Different Stages Of CKD Research Articles

Evaluating iron replacement therapies in pediatric CKD: A comparative analysis of oral liposomal iron, iron supported lactoferrin and IV iron Dextran

CKD is defined as longstanding kidney damage and reduction in renal function. The global burden of CKD in the pediatric population is 15 per million, with congenital renal anomalies and hereditary disorders being the primary causes. Of these, 10% of patients require RRT. The development of anemia in chronic disease is a significant concern as the disease progresses. This condition exacerbates the pathological state by increasing the risk of infection, inevitably resulting in mortality. The study aims to establish the comparative analysis of three types of iron replacement therapies including oral liposomal iron, iron supported lactoferrin and IV iron dextran by evaluating their safety and efficacy corresponding to the different stages of CKD in pediatric population. A comparison between all three variants of iron replacement therapy shows oral liposomal iron provides higher bioavailability and tolerance but effective only in lower CKD stages. In IV iron dextran, rapid iron store replenishment has been observed, but with significant side effects, including the risk of severe hypersensitivity reaction. Conversely, oral iron-supported lactoferrin has demonstrated a maximal iron recovery response after six months of therapy, but with frequent gastrointestinal side effects.

#2406 Echocardiographic characteristics of autosomal dominant polycystic kidney disease

Abstract Background and Aims Cardiovascular complications in patients with autosomal dominant polycystic kidney disease (ADPKD) are one of the most frequently investigated extrarenal manifestations. The results are many times contradictory. This is caused by a limited size of studied populations and high inter- and intrafamilial heterogeneity of ADPKD. Expanding knowledge of populations of patients from different regions and cohorts is crucial for improving the understanding and treatment of cardiovascular morbidity and mortality. This study aims to explore the prevalence of cardiovascular abnormalities in echocardiography and to analyze their relationships with clinical characteristics across different stages of CKD progression in patients with ADPKD. Method Sixty-eight patients were included in the study. All patients underwent transthoracic echocardiography with the use of GE Vingmed Ultrasound (GE Norway Health Tech, Oslo, Norway). Information about demography, prior medical history and taking antihypertension drugs was recorded. The results of creatinine, lipids and haemoglobin were collected. To diagnose the rapid progression of CKD, creatinine was sampled twice, in a one-year interval. Results Using different indicators of left ventricular hypertrophy (LVH), we found it in above 40% of ADPKD patients. A single associate of left ventricular mass was eGFR decline after one year of observation. Other highly prevalent findings were asymptomatic left ventricular diastolic dysfunction (ALVDD) (39%), left atrium (LA) enlargement (39%) and mild valvular regurgitations (80%). Ejection fraction, aortic root dimension, tricuspid annular plane systolic excursion (TAPSE) and prevalence of mitral valve prolapse were not importantly increased. Apart from age, the strong determinant of ALVDD diagnosis was the treatment with beta-blockers. Cardiac indices were not different across the eGFR stages. Conclusion LVH, LA enlargement, ALVDD and valvular regurgitations are characteristics of cardiac phenotype in ADPKD. Cardiac indices were not different across different stages of CKD pointing towards the diagnosis of ADPKD being main drive of their occurrence.

Correlation between neutrophil to lymphocyte ratio and platelet to lymphocyte ratio with proteinuria in different stages of chronic kidney disease

Abstract Background Chronic kidney disease (CKD) is a progressive failure of renal function with ongoing systemic inflammation. Inflammatory markers such as neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and proteinuria were documented as independent predictors of CKD progression. Although proteinuria estimated by the protein to creatinine ratio (UPCR) is generally employed to screen the disease progression of CKD, the correlation of NLR and PLR with different stages of CKD is yet to be studied. Consequently, this study strived to find the stage-wise correlation between NLR and PLR with proteinuria in CKD patients. Methods Eighty-five CKD patients with proteinuria who visited the Nephrology Clinic at Teaching Hospital Jaffna, Sri Lanka, were randomly selected and categorized as stages II to IV based on the estimated glomerular filtration rate (e-GFR). Blood samples were collected and subjected to investigate patients’ NLR and PLR. Furthermore, urine protein and creatinine were measured and UPCR was calculated. Participants’ demographic, clinical, and laboratory data were obtained from patients’ clinical registry. Spearman’s rank correlation and receiver operative characteristic (ROC) curve analysis was done, and the p value < 0.05 was considered statistically significant. Results Amongst the total participants, males were predominant (58.8%), with a mean age of 58.1. Severity analysis based on the e-GFR revealed that 17.64%, 18.82%, 29.41%, and 34.11% of CKD patients were in stages II, IIIA, IIIB, and IV, respectively. Stage-wise correlation and ROC curve analysis indicated that NLR and PLR were positively correlated with UPCR in stages IIIA, IIIB, and IV of CKD with more than 80% predictive sensitivity and specificity. Conclusion NLR and PLR can be used as novel predictive markers for monitoring the severity of CKD; however, further large-scale cohort studies of NLR and PLR with serial monitoring and multiple closely spaced measurements are recommended to develop these markers into clinically acceptable markers for CKD progression.

