Chronic Kidney Disease Classification Research Articles

Amide proton transfer magnetic resonance imaging to evaluate renal impairment in patients with chronic kidney disease

ObjectiveWe aimed to investigate the value of amide proton transfer magnetic resonance imaging (APT-MRI) in the classification of chronic kidney disease (CKD). Materials and methodsA total of 30 patients with chronic kidney disease (CKD) and 25 healthy volunteers were enrolled in this study. Patients with chronic kidney disease were divided into two groups according to glomerular filtration rates: mild and moderate-to-severe renal impairment. Differences in cortical and medullary APT values were compared, and the correlation between corticomedullary APT values and glomerular filtration rates was analyzed. Data were statistically analyzed using SPSS 23.0. ResultsBased on glomerular filtration rates, 14 patients were assigned to the mild renal impairment group, and 16 were assigned to the moderate-to-severe renal impairment group. Both of the cortical and medullary APT values showed a gradually increasing trend in the control, the mild, and the moderate-to-severe renal impairment groups. Cortical APT values were higher than medullary APT values in all the control and renal impairment groups (P < 0.05). APT values of the right renal cortex (r = −0.80, P < 0.05) and medulla (r = −0.83, P < 0.05) were negatively correlated with the glomerular filtration rate. Results of the receiver operating characteristic (ROC) curve analysis showed that corticomedullary APT values had high diagnostic efficacy in assessing different degrees of renal impairment. ConclusionsThe APT values of the cortex and medulla in patients with CKD gradually increased with disease progression. These findings indicated that APT imaging can be used to evaluate renal function and renal injury in patients with CKD.

Optimal Feature Selection Methods for Chronic Kidney Disease Classification using Intelligent Optimization Algorithms

Aim: Recently, classification of medical data gives more importance to identify the existence of disease. Background: Numerous classification algorithms for chronic kidney disease (CKD) are developed and produced better classification results. But, the inclusion of different factors in the identification of CKD reduces the effectiveness of the employed classification algorithm. Objective: To overcome this issue, feature selection (FS) approaches are proposed to minimize the computational complexity and also to improve the classification performance in the identification of CKD. Since numerous bio-inspired based FS methodologies are developed, a need arises to examine the feature selection approaches performance of different algorithms on the identification of CKD. Method: This paper proposes a new framework for classification and prediction of CKD. Three feature selection approaches are used namely Ant Colony Optimization (ACO) algorithm, Genetic Algorithm (GA) and Particle Swarm Optimization (PSO) in the classification process of CKD. Finally, logistic regression (LR) classifier is employed for effective classification. Results: The effectiveness of the ACO-FS, GA-FS and PSO-FS are validated by testing it against a benchmark CKD dataset. Conclusion: The empirical results state that the ACO-FS algorithm performs well and the results reported that the classification performance is improved by the inclusion of feature selection methodologies in CKD classification.

Abstract 8958: Cystatin C is Superior to Creatinine in Risk Prediction After Transcatheter Aortic Valve Replacement

Introduction: Cystatin C is an alternative marker of renal function less influenced by age, sex, race, and muscle mass compared with creatinine. No data has been reported about the prognostic meaning of chronic kidney disease classification by cystatin C-based estimated glomerular filtration rate (CKD Cys classification) in patients undergoing transcatheter aortic valve replacement (TAVR). Objective: The aim of this study was to compare the prognostic value of CKD Cys classification and classification by creatinine-based estimated glomerular filtration rate (CKD Cr classification) in the risk prediction after TAVR. Methods: We retrospectively analyzed consecutive 219 patients with symptomatic severe aortic stenosis who underwent TAVR in our institute between December 2016 and June 2019. Preoperative CKD Cys classification and CKD Cr classification were evaluated for their prognostic value of 2-year major adverse cardiovascular and cerebrovascular event (MACCE) after TAVR. MACCE was defined as the composite of all-cause mortality, myocardial infarction, cerebrovascular events, and rehospitalization for worsening congestive heart failure. Results: There were 59 MACCEs during the median follow-up period of 575.5days. CKD Cys classification not CKD Cr classification significantly stratified the risk of 2-year MACCE in patients after TAVR by log-rank test (P=0.002) (Figure 1). In multivariate Cox regression analysis, only CKD Cys classification stage 3b (hazard ratio=4.37; 95% confidence interval: 1.28 to 14.91; P=0.019) and CKD Cys classification stage4+5 (hazard ratio=3.72; 95% confidence interval: 1.06 to 12.99; P=0.040) were the independent predictors for MACCE after adjustment for potential confounders. Conclusions: The use of CKD Cys classification could provide better risk assessment than CKD Cr classification in patients undergoing TAVR. CKD Cys classification stage3b and stage4+5 correlated with adverse outcomes.

