Chronic Kidney Disease Stage 5D Research Articles

Status and trends in epidemiologic characteristics of diabetic end-stage renal disease: an analysis of the 2021 Korean Renal Data System.

Korean Renal Data System (KORDS) is a nationwide end-stage renal disease (ESRD) registry database operated by the Korean Society of Nephrology (KSN). Diabetes mellitus is currently the leading cause of ESRD in Korea; this article provides an update on the trends and characteristics of diabetic ESRD patients. The KORDS Committee of KSN collects data on dialysis centers and patients through an online registry program. Here, we analyzed the status and trends in characteristics of diabetic chronic kidney disease stage 5D (CKD 5D) patients using data from 2001 to 2021. In 2021, the dialysis adequacy of hemodialysis (HD) was lower in diabetic CKD 5D patients than in nondiabetic CKD 5D patients, while that of peritoneal dialysis (PD) was similar. Diabetic CKD 5D patients had a higher proportion of cardiac and vascular diseases and were more frequently admitted to hospitals than nondiabetic CKD 5D patients, and the leading cause of death was cardiac disease. From 2001 to 2020, diabetic CKD 5D patients had a higher mortality rate than nondiabetic CKD 5D patients, but in 2021 this trend was reversed. Diabetic PD patients had the highest mortality rate over 20 years. The mortality rate of diabetic HD patients was higher than that of nondiabetic HD patients until 2019 but became lower starting in 2020. There was a decreasing trend in mortality rate in diabetic CKD 5D patients, but cardiac and vascular diseases were still prevalent in diabetic CKD 5D patients with frequent admissions to hospitals. More specialized care is needed to improve the clinical outcomes of diabetic CKD 5D patients.

Echocardiographic assessment of left ventricular myocardial strain, as a non-invasive method for diagnosing pulmonary hypertension in patients with end-stage chronic kidney disease

Background. Pulmonary hypertension is a common complication of chronic kidney disease, with incidence of up to 50%. Currently, the prognostic significance of non-invasive diagnostic methods for pulmonary hypertension in patients with chronic kidney disease remains relevant.Aim. To determine the significance of transthoracic echocardiography in diagnosing pulmonary hypertension in patients with end-stage chronic kidney disease.Material and methods. The study group consisted of 53 patients with chronic kidney disease stage 5D who were evaluated for kidney transplantation at the N.V. Sklifosovsky Research Institute for Emergency Medicine in 2022. A control group was represented by 24 healthy volunteers. Transthoracic echocardiography was performed on all patients according to a standard protocol, with determination of left ventricular myocardial strain indices.Results. A statistically significant correlation was found between the left ventricular global longitudinal strain and pulmonary artery systolic pressure r=0.488 (p<0.001), as well as between the left ventricular global circumferential strain and pulmonary artery systolic pressure (r=0.545, p<0.001). Regression analysis showed that an increase in pulmonary artery systolic pressure by 1 mmHg increased the odds of lethal outcome by 13% (Odds ratio: 1.13; 95% Confidence interval: [1.05;1.22], p=0.002).Conclusions. Hemodialysis patients are characterized by the development of pre-capillary pulmonary hypertension, which significantly affects their prognosis. Determination of left ventricular myocardial strain indices based on echocardiography provides additional information on the hemodynamics of the pulmonary circulation without using invasive diagnostic methods.

Contemporary secondary prevention in survivors of ST-elevation myocardial infarction with and without chronic kidney disease: a retrospective analysis.

Survivors of myocardial infarction have an elevated risk of long-term mortality. We sought to evaluate guideline-directed medical treatment and its impact on long-term mortality in survivors of ST-elevation myocardial infarction (STEMI) according to their chronic kidney disease (CKD) stage. Using German health insurance claims data, 157663 hospitalized survivors of STEMI were identified. Regarding different CKD stages, we retrospectively analysed the filled prescriptions of platelet inhibitors (PAI)/oral anticoagulation, statins, beta-blocker and angiotensin-converting enzyme inhibitors/angiotensin II type 1 receptor antagonists (ACE-I/AT1-A) and their association with long-term mortality. Prescription rates for all four guideline-directed drugs were highest in patients without or with mild CKD and lowest in patients on dialysis. They dropped from 73.4% to 39.2% in patients without CKD and from 47.1% to 29% in patients on dialysis within the 5-year follow-up period. Mortality rates were dramatically increased in patients with CKD compared with patients without CKD (5-year mortality: no CKD, 16.7%; CKD stage 3, 47.1%; CKD stage 5d, 69.7%). Filled prescriptions of at least one drug class [one drug: hazard ratio (HR) 0.70, 95% confidence interval (95% CI) 0.66-0.74; four drugs: HR 0.28, 95% CI 0.27-0.30; P<.001 for both] as well as the distinct drug classes (statins: HR 0.55, 95% CI 0.54-0.56; ACE-I/AT1-A: HR 0.68, 95% CI 0.67-0.70; beta-blocker: HR 0.87, 95% CI 0.85-0.90; PAI/oral anticoagulation: HR 0.97, 95% CI 0.95-1.00; all P<.05) improved long-term mortality. An improved long-term guideline-recommended drug therapy after STEMI regardless of renal impairment might lead to beneficial effects on long-term mortality.