Chronic kidney disease is related to impaired left ventricular strain as assessed by cardiac magnetic resonance imaging in patients with ischemic cardiomyopathy

IntroductionChronic kidney disease (CKD) is an important cardiovascular risk factor. However, the relationship between CKD and myocardial strain as a parameter of myocardial function is still incompletely understood, particularly in patients with ischemic cardiomyopathy (ICM). Cardiac magnetic resonance imaging (CMR) feature tracking allows to analyze myocardial strain with high reproducibility. Therefore, the aim of the present study was to assess the relationship between CKD and myocardial strain as described by CMR in patients with ICM.MethodsWe retrospectively performed CMR-based myocardial strain analysis in 89 patients with ICM and different stages of CKD, classified according to the KDIGO stages. In all patients, global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS) analysis of left ventricular myocardium were performed. Furthermore, segmental longitudinal (SLS), circumferential (SCS) and radial strain (SRS) according to the AHA 16/17-segment model was determined.ResultsCreatinine levels (GLS: r = 0.46, p < 0.001; GCS: r = 0.34, p = 0.001; GRS: r = − 0.4, p < 0.001), urea levels (GLS: r = 0.34, p = 0.001; GCS: r = 0.30, p = 0.005; GRS: r = − 0.31, p = 0.003) as well as estimated glomerular filtration rate (GLS: r = -0.40, p < 0.001; GCS: r = − 0.27, p = 0.012; GRS r = 0.34, p < 0.001) were significantly associated with global strains as determined by CMR. To further investigate the relationship between CKD and myocardial dysfunction, segmental strain analysis was performed: SLS was progressively impaired with increasing severity of CKD (KDIGO-1: − 11.93 ± 0.34; KDIGO-5: − 7.99 ± 0.38; p < 0.001 for KDIGO-5 vs. KDIGO-1; similar data for SCS and SRS). Interestingly, myocardial strain was impaired with CKD in both segments with and without scarring. Furthermore, in a multivariable analysis, eGFR was independently associated with GLS following adjustment for LV-EF, scar burden, diabetes, hypertension, age, gender, LV mass or LV mass index.ConclusionCKD is related to impaired LV strain as assessed by CMR in patients with ICM. In our cohort, this relationship is independent of LV-EF, the extent of myocardial scarring, diabetes, hypertension, age, gender, LV mass or LV mass index.

Osteoporosis in Renal Disease.

Osteoporosis is a disorder characterized by decreased bone mass and skeletal fragility with increased fracture risk. Chronic kidney disease presents with wide range of bone metabolic disorders, including osteoporosis. Osteoporosis prevalence is high in early stages of CKD; whereas in late stages, it coexists with renal osteodystrophy. Risk factors for osteoporosis include advancing age, low bone mineral density (BMD), glucocorticoid therapy, smoking, alcohol intake, etc. The diagnosis of osteoporosis in renal disease is made after assessment of BMD, in addition to exclusion of chronic kidney disease-mineral bone disorder (CKD-MBD), eliciting history of prior fragility fractures and relevant laboratory investigations. The treatment of osteoporosis varies with the different stages of CKD, with management in stages 1-3 being similar to the general population. Special emphasis must be laid on prevention of fractures as well.

