Glomerular Filtration Rate In Group Research Articles

Elevated urinary angiotensinogen excretion links central and renal hemodynamic alterations

Inappropriate activation of intrarenal renin–angiotensin system (RAS) may contribute to the pathogenesis of cardio-renal syndrome (CRS). We aimed to examine the cross-sectional associations of urinary angiotensinogen (AGT) excretion, a biomarker of intrarenal RAS activity, with central (aortic) and renal hemodynamic parameters in middle-aged and older adults, including patients with chronic kidney disease. Aortic and renal hemodynamic parameters were measured using applanation tonometry and duplex ultrasonography in 282 participants. Urinary AGT, liver-type fatty acid-binding protein (L-FABP), and plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were measured for each participant. Multiple linear regression analyses demonstrated that urinary AGT levels were associated with aortic blood pressures, pulsatile measures of renal blood flow, plasma NT-proBNP and urinary L-FABP levels after adjusting for potential covariates, including age, sex, body mass index, estimated glomerular filtration rate (GFR), and medication use. Additionally, when classified based on GFR stages and urinary AGT levels, plasma NT-proBNP and urinary L-FABP levels increased in participants with lower GFR and higher AGT groups. Our findings suggest that urinary AGT excretion is a shared determinant of central (aortic) and renal hemodynamics in middle-aged and older adults, providing clinical evidence for the potential role of intrarenal RAS activity in the development of CRS.

Time-Dependent Changes of Klotho and FGF-23 Levels after Kidney Transplantation: Role of Cold Ischemia Time, Renal Function and Graft Inflammation.

We investigated the evolution of serum klotho (s-Kl) and FGF-23 during the first two years post-kidney transplantation (KT), considering the cold ischemia time (CIT), glomerular filtration rate (GFR) and graft subclinical inflammation (SCI). We undertook a prospective, cohort, multicenter study of consecutive patients between April 2018 and January 2021 (with follow-up at 24 months). Subgroups were analyzed according to the median CIT (<14 vs. ≥14 h), the median GFR (≤40 vs. >40 mL/min/1.73 m2) and the presence of SCI at month 3. A total of 147 patients were included. s-Kl and fibroblast growth factor-23 (FGF-23) levels were measured at baseline and at months 3, 12 and 24. Graft biopsies (n = 96) were performed at month 3. All patients had low s-Kl levels at month 3. Patients with CIT < 14 h exhibited a significant increase in s-Kl at month 24. In patients with CIT ≥ 14 h, s-Kl at month 3 fell and lower s-Kl levels were seen at month 24. Patients with a GFR > 40 had a lesser decrease in s-Kl at month 3. FGF-23 fell significantly at months 3 and 12 in both GFR groups, a reduction maintained during follow-up. There were significant inter-group differences in s-Kl from months 3 to 24. CIT, GFR at 3 months and SCI were significantly associated with s-KI at month 3. A reduction in s-Kl at month 3 post-KT could be explained by longer CIT and delayed graft function as well as by impaired graft function. Early SCI may regulate s-Kl increase post-KT.

The prognostic value of kidney failure based on glomerular filtration rate in predicting long in-hospital outcomes in patients with unstable angina

Objectives: Numerous recent studies have emphasized the role of kidney failure in developing ischemic heart disease (IHD) and the resulting adverse consequences. The purpose of the present study was to quantitatively assess the effect of kidney failure based on glomerular filtration rate (GFR) in predicting clinical outcomes in patients with unstable angina (U/A).&#x0D; Methods: This retrospective cohort study included 129 patients with unstable angina with preserved left ventricular function. Serum creatinine levels were specified at the beginning of their admission. The GFR at admission time was determined based on the MDRD index. Based on the GFR value, patients were classified into two groups, i.e., normal GFR (&gt;60) and decreased GFR (&lt;60).&#x0D; Results: The frequency of one-month mortality in &lt;60 GFR and &gt;60 GFR was 3.2% and 0.0%, respectively. Furthermore, the prevalence of 6-month mortality in &lt;60 GFR and &gt;60 GFR was 8.1% and 0.0%, respectively. The frequency of readmission in &lt;60 GFR and &gt;60 GFR was 29% and 11%, respectively. Likewise, the frequency of revascularization through coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) in &lt;60 GFR and &gt;60 GFR was 25.8% and 8.9%, respectively. According to the multivariate logistic regression model, &lt;60 GFR increased the risk of 6-month mortality up to 0.2 times (probability ratio of 2.081, P-value of 0.023). Regarding readmission, &lt;60 GFR increased the need for readmission up to 2.4 times (probability ratio of 2.433, P-value of 0.049). On the other hand, the risk of CABG or PCI recurrence following initial intervention was 2.8 times higher in patients with &lt;60 GFR than in the &gt;60 GFR group (probability ratio 2.882, p-value .03.&#x0D; Conclusions: The study revealed that &lt;60 GFR compared to higher values ​​of GFR is associated with an increased risk of 6-month mortality, increased readmission, and increased revascularization in patients with unstable angina.