Bone Turnover in Patients with Chronic Kidney Disease Stage 5D and Healthy Controls - a Quantitative [18F]Fluoride PET Study.

Chronic kidney disease (CKD) is prevalent in the aging population and increases the risk of fracture 2-4 times. We compared optimized quantitative [18F]fluoride PET/CT methods to the reference standard with arterial input function (AIF) to identify a clinically accessible method for evaluation of bone turnover in patients with CKD. Ten patients on chronic hemodialysis treatment and ten control patients were recruited. A dynamic 60-min [18F]fluoride PET scan was obtained from the 5th lumbar vertebra to the proximal femur simultaneously with arterial blood sampling to achieve an AIF. Individual AIFs were time-shifted to compute a population curve (PDIF). Bone and vascular volumes-of-interest (VOIs) were drawn, and an image-derived-input-function (IDIF) was extracted. PDIF and IDIF were scaled to plasma. Bone turnover (Ki) was calculated with the AIF, PDIF, and IDIF and bone VOIs using a Gjedde-Patlak plot. Input methods were compared using correlations and precision errors. The calculated Ki from the five non-invasive methods all correlated to the Ki from the AIF method with the PDIF scaled to a single late plasma sample showing the highest correlations (r > 0.94), and the lowest precision error of 3-5%. Furthermore, the femoral bone VOI's correlated positively to p-PTH and showed significant differences between patients and controls. Dynamic 30 min [18F]fluoride PET/CT with a population based input curve scaled to a single venous plasma sample is a feasible and precise non-invasive diagnostic method for the assessment of bone turnover in patients with CKD. The method may potentially allow for earlier and more precise diagnosis and may be useful for assessment of treatment effects, which is crucial for development of future treatment strategies.

Cardiovascular events in patients with deferred lesions and chronic kidney disease.

No study has reported the association between the worsening of chronic kidney disease (CKD) and cardiovascular events in patients with deferred coronary artery lesions. We included patients with deferred lesions, defined as a fractional flow reserve (FFR) value > 0.80 treated with conservative medical therapy. Patients were divided into three groups: group 1, CKD stages 1-2; group 2, CKD stages 3-5; and group 3, CKD stage 5D (hemodialysis), with the clinical outcomes compared. The primary endpoint was the first occurrence of target vessel myocardial infarction, ischemia-driven target-vessel revascularization, or all-cause death. The primary endpoint was noted in 17, 25, and 36 patients in groups 1, 2, and 3, respectively. Within the three groups, the incidence rate of deferred lesions was 7.0%, 10.4%, and 32.4%, respectively. No difference was observed in the incidence of the primary endpoint between groups 1 and 2 (log-rank p = 0.16). However, the patients in group 3 had a significantly higher risk for the primary endpoint than those in groups 1 and 2 (log-rank p < 0.0001). In the multivariate Cox proportional hazards model, the patients in group 3 exhibited a higher incidence of the primary endpoint than those in group 1 (HR: 2.14; 95% CI 1.02-4.49; p < 0.01). Careful management is needed in patients undergoing hemodialysis, even if coronary artery stenosis is considered a deferred lesion.

#6746 SAFETY OF ANGIOTENSIN RECEPTOR-NEPRILISIN INHIBITOR IN PERITONEAL DIALYSIS PATIENTS WITH HEART FAILURE: A MULTI-CENTER COHORT STUDY

Abstract Background and Aims Sacubitril/valsartan, the first approved angiotensin receptor neprilisin inhibitor (ARNi), is the current cornerstone in the treatment of heart failure with reduced ejection fraction (HFrEF), reducing hospitalizations and mortality. However, in patients with chronic kidney disease stage 5D, who have the highest prevalence of congestive heart failure, its use is still not approved. The aim of this study was to evaluate the safety of sacubitril/valsartan in peritoneal dialysis (PD) patients with HFrEF. Method Multi-center cross-sectional cohort study including 5 PD patients with NYHA class II-IV HFrEF who started sacubitril/valsartan between 2017 and 2022. Demographic and clinical data were collected from the electronic records. Clinical, biochemical and echocardiographic parameters were compared before and after treatment initiation. Results A total of 5 patients (all male) were included with a mean age of 71±9 years and a median follow-up time of 16 months (IQR 22). The dose of sacubitril/valsartan was 24/26mg, 2 times per day in all patients. The indication to start PD was hypervolemia in all patients and the mean left ventricular ejection fraction at PD beginning was 35±8%. DPCA was the modality of choice in all patients and 4 were under icodextrin. All patients had coronary artery disease and 3 patients were obese and diabetic. All patients were taking furosemide and 4 patients were under a beta-blocker and a SGLT-2 inhibitor. During follow-up, left ventricular ejection fraction increased from 35±8% to 38±8% (P = .018) and median residual diuresis decreased 25 mL per month (IQR 66), but none of the patients became anuric. De novo hyperkalemia or hypotension did not develop in any of the patients. No significant difference in blood pressure profile was noticed. A major adverse cardiovascular event occurred in only one patient (myocardial infarction requiring coronary artery revascularization and hospitalization). No deaths were reported. Conclusion Our results suggest that ARNi can be used safely in patients under PD with major cardiovascular risk. Further randomized studies are warranted to confirm safety and clarify the benefit of this therapy in PD patients with HFrEF.

