Effect Of Chronic Kidney Disease Research Articles

Mortality in a cohort of primary care patients treated with vitamin K antagonist anticoagulants

Introduction and objectivesThe use of anticoagulants to prevent embolic events in Spain is very high, tending to a progressive increase. For this reason, we intend to analyse the mortality of patients from a metropolitan area of ​​Granada treated with vitamin K antagonist anticoagulants (VKA), over 2 non-consecutive years. Patients and methodsLongitudinal, observational, retrospective study of 205 patients treated with AVK. Sociodemographic data, previous clinical conditions, pathology causing AVK treatment, degree of control and mortality were collected 2 years after the start of the study. ResultsAverage age, 76 ± 11.8 years (57.56% women). Two-year mortality was 22.4%, with a significant increase depending on age (p < .001) and years of treatment (p < .001). Patients with dementia (p < .05), with chronic kidney disease (p < .01) or with chronic obstructive pulmonary disease (p < .01) also presented higher mortality. Multivariate analysis showed significant effect of chronic kidney disease (odds ratio = 4.075), chronic obstructive pulmonary disease (odds ratio = 3.694), and years of treatment (odds ratio = 1.236). ConclusionsAt 2 years of follow-up, 1 in 5 patients treated with VKA died. The presence of chronic kidney disease, chronic obstructive pulmonary disease and a longer treatment time were independently associated with this increase of mortality. Most of the patients were anticoagulated by atrial fibrillation, they were elderly and had a high prevalence of comorbidities.

Chronic kidney disease is associated with increased risk of sudden sensorineural hearing loss and M\xe9ni\xe8re\u2019s disease: a nationwide cohort study

Several studies have demonstrated the harmful effects of chronic kidney disease (CKD) on the audiovestibular system. Through a time-to-event analysis, we aimed to compare the association of CKD with sudden sensorineural hearing loss (SSNHL), and Ménière’s disease against a control population without CKD. We used a total of 1,025,340 patients from the Korean National Health Insurance Service database from 2002 to 2013. The CKD group (n = 2572) included patients diagnosed with CKD more than three times between January 2003 and December 2005. The non-CKD group (n = 5144) consisted of two patients without CKD for every patient with CKD. Each patient was monitored until December 2013. We calculated the incidence, survival rate, and hazards ratio (HR) of SSNHL and Ménière’s disease. In the CKD group, the incidence of SSNHL and Ménière’s disease was 1.39 and 3.64 per 1000 person-years, respectively. Patients with CKD showed an adjusted HR of 2.15 and 1.45 for SSNHL and Ménière’s disease, respectively. Middle-aged patients with CKD were associated with a higher incidence of developing SSNHL and Ménière’s disease than those without CKD. Female patients with CKD had a higher risk of developing SSNHL; however, there was no significant difference in the risk of Ménière’s disease in patients with CKD according to sex. Our findings suggest that CKD is associated with an increased incidence of SSNHL and Ménière’s disease. Therefore, audiovestibular surveillance should be considered in patients with CKD.

Effect of chronic kidney disease on outcomes following proximal humerus fragility fracture surgery in diabetic patients: A nationwide population-based cohort study.

The proximal humerus fracture (PHF) is the third most common fragility fracture. Diabetes mellitus (DM) and chronic kidney disease (CKD) are both risks for fragility fractures; however, the interplay of DM and CKD makes treatment outcomes unpredictable. This study aimed to investigate and compare early and late outcomes following proximal humerus fracture fixation surgery in diabetic patients with different renal function conditions. DM patients receiving PHF fixation surgery during 1998-2013 were recruited from Taiwan's National Health Insurance Research Database. According to their renal function, patients were divided into three study groups: non-chronic kidney disease (CKD), non-dialysis CKD, and dialysis. Outcomes of interest were early and late perioperative outcomes. Early outcomes included in-hospital newly-onset morbidities. Late outcomes included infection, revision, readmission, and all-cause mortality. This study included a total of 10,850 diabetic patients: 2152 had CKD (non-dialysis CKD group), 196 underwent permanent dialysis (dialysis group), and the remaining 8502 did not have CKD (non-CKD group). During a mean follow-up of 5.56 years, the dialysis group showed the highest risk of overall infection, all-cause revision, readmission, and mortality compared to the non-dialysis CKD group and non-CKD group. Furthermore, subgroup analysis showed that CKD patients had a higher risk of surgical infection following PHF surgery than non-CKD patients in cases with a traffic accident or fewer comorbidities (Charlson Comorbidity Index, CCI <3) (P for interaction: 0.086 and 0.096, respectively). Also, CKD patients had an even higher mortality risk after PHF surgery than non-CKD patients, in females, those living in higher urbanization areas, or with more comorbidities (CCI ≥3) (P for interaction: 0.011, 0.057, and 0.069, respectively). CKD was associated with elevated risks for infection, revision, readmission, and mortality after PHF fixation surgery in diabetic patients. These findings should be taken into consideration when caring for diabetic patients.