Retrospective Analysis of Hospitalized Patients with Type 2 Diabetes Mellitus Treated with Glucagon-Like Peptide 1 Receptor Agonist Therapy.

The use and overall benefit of glucagon-like peptide-1 (GLP-1) receptor agonist therapy for hospitalized patients with type 2 diabetes mellitus (DM) with chronic kidney disease (CKD) has limited data regarding impact and safety. We studied the impact and safety of GLP-1 receptor agonist therapy in hospitalized DM patients with CKD. Retrospective study of 51 patients using either dulaglutide (n = 3) or liraglutide (n = 48). Glomerular filtration rate (GFR) groups of stages 3 to 5 and 1 and 2 were compared. The primary outcome was total amount of insulin within the last 24 hours in the hospital. The secondary outcomes were glucose management and safety. Mean insulin total amount within the last 24 hours in the hospital significantly differed (P = 0.01) between the GFR groups, with the GFR stages 3 to 5 group (mean 0.5, standard deviation 0.36) having a lower mean insulin level than the GFR stages 1 and 2 group (mean 0.8, standard deviation 0.45). Point-of-care glucose reached the target of 140 to 180 mg/dL within the last 24 hours in hospital, with increased odds for the GFR stages 3 to 5 group as compared with the GFR stages 1 and 2 group (odds ratio 4.08, 95% confidence interval 1.05-15.83, P = 0.04). For both GFR groups, there were minimal adverse events. Almost all of them continued GLP-1 receptor agonist therapy at discharge (94.1%). The use of GLP-1 receptor agonist therapy had better outcomes in patients with GFR stages 3 to 5 as compared with GFR stages 1 and 2. There were minimal adverse events reported for both GFR groups. This study suggests that the off-label use of GLP-1 receptor agonists for hospitalized DM patients with CKD may be useful.

The Influence of Renal Function on In-Hospital Complications in Patients with ST-Elevation Myocardial Infarction

Abstract Objective The goal of this study was to examine in-hospital complications in patients with acute ST-elevation myocardial infarction with a different renal function. Methods 351 patients were included in the study. Percutaneous coronary intervention was performed on all patients. 116 had a glomerular filtration rate &lt; 60 ml/min/1.73 m2 (Group 1), 120 ≥ 60 ml/min/1.73 m2 and &lt; 90 ml/min/1.73 m2 (Group 2) and 115 ≥ 90 ml/min/1.73 m2 (Group 3). Other parameters in the groups were comparable. The composite rate of acute pulmonary oedema and cardiogenic shock, in-hospital pneumonia, pulseless ventricular tachycardia or ventricular fibrillation, new-onset atrial fibrillation or atrial flutter, and in-hospital death were all compared among study groups. Results Mean glomerular filtration rate in Group 1 was 48.2±10.4; in Group 2, 74.7±8.7; and in Group 3, 104.1±14.6 (p &lt; 0.001). The incidence of atrial fibrillation or atrial flutter was higher in Group 1 than in Groups 2 and 3: 12.1%, 5.8%, and 3.5%, respectively (p &lt; 0.05). Group 3 had significantly lower rates of acute pulmonary oedema and cardiogenic shock than Groups 1 and 2: 10.3%, 5.8%, and 0.9%, respectively (p &lt; 0.05). There was also a significant difference between groups when comparing the rate of in-hospital pneumonia: Group 1 had reasonably higher rates of in-hospital pneumonia than Group 2 and Group 3: 13.8%, 6.7%, and 4.3% (p &lt; 0.05), respectively. The authors discovered no significant differences in additional complications: pulseless ventricular tachycardia or ventricular fibrillation occurred in 2.6%, 3.3%, and 0.9%, respectively (p &gt; 0.05). in-hospital death was 3.4% in Group 1; 0.8% in Group 2: and 0 in Group 3, (p &gt; 0.05). Conclusion Patients with lower glomerular filtration rate were more likely to develop in-hospital acute pulmonary oedema and cardiogenic shock, pneumonia, and new-onset atrial fibrillation or atrial flutter in ST-elevation myocardial infarction.

Prevalence and co-incidence of geriatric syndromes according to glomerular filtration rate in older patients.