Dietary Sodium and Potassium Intake Estimations in Different Stages of CKD by Multiple 24-Hour Urine Collections

Dietary Sodium and Potassium Intake Estimations in Different Stages of CKD by Multiple 24-Hour Urine Collections

Evaluation of liver function biomarkers, blood pressure, and anthropometric parameters among chronic kidney disease patients: Laboratory-based cross-sectional study in Northwest Ethiopia

BackgroundChronic kidney disease (CKD) is a non-communicable disease leading to a progressive decline in kidney functions and complications like liver disorders. Serum levels of liver parameters such as aminotransferases and bilirubin are important biomarkers for the diagnosis of liver diseases. Studies on the effect of CKD with and without end-stage renal disease (ESRD) on the levels of liver biomarkers in Ethiopia are limited. Hence, this study aimed to assess liver biomarkers, blood pressure (BP) and anthropometric indices in CKD patients attending a renal clinic of Felege Hiwot Comprehensive Specialized Hospital(FHCSH) in Bahir Dar, Ethiopia. MethodA hospital-based cross-sectional study was conducted among 100 CKD patients attending the renal clinic of FHCSH in Bahir Dar, Ethiopia. Data were collected using a structured questionnaire through face-to-face interview. BP and anthropometric parameters were measured based on the standard procedures. About 5 ml of serum was used to analyzeliver parameter using automated chemistry analyzer. All data analyses such as independent sample t-testand one-way ANOVA were done using SPSS version 25.0. Besides, Pearson’s correlation analysis and multiple linear regression were done to identify predictors of liver biomarkers in CKD patients. P-value< 0.05 were considered statistically significant. ResultsThe mean serum levels of AST and ALT were significantly lower in CKD patients under dialysis when compared to CKD patients with no dialysis (p < 0.05). These enzymes were positively and negatively correlated with eGFRand the severity of CKD, respectively. However, there were no significant differences in bilirubin level between different stages of CKD. There was also a significant increase (p < 0.05) in the levels of AST and ALT with BMI.There was also a significant rise of SBP and DBP in CKD patients under dialysis compared to CKD patients not in dialysis. ConclusionAminotransferases were significantly lower in CKD patients undergoing dialysis than in CKD patients not undergoing dialysis, warranting the need fora separate standard reference ranges or using other diagnostic criteria to diagnose liver comorbidities in CKD patients. The levels of AST and ALT in CKD patients were also significantly increased with BMI. Besides, BP was significantly elevated with the severity of CKD, indicating the more advanced the CKD is, the higher BP.

#3927 AN ANOREXIGENIC HORMONE IN PEDITARIC CKD PATIENTS

Abstract Background and Aims Chronic kidney disease (CKD) is a major health problem associated with faltering growth, which is a complex process, where anorexia, inadequate oral intake in addition to disturbed body metabolism play a significant role. Leptin, the anorexigenic hormone that's secreted by fat tissue, and affect appetite, &amp; hence, aids to weigh loss &amp; faltering growth. The present study evaluated serum leptin level, &amp; its relation to growth parameters in pediatric patients with different stages of CKD. Method A cross-sectional study that was conducted on 87 subjects, who were divided equally into groups; CKD stage 5 on regular hemodialysis (CKD5d), &amp; CKD stage 2–4, &amp; age &amp; gender matched controls. Patient with diabetes, infected with hepatitis C virus, &amp; on growth hormone therapies were excluded. Full history taking, assessment of growth parameters using gender &amp; age specific Z-scores of heights, weight &amp; body mass index were done. Fasting serum leptin, calcium, phosphorus, PTH, albumin, total proteins, iron &amp; hemoglobin were measured. Results Our patients had significantly lower growth parameters compared to controls. Hypocalcemia, high PTH, iron deficiency anemia &amp; hypoalbuminemia were significant in CKD2-4 groups compared to other groups. Serum leptin was abnormally high in 12.6% of CKD patients. The median leptin level was comparable between the groups (p = 0.20). Serum leptin hadn’t changed significantly as regards gender, BMI Z-scores, diagnoses, or CKD stage (p = 1.00, 0.379, 0.542, 0.171 respectively). A negative correlation was found between leptin level &amp; CKD duration (r = -0.276, P = 0.036), otherwise, no correlations were found with clinical &amp; laboratory variables. Conclusion Leptin level was not affected by CKD stage &amp; not a useful marker for growth in pediatric CKD patients. Large studies on relationship between leptin &amp; growth is needed.

