Filtration Rate In Patients Research Articles

A new model for estimating glomerular filtration rate in patients with cancer.

e14074 Background: The glomerular filtration rate (GFR) is essential for carboplatin chemotherapy dosing, however, the best method to estimate GFR in patients with cancer is unknown. We identify the most accurate and least biased method. Methods: Data on age, sex, height, weight, serum creatinine, and results for GFR from 51Cr-EDTA excretion measurements (51Cr-EDTA GFR) were obtained from Caucasian patients aged 18 years or older with histologically confirmed cancer diagnoses at the University of Cambridge Hospital NHS Trust, UK. We developed a new multivariable linear model for GFR using statistical regression analysis. 51Cr-EDTA GFR was compared to the estimated GFR (eGFR) from seven published and our new model using an internal validation data set and root-mean-squared-error (RMSE) and median residuals. A comparison of carboplatin dosing accuracy based on an absolute percentage error more than 20% (APE > 20%) was undertaken. Results: Between August 2006 and January 2013 data from 2,471 patients were obtained. The new model improved the eGFR accuracy (RMSE 15.00ml/min (95% CI 14.12-16.00)) compared to all published models. Body surface area (BSA) adjusted CKD-EPI was the most accurate published models for eGFR (RMSE 16.30ml/min (95% CI 15.34-17.38)) for the internal validation set. Importantly, the new model reduced the fraction of patients with a carboplatin dose APE > 20% to 14.17% in contrast to 18.62% for BSA adjusted CKD-EPI and 25.51% for the Cockcroft-Gault model. The results were externally validated. Conclusions: In a large data set, from patients with cancer, a new model improves eGFR and carboplatin dose calculations, when compared to BSA adjusted CKD-EPI, the model we identified as the best published model for determination of eGFR in patients with cancer.

Comparison of Telbivudine and Entecavir therapy on estimates of glomerular filtration rate in patients with hepatitis B virus-related compensated cirrhosis

Objective To compare the impact of Telbivudine (LDT) and Entecavir (ETV) administration on estimates of glomerular filtration rate for anti-viral therapy in patients with hepatitis B virus (HBV)-related compensated cirrhosis by an open, prospective randomized controlled study. Methods Patients with HBV-related compensated cirrhosis at clinic or hospitalized in Shaoxing Municipal Hospital from January 2012 to June 2013 were included. A total of 170 patients were randomly divided into LDT (600 mg/d) or ETV (0.5 mg/d) groups at a ratio of 1∶1 according to the random number table method. All patients were treated for more than 36 months. The LDT group was optimized according to the roadmap.Patients with poor response or resistance in both treatment group were added with Adefovir dipivoxil (ADV) 10 mg/d for optimal treatment. The clinical outcome, creatinine (CR), estimated glomerular filtration rate (eGFR) of patients before and after 36 months of treatment were compared between two groups. All categorical data were analyzed using chi-square test and data accorded with normal distribution were compared by t test. Results After 36 months of treatment, the virological and biochemical responses in LDT group and ETV group were similar. The mean CR levels at month 24 and 36 in LDT group were (74.25±22.98) μmol/L and (70.72±24.75) μmol/L, respectively, which were both lower than baseline level ([83.09±17.68] μmol/L, t=2.811 and 3.145, respectively, both P<0.01). The mean CR levels at month 36 between two groups were statistically different (t=3.431, P=0.001). The mean eGFR levels at month 12, 24 and 36 in LDT group were all significantly lower than that at baseline (t=3.976, 8.297 and 10.629, respectively, all P<0.01). The mean eGFR levels at month 24 and 36 between two groups were statistically different (t=9.684 and 15.019, respectively, both P<0.01). A total of 64 patients including 34 in LDT group and 30 in ETV group had mild nephritic injury at baseline. The mean eGFR in patients with mild nephritic injury at baseline in LDT group at month 12, 24 and 36 were significantly different compared to baseline (t=6.098, 10.191 and 14.378, respectively, all P<0.01). The mean eGFR level at month 36 in ETV group had statistical difference compared to baseline (t=2.058, P<0.05). The mean eGFR levels at months 12, 24 and 36 were all statistical different between two groups (all P<0.01). The mean eGFR levels at month 24 and 36 in the optimized group were superior to ETV group (P<0.01). Conclusions In patients with HBV-related compensated cirrhosis, LDT and ETV treatment have similar clinical efficacy. LDT is more effective in protecting nephritic function than ETV. Key words: HBV related compensated cirrhosis; Estimates of glomerular filtration rate; Telbivudine; Entecavir

