Chronic Kidney Disease Subgroups Research Articles

A study of baseline data from SPRINT: Exploring lipid profile changes in middle-aged and elderly patients.

The elderly population is at a higher risk of cardiovascular complications, and dyslipidemia plays a significant role as a contributing factor. Chronic kidney disease (CKD) patients are prone to lipid abnormalities, further increasing the risk of cardiovascular complications. We aimed to investigate the lipid profile characteristics of the middle-aged and elderly population, particularly CKD patients. We conducted a cross-sectional study using baseline data from the Systolic Blood Pressure Intervention Trial (SPRINT). It was examined how lipid profiles are affected by age within the general population, and how BMI and lipid characteristics are affected by CKD subtype. Among 8746 participants, we observed a decreasing trend in LnTAG (natural logarithm of Triacylglycerol) and total Cholesterol (CHR) levels with increasing age, while high-density lipoprotein cholesterol (HDL-C) levels increased with age. In the CKD and non-CKD subgroups created through propensity score matching based on age, sex, and race, CKD individuals exhibited significantly higher average LnTAG levels across all age groups compared to the non-CKD group. Multivariable linear regression analysis, controlling for confounding variables, revealed a negative correlation between LnTAG and estimated glomerular filtration rate (eGFR) (r = -0.002, p < 0.001). HDL-C showed a positive correlation with eGFR (r = 0.057, p < 0.001). That is, in the middle-aged and elderly population, age demonstrated a negative correlation with total CHR and TAG levels, while exhibiting a positive correlation with HDL-C levels. CKD patients exhibited relatively higher TAG levels, which were positively associated with CKD progression.

Assessment of the effect of gabapentin on blood pressure in cats with and without chronic kidney disease.

The aim of the present study was to assess the effect of gabapentin on blood pressure (BP) in cats with and without chronic kidney disease (CKD). A randomized, blinded, placebo-controlled crossover study was performed. A total of 29 cats were included: 13 cats with stable CKD (IRIS stage 2-4) and 16 apparently healthy cats (serum creatinine <1.6 mg/dl and urine specific gravity >1.035). The cats were evaluated twice, approximately 1 week apart, and BP (Doppler sphygmomanometry) was obtained 3 h after cats received either a single dose of gabapentin 10mg/kg PO or placebo. For each cat, BP readings were obtained at each visit using the same Doppler and sphygmomanometer unit, and the same cat holder and Doppler operator, in the same location. After administration of a single dose of gabapentin (10 mg/kg PO), BP was significantly lower (median 122 mmHg, range 82-170) than after administration of the placebo (median 150 mmHg, range 102-191; P = 0.001). In the CKD subgroup, BP was significantly lower after administration of gabapentin (median 129 mmHg, range 96-170) than after administration of the placebo (median 155 mmHg, range 102-191; P = 0.008). In the healthy cat subgroup, BP was significantly lower after administration of gabapentin (median 121 mmHg, range 82-139) than after administration of the placebo (median 137 mmHg, range 102-177; P = 0.002). The median change in BP was -12 mmHg (range -95 to 10) for healthy cats and -12 mmHg (range -43 to 21) for cats with CKD (no significant difference between subgroups). Gabapentin may decrease arterial BP in cats with and without CKD and these findings should be taken into account when gabapentin is administered to patients in which measurement of BP is needed.

Switching from Conventional Fibrates to Pemafibrate Has Beneficial Effects on the Renal Function of Diabetic Subjects with Chronic Kidney Disease.

Fibrates have renal toxicity limiting their use in subjects with chronic kidney disease (CKD). However, pemafibrate has fewer toxic effects on renal function. In the present analysis, we evaluated the effects of pemafibrate on the renal function of diabetic subjects with or without CKD in a real-world clinical setting. We performed a sub-analysis of data collected during a multi-center, prospective, observational study of the effects of pemafibrate on lipid metabolism in subjects with type 2 diabetes mellitus complicated by hypertriglyceridemia (the PARM-T2D study). The participants were allocated to add pemafibrate to their existing regimen (ADD-ON), switch from their existing fibrate to pemafibrate (SWITCH), or continue conventional therapy (CTRL). The changes in estimated glomerular filtration rate (eGFR) over 52 weeks were compared among these groups as well as among subgroups created according to CKD status. Data for 520 participants (ADD-ON, n=166; SWITCH, n=96; CTRL, n=258) were analyzed. Of them, 56.7% had CKD. The eGFR increased only in the SWITCH group, and this trend was also present in the CKD subgroup (P<0.001). On the other hand, eGFR was not affected by switching in participants with severe renal dysfunction (G3b or G4) and/or macroalbuminuria. Multivariate analysis showed that being older and a switch from fenofibrate were associated with elevation in eGFR (both P<0.05). A switch to pemafibrate may be associated with an elevation in eGFR, but to a lesser extent in patients with poor renal function.

Overnight 1-mg DST Serum Cortisol in Various Stages of Chronic Kidney Disease-Normative Data and Underlying Mechanisms.

