Chronic Kidney Disease Comorbidities Research Articles

Experiences and disease self-management in individuals living with chronic kidney disease: qualitative analysis of the National Kidney Foundation\u2019s online community

BackgroundSelf-management of chronic kidney disease (CKD) is one of the keys in improving CKD outcomes and quality of life. There has been an increased use of online health communities to share the experiences of those living with CKD. By analyzing the CKD online forum data, this study aims to: 1) understand the experiences and challenges of individuals living with CKD, and 2) explore how online communities may help CKD patients in improving CKD self-management.MethodsPublicly available posts of peer interactions on the National Kidney Foundation’s online community for individuals affected by CKD were extracted in April 2021 using computer programming. A total of 20,436 posts were collected, of which 400 posts were analyzed using inductive thematic analysis, and saturation was reached. Two researchers coded each post independently, and discrepancies were discussed to reach consensus.ResultsThe analysis identified seven themes: 1) Dynamics of CKD status, 2) CKD comorbidities, 3) Managing CKD and symptoms, 4) Life participation and outlook; 5) Navigating healthcare and clinical needs, 6) Medical tests and results; and 7) Support on the forum. The results revealed that comorbidities were common in CKD patients and early-stage CKD was not communicated in a timely manner to patients by the health care community; living with CKD challenged both CKD and caregivers; some common challenges included but were not limited to the management of a diet for CKD and co-morbidities (especially co-morbid diabetes), CKD dynamics and symptoms, and fear of/ways to prevent progression. Individuals living with CKD primarily used the online forum to share and seek information and emotional support for managing CKD (including co-morbidities).ConclusionsChallenges of living with CKD were found not only in those with advanced kidney disease and those on dialysis, but also in those with early and middle stages. Information and emotional support from the online forum serve as a platform to empower CKD individuals with the knowledge, skills and confidence for CKD self-management. Proactive and innovative strategies with a combination of virtual and real settings to improve self-management for individuals with all-stage CKD needs to be explored and tailored.

Advances in proteomic profiling of pediatric kidney diseases.

Chronic kidney disease(CKD) can progress to kidney failure and require dialysis or transplantation, while early diagnosis can alter the course of disease and lead to better outcomes in both pediatric and adult patients. Significant CKD comorbidities include the manifestation of cardiovascular disease, heart failure, coronary disease, and hypertension. The pathogenesis of chronic kidney diseases can present as subtle and especially difficult to distinguish between different glomerular pathologies. Early detection of adult and pediatric CKD and detailed mechanistic understanding of the kidney damage can be helpful in delaying or curtailing disease progression via precise intervention toward diagnosis and prognosis. Clinically, serum creatinine and albumin levels can be indicative of CKD, but often are a lagging indicator only significantly affected once kidney function has severely diminished. The evolution of proteomics and mass spectrometry technologies has begun to provide a powerful research tool in defining these mechanisms and identifying novel biomarkers of CKD. Many of the same challenges and advances in proteomics apply to adult and pediatric patient populations. Additionally, proteomic analysis of adult CKD patients can be transferred directly toward advancing our knowledge of pediatric CKD as well. In this review, we highlight applications of proteomics that have yielded such biomarkers as PLA2R, SEMA3B, and other markers of membranous nephropathy as well as KIM-1, MCP-1, and NGAL in lupus nephritis among other potential diagnostic and prognostic markers. The potential for improving the clinical toolkit toward better treatment of pediatric kidney diseases is significantly aided by current and future development of proteomic applications.

Predictors of cardio-kidney complications and treatment failure in patients with chronic kidney disease and type 2 diabetes treated with SGLT2\xa0inhibitors