Severity Renal Function Detection through Critical Changes Glomerular Filtration Rate in Hemodialysis Patients

Introductions: Hemodialysis is often interpreted incorrectly. People assume that the action is an action that will cure the treatment of hemodialysis patients with renal failure after hemodialysis. The purpose of this study was to determine the ability of critical changes in renal glomerular fi ltration rate in patients with hemodialysis nursing care.Methods: The design is quasi-experimental study carried out 2 times the observation that pre-test and post-test with a retrospective approach. The study population was all patients who underwent hemodialysis with a sample size of 33 respondents. Analysis of the research data using the paired t test.Results: The results of this study indicate that the glomerular fi ltration rate fi xing Hemodialysis towards better able to detect and prevent the severity of renal function as evidenced by the value of P = 0.031 for change 9.18.Conclusion: Hemodialysis fi x glomerular fi ltration rate towards better able to detect and prevent the severity of renal function with the ability to take into account the age and sex and weight stability. All the patients with chronic renal failure in the terminal stage are expected to follow and adhere to regular hemodialysis program with regard stabilization weight, age, and sex in order to avoid the severity of kidney function worse.

Arterial Stiffness Is More Associated with Albuminuria than Decreased Glomerular Filtration Rate in Patients with Type 2 Diabetes Mellitus: The REBOUND Study.

Aim The aim of this study was to evaluate the association between arterial stiffness and albuminuria and glomerular filtration rate (GFR) in patients with type 2 diabetes mellitus. Methods This multicenter cohort study analyzed 2613 patients with type 2 diabetes. Brachial-ankle pulse wave velocity (baPWV) was used as a noninvasive marker of arterial stiffness. Additionally, the patients were categorized into four groups according to their albumin-to-creatinine ratio (ACR, normoalbuminuria versus albuminuria) and estimated GFR (eGFR, <60 mL/min/1.73 m2 versus ≥60 mL/min/1.73 m2). Results A univariate analysis revealed that maximal baPWV was significantly associated with both the ACR (r = 0.297, P < 0.001) and eGFR (r = −0.220, P < 0.001). A multivariate analysis adjusted for significant clinical variables and eGFR showed that baPWV remained significantly correlated with the ACR (r = 0.150, P < 0.001). Also, baPWV was correlated positively with the ACR in patients with an eGFR ≥ 60 mL/min/1.73 m2 (r = 0.146, P < 0.001). However, baPWV was not correlated with eGFR after adjustment for significant clinical variables. Conclusions The present findings indicate that arterial stiffness is more associated with albuminuria than a decrease in GFR in patients with type 2 diabetes mellitus.

Chronic Kidney Diseases and Nanoparticle Therapeutics

Present review article describes main causes of chronic kidney disease a major health problem public health problem round the globe. Disease has multiple etiologies related to sequential pathophysiological stages. It has major concern with chronic changes in renal structure and that severely alter glomerular filtration rate in patients. This article explains CKD biomarkers in brief i.e. serum creatinine, periostin, a matricellular protein discoidin domain receptor 1 (DDR1), a transmembrane collagen receptor of the tyrosine kinase family, Phospholipase D4 (PLD4) renal biomarkers, metabolic biomarkers. The main focus was given on use of nanoparticles for CKD therapeutics. This article describes various metal and metal oxide nanaoparticles, such as cuprous oxide (CONPs), super paramagnetic iron oxide (new SPIO) nanoparticles, silica-coated iron oxide nanoparticle, Vanadium oxide nanoparticles (VONPs, Titanium dioxide and gold, calcifying nanoparticles, colloidal protein-mineral nanoparticles, Liposomal nanoparticles, MITO-Porter, SB-coated NPs, ASc-loaded polymeric nanoparticles, Carbon-coated iron nanocrystal, Nanodiamonds, Sodium-PLGA hybrid nanoparticles, Epidermal growth factor receptor (EGFR)-targeted chitosan (CS) nanoparticles, Photocaged nanoparticles, Mesoporous silica nanoparticles (MSNs Quantum dots (QDs) which are used for drug delivery patients. For successful management of disease progression of diseases, symptoms should analyze by good physician at an eerily stage, by using highly efficacious, sensitive and specific CKD markers. All factors must include knowing the status of disease and chemotherapeutics by using low toxic nanoparticles. Before being used nanoparticles should evaluate in experiment animal models. For future therapeutics metabolomics, kidney transplants and good wound healers are required.