Data on the overnight 1 mg-dexamethasone suppression test (ONDST) in renal dysfunction are limited. We aim to determine the normative range of ONDST cortisol across chronic kidney disease (CKD) stages and reasons for its alteration. Prospectively, 180 CKD (30 each in G2-G5/5D) patients and 30 healthy controls underwent ONDST 8 Am serum cortisol (chemiluminescent immunoassay [CLIA]). In an exploratory cohort, 45 (15 each: G3b/G4, G5/G5D, and healthy controls) individuals' blood biochemistry for basal (8 Am) cortisol and adrenocorticotropin (ACTH), post-ONDST 8 Am dexamethasone, ACTH, cortisol (CLIA and liquid chromatography-tandem mass spectrometry), and 4 Pm cortisol was collected. Post-ONDST cortisol (µg/dL) correlated inversely (r = 0.47; P < .005) with estimated glomerular filtration rate (eGFR) (mL/min/1.73 m2), with 95th percentile being 1.2 in controls, 3.0 in G2, 3.2 in G3a, 4.3 in G3b, 4.7 in G4, 5.7 in G5, and 7.1 in G5D. In the exploratory cohort, basal 8 Am cortisol and ACTH, and post-ONDST dexamethasone were similar among controls and CKD subgroups. ONDST ACTH (for evaluating the hypothalamo-pituitary-adrenal axis) was slightly higher in G5/5D vs controls (8.9 vs 6.1 pg/mL), while it was similar in G3b/G4 vs controls. Median 8 Am ONDST cortisol was similar on CLIA and LC-MS/MS in controls and higher on CLIA in G3b/4 (1.7 vs 1.1 µg/dL; P = .012) and G5/5D (2.4 vs 1.7 µg/dL; P = .002) than LC-MS/MS. Post-ONDST serum cortisol drop from 8 Am to 4 Pm was significant in controls (0.5-<0.2 µg/dL) and G3b/4 (1.7-1.2 µg/dL), but not in G5/5D (2.4-2.2 µg/dL). The normative data of ONDST serum cortisol with eGFR-based cutoffs are useful in evaluating Cushing syndrome in CKD. Prolonged cortisol half-life and immunoassay-related assay cross-reaction are likely contributors to higher ONDST cortisol.

Clinical Profile and Outcomes of Hospitalized Coronavirus Disease-2019 Patients Requiring Renal Replacement Therapy at a Tertiary Care Center

ABSTRACT Introduction: Patients with coronavirus disease-2019 (COVID-19) infection who have underlying chronic kidney disease (CKD) or experience acute kidney injury (AKI) are at an increased risk of severe disease and mortality. Materials and Methods: This single-center retrospective study was conducted at a tertiary care center offering hemodialysis (HD) facilities to COVID-19-positive patients. We included COVID-19-positive patients aged &gt;18 years who received HD during their hospital stay. Patients were classified as CKD-5D, acute on CKD, and AKI stage-3 (AKI-3D). Results: Severe disease was seen in ~60% of patients, with a higher overall mortality (46.15%). However, there was no significant difference in mortality between CKD-5D (n = 70), acute on CKD (n = 32), and AKI-3D (n = 15) groups (42.9% vs. 53.1% vs. 46.7%, P = 0.627). Advanced age, diabetic status, severe disease, and raised inflammatory markers were predictors of mortality. Conclusion: Among patients with COVID-19, severe renal disease requiring dialysis is associated with high mortality. We did not see any significant difference in mortality in either AKI or CKD subgroups.

The Relationship of Fetuin-A with Coronary Calcification, Carotid Atherosclerosis, and Mortality Risk in Non-Dialysis Chronic Kidney Disease.

This study investigated the relationship of fetuin-A with coronary calcification, carotid atherosclerosis, and mortality risk in non-dialysis chronic kidney disease (CKD). The study included 135 adult patients with CKD at stages 3-5, who were divided into coronary artery calcification (CAC) and non-CAC groups. We excluded current smokers and individuals with diabetes mellitus, inflammatory conditions, liver diseases, acute kidney failure, chronic hemodialysis, and cancer. We conducted kidney function tests, complete blood counts, and measured serum levels of fetuin-A, tumor necrosis factor-alpha (TNF-α), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), total cholesterol (TC), total triglycerides (TG), high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. Cardiac spiral computed tomography was used to calculate the CAC score, employing the Agatston method. Carotid ultrasonography was performed to assess carotid intima-media thickness (CIMT) and to detect the presence of plaques. CAC patients had considerably higher levels of TNF-α (p<0.001), IL-6 (p<0.001), hs-CRP (p=0.006), TC, TG, parathyroid hormone (PTH) (p<0.001) and phosphorus (p<0.001) than non-CAC patients. They also had significantly lower levels of fetuin-A (p<0.001). Fetuin-A was considerably lower in CKD subgroups as CKD progressed. Fetuin-A (p=0.046), age (p=0.009), TNF-α (p=0.027), IL-6 (p=0.005), TG (p=0.002), PTH (p=0.002), and phosphorus (p=0.004) were significant predictors of CAC. CAC and fetuin-A were strong predictors of all-cause mortality and cardiovascular (CV) mortality. Fetuin-A was a significant predictor of CIMT (p=0.045). Fetuin-A reliably predicted CAC and CIMT. Fetuin-A and CAC emerged as significant risk factors for all-cause and CV mortality in non-dialysis CKD.

