suggest that HL should be considered, requiring surveillance, and if necessary, early intervention.

Evaluation of visual evoked potentials and brain-stem auditory evoked response in patients of chronic kidney disease.

Chronic kidney disease (CKD) is associated with functional changes in the central nervous system (CNS) which, in the initial stages do not manifest clinically. Early involvement of the CNS can be identified by the assessment of the electrocortical activity. Visual evoked potential (VEP) and brain-stem auditory evoked response (BAER) are useful tests for the early diagnosis of CNS involvement in CKD and are more sensitive compared to electroencephalography. One hundred adult CKD patients (stage 3-5 and 5D) and 50 controls were included in the study. Clinical and biochemical parameters were assessed and all the patients and controls underwent VEP and BAER evaluation. Evaluation of the VEP showed prolonged latencies of all the three peaks (N75, P100, and N145) compared to controls. Furthermore, all the absolute and interpeak BAER latencies for the CKD patients were similarly prolonged compared to controls. CNS dysfunction is common in CKD patients. The electrophysiological tests of VEP and BAER can be used for the early diagnosis of these disorders, even in the sub-clinical stages, thus allowing for their better management.

Assessment of health-related quality of life of chronic kidney disease patients in aminu kano teaching hospital, Kano.

The prevalence of chronic kidney disease (CKD) is increasing globally. Recently, the concept of Health-Related Quality of Life (HRQOL) is receiving attention as a measure of treatment outcome in addition to traditional morbidity and mortality rates. To assess the HRQOL of CKD patients stages 1-5 using the Kidney Disease Quality of Life questionnaire (KDQOL). The study was a cross-sectional study of CKD patients at a teaching hospital in north-western Nigeria during the study period. The quality of life, sociodemographic, clinical, and laboratory variables were assessed using a pro forma and the KDQOL questionnaire during regular clinic visits/dialysis sessions. Age and sex-matched healthy volunteers without evidence of renal disease were recruited from the hospital environment into a comparison group. A total of 150 subjects with CKD and 150 individuals in the comparison group completed the study with 77 males and 73 females for both groups. The mean ± standard deviation (SD) ages of the CKD and comparison group was 52.83 ± 14.21 and 52.43 ± 14.50 years, respectively. Subjects in the comparison group had higher physical composite summary (PCS) and mental composite summary (MCS) scores than individuals with CKD (P value < 0.05). Subjects with CKD showed a progressive decline in the scores of all HRQOL domains with advancing CKD stages (P value < 0.05). The results suggest that subjects with CKD have worse HRQOL domain scores when compared to the normal population and these scores progressively worsened with advancing CKD stages.

Phenotypic features of vascular calcification in chronic kidney disease.

Patients with chronic kidney disease stage 5 (CKD5) are predisposed to vascular calcification (VC), but the combined effect of factors associated with VC was sparsely investigated. We applied the relaxed linear separability (RLS) feature selection model to identify features that concomitantly associate with VC in CKD5 patients. Epigastric arteries collected during surgery from living donor kidney transplant recipients were examined to score the histological extent of medial VC. Sixty-two phenotypic features in 152 patients were entered into RLS model to differentiate between no-minimal VC (n=93; score 0-1) and moderate-extensive VC (n=59; score 2-3). The subset of features associated with VC was selected on the basis of cross-validation procedure. The strength of association of the selected features with VC was expressed by the absolute value of 'RLS factor'. Among 62 features, a subset of 17 features provided optimal prediction of VC with 89% of patients correctly classified into their groups. The 17 features included traditional risk factors (diabetes, age, cholesterol, BMI and male sex) and markers of bone metabolism, endothelial function, metabolites, serum antibodies and mitochondrial-derived peptide. Positive RLS factors range from 1.26 to 4.05 indicating features associated with increased risk of VC, and negative RLS factors range from -0.95 to -1.83 indicating features associated with reduced risk of VC. The RLS model identified 17 features including novel biomarkers and traditional risk factors that together concomitantly associated with medial VC. These results may inform further investigations of factors promoting VC in CKD5 patients.

Machine learning distilled metabolite biomarkers for early stage renal injury.

