Degrees Of Chronic Kidney Disease Research Articles

Long-term safety of total knee arthroplasty in patients with chronic kidney disease in Taiwan: a retrospective cohort study

Background: Chronic kidney disease (CKD) is a prevalent condition in Taiwan, and the incidence of total knee arthroplasty (TKA) is on the rise. This study aimed to evaluate the postoperative results of patients with different degrees of CKD after TKA, using data from the Taiwan National Health Insurance Research Database.Methods: The study analyzed 3,078 patients who received TKA from 2012 to 2017, equally divided into three groups: none-CKD, mild CKD (without dialysis), and severe CKD (with dialysis). Propensity score matching was used to minimize selection bias.Results: After TKA, there was no significant difference in the risk of debridement surgery for infection between the three groups (adjusted HR of mild CKD 0.71 95% CI = 0.36 - 1.38, P = 0.3073; adjusted HR of severe CKD: 1.14, 95% CI = 0.63 - 2.06, P = 0.6616). However, CKD patients requiring dialysis had a significantly higher risk of mortality (adjusted HR 1.98, 95% CI = 1.57 - 2.50, P < 0.001) and readmission within 90 days of any causes (adjusted HR 1.83, 95% CI = 1.48 - 2.26, P < 0.001) than non-CKD and mild CKD patients.Conclusion: Severe CKD patients needing dialysis after TKA have a higher risk of mortality and readmission rates than that of the non-CKD or mild CKD patients. If the patient is in the early stage of CKD, their prognosis after receiving TKA is expected to be as good as non-CKD patients.Level of evidence : IV; well-designed cohort study.

#3018 CARDIOVASCULAR DISEASE AND DETECTION OF CLONAL HEMATOPOIESIS OF INDETERMINATE POTENTIAL IN THE CHRONIC KIDNEY DISEASE POPULATION

Abstract Background and Aims Cardiovascular disease (CVD) is the main cause of morbidity and mortality in patients with chronic kidney disease (CKD). Novel determination of clonal expansion of hematopoietic stem cells carrying mutations in certain genes is called Clonal hematopoiesis of indeterminate potential (CHIP), it is well known the association with an increased risk of hematologic malignancies but in general population, CHIP has been associated with increased mortality and increased cardiovascular risk. The aim of our study was to analyze the influence of CHIP on the risk of CVD and heart disease in the population with CKD. Method 128 patients with different degrees of CKD were roll in our prospective study in between September 1, 2020 and January 31, 2021. All of them have followed up in Nephrology clinics and any patient have previous cardiovascular pathology. For detection of silent heart disease was realized measurement of troponin I and NT-Pro-BNP in the blood using a microparticle chemiluminescence assay and the degree of coronary calcification was calculated by the computed tomography (CT): Agatston method. All the patients were prospectively followed up for 18 months, recording the occurrence of major cardiovascular events. For detection of CHIP massive sequencing was performed with Ion Chef System On-demand technology using Ion AmpliSeqTM Kit for Chef DL8. The data analysis was done with the Torrent SuiteTM software and Varsome software, following the criteria of the American College of Medical Genetics (ACMG). Results 36.7% of the patients presented CHIP (pathogenic and probably pathogenic mutations) and 24.2% (only pathogenic mutations). TET2 was the most frequently affected gene (21.1%). The percentage of patients with CHIP MPL gene mutation was 12,5%, DNMT3 7%, JAK 1,6% and ASXL1 0,8%. 9 patients developed major cardiovascular events (MACE). Using univariate Cox regression analysis, the presence of MACE was related to global coronary calcification (OR 1.001, 95% CI 1.001-1.001, p = &amp;lt; 0.001), NT-ProBNP (OR 1.090, 95% CI 1.050-1.132, p = &amp;lt; 0.001) but there was no relation to smoking (OR 2.796, 95% CI 0.750-10.415, p = 0.125). Patients with CHIP did not have a higher risk of MACE, although patients with DNMT3A mutations did have a higher risk (HR 6.637, 95% CI 1.443-30.533, p = 0.015) independently of other variables. Using multivariate logistic regression analysis, the presence of CHIP was not related to coronary calcification (OR 0.387, 95% CI 0.142-1.058, p = 0.387), nor was it related to troponin I or NT-Pro-BNP. Conclusion The presence of CHIP was not associated with a greater risk of silent heart disease or cardiovascular events, although DNMT3a mutations, analyzed independently, were associated with a greater number of cardiovascular events in our CKD population.