Effect of chronic kidney disease and sex oncarotid and femoral plaque volume as measured by three-dimensional ultrasound.

Previously, we reported the association between cardiovascular risk factors (CVRFs) and the presence of cardiovascular disease with peripheral atherosclerosis. In this paper, we specifically aimed to investigate the association of chronic kidney disease (CKD) and sex with carotid and femoral plaque volume. 404 patients (median age 64; 57% men) with at least 1 CVRF or established cardiovascular disease where included into the study. 3D ultrasonography evaluated with an automated software was used to measure peripheral plaque volume. Statistical analyses were performed using SPSS Statistic. CKD was diagnosed in 56 patients (13.9%), with most patients in stage 3a. Total atherosclerotic plaque volume was significantly higher in patients with CKD (p < 0.001) compared to those without CKD and in men compared to women in all vascular territories (p < 0.001). Our data show that we need to be even more vigilant about the presence of atherosclerotic plaques and cardiovascular disease in these patients. Already in patients with CKD stage 3a, efficient CVRF reduction and intensive treatment is warranted.

Effect of Experimentally Induced Chronic Kidney disease on Skeletal, Cardiac and Smooth Muscle fibers of albino rat

Abstract Background Chronic kidney disease (CKD), or chronic renal failure (CRF) as it was historically termed, includes all degrees of decreased renal function, starting from mild, and moderate, to severe chronic kidney failure. Skeletal muscle atrophy frequently complicates the course of CKD and is associated with excess morbidity and mortality. Cardiovascular diseases have been reported to be the leading causes of death in CKD patients. Chronic Kidney Disease was also reported to be associated with an increased incidence of acid-related gastrointestinal disorders. Aim of the work The aim of this study was to investigate the effect of chronic kidney disease experimentally induced by gentamicin intramuscular injection on the histological structure of gastrocnemius skeletal muscle, left ventricular cardiac muscle and smooth muscle fibers of lower esophagus. Materials and methods Twenty male adult Wistar albino rats were randomly and equally divided into two groups. Group I (control group) received physiological saline intramuscular injection, once daily for 28 consecutive days, in a dose equivalent to that taken in group II. Group II (Gentamicin-treated group) were given Gentamicin intramuscular injection for induction of CKD. Gentamicin was given as Gentamycin sulfate, 40 mg/ml (Sandoz, Switzerland), once daily, in a dose of 80 mg/kg/day for 28 days to induce CKD. After 28 days of the first injection of gentamicin, rats were anaesthetized and blood samples were collected to measure the level of serum urea and creatinine. The left kidneys, the middle third of left gastrocnemius muscle, the lateral wall of left ventricle (LV) and the gastroesophageal junction of all rats of both groups (I and II) were processed for light microscopic study. The middle third of left gastrocnemius muscle, the lateral wall of left ventricle (LV) were further processed for transmission electron microscopic study. Histomorphometrical and statistical analysis were also done. Results The LM examination revealed moderate obliteration of glomeruli, dilatation in some renal tubules and collapse in others, mainly in distal convoluted tubules, with significant fibrosis of renal parenchyma. Serum urea and creatinine levels were increased significantly. The skeletal muscle fibers of the rats in group II (CKD) showed focal areas of myofibers degeneration with siginificant fibrosis. The cardiac muscle fibers of the rats in the group II (CKD) showed focal areas of cardiomyocytes degeneration and other areas of significantly hypertrophied fibers. The smooth muscle fibers of the lower esophageal sphincter of the rats in group II (CKD) showed no significant structural changes compared with the control group, however, the myenetric plexus showed multiple pyknotic and karyolitic nuclei with vacuolated cytoplasm. In addition, insignificant increase in the amount of collagen fibers was observed in almost all layers. Conclusion CKD produced moderate atrophy of skeletal muscle fibers, significant increase in the cardiomyocyte size and no significant structural effect of smooth muscle fibers of the lower esophageal sphincter.

Effect of Chronic Kidney Disease on Perioperative Mortality and Morbidity After Complex Abdominal Aortic Aneurysm Repair

Preoperative chronic kidney disease (CKD) is associated with worse outcomes after abdominal aortic aneurysm (AAA) repair. However, between complex open and endovascular AAA repair, the effect of CKD on perioperative mortality and morbidity has not yet been defined. We compared the outcomes between strata of CKD severity after complex open and endovascular AAA repair (EVAR).