#3325 EXTRARENAL CYP27B1 ACTIVITY CONTRIBUTES TO THE CIRCULATING POOL OF 1,25(OH)2D

Abstract Background and Aims Alterations of vitamin D metabolism are ubiquitous in patients with chronic kidney disease (CKD) and a key feature of the syndrome of CKD-mineral and bone disorder. A central paradigm in vitamin D metabolism is that the kidneys are the only relevant source of activation of vitamin D for systemic effects. However, various cells and tissues exhibit CYP27B1 activity and are capable of producing 1.25(OH)2D, which could contribute to the circulating pool [1]. This longitudinal, observational study challenges the dogma of the kidneys as the only source of 1.25(OH)2D, by investigating vitamin D metabolites in anephric patients free of active vitamin D therapy. Method Anephric patients free of active vitamin D therapy were included at time of kidney transplantation. A subset had a second study visit at 12 months post-transplant. Liquid chromatography–tandem mass spectrometry was used to measure 25(OH)D2/3, 1,25(OH)2D3 and 24,25(OH)2D3. Metabolic ratios of vitamin D metabolites over precursors were used as measures of CYP24A1 (24,25(OH) 2D3/ 25(OH)D3) and CYP27B1(1,25(OH)2D/ 25(OH)D3) activity. Biointact PTH (1-84) was measured by an in-house immunoradiometric assay [2] and FGF23 was measured by ELISA (Kainos Laboratories, Tokyo, Japan). Interleukin 6 (IL6), tumor necrosis factor-Α (TNF- Α) and interferon-Γ (IFN-Γ) were measured using an electrochemiluminescence multiplex immunoassay (Human Proinflammatory 1 V-plex, MSD, Maryland, US). Two independent laboratories performed confirmatory analyses of 1,25(OH)2D. Results All anephric patients (n = 38) had detectable (&amp;gt;2.5 pg/mL) levels of 1,25(OH)2D, with a median value of 13.5 pg/mL (range 3.9 to 35.7 pg/ml). There was a significant correlation between levels of 25(OH)D and 1,25(OH)2D (r = 0.583, p≪0.001), with 25(OH)D-levels explaining 34% of the variation in 1,25(OH)2D (Fig. 1). 1,25(OH)2D levels were not significantly correlated to PTH (rho = 0.279, p = 0.09) or FGF23 (rho = –0.280, p = 0.09), nor to any of the inflammatory markers; IL6 (rho = 0.068, p = 0.69), TNF-Α (rho = –0.264, p = 0.11), IFN-Γ (rho = –0.001, p = 0.99). To validate our findings, anonymized samples of 17 anephric patients and 17 CKD stage 5D with residual renal function were sent to two independent laboratories. The presence of 1,25(OH)2D was confirmed in all anephric patients. Twenty-five anephric patients underwent a successful kidney transplantation and were free of active vitamin D therapy at a study visit 12 months post-transplant. After kidney transplantation, 25(OH)D-level decreased, while levels of 1,25(OH)₂D and 24,25(OH) ₂D substantially increased. The metabolic ratios expressing CYP24A1 and CYP27B1 activity both increased (Fig. 2). At 12 months post-transplant, 1,25(OH)₂D-levels correlated with levels of biointact PTH (rho = 0.603, p = 0.002), but not with levels of FGF23 (rho = –0.262, p = 0.21). Conclusion Extrarenal CYP27B1 activity contributes to the circulating active vitamin D pool and may sustain low-normal levels of active vitamin D, even in anephric individuals. While renal CYP27B1 activity is hormonally regulated, extrarenal CYP27B1 activity seems to be mainly substrate dependent.

