Lower Levels Of Glomerular Filtration Rate Research Articles

P0155CHARACTERISTICS OF HYPERTENSIVE NEPHROSCLEROSIS DIAGNOSED BY RENAL BIOPSY BASED ON 40-YEAR EXPERIENCE

Abstract Background and Aims Hypertensive nephrosclerosis (HT-N) is known as the second common cause of end stage renal disease (ESRD) in Korea as well as in other countries. However, the HT-N is assumed by clinical findings which are not well correlated to the pathologic findings. Therefore, we report the clinical characteristics of HT-N diagnosed by renal biopsy and compare the prognosis between patients with HT-N and hypertensive patients with focal segmental nephrosclerosis (FSGS) without pathologic HT-N. Method We enrolled 21,617 patients having native kidney biopsy for diagnosis of nephritis between 1979 and 2018, retrospectively. Among them, we selected 267 adult hypertensive patients with only HT-N and 984 hypertensive patients with FSGS without HT-N or other diagnoses (FSGS-HT). The estimated glomerular filtration rate (GFR) was calculated by original MDRD equation. The final outcomes were incidences of end stage renal disease (ESRD) and death. We matched blood pressures and GFR between two groups and analyzed the difference of outcomes within the matched cohort (mHT-N and mFSGS-HTN), also. Results The age of patients with HT-N was 49.5 ± 15.3 years at renal biopsy. There were 175 (65.5 %) men. Systolic blood pressure (SBP) was 139.1 ± 24.0 mmHg and diastolic blood pressure (DBP) was 83.7 ± 15.6 mmHg at renal biopsy. Levels of serum creatinine, GFR, and urine protein to creatinine ratio were 3.17 ± 3.05 mg/dl, 40.7 ± 32.5 ml/min/1.73 m2, and 2.277 ± 2.803 g/g cr, respectively. During follow-up period of 64.1 months (median), there were 52 (22.7%) patients progressed to ESRD and 8 (3.1%) patients were dead. Age, SBP, and hemoglobin were risk factors to mortality by Cox’s hazard proportional model adjusted with related factors to mortality. With increase of 10 mmHg in the level of SBP at renal biopsy, hazard ratio(HR) of mortality was increase by 1.645 folds (95% CI: 1.192-2.270, P=0.002). Presence of diabetes mellitus, serum albumin, and GFR were risk factors to incident ESRD. Compared to patients with FSGS-HT, patients with HT-N showed higher levels of SBP, DBP, and serum creatinine and lower levels of GFR, serum albumin, hemoglobin, and UPCR (all p-values <0.05), however, the risk of incident ESRD and mortality was not different. Therefore, we matched BP and GFR between groups and selected 235 patients in each group. The matched groups were not different in the values of age, SBP, DBP, and GFR. The risk of mortality was not different between groups (p-value =0.502), however, HR of incident ESRD was 1.558-fold higher (95% CI: 1.004-2.419, P=0.048) in mFSGS-HT compared to mHT-N by Cox’s hazard proportional model adjusted by factors related to ESRD. Conclusion Hypertensive nephrosclerosis was diagnosed in more advanced stage of CKD compared to hypertensive FSGS. Considering levels of GFR and SBP as risk factors to hard outcomes, we should consider early pathologic diagnosis for proteinuric and/or azotemic hypertensive patients and control blood pressures and renal dysfunction in more aggressive manners.

Kidney disease screening among a low-income group of hospital staffs who have less opportunity

Background: The prevalence of chronic kidney disease (CKD) has been rapidly increasing worldwide, and its early screening is vital to prevent the development of end-stage renal failure. Population-based studies on detection at early stage of kidney disease and its prevalence are scanty in our country. Hence, taking advantage of the observance of the World Kidney Day 2019, we conducted a screening program for kidney disease organized at the Chattagram Maa-O-Shishu Hospital premises among a low-income group of hospital staffs. Methods: This was a cross-sectional observational study among a low-income group of hospital staffs, working at our hospital. Age, body weight, height, body mass index (BMI), and blood pressure were documented, and urinary protein and serum creatinine were measured at a single sitting. Kidney function was estimated by calculating the glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease formula. Kidney function was classified according to the estimated GFR (eGFR) and Kidney Disease Outcomes Quality Initiative guidelines. Results: A total of 101 hospital staffs were studied. Majority of the participants (38%) were in the age group of 30–39 years. Among all, 24% of the participants had proteinuria (trace to ≥1 plus). The distribution of eGFR was symmetrical, with the majority (79%) of participants in the 60–89 ml/min category, 6.9% in the 30–59 ml/min category, and only 13.9% of the study population had eGFR >90 ml/min. An inverse relation between eGFR and age and a direct relation between eGFR and BMI were observed. Conclusion: Proteinuria, low GFR levels, and consequently the possibility of high burden of CKD are prevailing in the studied participants, and further targeted population-based studies are warranted to clarify these issues.

