Chronic Kidney Disease Levels Research Articles

#2897 Urinary CD44 levels in chronic kidney disease: a validation study

Abstract Background and Aims Proteinuria is the one of the main cause of kidney failure progression. There is inadequate data about protein components in urine and CKD severity. Our recent urinary proteomics study demonstrated the higher expression of CD44 in the urine proteome of healthy participants compared to CKD patients, arguing the protective role of CD44 in kidney health. However, the validation study needed to proof those differences in CD44 levels by ELISA tests in healthy participants and CKD patients. Therefore, we aimed to investigate urinary CD44 levels in our previously studied cohort of healthy controls and CKD patients using ELISA test. Method This study included 49 healthy participants and 88 early-stage CKD patients. Along with routine laboratory tests, 24 h collected urine samples were investigated using liquid chromatography-mass spectrometry (HPLC-MS) for proteomic analysis. Exponentially Modified Protein Abundance Index (emPAI) was used to estimate peptide count of proteins. Additionally, urinary CD44 levels were measured using ELISA kit to validate findings from proteomic study. Results A brief baseline characteristics of study population presented in Table 1. CKD group represented with lower eGFR, increased creatinine and higher proteinuria compared to healthy controls. Urinary CD44 levels were significantly higher in CKD group compared to healthy controls. Both CD44 levels measured by HPLC-MS and ELISA methods significantly positively correlated with eGFR levels (Table 2). Conclusion In this validation study, we compared the levels of CD44 measured by HPLC-MS and ELISA in healthy controls and CKD patients. We demonstrated that CD44 is overexpressed in urine samples of healthy people compared to CKD patients and may play a protective role in the kidney health. Further investigations needed to explain this finding in a different cohort and large number of CKD patients.

Correlation of serum fibroblast growth factor-23 levels and calcium phosphate products levels in chronic kidney disease; sub analysis of chronic kidney disease-mineral and bone disorder study

<em data-sider-select-id="0e59b1fc-fce5-41b4-b987-316daa778de4">Introduction: The body produces fibroblast growth factor-23 (FGF-23) to maintain normal phosphate levels when hyperphosphatemia occurs. Production of FGF-23 indirectly causes hypocalcemia. Phosphate and calcium disturbances also occur in chronic kidney disease (CKD), therefore this adaptation mechanism applies. This situation; however, only manifests in the early stages of CKD; if the estimated glomerular filtration rate (eGFR) is less than 30% of normal. This adaptation is no longer adequate and levels of calcium-phosphate (Ca×P) products and FGF-23 still rise. <em data-sider-select-id="f0dc3bf1-1598-419e-9de6-fe837eadc8e6">Objectives: In this study, the correlation between both the serum levels of FGF-23 and Ca×P products in CKD was analyzed. <em data-sider-select-id="a367eeb1-7c32-4bf0-98ef-e6ae52522dc7">Patients and Methods: A cross-sectional study including 78 subjects with CKD stages 3 to 5 dialysis was conducted. Serum FGF-23 levels were determined using the enzyme-linked immunosorbent assay (ELISA) method and Ca×P product levels were calculated using the formula calcium (mg/ dL) × phosphate (mg/dL). The Kolmogorov-Smirnov test and Spearman’s test were conducted in the statistical study. If the P value is less than 0.05, the statistical findings are significant. <em data-sider-select-id="e286c166-6c09-432e-b832-c902b1a13b81">Results: Serum FGF-23 levels and Ca×P product levels were shown to be significantly correlated. This analysis of the two correlations was independent of age and diabetes mellitus (DM). Based on stages of CKD, serum FGF-23 levels and Ca×P product levels were discovered to be significantly correlated only at stage 5 of non-dialysis. <em data-sider-select-id="9b3534d4-deaa-4ccf-8b82-745bb5380661">Conclusion: Increasing serum FGF-23 levels were correlated with increased Ca×P product levels, particularly in CKD stage 5 non-dialysis subjects. This correlation was independent of age and DM.