Diagnostic and predictive values of three criterias of acute kidney injury in children with chronic kidney disease

Objective: To compare the consistency in diagnosing and staging acute kidney injury (AKI) in children with chronic kidney disease (CKD) according to three criterias. Methods: Children with CKD hospitalized in the First Affiliated Hospital of Sun Yat sen University from January 2013 to December 2019 were analyzed retrospectively. These patients underwent serum creatinine examination more than twice during hospitalization. The AKI diagnosis and staging were performed for each patient according to the 2007 pRIFLE, 2012 KDIGO and 2018 pROCK criteria respectively. All the children were followed up for 1 year after discharge through outpatient visit, re-hospitalization or online consultation. The clinical characteristics and prognosis of CKD children with or without AKI that were diagnosed by 3 criteria were compared. Analysis of variance and chi-squared tests were used for the comparison among groups. Concordance between the different diagnostic criteria was evaluated using Cohen's kappa coefficient. Result: A total of 2 551 children with CKD were included in this study, with an age of (8±4) years. There were 1 628 boys and 923 girls. Nephrotic syndrome was the most prevalent primary disease (55.4%), followed by lupus nephritis (11.2%) and purpura nephritis (8.2%). Among all stages of CKD, CKD category G1 was the most common type (2 146 cases, 84.1%), followed by CKD category G2 (221 cases, 8.7%). AKI occurence rates according to pRIFLE, KDIGO and pROCK criteria were 33.9% (866/2 551), 26.2%(669/2 551) and 19.5% (498/2 551) respectively (χ²=136.3,P<0.01). The diagnostic consistency within three criteria for AKI was high in children with CKD (κ=0.702), but AKI staging consistency was low (κ=0.329). Both the diagnosis and staging consistency of three AKI criteria were poor in children with CKD category G5 (all κ<0.400). The length of hospital stay (LOS), hospitalization costs, the occurence of intensive care unit (ICU) admission and in-hospital mortality were significantly higher in children with AKI diagnosed by different criteria (P<0.05). After 1-year follow-up, the repeated admission rate and CKD staging progress significantly increased in children with AKI (P<0.05). In children with baseline serum creatinine≥200 μmol/L, compared with children who did not experience AKI during hospitalization, the LOS and the hospitalization costs in children who were diagnosed AKI according to pRIFLE or pROCK criteria was significantly higher (P<0.05). However, there was no significant difference in the LOS and hospitalization costs between children with or without AKI who were diagnosed according to KDIGO criteria (all P>0.05). Conclusions: AKI diagnosed by all of the three criteria (pRIFLE, KDIGO and pROCK criteria) was associated with the poor prognosis in children with CKD. However, in those whose baseline serum creatinine≥ 200 μmol/L, AKI diagnosed by pRIFLE and pROCK criteria could better reflect the poor outcomes than by KDIGO criteria.

The catastrophic impact of COVID-19 infection in patients with chronic limb-threatening ischemia