Reduced humoral response to mRNA SARS-CoV-2 BNT162b2 vaccine in kidney transplant recipients without prior exposure to the virus: No cause for alarm

To the Editor: Results of the study by Grupper et al1Grupper A, Rabinowich L, Schwartz D, et al. Reduced humoral response to mRNA SARS-Cov-2 BNT162b2 vaccine in kidney transplant recipients without prior exposure to the virus. Am J Transplant. Accepted Author Manuscript. 2021. https://doi.org/10.1111/ajt.16615 [Epub ahead of print].Google Scholar should not be surprising, since, as mentioned by the authors, most previous vaccines immunogenicity studies showed less response in transplant recipients (refs. 25–29 in that publication). Cellular immune response to the COVID-19 vaccine may be more important that the humoral immune response as recently described in a preprint publication by Chen et al.2Chen Y, Li P, Ding Y-B, et al. Epidemiological feature, viral shedding, and antibody seroconversion among asymptomatic SARS-CoV-2 carriers and symptomatic/presymptomatic COVID-19 patients. medRxiv. 2020.12.18.20248447. https://doi.org/10.1101/2020.12.18.20248447.Google Scholar Cellular immune response to the COVID-19 vaccine was not assessed in the study by Grupper et al. Only Caucasians were included in the study by Grupper et al, so results may not apply to a racially more diverse population. As the authors stated, controls were not matched to transplant recipients and were significantly younger. Vaccine immunogenicity decreases with age.3Walsh EE Frenck RW Falsey AR et al.Safety and immunogenicity of two RNA-based Covid-19 vaccine candidates.N Engl J Med. 2020; 383: 2439-2450Crossref PubMed Scopus (1428) Google Scholar Several factors may have skewed results in transplant recipients including the following: (1) transplant recipients who responded to the vaccine were more likely to be the recipients of living donors and thus were on dialysis for a shorter duration before transplant (chronic kidney disease impairs vaccines immunogenicity),4Overall immune profile and effect of chronic kidney disease on vaccination schedule.Indian J Nephrol. 2016; 26: S2-S4Google Scholar (2) transplant recipients who had been transplanted within the preceding 3 months are not expected to mount robust vaccine immunity, and (3)transplant recipients who have received rituximab are not expected to mount robust vaccine immunity.5Baker D Roberts CAK Pryce G et al.COVID-19 vaccine-readiness for anti-CD20-depleting therapy in autoimmune diseases.Clin Exp Immunol. 2020; 202: 149-161Crossref PubMed Scopus (141) Google Scholar I do not think this study should alarm the transplant community; neither the transplant recipients, nor their medical providers at a time we need to continue building confidence in the COVID-19 vaccine, while maintaining behavioral measures to reduce the risk of acquiring infection. The author of this manuscript has no conflicts of interest to disclose as described by the American Journal of Transplantation.

Temporal processing, spectral processing, and speech perception in noise abilities among individuals with chronic kidney disease undergoing hemodialysis

Background In the literature, the effect of chronic kidney disease on the peripheral auditory system has been well documented. But studies investigating the effect of chronic kidney disease on speech perception and auditory processing abilities are limited. Aims/objectives The present study investigated the effect of chronic kidney disease on different auditory processing tasks and speech perception in noise among adults. Material and methods A total of 28 adults participated in the study. Group 1 included 14 individuals with chronic kidney disease undergoing hemodialysis, and Group 2 included 14 individuals with no known kidney complications. Amplitude modulation detection threshold, gap detection threshold, spectral ripple discrimination threshold, and speech recognition threshold in noise were measured. Independent samples t-test was carried out to investigate whether mean thresholds are significantly different between groups. Results Results showed poorer gap detection threshold, amplitude modulation detection threshold, spectral ripple discrimination threshold, and speech recognition threshold in noise among individuals with chronic kidney disease compared to individuals with no known kidney complications. Conclusions The present study showed poorer auditory processing and speech perception abilities in individuals with chronic kidney disease.

Effect of Chronic Kidney Disease on Taste Function: A Case Control Study among Nigerian.