Geriatric syndromes are complex clinical manifestations and significant causes of mortality and morbidity. This study was aimed to determine the frequency and co-incidence of geriatric syndromes in older patients with chronic kidney disease (CKD). Older patients were included in this cross-sectional retrospective study. All patients were questioned in terms of geriatric syndromes including dementia, polypharmacy, malnutrition, frailty, probable sarcopenia, urinary incontinence, falls, fear of falling, depression, insomnia, and excessive daytime sleepiness. Geriatric syndromes were evaluated according to Glomerular Filtration Rate (GFR) ≥ 60ml/min/1.73 m2, 30-59ml/min/1.73 m2 and < 30ml/min/1.73 m2. Of the 1320 patients included, the mean age was 79.6 ± 7.8 and 929 (70%) were female. GFR groups ≥ 60ml/min/1.73 m2, 30-59ml/min/1.73 m2, and < 30ml/min/1.73 m2 comprised of 55%, 38%, and 7% patients, respectively. The rate of ≥ 3 syndromes in the same person was 66.4% in the group with GFR ≥ 60ml/min/1.73 m2. After age and sex adjusted; it was observed that frailty was 2.5 times, probable sarcopenia 2.4 times, and malnutrition 2.7 times more in those with GFR 30-59ml/min/1.73 m2 compared to those with GFR ≥ 60ml/min/1.73 m2 (p < 0.05). Dementia 1.4, frailty 1.55, polypharmacy 2.0, and urinary incontinence were 1.6 times more common in those with a GFR < 30ml/min/1.73 m2 (p < 0.05). Each of the geriatric syndromes and their co-incidence are high in older CKD patients. Geriatricians and nephrologists should be aware of geriatric syndromes in older CKD patients, and they should cooperate for the management of these patients.

Development and external validation of a nomogram for predicting renal function based on preoperative data from in-hospital patients with simple renal cysts.

ObjectiveTo develop and validate a nomogram for predicting renal dysfunction in patients with simple renal cysts (SRCs).MethodsWe performed a multivariable logistic regression analysis of an in-hospital retrospective cohort of patients with SRCs in the Urology Department of the First Affiliated Hospital of Anhui Medical University. For prognostic model development, 386 patients with SRCs were enrolled from January 2016 to December 2018. External validation was performed in 46 patients with SRCs from January 2019 to April 2019. The primary outcome was renal dysfunction.ResultsPatients were divided into normal or abnormal estimated glomerular filtration rate groups (293 vs. 93) based on the cut-off value of 90 mL/minute/1.73 m2. Logistical regression analysis determined that age, haemoglobin, globulin, and creatinine might be associated with renal dysfunction, and a novel nomogram was established. Calibration curves showed that the true prediction rate was 77.42%, and decision curve analysis revealed that the nomogram was more effective with threshold probabilities ranging from 0.1 to 0.8. The area under the curves were 0.829, 0.752, and 0.888 in the overall training, internal, and external validation cohorts, respectively.ConclusionsWe established a nomogram to predict the probability of developing renal dysfunction in patients with SRCs.

Abstract 11367: Chronic Kidney Disease and 6-12 Month Outcomes After Transcatheter Aortic Valve Replacement

Introduction: Chronic kidney disease (CKD) is known to accelerate the progression of aortic stenosis (AS) and portends adverse outcomes in patients treated with surgical valve replacement. Long-term outcomes in CKD patients after transcatheter aortic valve replacement (TAVR) have been less studied. The purpose of this study is to examine outcomes after TAVR in CKD patients as stratified by glomerular filtration rate (GFR). Hypothesis: CKD is associated with poorer outcomes after TAVR. Methods: Retrospective electronic medical record review from March 2018-June 2020 at the University of Illinois, Chicago and Jesse Brown Veteran’s Administration Medical Center (Chicago, Illinois) identified TAVR patients, who were included if they followed-up within 6 and 12 months of procedure. Patients were stratified into 4 classes by baseline GFR (mL/min): &gt;90, 60-89, 30-59, &lt;30 with the latter 3 groups comprising CKD patients. Outcomes were expressed as event rates and included 6 and 12-month MACE (all-cause mortality, MI, or CVA) and 30-day rehospitalization. Chi-square analysis was used to compare differences across GFR groups. Results: 118 patients (age 76±10 years, 79% male, 46% white) followed up at 6-months and 112 did so at 12-months. There were no statistically significant differences in baseline demographics or comorbidities between CKD and non-CKD patients. CKD patients were more likely to experience MACE compared to non-CKD patients at 6 (p=0.04) and 12-months (p=0.009, Fig. 1). CKD patients also had a higher rate of 30-day rehospitalization (p=0.003). Conclusion: Our results demonstrate that CKD portends adverse outcomes after TAVR with CKD patients experiencing an increased risk of 6 + 12-month MACE and 30-day re-hospitalization. Decreasing GFR correlated with higher rates of MACE at 6 and 12 months.