BackgroundTo determine the impact of COVID-19 infection in patients with chronic limb-threatening ischemia, mainly the limb salvage estimates rate and the overall survival. MethodsThis was a retrospective, consecutive cohort study of chronic limb-threatening ischemia in patients with COVID-19 infection. ResultsOverall, 35 patients with chronic limb-threatening ischemia and COVID-19 infection were evaluated. The mean age of the patients was 72.51 years, and most of them were male (60%), with arterial hypertension (85.7%), followed by diabetes mellitus (80%) and tobacco user (71.4%). There was a higher prevalence of wound, ischemia and foot infection (WIfI) classification 4 with 58.8% and Rutherford grade 5 (74.3%). The factors related to overall mortality rate were: D-dimer >1,000 mg/dL (hazard ratio = 22.7, P < .001, confidence interval = 10.49–26.52), respiratory symptoms (hazard ratio = 16.6, P < .001, confidence interval = 9.87–20.90), chest computed tomography compromising higher than 50% of the pulmonary tract (hazard ratio = 16,0, P < .001, confidence interval = 10.41–20.55), acute kidney failure (hazard ratio = 21.58, P < .001, confidence interval = 16.5–30.5), chronic kidney disease (hazard ratio = 4.4, P = .036, confidence interval = 1.45–10.1), therapeutic anticoagulation (hazard ratio = 8.37, P = .004, confidence interval = 1.35–8.45), and WIfI classification (hazard ratio = 5.28, P = .022, confidence interval = 1.34–10.01). The following were related to limb loss: D-dimer >1,000 mg/mL (hazard ratio = 5.47, P = .02, confidence interval = 1.94–10.52), respiratory symptoms (hazard ratio = 5.42, P = .02, confidence interval = 1.87–10.90), and WIfI classification (hazard ratio = 4.44, P = .035, confidence interval = 1.34–8.01). ConclusionThis study concluded that COVID-19 has a catastrophic impact among patients with chronic limb-threatening ischemia. The main factors related to overall mortality were D-dimer >1,000 mg/dL, respiratory symptoms, chest computed tomography compromising higher than 50% of the pulmonary tract, acute kidney failure, chronic kidney disease, therapeutic anticoagulation, and WIfI classification. The factors related to limb loss were WIfI classification, D-dimer >1,000 mg/mL and respiratory symptoms.

Risk Factor Identification, Classification and Prediction Summary of Chronic Kidney Disease

: The data generated by medical equipment is huge and humongous in size loaded with valuable information. This data set requires an effective classification for accurate prediction. The prediction of health issues is an extremely difficult task, especially Chronic Kidney Disease (CKD) is one of the major unpredictable diseases in the medical field. Perhaps, certain medical experts do not have identical awareness and skills to solve the issues of their patients. Most of the medical experts may have unsubstantiated results on disease diagnosis of their patients. Sometimes, patients may lose their life owing to disease severity. As per the Global Burden of Disease (GBD-2015) report, death by CKD was ranked at 17th position whereas GBD-2010 reported the same at 27th among the causes of death globally. Death by CKD constitutes 2.9% of all deaths between the years 2010 and 2013 among people in the age range of 15 to 69. As per the World Health Organization (WHO- 2005) report, CKD was the primary reason behind the death of 58 million people so far. Hence, this article presents a state-of-the-art review of the classification and prediction of Chronic Kidney Disease (CKD). Normally, advanced data mining techniques, fuzzy and machine learning algorithms are used to classify medical data and disease diagnosis. This study reviews and summarizes many classification techniques and disease diagnosis methods presented earlier. The main intention of this review is to point out and address some of the issues and complications of the existing methods. It also attempts to discuss the limitations and accuracy level of the existing CKD classification and disease diagnosis methods.

Novel Ensemble Model With Genetic Algorithm and Principal Components Analysis for Classification of Chronic Kidney Disease

This study aims to appraise the key features and components of chronic kidney disease (CKD) problems in the case of the classification task. There are different types of the classifier which presented a result with low accuracy. A new combined classifier may be needed to achieve better results. Classification techniques used include k-nearest neighbors (k-NN), naive bayes (NB), and their proposed ensemble model. A feature selection technique (FST) based on genetic algorithms (GA) is presented and compared to famous dimensionality reduction techniques (DRT), namely principal component analysis (PCA). The proposed ensemble model classifiers have higher accuracy rates on the CKD dataset than the other classification models before and after applying the FST and DRT. The results demonstrated that employing FST using GA and DRT as PCA has enhanced classification accuracy. This model can be used for the identification of CKD in the early stage.

A Novel Ensemble Model for Classification of Chronic Kidney Disease With Selected Features and Components

A Novel Ensemble Model for Classification of Chronic Kidney Disease With Selected Features and Components

Oppositional firefly optimization based optimal feature selection in chronic kidney disease classification using deep neural network

Oppositional firefly optimization based optimal feature selection in chronic kidney disease classification using deep neural network

A clinical audit of the diagnosis and management of chronic kidney disease in a primary care clinic.