Safety and Efficacy of Dotinurad on Uric Acid in Patients With Chronic Kidney Disease With Estimated Glomerular Filtration Rate Below 25 mL/Min/1.73 m².

Introduction Dotinurad is being developed as a selective uric acid reabsorption inhibitor. However, its effect on lowering serum uric acid (UA) levels in chronic kidney disease (CKD) patients with severe renal dysfunction is unknown. Therefore, the purpose of this study was to determine the effect of dotinurad on renal function in CKD patients with an estimated glomerular filtration rate (eGFR) below 25 mL/min/1.73 m2. Methods Seven patients with CKD who received dotinurad 0.5 mg to 4 mg per day were studied retrospectively. Changes in UA, eGFR, and urine protein-to-creatinine ratio (UPCR) were analyzed. The observation period was 10.9±2.1 months. Results Serum UA levels were decreased and maintained with dotinurad administration. Nevertheless, there were no improvements noted in renal function. Additionally, no serious adverse effects were identified in any of the patients throughout the observation period. Conclusion Although the sample size in this study was small, our findings demonstrate the efficacy of dotinurad in individuals with advanced CKD who have an eGFR lower than 25 mL/min/1.73 m2.

Troponin efficacy in the diagnosis of acute coronary syndrome in patients with chronic renal failure.

There is no consensus on whether cardiac troponins with high reliability values should be different diagnostic criteria for acute myocardial infarction in patients with and without renal dysfunction. Although it is often emphasized that the etiology of elevated troponin levels in chronic kidney disease (CKD) remains unclear, elevated cardiac troponin (cTnT) levels have been associated with increased subclinical cardiac damage in these patient groups. In this study, we investigated the value of cTnT value in diagnosing acute coronary syndrome in CKD patients with high clinical suspicion of acute coronary syndrome and without acute ST segment elevation on electrocardiogram. The aim was to prevent cardiac ischemia from being overlooked in CKD patients. Coronary angiography revealed vessel occlusion in 192 patients, and the mortality rate after treatment decisions was 6.7%. The first measured troponin results showed a significant difference in patients who did not survive, indicating the prognostic value of troponin levels. Troponin values were compared with cardiovascular pathologies obtained by angiography, and elevated troponin levels strongly correlated with pathologic angiography results. The conclusion highlighted that despite prognostic uncertainties, biomarkers used for acute myocardial infarction diagnosis in patients with renal insufficiency are reliable in those with renal dysfunction. Elevated cTnT levels in CKD patients are considered a clear marker of cardiac ischemia, emphasizing the need for careful consideration of troponin values in this population.

The effect of oral supplementation of Paricalcitol on C-reactive protein levels in chronic kidney disease patients: GRADE-assessed systematic review and dose-response meta-analysis of data from randomized controlled trials

BackgroundPrevious studies investigating the effect of oral supplementation of paricalcitol on reactive protein levels in chronic kidney disease (CKD) patients reported inconsistent findings. In this systematic review and meta-analysis, we have analyzed and interpreted the results obtained from previous randomized clinical trials on the effect of paricalcitol on C-reactive protein in CKD patients in the literature.MethodsMEDLINE, SciVerse Scopus, and Clarivate Analytics Web of Science databases were searched until January 2023 and related articles were obtained through a careful screening process allowing extraction of required data from selected articles. The effect size was calculated using a random effect model and weighted mean differences (WMD) and 95% confidence intervals (CI). Heterogeneity among studies was evaluated using Cochran’s Q test and I2.ResultsAmongst the 182 articles obtained from the initial search, 4 studies (6 arms) were finally included in the meta-analysis. Pooled analysis shows that C-reactive protein levels significantly decrease after oral supplementation with paricalcitol (WMD: -2.55 mg/L, 95% CI (-4.99 to -0.11; P = 0.04). The studies used in this meta-analysis showed significant heterogeneity (I2 = 66.3% and P = 0.01).ConclusionOral paricalcitol supplementation in CKD patients can significantly reduce C-reactive protein levels, which may prevent CKD progression.