BackgroundClinical practice guidelines recommend sodium-glucose co-transporter 2 inhibitors (SGLT2is) to mitigate adverse kidney and cardiovascular outcomes in patients with type 2 diabetes (T2D), including patients with comorbid chronic kidney disease (CKD), also referred to as diabetic kidney disease (DKD), who are at even higher risk. In this study, we sought to identify predictors of cardio-kidney events, cardio-kidney complications, and treatment failure (i.e., addition/initiation of a new T2D class, insulin, or discontinuation of SGLT2is) after new initiation of SGLT2is in patients with CKD and T2D (DKD).MethodsIn this retrospective cohort study, we identified adult patients with DKD who initiated SGLT2is between April 1, 2012, and June 30, 2019, in Optum claims data. Outcome rates per 1000 person-years (PY) are reported with 95% confidence intervals (CIs). Cox proportional hazards regression identified patient characteristics associated with each outcome.ResultsThe study population consisted of 6389 initiators of SGLT2is. The rate of CV hospitalization was 26.0 (95% CI 21.6, 30.4) per 1000 PY. Baseline characteristics associated with higher risk of CV hospitalization included age, atrial fibrillation, peripheral vascular disease (PVD), and cancer. The rate of kidney hospitalization was 12.0 (95% CI 9.0, 15.0) per 1000 PY. The risk increased significantly with baseline evidence of heart failure, hyperkalemia, respiratory failure, depression, and use of loop diuretics. In total, 55.0% of all SGLT2i initiators discontinued treatment during the follow-up period. The rate of treatment failure was 510.5 (95% CI 492.9, 528.1) per 1000 PY. Analysis of key time-dependent SGLT2i-associated adverse events showed that experiencing diabetic ketoacidosis and volume depletion were associated with risk of treatment failure.ConclusionsOur study demonstrated high rates of residual cardio-kidney outcomes and treatment failure in patients with DKD treated with SGLT2is. Patients with high baseline CV risk and the presence of certain conditions, such as atrial fibrillation, PVD, and heart failure, were at higher risk for cardio-kidney events. Further research is needed to assess the potential relationship between adverse events and SGLT2i treatment failure.

Development and Validation of a Predictive Model for Chronic Kidney Disease After Percutaneous Coronary Intervention in Chinese.

AimThere is no model for predicting the outcomes for coronary heart disease (CHD) patients with chronic kidney disease (CKD) after percutaneous coronary intervention (PCI). To develop and validate a model to predict major adverse cardiovascular events (MACEs) in patients with comorbid CKD and CHD undergoing PCI.MethodsWe enrolled 1714 consecutive CKD patients who underwent PCI from January 1, 2008 to December 31, 2017. In the development cohort, we used least absolute shrinkage and selection operator regression for data dimension reduction and feature selection. We used multivariable logistic regression analysis to develop the prediction model. Finally, we used an independent cohort to validate the model. The performance of the prediction model was evaluated with respect to discrimination, calibration, and clinical usefulness.ResultsThe predictors included a positive family history of CHD, history of revascularization, ST segment changes, anemia, hyponatremia, transradial intervention, the number of diseased vessels, dose of contrast media >200 ml, and coronary collateral circulation. In the validation cohort, the model showed good discrimination (area under the receiver operating characteristic curve, 0.612; 95% confidence interval: 0.560, 0.664) and good calibration (Hosmer-Lemeshow test, P = 0.444). Decision curve analysis demonstrated that the model was clinically useful.ConclusionsWe created a nomogram that predicts MACEs after PCI in CHD patients with CKD and may help improve the screening and treatment outcomes.

Management of Psychiatric Disorders in Patients with Chronic Kidney Diseases.

Management of Psychiatric Disorders in Patients with Chronic Kidney Diseases.

Incidence and risk factors of pneumonia in diffuse large B-cell lymphoma patients receiving first line R-CHOP/R-CHOP-like immunochemotherapy: a retrospective study of 287 patients in single center.

Diffuse large B-cell lymphoma (DLBCL) patients may develop pneumonia during immunochemotherapy. The purpose of this retrospective study was to determine the incidence of and risk factors for pneumonia. By retrospectively searching the hospital's computer-database, we reviewed the records of DLBCL patients who underwent the first-line rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP)/R-CHOP-like immunochemotherapy at our institution from January 2012 to June 2019. Statistical analyses were conducted to calculate the odds ratio (OR) of characteristics and identify the risk factors of pneumonia for these patients. In total, 287 DLBCL patients were recruited to this study. Among them, 84 (29.3%) patients developed pneumonia during treatment. The incidence of severe pneumonia was 19.4% (18/93) with a 33.3% mortality rate (6/18). Pneumonia was associated with inferior progression-free survival (PFS) [hazard ratio (HR) 1.78, 95% confidence interval (CI): 1.05 to 3.00, P=0.016]. Through multivariate logistic regression analysis, age (OR =1.030, 95% CI: 1.005 to 1.055), advanced stage (OR =2.176, 95% CI: 1.015 to 4.669), comorbidity of chronic kidney disease (CKD) (OR =11.794, 95% CI: 2.444 to 56.910), severe agranulocytosis (OR =8.777, 95% CI: 4.457 to 17.285), and pneumonia at onset (OR =9.548, 95% CI: 3.734 to 24.413) were identified as risk factors for pneumonia during the course of immunochemotherapy. Pneumonia has a negative impact on survival in DLBCL patients receiving the first-line R-CHOP/R-CHOP-like regimen. For patients with risk factors, surveillance should be emphasized to prevent pneumonia.

