Impaired Renal Function Group Research Articles

Increased physiological [18F]FDG uptake in the liver and blood pool among patients with impaired renal function.

In the daily clinical course, the liver uptake may seem to be increased in patients with renal failure. The purpose of this study was to investigate whether or not the FDG uptake of the liver, and the FDG uptake of blood pool which is generally used as a reference site as well as liver, is increased in patients with renal failure. We retrospectively analyzed 233 patients who underwent FDG positron emission tomography/computed tomography (PET/CT). Renal failure is defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2. We compared the FDG uptake in the liver and mediastinal blood pool of 67 patients with impaired renal function to that in 166 patients with a normal renal function (eGFR ≥ 60 mL/min/1.73 m2). Correlations between the liver or mediastinal blood pool FDG uptake and the eGFR were also analyzed by Spearman's correlation test. Maximum and mean standardized uptake values (SUVmax and SUVmean, respectively) of the liver and the SUVmean of the mediastinal blood pool were 3.48 ± 0.57, 2.56 ± 0.37, and 1.90 ± 0.28 in the impaired renal function group, respectively, and 3.13 ± 0.45, 2.29 ± 0.33, and 1.66 ± 0.23, in the normal group, respectively. The SUVmax and SUVmean of the liver and SUVmean of the mediastinal blood pool in the impaired renal function group were significantly higher than those in the normal group (p < 0.001, < 0.001, and < 0.001, respectively). The SUVmax and SUVmean of the liver and SUVmean of the mediastinal blood pool of patients showed a significant negative correlation with the eGFR (Spearman's p = -0.25, -0.30, and -0.40, respectively, each p < 0.001). FDG uptake in both the liver and mediastinal blood pool was higher in patients with impaired renal function.

Impact of Renal Insufficiency on Prognosis of Patients with Acute Coronary Syndrome.

PurposeChronic kidney disease (CKD) is common in patients admitted with acute coronary syndrome (ACS), and it is associated with poor outcomes. However, data are limited. Hence, we examined the long-term prognostic significance of estimated glomerular filtration rate (eGFR) among Chinese patients hospitalized with ACS.Patients and MethodsThis is a multicenter, observational study that included 1860 ACS patients enrolled between March 2014 and June 2019 from 11 hospitals in Chengdu. CKD-EPI equation was used to calculate the baseline eGFR. Patients were divided into three groups: eGFR ≥ 90 mL/min (normal renal function), eGFR 60 to <90 mL/min (mild impaired renal function), and eGFR < 60 mL/min (moderate or severe renal dysfunction). The endpoint was all-cause death during follow-up.ResultsAt baseline, 714 patients had normal renal function, while 746 patients had mild impaired renal function, and 400 patients had moderate or severe renal dysfunction. In the follow-up of 15 months (10 months, 22 months), 261 (14.0%) patients died;, 139 (34.8%) in the moderate or severe renal dysfunction group, 94 (12.6%) in the mild impaired renal function group, and 28 (3.9%) in the normal renal function group (log-rank p-value from Kaplan–Meier analysis <0.001). In multivariable Cox Proportional hazard analysis, age, systolic blood pressure (SBP), heart rate, eGFR, ST-elevation myocardial infarction (STEMI), and percutaneous coronary intervention (PCI) were independent predictors of all-cause death.ConclusionIn this study, among Chinese patients with ACS, renal insufficiency was associated with unfavorable long-term prognosis. Age, SBP, heart rate, eGFR, STEMI, and PCI could identify those at risk.

Texture analysis based on quantitative magnetic resonance imaging to assess kidney function: a preliminary study.