The Relationship between Lifestyle and Ureum Creatinine Levels in Chronic Kidney Disease (CKD) Patients at Kudungga Hospital, East Kutai

The aim of this study was to determine the relationship between lifestyle and urea creatinine levels in chronic kidney disease (CKD) patients at Kudungga Regional Hospital, East Kutai. The design of this research was cross sectional with a retrospective approach. The population is 43 patients with chronic kidney failure at Kudungga Regional Hospital from January to March 2023. The sampling technique used total sampling, so the sample totaled 43 patients. Data analysis used the independent sample t test. The characteristics of the respondents were mostly aged between 46-55 years (27.9%), female gender (55.8%), completed high school education (37.2%) and occupation as a housewife (51.2%). The lifestyle of chronic kidney disease patients is unhealthy (58.1%), abnormal urea levels (74.4%) and abnormal creatinine levels (74.4%). There is a relationship between lifestyle and urea levels (p value 0.000) and there is a relationship between lifestyle and creatinine levels (p value 0.002).

Cardiac Magnetic Resonance Imaging Versus Computed Tomography to Guide Transcatheter Aortic Valve Replacement (TAVR-CMR): A Randomized, Open-Label, Non-Inferiority Trial.

Background: Computed tomography (CT) is recommended for guiding transcatheter aortic valve replacement (TAVR). However, as a sizable proportion of TAVR candidates have chronic kidney disease (CKD), the use of iodinated contrast media is a limitation. Cardiac magnetic resonance (CMR) is a promising alternative, yet randomized data comparing the effectiveness of CMR- versus CT-guided TAVR are lacking. Methods: An investigator-initiated, prospective, randomized, open-label, non-inferiority trial was conducted at two Austrian heart centers. Patients evaluated for TAVR according to the inclusion (severe symptomatic aortic stenosis) and exclusion criteria (contraindication to CMR, CT, or TAVR, a life expectancy < 1 year, CKD 4 or 5) were randomized (1:1) to undergo CMR- or CT-guiding. The primary outcome was defined according to the Valve Academic Research Consortium-2 definition of implantation success at discharge, including absence of procedural mortality, correct positioning of a single prosthetic valve, and proper prosthetic valve performance. Non-inferiority was assessed using a hybrid modified intention-to-treat (mITT)/per-protocol (PP) approach based on an absolute risk difference margin of 9%. Results: Between September 11, 2017, and December 16, 2022, 380 candidates for TAVR were randomized to CMR-guided (191 patients) or CT-guided (189 patients) TAVR planning. Of these, 138 patients (72.3%) in the CMR-guided group and 129 patients (68.3%) in the CT-guided group eventually underwent TAVR (mITT cohort). Of these 267, 19 patients had protocol deviations, resulting in a PP cohort of 248 patients (n=121 CMR-guided, n=127 CT-guided). In the mITT cohort, implantation success was achieved in 129 patients (93.5%) in the CMR group and in 117 patients (90.7%) in the CT group (between-group difference, 2.8%; 90% confidence interval [CI]: -2.7 to 8.2%; p<0.01 for non-inferiority). In the PP cohort (n=248), the between-group difference was 2.0% (90% CI: -3.8 to 7.8%; p<0.01 for non-inferiority). Conclusions: CMR-guided TAVR was non-inferior to CT-guided TAVR in terms of device implantation success. CMR can therefore be considered as an alternative for TAVR planning.