Multiple Myeloma of the Young Subject Revealed In Chronic Hemodialysis: About an Observation and Review of the Literature

Introduction: Multiple myeloma (MM) is a monoclonal proliferation of mature plasma cells. It usually occurs in people over 50 years of age with a peak in frequency at 65 years of age and less than 2% of patients are under 40 years of age. Case presentation: This case report is of a 38 year old black African woman with chronic kidney disease stage 5D. The IR was of glomerular origin (hypertension for 2 years, proteinuria at 4 g/24 hours, oedematous syndrome). Serum protein electrophoresis showed a beta peak at 29.7 g/l and urine protein immunoelectrophoresis showed a kappa/lambda ratio of 8.4. The myelogram showed a rich marrow with 51% plasma cells. Radiography showed multiple cystic images at the upper 1/3 of the left humeral shaft. Renal histology showed minimal glomerular damage. The diagnostic profile of IgG kappa light chain MM with CRAB criteria complicated by chronic glomerulonephritis with unorganised monoclonal immunoglobulin deposits was suggested. Management consisted of chemotherapy with bortezomib and dexamethasone for 4 cycles. The evolution under chronic dialysis was favourable after 1 year. Conclusion: MM in young adults (defined as 19-40 years of age) is rare, but it does exist. In young patients, this condition is initially not considered in the differential diagnosis and the occurrence of IR has a strong prognostic impact. Survival seems to be better in young adults than in elderly patients, which needs to be proven by a longer follow-up.

Densitometric justification of the diagnosis of osteoporosis in patients with chronic kidney disease stage 5D

BACKGROUND. Chronic kidney disease leads to increased bone fragility and fractures. Assessing the risk of fractures is a direct way to prevent them. THE AIM: to assess the possibility of using DXA to predict fracture risk in patients with stage 5D CKD. PATIENTS AND METHODS. The prospective cohort study included 359 patients (166 men, 193 women). BMD was evaluated by DRA. Some markers of mineral and bone metabolism were also analyzed. All fractures in patients were recorded from the moment of inclusion in the study. RESULTS. All patients with fractures had lower BMD and received longer-term renal replacement therapy (RRT). The absolute risk of fractures increased as BMD decreased. Patients with fractures had higher levels of parathyroid hormone and alkaline phosphatase. Stepwise multivariate regression analysis showed that the combination of BMD scores of the forearm, hip, lumbar vertebrae and the duration of RRT best predicts the risk of fractures. The presence of previous fractures also increases risk for the future. Risk of fractures in man and women did not differ. CONCLUSION. The risk of fractures in patients with CKD 5 st. on maintenance hemodialysis increases with a decrease in BMD, an increase in the duration of RRT and the presence of previous fractures, but does not significantly depends on the gender of the patients. It is also can be concluded that it is possible to use criteria reflecting the state of BMD, taking into account their sensitivity and specificity, in assessing the risk of fractures in patients with CKD 5D st.

Physical performance of patients with chronic kidney disease stage 5D and coronary heart disease

BACKGROUND. Assessment of physical performance in patients is usually based on the results of the 6-minute walk test, which is primarily associated with heart or respiratory failure. THE AIM: to analyze the results of the 6-minute walk test with clinical and laboratory parameters of patients with CKD 5D, including criteria for protein-energy malnutrition. PATIENTS AND METHODS. 67 people with CKD 5D were examined, including 42 men and 25 women, mean age 49.0 ± 14.9 and 57.2 ± 15.5 years, respectively, p = 0.036. The duration of RRT in men was 96.1 ± 80.3 months, in women 100.7 ± 66.1 months, p = 0.810. The diagnosis of coronary heart disease was established in 22 people, 7 of them had AMI. The muscle strength of the skeletal muscles was assessed using a hand dynamometer, the performance of the skeletal muscles – during a test with a 6-minute walk. All patients filled out food diaries, where they indicated the qualitative and quantitative composition of the food which they consumed for 3 days. RESULTS. Walking load was most easily tolerated by patients without clinical manifestations of CAD. Between patients with and without AMI in history, the number of points on the Borg scale was comparable and reached the maximum values. The highest concentration of C-reactive protein and the lowest concentration of serum albumin were observed in patients who had had AMI. Relationships were found between serum albumin with C-reactive protein and the results of the 6-minute walk test, as well as between the mass index of the left ventricular myocardium with the results of the 6-minute walk test. CONCLUSION. Left ventricular hypertrophy masks the clinical signs of reduced physical performance, but increases the risk of cardiovascular complications. The results of the 6-minute walk test in patients with CAD should be evaluated in more detail. A number of studies are needed to clarify how dietary recommendations should be modified depending on the level of systemic inflammation in CKD.