Kidney Health and Care: Current Status, Challenges, and Developments.

The concept of chronic kidney disease (CKD) originated in the 2000s, and an estimated 850 million patients are currently suffering from health threats from different degrees of CKD. However, it is unclear whether the existing CKD care systems are optimal for improving patient prognosis and outcomes, so this review summarizes the burden, existing care models, effectiveness, challenges, and developments of CKD care. Even under the general care principles, there are still significant gaps in our understanding of the causes of CKD, prevention or care resources, and care burdens between countries worldwide. Receiving care from multidisciplinary teams rather than only a nephrologist shows potential profits in comprehensive and preferable outcomes. In addition, we propose a novel CKD care structure that combines modern technologies, biosensors, longitudinal data visualization, machine learning algorithms, and mobile care. The novel care structure could simultaneously change the care process, significantly reduce human contact, and make the vulnerable population less likely to be exposed to infectious diseases such as COVID-19. The information offered should be beneficial, allowing us to rethink future CKD care models and applications to reach the goals of health equality and sustainability.

Chronic Kidney Disease and Post-Percutaneous Coronary Intervention Mortality in Patients With Left Main and Equivalent Coronary Artery Disease.

Patients with chronic kidney disease are underrepresented in registries and in randomized trials of coronary artery disease management. To investigate effects of chronic kidney disease on outcomes of nonemergent percutaneous coronary intervention in patients with left main or left main-equivalent coronary artery disease, we analyzed data from the New York State Percutaneous Coronary Intervention Registry during the calendar year 2015, involving 2,956 elective percutaneous coronary intervention cases. Outcomes of percutaneous coronary intervention in patients with various degrees of chronic kidney disease and stable left main or left main-equivalent coronary artery disease were compared. Only patients with left main or left main-equivalent coronary artery disease and elective percutaneous coronary intervention were included in the study cohort. Patients with acute coronary syndromes within 24 hours of the index percutaneous coronary intervention, patients reported to be in shock, and patients with prior coronary artery bypass surgery were excluded from the study cohort. In this cohort, stage 4 or 5 chronic kidney disease, current congestive heart failure, and left main disease remained statistically significant predictors of post-percutaneous coronary intervention mortality. Our findings in this large, statewide cohort indicate that advanced kidney disease is associated with markedly increased post-nonemergent percutaneous coronary intervention mortality.

Pulse Wave Velocity for Risk Stratification of Patients with Aortic Aneurysm.

Background: Patients with an aortic aneurysm are at high cardiovascular risk. Pulse wave velocity (PWV) is used as a parameter for risk stratification but may be affected by aortic disease (AoD). This study aimed to investigate the dependence of PWV on treated or untreated AoD and to identify modifiable factors of PWV. Methods: The measurement of PWV with the Mobil-O-Graph was performed fully automatically in a collective of 381 patients (75.6% male and 24.4% female). Of all patients, 53.8% had nonaortic atherosclerotic vascular disease (AVD), 28.9% had treated AoD, and 17.3% had untreated AoD. Results: There was a statistically significant effect of age (R2 = 0.838) and current systolic blood pressure (SBP) on PWV (page corrected < 0.05). After correction for age, no statistically significant difference was found between the PWV of men and women, patients with different body weights or degrees of chronic kidney disease, diabetics and nondiabetics, and smokers and nonsmokers. Comparison between patients with nonaortic AVD and treated or untreated AoD revealed no statistically significant differences (PWVnonaortic AVD 10.0 ± 1.8 m/s, PWVtreated AoD 10.0 ± 1.5 m/s, PWVuntreated AoD 9.8 ± 1.6 m/s; page corrected > 0.05). Conclusions: PWV determined with the Mobil-O-Graph correlated with age and current SBP. Neither aortic disease versus nonaortic AVD, its treatment, nor other cardiovascular risk factors had a significant effect on PWV. Successful blood pressure control is crucial to avoid high PWV and thus an increase in cardiovascular events.

Retroperitoneal fibrosis - diagnosis and treatment.