This audit was performed to monitor the diagnosis and management of chronic kidney disease (CKD) according to the clinical practice guidelines (CPGs) of CKD 2018 in a primary care clinic. Patients who attended the clinic from April to June 2019 and fulfilled the diagnosis of CKD were included in this study, except for those diagnosed with a urinary tract infection, pregnant women and those on dialysis. These criteria were set based on the CPGs. The standards were set following discussions with the clinic team members with reference to local guidelines, the 2017 United Kingdom National CKD audit and other relevant studies. A total of 384 medical records were included in this audit. Overall, 5 out of 20 criteria for processes and 3 of 8 clinical outcomes for CKD care did not meet the set standards. These included the following: documentation of CKD classification based on albumin category (43.8%); CKD advice (19.0%); dietitian referral (9.1%); nephrologist referral (45.5%); haemoglobin level monitoring (65.7%); overall blood pressure (BP) control (45.3%); BP readings for diabetic kidney disease (DKD) and non-DKD with > 1 g/day of proteinuria (< 130/80 mmHg, 37.0%); eGFR reduction of < 25% over the past year (77.2%). Identified problems included the absence of a CKD registry, eGFR and albuminuria reports, and a dedicated team, among other factors. Overall, 8 out of 28 criteria did not meet the standards of CKD care set for this audit. The problems identified in this audit have been addressed. Moreover, strategies have also been formulated to improve the diagnosis and management of CKD in this clinic.

A Plant-Centered Diet and Markers of Early Chronic Kidney Disease during Young to Middle Adulthood: Findings from the Coronary Artery Risk Development in Young Adults (CARDIA) Cohort

BackgroundFew studies have evaluated whether plant-centered diets prevent progression of early stage chronic kidney disease (CKD). ObjectivesWe examined the association between plant-centered diet quality and early CKD markers. MethodsWe prospectively examined 2869 black and white men and women in the Coronary Artery Risk Development in Young Adults Study free of diagnosed kidney failure in 2005–2006 [examination year 20 (Y20); mean age: 45.3 ± 3.6 y]. CKD marker changes from Y20 to 2015–2016 (Y30) were considered, including estimated glomerular filtration rate (eGFR; serum creatinine), urinary albumin-to-creatinine ratio (ACR), and both. Diet was assessed through interviewer-administered diet histories at Y0, Y7, and Y20, and plant-centered diet quality was quantified with the A Priori Diet Quality Score (APDQS). Linear regression models were used to examine the association of APDQS and subsequent 10-y changes in CKD markers. ResultsAfter adjustment for sociodemographic, behavioral, and diet factors, we found that higher APDQS was related to less adverse changes in CKD markers in the subsequent 10-y period. Compared with the lowest APDQS quintile, the highest quintile was associated with an attenuated increase in lnACR (−0.25 mg/g; 95% CI: −0.37, −0.13 mg/g; P-trend < 0.001), whereas the highest quintile was associated with an attenuated decrease in eGFR (4.45 mL·min−1·1.73 m−2; 95% CI: 2.46, 6.43 mL·min−1·1.73 m−2). There was a 0.50 lower increase in combined CKD markers [ln(ACR) z score – eGFR z score] when comparing the extreme quintiles. Associations remained similar after further adjustment for hypertension, diabetes, and obesity as potential mediating factors. The attenuated worsening CKD marker changes associated with higher APDQS strengthened across increasing initial CKD category; those with the best diet and microalbuminuria in Y10–Y20 returned to high normal albuminuria (all P-interaction < 0.001). ConclusionsIndividuals who consumed plant-centered, high-quality diets were less likely to experience deterioration of kidney function through midlife, especially among participants with initial stage characterized as mild CKD.

Postoperative Acute Kidney Injury Is Associated With Progression of Chronic Kidney Disease Independent of Severity.

