Group Of Chronic Kidney Disease Patients Research Articles

Ubiquitin-Specific Protease 18 in Chronic Kidney Disease-Another Emerging Biomarker to Consider?

Ubiquitin-specific protease 18 (USP18) is a protein recognized for its dual enzymatic and non-enzymatic nature. It is involved in many physiological processes like the cell cycle and cell signaling. It also suppresses heart muscle remodeling upon an increase in the afterload. The role of USP18 in kidney pathology remains unknown. The objective of the study was to assess the relationship between serum and urine USP18 levels, the factors contributing to cardiovascular risk, and the markers of kidney disease activity at different stages of chronic kidney disease (CKD). One hundred participants, aged between 24 and 85 years (mean 53.1 ± 17.1 years), were included. Five groups (n = 20 each) were recruited according to their renal status (healthy individuals, patients with proteinuric glomerulonephritis, patients with non-proteinuric CKD, patients who were treated with hemodialysis, and kidney transplant recipients). The measurements of serum and urine USP18 levels were performed using ELISA. The median serum USP18 level was the highest in healthy participants (1143.0 pg/mL) and kidney transplant recipients (856.6 pg/mL), whereas, in individuals with different forms of CKD, it fitted within the range of 402.1-471.9 pg/mL. Urinary USP18 reached the highest level in the group of CKD patients not yet on dialysis (303.3 pg/mL). Only in this group did it correlate with serum creatinine and urea concentrations. Our results suggest the inhibition of cardioprotective USP18 signaling when kidney function is impaired. Moreover, an increased level of urinary USP18 may indicate chronic tubular damage.

Comprehensive proteomics of monocytes indicates oxidative imbalance functionally related to inflammatory response in chronic kidney disease-related atherosclerosis.

Atherosclerosis-induced cardiovascular events are the leading cause of mortality in chronic kidney disease (CKD) patients. Monocytes are involved in the formation of atherosclerotic plaques and mediate in the overproduction of ROS, promoting inflammation and oxidative stress. However, the relationship between monocytes, inflammation, and oxidative status in CKD-associated atherosclerosis has not been thoroughly investigated. Monocytes and plasma derived from two groups of CKD patients with varying degrees of atherosclerosis and two groups of patients with cardiovascular disease (CVD) and non-CKD atherosclerosis were analyzed. This study was designed to perform a comprehensive proteomic analysis of monocytes in combination with functional bioinformatics. In addition, a targeted investigation of oxidative stress- and inflammatory-related factors to explore CKD-associated atherosclerosis was applied. Dysregulation of proteins involved in lipid oxidation, cell survival, ROS synthesis and metabolism, and inflammatory responses has been revealed. The characteristic disturbances in the monocyte proteome changed with the progression of CKD. A closer examination of oxidative stress's triggers, mediators, and effects on protein and lipid levels showed alterations in the oxidative imbalance between CKD and CVD. CKD monocytes demonstrated a significant increase of oxidized glutathione without changing the level of its reduced form. Evaluation of enzymatic antioxidants, sources of ROS, and modifications caused by ROS also revealed significant alterations between the study groups. In CKD, inflammation and oxidative imbalance correlated and drove each other. However, in CVD, oxidative stress-related factors were associated with each other but not to inflammatory proteins. Moreover, lipid abnormalities were more specific to classical CVD and unrelated to CKD. Such a comprehensive characterization of monocytes and oxidative stress in CKD and CVD patients has never been presented so far. Obtained results support the involvement of distinct mechanisms underlying the acceleration of atherosclerotic and non-atherosclerotic CKD.

The Role of Dialysis in Outcomes of LVAD Implantation in Chronic Kidney Disease Patients: Insights from US National Readmission Database