Contemporary in-hospital and long-term prognosis of patients with acute ST-elevation myocardial infarction depending on renal function: a retrospective analysis

BackgroundCardiovascular disease is often associated with chronic kidney disease (CKD), resulting in an increased risk for poor outcome. We sought to determine short-term mortality and overall survival in ST-elevation myocardial infarction (STEMI) patients with different stages of CKD.MethodsIn our retrospective cohort study with health insurance claims data of the Allgemeine Ortskrankenkasse (AOK), anonymized data of all STEMI patients hospitalized between 2010 and 2017 were analyzed regarding presence and severity of concomitant CKD.ResultsA total of 175,187 patients had an index-hospitalisation for STEMI (without CKD: 78.6% patients, CKD stage 1: 0.8%, CKD stage 2: 4.8%, CKD stage 3: 11.7%, CKD stage 4: 2.8%, CKD stage 5: 0.7%, CKD stage 5d: 0.6%). Patients with CKD were older and had more co-morbidities than patients without CKD. With increasing CKD severity, patients received less revascularization therapies (91.2%, 85.9%, 87.0%, 81.8%, 71.7%, 76.9% and 78.6% respectively, p < 0.001). After 1 year, guideline-recommended medications were prescribed less frequently in advanced CKD (83.4%, 79.3%, 81.5%, 74.7%, 65.0%, 59.4% and 53.7%, respectively, p < 0.001). CKD stages 4, 5 and 5d as well as chronic limb threatening ischemia (CLTI) were associated with decreased overall survival [CKD stage 4: hazard ratio (HR) 1.72; 95% CI 1.66–1.78; CKD stage 5: HR 2.55; 95% CI 2.37–2.73; CKD stage 5d: 5.64; 95% CI 5.42–5.86; CLTI: 2.06; 95% CI 1.98–2.13; all p < 0.001].ConclusionsCKD is a frequent co-morbidity in patients with STEMI and is associated with a worse prognosis especially in advanced stages. Guideline-recommended therapies in patients with STEMI and CKD are still underused.

Age-Related Characteristics of Mineral and Bone Metabolism in Patients with Chronic Kidney Disease Stage 5D on Hemodialysis

Summary Abnormalities in mineral and bone metabolism are a risk factor for increased cardiovascular and all-cause mortality and bone fractures in patients with chronic kidney disease stage 5D (CKD 5D). This single-center study aimed to investigate the age-related features of mineral and bone disorders in patients with CKD 5D on haemodialysis treatment and analyse the therapy provided. The biochemical parameters of mineral and bone metabolism and the ongoing therapy were studied in 90 patients undergoing hemodialysis treatment, of whom 44 (48.9%) were aged &lt;65 years and 46 (51.1%) were aged ≥65 years. Serum phosphate, 25(OH) vit.D, parathyroid hormone, and serum albumin were significantly lower in patients aged ≥65 years compared with patients aged &lt;65 years. There was a significant negative correlation between these parameters and age. We found no significant differences in therapy between the two age groups. A significant proportion of the patients aged ≥65 years had serum calcium and parathyroid hormone values below the lower desirable limit, while most of those aged &lt;65 years had hyperphosphatemia and parathyroid hormone ≥600 pg/ml. Mineral and bone metabolism in CKD stage 5D patients on hemodialysis showed age-dependent patterns. Knowing them is crucial for optimal treatment.

Clinicopathological study of Pigment Induced Nephropathy: A retrospective study

Introduction: Rhabdomyolysis and haemolysis cause pigment nephropathy that progresses to Chronic kidney disease requiring haemodialysis in some patients. As this is a significant financial burden, an understanding of the aetiologies and renal biopsy findings aids in timely diagnosis and optimising the outcomes. Objectives: We analysed the aetiology, clinicopathological features and renal outcome of seventeen patients with pigment nephropathy. Methodology: This Retrospective study was conducted from 2018-2021. Data on detailed clinical history, lab parameters, renal biopsy records, and renal outcome was collected. Results: Among seventeen pateints with Pigment Nephropathy the etiology was rhabdomyolysis in fifteen patients and hemolysis in two patients. Oliguria was the most common clinical presentation and all patients presented as acute kidney injury (AKI). Renal biopsy revealed reddish beaded granule and vermiform like casts in 10, brownish casts with intratubular hemosiderin in 3, granular and calcific casts in 2 patients each. While fourteen patients recovered to normal renal function within 3 months, one progressed to Chronic Kidney Disease stage 5D(CKD), one had CKD stage 2 and one died. Conclusion: In a majority of patients, clinical history did not reveal a direct diagnosis of rhabdomyolysis, and hence one must remain vigilant even in the absence of the classical triad of symptoms.

Stroke incidence and chronic kidney disease: A hospital-based prospective cohort study.