The Effect of Sodium Bicarbonate Supplementation on Serum Alpha Klotho in Chronic Kidney Disease Patients Stage 3b to 4

Abstract Background Growing evidence suggests that the FGF–Klotho endocrine system also has a crucial role in the pathophysiology of ageing-related disorders, including diabetes, cancer, arteriosclerosis and chronic kidney disease. Aim of the Work The present study aimed to ascertain the potential significance of oral sodium bicarbonate supplementation on soluble α-Klotho serum levels in chronic kidney disease (stage 3b:4) according to CKD-EPI formula. Patients and Methods This was an uncontrolled clinical trial conducted on Inward and OPC patients at El-Demerdash Internal Medicine Hospital. The baseline values of plasma α-klotho were measured in 45 patients having CKD with an estimated glomerular filtration rate (eGFR) of (15:44) mL/min/1.73 m2 (according to CKD-EPI formula) with follow up plasma α-klotho after 3 months of taking sodium bicarbonate tabs orally 0.5 g/12 hrs. Results In our study, 14 (Fourteen) patients with Hypertension, 13 (Thirteen) patients Diabetes, 6 (Six) patients Glomerulus's nephritis, 6 (Six) patients Repeated urinary tract infection, 4 (Four) patient Recurrent stones, 4 (Four) patient Polycystic kidney and 2 (Two) patient Systemic lupus. The Klotho (pg/mL) Before ranged from 296.7 to 976.5 with mean 596.30 ± 202.89 and the Klotho (pg/mL) After ranged from 327.4 to 988.6 with mean 696.16 ± 185.32. The Hco3 before ranged from 17.6 to 22.5 with mean 19.74 ± 1.43 and the Hco3 After ranged from 15 to 28.3 with mean 23.63 ± 3.23. The current study showed that there was non statically significant correlation Between Klotho (pg/mL) and SPB, DPB, Pulse, Temperature, Respiratory rate. The present study showed that there was non statically significant correlation Between Klotho (pg/mL) and Platelets, Urea, Creat, U. creatinine, U. albumin, A/C Ratio, E-GFR, Na, K, Ca, Po4. There was Non statically significant correlation Between Klotho (pg/mL) and Hco3 Before, and there was statically significant Positive correlation Between Klotho (pg/mL)After and Hco3 After. Conclusion There was highly significant difference found between before and after sodium bicarbonate supplementation in terms of Klotho and Hco3 in chronic kidney disease patients stage 3b to 4.

CKD Knowledge and Its Associated Factors Among Patients with Type 2 Diabetes Mellitus Attending Follow-up in a Penang Primary Health Clinic

Objective: Information regarding the level of chronic kidney disease (CKD) knowledge and its associated factors among high-risk patients is crucial for the planning of CKD prevention strategies. This study aimed to determine the level of CKD knowledge and its associated factors among patients with a recent diagnosis of diabetes mellitus (DM) attending follow-ups at a primary healthcare clinic in Penang. Material and Methods: This cross-sectional study involved the consecutive sampling of 100 recently diagnosed DM patients (within 5 years) attending diabetic follow-up at the Kepala Batas Health Clinic. The level of CKD knowledge was assessed using a self-administered validated questionnaire. Demographic characteristics were described using frequencies, percentages, means and standard deviations. Associated factors of CKD knowledge were determined using multiple logistic regression analysis. The level of statistical significance was set at p-value&lt;0.05. Results: As high as 81.0% of the participants scored less than four out of seven marks for CKD knowledge. The mean score was 2.61, while the median score was 3.0. Educational level was identified as the single determinant of CKD knowledge among the study participants.Conclusion: In this study, patients with a recent diagnosis of DM attending follow-up in primary healthcare showed a poor level of CKD knowledge. To ensure the success of the CKD prevention programme among high-risk groups, healthcare providers must provide relevant and effective education to all diabetic patients in the early phase after DM diagnosis; particularly among those with a lower education background.