BackgroundIn patients with chronic kidney disease (CKD) undergoing left ventricular assist device (LVAD) implantation, there is an increased risk of mortality and morbidity. However, data on in-hospital complications for CKD patients, specifically comparing those on dialysis and those not on dialysis, is limited. Consequently, our study seeks to examine outcomes and determinants of complications in these two groups of CKD patients during their LVAD implantation hospitalizations in the United States. Methods and ResultsUtilizing the National Readmission Database (2016-2020), we identified LVAD and CKD diagnoses through ICD-10 codes. From this data, we found a total of 5,499 hospitalizations for LVAD procedures involving CKD patients, with 12.3% (678 cases) of them undergoing dialysis (CKD-D) treatment. CKD-D patients with had a lower mean age (55.9years,SD-12.6) compared to those without (58.5years,SD-12.6;p=0.000). Baseline demographics and comorbidities were shown in Figure 1. CKD-D shown to be predictor of CV complications including Myocardial-infraction (MI)[OR 3.78 (95% CI 2.72-5.24), p<0.000], Sudden-cardiac-arrest (SCA) [OR 2.01 (1.51- 2.67), p<0.000], major-adverse-cardiac-and-cerebrovascular-events (macce) [OR 1.15 (1.08-1.22), p<0.01], stroke [OR 1.8(1.11-2.93), p=0.017] and death [OR 3.12(2.34-4.14),p=0.000], compared to no dialysis (Figure 2). Furthermore, CKD-D patients were associated with increased mean length (74 vs 39 days, p<0.000) and cost of hospitalization ($20,18,792 vs $11,73,391, p<0.00). ConclusionsLVAD patients with chronic kidney disease on dialysis experienced an elevated risk of myocardial infarction, sudden cardiac arrest, major adverse cardiac and cerebrovascular events, stroke, and death. Additionally, CKD-D was linked to longer hospital stays and higher hospitalization expenses.

Adapting Clinical Practice Guidelines for Chronic Kidney Disease: Blood Pressure Management and Kidney Replacement Therapy in Adults and Children in the Saudi Arabian Context Using the Grading of Recommendations Assessment, Development, and Evaluation-ADOLOPMENT Methodology

This practice guideline was developed by the chronic kidney disease (CKD) Task Force, which was composed of clinical and methodological experts. The Saudi Arabian Ministry of Health and its health holding company commissioned this guideline project to support the realization of Vision 2030's health-care transformation pillar. The synthesis of these guidelines was guided by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)- ADOLOPMENT methodology. The final guidelines addressed 12 clinical questions on the management of blood pressure in patients with CKD through a set of recommen-dations and performance measures. The recom-mendations included antihypertensive agents in children; renin- angiotensin system inhibition (RASi) versus non-RASi in adults; intensive versus standard blood pressure targets; early versus late assessment for kidney replacement therapy (KRT); late versus early preparation strategies for KRT; CKD symptoms during assessment for KRT or conservative manage-ment; initiation of KRT in patients with deteriorating CKD; choice of KRT modality or conservative management in certain CKD patient groups; changing or discontinuing KRT modalities; the frequency of reviews for KRT or conservative management; and information, education, and support. These conditional recommendations were based on a low to very low certainty of evidence, which highlights the need for high-quality randomized trials com-paring different antihypertensive agents in patients with CKD.

Adapting Clinical Practice Guidelines for Chronic Kidney Disease: Blood Pressure Management and Kidney Replacement Therapy in Adults and Children in the Saudi Arabian Context Using the Grading of Recommendations Assessment, Development, and Evaluation-ADOLOPMENT Methodology.

This practice guideline was developed by the chronic kidney disease (CKD) Task Force, which was composed of clinical and methodological experts. The Saudi Arabian Ministry of Health and its health holding company commissioned this guideline project to support the realization of Vision 2030's health-care transformation pillar. The synthesis of these guidelines was guided by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)- ADOLOPMENT methodology. The final guidelines addressed 12 clinical questions on the management of blood pressure in patients with CKD through a set of recommen-dations and performance measures. The recom-mendations included antihypertensive agents in children; renin- angiotensin system inhibition (RASi) versus non-RASi in adults; intensive versus standard blood pressure targets; early versus late assessment for kidney replacement therapy (KRT); late versus early preparation strategies for KRT; CKD symptoms during assessment for KRT or conservative manage-ment; initiation of KRT in patients with deteriorating CKD; choice of KRT modality or conservative management in certain CKD patient groups; changing or discontinuing KRT modalities; the frequency of reviews for KRT or conservative management; and information, education, and support. These conditional recommendations were based on a low to very low certainty of evidence, which highlights the need for high-quality randomized trials com-paring different antihypertensive agents in patients with CKD.

The relationship between asymptomatic atherosclerosis and hepcidin-25 in chronic kidney disease patients.