Abstract 12861: Steroidal Mineralocorticoid Receptor Antagonist Treatment Patterns and Predictors of Discontinuation

Introduction: Steroidal mineralocorticoid receptor antagonists (sMRA), spironolactone and eplerenone, are indicated for several cardiovascular (CV) conditions, including heart failure and hypertension. However, adverse drug reactions may lead to discontinuation. This study aimed to explore sMRA treatment patterns and predictors of discontinuation. Methods: This retrospective observational study used administrative claims from the Healthcare Integrated Research Database® to identify naïve adult users of sMRAs between 01 Jan 2016 and 31 May 2021 with at least 12 months of continuous health plan enrollment before initiation. Five subgroups were identified based on comorbidities before sMRA initiation - heart failure with preserved or reduced ejection fraction (HFpEF/HFrEF), undetermined heart failure (undHF), chronic kidney disease (CKD) and type 2 diabetes (T2D), and nondiabetic-CKD (ndCKD). sMRA treatment patterns and discontinuation (i.e., no refill within two prescription cycles) were described. Multivariate logistic regression modeling was used to explore predictors (i.e., demographics, comorbidity burden, specialist prescribing, CV disease, and medications) of discontinuation in all sMRA users and subgroups separately. Results: We identified 224,100 sMRAs users (99% spironolactone), including 8,553 HFpEF, 19,636 HFrEF, 20,336 undHF, 11,336 CKD and T2D, and 10,134 ndCKD, patients. Over a median of 655 days, a dose change was observed in 23% of patients. A dose increase was more common than a decrease (16% vs. 7%), a trend that was observed across all subgroups. Overall, 73% of sMRA users discontinued treatment after a median of 90 days. Discontinuation in subgroups was lower; 62% in HFpEF, 58% in HFrEF, 61% in undHF, and 66% in both CKD subgroups. No specific factors were consistently associated with increased odds of sMRA discontinuation. However, increased comorbidity burden, use of other CV medications, and cardiologist prescribers significantly decreased the odds of discontinuation across most subgroups. Conclusions: Most naïve sMRA users discontinue therapy within six months of initiation. No demographic or clinical factors were consistently associated with increased odds of sMRA discontinuation.

The Relationship between Serum Selenium Levels and Restless Leg Syndrome in Chronic Kidney Disease Patients.

Background and Objectives: Chronic kidney disease (CKD) is a global public health issue with rising incidence linked to substantial morbidity and mortality. Selenium, an antioxidant trace element, has been linked to low serum levels in end-stage renal disease. Restless Leg Syndrome (RLS), a sleep disorder, is prevalent in CKD patients and significantly impacts their quality of life. The objective of this study was to examine the correlation between serum selenium levels and the prevalence of restless leg syndrome in individuals with chronic kidney disease. Materials and Methods: Forty-six CKD patients undergoing serum selenium level assessments between 1 January 2020 and 28 February 2022, at the Hitit University Faculty of Medicine Department of Nephrology Outpatient Clinic or Hemodialysis Unit, were included. Patients over 18 years of age with no history of hematological or oncological diseases or acute or chronic inflammatory conditions were included in the study groups. Patients taking selenium supplements were excluded. Demographic data, comorbidities, and laboratory values were collected, and RLS presence and severity were evaluated. Statistical analyses include descriptive statistics, correlation analysis, the Mann-Whitney U test, Student's t test, and Chi-square test. Results: Among the 46 patients, 16 (34.78%) had RLS symptoms. The patient group included 34.78% predialysis, 34.78% peritoneal dialysis, and 30.44% hemodialysis patients, with a median age of 47.98 years. There was no difference in age, gender, and Charlson comorbidity between patients with or without RLS (p = 0.881, p = 0.702, p = 0.650). RLS prevalence varied across CKD subgroups, with hemodialysis patients having a higher prevalence (p = 0.036). Clinical parameters such as blood urea nitrogen, creatinine, calcium, phosphorus, platelet counts, and parathyroid hormone levels exhibited significant differences between patients with and without RLS (p < 0.05). Serum selenium levels were not significantly different between patients with and without RLS (p = 0.327). Conclusions: With an increased comorbidity burden, CKD poses a significant healthcare challenge. When accompanied by RLS, this burden can be debilitating. The difference in CKD stages between groups has shed light on a critical determinant of RLS in this population, emphasizing the role of the chronic kidney disease stage. In our study, serum selenium levels were not associated with the presence and severity of RLS. However, prospective studies with larger numbers of participants are needed to draw a definitive conclusion.

Electrocardiographic measurements in children with pre-dialysis chronic kidney disease and undergoing kidney replacement therapy.

Cardiovascular diseases are the main causes of morbidity in children with chronic kidney disease (CKD). Electrocardiography (ECG) can provide important information about cardiac functions and parameters associated with sudden cardiac death. This study aims to evaluate the potentially dangerous changes in CKD and kidney replacement therapies by ECG and to determine the value of ECG in predicting cardiovascular outcome compared with echocardiography. 101 patients with CKD were divided into subgroups according to treatment modalities as pre-dialysis CKD, hemodialysis (HD), peritoneal dialysis (PD) and kidney transplantation (KTx). Differences in anthropometric measurements, laboratory results, blood pressures, ECG monitoring were compared within groups as well as with 40 healthy controls. Available echocardiographic findings were noted. In the patients, HD group had highest frequency of hypertension. ECG revealed prolonged QTc as more frequent (16.8% vs 0%, p = 0.006) and higher QTcD (56.7 ± 6.5 vs 39.9 ± 5.1ms, p = 0.001) in the patients compared to controls, especially in dialysis patients, whereas lowest values were in KTx subgroup. Left ventricular (LV) hypertrophy (LVH) was more frequent (47.1%) in HD compared to other CKD subgroups in ECG (p = 0.052). Echocardiography also showed LV mass index as highest in HD and lowest in KTx (121.4 ± 55.7 vs 63.7 ± 18.3g/m2, p = 0.000), with numerically highest LVH in HD (58.3%, p = 0.063). Conclusion: ECG can be used to detect cardiovascular problems in patients with CKD, especially in HD. As ECG results were in line with echocardiography, patients with ECG abnormalities suggestive of LVH should be referred for echocardiographic assessment. What is Known: • Cardiovascular diseases such as coronary artery disease, congestive heart failure, arrhythmias and sudden cardiac death are major causes of morbidity and mortality in chronic kidney disease. • Electrocardiography has significant advantages in demonstrating cardiac functions in children because it is readily available, non-invasive and often non-experts can interpret the results. What is New: • The heart rate is higher, QTc is longer and QTcD is higher in dialysis patients and the prolonged QTc is more frequent in patients with underlying glomerular diseases. • Left ventricular hypertrophy is more common in HD patients and those with hypertension, hypercalcemia, anemia or glomerular etiology. The cardiovascular risky conditions are less frequent in the patients with kidney transplantation.