Incidence and Risk Factors of Acute Kidney Injury in Patients Hospitalized with Pneumonia: A Prospective Observational Study.

Background: Acute kidney injury (AKI) is frequent in hospitalized patients with critical illness and presents in up to one-quarter of patients with non-severe community-acquired pneumonia (CAP), resulting in increased short and long-term mortality. There is a paucity of literature from resource-limited settings regarding the incidence and risk factors for AKI in patients with CAP. In this study, we looked at the incidence and risk factors for AKI in patients hospitalized with CAP in a resource-limited setting Methods: This prospective observational study conducted over 1 year period included patients ≥ 18 years of age diagnosed with CAP admitted to a tertiary care center. The differences in baseline characteristics between hospitalized CAP patients with and without AKI; and risk factors for AKI and the need for renal replacement therapy (RRT) were analyzed using Chi-square test, t-test, Mann-Whitney U test, and logistic regression with p-value <0.05 considered statistically significant. Results: We observed 27.6 % (58/210) of patients had AKI in our study. Patients with AKI had significantly higher baseline comorbidities of chronic kidney disease (p=0.005) and coronary artery disease (p=0.032), and significantly higher uric acid (p=0.002), lower albumin (p=0.005), lower total protein (p=0.015), higher bilirubin (p=0.001), higher LDH (p=0.041), and higher CURB-65 score (p<0.001) in addition to elevated creatinine, BUN (p<0.001) compared to the no-AKI group. The patient group requiring RRT had significantly more males (p=0.019), with significantly higher phosphorus (p=0.038), lower ALT (p=0.022), and expectedly higher creatinine (p<0.001) and blood urea nitrogen (p=0.016). The adjusted logistic regression analysis revealed that patients with higher CURB-65 scores were at increased odds of undergoing RRT (OR 8.74, 95% CI 5.27 to 12.21, p=0.039). Conclusion: There is a high incidence of AKI in patients hospitalized for CAP in developing countries. Clinicians should be alert for the prevention and early detection of AKI in CAP patients.

Guideline-Directed Medical Therapy in Patients with Chronic Kidney Disease Undergoing Peripheral Vascular Intervention

Introduction: Guideline-directed medical therapy (GDMT) is imperative to improve cardiovascular and limb outcomes for patients with critical limb ischemia (CLI), especially amongst those at highest risk for poor outcomes, including those with comorbid chronic kidney disease (CKD). Our objective was to examine GDMT prescription rates and their variation across individual sites for patients with CLI undergoing peripheral vascular interventions (PVIs), by their comorbid CKD status. Methods: Patients with CLI who underwent PVI (October 2016–April 2019) were included from the Vascular Quality Initiative (VQI) database. CKD was defined as GFR <60 mL/min/1.73 m². GDMT included the composite use of antiplatelet therapy and a statin, as well as an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker if hypertension was present. The use of GDMT before and after the index procedure was summarized in those with and without CKD. Adjusted median odds ratios (MORs) for site variability were calculated. Results: The study included 28,652 patients, with a mean age of 69.4 ± 11.7 years, and 40.8% were females. A total of 47.5% had CKD. Patients with CKD versus those without CKD had lower prescription rates both before (31.7% vs. 38.9%) and after (36.5% vs. 48.8%) PVI (p < 0.0001). Significant site variability was observed in the delivery of GDMT in both the non-CKD and CKD groups before and after PVI (adjusted MORs: 1.31–1.41). Discussion/Conclusion: In patients with CLI undergoing PVI, patients with comorbid CKD were less likely to receive GDMT. Significant variability of GDMT was observed across sites. These findings indicate that significant improvements must be made in the medical management of patients with CLI, particularly in patients at high risk for poor clinical outcomes.

Chronic Kidney Disease on Health-Related Quality of Life in Patients with Diabetes Mellitus: A National Representative Study.