The most common and lethal consequence of chronic kidney disease (CKD) is atherosclerotic cardiovascular disease. The persistent inflammation present in CKD increases hepcidin levels. Iron accumulates in the arterial wall in atherosclerosis. Hepcidin-25 was thought to accelerate the development of atherosclerotic plaques by blocking iron release from macrophages. Therefore, we sought to determine the relationship between hepcidin-25 and asymptomatic atherosclerosis in non-dialysis CKD patients. Investigate the relationship between hepcidin-25 and subclinical atherosclerosis in non-dialysis CKD patients. Cross-sectional SETTINGS: Outpatient clinic for urology and nephrology at a university hospital SUBJECTS AND METHODS: Participants above the age of 18 years included a group of healthy controls and a group of CKD patients who were not routinely maintained on hemodialysis. The latter group was further divided according to eGFR into CKD-3, CKD-4 and CKD-5 subgroups. We excluded patients with comorbidities, patients with chronic liver disease, and other conditions or habits. CBC, kidney function tests, and serum levels of hepcidin-25 (SH-25), TNF-α, IL-6, high-sensitivity C-reactive protein (hs-CRP), TC, TG, LDL-C and HDL-C were assessed. To measure carotid intima media thickness (CIMT) and determine presence of plaques, carotid ultrasonography was performed. The near or far walls of common carotid artery, bulb, and internal carotid artery were used to measure CIMT. SH-25 association and indicators of subclinical atherosclerosis. 128 participants, the control group (n=25) and the non-hemodialysis CKD patients (n=103) RESULTS: The CKD patients had significantly higher serum levels of markers of inflammation including IL-6, TNF-α, and hs-CRP (P<.001 for each) compared to the controls. There was a significantly higher level of TC, TG and LDL-C (P<.001 for each) and a lower level of HDL-C (P<.001) in the CDK patients compared to controls. SH-25 was considerably higher in all CKD subgroups, especially with progression of CKD. CIMT was increased in CKD patients especially CKD-4 and CKD-5 subgroups when compared to healthy participants (P<.001 for each). In the patient group, CIMT showed a positive correlation with SH-25, (r=.65 and P<.001), IL-6 (r=.65, P<.001), TNF-α (r=.71, P<.001), and hs-CRP (r=.52, P<.001). The ROC curve study showed that SH-25 (AUC=.86, P<.001), IL-6 (AUC=.83, P<.001), hs-CRP (AUC=.72, P<.001), TNF-α (AUC=.82, P<.001) were strong predictors of subclinical atherosclerosis in the CKD patients. SH-25 and CIMT had a positive relationship in CKD patients. The ROC curve showed that SH-25 is a reliable predictor of carotid atherosclerosis. Therefore, we suggest that SH-25 is a vital biomarker of asymptomatic atherosclerosis. Single-center.

The relationship between weight-adjusted-waist index and total bone mineral density in adults aged 20-59.

According to reports, obesity has a significant impact on bone health. And the weight-adjusted-waist index (WWI), superior to BMI and waist circumference (WC), is a new obesity indicator arising in recent years. This research investigated the relationship between WWI and total bone mineral density (BMD) for adults aged 20 to 59. Using data from the 2011-2018 NHANES, we looked into the independent link between WWI and total BMD as well as its nonlinearity using weighted multiple linear regression and smooth curve fitting. Two-stage linear regression models were employed to calculate the threshold effects. There were additional subgroup analyses and testing for interactions. Multiple linear regression studies on a total of 10,372 individuals showed a significant inverse link between WWI and total BMD in adults between 20 and 59 [β = -0.04, 95% CI: (-0.04, -0.03), P<0.0001]. And smoking, race, and chronic kidney disease (CKD) had no significant effect on this negative connection (P for interaction >0.05). In addition, we found a nonlinear relationship between WWI and total BMD in diabetic and CKD patients, for which the saturation point was 11.38 cm/√kg in the CKD patient group and 10.29 cm/√kg in the diabetic patient group. Our analysis demonstrated a significant inverse association between WWI and total BMD in adults aged 20-59.

Correlation between serum trimethylamine-N-oxide concentration and protein energy wasting in patients on maintenance hemodialysis

Objectives Chronic kidney disease (CKD) is a serious health problem that is associated with several systemic changes, including protein energy wasting (PEW). However, the exact mechanism of PEW in CKD remains unclear. As one of the important intestinal flora metabolites and uremic toxins, trimethylamine-N-oxide (TMAO) is involved in CKD-associated mortality, which might play a role in the development of PEW in CKD patients especially in patients on maintenance hemodialysis (MHD). However, this possibility has not been investigated. Methods PEW was diagnosed in a group of CKD patients on MHD according to the criteria of the International Society of Renal Nutrition and Metabolism. Serum TMAO concentration was assessed by high-performance liquid chromatography and mass spectrometry. The association between TMAO concentration and PEW was assessed using linear regression and logistic analysis after adjustment for confounding factors, including basic characteristics, comorbidities, and laboratory findings. Results The circulating TMAO level was higher in the MHD patients than in control (healthy) individuals (5653.76 ± 2853.51 vs. 254.92 ± 197.88 ng/mL, p < 0.001). Further, after the MHD patients were screened for PEW, those with PEW were found to have significantly higher serum TMAO levels than those without PEW (6760.9 vs. 4016.1 ng/mL, p < 0.001). Further, the serum TMAO concentration exhibited a significant negative correlation with body mass index (BMI) and dietary protein intake. In the logistic regression analysis, after adjustment for confounding factors, the serum TMAO concentration was still significantly correlated with PEW occurrence. Conclusions The circulating TMAO level is significantly correlated with the prevalence of PEW in MHD patients. TMAO might be a potential target in the prevention and treatment of PEW in CKD especially ESRD.