Native T1 mapping for non-invasive quantitative evaluation of renal function and renal fibrosis in patients with chronic kidney disease.

To investigate the role of native T1 mapping in the non-invasive quantitative assessment of renal function and renal fibrosis (RF) in chronic kidney disease (CKD) patients. A prospective analysis of 71 consecutive patients [no RF (0%): 9 cases; mild RF (<25%): 36 cases; moderate RF (25-50%): 17 cases; severe RF (>50%): 9 cases] who were clinically diagnosed with CKD that was pathologically confirmed and who underwent magnetic resonance imaging (MRI) examination between October 2021 and September 2022 was performed. T1-C (mean cortical T1 value), T1-M (mean medullary T1 value), ΔT1 (mean corticomedullary difference) and T1% (mean corticomedullary ratio) values were compared. Correlations between T1 parameters and clinical and histopathological values were analyzed. Regression analysis was performed to determine independent predictors of RF. The areas under the receiver operating characteristic curve (AUC) were calculated to assess the diagnostic value of RF. The T1-C, ΔT1 and T1% values (P<0.05) were significantly different in the CKD group, but T1-M was not (P>0.05). The ΔT1 and T1% values showed significant differences in pairwise comparisons among CKD subgroups (P<0.05) except for CKD 2 and 3. ΔT1 and T1% were moderately correlated with the estimated glomerular filtration rate (ΔT1: rs=-0.561; T1%: r=-0.602), serum creatinine (ΔT1: rs=0.591; T1%: rs=0.563), blood urea nitrogen (ΔT1: rs=0.433; T1%: rs=0.435) and histopathological score (ΔT1: rs=0.630; T1%: rs=0.658). ΔT1 and T1%, but not T1-C, were independent predictors of RF (P<0.05). ΔT1 and T1% were set as -410.07 ms and 0.8222 with great specificity [ΔT1: 91.7% (77.5-98.2%); T1%: 97.2% (85.5-99.9%)] to identify mild RF and moderate-severe RF. The optimal cutoff values for differentiating severe RF from mild-moderate RF were -343.81 ms (ΔT1) and 0.8359 (T1%) with high sensitivity [both 100% (66.4-100%)] and specificity [ΔT1: 90.6% (79.3-96.9%); T1%: 94.3% (84.3-98.8%)]. ΔT1 and T1% overwhelm T1-C for assessment of renal function and RF in CKD patients. ΔT1 and T1% identify patients with <25% and >50% fibrosis, which can guide clinical decision-making and help to avoid biopsy-related bleeding.

Chronic kidney disease and outcome of patients with tricuspid regurgitation

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Although chronic kidney disease (CKD) is common among patients with tricuspid regurgitation (TR), these patients are under-represented in clinical trials examining tricuspid transcatheter interventions, and data regarding their outcome are limited. Methods Consecutive echocardiographic reports linked to clinical data from the largest medical center in Israel (2007–2022) were reviewed. Patients were dichotomized into three groups TR groups (mild, moderate and severe), following by stratification according to renal function. The primary outcome was all-cause mortality. Kaplan Meier, Multivariate Cox regression and interaction analysis models were applied. Results The final study population included 78,461 patients with a mean age of 65 (IQR: 55–78 years), 2,998 (4%) of whom had severe TR. There were 11,443 (15%) patients with at least moderate CKD (estimated glomerular filtration rate [eGFR] &amp;lt; 45 mL/min/1.73 m2), 5573 (7%) with eGFR&amp;lt;30 and 1853 (2%) with eGFR&amp;lt;=15. During a median follow-up period of 4 years (IQR: 1–7 years), 28,228 patients (36%) died. Kaplan-Meier survival analysis demonstrated an increased risk for death with both increasing severity of TR and/or CKD grade (log-rank p&amp;lt;.001 for both;). The association of severe TR with poor survival was consistent among all CKD subgroups (FIGURE). Multivariate Cox analysis with adjustment for age, sex, ejection fraction, estimated pulmonary pressure and eGFR demonstrated that compared to mild TR, patients with severe TR were 56% more likely to die during follow up (95% CI 1.47–1.66, p&amp;lt;.001). Interaction analysis demonstrated that the association of severe TR degree with survival was consistent in all subgroups but dependent on renal function, such that it was more pronounced as renal function declined, with adjusted HR of 1.6 among patients with eGFR&amp;lt;=15 (P for intercation &amp;lt;.001). Conclusions While the association of TR with poor survival is consistent across all CKD groups, it is more pronounced among patients with advanced CKD. When examining data and outcome of tricuspid clinical trials, special emphasis should be given to CKD status.