#6018 SODIUM-GLUCOSE CO-TRANSPORTER-2 INHIBITOR USE IN THE MANAGEMENT OF PATIENTS WITH CHRONIC KIDNEY DISEASE AND TYPE 2 DIABETES MELLITUS

Abstract Background and Aims Sodium-glucose co-transporter-2 (SGLT-2) inhibitors were initially developed for the management of type 2 diabetes mellitus (T2DM). Results from large placebo-controlled clinical outcome trials have now highlighted efficacy of SGLT-2 inhibitors in reducing the risk of CKD progression [1,2]. NICE CKD guidelines now recommend use of SGLT-2 inhibitors alongside standard of care in those patients with T2DM [3]. This has subsequently extended SGLT-2 inhibitor licensing highlighting the importance of wider multi-disciplinary team practise awareness. The aim of this audit was to assess the level of implementation of updated NICE guidelines in patients under a specialist CKD clinic in Birmingham. Method A database of renal diabetics under a specialist CKD clinic in May 2022 was generated via the trust electronic patient record system. Patients with a recorded diagnosis of T2DM and estimated glomerular filtration rate (eGFR) &amp;gt;25ml/min (current UK regulatory licensing for SGLT-2 inhibitor use) were included. Parameters of renal function (urine albumin: creatinine ratio (uACR) and eGFR) as well as medication histories were retrospectively collected for 158 patients and analysed using descriptive statistics. Results Results demonstrated 19% (n = 43) of 143 patients with an accessible drug history were prescribed an SGLT-2 inhibitor. Less than half (44%) of those prescribed standard of care (ACEI/ARB) with a uACR &amp;gt;30 mg/mmol (n = 34) were prescribed an SGLT-2 inhibitor as per NICE recommendations. The prescribing of SGLT-2 inhibitors in patients at different stages of CKD was noted except in those with eGFR &amp;lt;30 ml/min. Conclusion Results suggest a number of patients with T2DM are not prescribed an SGLT-2 inhibitor as per NICE recommendations for CKD management. Whilst considering sample size limitation as well as possible contraindications relevant to SGLT-2 inhibitor treatment, these findings may reflect the recent update to NICE guidelines and delayed dissemination of information between multi-disciplinary teams around extended SGLT-2 inhibitor licensing. Glycaemic control is less effective in later stages of CKD however, trials have demonstrated the independent role of SGLT-2 inhibitors in reducing the risk of CKD progression irrespective of their attenuated ability to lower glucose in reduced kidney function [1,2]. It is imperative patients not currently prescribed an SGLT-2 inhibitor are reviewed for treatment eligibility and any contraindications. Results of this study were fed back to the local renal and diabetes team with the recommendation for development of clear guidelines for use of SGLT-2 inhibitors in all eligible patients in order to achieve maximum healthcare benefits. In addition, there are ongoing discussions with primary care regarding review of their use of SGLT-2 inhibitors.

#5730 PERLECAN AS A POTENTIAL BIOMARKER OF CARDIOVASCULAR RISK: ROLE OF ENDOTHELIAL GLYCOCALYX IN CHRONIC KIDNEY DISEASE

Abstract Background and Aims Chronic kidney disease (CKD) is associated with cardiovascular disease (CVD). CVD is in turn related to endothelial dysfunction, endothelial dysfunction, and degradation of the endothelial glycocalyx (EG), releasing its components into the bloodstream. The EG consists of glycosaminoglycans and proteoglycans, such as Perlecan. The aim of the study is to analyse the levels of perlecan in plasma in different stages of CKD, and to relate them to age and inflammatory monocytes, as well as their adhesion capacity (CD54/ICAM-1). Method An observational cross-sectional study was carried out. 56 patients were included: advanced chronic kidney disease (ACKD) (n=13), haemodialysis (HD) (n=13), peritoneal dialysis (PD) (n=15) and transplant recipients (TX) (n=15). Thirteen healthy subjects (CT) were analysed. Plasma perlecan levels were quantified using ELISA and phenotyping of monocyte subpopulations (classical (CD14++CD16-), intermediate (CD14+CD16+) and non-classical (CD14+CD16++)), as well as CD54 (ICAM-1) expression by flow cytometry. Statistical analysis: ANOVA and Spearman correlation. Results Patients with CKD had higher plasma levels of perlecan than healthy participants (p-value = 0.044 vs ACKD, 0.028 vs HD and 0.002 vs PD) (Fig. 1). These levels were associated with higher percentage of classical monocytes (p=0,011) intermediate monocytes (p=0,009) and non-classical monocytes (p=0,003) expressing ICAM-1 but not with a higher expression of ICAM-1 per monocyte. Perlecan levels correlate negatively with age (p=0,03) (Table 1). Conclusion Patients with ACKD, HD and PD have elevated plasma perlecan levels compared to CT and TX. Elevated perlecan concentrations are associated with increased ICAM-1 expression on monocytes, which is important for its possible role in the development of atherosclerosis. Perlecan may be postulated as a molecule of interest to assess endothelial and cardiovascular damage in CKD patients.