Taste dysfunction has been associated with chronic kidney disease (CKD) especially end stage kidney disease (ESKD) and also implicated as one of the predisposing factors for the prevalent malnutrition, muscle wasting and impaired quality of life among patients with CKD. To assess the taste function and determine the pattern of taste dysfunction in patients with CKD attending the University College Hospital, Ibadan. This was a cross sectional, hospital-based case-control study of adult patients with CKD. The control group were age and sex matched without CKD. Interviewer-assisted questionnaires were administered on all participants to obtain clinical information concerning demographics, clinical data on kidney disease and taste dysfunction. The four basic taste modalities namely; sweet, sour, bitter and salt taste senses of the participants were tested with validated "taste strips". There were 100 patients with CKD and 100 healthy controls, age ranges between 19 and 86years (mean ± SD = 46.3 ± 13.9years) and 20 and 85years (mean ± SD = 43.4 ± 14.9years), respectively. There was no statistically significant difference between cases and control gender distribution (p = 0.57). Hypogeusia was found in 27.0% of CKD patients with specific taste modalities dysfunction for salt, sour, sweet and bitter taste of 13.0, 24.0, 13.0 and 17.0%, respectively. The controls only had specific taste modalities dysfunction for salt, sour and bitter taste of 1.0% for each of the taste modalities. The mean total taste scores in the cases and controls were -9.8 ± 3.2 and 13.4 ± 1.5 (p = 0.001), respectively. The mean taste scores were significantly lower among the cases than controls, salt taste-2.82 ± 1.1 and 3.7 ± 0.7 (p = 0.001), sour taste -2.2 ± 1.0 and 3.2 ± 0.7 (p = 0.001), sweet taste-, 2.9 ± 1.8 and 3.8 ± 0.5 (p = 0.001), bitter taste -1.9 ± 1.2 and 2.8 ± 0.9 (p = 0.001). Taste dysfunction is prevalent among patients with CKD and the affectation involves all taste modalities.

Hypothyroidism and Leptin in Iraqi Patients with Chronic Kidney Disease

The present study aims at assessing the effects of chronic kidney disease (CKD) on thyroid hormone and leptin by evaluating the level of: leptin hormone along with thyroid hormone in CKD patients. The study has been conducted on 70 subjects, 50 patients with an age range between 20-50 years (25 males and 25 females) who were diagnosed to have CKD stage-5, and 20 normal controls whose ages ranged between 20-48 years (10 males and 10 females), who attended the Nephrology and Transplant Center in Medical City of Baghdad- Iraq from April 2018 to July 2018. The study showed a highly significant (P&lt;0.01) increase in TSH level in CKD patients in comparison with controls. While T3 and T4 levels observed highly significant decrease (P&lt;0.01) in CKD patients in comparison with their control groups; on the other hand, in Leptin levels, it has been demonstrated a highly significant (P&lt;0.01) increase in CKD patients compared to the controls. Also there was a significant (P&lt;0.05) positive correlation between TSH and Leptin, while the results showed a highly significant (P&lt;0.01) negative correlation between T3, T4 and Leptin. To conclude, this study confirms that thyroid dysfunction and hyperleptinemia have been found to be very common in CKD patients and reveals the significant association between CKD progression and thyroid dysfunction and hyperleptinemia.

Acoustic Characteristics of Voice in Patients with Chronic Kidney Disease.

PurposeTo investigate the multifactorial effects of chronic kidney disease (CKD) and hemodialysis (HD) on subjects’ voices by examining correlations between laboratory investigations, respiratory function, and acoustic voice parameters.MethodsThis case–control study was conducted on 60 participants aged 18−50 years, divided equally into three groups: controls (no health problems or voice disorders), cCKD (stage 3–5, no HD HD]), HD, and CKD stage 5. The study took 21 months. All participants underwent general and otolaryngological examinations, followed by laboratory investigations (hemoglobin, uric acid, HCO3, estimated glomerular filtration rate, urea, urea-reduction ratio, and creatinine), respiratory function tests, and acoustic voice analysis.ResultsThere were significant differences between the control and HD groups for jitter, shimmer, and harmonic:noise (HNR) ratio (P=0 and between the control and CKD groups for shimmer and HNR (P=0), with no significant difference between HD and CKD. There were statistically significant correlations between duration of HD and HNR, jitter percentage, and shimmer percentage (P=0.ConclusionSystemic effects of CKD and HD were found to impair the acoustic characteristics of voice in both groups. Regression analysis revealed that hemoglobin, uric acid, and expiratory time were the most significant predictors of impaired acoustic characteristics.