THU-049 - External validation of a new equation predicting glomerular filtration rate in patients with cirrhosis candidates for liver transplantation and impaired renal function

THU-049 - External validation of a new equation predicting glomerular filtration rate in patients with cirrhosis candidates for liver transplantation and impaired renal function

Markers of inflammation in patients with heart failure in association with chronic kidney disease

Aim. Evaluation of markers of systemic inflammation in patients with chronic heart failure in comorbidity with chronic kidney disease.Methods. The study included 188 patients with heart failure and kidney disease including control group (76 patients) with heart failure with preserved renal function aged 38 to 83 years (mean age 66.8±10.1 years), with the duration of heart failure of about 8 years. Quantitative measurement of C-reactive protein and proteins of blood serum and daily excretion of protein with urine were performed.Results. Glomerular filtration rate in patients without renal pathology was 71.1±11.7 ml/min/1.73 m2, and in the group with heart failure associated with kidney dysfunction it was 51.5±19.1 ml/min/1.73 m2. C-reactive protein, γ-globulin, albumin and total serum protein in patients with chronic kidney disease differed from those in patients with heart failure without kidney damage.Conclusion. C-reactive protein and γ-globulin in the serum significantly increase in patients with heart failure and chronic kidney disease and can be used as markers of cardiac as well as renal events.

Serum uromodulin concentrations correlate with glomerular filtration rate in patients with chronic kidney disease.

INTRODUCTION Urinary uromodulin excretion has been associated with kidney diseases. However, serum uromodulin concentrations have not been extensively studied in patients with chronic kidney disease (CKD), and the results of published studies are inconsistent. OBJECTIVES The aims of the study were to evaluate serum uromodulin concentrations in patients with CKD and to assess the utility of serum uromodulin measurements for diagnosing CKD stages. PATIENTS AND METHODS This observational study included 170 patients with CKD stages 1 to 5, not treated by renal replacement therapy, and 30 healthy individuals. The serum levels of creatinine, cystatin C, and uromodulin were measured, and estimated glomerular filtration rate (eGFR) was calculated according to the 2012 CKD Epidemiology Collaboration cystatin‑creatinine equation. RESULTS Among patients with CKD, serum uromodulin concentrations were significantly lower than in controls, and were strongly negatively correlated with renal retention markers (ie, serum creatinine and cystatin C) and strongly positively correlated with eGFR. An inverse, hyperbolic relationship between serum creatinine and uromodulin levels was analogous to the well‑known association between serum creatinine concentrations and eGFR. A receiver‑operating characteristic curve analysis showed a high diagnostic accuracy of the measurement of serum uromodulin concentrations in the assessment of CKD stages. CONCLUSIONS Serum uromodulin concentrations are closely correlated with eGFR, which is the recommended measure of renal function. As uromodulin is produced exclusively by renal tubular cells, the assessment of uromodulin levels in patients with CKD may be an alternative method for evaluating the number of functioning nephrons.