EVALUATION OF INFLAMMATORY BIOMARKERS IN CHRONIC KIDNEY DISEASE ASSOCIATED WITH CARDIOVASCULAR DISEASE IN A TERTIARY CARE HOSPITAL OF WEST BENGAL

Introduction: Factors responsible for cardiovascular disease (CVD) become operational from the early course of CKD and are spread over the entire spectrum of it. The relative risks of cardiovascular events are inversely related to the estimated glomerular ltration rate (eGFR). A patient with CKD is more likely to die from CVD rather than CKD which denotes high burden of CVD in subpopulation and need for early intervention to reduce mortality. Generally in the population, early CKD, atherosclerotic disease is predominant cardiovascular disease but as the CKD progresses the burden of non-atherosclerotic disease increases.Aims:To evaluate relation of Inammatory Biomarkers (IB) in CKD patients with and without ECG and Echocardiography evaluated LVH and IHD with hypokinetic or dyskinetic wall motion with specic ECG changes in KPCMCH. Materials and method: This study was conducted 18 months at KPC medical college and hospital jadavpur, kolkata-72. 100 patients were included in this study. Result: Our study showed that, majority number of patients were Abnormal [64 (87.7%)] in with Echo LVH compared to [16(59.3%)] without Echo LVH it was statistically signicant (p=0.0016) and we also found that, majority number of patients were Abnormal [64(87.7%)] in with Echo LVH compared to [17 (63.0%)] it was statistically signicant (p=0.0272). Conclusion:We concluded that the frequency and types of cardiovascular diseases associated with different stages of CKD, traditional risk factors in CVD associated with various stages of CKD

How to use COVID-19 antiviral drugs in patients with chronic kidney disease.

Antiviral drugs such as Remdesivir (Veklury), Nirmatrelvir with Ritonavir (Paxlovid), Azvudine, and Molnupiravir (Lagevrio) can reduce the risk for severe and fatal Coronavirus Disease (COVID)-19. Although chronic kidney disease is a highly prevalent risk factor for severe and fatal COVID-19, most clinical trials with these drugs excluded patients with impaired kidney function. Advanced CKD is associated with a state of secondary immunodeficiency (SIDKD), which increases the susceptibility to severe COVID-19, COVID-19 complications, and the risk of hospitalization and mortality among COVID-19 patients. The risk to develop COVID-19 related acute kidney injury is higher in patients with precedent CKD. Selecting appropriate therapies for COVID-19 patients with impaired kidney function is a challenge for healthcare professionals. Here, we discuss the pharmacokinetics and pharmacodynamics of COVID-19-related antiviral drugs with a focus on their potential use and dosing in COVID-19 patients with different stages of CKD. Additionally, we describe the adverse effects and precautions to be taken into account when using these antivirals in COVID-19 patients with CKD. Lastly, we also discuss about the use of monoclonal antibodies in COVID-19 patients with kidney disease and related complications.