Importance: With an increasing prevalence of diabetes mellitus (DM) and comorbid chronic kidney disease (CKD), health-related quality of life (HRQoL) in patients with DM and CKD needs to be better understood. Objective: To investigate the association between the severity of CKD on HRQoL in DM patients. Design: A cross-sectional study of a nationally representative population-based survey, the Korea National Health and Nutrition Examination Survey (KNHANES). Setting: Data collected between 2007 and 2018 from the KNHANES. Participants: Adult participants with DM who completed the self-administered European Quality of Life Questionnaire Five Dimension (EQ-5D) questionnaire (n = 7243). Exposures: CKD stages defined by the Kidney Disease Improving Global System (KDIGO) staging system. Main Outcomes and Measures: We estimated the odds ratios (ORs) and 95% confidence intervals (CIs) of the presence of having problems in the 5 dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) of EQ-5D by CKD stage after adjusting for socio-demographic parameters and comorbid conditions. In addition, the EQ-5D index, reflecting the overall health status, was compared across CKD stages. Results: Among 7243 participants (mean (standard error) age 58.2 (0.2) 56.9% male), 24.0% (n = 1768) had CKD and 8.6% (n = 775) had stage 3–5 CKD. Pain/discomfort was the most common problem (30.5%) among patients with DM. Participants with more advanced CKD were more likely to experience problems in all dimensions of EQ-5D except the anxiety/depression dimension. In particular, compared to those without CKD, the adjusted ORs (95% CI) for any problem in the usual activities dimension was 1.65 (1.30, 2.10) in CKD stage 3 and 4.23 (2.07, 8.67) in CKD stage 4–5. Moreover, participants with stage 3 (−0.016 (−0.029, −0.003)) and stage 4–5 CKD (−0.088 (−0.129, −0.048)) had significantly lower EQ-5D index than those without CKD. However, compared with no CKD, CKD stage 1–2 was not significantly associated with having any problem in any dimensions. Conclusions and Relevance: In this nationally representative study, patients with DM had a high prevalence of self-reported poor HRQoL and the prevalence increased with more advanced stages of CKD. Therefore, assessment of HRQoL and interventions are necessary at early stages of CKD in DM patients.

Clinical profile of children incidentally found to have advanced kidney failure.

No data exist on the epidemiology of children incidentally diagnosed with advanced kidney failure (KF) during evaluation for non-specific symptoms. This is likely related to unrecognized symptoms and signs of CKD. The objective of our study was to evaluate incidentally diagnosed patients with advanced KF requiring long-term kidney replacement therapy (KRT). An IRB-approved retrospective chart review of children who started KRT with dialysis (hemo- or peritoneal) was conducted. Included were children with no prior knowledge or diagnosis of underlying kidney disease with chronic kidney disease (CKD) disease stage 4 (GFR 15-29mL/min/1.73 m2) or 5 (GFR < 15mL/min/1.73 m2) at initial presentation and started on chronic KRT within 2months of presentation. Of 177 patients initiating KRT during the study period, 26 (15%) were categorized as incidental advanced KF. This cohort with mean age 12.25years consisted of 42% males, 54% African Americans included 46% with glomerular, and 54% with non-glomerular etiology for kidney failure. Vomiting (42%) and fatigue (39%) were most common, while growth failure (19%) and hyperkalemia (7%) were less frequent on initial presentation. Anemia (100%), hypertension (96%), hyperparathyroidism (96%), and hyperphosphatemia (92%) were the most frequently seen CKD comorbidities. Chronic KRT was started within 24h in 62% and within 2weeks in 88% of the cohort. Under-diagnosis of patients with advanced KF is most likely related to milder non-specific clinical symptoms and normal growth in the majority of patients. A higher resolution version of the Graphical abstract is available as Supplementary information.

Impact of Physical Activity and Natural Bioactive Compounds on Endothelial Dysfunction in Chronic Kidney Disease.

Chronic kidney disease (CKD) represents a world-wide public health problem. Inflammation, endothelial dysfunction (ED) and vascular calcifications are clinical features of CKD patients that increase cardiovascular (CV) mortality. CKD-related CV disease pathogenic mechanisms are not only associated with traditional factors such as arterial hypertension and dyslipidemia, but also with ED, oxidative stress and low-grade inflammation. The typical comorbidities of CKD contribute to reduce the performance and the levels of the physical activity in nephropathic patients compared to healthy subjects. Currently, the effective role of physical activity on ED is still debated, but the available few literature data suggest its positive contribution. Another possible adjuvant treatment of ED in CKD patients is represented by natural bioactive compounds (NBCs). Among these, minor polar compounds of extra virgin olive oil (hydroxytyrosol, tyrosol and oleocanthal), polyphenols, and vitamin D seem to exert a beneficial role on ED in CKD patients. The objective of the review is to evaluate the effectiveness of physical exercise protocols and/or NBCs on ED in CKD patients.