This prospective cohort study aimed to (i) examine stroke incidence and stroke subtypes by chronic kidney disease (CKD) stage, (ii) examine whether CKD patients with or without proteinuria have a high risk of stroke independent of traditional cardiovascular risk factors, and (iii) determine precise estimates of stroke risk by CKD stage while accounting for competing mortality risk. Participants were 2023 patients enrolled in the Project in Sado for Total Health between June 2008 and December 2016 (55% men; mean age, 69 years), of whom 52% had CKD (stage 1-2, 10%; G3a, 48%; G3b, 17%; G4-5, 11% and G5D, 14%). During a median follow-up of 5.7 years, 157 participants developed stroke and 448 died without developing stroke. Most stroke cases were ischaemic among non-dialysis-dependent CKD participants, but the relative frequency of ischaemic stroke was near that of intracerebral haemorrhage among dialysis-dependent CKD participants. After adjustment, stage 1-2 (hazard ratio [HR], 2.97; 95% confidence interval [CI], 1.60-5.51) and stage G3-5 participants with proteinuria (HR, 2.50; 95% CI, 1.56-4.02), but not stage G3-5 participants without proteinuria (HR, 0.64; 95% CI, 0.38-1.08), had a higher stroke risk compared to non-CKD participants. In competing risk analyses, the association was attenuated but remained significant. Although the distribution of stroke subtypes differed, CKD participants with proteinuria and those with CKD stage 5D had a 2- and 4-times higher risk of stroke, respectively, than that of non-CKD participants, after accounting for competing mortality risk and traditional risk factors.

MO727: Acute Myocardial Infarction in Diabetic Versus Non-Diabetic Haemodialysis Patients: A Single Centre 4-Years’ Experience

Abstract BACKGROUND AND AIMS Cardiovascular disease (CVD) is the leading cause of death among patients with end-stage renal disease accounting for 40% of all mortality. Diabetes mellitus, the main cause of chronic kidney disease (CKD) worldwide, together with obesity, hypertension and dyslipidaemia, places patients at higher risk for acute myocardial infarction (AMI). Effective treatment such as coronary revascularization is critical to lowering the subsequent risk of CV events and improving long-term survival. In this study, we aim to compare the cardiovascular outcomes in diabetic versus non-diabetic patients in dialysis following an AMI. Methods We retrospectively enrolled 70 CKD stage 5d patients (4 h/3 times a week) aged ≥ 18 years old who were admitted at the cardiac intensive care unit with AMI between January 2017 and December 2020. Baseline variables and laboratory data were collected at admission and 1 month after discharge for follow-up. Two groups were created: G1 (diabetic) and G2 (non-diabetic). Data were collected by consulting electronic medical records. Statistical analyses were performed using the SPSS statistics version 23.0. RESULTS Seventy patients (male: 72.9%) with a mean age of 70.9 ± 12 years were selected. G1 (n = 33; 47.1%) and G2 (n = 37; 52.1%) had similar distributions of gender (male: 72.7% versus 72.9%; P = 0.081) and age (70.9 ± 9 versus 70.8 ± 10 years; P = 0.076) opposite to dialysis vintage (33 versus 17 months; P = 0.003). The main CKD cause in G2 was hypertensive nephrosclerosis (n = 14, 37.8%), followed by uncertain aetiology (n = 10, 27.1%), obstructive uropathy (n = 6, 16.2%), autosomal dominant polycystic kidney disease (n = 3, 8.1%), IgA nephropathy (n = 2, 5.4%) and small vessel vasculitis (n = 2, 5.4%). Previous comorbidities were (G1 versus G2): arterial hypertension (93.9% versus 97.3%; P = 0.77), smoking habits (9.1% versus 16.2%; P = 0.033), heart failure (78.8% versus 67.6%; P = 0.064), left ventricular hypertrophy (47.9% versus 52.8%; P = 0.082), body mass index &amp;gt; 30 kg/m2 (57.6% versus 56.8%; P = 0.72) and dyslipidaemia (100% versus 99%; P = 0.91). At admission, groups were compared hypoalbuminemia (serum albumin &amp;lt; 3.0 g/dL) [37.9% versus 26.8%, OR 4.1, 95% confidence interval (95% CI) 2.1–24.4; P = 0.0022] and clinical frailty score &amp;gt; 4 points (56 versus 32%, OR 5.4, 95% CI 1.4–25.1, P = 0.0041). Total cholesterol (149 ± 38 versus 146 ± 39 mg/dL) and low-density lipoprotein cholesterol (97 ± 31.6 versus 94 ± 29.9 mg/dL) were also compared with no statistically significant differences. In G1, glycaemic control was satisfactory (HbA1c: 7.4%); 45.5% (n = 15) were taking insulin alone, 9.0% (n = 3) were taking oral antidiabetics (DPP-4 inhibitors) and 45.5% (n = 15) were using a combined therapy. Regarding AMI in G1 and G2, ST segment elevation myocardial infarction (STEMI) was present in 8 (24.2%) versus 11 (29.7%) patients (P = 0.08); all patients underwent coronary revascularization except 3 patients on each group (9% versus 8.1%), who had a NSTEMI. During hospitalization (10.5 ± 6 days versus 10.2 ± 12 days; P = 0.12), 13 patients died (n = 6; 18.2% versus n = 7; 18.9%, P = 0.07); 3 were treated conservatively and all 3 belonged to G1. The main cause of death was cardiogenic shock (n = 10, 83.3%). No deaths or new CV events occurred 30 days post-AMI. Multiple regression analysis showed that dialysis vintage was the only significant predictor for the occurrence of a CV event, regardless of being STEMI/NSTEMI or of any intervention. CONCLUSION Based on our results, G1 and G2 showed no difference in mortality or risk of developing a new CV event in the following month post-AMI. This might be related with several non-traditional risk factors, such as chronic volume overload, anaemia, inflammation, oxidative stress, and chronic kidney disease-mineral bone present in the majority of dialysis patients that were not evaluated or with the size of our sample.