Effect of sevelamer on serum phosphorus levels in chronic kidney disease and hemodialysis patients; a systematic review and meta-analysis

Introduction: Hyperphosphatemia is an independent risk factor for mortality in chronic kidney disease (CKD) patients. Objectives: This systematic review and meta-analysis aimed to investigate the effect of Sevelamer on serum phosphorus levels in CKD and hemodialysis patients. Materials and Methods: The data were obtained after searching the international databases of Cochrane, PubMed, Scopus, Web of Science, and the Google Scholar search engine until February 28, 2023. The heterogeneity of articles was assessed using the I2 index. The data were analyzed in STATA 14, and P values &lt; 0.05 were considered significant. Findings: A total of 22 articles were assessed with a total sample size of 3221. Sevelamer reduced calcium levels in CKD and hemodialysis patients compared with those in the comparison group (standardized mean difference [SMD]: -0.67; 95% CI: -1.23, -0.11); however, sevelamer had no significant effect on serum parathyroid hormone (PTH) levels (SMD: 0.07; 95% CI: -0.39, 0.54) and Ca × P product (SMD: -0.20; 95% CI: -0.41, 0). A significant decrease in serum phosphorus level was observed in patients who had taken sevelamer for a maximum of 12 weeks compared with the comparison group (SMD: -0.27; 95% CI: -0.54, -0.01); however, no significant decrease in serum phosphorus level was observed in patients who had taken sevelamer for more than 12 weeks. A significant decrease in serum phosphorus level was observed in sevelamer users compared to placebo group members (SMD: -0.36; 95% CI: -0.68, -0.05). Conclusion: The administration of sevelamer reduced serum phosphorus levels in CKD and hemodialysis patients compared with those in the placebo group in the short term. Therefore, physicians are recommended to prescribe sevelamer for a maximum period of three months. Registration: This study has been compiled based on the PRISMA checklist, and its protocol was registered on the PROSPERO website (ID: CRD42023406804).

Impact of dietary education on blood cadmium and mercury levels in chronic kidney disease: a path to renal health improvement

Impact of dietary education on blood cadmium and mercury levels in chronic kidney disease: a path to renal health improvement

Chemerin levels in chronic kidney disease: A systematic review and meta-analysis.

Chemerin as an inflammatory biomarker has gained attention in its biomarker capability. Several studies measured its levels in chronic kidney disease (CKD), as one of the common non-communicable causes of mortality and morbidity. Hence, this systematic review and meta-analysis aimed to investigate this association. PubMed, Scopus, Embase, and the Web of Science databases were systematically searched for studies investigating chemerin levels in any CKD stage (including end-stage renal disease patients undergoing hemodialysis (HD)) and comparing it with healthy controls. Random effect meta-analysis was performed to calculate the standardized mean difference (SMD) and 95% confidence interval (CI). A total of eight studies were included, comprised of 875 individuals, with a mean age of 56.92 ± 11.78 years. All studies had high quality based on the New Castle-Ottawa Scale (NOS). Meta-analysis revealed significantly higher levels of chemerin in CKD patients compared to healthy controls (SMD 2.15, 95% CI 0.83-3.48, p-value<0.01). Additionally, HD patients had statistically higher levels of chemerin than controls (SMD 2.10, 95% CI 0.58-3.62, p-value=0.01). In meta-regression, publication year accounted for 23.50% and 24.17% of heterogeneity for these analyses, respectively. Chemerin can be potentially used as a biomarker in CKD patients, which can suggest the inflammatory pathways for the disease. Further research is warranted for the assessment of its clinical applications and enlightening its role in the pathophysiology of CKD.

Estimation of serum and salivary creatinine and urea levels in chronic kidney disease: A case–control study

Estimation of serum and salivary creatinine and urea levels in chronic kidney disease: A case–control study

Role of the gut microbiota and their metabolites in hemodialysis patients.