Idiopathic retroperitoneal fibrosis (IRF) is a rare condition characterized by the development of a peri-aortic and peri-iliac tissue showing chronic inflammatory infiltrates and pronounced fibrosis. Ureteral entrapment with consequent obstructive uropathy is one of the most common complications which can lead to acute renal failure and, in the long term, to varying degrees of chronic kidney disease. Common symptoms at onset include lower back, abdominal or flank pain. Pain is frequently referred to the hip, to the groin and to the lateral regions of the leg, often with nocturnal exacerbations and not responding to position changes. The disease is commonly associated with signs of systemic inflammatory response (malaise, fever, and anorexia and weight loss). Glucocorticoids are considered the cornerstone of the therapy. The use of other immunosuppressive agents, including cyclophosphamide, azathioprine, methotrexate, mycophenolate mofetil and biological agents such as rituximab, tocilizumab and infliximab have been reported as a valuable option mostly in case reports, cases series and small studies. These agents allowed to reduce cumulative dose of glucocorticoids and their adverse effects. Combined therapy is preferable for all patients who suffer from significant glucocorticoid- related toxicity or in cases where glucocorticoids alone are insufficient to treat the condition.

Analysis of N-Terminal Fragment B Type Natriuretic Peptide Serum In Chronic Kidney Disease

Chronic kidney disease (CKD) is a condition of decreased kidney function due to chronic and irreversiblerenal parenchymal damage. Chronic kidney disease is one of the world’s health problems due to itshigh prevalence of the disease, increasing morbidity and mortality rates and expensive treatment costs.Cardiovascular complications have been recognized as the leading cause of death in CKD. Left ventricularhypertrophy (LVH), systolic and diastolic dysfunction are the most common cardiovascular complicationsfound in CKD. NTproBNP is an early diagnostic and prognostic biomarker of cardiovascular diseases,hence it can distinguish between acute and chronic cardiovascular diseases. Therefore, this examination isrecommended to monitor patient treatment. NTproBNP levels circulating in the circulations of cardiovascularpatients are about six times higher than other biomarkers including BNP. This study aims to assess serumNTproBNP levels in various degrees of CKD. This research is an observational analytic study with crosssectional approach. It was conducted between June and August 2019 at Dr. Wahidin Sudirohusodo hospitalwith total sample of 86 patients diagnosed with CKD who met the inclusion and exclusion criteria. Basedon the Kruskal Wallis test, which were used due to abnormal data distribution, a significant difference wasfound in serum NTProBNP levels based on the degree of CKD with the initial increase occured in grade IIICKD with mean value of 4,653 ng/L. Serum NTproBNP levels were not significantly different based on thedegree of hypertension. Serum NTProBNP levels were significantly correlated with urea and creatinin levelsand GFR value based on the Rho Spearman correlation test with a p value &lt;0.05.

Idiopathic retroperitoneal fibrosis: an update for nephrologists.

Idiopathic retroperitoneal fibrosis (IRF) is a rare condition characterized by the development of a peri-aortic and peri-iliac tissue showing chronic inflammatory infiltrates and pronounced fibrosis. Ureteral entrapment with consequent obstructive uropathy is one of the most common complications of IRF, which can lead to acute renal failure and, in the long term, to varying degrees of chronic kidney disease. IRF may be isolated or develop in association with autoimmune diseases (e.g. Hashimoto's thyroiditis and psoriasis) and other fibro-inflammatory disorders (often within the spectrum of immunoglobulin G4-related disease), which suggests that it should be considered as a potentially systemic condition. IRF is an immune-mediated disease: genetic variants (e.g. human leukocyte antigen (HLA)-DRB1*03) and environmental agents (mainly exposure to asbestos and smoking) are strongly associated with an increased risk of developing the disease, while a complex network of chemokines (e.g. CXCL12 and C-C moti chemokine 11 (CCL11)) and cytokines [e.g. interleukin (IL)-6, IL-12 and IL-13] is likely to orchestrate the inflammatory response and simultaneously promote fibrosis. Glucocorticoids, alone or in combination with traditional immunosuppressants such as methotrexate and mycophenolate mofetil, are usually efficacious and promptly induce disease remission; however, up to 50% of patients relapse, thus requiring repeat immunosuppressive courses. Biologic drugs, namely rituximab, are being explored for the treatment of IRF. In addition to medical therapies, interventional procedures (mainly ureteral stenting) are required to relieve ureteral obstruction, whereas surgical ureterolysis is generally reserved to refractory cases. If appropriately treated, then the overall and renal prognosis of IRF are good, with <5% patients developing end-stage renal disease.