Magnetic resonance imaging (MRI) has demonstrated its potential in the evaluation of renal function. Texture analysis (TA) is a novel technique to quantify tissue heterogeneity. We aim to investigate the feasibility of using TA based on the apparent diffusion coefficient (ADC), as well as T1 and T2 maps to evaluate renal function. Patients with impaired renal function and subjects with a normal renal function who underwent renal diffusion weighted imaging (DWI), as well as T1 and T2 mapping at 3T, were prospectively enrolled. The participants were classified into four groups according to the estimated glomerular filtration rate (eGFR, mL/min/1.73 m2): normal (eGFR ≥90), mildly impaired (60≤ eGFR <90), moderately impaired (30≤ eGFR <60), and severely impaired (eGFR <30) renal function groups. Texture features quantified from the renal cortex or medulla were selected to build classifiers to discriminate different renal function groups by plotting receiver operating characteristic (ROC) curves and calculating the area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). In total, 116 candidates were included (94 patients and 22 healthy volunteers, mean age 37.9±14.9 years). There were 46 participants in the normal renal function group, 14 in the mildly impaired renal function group, 27 in the moderately impaired renal function group, and 29 in the severely impaired renal function group. Texture features from the ADC and T1 maps exhibited a good correlation to eGFR. The AUC, sensitivity, specificity, PPV, and NPV to differentiate between the normal and impaired renal function groups were 0.835, 0.792, 0.867, 0.905, and 0.722, respectively; to differentiate between the mildly impaired and moderately impaired groups were 0.937, 0.889, 0.857, 0.923, and 0.800, respectively; and to differentiate between the moderately impaired and severely impaired groups was 0.940, 0.759, 0.889, 0.880, and 0.774, respectively. TA based on ADC and T1 maps is feasible for evaluating renal function with relatively good accuracy.

Predictive performance of reported vancomycin population pharmacokinetic model in patients with different renal function status, especially those with augmented renal clearance

BackgroundThere is a significant correlation between augmented renal clearance (ARC) and lower serum trough concentrations of vancomycin (VCM) during therapy. There is a need to evaluate the predictive performance of...

Association between Blood Pressure and Renal Progression in Korean Adults with Normal Renal Function.

BackgroundAlthough hypertension (HTN) is a well-established major risk factor for renal progression in patients with chronic kidney disease (CKD), few studies investigating its role in renal deterioration in the general population with normal renal function (NRF) have been published. Here, we analyzed the correlation between blood pressure (BP) and impaired renal function (IRF) in Korean adults with NRF.MethodsData for the study were collected from the national health screening database of the Korean National Health Insurance Service. Patients whose baseline estimated glomerular filtration rate (eGFR) was less than 60 mL/min/1.73 m2 or whose baseline urinalysis showed evidence of proteinuria were excluded. IRF was defined as an eGFR below 60 mL/min/1.73 m2. We performed follow up for eGFR for 6 years from 2009 to 2015 and investigated IRF incidence according to baseline BP status. We categorized our study population into two groups of IRF and NRF according to eGFR level in 2015.ResultsDuring 6 years of follow-up examinations, IRF developed in 161,044 (2.86%) of 5,638,320 subjects. The IRF group was largely older, and the incidence was higher in females and patients with low income, HTN, diabetes mellitus, dyslipidemia, and obesity compared with the NRF group. Subjects whose systolic BP was more than 120 mmHg or whose diastolic BP was more than 70 mmHg had an increased risk of developing IRF compared with subjects with lower BP (odds ratio [OR], 1.037; 95% confidence interval [CI], 1.014–1.061 vs. OR, 1.021; 95% CI, 1.004–1.038).ConclusionBP played a major role in renal progression in the general population with NRF. Strict BP control may help prevent CKD in the general population.

Clinical impacts of changes of renal function during hospitalization depend on grades of renal dysfunction in acute decompensated heart failure.

Clinical impact of changes of renal function (RF) in heart failure (HF) hospitalization is controversial. This study aimed to clarify whether clinical impact of changes of RF during HF hospitalization depends on the intrinsic RF. In 786 hospitalized HF patients, RF were classified into 3 grades based on estimated glomerular filtration rate (eGFR, mL/min/1.73m2) at discharge; ≥ 60 (n = 243), < 60 and ≥ 30 (n = 400), and < 30 (n = 143). Increase and decrease of serum creatinine over 0.3mg/dL during HF hospitalization were defined as worsening renal function (WRF) and improved renal function (IRF), respectively, and remaining subjects were defined as stable RF. The primary endpoint was a composite of cardiovascular death and rehospitalization for HF. In all patients, WRF was not associated with clinical outcomes, although eGFR has a significant association with prognosis. Clinical outcomes did not differ between changes of RF patterns in both preserved and severely impaired RF groups. In contrast, IRF, not WRF, was an independent predictor of clinical outcomes in the moderately impaired RF group (HR 1.965, 95% CI 1.09-3.18, p = 0.01). Only in patients with moderately impaired RF, changes of RF were associated with clinical outcome, and IRF was an independent predictor of clinical outcomes.