The association of the decline in glomerular filtration rate with aggressive endometrial cancers.

Most site-specific cancer incidence is increased with the decrease of glomerular filtration rate (GFR). We analyzed endometrial cancers depending on different type, staging, and histology grades. We hypothesized that patients with lower GFR levels have an increased risk for higher staging and histology grades of endometrial cancers. Patients were divided into two subgroups regarding GFR; the first group with GFR < 60ml/min and the second group with GFR > 60ml/min and regarding different histology grades and cancer stages. Cancers were also divided by stages (1-4). Patients were followed up during 1 year through regular controls in the outpatient clinic and during that time cancer recurrence was recorded. GFR was the strongest predictor for higher cancer histology grade and higher cancer staging. Patients with reduced GFR had OR for higher histology grade and higher staging of 1.06 and 1.06. Traditional risk factors for endometrial cancer development were not associated with higher histology grade or higher cancer staging. Higher staging and histology grades in patients with endometrial cancers are associated with reduced GFR. Patients with mild-to-moderate CKD had significantly higher number of cancers with higher histology grades and higher stages than patients with mild or normal GFR category. Decline in GFR was independently associated with more aggressive cancers without other well-known risk factors for endometrial cancer development like age, menopause, diabetes, and obesity.

Abstract P037: Independent and Joint Associations of 25-Hydroxy Vitamin D and Parathyroid Hormone Levels With Cardiometabolic Biomarkers Among American White and Black Postmenopausal Women

Introduction: Despite evidence of racial disparities in independent relationships of 25-hydroxyvitamin D (25[OH]D) and parathyroid hormone (PTH) status with cardiovascular risk, little is known about their joint associations with intermediate cardiovascular biomarkers. Hypothesis We hypothesized that there are White-Black differences in the direction and shape of the associations of total 25(OH)D and PTH with cardiovascular biomarkers of insulin resistance, beta cell function, systemic inflammation, and renal function among postmenopausal women. Methods: A random subcohort of 2,800 American White (n=1,500) and Black (n=1,300) postmenopausal women without cardiovascular disease (CVD) at baseline was selected from the Women’s Health Initiative Observational Study (N=93,676). We assessed plasma total 25(OH)D, PTH, high-sensitive C-reactive protein (hs-CRP), as well as creatinine-based glomerular filtration rate (GFR). Fasting glucose and insulin were measured to derive the homeostasis model assessment of insulin resistance (HOMA-IR) and beta cell function (HOMA-B). Weighted linear regression analyses were performed to assess independent and joint associations after adjusting for age, race/ethnicity, clinical center, education, body mass index, season of blood draw, smoking status, physical activity, alcohol consumption, postmenopausal hormone therapy use, and family history of CVD. Results: Total 25(OH)D levels were inversely associated with HOMA-IR among White women only (5.6% decrease per 1 SD increase in 25[OH]D; P for linear trend = 0.001). This association persisted among White women with PTH ≤65 pg/mL (5.9% decrease per 1 SD increase in 25[OH]D; P for linear trend = 0.001). While there was a linear trend towards higher 25(OH)D levels associated with lower GFR levels among White women with PTH ≤65 pg/mL (P for linear trend = 0.045), we found a non-linear relationship between total 25(OH)D and GFR among Black women with PTH &gt;65 pg/mL (P for non-linearity = 0.001). Conclusions: Higher levels of total 25(OH)D, independently and jointly with PTH, were associated with lower HOMA-IR in White postmenopausal women. The shapes of the associations between total 25(OH)D and GFR markedly differed between White and Black women after accounting for PTH, suggesting potential racial disparities in vitamin D/PTH mechanisms underlying cardiovascular health.

Kidney disease screening in a group of female health personnel: Who are often missing?

Background and Objective: Data on early-stage of chronic kidney disease (CKD) and the prevalence of CKD are very limited, especially more scanty in our female population. Hence, data from a kidney screening program organized at the Chattagram Maa-O-Shishu Hospital premises in connection with the observance of World Kidney Day 2018 were looked at for renal function among a group of female health personnel. Methods: This was a cross-sectional study among a group of female health personnel working at the hospital. Age, body weight, height, Body mass index (BMI), and blood pressure were documented, and serum creatinine was measured at a single sitting. The kidney function was estimated by calculating the glomerular filtration rate (GFR) using the Modified Diet in Renal Disease formula. Kidney function was classified according to estimated GFR (eGFR) and Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines. Results: A total of 101 female health personnel were studied – physicians - 23; nurses - 45, and health assistants - 33. Majority participants (51%) were in the age group of 20–29 years; 5% were 90 mL/min category. An inverse relation between the age and eGFR and a direct relation between the BMI and eGFR were observed in the study. Conclusion: The results indicate that low GFR levels and consequently a high burden of likely CKD are prevailing in our female population. It is not clear whether such observations are the result of the transportability problems associated with the GFR prediction equations or with the suitability of K/DOQI guidelines for the classification of CKD in our population or both. Well-planned, larger, and community- and hospital-based studies are warranted to clarify these issues, especially for our female population.