Inverse Relationship between Mean Corpuscular Volume and T-Score in Chronic Dialysis Patients

Background and Objectives: Osteoporosis and anemia are prevalent among chronic kidney disease stage 5D (CKD stage 5D) patients. Osteoblasts are known as the niche cells of hematopoietic stem cells (HSCs) and stimulate HSCs to form blood-cell lineages within bone marrow microenvironments. We hypothesized that an inverse correlation may exist between mean corpuscular volume (MCV), a surrogate for ineffective hematopoiesis, and bone mineral density (BMD) in the CKD stage 5D population. Materials and Methods: This is a cross-sectional designed cohort study evaluating CKD stage 5D patients who have received dialysis therapy for over three months. Baseline clinical characteristics and laboratory data were prospectively collected. The dual-energy X-ray absorptiometry (DXA) method was used to measure BMD at five sites, which were bilateral femoral neck, total hip, and lumbar spine 1–4. The Pearson correlation test was initially adopted, and a multivariate linear regression model was further applied for potential confounder adjustments. Results: From September 2020 to January 2021, a total of 123 CKD stage 5D patients were enrolled. The Pearson correlation test revealed a significant inverse association between MCV and BMD at bilateral femoral neck and lumbar spine. The lowest T-score of the five body sites was determined as the recorded T-score. After adjustments for several potential confounding factors, the multivariate linear regression model found consistent negative associations between T-score and MCV. Conclusions: The present study found significant inverse correlations between MCV and BMD at specific body locations in patients on dialysis. A decreased T-score was also found to be associated with macrocytosis after adjustments for confounding variables. However, direct evidence for the causative etiology was lacking.

Angiodysplasia and its correlation to serum magnesium level in patients with chronic kidney disease stage 5D under maintenance hemodialysis

Background Angiodysplasias (ADs) are vascular ectasias not associated with any familial syndrome, cutaneous lesions, or systemic vascular disease. They are the most common vascular malformations of the gastrointestinal tract in the general population with a prevalence of 0.82%. Most AD occurring in the general population are detected in patients older than 60 years of age, although presentation in patients with chronic kidney disease (CKD) can be earlier. The aim was to correlate AD with serum magnesium level in patients with CKD stage 5D under maintenance hemodialysis.Patients and methods This study included 60 patients with CKD stage 5D on maintenance hemodialysis. Upper and lower gastrointestinal tract endoscopy was done for all patients in Kafr Elsheikh University Hospital in a cross-sectional ‘prospective study,’ and all laboratory investigations were done.Results The mean age of patients with CKD was 49.03±14.66 years. There was a statistically significant increase in Mg among patients with AD and those without AD. This study showed that there were statistically significant negative correlations between Mg and parathyroid hormone.Conclusion AD is one of the common causes of gastrointestinal bleeding in all population and is the most common cause of bleeding in patients with CKD. Hypermagnesemia is associated with AD in patients with CKD.

The Risk Factors of Blood Cadmium Elevation in Chronic Kidney Disease.

Low-level cadmium exposure has adverse effects on chronic kidney disease (CKD); however, the risk factors for elevated blood cadmium levels (BCLs) have not been studied in CKD. We conducted a cross-sectional investigation in 200 CKD patients and stratified them by the tertiles of BCL to compare their demographic, environmental, and biochemical data. The factors associated with BCL were identified, and their effects were examined in subgroups. In the analyses, female sex, smoking, and CKD stage 5D were associated with high BCL, and statin was inversely correlated with BCL (odds ratio [95% confidence interval, CI], 6.858 [2.381–19.746], p < 0.001, 11.719 [2.843–48.296], p = 0.001, 30.333 [2.252–408.520], p = 0.010, and 0.326 [0.122–0.873], p = 0.026; deviations of BCL [nmol/L, 95% CI], 2.66 [1.33–4.00], p < 0.001, 3.68 [1.81–5.56], p < 0.001, 3.38 [0.95–5.82], p = 0.007, and −2.07 [−3.35–−0.78], p = 0.002). These factors were also independently correlated with BCL in subgroups, including non-dialysis CKD, hypertensive patients, non-smokers, and male patients. In conclusion, female sex, smoking, and CKD stage 5D were the major risk factors for elevated BCL; additionally, statins were negatively associated with BCL in CKD.