Lactic acidosis incidence with metformin in patients with type 2 diabetes and chronic kidney disease: A retrospective nested case-control study.

ObjectiveCompare rates of lactic acidosis (LA) among metformin‐exposed and unexposed patients with type 2 diabetes mellitus and varying degrees of chronic kidney disease (CKD).Research Design and MethodsRetrospective, nested case‐control study using data from national VA Corporate Data Warehouse. All adult patients with type 2 diabetes and CKD newly dispensed any antihyperglycaemic medication during FY 2003‐13 were included. The outcome was LA hospitalization or serum lactate >5 mEq/L. Exposure to metformin was evaluated in the three months prior to event. Estimates were adjusted for 31 covariates, including demographics, comorbidities and medications.ResultsOverall, 320 882 patients were included, contributing a total of 1 331 784 person‐years of follow‐up. LA occurred in 2 665 patients, generating an overall incidence rate of 2.00 (95% CI 1.93‐2.08) per 1000 person‐years. Metformin exposure in the prior 3 months was associated with an elevated adjusted hazard of LA (HR 1.97, 95% CI 1.69‐2.29). No association was evident in patients with CKD stage 1 or 2 (HR 1.05, 95% CI 0.71‐1.57), but associations were present and progressively greater in patients with CKD stage 3a through 5: HR 3.09, 95% CI 2.19‐4.35 in CKD 3a, HR 3.34, 95% CI 1.95‐5.72 in CKD 3b, HR 7.87, 95% CI 3.51‐17.61 in CKD stage 4&5.ConclusionMetformin was not associated with an elevated risk of LA in persons with stage 1‐2 CKD, but was associated with a progressively higher risk at more advanced stages of CKD.

Additional prognostic value of electrocardiographic left ventricular hypertrophy in traditional cardiovascular risk assessments in chronic kidney disease.

Left ventricular hypertrophy (LVH) is a common predictor of the cardiovascular prognosis in chronic kidney disease (CKD). However, whether or not electrocardiography-derived LVH (ECG-LVH) has prognostic value in patients with various degrees of CKD and improves the cardiovascular risk stratification based on traditional risk factors remains unclear. A total of 7206 participants at least 40 years of age who were free from cardiovascular events in a general population were followed for the incidence of cardiovascular events. CKD was confirmed by either the presence of a reduced estimated glomerular filtration rate (eGFR) (<60 ml/min per 1.73 m) or albuminuria, defined as a urinary albumin-to-creatinine ratio (UACR) of at least 30 mg/g Cr. A total of 1886 (26.2%) had CKD, of which 1471 (78.0%) had a preserved eGFR (CKD stage 1-2). After an average 11.3 years of follow-up, the adjusted hazard ratio for the incidence of cardiovascular events significantly increased for ECG-LVH according to the Sokolow--Lyon voltage, Cornell voltage, or Cornell voltage product among participants with CKD (hazard ratio 1.47, P = 0.002), in contrast to those without CKD (hazard ratio 1.15, P = 0.210). The inclusion of any ECG-LVH parameters improved the accuracy of reclassification in any risk prediction model based on the eGFR, UACR, or Framingham 10-year risk score in the CKD participants (net reclassification improvement = 0.13-0.32, all P values <0.040). In patients with CKD stage 1-5, ECG-LVH is useful for predicting the risk of future cardiovascular events and adds prognostic information to traditional cardiovascular risk assessments.

P0200KEEP ON (KEEPING RAAS INHIBITION TREATMENT WITH OPTIMAL POTASSIUM CONTROL). DESIGN OF A CLINICAL TRIAL OF USING SODIUM ZIRCONIUM CYCLOSILICATE FOR KEEPING RAAS INHIBITION AND/OR MRAS IN PATIENTS WITH CKD AND CONGESTIVE HEART FAILURE HISTORY