Evaluation of Thyroid Function Tests among Chronic Kidney Disease Patients attended at a Tertiary Care Hospital in Dhaka City

Background: Serological status of thyroid hormones is important among chronic kidney disease patients.&#x0D; Objective: The purpose of the present study was to see the status of thyroid hormones among chronic kidney disease patients.&#x0D; Methodology: This cross-sectional study was done From January 2013 to December 2013 in the Department of Nephrology, Dhaka Medical College Hospital. A total of 50 diagnosed cases of adult male with different stages of CKD (CKD stage 3, 4, 5 and 5D) patients along with age-matched 51 healthy individuals were included. Serum Thyroid hormone T3 done by [1251] RIA kit, T4 done by T4 [1251] RIA kit, TSH level done by Turbo TSH [1251] IRMA kit.&#x0D; Result: A total number of 101 patients were recruited for this study of which 51 cases were in the group A and the rest of the 50 cases were in the group B. The mean serum T3 level was found 1.85±0.7 nmoL/L in group A and 2.79±0.55 nmoL/L in group B (p&lt;0.05) which indicated that low serum T3 level was significantly associated with CKD. The mean serum T4 level was found 104.65±34.9 nmol/L in group A and 138.8±31.5 nmol/L in group B (p&lt;0.05). Serum TSH level of the study patients showed that the mean serum TSH level was found 4.23±4.6 mIU/L in group A and 2.06±2.5mIU/L in group B (p&lt;0.05).&#x0D; Conclusion: In conclusion the mean with SD of serum level of T3, T4 and TSH were significantly associated with chronic kidney disease.&#x0D; Journal of National Institute of Neurosciences Bangladesh, July 2022;8(2):147-151

Correlation of Fructosamine and HbA1c (Glycosylated Haemoglobin) in Type 2 Diabetes Mellitus Patients with Chronic Kidney Disease

Background: In 2015, India had 69.2 million diabetes and 36.5 million impaired Glucose Tolerance (IGT) people (20-79yrs) which are expected to rise to 123.5 million and 63.6 million by 2040 respectively. Therefore need for assessing correct glycemic status of patients of Diabetes Mellitus as well as Diabetes Mellitus patients with CKD at correct time becomes necessary. Use of Fructosamine for the analysis of blood glucose levels might give better, comparatively fast results in these patients. Aims: The purpose of this study was to find out the correlation between Fasting Blood sugar, Fructosamine and HbA1c( Glycosylated haemoglobin) in patients of Type 2 Diabetes Mellitus with and without kidney disease Method: A total of 100 patients were taken and divided into 2 groups: Group A (n=50) – Patients with Diabetes Mellitus and Group B (n=50)- Patients with Diabetes Mellitus and Chronic Kidney Disease. 50 healthy controls (without DM and CKD) were taken. Result: Mean value of Fasting blood glucose in Group A – 186mg/dL SD- 52.2; Group B-182mg/dL, SD - 49.4. (t=0.781, p=0.437).The patients with DM and CKD (Group B) had lower levels of mean HbA1c (6.93%) as compared to Group A (DM), mean HbA1c -8.4%.There was significant difference between the groups (t=5.396, p&lt;0.001). The mean of Fructosamine in Group A-439, SD-127 , Group B-421,SD-112.(t=0.757,p=0.451).Our study also showed that in different stages of CKD ,there was no statistical difference between Fructosamine and HbA1c (HbA1c Vs GFR: r= - 0, 038, p=0.817, Fructosamine Vs GFR :r= -0.057, p=0.726). Conclusion: Serum Fructosamine is superior to HbA1c in assessing blood glucose control in Diabetes Mellitus patients with CKD.

Significant associations between bone mineral density and vascular calcification in patients with different stages of chronic kidney disease

IntroductionChronic kidney disease—mineral and bone disorders (CKD-MBD) is characterised by generalised vascular calcification (VC) and impaired bone health. We aimed to investigate the relationship between VC and bone mineral density (BMD) in CKD patients.MethodsWe performed a cross-sectional study of patients with different stages of CKD. For assessment of VC of abdominal aorta lateral lumbar X-rays (Kauppila score), the ankle-brachial index (ABI) and echocardiography were used. Total body densitometry provided BMD.ResultsNinety patients (41% male, median age 64 years (range 29–87)) were included, of whom 41.1% had a Kauppila score > 1. Evidence of peripheral VC as measured by ABI was detected in 23.3% of cases. Lesions of the heart valves were found in 46.7% of patients. There was a significant association between high ABI and lesions of the heart valves. In the multivariate regression model to analyse the independent determinants of abdominal aorta calcification (AAC) and ABI, the BMD of the femoral neck was identified as significant for both (p = 0.001, p = 0.001). The total spine BMD was found to be significant for AAC (p = 0.001), and the BMD of spine L1-L4 and the ribs were found to be significant for ABI (p = 0.01, p = 0.002 respectively). In factorial regression analysis, where BMD was independent determinant, valvular calcification was significant for BMD of femur, femoral neck and total BMD. Age and tALP were inversely correlated with the BMD of femur and femoral neck.ConclusionsOur work highlighted clinically important relationships between VC and bone mineral density (BMD) in CKD patients. We detected inverse relationships between AAC, high ABI and BMD. Secondly, BMD at certain bone sites (femur, femoral neck) and total BMD were associated with important lesions of heart valves. Thirdly, a significant association between a high ABI and lesions of the heart valves. We believe that the results of our study will help in the planning of future research and in current clinical practice for the early diagnosis, further monitoring and management of CKD-MBD. Additionally, these results may have treatment implications on use of different CKD-MBD medications.