Comparative evaluation of iron status by reticulocyte haemoglobin content (CHr) in chronic kidney disease patients on haemodialysis and erythropoietin

Due to the inflammatory state associated with uraemia, diagnosing iron deficiency using currently available assays is difficult in individuals with chronic kidney disease (CKD). The goal of this study was to see how useful reticulocyte haemoglobin (CHr) is as a diagnostic tool for iron deficiency and a predictor of intravenous iron therapy in a group of CKD patients in Sri Lanka who were on haemodialysis. A hundred (100) individuals with CKD on regular haemodialysis and erythropoietin participated in this descriptive cross-sectional study. Serum ferritin, transferrin saturation, and reticulocyte haemoglobin were used to divide patients into groups (CHr). A single dose of intravenous (IV) iron 500 mg was given to all individuals with CHr&lt;29 pg.To examine the response, the CHr was measured 72 hours after the IV iron treatment. Mean haemoglobin was 9.27 g/dL, mean serum ferritin was 243.5 ng/mL, mean transferrin saturation was 18.6%, and mean CHr was 29.2 pg in the population. Thirty-three of the 100 patients (33%) received IV iron therapy, which resulted in a significant increase in CHr 72 hours following treatment (p&lt;0.001).

A pragmatic approach for implementation of value-based healthcare in Amsterdam UMC, the Netherlands

BackgroundThe emphasis on implementation of value-based healthcare (VBHC) has increased in the Dutch healthcare system. Yet, the translation of the theoretical principles of VBHC towards actual implementation in daily practice has been rarely described. Our aim is to present a pragmatic step-by-step approach for VBHC implementation, developed and applied in Amsterdam UMC, to share our key elements. The approach may inspire others and can be used as a template for implementing VBHC principles in other hospitals.MethodsThe local approach is developed in a major academic hospital in the Netherlands, based at two locations with 15,000 employees in total. Experience-based co-design is used, building on our learning experiences from implementing VBHC for 14 specific patient groups. The described steps and activities devolved from iterative and participative co-design sessions with various experienced stakeholders involved in the implementation of one or more VBHC pathways.ResultsThe approach includes five phases; preparation, design (team introduction, outcome selection, action agenda), building (outcome set integration in daily practice), implementation (training, outcome registration and implementation) and the continuous improvement cycle. We described two cases for illustration of the approach; the Cleft Lip and Palate and the Chronic Kidney Disease patient groups. For a good start, involvement of a clinical leader as driving force, ensuring participation of patient representatives and sufficient resources are needed.ConclusionWe have experienced that several defining features of the development and implementation of this approach may have contributed to its completeness and applicability. Key elements for success have been organisational readiness and clinical leadership. In conclusion, the approach has provided a first step towards VBHC in our hospital. Further research is needed for evaluation of its effectiveness including impact on value for patients.

On the comparison of survival curves of two groups of chronic kidney disease patients based on progressively censored data

Introduction: Chronic kidney disease (CKD) is the progressive loss of kidney function. Prevalence of every stage of CKD is rising over the period with increasing number of diabetic, hypertensive and elderly population. It is becoming a problem of epidemic proportions in India. Objectives: Comparison of the survival function of CKD patients with different disease stages criticality grouped on the basis of gender, diabetes and hypertension. Patients and Methods: The retrospective data of 117 patients suffering from CKD during the period March 2006 to October 2016 is used. In the present study, log-rank, Gehan-Wilcoxon, Tarone-Ware, Peto-Peto, modified Peto-Peto and tests belonging to Fleming-Harrington test family with different (p, q) values are applied to test the statistical significance of the difference between two survival functions under different conditions. The parametric test has also been applied to compare the survival time distribution of two groups. Results: Kaplan-Meier method and survival comparison tests suggest no difference between survival experiences of the two groups namely female and male on the basis of grouping variable gender. However, in simulation study as we increase the sample size it is observed that it affects more women than men especially in stage 3 of CKD patients. The survival functions of two groups of CKD patients based on diabetes and hypertension differ significantly. Conclusion: The survival experiences of two groups of CKD patients based on the grouping variables diabetes and hypertension differ significantly on the basis of real data and simulation study. The grouping variable gender as a significant factor becomes evident only when large samples are generated under simulation study