Abstract Background and Aims Hyperkalemia (HK) is a potentially life-threatening condition, in patients with chronic kidney disease (CKD) and congestive heart failure (CHF). The majority of patients affected with CKD or CHF, must be treated with inhibitors of renin angiotensin aldosterone system (RAASi) and mineralocorticoid receptor antagonists (MRAs). However, the treatments previously mentioned, increase the risk of HK episodes, which is the main cause of RAASi and MRAs downtitration or discontinuation, representing an undesirable clinical scenario, given that the patients are at high risk of be deprived of their nephroprotective effect and cardio-renal benefits The aim of the study is: to analyze if, in patients with HK, CKD and CHF treated with RAASi and/or MRA, serum potassium (sK) reduction by Sodium zirconium cyclosilicate (SZC) treatment is non-inferior to RAASi and/or MRAs discontinuation or downtitration. Method Results The study will demonstrate results on serum electrolytes, renal function, albuminuria, KDQoL questionnaire and changes in relative overhydration (multifrequency bioimpedance -BCM Fresenius-) Conclusion The KEEP ON study will define the ability of SZC to facilitate the use of RAAS-I and / or MRA in patients with HK and cardiorenal syndrome allowing the maintenance of the medications recommended by international guidelines for the treatment of CHF at different degrees of CKD while maintaining the potential cardio-renal and nephroprotective benefit.

Two-Dimensional Shear-Wave Elastography for Kidney Stiffness Assessment.

This study aimed to analyze the utility of bidimensional shear-wave elastography for renal assessment and in the prediction of chronic kidney disease (CKD).The study included 92 subjects: 50 healthy volunteers and 42 patients with different degrees of CKD (mean age, 57.5 ± 13.4; 50% were female), excluding those undergoing renal replacement therapies, obstructive pathology, or renal lithiasis. We performed kidney shear-wave velocity (KSWV) determinations in the midportion of the parenchyma of each kidney. The median values were expressed in meters per second.We obtained successful assessments in 94% of the cases for the right kidney (RK) and 90.2% for the left kidney (LK), with an intraclass correlation coefficient of 0.96 (RK) and 0.91 (LK). We obtained significantly lower KSWV values in the CKD lot as opposed to the healthy volunteers: RK: 1.38 ± 0.1 versus 1.78 ± 0.1 m/s, P = 0.05; LK: 1.37 ± 0.1 m/s versus 1.72 ± 0.1 m/s. We could predict the presence of CKD with a sensitivity of 89.2% and a specificity of 76.9% for a KSWV of less than 1.47 m/s, with a tendency of KSWV to decrease with CKD progression.Our study shows that KSWV measured using bidimensional shear-wave elastography decreases in patients with CKD compared with normal subjects, and that for a cutoff value of below 1.47 m/s we could predict, with a good sensitivity and specificity, the presence of CKD.

Prevalencia de las alteraciones del metabolismo óseo-mineral asociadas a enfermedad renal crónica no en diálisis

la enfermedad renal crónica (ERC) es un problema de salud pública, siendo el trastorno del metabolismo óseo mineral una de sus principales complicaciones y que contribuye directamente a la morbilidad y mortalidad. Varios estudios previos han demostrado un aumento de su prevalencia a medida que disminuye la tasa de filtración glomerular (TFG), sin embargo, no contamos con datos en nuestro país ni en América Latina.

Supersonic Shear Wave Ultrasonography for Assessing Tissue Stiffness in Native Kidney

Recent years have brought shear wave elastography to the attention of nephrologists as a non-invasive method for detecting kidney fibrosis and, therefore, as a potential tool for reducing the need for kidney biopsy. Few studies are performed on native kidney. We aimed to compare cortical stiffness, assessed by measuring Young's modulus (YM, kPa) with SuperSonic Imaging technology, in patients with various degrees of chronic kidney disease (CKD) compared with healthy individuals. Cortical stiffness was measured by two operators, in different sessions, in 32 patients with CKD stages 3–5 and 20 healthy individuals. Comparison between mean YM values in CKD and those in controls and also between the different stages of CKD was our primary objective. The influence of other possible confounders on YM readings was also investigated and analyzed. Mean YM was significantly greater in CKD patients than in controls. Estimated YM was not able to differentiate the stages of CKD, except stage 5. Intra-subject variability was greater in CKD than in controls. Body mass index was the most important confounder in multiple analyses, in both the CKD and control groups. Our results highlight a positive correlation between increased cortical stiffness and presence of CKD. Further studies are needed to validate this method for implementation in daily clinical practice.