Kidney dysfunction requiring dialysis is a heterogeneous syndrome: we should treat it like one.

Advanced kidney failure requiring dialysis, commonly labeled end-stage kidney disease or chronic kidney disease stage 5D, is a heterogeneous syndrome -a key reason that may explain why: treating advanced kidney dysfunction is challenging and many clinical trials involving patients on dialysis have failed, thus far. Treatment with dialytic techniques - of which maintenance thrice-weekly hemodialysis is most commonly used - is broadly named kidney 'replacement' therapy, a term that casts the perception of a priori abandonment of intrinsic kidney function and subsumes patients into a single, homogeneous group. Patients with advanced kidney failure necessitating dialytic therapy may have ongoing endogenous kidney function, and differ in their clinical manifestations and needs. Different terminology, for example, kidney dysfunction requiring dialysis (KDRD) with stages of progressive severity could better capture the range of phenotypes of patients who require kidney 'assistance' therapy. Classifying patients with KDRD based on objective, quantitative levels of endogenous kidney function, as well as patient-reported symptoms and quality of life, would facilitate hemodialysis prescriptions tailored to level of kidney dysfunction, clinical needs, and personal priorities. Such classification would encourage clinicians to move toward personalized, physiological, and adaptive approach to hemodialysis therapy.

Contemporary in-hospital and long-term prognosis of patients with acute ST-elevation myocardial infarction and chronic kidney disease in Germany

Abstract Background Although acute myocardial infarction (AMI) incidence and mortality have decreased over the last decades, survival rates of AMI patients remain rather stable. About 25% of patients with ST-elevation myocardial infarction (STEMI) suffer from chronic kidney disease (CKD). Purpose We sought to determine short- and long-term mortality in STEMI patients with different stages of CKD. Methods We identified all patients who were hospitalised with a main diagnosis of STEMI between 2010 and 2017 from the dataset of the Federal Association of the Local Health Insurance Funds (Allgemeine Ortskasse), Germany. The patients were grouped according to their CKD stage at index hospitalisation. We analysed concomitant diseases, in-hospital treatment and complications. Overall survival was analysed using Kaplan Meier methods and predictors for overall survival were identified by Cox regression analysis. Results A total of 175,187 patients were identified with an index hospitalisation for STEMI, thereof 137,682 (78.6%) patients without CKD, 8,347 (4.8%) patients with CKD stage 2, 20,459 (11.7%) patients with CKD stage 3, and 4,960 (2.8%) patients with CKD stage 4. The CKD stages 1, 5 and 5d (dialysis dependent CKD) each comprised less than 1,500 patients (&amp;lt;1.0%). STEMI patients with CKD were older and had more often cardiovascular risk factors, e.g. diabetes (no CKD: 33.2% vs CKD stage 5: 66.1%, p&amp;lt;0.001). Overall, patients with CKD received percutaneous coronary interventions (no CKD: 84.4% vs CKD stage 4: 62.0%, p&amp;lt;0.001) less frequently, and suffered more often from complications like shock (no CKD: 12.5% vs. CKD stage 5: 27.7%, p&amp;lt;0.001) or requirement of invasive/non-invasive ventilation (no CKD: 17.3% vs. CKD stage 5: 42.7%, p&amp;lt;0.001) than patients without CKD. With increasing CKD stages, patients were more likely to die within 30 days after STEMI (30-day mortality no CKD: 13.7% vs. CKD stage 5d: 37.2%, p&amp;lt;0.001). Kaplan-Meier estimates showed dramatically decreasing survival with decreasing renal function (Figure 1). Multivariable time-dependent Cox regression analysis for overall survival showed that the CKD stages 4, 5 and 5d, as well as chronic limb threatening ischemia (CLTI) were associated with a higher risk for death (CKD stage 5d: hazard ratio (HR) 5.64; 95% CI 5.42–5.86; CKD stage 5: HR 2.55; 95% CI 2.37–2.73; CKD stage 4: 1.72; 95% CI 1.66–1.78; CLTI: 2.06; 95% CI 1.98–2.13; all p&amp;lt;0.001). Conclusion CKD is a frequent co-morbidity in patients with STEMI which is associated with a devastating prognosis especially for patients with advanced CKD stages. More research is needed to gain evidence on optimized treatment strategies for patients with STEMI and concomitant CKD in this highly vulnerable cohort. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The project upon which this publication is based was funded by The Federal Joint Committee, Innovation Committee (G-BA, Innovationsfonds, number 01VSF18051). Figure 1. Unadjusted Kaplan-Meier survival curves