Association between glomerular filtration rate (measured by high-performance liquid chromatography with iohexol) and plasma oxalate.

ABSTRACTIntroduction:Secondary hyperoxalemia is a multifactorial disease that affects several organs and tissues in patients with native or transplanted kidneys. Plasma oxalate may increase during renal failure because it is cleared from the body by the kidneys. However, there is scarce evidence about the association between glomerular filtration rate and plasma oxalate, especially in the early stages of chronic kidney disease (CKD).Methods:A case series focuses on the description of variations in clinical presentation. A pilot study was conducted using a cross-sectional analysis with 72 subjects. The glomerular filtration rate (GFR) and plasma oxalate levels were measured for all patients. Results: Median (IQR) GFR was 70.50 [39.0; 91.0] mL/min/1.73 m2. Plasma oxalate was < 5.0 µmol/L in all patients with a GFR > 30 mL/min/1.73m2. Among the 14 patients with severe CKD (GFR < 30 mL/min/1.73 m2) only 4 patients showed a slightly increased plasma oxalate level (between 6 and 12 µmol/L).Conclusion:In non-primary hyperoxaluria, plasma oxalate concentration increases when GFR < 30mL/min/1.73 m2 and, in our opinion, values greater than 5 µmol/L with a GFR > 30 mL/min/1.73 m2 are suggestive of primary hyperoxaluria. Further studies are necessary to confirm plasma oxalate increase in patients with low GFR levels (< 30mL/min/1.73 m2).

R2(GFR)CHADS2 and R2(GFR)CHA2DS2VASc schemes improved the performance of CHADS2 and CHA2DS2VASc scores in death risk stratification of Chinese older patients with atrial fibrillation.

BackgroundThis analysis was carried out to refine the CHADS2 and CHA2DS2VASc scores by combining creatinine clearance (CrCl) and glomerular filtration rate (GFR) and evaluate the performance of CrCl-based and GFR-based schemes in death risk stratification of Chinese older patients with atrial fibrillation (AF).MethodsThere were 219 older patients with AF, and all-cause mortality was assessed during the follow-up of 1.11 years. Renal function was evaluated using the CrCl formula and different GFR (Modification of Diet in Renal Disease [MDRD], Chinese MDRD [CMDRD], Mayo Clinic Quadratic [Mayo] and Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]) formulas, and five kinds of R2CHADS2 and R2CHA2DS2VASc schemes were generated by combining CrCl and GFR with CHADS2 and CHA2DS2VASc scores.ResultsIn Cox regression multivariate analysis, CrCl <60 mL/min was moderately associated with death risk (P=0.122 and P=0.144). When MDRD, CMDRD, CKD-EPI and Mayo formulas were used to ascertain the GFR, GFR <60 mL/min/1.73 m2 was significantly associated with death risk (P<0.001 for all). In the models with CHADS2 and CHA2DS2VASc scores as the linear covariates, CrCl and GFR as the continuous variables were significantly associated with death risk (P<0.05 for all). C-statistics of CrCl-based schemes – R2(CrCl)CHADS2 and R2(CrCl) CHA2DS2VASc – moderately exceeded that of CHADS2 and CHA2DS2VASc scores (P=0.081 and 0.082). C-statistics of GFR-based schemes – R2(GFR)CHADS2 and R2(GFR)CHA2DS2VASc – significantly exceeded that of CHADS2 and CHA2DS2VASc scores (P<0.05 for all).ConclusionChinese older patients with AF with lower levels of GFR and GFR <60 mL/min/1.73 m2 had a significantly high death risk, and those with lower levels of CrCl or CrCl <60 mL/min had a significantly or modestly high death risk. There was significantly better performance of GFR-based schemes and moderately better performance of CrCl-based schemes in death risk stratification compared with CHADS2 and CHA2DS2VASc scores.