Cystatin C, vascular biomarkers and measured glomerular filtration rate in patients with unresponsive hypertensive phenotype: a pilot study

Background: Biomarkers are commonly used to estimate the presence of subclinical cardiovascular disease (CVD) in patients with essential arterial hypertension (HT). In addition to known association between cystatin C and glomerular filtration rate (GFR), elucidating the association between cystatin C and vascular biomarkers (intima-media thickness of common carotid arteries (CCIMT), carotid plaque and renal artery resistance index (RRI)) in patients with unresponsive hypertensive phenotype could be of significant clinical interest.Methods: Participants (n = 200, median age 58 (52–64) years, 49% female) under treatment with antihypertensive drugs were stratified into two subgroups based on their blood pressure level as having responsive hypertension (RHT – compliant and responsive to treatment, n = 100), or nonresponsive (URHT – compliant but nonresponsive to treatment, n = 100). GFR was measured by isotopic (slope-intercept) method (99m Tc diethylene triamine penta-acetic acid – mGFR).Results: The URHT group had significantly higher median cystatin C serum concentration (p = 0.02) and CCIMT (p = 0.00) compared to the RHT group, with no significant difference in RRI (p = 0.51) and mGFR among subgroups [69.9 ± 28.2 vs 76.74 ± 23.61 ml/min/1.73m2, p = 0.27]. In the URHT group, cystatin C was found to be associated with CCIMT (p = 0.02), hsCRP (p = 0.01) and duration of HT (p = 0.02), independently of mGFR and age. Independent predictors of URHT phenotype were CCIMT (p= 0.02) and hsCRP (p= 0.04).Conclusion: In addition to GFR, cystatin C serum concentration is positively and independently associated with CCIMT in patient with URHT phenotype and subclinical CVD. Prospective larger studies should further investigate the clinical importance of this relationship.

Autosomal Dominant Polycystic Disease is Associated with Depressed Levels of Soluble Tumor Necrosis Factor-Related Apoptosis-Inducing Ligand.

Autosomal dominant polycystic kidney disease (ADPKD) is characterized by multiple, large renal cysts and impaired kidney function. Although the reason for the development of kidney cysts is unknown, ADPKD is associated with cell cycle arrest and abundant apoptosis of renal tubular epithelial cells. We asked whether serum-soluble TNF-related apoptosis-inducing ligand (sTRAIL) might underlie ADPKD. Case-control study. Serum sTRAIL levels were measured in 44 patients with ADPKD and 18 healthy volunteers. The human soluble TRAIL/Apo2L ELISA kit was used for the in vitro quantitative determination of sTRAIL in serum samples. Mean serum sTRAIL levels were lower in patients with ADPKD as compared to the control group (446.9±103.1 and 875.9±349.6 pg/mL, p<0.001). Serum sTRAIL levels did not differ among stages of renal failure in patients with ADPKD. There was no correlation between serum sTRAIL levels and estimated glomerular filtration rate in patients with ADPKD (p>0.05). Our results show that ADPKD patients have depressed sTRAIL levels, indicating apoptosis unrelated to the stage of chronic renal failure.

1470P - Estimation of glomerular filtration rate in patients with abnormal body composition and relation with carboplatin toxicity

1470P - Estimation of glomerular filtration rate in patients with abnormal body composition and relation with carboplatin toxicity

The impact of renal angiomyolipoma on estimated glomerular filtration rate in patients with tuberous sclerosis complex.

BACKGROUNDThere is a growing concern that renal impairment may develop in patients with renal angiomyolipomas (AMLs) associated with tuberous sclerosis complex (TSC) as a consequence of the disease itself and/or the interventions to mitigate the risk of hemorrhage.OBJECTIVETo assess the estimated glomerular filtration rate (eGFR) in patients with bilateral renal AMLs and the impact of tumor burden and intervention on renal function.DESIGNRetrospective study.SETTINGUrology department of a tertiary care hospital.PATIENTS AND METHODSAll adult patients (≥18 years of age) with TSC-associated renal AMLs seen from October 1998 to June 2015. We included only patients with bilateral tumors or solitary kidneys at the last follow-up.MAIN OUTCOME MEASURESThe eGFR, renal volume, and number and type of interventions.RESULTSWe identified 12 patients (median age 27.6, interquartile range 23.7–39.9 years), a median follow-up period of 1266 days (33–3133), and a median renal size of 454.7 mL (interquartile range 344.7–1016.9 on the right side; 558.1 mL, interquartile range 253.7–1001.4 on the left). In 11 (91.7%) patients, the eGFR was >60 mL/min/1.77 m2. Six patients had three total nephrectomies, one had a contralateral partial nephrectomy, and seven had selective arterial embolizations. Intervention was associated with a significantly reduced eGFR. The renal size did not correlate with the eGFR.CONCLUSIONSTSC-associated renal AMLs may attain a large size but normal renal function is maintained in 92% of patients. Interventions to mitigate the risk of hemorrhage are associated with decreased renal function.LIMITATIONSThe renal size was used as a surrogate for tumor size. Other limitations were the limited number of patients and lack of split renal function testing.