#5776 HIGHER DIETARY NA/K RATIO IS ASSOCIATED WITH AN INCREASED RISK OF CARDIOVASCULAR OUTCOMES IN THE GENERAL POPULATION, BUT NOT IN CKD PATIENTS

Abstract Background and Aims High sodium and low potassium intake have been recognized as cardiovascular risk factors. The combined effect of sodium and potassium intake, reflected by the dietary sodium-to-potassium ratio (Na/K ratio), may be an even better predictor of cardiovascular disease (CVD). The primary objective of this meta-analysis is to investigate the effect of the estimated dietary Na/K ratio on the composite outcome of cardiovascular events (CVE) and all-cause mortality. As the ideal sodium and potassium intake may be different for chronic kidney disease (CKD) patients, we will compare subjects with and without CKD. Method We performed a systematic search in MEDLINE and EMBASE databases from January 1946 to December 2022. We included randomized controlled trials and cohort studies with a mean follow-up duration of ≥1 year, which reported the association between the estimated dietary Na/K ratio and CVE and/or all-cause mortality. Two reviewers independently assessed the eligibility of identified studies, extracted data, and assessed the risk of bias according to the Cochrane Handbook Guidelines. We compared hazard ratios (HRs) among subgroups with increasing dietary Na/K ratio using the group with lowest estimated dietary Na/K ratio as a reference. We performed a random-effects meta-analysis using these HRs. A sensitivity analysis was performed using the leave-one-out approach. In a subgroup analysis, we compared CKD patients with the general population and adults with a history of CVD. We performed a meta-regression analysis to investigate the impact of the absolute increase in estimated dietary Na/K ratio (Δ Na/K) on the composite outcome, when adjusted for the mean estimated dietary Na/K ratio of the reference group and the follow-up duration of the studies. Results Of the 8,249 studies initially identified, 16 studies with 404,301 subjects were included in our main analysis. Mean age was 55.2 years, and 49% were male. For estimation of dietary Na/K ratio, 3 studies used spot urines, 3 studies used 24-hour urine collections, and 10 studies used food frequency questionnaires. Mean follow-up duration was 12 years. Higher estimated dietary Na/K ratio was associated with a significant higher risk for the composite endpoint of CVE and all-cause mortality (HR 1.16 [95% CI: 1.10-1.23], P&amp;lt;0.00001, I2 = 41%) (Figure 1). We observed no significant changes in our results using the leave-one-out approach. In the subgroup analysis, we observed that increased estimated dietary Na/K ratio associated with significantly higher CVE and all-cause mortality risk in the general population (10 studies; 387,679 subjects; HR 1.17 [1.10-1.25], P&amp;lt;0.00001, I2 = 48%), and in adults with a history of CVD (5 studies; 15,779 subjects; HR 1.18 [1.04-1.33], P = 0.008, I2 = 0%), but not in CKD patients (1 study; 843 subjects; mean eGFR 55 ± 29 mL/min/1.73m2; HR 0.68 [0.44-1.05], P = 0.08) (Figure 1). Six studies could be included in the meta-regression analysis. In the general population, we observed a significant positive association between Δ Na/K (P = 0.004) and the HR for the composite outcome of CVE and all-cause mortality, when adjusted for follow-up duration and the estimated dietary Na/K ratio of the reference group. For every unit increase in Δ Na/K ratio the HR increased by a factor 1.50 (Figure 2). No significant association was found in the CKD subgroup (p = 0.69). Conclusion Our data suggest that a higher estimated dietary Na/K ratio is associated with an increased risk for CVE and all-cause mortality in the general population and in patients with a history of CVD. These results could not be reproduced in limited data that was available for the CKD population.

#5817 EPIDEMIOLOGY OF CHRONIC KIDNEY DISEASE AND COMORBID ILLNESS IN OLDER HOSPITALIZED PATIENTS

Abstract Background and Aims The number of older people in Europe is expanding. Although chronic kidney disease (CKD) becomes more common with increasing age, data concerning epidemiology of CKD in older people are scarce, especially in Eastern Europe countries. These patients have multiple chronic conditions that must be correctly quantified for guiding risk stratification and subsequent management. Previously, European Renal Best Practice (ERBP) guidelines shed some light on managing older patients with advanced CKD, by stimulating the implementation of validated tools for predicting the most critical risks (death and progression to end-stage renal disease). Risk stratification can further inform decisions about the intensity of care (dialysis versus conservative treatment). In the current analysis, we aimed to fill the gap in CKD epidemiology in older people from Romania by describing a large population of hospitalized geriatric patients. Method In this retrospective cohort study, we included all patients aged ≥ 65 years hospitalized in the Geriatric Department of “Dr. C. I. Parhon” Hospital from Iași, Romania, between 2012 – 2022. This Geriatric Unit covers the entire North-East region of the country, so patients are representative of a population of almost 4 million people. CKD was identified as decreased estimated glomerular filtration rate (&amp;lt;60 ml/min/1.73 m2) according to CKD-EPI equation. We investigated comorbid conditions including diabetes mellitus, hypertension/hypertensive heart disease, coronary artery disease, congestive heart failure, atrial fibrillation, chronic respiratory failure and anemia. Results 3563 geriatric patients (59,2% females) were hospitalized between 2012–2022, totalling 5124 hospital admissions. The most common diagnosis was congestive heart failure (1958 cases, 38,2%) frequently due to hypertensive heart disease (877 patients, 44.8% of CHF cases). 3116 patients (87,4% of the total population) had a serum creatinine assay. Among these patients, the prevalence of CKD using the CKD-EPI equation was 32%. The mean age of CKD patients was 79 years, gender distribution was unequal (63,4% females) and almost half of them (49,1%) had stage 3a CKD. The most frequent comorbidities in patients with CKD were congestive heart failure (33%), diabetes (19%) and hypertension (17%), followed by atrial fibrillation (11%), chronic respiratory failure (9%), coronary artery disease (6%) and anemia (3%). The distribution of CKD patients stratified by the number of comorbidities showed that 86,7% had ≥ 2 comorbidities. The largest CKD subgroup was the one that associated three comorbidities (315 patients, 31.5%), followed by two subgroups that had two comorbidities (249 patients, 24,9%), respectively four comorbidities (189 patients, 18.9%). Only a minority of CKD patients (24 adults, 2,4%) had no other chronic condition. Conclusion With the ageing of the population, cardiovascular disease is becoming more common. In our population of geriatric patients, heart failure was the leading cause of hospitalization and the most frequent comorbid condition in CKD patients. One in three adults ≥ 65 years had CKD, a finding similar to other literature data. We emphasized that in older adults, CKD is not an isolated entity, which makes caring for these patients challenging, especially if we add the negative impact of other superimposed geriatric syndromes like frailty and cognitive decline.