Abstract LB083: Characterizing colon and prostate cancers with comorbid chronic kidney disease in NHANES

Abstract In the US, the prevalence of chronic kidney disease (CKD) is estimated at 30 million, or approximately 15% of the population. Compared to Caucasians (CA), African Americans (AAs) have a higher prevalence of CKD, and faster decline in kidney function. Relationships between low socio-economic status (SES), area-level social disadvantages, and CKD are well documented. In cancer patients, CKD impedes overall survival, treatment, and surgical outcomes. Given the link between kidney disease preceding cancer, as well as the higher risk of mortality for cancer patients with CKD, the goals of this research were to identify the tumor types most associated with CKD prevalence and to elucidate the modifying effects of age, race, gender, and lifestyle/environmental measures on these relationships. Using the National Health and Nutrition Examination Survey (NHANES), we generated cross-sectional associations between CKD and various cancer types for the years of 2007-2018. After exclusion for age under 18 years, non-AA or non-CA race, or incomplete information for exposure (CKD) or outcome (cancer), a nationally representative, weighted sample of ~25,000 subjects was included in the analysis. CKD was defined as estimated glomerular function (eGFR) &amp;lt;60 ml/min/1.73 m2. Self-reported measures of ever having any type of cancer and type of cancer were used for tumor variables. CKD was present in 15% of all NHANES subjects, and 21% of those with CKD reported having any cancer versus 12% of those without CKD. In a cancer-only analysis, overrepresented tumor types in CKD vs. non-CKD patients were prostate (23% vs. 6%) and colon (7% vs. 4%). Cases of colon cancer were significantly higher for CKD patients of all races, with the largest CKD-related difference for female AAs (28% in CKD vs. 7% in non-CKD). For both races, prostate cancer had higher CKD comorbidity, strongest for male AAs. While eGFR normally decreases with age, AAs had low eGFR in younger cases (50-60years), for both prostate and colon cancers, notably in female AAs with colon cancer. Body mass index (BMI) was higher for those with CKD (29.4) versus non-CKD (28.9). In a gender/race stratified analysis, AA women with colon cancer who were obese (BMI 30+) had 1.66 times the odds of also having CKD relative to all other BMI categories. Men with colon cancer also showed increased odds of CKD in obese versus all other BMI categories (AA 1.98, CA 1.21). There was no effect of BMI on prostate cancer. Overall, CKD is a more frequent in cancer patients than for cancer-free patients even when accounting for age. This relationship is modified by tumor type, race, and gender. Prostate and colon cancers have strong associations with CKD which are independent of age in AAs. Obesity is linked to CKD-comorbid colon cancers for AAs and males. These findings identify high-risk subgroups for colon cancer and suggest dietary/metabolic/environmental etiology and intervention strategies. Citation Format: Michael Behring, Dawna Nelson, Tina Vazin, Ram Alagan, Seela Aladuwaka, Manoj Mishra, Tariq Shafi, Orlando Gutierrez, Upender Manne. Characterizing colon and prostate cancers with comorbid chronic kidney disease in NHANES [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr LB083.

Взаємовплив стану ліпідного спектру крові та вмісту адипокінів на клінічний перебіг неалкогольної жирової хвороби печінки за наявності коморбідної хронічної хвороби нирок

The purpose of the study was to find out the probable mutual influence of the state of the lipid spectrum of blood and content of adipokines in blood: leptin, adiponectin on the clinical course of non-alcoholic fatty liver disease against the background of obesity depending on its form and the presence of comorbid chronic kidney disease. Materials and methods. 444 patients were examined: of which 84 patients with non-alcoholic fatty liver disease with grade I obesity (group 1), which contained 2 subgroups: 32 patients with non-alcoholic hepatic steatosis and 52 patients with non-alcoholic steatohepatitis; 270 patients with non-alcoholic fatty liver disease with comorbid obesity of the I degree and chronic kidney disease of the I-III stage (group 2), including 110 patients with non-alcoholic steatosis of the liver and 160 patients with non-alcoholic steatohepatitis. The control group consisted of 90 patients with chronic kidney disease stage I-III with normal body weight (group 3). The mean age of patients was (45.8±3.81) years. Results and discussion. The study showed that patients with non-alcoholic steatohepatitis and obesity without concomitant chronic kidney disease are characterized by the following changes in the blood lipid spectrum: maximum increase in blood triacylglycerols (by 2.1 times, p &lt;0.05), a probable increase in total cholesterol (by 1.4 times, p &lt;0.05) and proatherogenic low-density lipoproteins (by 1.6 times, p &lt;0.05), a probable decrease in anti-atherogenic high-density lipoproteins (by 1.6 times, p &lt;0.05), which with the addition of comorbid chronic kidney disease are likely to deepen (within 1.5-1.8 times, p &lt;0.05), in addition to hyper triacylglycerol. According to the results of the study, the content of leptin in the blood was significantly increased by 1.4 times (p &lt;0.05) compared with almost healthy individuals, which differed significantly from patients with non-alcoholic steatosis of the liver with chronic kidney disease and non-alcoholic steatohepatitis with chronic kidney disease (p &lt;0.05). The content of adiponectin in the blood was significantly reduced by 1.4 times compared with almost healthy individuals (p &lt;0.05) and also differed significantly from patients with non-alcoholic hepatic steatosis with chronic kidney disease and non-alcoholic steatohepatitis with chronic kidney disease (p &lt;0.05). Conclusion. Based on the results, it was found that significant metabolic prerequisites for the development of non-alcoholic steatohepatitis against the background of obesity and chronic kidney disease are probable postprandial hyperglycemia, hyperinsulinemia, increased glycosylation of hemoglobin. Hyperleptinemia and hypoadiponectinemia are also factors in the burden of non-alcoholic steatohepatitis and obesity due to the progression of mesenchymal inflammation and cytolysis of hepatocytes