Change in renal hemodynamics after renal denervation in diabetic patients with resistant hypertension and chronic kidney disease

Abstract Background There are very few data on the initial features of hemodynamics and its changes after renal denervation (RDN) in patients with resistant hypertension (RHTN) and type 2 diabetes mellitus (DM), depending on the presence of chronic kidney disease (CKD), and the mechanisms of this effect require further study. Purpose To assess the features of renal hemodynamics and its change after RDN in patients with RHTN with type 2 DM, depending on the presence or absence of CKD. Methods In the study were included 38 patients with RHTN with type 2 DM (mean age 60.6±8.1 years, 14 men, 24-hour systolic / diastolic blood pressure (24-hr SBP/DBP) 160.9±16.5 / 82.2±11.3 mm Hg, mean HbA1c 7.87±1.62%), of which CKD occurred in 18 pts. (eGFR – 47.1 ml/min/1.73 m2), and 20 pts. without CKD (eGFR – 80.3 ml/min/1.73m2). All patients underwent baseline office and 24-hr BP measurement with calculation DBP/SBP ratio (D/S ratio), Doppler ultrasonography, serum creatinine, estimated glomerular filtration rate (eGFR) (CKD-EPI formula), urinary albumin excretion (UAE). The six-month follow-up period was completed by 14 patients in the group with CKD and 18 patients without CKD. Results At baseline, patients with CKD compared with those without CKD had higher pulse BP (82.2±10.0 versus 75.6±15.9, p=0.061), renal resistive indices (RRI) (0.78±0.06 versus 0.69±0.05, p=0.001 in the main renal arteries (RA); 0.73±0.07 versus 0, 63±0.06, p=0.001 in segmental RA) and significantly lower level of D/S ratio (0.49±0.06 versus 0.53±0.06, p=0.040). At the same time, the frequency of increased RRI (&amp;gt;0.70) in the CKD group was almost 14 times higher than in those without CKD (73% and 5.3%, respectively, p&amp;lt;0.001).After RDN, patients with CKD showed a significant decrease in SBP (−10.7 mm Hg, p=0.008) and an insignificant decrease in DBP (−3.9 mm Hg, p=0.118). In group without CKD, on the contrary, there was an insignificant decrease in SBP (−7.6 mm Hg, p=0.102) and a significant decrease in DBP (−5.5 mm Hg, p=0.030). The D/S ratio tended to increase in the group of CKD patients (p=0.08), whereas these indicators did not change significantly in the group without CKD. Additionally, there were a positive dynamics of RRI (decrease &amp;gt;0.05) in patients with CKD, the frequency of which was almost 4 times higher than that in persons without CKD (43% and 11%, respectively, p=0.049). Moreover, a decrease in RRI correlated with an increase in the D / S ratio of both the main RA (R = 0.50; p=0.005) and in segmental RA (R = 0.40; p=0.028). There were no significant changes in UAE and serum creatinine in both groups. Conclusions Thus, CKD in patients with RHTN with type 2 DM is characterized by a significant increase in renal vascular resistance, while RDN in this patients, in contrast to patients without CKD, can be an effective therapeutic option not only for BP reduction, but also for improvement of renal hemodynamics. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Russian Foundation for Basic Research

Analysis of profibrogenic microRNAs (miRNAs) expression in urine and serum of chronic kidney disease (CKD) stage 1\u20134 patients and their relationship with proteinuria and kidney function