Usefulness of a Pretreatment CT-Based Modified RENAL Nephrometry Score in Predicting Renal Function After Cryotherapy for T1a Renal Mass.

We investigated the usefulness of the modified RENAL nephrometry (mRN) scoring system for predicting post-cryotherapy renal function in patients with T1a renal mass. A total of 75 patients with a T1a renal mass were enrolled. The mRN score was determined based on the tumor size, the tumor's exophytic/endophytic properties, the tumor's nearness to the collecting system, and the anterior/posterior location of the kidney. The change in the estimated glomerular filtration rate (ΔeGFR) was calculated as follows: ΔeGFR = 100 × ([pretreatment eGFR - eGFR at 6months after cryotherapy]/pretreatment eGFR). Based on the ΔeGFR results, we classified the patients into two groups: a preserved renal function group (ΔeGFR < 10%) and an impaired renal function group (ΔeGFR ≥ 10%). We then analyzed the relationships between the mRN score and ΔeGFR and between the mRN score and the chronic kidney disease (CKD) stage. The mean ΔeGFR for all patients was 5.5%. The mRN scores of the preserved renal function group (5.8 ± 0.3) were significantly lower than those of the impaired group (7.4 ± 0.3) (p < 0.001). When the mRN score cutoff value was set at 7 points, the mRN had 67.7% sensitivity, 72.7% specificity, 61.8% positive predictive value (PPV), 76.1% negative predictive value (NPV), and 70.7% accuracy for predicting impaired renal function. For predicting a deterioration of CKD stage, the mRN had 92.9% sensitivity, 67.2% specificity, 39.4% PPV, 97.6% NPV, and 72% accuracy. Our newly proposed modified RENAL nephrometry score was suggested to be useful for predicting renal function after renal cryotherapy.

Imaging features of cerebral small vessel disease in systemic lupus erythematosus patients with impaired renal function and its associated risk factors

Objective To investigate the imaging features of cerebral small vessel disease(SVD) in systemic lupus erythematosus(SLE) patients with impaired renal function and their related risk factors. Methods Seventy-six SLE patients and forty age- and sex-matched healthy controls were recruited, and SLE patients were divided into the impaired renal function group [estimated glomerular filtration rate (eGFR) <90 ml/(min·1.73 m2)] (n=38) and the normal renal function group [eGFR≥90 ml/(min·1.73 m2)] (n=38) according to their eGFR. All subjects underwent brain MRI, cognitive and psychiatric testing. The SVD scores were measured, total white matter hyperintensity (WMH) and SVD scores were calculated, and the risk factors of SVD scores were analyzed by using ordinal logistic regression. Results SLE patients in the impaired renal function group showed higher basal ganglia PVS, centrum semiovale perivascular space (PVS), periventricular WMH, deep WMH and total SVD scores compared with normal controls or patients with normal renal function (H=44.568, 31.380, 31.172, 43.419, 24.317, P<0.001) . The ordinal logistic regression analysis showed that C-reactive protein was a risk factor for SVD in patients with SLE(OR=1.323, P<0.01). Conclusion SLE patients with impaired renal function had a higher SVD burden on MR imaging, particularly PVS in the basal ganglia and deep WMH, which was affected by the C-reactive protein level. Key words: Lupus erythematosus, systemic; Cerebral small vessel disease; Glomerular filtration rate; White matter lesions

Homocysteine as a predictive biomarker in early diagnosis of renal failure susceptibility and prognostic diagnosis for end stages renal disease