MO204CHRONIC KIDNEY DISEASE, SLEEPINESS, MILD COGNITIVE IMPAIRMENT AND FINE MOTOR CONTROL

Abstract Background and Aims Chronic kidney disease (CKD) is a systemic condition because it modifies all organs' function due to an imbalance in plasma volume, electrolytes, hormones, and proteins. Indeed, at the nervous system level, mild cognitive impairment (MCI), sleep disorders and depression often accompany CKD. MCI partially explains the low quality of life of CKD patients, comparable to that of metastatic cancer patients. Mild Cognitive Impairment (MCI) has a high prevalence in this cohort (27-62%). Nevertheless, scattered literature data suggest that CKD patients can also have poor motor control, evidenced by a higher risk of falls, postural instability, reduced gait speed. In this cohort, few data are available regarding the motor circuits called central pattern generators, which control physiological tremor. Specifically, uraemic encephalopathy accentuates physiological tremor, which is regulated by central and peripheral oscillators. Overall, subtle changes in motor control often accompany other forms of MCI. Therefore, this study aimed at evaluating the effects of chronic kidney disease on cognitive and motor functions using up-to-date technologies to record physiological tremor and innovative data analysis. Method This retrospective case-control study enrolled 313 patients (139 controls, 79 CKD patients stage III-IV, 35 kidney transplant (Tx), 60 dialysis (HD) patients). These groups were comparable for age and weight. Creatininemia, azotemia, LDL, HDL, hemoglobin, and proteinuria were used for correlative analyses. We evaluated the chronotype using the Morningness-Eveningness Questionnaire (MEQ) and the degree of sleepiness using the Epworth Sleepiness Scale (ESS). Cognitive impairment was assessed by the Montreal Cognitive Assessment test (MoCA). Cognitive domains of the MoCA score were projected onto brain regions using CerebroViz library in R and a new transformation matrix derived from fMRI literature data. UMAP algorithm was used to identify patients' subgroups. The physiological tremor was recorded on patients maintaining the dominant arm extended using the smartphone App Phyphox. The tremor frequency spectrum was extracted by Fourier analysis. Results The sleepiness score (ESS) was significantly increased in HD (ESS = 5±0.4) compared to the healthy controls (ESS= 4±0.41) whereas was not significantly modified in CKD patients (3.24± 0.32). The chronotype was also not significantly different among the various groups. The mean score of the MoCA test was significantly lower in CKD, Tx, and HD groups (CKD MoCA =24.5±0.3; Tx MoCA =25.4±0.6; HD MoCA =24.6±0.7) than controls (MoCA score=28±0.1). A different pattern of impairment in the cognitive domains of MoCA was evidenced in the various groups using the CerebroViz projection and UMAP tools. MoCA score was inversely correlated with proteinuria (Pearson coefficient=-0.47; p&amp;lt;0.05). The higher frequencies of the physiological tremor (11-13 Hz) were significantly more represented in Tx patients compared to controls (p&amp;lt;0.05). Conversely, the lower frequencies (1-4 Hz) were significantly less represented in the HD group compared to controls (p&amp;lt;0.05). The peak frequency was inversely correlated with age in all patients (Pearson coefficient= -0.45; p&amp;lt;0.05) and inversely associated with azotemia levels, particularly in HD patients (Pearson coefficient=0.43; p&amp;lt;0.05). Conclusion Our results suggest that CKD patients present altered cognitive and motor control patterns, linked in part to the proteinuria level, suggesting a pathogenetic role of endothelial dysfunction. The characteristic motor, sleepiness and cognitive patterns of HD patients might be due to the arteriovenous fistula or the other peculiarities of these patients. These results might help identify new early markers of brain dysfunction in these patients, with the possibility of delaying or reversing cognitive decay.

The effect of concomitant chronic kidney disease on the recurrence of atrial fibrillation after catheter ablation: A protocol for systematic review and meta-analysis.

Background:Some new trials have reported the effectiveness of chronic kidney disease on recurrence of atrial fibrillation following catheter ablation. Limited by small number of studies and insufficient outcomes, previous meta-analyses also failed to draw a consistent conclusion on this topic. We thus conducted a new meta-analysis to systematically analyze the effect of chronic kidney disease on recurrence of atrial fibrillation following catheter ablation.Methods:Two independent investigators followed The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines to conduct the present meta-analysis. From the inception to June 2021, the EMBASE, PubMed, Web of Science, and Cochrane Library electronic databases were searched using the key phrases “atrial fibrillation,” “chronic kidney disease,” “catheter ablation,” “renal failure,” “renal function,” “renal insufficiency,” “end-stage renal disease,” and “dialysis” for all relevant English-language trials. Observational or randomized controlled trial focusing on assessing the effectiveness of chronic kidney disease on recurrence of atrial fibrillation following catheter ablation was included. P < .05 was set as the significance level.Results:Our hypothesis was that chronic kidney disease is associated with increased atrial fibrosis and a higher risk of arrhythmia recurrence and that restoration of normal rhythm through catheter ablation is associated with improved kidney function.Registration number:10.17605/OSF.IO/3WJAE.