Moderating Effect of the Lean Tissue Index on the Relationship between the Trabecular Bone Score and Augmentation Index in Dialysis Naïve Patients with Stage 5 Chronic Kidney Disease.

Osteopenia, sarcopenia, and increased vascular stiffness are common in patients with chronic kidney disease-mineral bone disorder (CKD-MBD) with protein energy wasting and can lead to worse clinical outcomes. We investigated the potential moderating role of the lean tissue index (LTI) in the relationship between bone microarchitecture and vascular stiffness in dialysis naïve patients with stage 5 CKD. Bioimpedance spectroscopy for evaluating LTI, lumbar spine dual energy X-ray absorptiometry for determining the trabecular bone score (TBS), and arterial applanation tonometry measurements for the central augmentation index, at a heart rate of 75 beats/minute (cAIx75), were simultaneously performed in 117 consecutive patients. A hierarchical regression analysis was conducted to assess the moderating effect of LTI on the relationship between TBS and cAIx75 after adjusting for age and sex. The effect of the interaction between LTI and TBS on cAIx75 was statistically significant (p = 0.030), demonstrating that the cAIx75 tends to decrease more, with the joint effect of LTI and TBS. In the separate analyses, the interaction effect was significant only in women (p = 0.048) and the group of diabetes (p = 0.042). Our study suggests that the evaluation of changes in body composition, bone health, and vascular stiffness needs to be performed simultaneously in patients with advanced-stage CKD. Further research in patients with different stages of CKD warranted to generalize and apply our results to patients in other stages.

Assessment of the bone mineral density in patients with secondary hyperparathyroisis due to chronic kidney disease

Osteopathy in patients with SHPT and CKD is one of the most significant consequences of this pathology, the diagnostic issues of which are an urgent problem of medicine. The bone mineral density parameters were analyzed according to the double X-ray absorptiometry data for 452 patients with different stages of CKD and for 50 persons of the comparison group, including the use of a neural network algorithm. A high prevalence of osteoporosis in patients with CKD was established, from 13.8 to 28.2 % in different regions of the skeleton, increasing with the aggravation of the stage of CKD to maximum values in patients with CKD 4, 5 and in transplanted patients. It was shown that PTH is an important, but not the only risk factor for a bone mineral density reduction in patients with CKD. It was justified to perform osteodensitometry in all patients with SHPT against the background of CKD; all patients with end-stage CKD, as well as those who underwent kidney transplantation, regardless of the level of SHPT. Osteodensitometry indicators should be assessed in all regions of the skeleton, Tsc of the lumbar spine and the total hip have a maximum importance.

Ambulatory pulse pressure and its contributors in autosomal dominant polycystic kidney disease.

Pulse pressure (PP) is a pulsatile component of blood pressure (BP), strongly correlated with arterial stiffness (AS) and impacting prognosis. Disproportionally increased PP values in individuals with autosomal dominant polycystic kidney disease (ADPKD) should be expected, given the multifactorial cardiovascular involvement in the natural course of this disease. To investigate ambulatory PP in a group of ADPKD patients, and to examine the impact of age, sex, kidney function, hypertension, circadian rhythm, and antihypertensive drugs (AH) on studied parameters. A total of 130 ADPKD patients (median age 41 years, 35% men) who underwent 24-hour BP measurement with portable oscillometer Spacelabs 90217, were included in the study and their recordings were retrospectively analyzed. Demographic data and the medical history including antihypertensive treatment were collected, ADPKD was diagnosed based on the criteria by Pei et al., and estimated glomerular filtration rate (eGFR) was calculated according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Pulse pressure in the whole group was 46 (IQR: 42-53) mm Hg and it was significantly higher in men than in women and during the day compared to nighttime. There was a negative correlation of PP with eGFR and a positive correlation with age. Pulse pressure was not different in ADPKD patients with or without a diagnosis of hypertension. Ambulatory PP is not substantially increased in ADPKD patients across different stages of CKD. It follows a regular pattern of being increased with age, male sex, daytime, and decreasing eGFR, but not with the diagnosis of hypertension.