Glomerular filtration rate and/or creatinine are not accurate methods for renal failure prediction. This study tested homocysteine (Hcy) as a predictive and prognostic marker for end stage renal disease (ESRD). In total, 176 subjects were recruited and divided into: healthy normal group (108 subjects); mild-to-moderate impaired renal function group (21 patients); severe impaired renal function group (7 patients); and chronic renal failure group (40 patients) who were on regular hemodialysis. Blood samples were collected, and serum was separated for analysis of total Hcy, creatinine, high sensitive C-reactive protein (CRP), serum albumin, and calcium. Data showed that Hcy level was significantly increased from normal-to-mild impairment then significantly decreases from mild impairment until the patient reaches severe impairment while showing significant elevation in the last stage of chronic renal disease. Creatinine level was increased in all stages of kidney impairment in comparison with control. CRP level was showing significant elevation in the last stage. A significant decrease in both albumin and calcium was occurred in all stages of renal impairment. We conclude Hcy in combination with CRP, creatinine, albumin, and calcium can be used as a prognostic marker for ESRD and an early diagnostic marker for the risk of renal failure.

Impaired Renal Function is Associated with Severe Coronary Artery Disease in Chronic Stable Angina Patients

Background: Cardiovascular disease is the leading cause of morbidity and mortality in renal impaired patients. Many of the patients of chronic kidney disease die of cardiovascular disease before requiring dialysis. Cardiovascular disease in renal impaired patient is potentially preventable and treatable. The aim of this study was to evaluate the association between renal impairment and coronary artery disease severity in chronic stable angina patients. Methods: 110 patients with chronic stable angina who got admitted for coronary angiography were included in the study. They were divided into impaired renal function group (with estimated glomerular filtration rate [eGFR] &lt;90 ml/min/1.73m2) and normal renal function group (eGFR e” 90 ml/min/1.73m2) on the basis of eGFR. The severity of the CAD was assessed by angiographic Vessel score and Gensini score. Results: Mean Gensini score was significantly high in impaired renal function group (42.30±24.9 vs 25.65±17.9, p &lt;0.05). There was significant negative correlation between eGFR and vessel score (r=-0.30, p &lt;0.05) and between eGFR and Gensini score (r =-0.65, P &lt;0.05). In multivariate logistic regression analysis, after adjustment of factors eGFR remain independent predictors of severe CAD (P=0.002, OR -5.73). Conclusion: Impaired renal function, assessed by eGFR is associated with angiographic severe coronary artery disease in chronic stable angina patients and this association is independent of conventional cardiovascular risk factors. DOI: http://dx.doi.org/10.3329/cardio.v7i1.20796 Cardiovasc. j. 2014; 7(1): 17-23

Mild to Moderate Renal Impairment Is Associated With No-Reflow Phenomenon After Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction.

We investigated whether admission estimated glomerular filtration rate (eGFR) values are associated with no-reflow phenomenon in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). Patients (n = 673; 59 ± 13 years; 77.1% men) were stratified into 3 groups according to eGFR at admission: normal renal function (eGFR ≥ 90 mL/min/1.73 m2), mild renal impairment (eGFR 60-89 mL/min/1.73 m2), and moderate renal impairment (eGFR 30-59 mL/min/1.73 m2). No-reflow phenomenon was defined as thrombolysis in myocardial infarction flow grade <3 after pPCI. The rate of no-reflow gradually increased from the normal renal function group to the moderate impaired renal function group (P < .001). Multivariate analysis showed that eGFR (odds ratio [OR] 0.942, P < .001), Killip ≥2 class (OR 3.968, P = .008), left ventricular ejection fraction (OR 0.959, P = .034), and early patency of infarct vessel (OR 0.186, P < .001) were independent predictors of no-reflow phenomenon. Mild to moderate renal impairment at admission is independently associated with no-reflow phenomenon after pPCI.

The incidence and risk factors of stroke in patients with acute myocardial infarction treated invasively and concomitant impaired renal function