Exercise training in chronic kidney disease-effects, expectations and adherence.

There is increasing evidence showing the health benefits of physical activity, such as better survival and possibly even a slower decline in kidney function, in people with chronic kidney disease (CKD). There is convincing evidence that exercise training improves physical function measured as aerobic capacity, muscle endurance strength and balance at all ages and all stages of CKD. In fact, long-term adherence to well-designed and adequately monitored exercise training programmes is high. In general, patients express interest in exercise training and are motivated to improve their physical function and health. A growing number of nephrologists regard physical activity and exercise training as beneficial to patients with CKD. However, many feel that they do not have the knowledge to prescribe exercise training and suppose that patients are not interested. Patients state that support from healthcare professionals is crucial to motivate them to participate in exercise training programmes and overcome medical, physical and psychological barriers such as frailty, fatigue, anxiety and fear. Equally important is the provision of funding by healthcare providers to ensure adequate prescription and follow-up by trained exercise physiologists for this important non-pharmacological treatment.

Effect of Chronic Kidney Disease on Outcome of Adult Patient Admitted With Hyperthyroidism: Analysis of the National Inpatient Sample 2016–2017

Introduction: Kidney and thyroid function and dysfunction are interrelated through several mechanisms. Thyroid hormones can also have significant impact on kidney disease so it is important to consider the physiological association of thyroid dysfunction in relation to chronic kidney disease (CKD). Research shows that hyperthyroidism is usually not associated with CKD but is known to accelerate it. We sought to determine the effect of chronic kidney disease on patient admitted with hyperthyroidism. Methods: We queried the National Inpatient Sample (NIS) databases from 2016 to 2017 for adults aged 18 and above with hyperthyroidism as a principle diagnosis with and without hypertriglyceridemia using ICD-10 codes. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders Results: There were over 71 million discharges in the combined 2016 and 2017 NIS database. Out of 17,705 hyperthyroidism hospitalizations, 4% had chronic kidney disease. Chronic kidney disease with hyperthyroidism had a similar odd of inpatient mortality (AOR 0.79, CI 0.34–4.52, P= 0.787) and cardiogenic shock (AOR 2.66, CI 0.35–20.50, P=0.347). There was a statistically significant increase in odds of acute kidney injury (AOR 2.77, CI 1.60- 4.80, P <0.001) in those hospitalized with hyperthyroidism and chronic kidney disease compared to those with hyperthyroidism alone Conclusion: Chronic kidney disease is associated with similar odds of hospital mortality and cardiogenic shock among patients hospitalized for hyperthyroidism with increased odds of acute kidney injury compared to those without hyperthyroidism. It is very important to consider all clinical features and thyroid manifestations in those patients with CKD.

Effect of Chronic Kidney Disease on Outcomes of Adult Patients Admitted With Hyperosmolar Hyperglycemic State: Analysis of National Inpatient Sample

Background: Treatment guidelines have been well established in patients with HHS and a normal renal function. The mainstay of treatment for patients with HHS includes intravenous volume replacement, potassium replacement, and blood glucose correction by administering insulin. However, this treatment protocol cannot be directly applied to a patient with decreased GFR as it increases the risk of hypoglycemic episodes due to decreased insulin clearance along with increasing the risk of hyperkalemia and volume overload. Hence titrating insulin, maintaining euvolemia and normokalemia becomes further challenging in a patient with HHS in the setting of CKD. Although the above-mentioned complications are well described in multiple studies, there is not enough evidence demonstrating the association between the inpatient mortality and secondary outcomes in patients with HHS with and without CKD.Objective: To compare the inpatient mortality and secondary outcomes in patients admitted with HHS with CKD vs without CKD.Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample from 2016 and 2017. About 42 740 hospitalizations who had HHS as primary diagnosis were enrolled and further stratified based on the presence or absence of CKD as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality and secondary outcomes included length of hospital stay, total Hospital charges, Sepsis, Septic Shock, Acute Kidney Injury (AKI), and Acute Respiratory Failure (ARF). Multivariate regression analysis was done to adjust for confounders.Results: Out of the 42 740 hospitalizations with HHS, about 9 545 had CKD. The in-hospital mortality for patients with HHS was 305 overall, out of which 105 patients had Atrial Fibrillation as a secondary diagnosis. Compared with patients without CKD, patients with CKD had similar in-hospital mortality (aOR 0.93, 95% CI 0.48–1.8, p=0.83) when adjusted for patient and hospital characteristics. Patients with HHS and CKD had similar length of hospital stay, total hospital charges, rate of Sepsis, Septic Shock, and ARF in comparison to patients without CKD; however, patients with CKD had higher odds of developing AKI thorough out hospitalization.Conclusion: This study found that patients admitted with HHS and CKD have similar in-hospital mortality when compared to patients without CKD. However, the study group with CKD has higher odds of developing AKI when compared to the group without CKD. Although AKI is common and correctable in HHS, the above-mentioned association is possible due to the judicious IV fluid replacement in an HHS patient with CKD as a concern for volume overload. Further studies are needed to identify contributing risk factors and establishing fluid replacement guidelines in a patient with HHS and CKD.