Evaluation of serum soluble klotho protein in patients with different degrees of chronic kidney disease

Objectives The aim of this study was to investigate serum α-klotho as a new biomarker for the diagnosis of chronic kidney disease (CKD), especially in its early stages. Background α-Klotho is a novel antiaging protein that was identified as a regulator of calcium and phosphate homeostasis, which is highly expressed in the kidney. The soluble form of klotho acts as an endocrine substance that exerts multiple actions including the modulation of renal solute transport and protection of the kidney. Methods A case–control study was conducted at the Clinical Pathology Department, Menoufia University Hospitals, Faculty of Medicine, during the period from January 2015 to November 2016. Sixty-eight patients suffering from CKD who were admitted to the hospital during the period from January 2015 to November 2016 were included in this study. In addition, 10 apparently healthy subjects with matching age and gender formed the control group. Routine laboratory investigations performed were: hemoglobin, urea, creatinine, uric acid, calcium (Ca2), phosphate (PO4), and albumin and the estimated glomerular filtration rate were measured and the α-klotho protein level was measured by ELISA. Results Serum soluble α-klotho protein levels were significantly lower in CKD patients compared with normal controls. Besides, α-klotho protein levels were positively correlated with estimated glomerular filtration rate, hemoglobin and were negatively correlated with renal function tests and phosphate. Conclusion Soluble α-klotho levels are significantly decreased in CKD not only in the advanced stages but also in the early stages.

Percutaneous Coronary Intervention and Inpatient Mortality in Patients with Advanced Chronic Kidney Disease Presenting with Acute Coronary Syndrome

Chronic kidney disease (CKD) is an important risk factor for coronary artery disease, yet patients with CKD are less likely to undergo coronary angiography and percutaneous coronary intervention (PCI). We retrospectively analyzed the 2006-2012 National Inpatient Sample Database to examine the temporal trends in coronary angiography and PCI among patients without CKD, with advanced CKD (CKD III-V), and with end-stage renal disease (ESRD) presenting with unstable angina/non-ST elevation myocardial infarction (NSTE-ACS) and ST-elevation myocardial infarction (STEMI). A total of 579,747 admissions for NSTE-ACS and 293,950 admissions for STEMI were studied. Patients with NSTE-ACS were less likely to undergo coronary angiography/PCI than those with STEMI, irrespective of CKD. Between 2006 and 2012, performance of PCI saw an uptrend across all CKD groups with NSTE-ACS (no CKD, 29.9%-36.8%; CKD III-V, 18.2%-21.5%; ESRD, 19.8%-27.5%; all Ptrends < 0.01) and STEMI (no CKD, 57.0%-76.0%; CKD III-V, 33.0%-52.6%; ESRD, 29.9%-42.9%; Ptrends < 0.01). Multivariate analyses revealed that PCI was associated with a lower risk of hospital mortality across all degrees of CKD in both NSTE-ACS (adjusted odds ratios: no CKD, 0.44; CKD III-V, 0.48; ESRD, 0.46; P < 0.01) and STEMI (no CKD, 0.35; CKD III-V, 0.50; ESRD, 0.52; P < 0.01). Performance of PCI increased over time among patients presenting with NSTE-ACS and STEMI in the presence of advanced CKD and independently predicted lower in-hospital mortality.

P498Effect of various degrees of Chronic Kidney Disease on Long-term Outcome of Patients who Underwent Percutaneous Coronary Intervention

P498Effect of various degrees of Chronic Kidney Disease on Long-term Outcome of Patients who Underwent Percutaneous Coronary Intervention

Impact of atrial fibrillation in patients with chronic kidney disease undergoing transcatheter aortic valve replacement: Insights of the Healthcare Cost and Utilization Project's National Inpatient Sample.

Limited data exists exploring the relationship between varying degrees of chronic kidney disease (CKD) and atrial fibrillation (AF) in patients undergoing transcatheter aortic valve replacement (TAVR). Records were selected from the 2011 to 2012 Healthcare Cost and Utilization Project's National Inpatient Sample for TAVR patients with pre-existing AF and CKD. Demographics, clinical characteristics, and TAVR-related in-hospital adverse events were identified and compared between patients with and without AF and moderate CKD (CKD stage 3-4), and between patients with and without AF and severe CKD (CKD stage 5 or end stage renal disease [ESRD]). Evaluated outcomes included major adverse cardiac and cerebrovascular events (MACCE). We identified a total of 293 patients with moderate CKD (stage 3 and higher) that underwent TAVR at selected U.S. hospitals between 2011 and 2012. Among these patients, 112 had a diagnosis of AF and 181 did not have AF. MACCE rates were similar among CKD 3-4 patients with and without AF (10.3% and 9.0% respectively, p=0.74). MACCE rates were similar among CKD 5/ESRD patients with and without AF (20.0% and 16.2% respectively, p=0.74). However, MACCE rates were higher in patients with CKD 5/ESRD compared with CKD 3-4 patients. Multivariate logistic regression analysis did not show that AF was an independent predictor of in-hospital MACCE. In a large retrospective analysis of CKD stage 3-4 or CKD 5/ESRD patients undergoing TAVR at selected U.S. hospitals, the presence of AF did not seem to be associated with increased adverse in-hospital events or length of stay.