Ticagrelor or prasugrel in patients with acute coronary syndrome in relation to glomerular filtration rate

Abstract Objectives The aim of this study was to assess the safety and efficacy of ticagrelor versus prasugrel for patients with acute coronary syndrome (ACS) according to their glomerular filtration rate (GFR). Background The outcomes of ticagrelor versus prasugrel in patients with ACS according to GFR have not been defined. Methods Patients (n=3985) with GFR available were categorized in three groups according to the tertiles of GFR. The primary endpoint was a composite of all-cause death, myocardial infarction and stroke at 1 year. Results The primary endpoint occurred significantly more often in patients with low GFR compared to high GFR as well as in patients with low GFR compared to intermediate GFR (picture 1). Patients in the lowest GFR group had significantly higher ischemic and bleeding risks than patients in the intermediate (hazard ratio [HR] 1.93 and 1.68) or high GFR groups (HR 3.52 and 2.96). In the group with low GFR, the primary endpoint occurred in 103 of 677 ticagrelor patients (15.4%) and in 72 of 652 prasugrel patients (11.2%; (HR=1.45, [1.07–1.96], p=.016, picture 2). In addition, each single component of the primary endpoint and stent thrombosis were numerically lower with prasugrel compared with ticagrelor. Occurrence of myocardial infarction was 3.7% with prasugrel compared to 6.6% with ticagrelor (p=0.019). BARC 3–5 bleeding events were similar with ticagrelor and prasugrel (8.8% versus 7.1%, p=0.278). In the intermediate and high GFR group the primary endpoint and bleeding events were similar between prasugrel and ticagrelor. Conclusions The incidence of a composite endpoint (all-cause death, myocardial infarction or stroke) occurred less frequently in patients who received prasugrel compared to patients who received ticagrelor in the low GFR population, whereas rate of bleeding events was similar. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Supported by a grant (FKZ 81X1600501) from the German Center for Cardiovascular Research and the Deutsches Herzzentrum München, Germany. Primary endpoint according to GFRLow GFR: Prasugrel versus Ticagrelor

Analysis of Glomerular Filtration Rate in Ischemic Cerebrovascular Diseases under the Magnetic Resonance Angiography Image Segmentation Algorithm

In order to discuss the segmentation effect of the magnetic resonance angiography (MRA) image segmentation algorithm based on the fuzzy clustering algorithm and DR-CV model and the prognostic value of glomerular filtration rate (GFR) in the ischemic cerebrovascular disease (ICVD), a total of 178 patients who were admitted to the hospital and received MRA due to ICVD were selected as the research objects of this study. Blood vessel segmentation was performed on the MRA image by fuzzy clustering algorithm and DR-CV model, and all patients were divided into a control group (group A), a single-vessel stenosis group (group B), a two-vessel stenosis group (group C), and a multiple-vessel stenosis group (group D). The GFR was estimated by using the dietary modification equation for kidney disease, and the correlation between GFR and the severity of arterial stenosis in patients with ICVD was analyzed. It was found that the results of the Dice similarity index (DSI) of the MRA image blood vessel segmentation algorithm based on the fuzzy clustering algorithm and the integrated model of boundary and regional information (DR-CV model) were all above 85%. The age and GFR values of the four groups of patients were significantly different ( P &lt; 0.05). The proportions of patients in groups C and D in the group with low DFR were significantly different from those in groups A and B ( P &lt; 0.01); the proportions of patients in groups A and B in the high-level GFR group had extremely significant differences compared with group D ( P &lt; 0.01). Age, GFR, total cholesterol (TC), and high-density lipoprotein-C (HDL-C) were correlated with the degree of arterial stenosis ( P &lt; 0.05). It showed that the segmentation effect of MRA image blood vessel segmentation algorithm based on the fuzzy clustering algorithm and DR-CV model was better, and the GFR level can be used as an independent risk factor for the ICVD.

Lanthionine, a Novel Uremic Toxin, in the Vascular Calcification of Chronic Kidney Disease: The Role of Proinflammatory Cytokines.