Both postoperative acute kidney injury (AKI) and preoperative chronic kidney disease (CKD) are associated with significantly worse outcomes following surgery. The relationship of both of these conditions with each other and with CKD progression after surgery remains poorly studied. Our objective was to assess if there was an interaction between preoperative kidney function estimated by preoperative estimated glomerular filtration rate (eGFR)/CKD stage, postoperative AKI, and eGFR/CKD progression within 1 year of surgery. Our hypothesis was that AKI severity would be associated with a faster time to eGFR/CKD stage progression within 1 year of surgery in a graded-fashion, which would be exacerbated by preoperative kidney dysfunction. This was a retrospective cohort study at Landspitali University Hospital in Iceland, which serves about 75% of the population. Participants included adults receiving their first major anesthetic between 2005 and 2018. Patients with CKD stage 5, undergoing major urologic procedures, or having missing creatinine values for follow-up of eGFR stage were excluded from analysis. The primary exposure was postoperative AKI stage within 7 days after surgery classified by the kidney disease improving global outcome (KDIGO) criteria. The primary outcome was time to progression of CKD by at least 1 eGFR/CKD stage within 1-year following surgery. Multivariable Cox proportional hazards models were used to estimate hazard of eGFR/CKD stage progression, including an interaction between AKI and preoperative CKD on eGFR/CKD stage progression. A total of 5548 patients were studied. In the multivariable model adjusting for baseline eGFR/CKD stage, when compared to patients without AKI, postoperative AKI stage 1 (hazard ratio [HR], 5.91; 95% confidence interval [CI], 4.34-8.05), stage 2 (HR, 3.86; 95% CI, 1.82-8.16), and stage 3 (HR, 3.61; 95% CI, 1.49-8.74) were all independently associated with faster time to eGFR/CKD stage progression within 1 year following surgery, though increasing AKI severity did not confer additional risk. The only significant interaction between the degree of AKI and the preexisting renal function was for stage 1 AKI, where the odds of 1-year eGFR/CKD stage progression actually decreased in patients with preoperative CKD categories 3a, 3b, and 4. KDIGO-AKI was independently associated with eGFR/CKD stage progression within the year following surgery after adjustment for baseline eGFR/CKD stage and without an interaction between worse preoperative kidney function and higher stage AKI. Our observations suggest that further studies are warranted to test whether CKD progression could be prevented by the adoption of perioperative kidney protective practices.

Does Disease Activity Influence the Levels of Uric Acid in Psoriatic Arthritis?

Background: Hyperuricemia is not only associated with the development of gout but also with renal and vascular dysfunction. The prevalence of this condition has already been studied in psoriasis, but there are a few studies that have been carried out in psoriatic arthritis (PsA). Some studies have shown an association with metabolic syndrome, while others with the extent of cutaneous involvement, but there are no studies that have evaluated the disease activity with compound indexes. Objective: The aim of the study was to determine if disease activity, measured by different composite scores, influences the levels of uric acid. Method: This was a cross-sectional, observational study, which included 52 PsA patients. Clinical assessments included dactylitis, tender and swollen joint counts, Psoriasis Area and Severity Index, Leeds Enthesis Index, Minimal Disease Activity and Disease Activity for Psoriatic Arthritis. Hyperuricemia was defined as serum uric acid levels ≥ 6mg/dL in females and ≥ 7mg/dL in males. Results: Among the 52 included patients, 55.76% were female. The mean age was 54.9 ± 11.6 years. Hyperuricemia occurred in 26.92%. Demographic data, diet, comorbidities and medication were similar between patients with and without hyperuricemia. Patients with hyperuricemia had higher waist circumference (p &lt;0.0046). There was no difference in disease activity between groups, either in the isolated items or in the composite indexes. There was a significant difference in uric acid levels according to the classification of chronic kidney disease by estimated glomerular filtration rate (p=0.0016). Individuals using leflunomide had significantly lower levels of uric acid than those who were not using (p=0.0071). Conclusion: This study supports the notion that, in PsA, hyperuricemia is more related to metabolic factors than to disease activity.

Nefrotoxicidad y hematotoxicidad un año después de cuatro ciclos de terapia con péptidos marcados con radionúclidos (PRRT) y su impacto en la planificación del tratamiento futuro. Un análisis retrospectivo