Network-based transcriptomic analysis identifies the genetic effect of COVID-19 to chronic kidney disease patients: A bioinformatics approach.

COVID-19 has emerged as global health threats. Chronic kidney disease (CKD) patients are immune-compromised and may have a high risk of infection by the SARS-CoV-2. We aimed to detect common transcriptomic signatures and pathways between COVID-19 and CKD by systems biology analysis. We analyzed transcriptomic data obtained from peripheral blood mononuclear cells (PBMC) infected with SARS-CoV-2 and PBMC of CKD patients. We identified 49 differentially expressed genes (DEGs) which were common between COVID-19 and CKD. The gene ontology and pathways analysis showed the DEGs were associated with “platelet degranulation”, “regulation of wound healing”, “platelet activation”, “focal adhesion”, “regulation of actin cytoskeleton” and “PI3K-Akt signalling pathway”. The protein-protein interaction (PPI) network encoded by the common DEGs showed ten hub proteins (EPHB2, PRKAR2B, CAV1, ARHGEF12, HSP90B1, ITGA2B, BCL2L1, E2F1, TUBB1, and C3). Besides, we identified significant transcription factors and microRNAs that may regulate the common DEGs. We investigated protein-drug interaction analysis and identified potential drugs namely, aspirin, estradiol, rapamycin, and nebivolol. The identified common gene signature and pathways between COVID-19 and CKD may be therapeutic targets in COVID-19 patients with CKD comorbidity.

Dysbiosis-Related Advanced Glycation Endproducts and Trimethylamine N-Oxide in Chronic Kidney Disease.

Chronic kidney disease (CKD) is a public health concern that affects approximately 10% of the global population. CKD is associated with poor outcomes due to high frequencies of comorbidities such as heart failure and cardiovascular disease. Uremic toxins are compounds that are usually filtered and excreted by the kidneys. With the decline of renal function, uremic toxins are accumulated in the systemic circulation and tissues, which hastens the progression of CKD and concomitant comorbidities. Gut microbial dysbiosis, defined as an imbalance of the gut microbial community, is one of the comorbidities of CKD. Meanwhile, gut dysbiosis plays a pathological role in accelerating CKD progression through the production of further uremic toxins in the gastrointestinal tracts. Therefore, the gut-kidney axis has been attracting attention in recent years as a potential therapeutic target for stopping CKD. Trimethylamine N-oxide (TMAO) generated by gut microbiota is linked to the progression of cardiovascular disease and CKD. Also, advanced glycation endproducts (AGEs) not only promote CKD but also cause gut dysbiosis with disruption of the intestinal barrier. This review summarizes the underlying mechanism for how gut microbial dysbiosis promotes kidney injury and highlights the wide-ranging interventions to counter dysbiosis for CKD patients from the view of uremic toxins such as TMAO and AGEs.

Impact of Chronic kidney disease on the outcomes of hospitalizations for implantable cardioverter defibrillator or cardiac resynchronization defibrillator placement: An analysis of Inpatient Sample