Relationship between glomerular filtration rate and diabetic retinopathy in type 2 diabetic patients

Objective To investigate the relationship between glomerular filtration rate (GFR) and diabetic retinopathy (DR) and macular thickness in patients with type 2 diabetes mellitus (T2DM). Methods A total of 161 T2DM inpatients were enrolled in this study. There were 95 males (95 eyes) and 66 females (66 eyes), with an average age of (62.2±11.0) years. The average duration of diabetes was (14.8±7.9) years. The patients were grouped according to the degree of DR. Among them, 91 patients were no DR, 24 patients were mild non-proliferative DR (NPDR), 24 patients were moderate NPDR, 13 patients were severe NPDR and 9 eyes were proliferative DR (PDR). Severe NPDR and PDR were combine into severe DR group for statistical analysis. All patients underwent direct ophthalmoscope, fundus colorized photography, spectral domain optical coherence tomography (SD-OCT), fasting blood-glucose, glycated hemoglobin and renal function examinations. GFR was evaluated by 99 mTcDTPA. DR degree was evaluated by direct ophthalmoscope and fundus colorized photography. Central subfield (CSF), central macular volume and mean retinal thickness (MRT) were measure by SD-OCT. The correlation between GFR and DR staging and macular retinal thickness were analyzed by Spearman correlation analysis and Pearson correlation analysis. Logistic regression analysis was used to analyze the correlation between GFR and presence of DR. Results GFR was gradually decreased in patients with no DR, mild NPDR, moderate NPDR and severe DR (F=12.32, P<0.001). Pearson correlation analysis demonstrated that GFR was negatively correlated to CSF (r=-0.202, P=0.010); but no correlation with MRT (r=-0.087, P=0.272). Spearman correlation analysis demonstrated that GFR was negatively correlated to DR staging (r=-0.325, P<0.001). The difference of DR prevalence rate in normal, slight abnormal renal function and renal insufficiency patients was significant (χ2=12.32, P=0.002). Logistic regression analysis demonstrated that lower levels of GFR was significantly associated with presence of DR (95% confidence interval=1.71–4.32, odds ratio=2.72, P<0.001). Conclusion In T2DM patients, GFR is negatively correlated to DR staging and CSF. Lower GFR is independent risk factors for DR. Key words: Diabetes mellitustype 2/complications; Diabetic retinopathy; Glomerular filtration rate; Retina/physiopathology; Tomography, optical coherence

Role of calculated glomerular filtration rate using percutaneous nephrostomy creatinine clearance in the era of radionuclide scintigraphy.

Context:Gates method tends to over-estimate glomerular filtration rate (GFR) in borderline functioning kidneys. We study the role of calculated GFR in these cases in decision-making regarding performing kidney-sparing surgery or nephrectomy.Aims:The aim of this study is to find the correlation between GFR calculated by percutaneous nephrostomy (PCN) urine creatinine clearance in obstructed kidneys and GFR by radionuclide scintigraphy. It also studies the role of this calculated GFR in borderline functioning kidneys.Settings and Design:Single tertiary care center; retrospective.Materials and Methods:A total of 46 patients in whom PCN was inserted as an emergency measure in an obstructed kidney and for whom diethylene-triamine-penta-acetic acid/ethylene-di-cysteine (DTPA/EC) scan was also done (Gates method) were analyzed retrospectively. PCN creatinine clearance was calculated for 3 consecutive days, and the mean value was used.Statistical Analysis Used:Pearson's correlational analysis; Chi-square test.Results:Overall strong correlation was found between the two GFR values (Pearson's r = 0.540692, P < 0.001). Totally 26 patients (56.52%) had comparable GFR values (P > 0.05). Among the 36 patients with borderline functioning kidneys, DTPA/EC scan significantly over-estimated GFR in one-third of the patients. The management plan was changed in 7 out of those patients (46.67%), with nephrectomy performed in all instead of kidney-sparing procedure. When the highest value of calculated GFR was compared, 28 patients had comparable GFRs (60.87%).Conclusions:GFR based on radionuclide scintigraphy may be insufficient for evaluation of residual renal function to determine the management of obstructed kidney with borderline function. For adequate decision-making, other factors including creatinine clearance via PCN should also be considered. Gates method tends to overestimate GFR as compared to calculated creatinine clearance at low GFR levels.

The Relationship between Serum Hemoglobin and Creatinine Levels and Intra-Hospital Mortality and Morbidity in Acute Myocardial Infarction