LBPS 02–18 SCREENING OF ARTERIAL STIFFNESS IN PATIENTS WITH MILD-TO-MODERATE RENAL IMPAIRMENT AMONG YOUNGER-AGE POPULATION USING PULSE WAVE VELOCITY

Objective: We aimed to study arterial stiffness using pulse wave velocity (PWV) among patients with chronic kidney disease (CKD) stage 2 to 4 and normal renal function in younger-age population. Design and Method: Patients with confirmed CKD stage 2 to 4 were recruited from various clinics from Universiti Teknologi MARA Medical Center, Sungai Buloh, Malaysia from 1st August 2015 until 31st January 2016. Sociodemographic and anthropometric indices were recorded on recruitment. Each patient underwent carotid-femoral (aortic) PWV measurement to determine arterial stiffness. PWV is determined using a one-probe device (SphygmoSore XCEL). Results: 87 patients with CKD stage 2–4 and 87 control patients were recruited. The mean age was 47 + 5.4 years. CKD patients had a higher mean PWV (7.8 m/s + 1.7) than healthy controls (5.6 m/s + 1.0) (p < 0.001, 95% CI −2.59, −1.77). There was significant difference of mean PWV between control (5.6 m/s + 1.0) and CKD stage 2 (7.6 m/s + 1.5) (p < 0.001, 95% CI −2.40, −1.49). Our results showed a stepwise increase in PWV from control subjects, CKD stage 2 through stage 4 (p < 0.001). The mean difference of PWV between CKD stage 2 (7.6 m/s, + 1.5) and stage 4 (9.0 m/s, + 0.8) was 1.43 (p < 0.001, 95% CI −2.50, −0.35). There was significant difference of mean PWV between diabetes mellitus (DM) (8.2 m/s + 1.8) and non-DM (7.3 m/s + 1.3) patients with CKD stage 2–4 (p = 0.022, 95% CI −1.50, −0.12). Mutiple linear regression analysis showed only age (β = 0.078, p = 0.014), mean arterial pressure (MAP) (β = 0.031, p = 0.007) and diuretics usage as the combination antihypertensive medication (β = 0.839, p = 0.018) were independently associated with PWV (r2 = 0.249, p < 0.001). Conclusions: This study shows that arterial stiffness as assessed by PWV occurs early in CKD patient and increased arterial stiffness occurs in parallel with decline of glomerular filtration rate in patients with mild-to-moderate CKD of younger-age population.

Glomerular filtration rate in patients with psoriasis treated with etanercept

ObjectiveTo estimate the prevalence of chronic kidney disease (CKD) and evaluate renal function in patients with moderate-to-severe chronic plaque psoriasis treated with etanercept (an anti-tumour necrosis factor-α drug).MethodsThis retrospective cohort study included patients with moderate-to-severe chronic plaque psoriasis. Kidney function was evaluated using estimated glomerular filtration rate (EGFR).ResultsThe prevalence of CKD at baseline was 3.9% (two of 51 patients). EGFR was unaffected by etanercept therapy (83.6 ± 23.9 at baseline vs 82.2 ± 21.6 ml/min per 1.73 m2 after 6 months).ConclusionEGFR was unaffected by 6 months’ etanercept treatment. Physicians should be aware of the risk of CKD when providing comprehensive care to patients with moderate-to-severe psoriasis.