Vascular calcification (VC) is a risk factor for cardiovascular events and mortality in chronic kidney disease (CKD). Several components influence the occurrence of VC, among which inflammation. A novel uremic toxin, lanthionine, was shown to increase intracellular calcium in endothelial cells and may have a role in VC. A group of CKD patients was selected and divided into patients with a glomerular filtration rate (GFR) of <45 mL/min/1.73 m2 and ≥45 mL/min/1.73 m2. Total Calcium Score (TCS), based on the Agatston score, was assessed as circulating lanthionine and a panel of different cytokines. A hemodialysis patient group was also considered. Lanthionine was elevated in CKD patients, and levels increased significantly in hemodialysis patients with respect to the two CKD groups; in addition, lanthionine increased along with the increase in TCS, starting from one up to three. Interleukin IL-6, IL-8, and Eotaxin were significantly increased in patients with GFR < 45 mL/min/1.73 m2 with respect to those with GFR ≥ 45 mL/min/1.73 m2. IL-1b, IL-7, IL-8, IL-12, Eotaxin, and VEGF increased in calcified patients with respect to the non-calcified. IL-8 and Eotaxin were elevated both in the low GFR group and in the calcified group. We propose that lanthionine, but also IL-8 and Eotaxin, in particular, are a key feature of VC of CKD, with possible marker significance.

Relationship between periodontitis and glomerular filtration rate in non-diabetic Chinese elderly patients in Beijing community

Objective: To investigate the correlation between clinical periodontal indexes of periodontitis and glomerular filtration rate (GFR) in a non-diabetic elderly population in four communities of Shijingshan, Beijing. Methods: This was a cross-sectional study. Questionnaires, blood biochemical examinations, and periodontal indexes were conducted in elderly people (35 to 84 years old) in four communities of Shijingshan, Beijing between May and July 2005. Non-diabetic patients with fasting blood glucose<6.1 mmol/L, postprandial blood glucose<7.8 mmol/L, and ≥ 10 remaining teeth were included. Patients with diabetes, fasting blood glucose ≥6.1 mmol/L or postprandial blood glucose ≥7.8 mmol/L, and total residual teeth less than 10 were excluded. A total of 362 study subjects met the inclusion criteria. The survey subjects were selected by convenient sampling method. The mean full-mouth probing depth (PD), bleeding index (BI), attachment loss (AL), and plaque index (PLI), as well as PD≥4 mm% (the number of sites with PD≥4 mm as a percentage of the total number of sites in full mouth), PD≥5 mm%, PD≥6 mm%, AL≥3 mm%, AL≥4 mm%, AL≥5 mm% and AL≥6 mm% were used for the analysis. Serum creatinine values was used to calculate GFR. GFR≥90 ml/(min·1.73 m2) was defined as normal group and GFR<90 ml/(min·1.73 m2) was defined as reduced group. Univariate analysis was conducted between two groups. Multivariate regression analysis was performed with GFR as dependent variable and adjusted for risk factors such as age, sex, smoking, waist-hip ratio and physical activity. Results: There were 164 subjects in the normal GFR group (45.3%) and 198 in the reduced GFR group (54.7%). Percentage of males in the reduced GFR group, 118 in total, accounting for 59.6%, were significantly higher than in the normal GFR group (73, 44.5%)(P=0.004). The median of age, uric acid, triglyceride, and waist-to-hip ratio (65 years, 323 mmol/L, 1.73 mmol/L, 0.90) were significantly higher in the reduced GFR group than in the normal GFR group (54 years, 277 mmol/L, 1.45 mmol/L, 0.88) (P<0.05). The median of PD mean, AL mean, BI mean, PD≥4 mm%, AL≥3 mm%, and AL≥4 mm% in the reduced GFR group were 2.80 mm, 2.52 mm, 2.06, 20.4%, 46.5%, and 30.4%, respectively, which were significantly higher than those in the GFR normal group (2.60 mm, 2.37 mm, 1.93, 16.6%, 42.9%, 28.9%) (P<0.05). After adjusting for confounding factors such as age, gender, smoking, waist-to-hip ratio and physical activity, the results of logistic regression analysis showed that PD mean, AL mean, PD≥4 mm%, PD≥5 mm%, PD≥6 mm%, AL≥3 mm% and AL≥4 mm% of clinical periodontal indexes were significantly correlated with reduced GFR in this population (OR values were 1.765, 1.879, 1.430, 1.713, 1.771, 1.428, 1.445, respectively, P<0.05). Conclusions: In the non-diabetic elderly population in communities of Shijingshan, Beijing, clinical periodontal indexes reflecting the degree of periodontal tissue destruction were associated with a decreased level of GFR.

Kidney function in patients with primary distal renal tubular acidosis.