Background: Studies have shown that Glomerular Filtration Rate (GFR) and Hemoglobin (Hb) concentrations are two predictive values for ST-elevation Myocardial Infarction (MI) mortality. Objectives: This study aimed to investigate the relationship between GFR and Hb concentrations and intra-hospital mortality and electrocardiographic (ECG) and echocardiographic abnormalities in ST-elevation MI patients admitted to a highly equipped hospital in Mashhad. The results will help define some factors to manage these patients more efficiently. Patients and Methods: This descriptive study aimed to assess the relationship between Hb and GFR concentrations and mortality and morbidity among 294 randomly selected patients with ST-elevation MI. Echocardiography, ECG, and routine laboratory tests, including Hb and creatinine, were performed for all the patients. Then, the data were entered into the SPSS statistical software, version 16 and were analyzed using chi-square, t-test, and ANOVA. P < 0.05 was considered as statistically significant. Results: Intra-hospital mortality rate was 10.5%. Besides, the results showed higher levels of serum blood sugar (P < 0.001), higher levels of creatinine (P < 0.001), lower levels of GFR (P < 0.001), lower ejection fraction (P < 0.001), higher grades of left ventricular diastolic dysfunction (P = 0.002), and lower mean Hb concentration (P = 0.022) in the dead compared to the alive cases. Besides, the patients with mechanical complications had lower Hb levels (P = 0.008). The results showed no significant relationship between creatinine level and mechanical and electrical complications (P = 0.430 and P = 0.095, respectively). However, ejection fraction was significantly associated with GFR (P = 0.016). Conclusions: According to the results, low levels of Hb and GFR could predict mortality caused by ST-elevation MI and ECG abnormalities could notify intra-hospital death. Moreover, lower Hb levels were associated with mechanical complications and could be used as a parameter for diagnosis of high-risk patients.

Markers of Chronic Kidney Disease in Children with Obstructive Uropathy or Vesicoureteral Reflux

Background. Identification of markers of chronic kidney disease and its progression in the early stages of the disease is important, however, the most of research concerns late (3–5) stages of the disease. Objective . Identification of the markers of chronic kidney disease (CKD) and its progression in the early stages of the disease in children with obstructive uropathy and vesicoureteral reflux. Methods. Prospective follow-up (for 5 years) of 92 children with obstructive and reflux uropathies (1st to 4th stages of CKD). All patients had episodes of urinary tract infections, mostly pyelonephritis, minimum once a year. Results . High prevalence of proteinuria (60.9%), reduced renal functional reserve (88.7%) and disorders of cortical renal blood flow (by Doppler Color Flow Imaging) (69.6%) were found in children with 1st stage of CKD. Groups of children with proteinuria and a reduced renal functional reserve had a higher level of systolic and diastolic blood pressure in comparison with the patients without proteinuria and the reduced renal functional reserve (p < 0.05). In patients with 2–4 stages of CKD the glomerular filtration rate (GFR) correlated with atypical flora in the etiology of urinary tract infections (rpb = 0.66; n = 23; p = 0.0006), sex (boys had lower levels of GFR, rpb = 0.61; n = 23; p = 0.001), bilateral renal abnormalities (rpb = -0.53; n = 23; p = 0.009) the level of hemoglobin (r = 0.45; n = 23; p = 0.02). Conclusion . Markers of CKD of children with obstructive and reflux uropathies are: proteinuria, arterial hypertension, reduction of renal functional reserve and the impaired cortical renal blood flow (by Doppler Color Flow Imaging). The importance of arterial hypertension and proteinuria as markers of the progression of CKD of children with urinary tract obstruction and vesicoureteral reflux was confirmed. Additional markers for the progression of CKD in children with obstructive and reflux uropaties might be: male sex, bilateral renal abnormalities, anemia and atypical bacteriuria during relapses of urinary tract infections.

The association of chronic kidney disease complications by albuminuria and glomerular filtration rate: a cross-sectional analysis

Background: Albuminuria is strongly associated with future risk for cardiovascular and kidney outcomes, and has been proposed to be included in the classification of chronic kidney disease (CKD) along with glomerular filtration rate (GFR). Few data are available on whether albuminuria is associated with concurrent complications of CKD. Methods: A cross-sectional analysis of 1,665 participants screened for the Modification of Diet in Renal Disease (MDRD) study was performed to examine the association between albuminuria (determined using urine albumin-creatinine ratio (ACR)) and measured GFR (determined using urinary clearance of iothalamate) with anemia, acidosis, hyperphosphatemia, and hypertension. Results: Mean GFR (± SD) was 39 ml/min/1.73 m2 (± 21) and the median (25 – 75th percentile) ACR was 161 (38 – 680) mg/g. In multivariable models adjusted for age, sex, race, kidney disease etiology, and GFR, higher ACR levels were not associated with any complication. For example, comparing ACR > 300 mg/g vs. < 30 mg/g, the prevalence ratio (95% CI) for anemia was 0.98 (0.81 – 1.20), acidosis 1.13 (0.86 – 1.48), hyperphosphatemia 1.69 (0.91 – 3.17), and hypertension 1.04 (0.97 – 1.12). Lower levels of GFR were associated with all complications. For example, GFR levels < 30 ml/min/1.73 m2 vs. GFR levels 60 – 89 ml/min/1.73 m2 were associated with prevalence ratios (95% CI) of anemia 4.35 (3.18 – 5.96), acidosis 5.31 (3.41 – 8.29), hyperphosphatemia 23.8 (7.71 – 73.6), and hypertension 1.21 (1.10 – 1.32). Conclusions: Albuminuria is not associated with complications after controlling for GFR in patients younger than 70 years of age with non-diabetic CKD and GFR less than 90 ml/min/1.73 m2 and thus would not affect clinical action plans for decisions regarding evaluation and treatment of complications in similar populations.