High serum phosphate levels in chronic kidney disease (CKD) are linked to adverse health outcomes, including cardiovascular disease, kidney disease progression, and all-cause mortality. This study is aimed to find out which microorganisms or microbial functions have a significant impact on higher calcium-phosphorus product (Ca x P) after they undergo hemodialysis (HD) treatment. Feces samples from 30 healthy controls, 15 dialysis patients with controlled Ca xP (HD), and 16 dialysis patients with higher Ca xP (HDHCP) were collected to perform in 16S amplicon sequencing. We found gut microbial composition was significantly different between hemodialysis patients and healthy controls. Three phyla including Firmicutes, Actinobacteria, and Proteobacteria were significantly enriched in hemodialysis patients. Although only one genus, Lachnospiraceae_FCS020_group, was significantly increased in higher Ca xP group, there were four metabolic pathways predicted by PICRUSt significantly increased in higher Ca xP group and associated with causing VC, including the pentose phosphate pathway, steroid biosynthesis, terpenoid backbone biosynthesis, and fatty acid elongation pathway. Characterizing dysbiosis of gut microbiome played the important role in hemodialysis patients.

Serum Magnesium Levels in Chronic Kidney Disease with and without Diabetes Mellitus and its Correlation with Calcium and Phosphate Levels: A Case-control Study

Introduction: Nearly 10% of the world population is affected by Chronic Kidney Disease (CKD). Hypermagnesaemia is seen in late stages of CKD whereas Diabetes Mellitus (DM) is commonly associated with hypomagnesaemia. Monitoring Mg levels and early correction may prevent the future risk for cardiovascular and CKD. Aim: To compare the serum Mg levels in healthy controls, diabetic patients without CKD, late stages of CKD with and without diabetes and to evaluate its correlation with serum phosphate and calcium levels in CKD patients. Materials and Methods: A case-control study was conducted in Vydehi Institute of Health Science from January 2018 to December 2019. A total of 100 participants were divided into four groups of 25 each. Group-I were healthy controls, GroupII were DM patients without CKD, Group-III CKD stage 3 and more without DM and Group-IV CKD stage 3 and more with DM. Serum creatinine, urea, estimated Glomerular Filtration Rate (eGFR), calcium, phosphorous and magnesium levels were estimated in all the groups. Analysis of Variance (ANOVA) and Pearson’s correlation was used to statistically analyse the data. Results: The Group-III participants who had CKD but no DM were relatively younger in age (mean age 48.5±5.5 years) compared to other groups and there was a significant difference in the age group between four groups (p-value 0.0113). Though there was a male preponderance in all the four groups, the gender difference was not significant. Significant difference in the Mg was observed between the four groups (p-value&lt;0.001). The DM group showed low serum magnesium. CKD patients with and without DM showed high but within reference range Mg levels. Sub-group analysis revealed DM patients on haemodialysis had lower Mg level as compared to non DM. Mg levels in CKD showed significant positive correlation with phosphorous levels (r-value 0.5002, p-value 0.0002). Conclusion: High levels of Mg in late stages of CKD are expected but CKD with DM had relatively low Mg level. Low Mg level was also seen in DM patients on haemodialysis.

New analysis of the comparative diagnostic performances of five different eGFR equations: The revised 2021 CKD-EPI eGFR, and the four older equations