Assessment of Prevalence of Chronic Kidney Disease and Its Predisposing Factors in Kerman City

Background: Chronic kidney disease (CKD) is a prevalent, progressive, and treatable disease. However, lack of enough data about its prevalence in Iran is a major obstacle for its early detection. In order to determine the prevalence of the disease in the country, it is necessary to conduct epidemiologic studies especially on populations with ethnic diversity; hence, this study aimed at determining the prevalence of CKD and its predisposing factors in an adult population aged 15 to 75 years old in Kerman city. Methods: This cross-sectional study was conducted on 988 adults aged 15 to 75 years in Kerman city, during year 2010. We collected data on the status of hypertension (HTN) and Diabetes Mellitus (DM) in all participants. Moreover, height, weight, and blood pressure of all participants were measured and a blood sample was taken for laboratory tests. In addition, a morning urine sample was taken to detect microalbuminuria and measure protein, and creatinine. Patients’ glomerular filtration rate (GFR) was calculated using modification of diet in renal disease (MDRD) formula, and the stage of the chronic kidney disease (CKD) was determined. Results: Of all the participants, 58% were female and the mean age (SD) of participants was 45 ± 16 years. Considering participants’ body mass index (BMI), 37% were overweight and 18% were obese. The prevalence of HTN and DM were 20% and 14%, respectively. Mean GFR (SD) was 67 ± 20 mL/min/1.73 m2. Overall, 91% of the participants were affected by some degree of CKD (stage 1:5%; stage 2: 55.1%; stage 3: 30.5%; stage 4: 0.4%). Prevalence of CKD that was defined through GFR 0.05). Conclusions: The findings of the present study showed that 91% of the adult population living in Kerman city was affected by some degrees of CKD and more than one-third were at stages 3 or 4. Prevalence of CKD that was defined through GFR < 60 cc/min was 30.9%. Since early detection of CKD could help adopt preventive measures and interventions, and prevent disease progression, policy makers must pay special attention to preventive programs, such as programs for life style modification, and design treatment plans for different risk factors, such as HTN, DM, and dyslipidemia.

Levosulpiride Use in Chronic Kidney Disease Patients – Do We Need to Be Cautious?

Background: A challenging scenario for today’s clinician is to treat dyspeptic symptoms among the chronic kidney disease (CKD) patients. Levosulpiride is a substituted benzamide which is most commonly used as a prokinetic drug. At present there is enough evidence to say that levosulpiride causes movement disorders (LIM) when used in elderly patients. This study attracts attention as there was high occurrence of extra pyramidal symptoms (EPS) in CKD patients even with recommended doses for dyspeptic symptoms. Methodology: This study was done in the Department Of Nephrology of a tertiary care private hospital by retrospective analysis of data gathered from patients who had developed movement disorders following exposure to levosulpiride for dyspeptic symptoms. Statistical analysis was done using Microsoft XL sheet. Results: Twelve patients (nine males and three females) with varying degrees of chronic kidney disease who developed levosulpiride induced movement disorders were included in the study. The number of patients who developed dystonia, Parkinsonism, isolated tremors and Orofacial dyskinesia were eight, two, one, and one (66.6%, 16.6%, 8.3% and 8.3%) respectively. All except one patient recovered completely after the discontinuation of medication. Conclusion: Levosulpiride is an effective prokinetic agent. Even though the occurrence of LIM is rare in patients with normal kidney function, LIM occurs much more commonly in chronic kidney disease patients contrary to the belief. Hence the dose of levosulpiride should be modified in patients with chronic kidney disease and prompt discontinuation of levosulpiride should be done with the occurrence of LIM as it leads to complete recovery of symptoms.