Evaluation of Nutritional Status in Renal Transplant Recipients in Accordance with Changes in Graft Function

Introduction and AimsRenal transplantation (RT) is the ultimate treatment modality for end-stage renal disease (ESRD) patients. Malnutrition is a strong predictor of cardiovascular disease among ESRD patients. Body composition analysis using bioimpedance devices (BIA) is a useful noninvasive tool to detect malnutrition in this population. We investigated the impact of graft function on nutritional status and reliability of BIA to detect malnutrition in RT recipients. MethodsWe evaluated retrospectively 189 RT recipients including 59 females, and of overall mean age of 38.3 ± 10.6 years who had a minimum posttransplant follow-up of 12 months. Body Composition Analyzer (Tanita BC-420MA) determinations were complemented with monthly assessments of biochemical parameters. Patients were divided into 3 groups according to glomerular filtration rate (GFR) levels: normal graft function/high GFR group (group 1, normal creatinine levels, no proteinuria and GFR ≥ 90 mL/min; n = 59); low renal function/low GFR group (normal or high creatinine levels with low GFR levels; group 2; GFR 89–60 mL/min; n = 87) and group 3, (GFR < 60 mL/min; n = 43). ResultsGroup 3 patients displayed significantly lower as well as hemoglobin albumin and calcium concentrations, with higher phosphorus and parathyroid hormone levels (P = .0001). They also showed significantly lower body weight (P = .0001), body mass index (P = .002), fat (P = .002) and muscle (P = .0001) contents as well as fat-free mass (P = .0001). Group 2 patients had significantly lower values compared with group 1 and higher values than group 3. GFR values positively correlated with albumin, fat, muscle, and fat-free mass (r = 0.337, 0.299, 0.281, 0.278, respectively; P = .0001). GFR values positively correlated with visceral fat ratio (r = 0.170; P = 0.02), body mass index (r = 0.253; P = .0001), and waist-hip ratio (r = 0.218; P = .006). ConclusionLoss of muscle and fat mass is an early sign of malnutrition among RT recipients. It is closely associated with loss of GFR. BIA is a noninvasive and reliable diagnostic tool that should be included in the follow-up of these patients for an early diagnosis of malnutrition-related complications.

Low Glomerular Filtration Rate Increases Hemorrhagic Transformation in Acute Ischemic Stroke

Background: Decreased glomerular filtration rate (GFR) can increase the risk of bleeding tendency and hemorrhagic stroke. However, the relationship between the levels of GFR and hemorrhagic transformation (HT) after acute ischemic stroke is largely unknown. The aim of this study was to assess whether GFR level is associated with HT in acute ischemic stroke. Methods: We reviewed 770 consecutive patients with acute ischemic stroke within 7 days from September 2007 to February 2012 in a prospective stroke registry database. We calculated the patient’s GFR using the Cockcroft-Gault equation, and divided them into 3 groups: ≥60, 30–59 and <30 ml/min/1.73 m². HTs were identified by follow-up computed tomography (CT) or magnetic resonance imaging, and were defined as (1) any degree of high density within the area of low attenuation of vascular territory on noncontrast brain CT, or (2) low-signal intensity area in gradient echo within high-signal intensity meaning acute infarct on diffusion-weighted imaging. Multivariable logistic regression analyses were used to estimate the risk of GFR for HT. Stratification analyses were done according to the presence of HT high risk factors: atrial fibrillation (AF), thrombolysis and large size infarction. Additional logistic regression model for symptomatic HTs was established with the same variables. Results: HTs were noted in 131 patients (17.0%) and symptomatic HTs in 63 patients (8.2%). In univariate analysis, HTs were more frequent in patients with AF (51.9 vs. 16.7%, p < 0.001) and large-size infarction (42.0 vs. 5.3%, p < 0.001). The risk of HT was associated with decreased GFR among 3 subgroups classified according to the value of estimated GFR: 49/394 (12.4%) in the GFR ≥60 group, 66/312 (21.2%) in the 30≤ GFR <59 group and 16/64 (25.0%) in the GFR <30 group (p = 0.002). We found a significant association between the GFR <30 group and HTs in acute ischemic stroke (OR 2.90; 95% CI 1.26–6.68, p = 0.012) after adjusting for other risk factors. Moreover, the incidence of HTs was higher in the subgroups without thrombolysis (OR 3.49; 95% CI 1.44–8.46) and without AF (OR 3.44; 95% CI 1.10–10.76). Decreased GFR also had a tendency of increasing symptomatic HTs (OR 2.39; 95% CI 0.72–7.94, p = 0.154). Conclusions: Low levels of GFR are associated with a high risk of HT after acute ischemic stroke. Further studies are needed to elucidate whether HT in the patients with renal insufficiency are related to a worse outcome after acute ischemic stroke.