Abstract Funding Acknowledgements Type of funding sources: None. 1. Background Implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy defibrillator (CRT-D) are indicated in primary and secondary prevention of dysrhythmias among other indications. We sought to determine the impact of chronic kidney disease (CKD) on hospitalizations for ICD or CRT-D placement. 2. Purpose Determine how CKD impacts in-patient mortality and cardiovascular outcomes in patients undergoing ICD or CRT-D placement while hospitalized. 3. Methods Data were extracted from the National Inpatient Sample (NIS) 2016 - 2018 Database. The NIS was searched for patients who underwent ICD or CRT-D placement. The patients were divided into two groups based on presence or absence of CKD as secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders (A univariate screen was done to confirm the confounders affected outcomes with variables having a p less than 0.2 were included in the multivariate regression analysis). STATA software was used to for analysis. 4. Results Of 145,550 patients admitted for ICD or CRT-D placement, 47740 (32.8%) had CKD. The adjusted odds ratio (aOR) for inpatient mortality for patients undergoing ICD or CRT-D placement with co-morbid CKD compared to those without CKD was 1.66 (95% CI 1.194 – 2.329, p = 0.003). Patients with comorbid CKD had lower odds of developing cardiogenic shock (aOR: 0.83, 95% CI 0.718 – 0.948, p = 0.007) and cardiac arrest (aOR: 0.88, 95% CI 0.766 – 0.999, p = 0.048) compared to patients without CKD. Detailed outcomes are listed in table 1. 5. Conclusion Chronic kidney disease is a risk factor associated with increased in-patient mortality in patients admitted for ICD or CRT-D placement. Outcome Without CKD, % With CKD, % aOR (95% CI) p-value* Primary outcome In hospital mortality 0.6 1.9 1.66 (1.194 - 2.329) 0.003* Secondary outcomes Length of stay (days), mean 7.0 9.2 -0.01 (-0.345 - 0.322) # 0.945 Total hospital charges (US$), mean 218,962 241,679 -13047 (-20924 - -5171) # 0.001* Cardiogenic shock 6.8 8.0 0.83 (0.718 - 0.948) 0.007* IABP placement 1.7 1.7 0.52 (0.399 - 0.671) &amp;lt;0.001* Cardiac arrest 12..1 8.5 0.88 (0.766 - 0.999) 0.048* Acute renal failure 17.9 48.1 2.89 (2.648 - 3.163) &amp;lt;0.001* Abbreviations: *; statistically significant, #; adjusted mean difference, aOR: adjusted odds ratio, CI: confidence interval, IABP: Intra-aortic balloon placement.Adjusting factors: Age, Charlson comorbidity index, patient’s insurance, location and teaching status of the admitting hospital, dyslipidemia, old myocardial infarction, cerebral infarction, hypertension, diabetes mellitus, liver disease, smoking status and obesity.

Kidney disease and COVID-19 disease severity-systematic review and meta-analysis.

We aimed to identify prevalence and association of comorbid chronic kidney disease (CKD), acute kidney injury (AKI) and utilization prevalence of continuous renal replacement therapy (CRRT) in COVID-19-hospitalized patients as a function of severity status. With the ongoing struggle across the globe to combat COVID-19 disease, published literature has described the role of kidney disease in COVID-19 patients based on single/multicenter experiences across the globe. We extracted data from observational studies describing comorbid CKD, AKI and CRRT and outcomes and severity of COVID-19-hospitalized patients from December 1, 2019–August 20, 2020 following PRISMA guidelines. Severity of COVID-19 includes intensive care unit admission, oxygen saturation < 90%, invasive mechanical ventilation utilization, in-hospital admission and mortality. Meta-analysis was performed using a random-effects model to calculate pooled estimates, and forest plots were created. In total, 29 studies with 15,017 confirmed COVID-19 patients were included. The overall prevalence of AKI was 11.6% [(430/3693)], comorbid CKD 9.7% [(1342/13,728)] and CRRT 2.58% [(102/3946)] in our meta-analysis. We also found higher odds of comorbid CKD (pooled OR: 1.70; 95%CI: 1.21–2.40; p = 0.002), AKI (8.28; 4.42–15.52; p < 0.00001) and utilization of CRRT (16.90; 9.00–31.74; p < 0.00001) in patients with severe COVID-19 disease. Conclusion Our meta-analysis suggests that comorbid CKD, AKI and utilization of CRRT were significantly associated with COVID-19 disease severity. Clinicians should focus on early triaging of COVID-19 patients with comorbid CKD and at risk for AKI to prevent complication and mortality.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10238-021-00715-x.

INCREASED PREVALENCE AND HIGHER 1-YEAR MORTALITY OF PATIENT HOSPITALIZED FOR AORTIC STENOSIS WITH COMORBID CHRONIC KIDNEY DISEASE IN THE PROVINCE OF QUEBEC, CANADA