Relationships of Chronic Kidney Disease and Thyroid Dysfunction in Patients with Stage 4 and 5 Chronic Kidney Disease: A Cross-Sectional Study

Introduction: Chronic kidney disease (CKD) affects the pituitary-thyroid axis and peripheral metabolism of thyroid hormones, thereby causing dysfunction of thyroid hormones. This study aimed to highlight the correlation between thyroid dysfunction and the staging of chronic kidney disease. Methods: Fifty patients with CKD were studied between 2014–2017 in a tertiary care centre in Western India. These patients were split into a subgroup for Stage 4 and 5 CKD, based upon estimated glomerular filtration rate as per the Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Thyroid function tests and lipid levels were compared in the different CKD subgroups by analysis of variance. Pearson’s correlation coefficient was used to evaluate the thyroid dysfunction with respect to degree of renal dysfunction in the study population. Results: Thyroid abnormalities were seen in 68% of the author’s patients. Euthyroid sick syndrome (ESS) was the most prevalent thyroid hormonal abnormality seen in 32% (n=16), followed by hypothyroidism category seen in the remaining 36% (n=18) of the study population. Of these, 18% (n=9) of the patients had subclinical hypothyroidism, while the remaining 18% (n=9) manifested overt hypothyroidism. Results showed that ESS had a positive correlation with estimated glomerular filtration rate (r=0.822; p&lt;0.001). No significant differences were found between groups in thyroxine or thyroid-stimulating hormone (p&gt;0.05). Linear regression in unadjusted analysis revealed that deranged low-density lipoprotein levels was found to be significantly associated negatively with hypothyroidism (p&lt;0.001) in patients with CKD. Conclusion: Patients with Stage 4 and 5 CKD have many hormonal disturbances, of which ESS is a common occurrence, and has a significant association with dyslipidaemia, increasing morbidity in these patients. Hypothyroidism is more prevalent in patients with severe renal dysfunction, as a result of higher uremic milieu in these patients.

Perioperative adverse cardiac events and mortality after non-cardiac surgery: a multicenter study.

Perioperative adverse cardiac events (PACE), a composite of myocardial infarction, coronary revascularization, congestive heart failure, arrhythmic attack, acute pulmonary embolism, cardiac arrest, and stroke during 30-day postoperative period, is associated with long-term mortality, but with limited clinical evidence. We compared long-term mortality with PACE using data from nationwide multicenter electronic health records. Data from 7 hospitals, converted to Observational Medical Outcomes Partnership Common Data Model, were used. We extracted records of 277,787 adult patients over 18 years old undergoing non-cardiac surgery for the first time at the hospital and had medical records for more than 180 days before surgery. We performed propensity score matching and then an aggregated meta‑analysis. After 1:4 propensity score matching, 7,970 patients with PACE and 28,807 patients without PACE were matched. The meta‑analysis showed that PACE was associated with higher one-year mortality risk (hazard ratio [HR]: 1.33, 95% CI [1.10, 1.60], P = 0.005) and higher three-year mortality (HR: 1.18, 95% CI [1.01, 1.38], P = 0.038). In subgroup analysis, the risk of one-year mortality by PACE became greater with higher-risk surgical procedures (HR: 1.20, 95% CI [1.04, 1.39], P = 0.020 for low-risk surgery; HR: 1.69, 95% CI [1.45, 1.96], P < 0.001 for intermediate-risk; and HR: 2.38, 95% CI [1.47, 3.86], P = 0.034 for high-risk). A nationwide multicenter study showed that PACE was significantly associated with increased one-year mortality. This association was stronger in high-risk surgery, older, male, and chronic kidney disease subgroups. Further studies to improve mortality associated with PACE are needed.

The relationship between asymptomatic atherosclerosis and hepcidin-25 in chronic kidney disease patients.