IntroductionNephro- and hematotoxicity after peptide receptor radionuclide therapy (PRRT) have been described in multiple studies with heterogeneous cumulative activities, number of cycles or radiolabelled peptides. Though highly differentiated metastasized neuroendocrine tumours (NET) have long progression free survival, they may progress. We analysed long-term side effects in a homogenous treatment schedule in PRRT-patients and their impact on future oncologic treatment in case of progression. MethodsFrom our database 89/384 patients receiving the same PRRT (Lu-177-DOTATATE or Y-90-DOTATOC) 4 times every 10 to 12 weeks and a follow-up at 12 months were analysed. One patient had three and 11 patients had two times four PRRT-cycles resulting in 102 cases. eGFR, Hb, WBC and platelets before the first and one year after the fourth therapy cycle were compared. eGFR-Grading was done according to chronic kidney disease classification (CKD) and grading of hematotoxicity according to Common Terminology Criteria for Adverse Events (CTCAE). Impact of age, gender, cumulative activity, type of PRRT on long-term-toxicity was also assessed. ResultseGFR grade 1-2 dropped from 87/102 at the baseline to 71 cases at follow-up (p<0.001). Before treatment grade 3a was found in 13, grade 3b in 2 cases, and at follow-up grade 3a in 25, grade 3b in 5, and grade 4 in 1 case. Anaemia prior to PRRT and at follow-up was grade 0 in 63 versus 48 (p<0.001), grade 1 in 36 versus 48, and grade 2 in three versus six cases. In white blood cell count and platelets, there were no significant changes in grading occurring. Subgroup analysis revealed that only in the age group 65 and older was there a higher incidence for anaemia (p=0.006). ConclusiónIn roughly 20% of cases an increase in grading of nephro- or hematotoxicity is observed. In those patients, except in one, toxicity findings were mild or moderate one year after completion of four cycles of PRRT with either Y-90- or Lu-177-SST-analogues. In terms of safety, PRRT has no critical impact on further oncologic treatment options in the case of disease progression.

Sex Differences in Biopsy-Confirmed Diabetic Kidney Disease.

BackgroundTo investigate the association between sex differences and end-stage kidney disease (ESKD) in patients with biopsy-confirmed diabetic kidney disease (DKD).MethodWe performed a retrospective cohort study. A total of 336 patients with biopsy-confirmed DKD who were followed up for at least 12 months were enrolled. Baseline clinical and pathological data at the time of biopsy were collected. ESKD was defined by an estimated glomerular filtration rate of <15 ml/min/1.73 m2 or initiation of renal replacement therapy. The association between sex differences and ESKD was assessed using the log-rank test and Cox regression.ResultThere were 239 (71%) male and 97 (29%) female patients in our cohort. Female patients had higher systolic blood pressure, total cholesterol and low-density lipoprotein cholesterol levels compared with male. There were a lower proportion of female patients in the very high risk grade according to the chronic kidney disease categories (37% of female vs. 44% of male). During a median follow-up time of 20 months, 101 (57.7%) male and 43 (44.3%) female entered into ESKD, with no significant difference by the log-rank test (P >0.05). Univariate [male: hazard ratio (HR) [95% confidence interval (CI)], 1.005, (0.702–1.439)] and multivariable ([male: HR (95%CI), 1.164, (0.675–2.007)]. Cox regression further showed that sex difference was not significantly associated with ESKD.ConclusionFemale patients had the higher systolic blood pressure, total cholesterol, LDL-C, compared with male patients. However, there was no significant association observed between sex difference and ESKD in our study.

Interleukin-2 receptor antibody induction with early low dose tacrolimus preserves post-liver transplant renal function in at risk individuals

BackgroundRenal dysfunction post liver transplantation (LT) is common. We report our real-world experience of IL2Ra induction with immediate exposure to reduced dose tacrolimus used for patients with chronic kidney disease (CKD) and evolving acute kidney injury (AKI). MethodA single-centre retrospective analysis of elective adult LT from 1/1/17 to 31/12/17. The primary outcome measure was increase in CKD stage at month 6 post-LT, and secondary outcome was early biopsy proven acute rejection (BPAR). Results161 patients were included: 17 planned-IL2Ra for CKD; 38 unplanned-IL2Ra for AKI; and 106 standard immunosuppression. IL2Ra group had lower trough tacrolimus levels till month 3 post-LT. Patients receiving IL2Ra did not have an increased risk of increase in CKD class at month 6 (aOR 0.95, 95% CI 0.34–2.75, P = 0.92), or of early BPAR (aOR 0.53, 95% CI 0.19–1.32, P = 0.19). ConclusionIL2Ra induction with immediate exposure to reduced dose tacrolimus can be given to patients with CKD or early evolving AKI post-LT, with no greater attrition of renal function at 6 months or an increased risk of early BPAR when compared to standard IS. Longer-term outcome data is required, however this regimen can be considered for high risk LT recipients with CKD and AKI.