Pregnancy outcomes in women with chronic kidney disease and chronic hypertension: a National cohort study

Maternal chronic kidney disease and chronic hypertension have been linked with adverse pregnancy outcomes. We aimed to examine the association between these conditions and adverse pregnancy outcomes over the last 3 decades. We conducted this national cohort study to assess the association between maternal chronic disease (CH, CKD or both conditions) and adverse pregnancy outcomes with an emphasis on the effect of parity, maternal age, and BMI on these associations over the last three decades. We further investigated whether different subtypes of CKD had differing effects. We used data from the Swedish Medical Birth Register, including 2,788,490 singleton births between 1982 and 2012. Women with chronic kidney disease and chronic hypertension were identified from the Medical Birth Register and National Patient Register. Logistic regression models were performed to assess the associations between maternal chronic disease (chronic hypertension, chronic kidney disease, or both conditions) and pregnancy outcomes, including preeclampsia, in-labor and prelabor cesarean delivery, preterm birth, small for gestational age, and stillbirth. During the 30-year study period, 22,397 babies (0.8%) were born to women with chronic kidney disease, 13,279 (0.48%) to women with chronic hypertension and 1079 (0.04%) to women with both conditions. Associations with chronic hypertension were strongest for preeclampsia (adjusted odds ratio, 4.57; 95% confidence interval, 4.33-4.84) and stillbirth (adjusted odds ratio, 1.65; 95% confidence interval, 1.35-2.03) and weakest for spontaneous preterm birth (adjusted odds ratio, 1.07; 95% confidence interval, 0.96-1.20). The effect of chronic kidney disease varied from (adjusted odds ratio, 2.05; 95% confidence interval, 1.92-2.19) for indicated preterm birth to no effect for stillbirth (adjusted odds ratio, 1.16; 95% confidence interval, 0.95-1.43). Women with both conditions had the strongest associations for in-labor cesarean delivery (adjusted odds ratio, 1.86; 95% confidence interval, 1.49-2.32), prelabor cesarean delivery (adjusted odds ratio, 2.68; 95% confidence interval, 2.18-3.28), indicated preterm birth (adjusted odds ratio, 9.09; 95% confidence interval, 7.61-10.7), and small for gestational age (adjusted odds ratio, 4.52; 95% confidence interval, 3.68-5.57). The results remained constant over the last 3 decades. Stratified analyses of the associations by parity, maternal age, and body mass index showed that adverse outcomes remained independently higher in women with these conditions, with worse outcomes in multiparous women. All chronic kidney disease subtypes were associated with higher odds of preeclampsia, in-labor cesarean delivery, and medically indicated preterm birth. Different subtypes of chronic kidney disease had differing risks; strongest associations of preeclampsia (adjusted odds ratio, 3.98; 95% confidence interval, 2.98-5.31) and stillbirth (adjusted odds ratio, 2.73; 95% confidence interval, 1.13-6.59) were observed in women with congenital kidney disease, whereas women with diabetic nephropathy had the most pronounced increase odds of in-labor cesarean delivery (adjusted odds ratio, 3.54; 95% confidence interval, 2.06-6.09), prelabor cesarean delivery (adjusted odds ratio, 7.50; 95% confidence interval, 4.74-11.9), and small for gestational age (adjusted odds ratio, 4.50; 95% confidence interval, 2.92-6.94). In addition, women with renovascular disease had the highest increased risk of preterm birth in both spontaneous preterm birth (adjusted odds ratio, 3.01; 95% confidence interval, 1.57-5.76) and indicated preterm birth (adjusted odds ratio, 8.09; 95% confidence interval, 5.73-11.4). Women with chronic hypertension, chronic kidney disease, or both conditions are at an increased risk of adverse pregnancy outcomes which were independent of maternal age, body mass index, and parity. Multidisciplinary management should be provided with intensive clinical follow-up to support these women during pregnancy, particularly multiparous women. Further research is needed to evaluate the effect of disease severity on adverse pregnancy outcomes.