The most common and lethal consequence of chronic kidney disease (CKD) is atherosclerotic cardiovascular disease. The persistent inflammation present in CKD increases hepcidin levels. Iron accumulates in the arterial wall in atherosclerosis. Hepcidin-25 was thought to accelerate the development of atherosclerotic plaques by blocking iron release from macrophages. Therefore, we sought to determine the relationship between hepcidin-25 and asymptomatic atherosclerosis in non-dialysis CKD patients. Investigate the relationship between hepcidin-25 and subclinical atherosclerosis in non-dialysis CKD patients. Cross-sectional SETTINGS: Outpatient clinic for urology and nephrology at a university hospital SUBJECTS AND METHODS: Participants above the age of 18 years included a group of healthy controls and a group of CKD patients who were not routinely maintained on hemodialysis. The latter group was further divided according to eGFR into CKD-3, CKD-4 and CKD-5 subgroups. We excluded patients with comorbidities, patients with chronic liver disease, and other conditions or habits. CBC, kidney function tests, and serum levels of hepcidin-25 (SH-25), TNF-α, IL-6, high-sensitivity C-reactive protein (hs-CRP), TC, TG, LDL-C and HDL-C were assessed. To measure carotid intima media thickness (CIMT) and determine presence of plaques, carotid ultrasonography was performed. The near or far walls of common carotid artery, bulb, and internal carotid artery were used to measure CIMT. SH-25 association and indicators of subclinical atherosclerosis. 128 participants, the control group (n=25) and the non-hemodialysis CKD patients (n=103) RESULTS: The CKD patients had significantly higher serum levels of markers of inflammation including IL-6, TNF-α, and hs-CRP (P<.001 for each) compared to the controls. There was a significantly higher level of TC, TG and LDL-C (P<.001 for each) and a lower level of HDL-C (P<.001) in the CDK patients compared to controls. SH-25 was considerably higher in all CKD subgroups, especially with progression of CKD. CIMT was increased in CKD patients especially CKD-4 and CKD-5 subgroups when compared to healthy participants (P<.001 for each). In the patient group, CIMT showed a positive correlation with SH-25, (r=.65 and P<.001), IL-6 (r=.65, P<.001), TNF-α (r=.71, P<.001), and hs-CRP (r=.52, P<.001). The ROC curve study showed that SH-25 (AUC=.86, P<.001), IL-6 (AUC=.83, P<.001), hs-CRP (AUC=.72, P<.001), TNF-α (AUC=.82, P<.001) were strong predictors of subclinical atherosclerosis in the CKD patients. SH-25 and CIMT had a positive relationship in CKD patients. The ROC curve showed that SH-25 is a reliable predictor of carotid atherosclerosis. Therefore, we suggest that SH-25 is a vital biomarker of asymptomatic atherosclerosis. Single-center.

Impact of ABC pathway adherence in high-risk patients with atrial fibrillation: an analysis from the ESC-EHRA EORP-AF long-term general registry

Abstract Background The impact of Atrial Fibrillation Better Care (ABC) pathway adherence among high-risk subgroups of patients with atrial fibrillation (AF), ie. those with chronic kidney disease (CKD), advanced age and/or prior thromboembolism remains unknown. We evaluated the impact of ABC pathway adherence on clinical outcomes in these high-risk AF patients. Methods The EORP-AF General Long-Term Registry is a prospective, observational registry from 250 centres across 27 European countries. High-risk patients were defined as those with either CKD (eGFR &amp;lt;60 mL/min/1.73 m2), older age (≥75 years) and/or prior thromboembolism. The primary outcome was a composite event of all-cause death, any thromboembolism and acute coronary syndrome, evaluated according to ABC pathway adherence. Results A total of 6646 patients with AF were included (median age was 70 [IQR 61–77] years; 40.2% females). There were 3304 (54.2%) `high risk' patients with either CKD (n=1750), older age (n=2236) or prior thromboembolism (n=728). Among these there were 924 (28.0%) managed as adherent to ABC. At 2-year follow-up, a total of 966 (14.5%) patients reported the primary outcome. The incidence of the primary outcome was significantly lower in high-risk patients managed as adherent to ABC pathway (IRR 0.53 [95% CI, 0.43–0.64]). Consistent results were obtained in the individual subgroups [Table]. Using multivariable Cox proportional hazards analysis, ABC adherence in the high-risk cohort was independently associated with a lower risk of primary outcome (aHR 0.64 [95% CI, 0.51–0.80]), as well as in the CKD (aHR 0.51 [95% CI, 0.37–0.70]) and elderly subgroups (aHR 0.69 [95% CI, 0.53–0.90]). Overall, there was greater reduction in the risk of primary outcome as more ABC criteria were fulfilled, both in the overall high-risk patients, as well as in the individual subgroups [Figure]. Conclusion In a large, contemporary European AF cohort there was a significant proportion of high-risk patients. Among these, a low prevalence of integrated care, as assessed by adherence to ABC pathway, was found. Nonetheless, a clinical management adherent to the ABC pathway was associated with a significant reduction in the risk of adverse outcomes, the benefits of which were more significant with increasing number of ABC criteria adherent. Funding Acknowledgement Type of funding sources: None.

Temporal trends of aortic stenosis and comorbid chronic kidney disease in the province of Quebec, Canada

ObjectiveTo investigate temporal trends of chronic kidney disease (CKD) among patients with incident aortic stenosis (AS) and to compare these trends with that of a matched control population.MethodsUsing the Quebec...