MO380: Bio-Conductivity Measurement for Electrical Impedance Tomography (EIT) in Chronic Kidney Disease—A Non-Invasive and Portable Monitoring Approach

Abstract BACKGROUND AND AIMS Chronic kidney disease (CKD) is an escalating global health concern, and non-invasive means for early CKD detection is eagerly awaited. Kidneys are water- and electrolytes-rich organs with good bio-conductivity. Kidney fibrosis and tubular atrophy are characteristic pathological changes in CKD [1], and is associated with restricted blood perfusion, fluid diffusion [2,3] and hence reduced bio-conductivity. Electrical impedance tomography (EIT) emerges as a non-invasive, ionizing radiation-free imaging technique measuring dielectric properties of the body parts [4]. This study investigated the relationship of EIT indices and renal function in patients with various stages of CKD. METHOD We prospectively recruited 98 patients with different stages of CKD (Stage 1, n = 16; Stage 2, n = 15; Stage 3, n = 20, Stage 4, n = 36 and Stage 5, n = 11). EIT measurements were performed at two frequencies (33.6 and 100 kHz) using a portable EIT device with an electrode belt consisting of 16 gel electrodes. EIT data was pre-processed and reconstructed as mean conductivity maps. Frequency differencing was then performed between conductivity maps at two frequencies. Kidney-related dielectric parameters were extracted around the kidney region located at lower one-third of the frequency differencing conductivity map. Conductivity changes between frequencies were then computed and further regressed with individual biometrics. Predicted eGFR values was then computed and compared with the standard eGFR scores to evaluate its effectiveness on classifying CDK stages. RESULTS The detected mean bio-conductivity changes were −3.9, −67.5, −133.5, −212.6 and −294.7 (a.u.) in patients with CKD Stage 1, 2, 3, 4 and 5, respectively (Fig. 1A). Patients with more advanced stages of CKD tend to show more reduction in bio-conductivity, and eGFR correlated positively with reduction in bio-conductivity (R2 = 0.37, P &amp;lt; 0.001) (Fig. 1B). EIT-predicted eGFR (eGFREIT) was further computed by the captured conductivity changes and individual biometrics (Fig. 2). eGFREIT showed significant correlation with eGFR measured by blood tests (R2 = 0.54, P &amp;lt; 0.001). CONCLUSION EIT showed good correlation with renal function changes in CKD patients, and thus holds promise to be developed into a non-invasive and portable device for early CKD detection in both clinical and community settings.

Thyroid Function Abnormalities in Patients with Chronic Kidney Disease

The function of the thyroid gland is one of the most important in the human body as it regulates the majority of the body's physiological actions. The thyroid produces hormones (T3 and T4) that have many actions including metabolism, development, protein synthesis, and the regulation of many other important hormones. There is a lot of interaction between the kidney and thyroid gland during the disease States thyroid hormones have a major role in regulating the glomerular filtration rate through its hormonal actions in normal physiology. But these things are altered in the disease States such as chronic kidney disease. It is a well-known fact that hypothyroidism causes decreased Glomerular filtration rate whereas hyperthyroidism causes increased Glomerular filtration rate leading to renin-angiotensin-aldosterone system activation. In our study we aim to see the prevalence of low T3 syndrome in different stages of CKD which is a state of physiological benefit in preserving the proteins lost through the Kidneys in CKD patients and since CKD is progressed in hyperthyroidism state it is a protective mechanism in restoring the CKD status. Other subclinical hypothyroidism hyperthyroidism. Autoimmune hypothyroidism. Glomerulonephritis are all part of a dynamic endocrine and nephrology sequence. Thorough knowledge of these is required for optimum treatment of thyroid in CKD patients.