Assessment of erectile function among patients with chronic kidney disease : A case–control study

Objective: The aim was to assess the effect of chronic kidney disease (CKD) on erectile function.Patients and Methods: This study included 40 patients on hemodialysis (HD), 40 patients on medical treatment [predialysis (PD)], and 20 controls. They were assessed using international index of erectile function questionnaire andlaboratory investigations (blood urea, serum creatinine, and both total and free testosterone).Results: The mean age in HD patients was 42.20±5.08 years, in PD patients was 43.83±6.59 years,and in control group, it was 42.10±5.66 years, with no significant difference among the three groups (P=0.383). Overall, 10% of HD patients had severe degree of erectile dysfunction (ED) in comparison with only 2.5% of PD patients, with no patient experiencing severe ED in the control group. There was a significant difference among the three groups regarding the grade of ED (P 0.05).Conclusion: CKD has deleterious effect on erectile function which was more severe in patients on HD than those on medical treatment. Free testosterone level was significantly reduced in patients with CKD. There was a relationship between age of HD patients and severity of ED. No relationships were found between severity of ED and disease duration, serum testosterone level (total and free), blood urea, and serum creatinine in patients with CKD.

Effects of chronic kidney disease and declining renal function on coronary atherosclerotic plaque progression: a PARADIGM substudy

To investigate the change in atherosclerotic plaque volume in patients with chronic kidney disease (CKD) and declining renal function, using coronary computed tomography angiography (CCTA). In total, 891 participants with analysable serial CCTA and available glomerular filtration rate (GFR, derived using Cockcroft-Gault formulae) at baseline (CCTA 1) and follow-up (CCTA 2) were included. CKD was defined as GFR <60 mL/min/1.73 m2. Declining renal function was defined as ≥10% drop in GFR from the baseline. Quantitative assessment of plaque volume and composition were performed on both scans. There were 203 participants with CKD and 688 without CKD. CKD was associated with higher baseline total plaque volume, but similar plaque progression, measured by crude (57.5 ± 3.4 vs. 65.9 ± 7.7 mm3/year, P = 0.28) or annualized (17.3 ± 1.0 vs. 19.9 ± 2.0 mm3/year, P = 0.25) change in total plaque volume. There were 709 participants with stable GFR and 182 with declining GFR. Declining renal function was independently associated with plaque progression, with higher crude (54.1 ± 3.2 vs. 80.2 ± 9.0 mm3/year, P < 0.01) or annualized (16.4 ± 0.9 vs. 23.9 ± 2.6 mm3/year, P < 0.01) increase in total plaque volume. In CKD, plaque progression was driven by calcified plaques whereas in patients with declining renal function, it was driven by non-calcified plaques. Decline in renal function was associated with more rapid plaque progression, whereas the presence of CKD was not.

Factors associated with the frequency of antihypertensive drug adjustments in chronic kidney disease patients: a multicentre, 2-year retrospective study.

Background Optimum antihypertensive drug effect in chronic kidney disease is important to mitigate disease progression. As frequent adjustments to antihypertensive drugs might lead to problems that may affect their effectiveness, the modifiable factors leading to frequent adjustments of antihypertensive drugs should be identified and addressed. Objective This study aims to identify the factors associated with frequent adjustments to antihypertensive drugs among chronic kidney disease patients receiving routine nephrology care. Setting Nephrology clinics at two Malaysian tertiary hospitals. Method This multi-centre, retrospective cohort study included adult patients under chronic kidney disease clinic follow-up. Demographic data, clinical information, laboratory data and medication characteristics from 2018 to 2020 were collected. Multiple logistic regression was used to identify the factors associated with frequent adjustments to antihypertensive drugs (≥ 1 per year). Main outcome measure Frequent adjustments to antihypertensive drugs. Results From 671 patients included in the study, 219 (32.6%) had frequent adjustments to antihypertensive drugs. Frequent adjustment to antihypertensive drugs was more likely to occur with follow-ups in multiple institutions (adjusted Odds Ratio [aOR] 1.244, 95% confidence interval [CI] 1.012, 1.530), use of traditional/complementary medicine (aOR 2.058, 95% CI 1.058, 4.001), poor medication adherence (aOR 1.563, 95% CI 1.037, 2.357), change in estimated glomerular filtration rate (aOR 0.970, 95% CI 0.951, 0.990), and albuminuria categories A2 (aOR 2.173, 95% CI 1.311, 3.603) and A3 (aOR 2.117, 95% CI 1.349, 3.322), after controlling for confounding factors. Conclusion This work highlights the importance of close monitoring of patients requiring initial adjustments to antihypertensive drugs. Antihypertensive drug adjustments may indicate events that could contribute to poorer outcomes in the future.