With chronic kidney disease (CKD), kidney becomes damaged overtime and fails to clean blood. Around 15% of US adults have CKD and nine in ten adults with CKD do not know they have it. Early prediction and accurate monitoring of CKD may improve care and decrease the frequent progression to end-stage renal disease. There is an urgent demand to discover specific biomarkers that allow for monitoring of early-stage CKD, and response to treatment. To discover such biomarkers, shotgun high throughput was applied to the detection of serum metabolites biomarker discovery for early stages of CKD from 703 participants. Ultra performance liquid chromatography coupled with high-definition mass spectrometry (UPLC-HDMS)-based metabolomics was used for the determination of 703 fasting serum samples from five stages of CKD patients and age-matched healthy controls. We discovered a set of metabolite biomarkers using a series of classic and neural network based machine learning techniques. This set of metabolites can separate early CKD stage patents from normal subjects with high accuracy. Our study illustrates the power of machine learning methods in metabolite biomarker study.

Hearing and Kidney: Effects of Chronic Kidney Disease on Various Auditory Parameters – Results from a Tertiary Care Hospital in India

Background: An association between chronic kidney disease (CKD) and hearing loss was first described in patients with Alport syndrome. Patients with CKD develop sensorineural hearing loss with the progression of the disease. Studies using BAER as an index of auditory function among patients with CKD showed evidence of various degrees of auditory dysfunction.&#x0D; Materials and methods: 100 adult CKD patients (stage 3 – 5 and 5D) and 50 controls were included in the study. Clinical and biochemical parameters were assessed and all the patients and controls underwent Pure Tone Audiometry (PTA) and Brainstem Auditory Evoked Response (BAER) evaluation.&#x0D; Results: When hearing thresholds were compared between the patients and controls PTA showed an increase in hearing threshold in all patient groups. This increase was more noticeable at higher frequencies (4 and 8 kHz). Compared with healthy controls, a highly significant delay was observed in CKD patients in both absolute and interpeak latencies in BAER in the present study.&#x0D; Conclusion: The present study provides a concrete evidence to the otherwise disputed relation of auditory function in CKD proving that hearing is permanently affected by ESRD at all levels of the auditory neural pathway.&#x0D; J MEDICINE JAN 2020; 21 (1) : 31-35

Sensitivity and specificity of the Brazilian version of the Montreal Cognitive Assessment – Basic (MoCA-B) in chronic kidney disease

Cognitive impairment in chronic kidney disease (CKD) is commonly associated with neuropsychiatric disorders. As a complex pathology, at all stages of CKD patients need to have a good understanding of the need for drug and nutritional adherence. Cognitive screening is the starting point for detection of cognitive impairments. To determine the specificity and sensitivity of the Brazilian Portuguese version of the Montreal Cognitive Assessment - Basic (MoCA-B) for identification of cognitive impairment in the CKD population. This was a cross-sectional study with 163 CKD patients undergoing hemodialysis treatment. The Mini-Mental State Examination (MMSE) and MoCA-B were administered. The MoCA-B has reliable internal consistency (Cronbach's alpha = 0.74). A cutoff point of ≤ 21 points provides the best sensitivity and specificity for detection of cognitive impairment. The education variable had less impact on the total MoCA-B score than on the total MMSE score. The MoCA-B is a suitable screening instrument for evaluating the global cognition of hemodialysis patients. The results can help health professionals to conduct evaluations and plan clinical management.

Particulars of the perioperative management of patients with end stage renal disease during hip and knee replacement arthroplasty

The world prevalence of chronic kidney disease (CKD) stages 1 to 5 ranges from 11.7 to 15.1%. Incidence of fractures in patients with CKD stage 5 is 5-fold higher than that in the general population, which is related to mineral metabolism disorders, secondary hyperparathyroidism, and osteoporosis. By damaging multiple organs and systems, CKD triggers a whole pathological cascade. There are hematopoietic abnormalities, cell lineages, direct toxic effect on blood cell elements, with simultaneously increased risk of bleeding and a high and extremely high risk of thrombi formation and thromboembolic complications. Calcium and phosphorus metabolism disorders lead to calcification and mineralization of vasculature, myocardium and heart valves; progressive renal dysfunction affects the course of heart and vessel diseases, aggravating their clinical manifestations. Cardiovascular disorders become the main cause of death of such patients, and the development of pulmonary hypertension is associated with increased morbidity and mortality. At the same time, protein and energy deficiencies do occur, with disturbance of the acid-base balance, water and electrolyte balance; uremic toxins exert unhealthy effects on the gastrointestinal tract. Various extra-renal pathologies, specific pharmacokinetics, regimen and frequency of renal replacement therapy needed to maintain an adequate volume status make it necessary to thoroughly prepare the patients for surgery and define special requirement to perioperative management in arthroplasty. Currently, there are no guidelines on the perioperative management of this patient category. In this review article we consider specifics and particulars of preoperative, intraoperative and postoperative management of the end stage CKD patients during knee and hip replacement arthroplasties.