Endovasal laser obliteration of arteriovenous fistulas in patients on chronic hemodialy

Introduction. Vascular access complications are associated with about 30% of patient hospitalizations, and annual costs of vascular access maintenance account for 14–20% of total healthcare costs for dialysis patients. At the same time, current international clinical guidelines emphasize the need to implement a patient-centered approach with planning of possible vascular access complications and selection of optimal surgical interventions (risk/benefit balance) for correction of compromised access.Aim. To present the first experience of endovasal laser obliteration of arteriovenous fistulas for correction of venous hypertension syndrome.Materials and methods. The first experience of complicated arteriovenous fistulas liquidation using endovasal laser obliteration in 6 patients receiving hemodialysis replacement therapy for stage 5 chronic kidney disease (National kidney Foundation (NkF) classification) is presented. In 5 patients due to the presence of venous hypertension of the upper extremity, where the arteriovenous fistula functioned, open intervention was unacceptable because of the high risk of bleeding. In one patient the arteriovenous fistula was closed due to its aneurysmatic transformation. we performed endovasal laser obliteration of four Cimino-type radial artery-cephalic arteriovenous fistulas, one brachial-basilar arteriovenous fistula, and one brachial-cubital arteriovenous fistula. Endovasal laser obliteration was performed with an endovascular light guide under ultrasound navigation using tumescent anesthesia. we used a laser device with a wavelength of 1.56 µm and power of 15 w, working in continuous mode (time 2–4 min, energy density 500 to 1,000 J/cm). The average diameter (Me) of the fistula vein was 8 mm.Results. The course of the early postoperative period in all patients was uncomplicated. The follow-up period was 30 days. Symptoms of venous hypertension were eliminated in all patients, the pain syndrome disappeared completely, there were slight feelings of heaviness and fullness of the limb.Discussion. Experience has shown that standard modes used for varicose vein obliteration for elimination of arteriovenous fistulas in chronic renal failure are ineffective: under conditions of blood flow in the area of arteriovenous anastomosis the energy density is almost 10 times higher. Therefore, other modes were used in our study: energy density from 500 to 1,000 J/cm. This was due to the lack of coagulation of the fistula vein when using standard parameters due to high blood flow rate, despite the use of proximal and distal vascular compression. In all cases we obtained positive results (obliteration of arteriovenous fistulas) without complications along with the correction of venous hypertension within 1 month after the intervention.Conclusion. The advantages of this method are technical simplicity and minimal blood loss, which is especially important for this cohort of patients with initial anemia against chronic renal failure.

Chronic kidney disease patients with intertrochanteric fracture have a high mortality rate

AimsThe prognosis of patients with chronic kidney disease (CKD) and intertrochanteric fractures is unclear. This study was aimed to analyze the mortality and complication rates among CKD patients with intertrochanteric femoral fractures and the risk factors of one-year mortality after surgery. Patients and methodsThis retrospective cohort study included 49 patients diagnosed with grades III, IV, or V CKD who were surgically treated for an intertrochanteric fracture between January 2011 and February 2019 at a tertiary university hospital. Preoperative parameters, including age, gender, bone mineral density, follow-up period (mean: 8.6 months range: 1~82 months), underlying disease, American Society of Anesthesiologists classification, fracture classification, and grade of CKD were identified, and complications and mortality rates after surgery were examined. The patients were divided into two groups according to whether one-year mortality after surgery had occurred or not, and a logistic regression analysis was performed to analyze the risk factors of mortality. ResultsOf the 49 total patients, 16 died <1 year postoperatively. Pneumonia (n = 11) was the most common postoperative complication. Twenty-one patients died during the follow-up period. Significant differences in gender (p = 0.006) and grade of CKD (p = 0.022) distributions were found between the two groups, divided according to whether one-year mortality had occurred or not. In a univariate analysis, CKD grade and postoperative septic shock were highly associated with one-year mortality. In a multivariate analysis, septic shock, acute kidney injury, and CKD grade were identified as the risk factors of one-year mortality. ConclusionThe mortality and complication rates were high among the CKD patients with intertrochanteric fractures. Grades of CKD significantly correlated with one-year mortality after surgery; therefore, they and an important factor that must be considered when developing a strategy to improve the postoperative survival rate of patients with CKD.