Recent reports indicate that chronic reduction of glomerular filtration rate (GFR) is common in patients with distal renal tubular acidosis (DRTA). Factors responsible for decreased GFR need clarification. We reviewed records of 25 patients with genetically confirmed DRTA included in the RenalTube database. Patients < 18 years at diagnosis and having at least one annual follow-up were selected and classified in two groups according to GFR ≥ 90 (normal GFR) or < 90 mL/min/1.73 m2 (low GFR) after median follow-up of 8.8 years. Eighteen and seven patients had normal and low GFR (X ± SEM, 121.16 ± 28.87 and 71.80 ± 10.60 mL/min/1.73 m2, respectively, p < 0.01). At diagnosis, these 2 subgroups did not differ in sex, age, underlying mutated gene, GFR, height SDS, or percentage of ultrasound nephrocalcinosis. Serum creatinine (SCr) was different but likely due to median ages of presentation being 0.6 and 4.0 in normal and low GFR patients, respectively. On the last recorded visit, no differences between both groups were found in serum bicarbonate, serum potassium, or alkali dosage. Height SDS of patients with normal GFR was - 0.15 ± 0.47 whereas it was - 1.06 ± 0.60 in the low GFR group (p = 0.27). Interestingly, 23% of the whole group had low birth weight (LBW; < 2500 g), equating to 20% and 29% in the normal and low GFR patients, respectively (p = 0.65). Our findings confirm the risk of kidney function reduction in patients with DRTA of pediatric age onset, suggesting that low GFR is related with less favorable growth outcome and discloses the high frequency of LBW in primary DRTA, a hitherto unrecognized feature.

Competing risk analysis of ventricular arrhythmia events in heart failure patients with moderately compromised renal dysfunction.

Patients with impaired renal function were shown to have an attenuated benefit from implantable cardioverter-defibrillator. However, there are limited data on the competing risk of ventricular arrhythmia events and death by renal function in patients without severe disease. Therefore, we aimed to assess the competing risk of ventricular arrhythmia events and death by renal function. We analysed 1782 patients (99%) enrolled in Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT) with glomerular filtration rate (GFR) data available. Cumulative incidence function curves were used to display the rate of ventricular tachycardia (VT), ventricular fibrillation (VF), and the competing risk of death without experiencing VT/VF. Multivariable Fine and Gray regression models and recurrent event analysis were performed. There were 355 (20%) patients with GFR < 52 and 1427 with GFR ≥ 52 (lowest quintile). The incidence of non-fatal VT/VF at 4 years was higher in patients with high GFR (26%) as compared to low GFR (16%), whereas rates of death without non-fatal VT/VF were 5% and 20% (P < 0.001). In Fine and Gray models, the low GFR group was 35% less likely to experience VT/VF compared to the high GFR [95% confidence interval (CI) 0.48-0.88, P = 0.005]. In contrast,death without experiencing VT/VF was 3.5-fold higher in the low GFR group (95% CI 2.38-5.12, P-value < 0.001). Recurrent event analysis consistently showed a lower risk of recurrent VT/VF, recurrent anti-tachycardia pacing only, and shock in the low GFR group. We show, in a competing risk model, a lower risk of VT/VF events and a higher risk of mortality without an arrhythmic event in patients with moderate renal dysfunction in MADIT-CRT. These findings can be used for improved selection of patients for defibrillator therapy among CRT candidates. https://clinicaltrials.gov/ct2/show/NCT00180271.

Serum Klotho protein level in type 2 diabetic patients depending on the renal function

The study aimed to assess serum Klotho protein level in type 2 diabetic patients depending on kidney function.&#x0D; Methods. This observational study included 72 patients with diabetes mellitus (DM) and 26 patients with acute coronary syndrome. The control group consisted of 20 healthy subjects. Depending on the presence of albuminuria and glomerular filtration rate (GFR), the diabetics were divided into the following groups: group I included the patients with normal GFR and without albuminuria (n = 25); group ІІ consisted the patients with normal GFR and albuminuria (n = 23); group III – the patients with reduced GFR and albuminuria (n = 24) and group ІV included the patients with acute coronary syndrome (n = 26).&#x0D; The GFR was calculated using the CKD EPI formula (KDIGO 2012). The concentration of Klotho protein was determined by enzyme-linked immunosorbent assay.&#x0D; Results. The development of diabetic nephropathy in type 2 diabetic patients accompanied by a significant decrease of soluble Klotho compared with the controls and the patients of the1-st group. The level of Klotho protein in the group of patients with albuminuria decreased to (490.66 ± 58.76) pg/ml (p &lt;0.05). The lowest concentration of Klotho (443.58 ± 46.92) pg/ml was found in the advanced stages of diabetic nephropathy, namely in patients with albuminuria and impaired renal function. Moreover, a significantly decreased serum Klotho was observed in acute coronary syndrome group in comparison with the control group (p &lt;0.05). There were inverse correlations of Klotho concentration with urinary albumin and blood creatinine levels and a direct correlation between Klotho and GFR.&#x0D; Conclusions. The obtained data indicated the key role of Klotho protein in the formation of renal pathology in type 2 diabetes and the feasibility of practical use of Klotho determination as an early diagnostic marker of renal disorders and cardiovascular risk assessment. The strategies improving Klotho production may be useful in the reduction of both renal and vascular lesions progression in type 2 diabetic patients.