Abstract PR086

Background & Objectives: To investigate the influence of paravertebral analgesia on renal function in patients with intra-abdominal hypertension after various emergency surgery. Materials & Methods: The work is based on a study of treatment outcomes in 52 patients with generalized peritonitis (mean age 43,2 ± 3,84 years). All the patients were divided into 2 groups. The first (control) group included 24 patients who received postoperative conventional (antibiotics, analgesics, infusion-transfusion therapy, stimulate bowel, etc.) therapy. The second group involved 28 patients whom paravertebral analgesia was included in the complex of intensive therapy at Th-9–10 (1% - 50 mg lidocaine bilaterally (1.2-1.4mg/kg) every 4 hours). The glomerular filtration rate (GFR), filtration gradient (FG), urea and creatinine of blood,hourly urine output, and a verbal pain scale were studied in both groups. Measurement of intra-abdominal pressure (IAP) was performed by the method I. Kron (1984) through the bladder. Results: The analysis showed that both groups against the background of intensive therapy tend to decrease of IAP and improvement in renal function. However, the most prominent and persistent changes were observed in patients 2nd group. In this group, the baseline IAP of 15,7 ± 0,4 mm Hg, after 24 hours, dropped to 8,1 ± 0,4 mm Hg (P <0.05). In day 1 the IAP of first-group patients actually remained unchanged, and only since day 2 the decline had been significant (p <0.05). Glomerular filtration rate in patients with usage of paravertebral analgesia after a day has increased from 76,7 ± 6,4 ml / min to 83,0 ± 4,5 ml / min, reaching 100,5 ± 8,8 ml / min to the end of day 3. Filtration gradient also had a similar picture. At the same time the indications significantly differ from group 1 at all stages of the research. Indicators of blood urea in group 2 patients significantly decreased only on day 3 of the study compared with baseline (6,8 ± 0,7 mmol / l). A similar pattern was observed with serum creatinine levels. No significant changes were observed in patients of group 1. Conclusion: Our studies show that blockade of the sympathetic innervation due to the administering of lidocaine in the paravertebral space leads to a decrease of pain impulses and reduce stress of the abdominal wall and results of reduction intra-abdominal pressure. Moreover renal hyperemia is improved, which obviously leads to an increase in glomerular filtration rate and urine output. Apparently this is due to improvement of renal blood flow, glomerular vazodilatation and reduction tubular reabsorption. However, in order to decrease in blood urea and creatinine more time is needed. Disclosure of Interest: None declared

Reconsidering risk factors for renal dysfunction in lithium-treated patients

ABSTRACT FROM: Clos S, Rauchhaus P, Severn A, et al . Long-term effect of lithium maintenance therapy on estimated glomerular filtration rate in patients with affective disorders: a population-based cohort...

ALBUMINURIA AS A MARKER OF ENDOTHELIAL DYSFUNCTION AND EARLY PREDICTOR OF CARDIOVASCULAR COMPLICATION IN PATIENTS WITH DIABETES MELLITUS

The necessity to identify was grounded and assesses the dynamics of albuminuria and glomerular filtration rate in patients with type 1 and type 2 diabetes (as an early marker of endothelial dysfunction and a predictor of cardiovascular complication) on the background of pathogenetic therapy with glycosaminoglycans sulodexide was done. Clinically significant reduction in the excretion of both total protein and albumin in the urine was found. It indicates an improvement of microcirculation in the kidney along with an increase in glomerular filtration rate. The increase in the glomerular filtration rate is most pronounced in patients with type 2 diabetes with comorbid non-alcoholic fatty liver disease.

The impact of bariatric surgery on estimated glomerular filtration rate in patients with type 2 diabetes: a retrospective cohort study