SUN-282 INCREASE LEVEL OF TNF-α NOT CORRELATED WITH TOTAL ANTIOXIDANT CAPACITY ON CHRONIC KIDNEY DISEASE PATIENTS STAGE 3-5

CKD patients showed higher level of inflammation such as TNF-α and oxidative stress that result in an imbalance between free radical production and antioxidant defenses. Total antioxidant capacity (TAOC) is a parameter of combined antioxidant defenses in biological fluids. There are only few information about association between total antioxidant capacity (TAOC) and TNF-α. This is an observational analytic study on 80 chronic kidney disease patients stage 3-5. CKD staging of eGFR was measured by CKD-EPI. Blood samples was then measured for total antioxidant capacity (TAC) and TNF-α. Correlation between TAOC and TNF-α was measured with Rank-Spearman There were 21 patients on stage 3, 20 patients on stage 4 and 39 patients on stage 5 CKD. There were no significant difference of TAOC among CKD stage 3 to 5 respectively 21,3 ± 10,9;18,3 ± 9,9;20,6 ± 6,9 U/mL with p=0,521 but there were a significant difference of TNF-α among group of CKD stage 3-5 and respectively 2953(1661–9460);3394(1520–8467);3918(1936–17601) pg/mL with p=0,008. TNF-α shows strong negative correlation with eGFR by CKD-EPI (r=-0,383;p=0,000) but there was no correlation between TAC and eGFR (r=-0.119;p=0.146). Statistical analysis using Rank Spearman found that there was no significant correlation between TNF-α level and TAC level (r = 0.127, p = 0.131). Total antioxidant capacity reveals a stagnant level among CKD group 3-5 while the TNF-a level increase among CKD stage 3 to 5 There is no significant correlation between TAC levels and TNF- α. Although there was an increase level of TNF-α but it does not followed by increase capacity of total antioxidant in CKD stage 3-5

Validity and internal consistency of EQ-5D-3L quality of life tool among pre-dialysis patients with chronic kidney disease in Sri Lanka, a lower middle-income country.

ObjectiveEQ-5D-3L is a generic QOL tool used mainly in economic evaluations. Burden of Chronic Kidney Disease (CKD) is rising in Sri Lanka. Assessing the validity of generic QOL tools creates new opportunities of their utilization among patients with CKD.MethodsA cross-sectional study was conducted among 1036 CKD patients, selected using the simple random sampling technique. The validity was tested with six a-priori hypotheses. These included construct validity assessments, evaluating convergent validity and performing known group comparisons. EQ-5D-3L, Short Form-36 (SF-36) were used to assess QOL. Center for Epidemiological Studies Depression Scale (CES-D-20) and General Health Questionnaire-12 (GHQ-12) were used to assess the presence of depression and psychological distress respectively. Internal consistency of the whole tool and when each item is removed was assessed by Cronbach alpha.ResultsThe response rate was 99.2%. Majority of participants were males (n = 646,62.4%) in the age category of 41–60 (n = 530; 51.2%). Most were in either stage 4 or 5 of CKD (n = 646,75.1%). The summary measures of SF-36, positively and significantly correlated with the EQ-5D-3L index and VAS scores (p<0.001). EQ-5D-3L QOL scores were significantly different between the group with depression and without as measured by CES-D-20 (p<0.001). Assessed using GHQ-12, similar significance was detected between the group with psychological distress and without (p<0.001). The Cronbach alpha was 0.834 and when each item was removed, ranged from 0.782 to 0.832.ConclusionEQ-5D-3L is a valid generic QOL tool with satisfactory internal consistency to be used among CKD patients in the pre-dialysis stage.