Impaired renal function is a marker of poor prognosis in patients with acute myocardial infarction (AMI). The aim of the study was to assess the incidence and independent predictors of stroke in population of patients with AMI treated invasively and concomitant impaired renal function (IRF). We analyzed 2,520 consecutive AMI patients admitted to our Center between 2003 and 2007 and treated with percutaneous coronary intervention. The whole population was divided into patients with IRF, defined as glomerular filtration rate < 60 mL/min/1.73 m(2) or contrast induced nephropathy (IRF group, n = 933; 37.02%) and patients without IRF (control group, n = 1587; 62.98%). The IRF group was subjected to further analysis. Data on long-term follow-up were screened to identify the patients who experienced stroke. During median of 25.5 months of follow-up 52 (2.07%) the patients experienced stroke - 33 (3.54%) in the IRF group and 19 (1.2%) patients in the control group. The risk of major adverse cardiovascular events in the IRF group, including repeated AMI (68.8 vs.14.9%, p < 0.001) and death (45.5 vs. 25.1%, p < 0.05) was significantly higher in patients with stroke. Previous stroke (HR 6.85), female gender (HR 3.13), as well as STEMI anterior (HR 2.55) were independent risk factors of stroke in this population. Patients with AMI treated invasively and concomitant IRF were at higher risk of stroke occurrence in the future. Stroke was associated with poor outcome in the studied population. Independent predictors of stroke in patients with IRF and AMI treated invasively were different from commonly recognized stroke predictors.

Impairment of Renal Function in Eclampsia

Objective: Aim of the study is to identify changes that occur in renal function in eclampsia patients and to determine the effect of impaired renal function on pregnancy outcome Materials and Methods: This cross-sectional study on the impairment of renal function in eclamptic patients was carried out in the Eclampsia ward of Dhaka Medical College Hospital from July 2009 to December 2009. Study group comprised of 50 diagnosed cases of eclampsia and 50 patients with uncomplicated pregnancy was taken as control. Results: In this study 30% of the eclamptic patients were found to have impairment of renal function. Incidence of impaired renal function was significantly increased among the patients &gt; 25 years of age. Multigravida eclamptic patients were found to be more prone to develop impaired renal function compared to primigravida patients. Blood pressure was significantly increased and platelet count was significantly low in the impaired renal function group of eclamptic patients compared to the normal renal function group. Incidence of foetal complications was significantly higher among the patients with impaired renal function. The eclamptic patients who had proteinuria of &gt;1 gm in 24 hours had more foetal complications than those who had protienuria of &lt;1 gm/day.Conclusion: It has been observed that impairment of renal function is common among the patients with eclampsia. So, special attention should be paid to assess renal function in this group of patient DOI: http://dx.doi.org/10.3329/bjog.v26i1.13758 Bangladesh J Obstet Gynaecol, 2011; Vol. 26(1) : 31-36

Renal Function Impairment (creatinine>=2mg/dL) Limits Progress Noted with the Transition From Total Therapies TT1 to TT2 to TT3 Across Age Groups