Abstract Objective: Development of aortic stenosis is associated with valvular calcifications which are highly prevalent in chronic kidney disease (CKD). The objective of this study was to evaluate the temporal trends in the prevalence and 1-year mortality of patients hospitalized for aortic stenosis according to comorbid CKD status in the province of Quebec, between 2000–2017. Design and method: Using the Quebec Integrated Chronic Disease Surveillance System, we identified patients aged 20 years and older with incident aortic stenosis using International Classification of Diseases diagnostic codes versions 9 and 10, in the hospital discharge database. We subsequently combined hospital discharges and physician billing claims databases to identify patients with comorbid CKD in the two years prior to aortic stenosis’ diagnosis. Three subgroups of CKD were considered: 1) non-CKD, 2) pre-dialysis and 3) dialysis. The distribution of the 2016–2017 aortic stenosis population was used for age-standardization of prevalence, 1-year all-cause and cardiovascular mortality. Results: We included 108 780 patients with incident aortic stenosis (females: 51.8%; mean age (±SD): 76.4 ± 11.7; comorbid CKD status: 80 768 non-CKD; 26 809 pre-dialysis; 1 203 dialysis). During the study period, the age-standardized prevalence of non-CKD patients decreased by 14% (80.72% [95% CI 77.56–83.99] to 69.56% [95% CI 67.23–71.94]; Figure 1). Inversely, the age-standardized prevalence of pre-dialysis and dialysis patients increased by 58% (18.52% [95% CI 16.93–20.21] to 29.33% [95% CI 27.82–30.91]) and 46% (0.76% [95% CI 0.51–1.11] to 1.11% [95% CI 0.84–1.44]), respectively. Age-standardized 1-year all-cause and cardiovascular mortality decreased over time but remained higher in patients with comorbid CKD. In 2015–2016, age-standardized relative risk of 1-year all-cause mortality was significantly higher in pre-dialysis (RR = 1.56 [95% CI 1.44, 1.69]) and dialysis (RR = 2.04 [95% CI 1.62–2.61]) than in non-CKD patients. Age-standardized relative risk of 1-year cardiovascular mortality was also significantly higher in pre-dialysis (RR = 1.83 [95% CI 1.66–2.03]) and dialysis (RR = 2.28 [95% CI 1.68–3.09]) than in non-CKD patients. Conclusions: Prevalence of patients with incident aortic stenosis and comorbid CKD increased between 2000–2017. 1-year all-cause and cardiovascular mortality improved over time but remain higher in aortic stenosis patients with comorbid CKD.

Outcome trends in people with heart failure, type 2 diabetes mellitus and chronic kidney disease in the UK over twenty years.

BackgroundHeart failure (HF) together with type 2 diabetes (T2D) and chronic kidney disease (CKD) are major pandemics of the twenty first century. It is not known in people with new onset HF, what the distinct and combined associations are between T2D and CKD comorbidities and cause-specific hospital admissions and death, over the past 20 years.MethodsAn observational study using the UK Clinical Practice Research Datalink linked to the Hospital Episode Statistics in England (1998–2017). Participants were people aged ≥30 years with new onset HF. Exposure groups were HF with: (i) no T2D and no CKD (reference group); (ii) CKD-only (estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m2); (iii) T2D-only; (iv) T2D and CKD. CKD severity groups were: CKD-3a (eGFR 45–59); CKD-3b (30–44); CKD-4 (15–29); CKD-5 (<15). Outcomes were cardiovascular and non-cardiovascular hospitalisations and all-cause death.FindingsIn 87,709 HF patients (mean age, 78 years; 49% female), 40% had CKD-only, 12% T2D-only, and 16% both. Age-standardised first-year CVD hospitalisation rates were significantly higher in HF patients with CKD-only (46.4; 95% CI 44.9,47.9 per 100 person years) and T2D-only (49.2; 46.7,58.8) than in the reference group (35.1; 34.0,36.1); the highest rate was in patients with T2D-CKD-5: 89.1 (65.8,112.4). Similar patterns were observed for non-CVD hospitalisations and deaths. Group differences remained significant after adjustment for potential confounders. Median survival was highest in the reference (4.4 years) and HF-T2D-only (4.1 years) groups, compared to HF-CKD-only (2.2 years). HF-T2D-CKD group survival ranged from 2.8 (CKD-3a) to 0.7 years (CKD-5). Over time, CVD hospitalisation rates significantly increased for HF-CKD-only (+26%) and reduced (-24%) for HF-T2D-only groups; no reductions were observed in any of the HF-T2D-CKD groups. Trends were similar for non-CVD hospitalisations and death: whilst death rates significantly reduced for HF-T2D-only (-37%), improvement was not observed in any of the T2D-CKD groups.InterpretationIn a cohort of people with new onset HF, hospitalisations and deaths are high in patients with T2D or CKD, and worst in those with both comorbidities. Whilst outcomes have improved over time for patients with HF and comorbid T2D, similar trends were not seen in those with comorbid CKD. Strategies to prevent and manage CKD in people with HF are urgently needed.Funding10.13039/100006662NIHR fellowship [reference: NIHR 30011]

Risk of Death in COVID-19 Patients with Comorbidity of Chronic Kidney Disease: Meta Analysis

Risk of Death in COVID-19 Patients with Comorbidity of Chronic Kidney Disease: Meta Analysis