Performance of Methods to Assess Kidney Function in a Predominantly Overweight Sample of Patients with Liver Disease

The assessment of glomerular filtration rate (GFR) in patients with liver disease is necessary to make decisions about organ allocation. Creatinine is widely used as a marker of GFR; however, it is not reliable in patients with liver disease. The aims of this study were to (1) determine if iodine 125-labeled iothalamate (125I-iothalamate) clearance calculated using the plasma decay method is equal to renal clearance of 125I-iothalamate and (2) estimate kidney function using the creatinine-based Cockcroft–Gault and the Modification of Diet in Renal Disease equations, a cystatin C-based equation, the urine collection method for creatinine clearance, and plasma clearance of vancomycin (V) and compare these estimates to renal clearance of 125I-iothalamate in adult patients with liver disease. Adults with liver disease received 125I-iothalamate and V and had a catheter placed for urine collection. Blood and urine samples were collected over 8 h for analysis of 125I-iothalamate, creatinine, and V to determine kidney function. Estimates were compared to renal 125I-iothalamate clearance. Eight patients classified as Child–Pugh class B were enrolled: age was 52 ± 6 years; body mass index was 36.5 ± 19 kg/m2; and Model for End-Stage Liver Disease score was 13 ± 3. Mean estimates of kidney function did not differ significantly from mean renal 125I-iothalamate clearance (74 ± 38 mL/min/1.73 m2). Other methods overestimated kidney function at lower levels of GFR (<60 mL/min/1.73 m2) and underestimated kidney function at higher GFR levels. Given the variability in performance of methods to assess kidney function in this population, direct measurement of GFR may be preferable to indirect estimates based on marker compounds such as creatinine and cystatin C until more accurate methods are developed.

Association of Renal Artery Stenosis With Aortic Jet Velocity in Hypertensive Patients With Aortic Valve Sclerosis

Patients with aortic valve sclerosis (AVS) have an increased risk of cardiovascular events. Patients with atherosclerotic renal artery stenosis (RAS) develop resistant hypertension and heart failure. We hypothesized AVS may be copresent with RAS in hypertensive patients. Hypertensive patients with AVS (n = 167) underwent magnetic resonance (MR) angiography using nonenhanced steady-state free precession (SSFP) technique. More than 75% luminal narrowing in the proximal region of main renal artery was regarded as significant RAS. Peak aortic jet velocity was obtained by Doppler echocardiography. We measured brain natriuretic peptide (BNP), and estimated glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease equation. Unilateral or bilateral RAS was detected in 40 patients. AVS patients with RAS were older (78 +/- 6 vs. 74 +/- 8 years), and had higher levels of aortic jet velocity (162 +/- 4 vs. 144 +/- 3 cm/s), and lower levels of GFR (55 +/- 13 vs. 62 +/- 14 ml/min/1.73 m(2)) than those without RAS. Higher aortic jet velocity (odds ratio (OR) = 1.58, 95% confidence interval (CI) = 1.09-2.31) and lower GFR (OR = 0.54, 95% CI = 0.33-0.38) were associated with the presence of RAS, after being adjusted for age, systolic blood pressure, and BNP. RAS was detected in hypertensive patients with AVS, particularly in patients with higher aortic jet velocity and lower GFR. Higher aortic jet velocity and lower GRF may be useful as a potential indicator for those needing assessment of RAS for risk stratification and deserves further study.

Agreement between methods

Before new tests are implemented, it is important to compare their results with those of other measurement methods that are already in use. In the determination of this so-called agreement between methods, one may choose between several statistical approaches. The correlation coefficient is a popular approach to determine the agreement between measurement methods. It is easy to calculate, but has important limitations: it does not provide any information on the type of association and it is extremely sensitive to the range of values within the study. Finally, a correlation coefficient does not reveal whether any difference between two measurements is systematic or random. Therefore, it is highly preferable to use Bland-Altman plots instead, as these reveal both systematic and random errors. Bland-Altman plots are also preferable in case of repeated measurements and calibrations.