AbstractAbstract 1962Older age and higher serum creatinine levels have long been considered adverse features for overall survival (OS) and progression-free survival (PFS) in MM. Here we are reporting on these variables and their impact on clinical outcomes with the evolution of TT protocols. Among patients <55yr, median OS was 6.4yr with TT1 with 30% alive at 15yr and 12.2yr with TT2. KM curves for TT2 and TT3 were superimposable and medians have not been reached for TT3. (p<0.0001) (Figure 1). The proportions alive were 30% at 15yr in TT1, 60% at 10yr in TT2, and 80% at 5yr in TT3. Median PFS was 2.7yr with TT1, 6.0yr with TT2, and not reached with TT3; ∼10% remain event-free from 15 to 20 years in TT1, 40% at 10yr in TT2, and almost 60% at 5yr in TT3 (p<0.0001). For the middle age group 55–64yr, 15% are alive at 15yr in TT1, 40% at 10yr in TT2, and 75% at 5yr in TT3 (p=0.006). The corresponding PFS was ∼10% at 15yr with TT1, 25% at 10yr with TT2, and 70% at 5yr with TT3 (p<0.0001). For patients >64yr, median OS was 3.3yr with TT1, 6.5yr with TT2, and not reached with TT3 (p=0.01); 15% are alive at 10yr with TT1, 30% at 10yr with TT2, 70% at 5yr with TT3. PFS was 1.9yr with TT1, 3.8yr with TT2 and not reached with TT3; No patients remain at 16yr with TT1, 30% at 10yr with TT2, and 65% at 5yr with TT3. Within protocols, age effects on OS were most apparent in TT1; with TT2 those <55yr outperformed the 2 older age groups, and no significant age difference was apparent for TT3. As to renal function, creatinine >=2 mg/dL was significantly linked to inferior OS in all 3 trials, with medians of 3.6yr v 6.1yr in TT1, 4.1yr v 9.1yr in TT2, and ∼50% v 75% alive at 5yr in TT3 (p=0.008,p=0.001,p=0.002) (Figure 2). PFS was 2.5yr with TT1 regardless of renal function(p=0.36), 3yr v 4.9yr with TT2 (p=0.002), and ∼40% v 70% at 5yr with TT3 (p<0.0001). Thus, major advances in both OS (p<0.0001) and PFS (p<0.0001) were observed with the transition from TT1 to TT2 to TT3 among patients with creatinine <2 mg/dL, whereas results remained dismal for the more impaired renal function group (OS: p=0.22, PFS: p=0.42). Accounting for all possible interactions between TT trial, age, and creatinine, multivariate logistic regression to predict 4-yr OS and 4-yr PFS showed consistently improved OR for OS with TT3>TT2>TT1 regardless of age groups; 4-yr PFS also benefited from TT3>TT2>TT1, but this was most clearly seen in the 55–64yr age group. Significant interactions with creatinine were not observed but levels >=2mg/dL remained an independent dominant adverse variable (OS: OR=2.31, p<0.0001; PFS: OR=2.11, p<0.0001) (Table 1). In conclusion, treatment advances have been realized in patients with preserved renal function across age groups. The poor outcome in patients with creatinine >=2.0mg/dL may not only reflect host- but also MM-related issues. Delaying more toxic VTD-PACE induction until improvement in renal function with VTD for 1 or 2 cycles may improve clinical outcomes. [Display omitted] [Display omitted] Table 1Multivariate Logistic Regression on Age, Creatinine and ProtocolStepwise selection was used to determine the best models for 4-year OS and PFS in TT1-3. All 2-way (i.e. TT by Age) and 3-way (i.e. TT by Age by Creatinine) interactions were considered for inclusion in the logistic models. The lack of any significant interactions with Creatinine may be due to the small number of patients enrolled to TT trials with Creatinine >= 2 mg/dL.EndpointOR ComparisonOR (95% CI)p-value4-year OSTT2 v TT10.58 (0.42, 0.81)0.0013TT3 v TT20.77 (0.59, 1.01)0.0623Age 55–64 v Age < 551.77 (1.34, 2.34)<.0001Age >= 65 v Age 55–641.25 (0.92, 1.71)0.1596Cr >= 2mg/dL2.31 (1.57, 3.41)<.00014-year PFSTT2 v TT1 Age < 550.28 (0.18, 0.43)<.0001TT3 v TT2 Age < 550.75 (0.49, 1.15)0.1881TT2 v TT1 Age 55–640.55 (0.31, 0.99)0.0463TT3 v TT2 Age 55–640.33 (0.22, 0.51)<.0001TT2 v TT1 Age >= 650.63 (0.25, 1.64)0.3459TT3 v TT2 Age >= 650.59 (0.36, 0.97)0.0385Cr >= 2mg/dL2.11 (1.41, 3.16)0.0003 Disclosures:No relevant conflicts of interest to declare.

Prognostic Significance of Hyperuricemia in Patients with Different Types of Renal Dysfunction and Acute Myocardial Infarction Treated with Percutaneous Coronary Intervention

Aim: This study evaluated the impact of hyperuricemia (HUR) on outcome in patients with different types of impaired renal function (IRF) and acute myocardial infarction (AMI) treated invasively. Methods: Out of 3,593 consecutive AMI patients treated invasively, 1,015 IRF patients were selected. The IRF group consisted of patients with baseline kidney dysfunction (BKD group) and/or patients with contrast-induced nephropathy (CIN group). HUR was defined as a serum uric acid concentration (SUAC) >420 µmol/l (>7 mg/dl). Independent predictors of death and major adverse cardiovascular events (MACE) were selected by the multivariate Cox-regression model. Results: Remote mortality rates were higher in HUR patients: IRF (32.7 vs. 18.6%), BKD (41.3 vs. 25.9%), CIN (35.4 vs. 16.7%); all p < 0.001. HUR was an independent predictor of death in BKD (hazard ratio (HR) 1.38, p < 0.05). Each 100-µmol/l increase in SUAC was associated with a significant increase of HR for mortality: 1.087 in IRF patients, 1.108 in BKD patients, 1.128 in CIN patients; all p < 0.05. Remote major adverse cardiovascular event rates were higher in HUR patients: IRF (55.4 vs. 48.9%), CIN (56.8 vs. 48%); both p < 0.05. Conclusions: In AMI patients treated invasively, an increase in SUAC is an independent predictor of death within all types of renal dysfunction; HUR defined as SUAC >420 µmol/l (>7 mg/dl) is a predictor only in BKD patients.