Purpose: In 2021, the CKD-EPI-creatinine and CKD-EPI-creatinine-cystatin-C combined equations were revised again by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and the National Institute of Diabetes &amp; Digestive and Kidney Diseases (NIDDK) and it was reported that its accuracy was increased. The main object of this study is to compare the diagnostic accuracy and performance of 2009 CKD-EPI eGFRcr, 2012 CKD-EPI eGFRCysC, 2012 CKD-EPI eGFRcr-CysC, MDRD, and revised 2021 CKD-EPI to provide a better estimation.&#x0D; Materials and Methods: The study design was prospective. The sample consisted of 111 CKD patients and 35 healthy individuals who applied to the nephrology clinic. All participants were evaluated by a nephrologist. The participants were divided into study groups according to their KDIGO classification. Five variables were used: age, race, gender, serum creatinine, and serum cystatin-C.&#x0D; Results: 2012 CKD-EPI eGFR cystatin-C out performed existing equations in terms of accuracy, specificity, and sensitivity (AUC:0.988). Furthermore, when both creatinine and cystatin-C are included in an equation, it consistently improves diagnostic values over formulas containing only creatinine (2009CKD-EPI eGFRcr AUC:0.953, 2012CKD-EPI eGFRcr-CysC AUC: 0.985, 2021CKD-EPI eGFRcr AUC:0.954, MDRD AUC: 0.953, 2021CKD-EPI eGFRcr-CysC AUC: 0.985).&#x0D; Conclusion: The new formula has not been confirmed to be superior to other equations in its ability to estimate eGFR values, particularly at higher levels of chronic kidney disease. When compared with existing equations, 2012 CKD-EPI eGFRCysC had higher specificity and sensitivity. Combined formulas containing both blood tests had higher diagnostic values than equations containing only creatinine. Our results can help inform which equations to use for better estimation in renal function screening.

Acute Kidney Injury in Patients with Non-Valvular Atrial Fibrillation Treated with Rivaroxaban or Warfarin: A Population-Based Study from the United Kingdom.

To compare the risk of acute kidney injury (AKI) among users of rivaroxaban vs warfarin. We identified two cohorts of patients with non-valvular atrial fibrillation (NVAF) who initiated rivaroxaban (15/20 mg/day, N = 6436) or warfarin (N = 7129) excluding those without estimated glomerular filtration rate values recorded in the year before oral anticoagulant (OAC) initiation and those with a history of end-stage renal disease or AKI. We used two methods to define AKI during follow-up (mean 2.5 years): coded entries (method A) and the Aberdeen AKI phenotyping algorithm (method B) using recorded renal function laboratory values during the study period to identify a sudden renal deterioration event. Cox regression was used to calculate hazard ratios (HRs) for AKI with rivaroxaban vs warfarin use, adjusted for confounders. The number of identified incident AKI cases was 249 (method A) and 723 (method B). Of the latter, 104 (14.4%) were also identified by method A. After adjusting for age, sex, baseline renal function and comorbidity, HRs (95% CIs) for AKI were 1.19 (0.92-1.54; p=0.18) using method A and 0.80 (0.68-0.93; p<0.01) using method B. Estimates stratified by baseline level of chronic kidney disease were largely consistent with the main estimates. Our results support a beneficial effect of rivaroxaban over warfarin in terms of AKI occurrence in patients with NVAF. More research into how best to define AKI using primary care records would be valuable for future studies.

Comparing Prescribing Practices of Statin Therapy in Atherosclerotic Cardiovascular Disease Patients with Varying Levels of Chronic Kidney Disease

Lead Author's Financial Disclosures Nothing to disclose. Study Funding None. Background/Synopsis Evidence supporting high-intensity statin therapy in patients with atherosclerotic cardiovascular disease (ASCVD) and advanced chronic kidney disease (CKD), not on dialysis, is not robust. Cardiovascular risk reduction from statin therapy within this population is predominantly derived from post-hoc subgroup analysis of larger trials. This subset of ASCVD patients is often at higher risk for medication-related adverse effects, secondary to reduced renal clearance, polypharmacy, and high prevalence of co-morbidities. This increased risk may result in provider hesitation and under prescribing of high-intensity statin therapy among ASCVD patients. Of the available high-intensity statins atorvastatin does not require renal dose adjustments although rosuvastatin does. On a population level, prescribing of statins among patients with ASCVD and CKD has improved in recent years but remains sub-optimal. Results from this study can provide insight into whether providers are following guideline recommendations and package labeled dosing when prescribing statin therapy in a real-world setting. Objective/Purpose This study aims to evaluate real-world prescribing patterns of statin-therapy among ASCVD patients with non-dialysis dependent Stage 4-5 CKD and Stage 3a and 3b CKD. Methods This study is a retrospective, cross-sectional observational study and has been reviewed by the Colorado Multiple Institutional Review Board as exempt. Patients with a diagnosis of clinical ASCVD, non-dialysis dependent CKD stage 3a-5, and prescribed a statin between 1/1/2020-9/30/2021 were identified. The primary outcome will be prescribing ahigh-intensityy statin among patients with eGFR <30 mL/min compared to patients with eGFR 30-<60 mL/min. Secondary outcomes will include differences in mean LDL-C between the two groups and proportion of patients on FDA approved dosing of rosuvastatin. A chi-square test will be used for qualitative data and a student t-test for quantitative data. Results A total of 6000 patients have been identified and will be evaluated for inclusion into this study. Results are currently in progress. Conclusions Will be presented. Nothing to disclose.