PurposeBesides conventional kidney diseases diagnostics, micro RNAs (miRNAs) assessment in urine and serum is considered to be a promising non-invasive method of diagnostics of renal parenchymal diseases and valuable therapeutic target also. The purpose of the study was to investigate the role of several miRNAs as a markers of kidney damage.MethodsAssessment of 45 chronic kidney disease (CKD) patients stage 1–4 and 17 healthy control. Sample of urine and blood was taken from each participant for molecular analysis using Real Time PCR method to identify such micro-RNAs as: hsa-miR-155-5p, hsa-miR-214-3p, hsa-miR-200a-5p, hsa-miR-29a-5p, hsa-miR-21-5p, hsa-miR-93-5p, and hsa-miR-196a-5p. Basic biochemical test was done. Analysis was performed in CKD patients group and subgroup with chronic glomerulonephritis (CGN) confirmed by kidney biopsy. Moreover, analysis was performed in subgroup with different estimated glomerular filtration rate (eGFR) (according to CKD–EPI equation: eGFR < 60 ml/min, eGFR > 60 ml/min) and different daily protein excretion (DPE): (DPE < 3.5 g; DPE > 3.5 g).ResultsIncreased relative expression of hsa-miR-29-5p, hsa-miR-21-5p, and hsa-miR-196a-5p and decreased expression of hsa-miR-155-5p, hsa-miR-214-5p, hsa-miR-200a-5p, and hsa-miR-93-5p was demonstrated in urine of analyzed CKD patients. In subpopulation of chronic glomerulonephritis (CGN) patients, there was higher level of expression in urine of hsa-miR-155-5p, hsa-miR 214-3p, hsa-miR-93-5p, and hsa-miR-196a-5p in CGN with DPE < 3.5 g. CGN patients with eGFR < 60 ml/min showed higher expression level of miRNAs such as hsa-miR-214-3p, hsa-miR-29-5p, hsa-miR-93-5p, and hsa-miR-196-5p in urine. There was increase in hsa-miR 155-5p, hsa-miR-214-3p, and hsa-miR-200a-5p serum expression level in CKD population and reduction of hsa-miR-29a-5p, hsa-miR-21-5p, and hsa-miR-93-5p expression. Increased level of expression of hsa-miR-155-5p; hsa-miR-214-3p, hsa-miR-200a-5p, and hsa-miR-29-5p was found in CGN patients with eGFR > 60 ml/min.ConclusionIncreased relative expression of profibrogenic miRNAs in urine or serum of CKD patients with eGFR > 60 ml/min and DPE < 3.5 g may indicate higher degree of fibrosis at early CKD stages.

Predictors of health activation for patients with chronic kidney disease undergoing hemodialysis

Introduction: the quality of self-care in patients with chronic kidney disease (CKD) is important to improve quality of life, increase survival and reduce complications. Self-care can be evaluated by measuring the health activation of these patients. Objectives: evaluating the health activation of patients with CKD undergoing hemodialysis (HD) compared to a normative group (health self-reported subjects), and to identify the social, demographic and clinical determinants that are associated with the health activation. Method: cross-sectional, analytical, descriptive and quantitative study approved by the local ethics committee and conducted in a public and a private outpatient hemodialysis clinic. Participants were patients with CKD on HD (focal group) and subjects on a normative group. All of them answered the questionnaire of sociodemographic and clinical characterization and the instrument "Patient Activation Measure" (PAM13). For scores comparisons were used the Mann-Whitney test. Regarding the evaluation of the linear effect of the variables of profile on PAM13, multiple linear regression was used, including the evaluation of the two groups and only for patients with CKD. Results: the study included in each group. Regarding the characteristics of the CKD patients, there was a predominance of males (59%), incomplete high school or less (68%). Most of them too was from a private administration clinic (53%) and reported having already presented some type of complication stemming from CKD (57%). Regarding the evaluation of activation, the activation scores did not differ between the two groups (median of 56.4 in CKD patients and 56.4 in normative group, p &gt; 0.05) and the activation scores of both groups corresponded to activation level 3 with 34.5% of prevalence (p &gt; 0.05). When the two groups were analyzed together, schooling (Bi = 5.38; p= 0.002), practice physical activity (Bi = 4.2; p= 0.019) and the number of people who co-reside (Bi = -2.22; p= 0.001) influenced the activation score. In the CKD patients, independently, the variables that influenced the activation score were gender (Bi = -4.69; p = 0.050); schooling (Bi = 6.55; p = 0.008); type of clinic of origin (Bi = -5.48; p = 0.02) and the presence of complications related to CKD (Bi = -5.25; p = 0.026). Conclusion: activation scores did not differ between the patients with CKD on HD and the health subjects. Schooling, practice physical activity and number of people residing with the individual were predictors of health activation in both groups. For the CKD patients group, the variables that influenced positively the activation was schooling; and that influenced negatively was the gender, type of clinic of origin and the presence of complications related to CKD.

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.