BackgroundDiabetes mellitus is the most common cause of end-stage renal disease, which is associated with increased morbidity and mortality. The impact of bariatric surgery on chronic kidney disease is unclear. ObjectivesOur primary aim was to assess the impact of bariatric surgery on estimated glomerular filtration rate (eGFR) in type 2 diabetes (T2D) patients. Our secondary aim was to compare the impact of bariatric surgery versus routine care on eGFR in patients with T2D. SettingUniversity Hospital, United Kingdom. MethodsA retrospective cohort analysis of adults with T2D who underwent bariatric surgery at a single center between January 2005 and December 2012. Data regarding eGFR were obtained from electronic patients records. eGFR was calculated using the Modification of Diet in Renal Disease formula. Data regarding patients with T2D who did not undergo bariatric surgery (“routine care”) were obtained from patients attending the diabetes clinic at the same center from 2009 to 2011. ResultsOne hundred sixty-three patients were included (mean age 48.5±8.8 yr; baseline body mass index 50.8±9.1 kg/m2) and were followed for 3.0±2.3 years. Bariatric surgery resulted in an improvement in eGFR (median [interquartile range] 86.0 [73.0−100.0] versus 92.0 [77.0−101.0] mL/min/1.73 m2 for baseline versus follow-up, respectively; P = .003), particularly in patients with baseline eGFR≤60 mL/min/1.73 m2 (48.0 [42.0−57.0] versus 61.0 [55.0−63.0] mL/min/1.73 m2; P = .004). After adjusting for baseline eGFR, glycated hemoglobin (HbA1C), body mass index, age, and gender, bariatric surgery was associated with higher study-end eGFR compared with routine care (B = 7.787; P< .001). ConclusionBariatric surgery results in significant improvements in eGFR in T2D patients, particularly those with an eGFR≤60 mL/min/1.73 m2, while routine care was associated with a decline in eGFR.

Glomerular filtration rate in patients with atrial fibrillation and 1-year outcomes.

We assessed 1-year outcomes in patients with atrial fibrillation enrolled in the EurObservational Research Programme AF General Pilot Registry (EORP-AF), in relation to kidney function, as assessed by glomerular filtration rate (eGFR). In a cohort of 2398 patients (median age 69 years; 61% male), eGFR (ml/min/1.73 m2) calculated using the CKD-EPI formula was ≥80 in 35.1%, 50–79 in 47.2%, 30–49 in 13.9% and <30 in 3.7% of patients. In a logistic regression analysis, eGFR category was an independent predictor of stroke/TIA or death, with elevated odds ratios associated with severe to mild renal impairment, ie. eGFR < 30 ml/min/1.73 m2 [OR 3.641, 95% CI 1.572–8.433, p < 0.0001], 30–49 ml/min/1.73 m2 [OR 3.303, 95% CI 1.740–6.270, p = 0.0026] or 50–79 ml/min/1.73 m2 [OR 2.094, 95% CI 1.194–3.672, p = 0.0003]. The discriminant capability for the risk of death was tested among various eGFR calculation algorithms: the best was the Cockcroft-Gault equation adjusted for BSA, followed by Cockcroft-Gault equation, and CKD-EPI equation, while the worst was the MDRD equation. In conclusion in this prospective observational registry, renal function was a major determinant of adverse outcomes at 1 year, and even mild or moderate renal impairments were associated with an increased risk of stroke/TIA/death.

Irreversible deterioration of estimated glomerular filtration rate in patients with acute myocardial infarction after primary percutaneous coronary intervention.

Contrast-induced nephropathy is a possible complication after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (MI). Deterioration of renal function is reported to be generally reversible. However, renal insufficiency worsens the prognosis for some patients with primary PCI. We evaluated sequential changes in renal function before primary PCI and until the chronic phase. We retrospectively studied 302 patients who had undergone PCI for acute MI. Renal function was evaluated based on estimated glomerular filtration rates (eGFRs) measured at the following four points: before PCI, within 1week after PCI, at discharge from the hospital, and 180-365days after MI. Patients were classified into the preserved eGFR group and the reduced eGFR group according to the median eGFR change from the basal level after PCI. Changes in eGFR in the two groups had significantly different time courses. In the preserved eGFR group, eGFR values during the chronic phase did not differ from the values obtained before PCI. In contrast, eGFRs in the reduced eGFR group did not recover to pre-PCI basal levels, with the median decrease being 10.3mL/min/1.73m2. The eGFR change after PCI was the strongest predictor of eGFR change during the chronic phase. In the reduced eGFR group, incidence of major adverse cardiac events was significantly higher (logrank: p=0.048), and the hazard ratio was 2.28 (95% confidence interval 1.02-5.60). A decline in eGFR after primary PCI for acute MI is not uncommon, and it appears to remain irreversible, even during the chronic phase.