Correlation of glomerular filtration rate and fibroblast growth factor-23 levels in chronic kidney disease; sub analysis chronic kidney disease–mineral and bone disorder study

Introduction: One of the chronic kidney disease (CKD) manifestations is mineral disorder, such as phosphate and calcium. Phosphatonin levels are regulated by the hormone phosphatonin, which the most commonly associated with CKD is fibroblast growth factor-23 (FGF-23), mainly synthesized by bone cells. The increase in FGF-23 in CKD subjects is a physiological response to stabilize phosphate levels. Several conditions can increase FGF-23 levels including age, body mass index (BMI), diabetes mellitus (DM), and hypertension. Objectives: This study aims to test the correlation between FGF-23 levels at various stages of glomerular filtration rate (GFR) in CKD. Patients and Methods: This study is observational with a cross-sectional approach conducted at Wahidin Sudirohusodo and Unhas hospitals of Makassar. Subjects are CKD patients which meet inclusion criteria. Intact serum FGF-23 levels were measured using an ELISA (enzyme-linked immunosorbent assay) kit (Immutopics). Statistical analysis was conducted using ANOVA test, Mann-Whitney U, and Spearman’s correlation tests. Statistical results are considered significant if P&lt;0.05. Results: The research was conducted on 78 subjects with CKD stages 3, 4 and 5, which consisted of 40 men and 38 women. The correlation test showed that the lower the GFR, the higher the FGF-23 level (P&lt;0.05). No significant correlation between age, body mass index, diabetes mellitus, and hypertension with FGF-23 were detected (P&gt;0.05). Conclusion: We found that every increase in the CKD stages and decrease of GFR, would be associated with an increase in the plasma levels of FGF-23. However, FGF-23 plasma concentration had no significant correlation with age, BMI, DM, and hypertension.

Low-dose ferrous bisglycinate chelate supplementation in chronic kidney disease and hemodialysis patients

Provision of parenteral or oral iron supplementation can restore iron stores and maintain stable hemoglobin levels in chronic kidney disease (CKD) and hemodialysis (HD) patients. The route for oral or intravenous (IV) administration of iron depends on the acuity of anemia, costs, and patient tolerance. IV iron can restore iron stores rapidly but also carries higher risks for allergy and infection. Oral iron supplementation is limited by high gastrointestinal adverse effects. We conducted an open-label trial to study the efficiency of a film-coated iron supplementation tablet, which contains ferrous bisglycinate chelate, vitamin C, and folic acid, in CKD stage 3b to 4 and HD patients. Twenty-seven HD patients and 20 CKD patients participated this study. After a 16-week intervention, low-dose ferrous bisglycinate chelate improved serum iron concentration (67.8 vs 87.2 mg/dL, p = 0.04) and transferrin saturation (24.7% vs 31.3%, p = 0.03) in stage 3 to 4 CKD patients, restored iron loss, and maintained stable hemoglobin levels in HD patients. No GI upset events were reported. Ferrous bisglycinate chelate is a well-tolerated oral iron supplementation for CKD and HD patients.