Reperfusion Strategy and Mortality in ST-Elevation Myocardial Infarction among Patients with and without Impaired Renal Function

Several randomised controlled trials have demonstrated better outcomes with primary percutaneous coronary intervention (PCI) over fibrinolytic therapy in the treatment of patients with ST-segment elevation myocardial infarction (STEMI) and normal renal function. Whether this benefit extends to patients with impaired renal function is uncertain. We studied 1672 patients with STEMI within 12 hours of symptom onset who were admitted to 2 major public hospitals in Singapore from 2000 to 2002. All patients received either upfront fibrinolytic or PCI as determined by the attending cardiologist. Serum creatinine was measured on admission and the glomerular filtration rate (GFR) was determined using the Modification of Diet in Renal Disease equation. The impact of reperfusion strategy on 30-ay mortality was then determined for patients with GFR > or =60 mL min-(1) 1.73 m-(2) and GFR <60 mL min-(1) 1.73 m-(2). The mean age was 56 +/- 12 years (85% male) and mean GFR was 81 +/- 30 mL min-(1) 1.73 m-(2). Unadjusted 30-day mortality rates for fibrinolytic-treated vs primary PCI-treated patients were 29.4% vs 17.9%, P <0.05, in the impaired renal function group and 5.4% vs 3.1%, P <0.05, in the normal renal function group. After adjusting for covariates, primary PCI was associated with a significantly lower mortality in the normal renal function group [odds ratio (OR), 0.41; 95% confidence interval (CI), 0.19-0.89] but not in the impaired renal function group [OR, 0.70; 95% CI, 0.31-1.60]. Primary PCI was associated with improved 30-day survival among patients with normal renal function but not among those with impaired renal function. Randomised trials are needed to study the relative efficacy of both reperfusion strategies in patients with impaired renal function.

Increased Nitric Oxide and Attenuated Diastolic Blood Pressure Variability in African Americans with Mildly Impaired Renal Function

We investigated the relationship between renal function, blood pressure variability (BPV), and nitric oxide (NO) in a group of African Americans with normal or mildly impaired renal function. 24-hour ambulatory blood pressure monitoring was performed, NO measured, and glomerular filtration rate (GFR) calculated in 38 African Americans. Participants were categorized as having normal (GFR > 90 mL/min per 1.73 m2) or mildly impaired (GFR 60–89 mL/min per 1.73 m2) renal function. Diastolic BPV was significantly lower in the mildly impaired renal function group. Regression analyses revealed a significant positive association between GFR and diastolic BPV for the entire study group. Plasma NO levels were significantly higher in the mildly impaired renal function group and negatively correlated with diastolic BPV. In conclusion, diastolic BPV was reduced in African Americans with mildly impaired renal function, which may be the result of increased NO production. These results conflict with previous findings in diseased and nonblack populations and could provide rationale for studying BPV early in the disease state when BP-buffering mechanisms are still preserved.

A Retrospective Review Assessing the Efficacy and Safety of Nitrofurantoin in Renal Impairment

Background: Nitrofurantoin (NF) is an antibiotic commonly used to treat uncomplicated urinary tract infections (UTIs). Although NF is contraindicated in patients with an estimated glomerular filtration rate (GFR) of less than 60 mL/min, the evidence demonstrating its lack of efficacy and an increased rate of adverse reactions in these patients is marginal. Methods: A retrospective chart review was conducted to determine the efficacy and safety of NF in patients with a UTI and an estimated GFR ≤50 mL/min (impaired renal function group) compared to &gt;50 mL/min (control group). Results: A total of 356 patients met our inclusion criteria. The Modified Cockcroft-Gault equation was used to estimate GFR. The point estimate for cure rate in the impaired renal function group was 71% (95% CI 63–79), versus 78% (95% CI 73–84) for the control group. Conclusions: Similar NF cure rates were observed in patients with impaired renal function (estimated GFR ≤50 mL/min) and patients in the control group (estimated GFR &gt;50 mL/min). The occurrence of adverse events was comparable between the 2 groups.