MO440KLOTHO AS A BIOMARKER OF SUBCLINICAL CARDIOVASCULAR DISEASE IN CHRONIC KIDNEY DISEASE: A PROOF-OF-CONCEPT STUDY*

Abstract Background and Aims Cardiovascular disease (CVD) is the major cause of mortality among chronic kidney disease (CKD) patients. Reductions in serum Klotho levels are related to the prevalence of CVD in CKD patients. However, it is unclear whether circulating Klotho, and its expression in peripheral blood cells (PBCs), are associated with subclinical atherosclerotic cardiovascular disease (sCVD) in these subjects. In this proof-of-concept study, we analyzed in a group of CKD patients the relationship between Klotho and two markers of sCVD: ankle-brachial index (ABI) and carotid intima-media thickness (CIMT). Method Gene expression in PBCs and serum levels of Klotho and inflammatory cytokines (TNF, IL6 and IL10) were measured in 103 CKD patients (stages 3-4), older than 18 years of age, and without known atherosclerotic cardiovascular disease. Biochemical data were obtained following standardized clinical methods. The presence of sCVD was defined as ABI &amp;lt; 0.9 and/or CIMT ≥ 0.9 mm. Patients with ABI values ≥ 1.3 were excluded. Results Patients with sCVD presented lower serum and PBCs expression levels of Klotho (P&amp;lt;0.001 for both). Stratified analysis showed that upper tertiles of both serum and PBCs expression levels of Klotho presented significantly higher ABI (P&amp;lt;0.001 for both Klotho determinations) and lower CIMT (P&amp;lt;0.001 for serum levels and P&amp;lt;0.01 for KL expression in PBCs), which resulted in a lower prevalence of sCVD (P&amp;lt;0.001 for both determinations of Klotho). Correlation analysis showed that both serum and PBCs mRNA Klotho levels were positively correlated with ABI (r=0.556, P&amp;lt;0.0001; and r=0.373, P&amp;lt;0.0001, respectively) and inversely correlated with CIMT (r=-0.541, P&amp;lt;0.0001; and r=-0.437, P&amp;lt;0.0001, respectively). Among inflammatory markers, only serum IL6 levels presented significant associations with sCVD, being inversely related with ABI (r=-0.568, P&amp;lt;0.0001) and positively associated with CIMT (r=0.558, P&amp;lt;0.0001). Multiple regression analysis with ABI and CIMT as dependent variables demonstrated that both Klotho variables, together with serum IL6, were positively and significantly associated with ABI (adjusted R2=0.511, P&amp;lt;0,0001) and CIMT (adjusted R2=0.445, P&amp;lt;0,0001) values, independently of traditional and emergent cardiovascular risk factors. Multivariate logistic regression, using the presence/absence of sCVD as the dependent variable, showed that circulating Klotho, and its expression in PBCs constituted independent protective factors for sCVD [OR (95% CI): 0.993 (P=0.002) and 0.231 (P=0.025), respectively]. Receiver operating curve (ROC) analysis pointed to the prognostic ability for sCVD of serum Klotho (area under the curve [AUC]: 0.817, 95% CI: 0.736–0.898, P&amp;lt;0.001) and its gene expression in PBCs (AUC: 0.742, 95% CI: 0.647–0.836, P&amp;lt;0.001). Conclusion The reductions in serum soluble and PBCs expression levels of Klotho in CKD patients are independently associated with the presence of sCVD. Further research exploring whether therapeutic approaches to maintain or elevate the Klotho level could reduce the impact of CVD in CKD patients is warranted.

PREVALENCE OF DYSLIPIDEMIA IN CHRONIC KIDNEY DISEASE

BACKGROUND: Chronic kidney disease (CKD) is a worldwide health problem with increasing incidence and prevalence. The annual mortality rate of patients undergoing dialysis is more than 20%. The leading causes of morbidity and mortality in CKD are cardiovascular diseases, primarily atherosclerotic coronary artery disease. Dyslipidemia is a common complication of CKD. It is a signicant risk factor for the development of cardiovascular disease. Alteration in lipid prole correlates with declining glomerular ltration rate (GFR) and degree of proteinuria. AIM: Ÿ To identify the altered lipid prole in patients with chronic kidney disease. Ÿ To note the alterations in different lipoprotein fractions in chronic kidney disease patients. Ÿ To note the difference in lipid prole in CKD patients on conservative management and maintenance hemodialysis. MATERIALS AND METHODS: A Hospital-based observational Prospective study was conducted in the Department of Medicine, Santhiram medical college, and general hospital for six months. Chronic kidney disease patients who are non-diabetic were taken for the study with informed and written consent taken from the patient. RESULTS: Plasma triglycerides(153.14±54.37mg/dl) were elevated, and plasma HDL (36±43.5mg/dl) was decreased in CKD patients. There is no signicant elevation of total cholesterol levels. On comparing lipid proles of CKD patients on conservative management and hemodialysis, there was a signicant increase in triglycerides in the hemodialysis group. CONCLUSION: Signicant elevation of triglycerides and VLDL was observed in patients of CKD on hemodialysis. Further, a reduced HDL cholesterol level was also observed in both conservative and hemodialysis groups of CKD patients. Dyslipidemia observed in Uremic patients may contribute to accelerated atherosclerosis and further progression of chronic renal failure.