Impact of Glomerular Filtration Rate on the Incidence and Prognosis of New-Onset Atrial Fibrillation in Acute Myocardial Infarction.

Background: Atrial fibrillation (AF) is a frequent complication of acute myocardial infarction (AMI) and is associated with a worse prognosis. Patients with chronic kidney disease are more likely to develop AF. Whether the association between AF and glomerular filtration rate (GFR) is also true in AMI has never been investigated. Methods: We prospectively enrolled 2445 AMI patients. New-onset AF was recorded during hospitalization. Estimated GFR was estimated at admission, and patients were grouped according to their GFR (group 1 (n = 1887): GFR >60; group 2 (n = 492): GFR 60–30; group 3 (n = 66): GFR <30 mL/min/1.73 m2). The primary endpoint was AF incidence. In-hospital and long-term (median 5 years) mortality were secondary endpoints. Results: The AF incidence in the population was 10%, and it was 8%, 16%, 24% in groups 1, 2, 3, respectively (p < 0.0001). In the overall population, AF was associated with a higher in-hospital (5% vs. 1%; p < 0.0001) and long-term (34% vs. 13%; p < 0.0001) mortality. In each study group, in-hospital mortality was higher in AF patients (3.5% vs. 0.5%, 6.5% vs. 3.0%, 19% vs. 8%, respectively; p < 0.0001). A similar trend was observed for long-term mortality in three groups (20% vs. 9%, 51% vs. 24%, 81% vs. 50%; p < 0.0001). The higher risk of in-hospital and long-term mortality associated with AF in each group was confirmed after adjustment for major confounders. Conclusions: This study demonstrates that new-onset AF incidence during AMI, as well as the associated in-hospital and long-term mortality, increases in parallel with GFR reduction assessed at admission.

Microalbuminuria and Serum Cystatin C in Prediction of Early-Renal Insufficiency in Children with Obesity.

Serum cystatin-C (SCysC) and microalbuminuria are well-recognized early markers of renal damage. This study aims to assess whether these early markers are elevated in children with obesity and normal serum creatinine (SCr). Pediatric patients diagnosed with obesity were included (n = 105, ages 4-18y) in this study. The patients were divided into three groups as follows: solely obese, metabolic syndrome and type 2 diabetes. Serum cystatin-C, 24-h microalbuminuria, SCr and glomerular filtration rate (GFR) were evaluated in all patients. All patients were examined with history, physical examination, laboratory analysis and ultrasonography evaluation. The findings showed that renal function, GFR and SCr levels were normal in all patients. There was microalbuminuria in six patients and SCysC was elevated in eight patients. There were also both elevated SCysC and microalbuminuria in eight patients. Significant elevations of both microalbuminuria and SCysC were detected in cases with type 2 diabetes (p < 0.05). The findings suggest that SCysC may have a diagnostic value in early-renal insufficiency. Although there was not any statistically significant difference between groups in GFR, significant elevations for both microalbuminuria and SCysC in patients with type 2 diabetes were detected. This suggests that the risk factors of diabetes may have a direct relation with renal damage. Regarding renal function in type 2 diabetic and obese pediatric patients, microalbuminuria and SCysC may be screened to observe early-renal damage, even in cases with normal GFR and SCr levels.

Glomerular Hyperfiltration Is Associated with Liver Disease Severity in Children with Nonalcoholic Fatty Liver Disease

To determine the prevalence of renal impairment in a large cohort of youths with histologically confirmed nonalcoholic fatty liver disease (NAFLD), and to determine its association with liver disease severity. Clinical, laboratory, and histology data were collected retrospectively in a pediatric cohort with biopsy-confirmed NAFLD at a tertiary care center between 2010 and 2017. Histological NAFLD severity was scored using validated criteria. Glomerular filtration rate (GFR) was calculated and categorized as low (<90mL/min/1.73m2), normal (90-136mL/min/1.73m2), or high (>136mL/min/1.73m2). Univariate and multivariate modeling were used to determine differences between the GFR groups and to control for confounders. The cohort comprised 179 patients (82% non-Hispanic; median age; 14years; IQR, 12-16years). One-third of the patients had abnormal renal function, including 36 (20%) with glomerular hyperfiltration and 26 (15%) with low GFR. In multivariable logistic regression, compared with normal GFR, hyperfiltration was independently associated with higher NAFLD activity score (aOR, 2.96; 95% CI, 1.49-5.87; P=.002), after adjusting for age, sex, ethnicity, obesity severity, presence of type 2 diabetes mellitus, and medications. In this large cohort with histologically confirmed NAFLD, renal impairment was highly prevalent and associated with liver disease severity, independent of obesity severity. Screening patients with confirmed NAFLD for renal complication is recommended.