PUK4 General Practitioner Utilization and Costs of Chronic Kidney Disease According to the 2012 KDIGO CKD Classification: A Report from the DISCOVER CKD Retrospective Cohort

The DAPA-CKD Trial, designed to assess the effect of dapagliflozin (a sodium–glucose cotransporter 2 [SGLT2] inhibitor) on adverse kidney and cardiovascular outcomes in patients with chronic kidney disease (CKD), with or without type 2 diabetes reported a significant risk reduction (hazard ratio [95% CI] 0.61 [0.51–0.72]) on these outcomes. Data reporting general practitioner (GP) utilization and cost associated with CKD categorized according to 2012 KDIGO recommendations are scarce. We assessed GP visits and costs in a “DAPA-CKD-like population” (estimated glomerular filtration rate [eGFR] 25–75ml/min/1.73m2 and urine-albumin-creatinine-ratio [UACR] 200–5000mg/g) compared to patients categorized according to KDIGO 2012 recommendations.

MO591THE EVALUATION OF SARCOPENIA IN NON-DIALYSIS CHRONIC KIDNEY DISEASE STAGES BY COMPUTED TOMOGRAPHY

Abstract Background and Aims Sarcopenia is common in chronic kidney disease (CKD) and it has been reported a correlation between the increased prevalence of sarcopenia and worsening kidney function. Computed tomography (CT) is the gold standard for studying sarcopenia because of its capacity to identify quantitative and qualitative changes in muscle mass. Our major aim was to evaluate the prevalence of sarcopenia ant its association with renal function, in non-dialysis CKD patients, using a diagnostic criterion that has not been applied before in this population. Method We conducted a longitudinal retrospective analysis on a cohort of non-dialysis CKD patients who visited an outpatient Nephrology clinic between January 2012 and December 2012 and continued follow-up until December 2018. We selected those who underwent a CT scan as part of their clinical workup and simultaneously had a serum creatinine determination within 90 days of the scan. CT images were obtained and evaluated for body composition analysis by one investigator blinded to clinical data. Images were selected by radiologists at the third lumbar vertebra (L3). Segmentation of tissue cross-sectional areas was conducted according to the following Hounsfield unit thresholds: -29 to 150 for skeletal muscle, -190 to -30 for subcutaneous and intramuscular adipose tissue and -50 to -150 for visceral adipose tissue. Skeletal muscle area (SMA) was normalized for stature to calculate the skeletal muscle index (SMI). Sarcopenia was defined as SMI lower than 41 cm2/m2 in women and 43 cm2/m2 in men with body mass index (BMI) &amp;lt; 25 kg/m2 and &amp;lt; 53 in men with BMI &amp;gt; 25 kg/m2, as described by Martin et al, based on the International Consensus of Sarcopenia. Visceral obesity was defined as visceral fat area &amp;gt; 130 cm2. Diagnosis and classification of CKD were based on the Kidney Disease Improving Global Outcomes criteria and the glomerular filtration rate was estimated from the serum creatinine levels using the CKD Epidemiology Collaboration equation. Results Out of the 521 non-dialysis CKD patients referred to the nephrology clinic, 43 patients met the inclusion criteria. Mean age was 71.0 ± 14.6 years, 55.8% were male and 97.7% were caucasian. The mean follow-up time was 4.3 ± 2.3 years. Most patients had CKD stages 3 to 5 (67.4%) and the mean GFR was 45.4 ± 32.6 ml/min/1.73m2. In our entire cohort, 16 patients were sarcopenic (37.3%; median age: 77.5 years; 9 female and 7 male) and a high prevalence of sarcopenia was observed in stages 3 and 4 of CKD (54,5% and 50%, respectively). There was a non-significant difference in age (77.5 vs. 68, p=0.068), comparing with patients without sarcopenia. The group of the sarcopenic patients had lower BMI (24.4 vs. 28.4 Kg/m2, p=0.008) and height (65.9 vs. 77.6, p=0.01), although BMI &amp;gt; 30 Kg/m2 (1 vs. 9, p=0.052) and visceral obesity (7 vs. 19, p=0.084) were not significantly different between the two groups. Moreover, we observed that patients with sarcopenia tended to have lower albumin levels (2.9 vs. 3.7, p=0.034) and higher LDL levels (135 vs. 67.5, p=0.04). Regarding mortality, 18 patients (41,9%) died during follow-up and the frequency of sarcopenia was significantly higher among non-survivors (68.8% vs. 25.9%, p=0.006). In the univariate logistic regression, for every decrease of one unit in the SMI, mortality increased by 10% (p=0.012). Conclusion Sarcopenia is common in patients with non-dialysis dependent CKD, particularly in advanced stages, and is strongly associated with mortality in this population. Our study highlights the importance of early diagnosis and implementation of therapeutic strategies to minimize the adverse outcomes in CKD patients.