A study on epidemiology, etiology, risk factor and treatment management in chronic kidney disease on children, adult and geriatric patients in a tertiary care teaching hospital: A systematic mini-review

Chronic kidney disease (CKD) was recognized as universal health problem for population. It can result in a systemic review of epidemiology, etiology, risk factors, and treatment management was reporting the incidence of CKD about children, adult, and geriatric patients by using the research articles from 1982 to 2020. The object of study to find out a incidence about epidemiology, etiology, risk factor, and treatment management for all age groups with CKD patients in review articles. The discussion in this study systemic mini-review was about CKD in children, adult, and geriatric patients. In 2012, 2018 and 2019 epidemiology is mostly geriatrics are effected with CKD compared with children and adults but in 2016 children and geriatrics are equally effected with CKD. In 2017 to 2019 etiology is mostly geriatrics are effected with CKD when compared with children and adults. From 2000 to 2010 and 2011 to 2020 risk factors are mostly children’s are effected with CKD having risk factors to compare with adults and geriatrics. The treatment management from 1982 to 2020 the medications are intervented like radioactive iodine, Azathioprine, methotrexate, lisinopril, hemodialysis, methotrexate, and lisinopril for all age groups of CKD patients. The study was concluded that patients with CKD has increased the epidemiology, etiology, risk factor, and treatment management on children, adult, and geriatric patients with CKD. Future research should investigate adequate information about children, adults, and geriatric patients with CKD for better outcomes in further study.

Echocardiographic Assessment of Systolic Myocardial Dysfunction in Children with Chronic Kidney Disease

Background and Aim: Chronic Kidney Disease (CKD) is associated with significantly increased morbidity and mortality. Cardiovascular causes contribute to the large proportion of morbidity and mortality in this group. The aim of the current study was to assess systolic myocardial dysfunction of the heart in children with chronic kidney disease (stage V). Methods: This cross-sectional study was carried out in a tertiary center from January 2018 to December 2018. Children aged 1 to 18 years having chronic kidney disease (stage V) were included in the study. All the patients underwent color Doppler echocardiography for the evaluation of cardiac abnormalities. Age and sex-matched healthy children with no clinical evidence of renal and cardiovascular disease were taken as a comparison group. Results: Out of Thirty children with Chronic kidney disease (stage V), 21(70%) were male and 9 (30%) female. Echocardiographic findings revealed a statistically significant difference in case of CKD patients group and a comparison group in relation with left atrium (LA), left ventricular internal diameter in diastole (LVIDd), left ventricular internal diameter in systole (LVIDs), interventricular septum in diastole (IVSd), interventricular septum in systole (IVSs), left ventricular posterior wall thickness in diastole (LVPWd) and left ventricular posterior wall thickness in systole (LVPWs) (p<0.001) but no difference in relation to FS and EF (p-0.934 & p-0.754 respectively). Conclusion: It can be concluded from the present study that children with chronic kidney disease are prone to develop left ventricular structural abnormality but systolic functional changes are less frequent.

Cross-correlation of plasma concentrations of branched-chain amino acids: A comparison between healthy participants and patients with chronic kidney disease.

Plasma concentrations of branched-chain amino acids (BCAAs) are known to exhibit strong intercorrelations; however, the associated regulatory mechanism is not sufficiently understood. Furthermore, the mechanisms underlying the intercorrelation changes in metabolic disorders with the disease are unclear. Therefore, plasma BCAAs in patients with chronic kidney disease (CKD) were examined. This study included a healthy group of older participants (Group C; n=87, 46 males, 41 females) who had undergone health examinations at Sanyudo Hospital and a group of CKD patients (Group CKD; n=71, 49 males, 22 females) receiving maintenance hemodialysis at the same hospital. Samples from Group C were collected 12h after fasting. CKD samples were collected before and after hemodialysis (pre-HD and post-HD, respectively), without 12h fasting. The samples were analyzed for 38amino acids by SRL Inc., using liquid chromatography-mass spectrometry (LC-MS). Differences between the plasma BCAA concentrations of Group C and pre-HD were determined. Dialysis-induced BCAA losses were different for each BCAA. However, strong intercorrelations between the plasma concentrations of each BCAA were maintained. In addition, the regression lines did not converge at the origin and were in different positions for groups C, pre-HD, and post-HD. A different distribution of the constant (b) for each group was observed for each BCAA correlation when a in the regression line (Y=aX+b) was fixed at the value for Group C, and b was calculated. Strong intercorrelations among plasma concentrations of BCAAs were maintained in CKD patients both pre- and post-dialysis, whereas the changes in the plasma concentrations of each BCAA were different. We speculate that there is a novel mechanism that selectively regulates each BCAA and suggest that changes in the constant of the regression formula for correlation may have a novel function as an index for renal contribution to BCAA metabolism.