MP50-01 ASSOCIATION BETWEEN KIDNEY FUNCTION, PROTEINURIA AND THE RISK OF KIDNEY CANCER

INTRODUCTION AND OBJECTIVE: While decreased renal function is a well-known risk factor of kidney cancer (KC), association of proteinuria with KC is unclear. In this large cohort study, we evaluated the risk of KC according to glomerular filtration rate (GFR) and dipstick proteinuria, as well as the joint effects between the two. METHODS: A total of 9,809,366 participants who participated in the nationwide health screening program in 2009 and did not have history of any cancer were included. The impact of GFR, dipstick proteinuria, and interactive associations of the two factors on the development of KC were analyzed. RESULTS: During the median follow-up of 7.3 years, 10,634 participants developed KC (overall incidence rate: 14.9 per 100,000 person-years). Subjects with low GFR (<60 mL/min/1.73 m2) had a higher incidence of KC (adjusted hazard ratio [aHR] 1.26, 95% CI 1.18-1.34) than those with a high GFR (≥ 60). When GFR of 60-90 was considered the reference group, KC risk was higher in low GFR groups: GFR <30 (aHR 1.21) and GFR 30-60 group (aHR 1.27), while there was no decreased risk in higher GFR groups (GFR >90 or ≥ 120). A clear dose-response relationship was also found with the degree of dipstick proteinuria; compared to the no proteinuria group, even the trace group had an elevated risk of KC (aHR 1.20) and the risk increased more than double in the 4+ proteinuria group (aHR 2.15). Analyses of joint effects of GFR and dipstick proteinuria showed that in the no proteinuria group, the increased incidence of KC was less evident with decreasing GFR, whereas in the proteinuria group, there was marked increase in KC incidence along with decreasing GFR (Figure 1). The association between smoking and KC was more evident in low GFR groups (GFR <30 and GFR 30-60) (P-interaction <0.001), while there were no interactions between smoking and proteinuria. Clinically significant association was not found between BMI and GFR/proteinuria. CONCLUSIONS: Low GFR and proteinuria were associated with future KC development, possibly in synergistic manner. Smoking had a more profound effect when GFR was lower. Further research is warranted to develop strategies to reduce cancer risk in the CKD population.Source of Funding: This work was supported by a creative research program grant from Samsung Medical Center.

Prognostic Value of Creatinine Concentration and Glomerular Filtration Rate in Acute Kidney Injury Development in the Early Postoperative Period After Heart Transplantation

IntroductionRecipients of nonrenal organ transplants, including the heart, are at risk for developing acute kidney injury (AKI). This situation significantly jeopardized the outcome of patients. The most effective treatment is continuous renal replacement therapy (CRRT) AimThe goal of this project is to verify the prognostic value of preoperative serum creatinine concentration and glomerular filtration rate (GFR), calculated by the Modification of Diet in Renal Disease formula, to determine the risk of renal failure after grafting ResultsIn the group of 39 patients, CRRT was needed in 7 patients (17.9%; group K); 32 patients were in the control group (group C). The pretransplant creatinine level in group K was 133.7 ± 31.3 μmol/L and in group C was 160.8 ± 97.6 μmol/L; P = .47. We did not find a difference between groups in GFR: group K 51 ± 6mL/min/1.73 m2 versus group C 43 ± 20 mL/min/1.73 m2; P = .65. Demographic data differed between groups. Patients in group C had significantly more often hypertension, diabetes mellitus, ischemic cardiomyopathy, and previous neurologic disorders and were male. Patients with CRRT had longer intensive care unit (ICU) stays after transplantation than the control population: 25 ± 19 versus 12 ± 10 days; P = .02. Other results showed that primary graft dysfunction occurred in 2 patients in group K and 6 in the control group; 1 needed extracorporeal membrane oxygenation support, and he died on the 12th day. The mean duration of renal replacement therapy was 9.8 days. There were 2 neurologic disorders—1 in each group—and 6 reoperations due to bleeding. ConclusionsDeveloping AKI requiring CRRT after heart transplantation prolonged the length of ICU stays. Preoperative creatinine concentration and glomerular filtration rate do not predict AKI.