Is There a Chronic Kidney Disease Epidemic? Profile of Chronic Kidney Disease in an Urban Renal Camp in Southern India

The incidence of chronic kidney disease (CKD) and end-stage renal disease (ESRD) is growing at an alarming rate. It is widely believed that the rising ESRD population is just the tip of the CKD iceberg. Data on early-stage CKD and the prevalence of CKD in India are very limited. Therefore, data from a renal camp organized in connection with World Kidney Day were looked at for renal function. This was a cross-sectional study. A renal camp was advertised using a set of eight questions; any person who answered yes to one or more questions were advised to attend the camp. Body weight, height, blood pressure, blood sugar and serum creatinine were measured. Urine examination for sugar, albumin and blood was carried out. Renal function was assessed by calculating the glomerular filtration rate (GFR) using the Cockcroft-Gault (C-G) and Modified Diet in Renal Disease (MDRD) formulas. Kidney function was classified according to estimated GFR (eGFR) and Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines. A total of 123 people (82.1% male) were studied; 9% were less than 20 years old and 26% were aged 60 years or older. The distribution of eGFR was symmetrical, with the majority of people in the 70–79 mL/min category; 69.9% of the study population had eGFR < 100 mL/min. There was a gradual increase in eGFR from the < 20-year-old group to the 30–39-year-old group (which had the highest eGFR of about 110 mL/min), and then a gradual decline with increasing age. An inverse relation between eGFR and age was observed: eGFR declined by 1 mL/min/year (95% confidence interval, 0.7–1.3). C-G eGFR indicated that about 69% of the study population was normal and 31% had CKD stage I to V. MDRD eGFR indicated that 7.3% had CKD stage III to V. Only in CKD stages IV and V could elevated levels of serum creatinine be seen. The results indicate low GFR levels and, consequently, a high burden of CKD in the Indian population. It is not clear whether such observations are the result of the transportability problems associated with the GFR prediction equations or with the suitability of K/DOQI guidelines for the classification of CKD in the Indian population or both. Well-planned, larger, community-and hospital-based studies are warranted to clarify these issues.

Kidney Allograft Fibrosis and Atrophy Early After Living Donor Transplantation

Kidney allograft failure is most often caused by chronic allograft nephropathy, a process of interstitial fibrosis (GIF) and tubular atrophy (TA). We assessed the pathology of living donor (LD) grafts compared to deceased donor (DD). Included are 321 recipients (245 LD; 76 DD) with protocol biopsies the first 2 years of transplant. In LD, GIF was present in 7%, 31%, 61% and 71% of grafts at 0, 4, 12 and 24 months. TA progressed in parallel to GIF. Compared to LD, more DD grafts had GIF at time 0 (29%, p = 0.002); thereafter the incidence of GIF was similar. In LD, GIF was associated with lower glomerular filtration rate (GFR)(1 year) (no GIF, 62 +/- 16; GIF, 49 +/- 15 mL/min/m(2) iothalamate clearance, p = 0.001) and reduced graft survival (HR = 2.2, p = 0.009). GIF in LD related to acute rejection (HR = 2.6, p = 0.01), polyoma nephropathy (OR = 4.4, p = 0.02) and lower levels of GFR 3 weeks post-transplant (HR = 0.961; p = 0.03, multivariate). However, GIF also developed in 53% of recipients lacking these covariates. Thus, GIF/TA develops in the majority of LD grafts, it is often mild but is associated with reduced function and survival. GIF frequently develops in the absence of risk factors. Lower GFR post-transplant identify patients at highest risk of GIF.

Increased prevalence of subclinical and clinical hypothyroidism in persons with chronic kidney disease

Previous studies have suggested a higher prevalence of thyroid abnormalities in persons with end-stage renal disease. However, little is known regarding the epidemiology of thyroid disorders in persons with less severe kidney dysfunction. We used data from the Third National Health and Nutrition Examination Survey to examine the prevalence of hypothyroidism (clinical and subclinical) at different levels of estimated glomerular filtration rate (GFR). We used multivariable logistic regression to evaluate the association between GFR and prevalent hypothyroidism. Among 14,623 adult participants with serum creatinine and thyroid function test results, the mean age was 48.7 years, and 52.6% were women. The prevalence of hypothyroidism increased with lower levels of GFR (in units of mL/min/1.73 m(2)), occurring in 5.4% of subjects with GFR >/=90, 10.9% with GFR 60-89, 20.4% with GFR 45-59, 23.0% with GFR 30-44, and 23.1% with GFR <30 (P < 0.001 for trend). Overall, 56% of hypothyroidism cases were considered subclinical. Compared with GFR >/=90 mL/min/1.73 m(2), reduced GFR was associated with an increased risk of hypothyroidism, after adjusting for age, gender, and race/ethnicity: adjusted odds ratio 1.07 (95% confidence interval: 0.86-1.32) for GFR 60-89, 1.57 (1.11-2.22) for GFR 45-59, 1.81 (1.04-3.16) for GFR 30-44, and 1.97 (0.69-5.61) for GFR <30 mL/min/1.73 m(2) (P= 0.008 for trend). Among a nationally representative sample of adults, reduced glomerular filtration rate was associated with a higher prevalence of hypothyroidism, with many subclinical cases. Future studies are needed to determine the potential adverse effects of subclinical and clinical hypothyroidism in persons with chronic kidney disease.