Percutaneous nephrolithotomy in patients with normal versus impaired renal function

This study aimed to compare the results of percutaneous nephrolithotomy (PCNL) in patients with impaired renal function (IRF) and normal renal function (NRF). Records of 300 consecutive patients who underwent PCNL from July 2002 to July 2005 were retrospectively reviewed. Nineteen patients (6.3%) had serum creatinine values higher than 1.5 mg/dl before surgery (IRF Group). Nineteen gender and age matched patients with normal renal function were chosen as controls (NRF Group). The surgical parameters, outcome, and complication rates were compared. The effect of PCNL on the renal function was assessed in patients with IRF. There were 13 male and 6 female patients in both groups. In the IRF group, seven patients had a solitary kidney and three had bilateral stones. Thus, PCNL was performed on 22 kidneys. No patients in the NRF Group had solitary kidney or bilateral stones and PCNL was performed on 19 kidneys. There were no statistically significant differences between the two groups for success and complication rates (P = 0.376 and P = 0.184, respectively). In a mean follow-up of 15.6 months, mean serum creatinine decreased from 2.8 to 2.6 mg/dl (P = 0.273) in patients of the IRF group. Similar stone clearance and complication rates were obtained with PCNL in patients with impaired and normal renal function. Surgery does not cause biochemical deterioration in patients with compromised renal function before treatment.

Macroalbuminuria Is a Better Risk Marker than Low Estimated GFR to Identify Individuals at Risk for Accelerated GFR Loss in Population Screening

Macroalbuminuria, erythrocyturia, and impaired renal function are strong predictors of poor renal outcome in patients with known renal disease. However, the yield of mass screening for these variables to identify individuals who are at risk for GFR loss is yet unknown in a Western population. With the use of data from the Prevention of Renal and Vascular End-Stage Disease (PREVEND) study, a prospective, population-based cohort study, the cardiovascular and renal prognosis was investigated in patients with classical renal risk markers: Macroalbuminuria (> or =300 mg albumin/24 h urine), erythrocyturia (> or =250 erythrocytes/L, without leukocyturia), and impaired renal function (both 24-h creatinine clearance and Modification of Diet in Renal Disease clearance below the fifth percentile of age- and gender-matched control subjects). The 8592 patients who were included in this study were followed for a 4-yr period. We identified 134 patients with macroalbuminuria, 128 with erythrocyturia, and 103 with impaired renal function. There was only a little overlap among the three groups. The prevalence of macroalbuminuria, erythrocyturia, and impaired renal function was calculated to be in the general population 0.6, 1.3, and 0.9%, respectively. In all three groups, fewer than 30% of patients were known to have this laboratory abnormality before screening. The incidence of cardiovascular disease was high in the macroalbuminuria group (e.g., the age- and gender-adjusted hazard ratio for mortality as a result of cardiovascular disease is 2.6 [1.1 to 6.0]) and for the impaired renal function group (3.4 [1.5 to 8.0]). After a mean follow-up of 4.2 yr, the macroalbuminuria group showed a -7.2 ml/min per 1.73 m2 estimated GFR (eGFR) loss, compared with -2.3 ml/min per 1.73 m2 in the control group (difference P < 0.001), whereas the rate of eGFR loss in the impaired renal function group (-0.2 ml/min per 1.73 m2; P = 0.18) and the erythrocyturia group (-2.6 ml/min per 1.73 m2) was not different from the control group. Macroalbuminuria and impaired renal function both predict a worse prognosis with respect to cardiovascular morbidity and mortality. However, macroalbuminuria is a better risk marker than low eGFR or erythrocyturia to identify in population screening of individuals who are at risk for accelerated GFR loss.