MO198: Outcomes with Finerenone in Patients with Stage 4 Chronic Kidney Disease and Type 2 Diabetes: A Fidelity Subgroup Analysis

Abstract BACKGROUND AND AIMS Patients with stage 4 chronic kidney disease (CKD) and type 2 diabetes (T2D) have a high residual risk of cardiovascular (CV) and kidney disease progression, and effective treatment options to reduce the risk are limited. The non-steroidal selective mineralocorticoid receptor antagonist finerenone has previously demonstrated significant cardiorenal benefits versus placebo in patients with stage 1–4 CKD [1–3]. This FIDELITY subgroup analysis investigated the effects of finerenone in patients with stage 4 CKD [estimated glomerular filtration rate (eGFR) &amp;lt;30 mL/min/1.73 m2) versus those with stage 1–3 CKD (eGFR ≥ 30 mL/min/1.73 m2). METHOD FIDELIO-DKD and FIGARO-DKD were phase III trials of patients with CKD and T2D randomised 1:1 to finerenone or placebo. FIDELITY was an individual patient-level prespecified pooled efficacy and safety analysis of these studies. Efficacy outcomes included change in urine albumin-to-creatinine ratio (UACR) between baseline and month 4, change in eGFR over time, a kidney composite outcome (kidney failure, a sustained ≥57% decrease in eGFR from baseline over ≥ 4 weeks or renal death) and a CV composite outcome [CV death, non-fatal myocardial infarction, non-fatal stroke or hospitalization for heart failure (HHF)], as well as the individual components of these composite outcomes. RESULTS Of 13 023 patients included in the analysis, 890 patients (6.8%) had stage 4 CKD; key baseline characteristics are listed in Table 1. In patients with stage 4 CKD, finerenone reduced UACR by 31% vs placebo between baseline and month 4 [ratio of least-squares (LS) mean change 0.69; 95% confidence interval (CI) 0.63–0.77), an effect maintained for the duration of the study. Total eGFR slope (LS mean change in eGFR from randomisation to end of treatment) in patients with stage 4 CKD was –0.7 mL/min/1.73 m2/year with finerenone versus –1.6 mL/min/1.73 m2/year with placebo; the chronic eGFR slope (LS mean change in eGFR from month 4 to end of treatment) was –1.8 mL/min/1.73 m2/year with finerenone vs –3.2 mL/min/1.73 m2/year with placebo. The hazard ratio (HR) for risk of the kidney composite in stage 4 CKD was 1.01 (95% CI 0.75–1.37; Figure 1) for finerenone versus placebo. Reduction in risk of sustained ≥ 57% decrease in eGFR with finerenone (stage 4 CKD: HR 0.69, 95% CI 0.43–1.11) was similar between CKD subgroups (pinteraction = 0.71). Reduction in risk of the composite CV outcome (stage 4 CKD: HR 0.78, 95% CI 0.57–1.07) and HHF (stage 4 CKD: HR 0.99, 95% CI 0.62–1.58) was also consistent between CKD subgroups (pinteraction = 0.67 and 0.31, respectively). Overall, incidences of adverse events were balanced between treatment arms in patients with stage 4 CKD and stage 1–3 CKD. The incidence of hyperkalaemia leading to permanent discontinuation was low in patients with stage 4 CKD (3.2% versus 2.2% for finerenone versus placebo). CONCLUSION The cardiorenal benefits and safety profile of finerenone in FIDELITY were also observed in the subgroup of patients with stage 4 CKD.

MO085: 10-Year Clinical Events Avoided in Diabetic and Chronic Kidney Disease Hypertension Patients Treated With Radiofrequency Renal Denervation: Projections Based on 3-Year Data From the Global Symplicity Registry

Abstract BACKGROUND AND AIMS Clinical event rates over 3 years have been published for patients with uncontrolled hypertension treated with radiofrequency renal denervation (RDN) in the Global SYMPLICITY Registry (GSR). We estimated 10-year clinical event reductions following RDN versus a simulated control group without RDN, for the type 2 diabetes (T2DM) and chronic kidney disease (CKD) subgroups and the full GSR cohort. METHOD A Markov model based on Framingham and other multivariate risk equations [1] was used to compare projected 10-year clinical events [stroke, myocardial infarction (MI), cardiovascular death (CVD), heart failure (HF), all-cause death (ACD) and a composite of major adverse cardiac events (MACE, calculated as sum of stroke, MI and CVD)] for RDN patients versus a hypothetical control for the T2DM subgroup (n = 1007; 64 ± 10 years), the CKD subgroup (n = 630; 65 ± 12 years), and for all GSR patients (n = 2651; 61 ± 12 years). The simulated control assumed maintenance of baseline office systolic blood pressure (oSBP) over time. The model was calibrated to 3-year stroke and MI events reported in the GSR and used published meta-regression data [2] to calculate risk reduction based on cohort-specific changes in oSBP from baseline. Relative risks (RRs), events avoided, and numbers needed to treat (NNTs) were calculated at 3 and 10 years, along with the ratio of 10- versus 3-year projected events avoided. RESULTS Ten-year MACE rates were 35.8% versus 48.5% (-12.7%, RR = 0.74) for RDN versus simulated control for all patients, 40.5% versus 54.0% (-13.5%, RR = 0.75) for the T2DM subgroup and 48.4% versus 61.3% (-12.9%, RR = 0.79) for the CKD subgroup. Across the studied subgroups, avoided stroke events contributed the most to overall event reductions. RRs of events were lowest for HF (0.53–0.61) and highest for all-cause death (0.88–0.90) across the three subgroups (Table 1). Ten-year NNTs for MACE were comparable between the three cohorts, estimated between 7 and 8. The ratio of 10- versus 3-year events avoided ranged from 4.44 to 4.87 for stroke, 3.74 to 3.96 for MI and 4.22 to 5.20 for MACE across studied cohorts. CONCLUSION Based on 10-year model projections from the GSR, RDN may lead to meaningful clinical event reductions in diabetic and chronic kidney disease patients. Ten-year events avoided can be expected to be 3 to 5 times higher than those recently reported for a 3-year horizon.