Management Of Chronic Kidney Disease Patients Research Articles

Impact of Health Education Intervention on Fluid Management and Quality of Life Among Patients with Chronic Kidney Disease Undergoing Hemodialysis

Introduction: Chronic Kidney Disease (CKD) is a global concern, impacting over 13% of individuals. Hemodialysis (HD) poses challenges, and education on fluid management can improve quality of life (QOL) of individuals with CKD. This study is aimed to evaluate, the impact of health education intervention on fluid management and QOL among dialysis-receiving CKD patients in Dialysis units (DU) at the National Hospital of Sri Lanka (NHSL).Methods: One-group pretest-posttest design was utilized. Two interviewer-administered questionnaires were used to collect data from randomly selected 110 CKD patients receiving HD. The instrument consisted of items assessing the history of the disease condition, signs and symptoms of fluid overload, and fluid management status. The Kidney Disease Quality of Life (KDQOL) questionnaire was used as instrument II. Both instruments were administered before and after health education intervention regarding control of fluid intake during HD. Descriptive statistics and paired samples t-tests were performed for data analysis. The Ethics Review Committee of NHSL approved this study.Results: The study primarily involved CKD patients, with a significant majority (46.4%) falling in the 51-70 years age group, and a predominance of males (76.4%). Almost half (44.5%) had attained education up to the Ordinary Level, and the majority were married (80.9%). The findings revealed a positive impact of health education sessions on fluid management, with post-scores increasing from 67% to 79%, indicating a significant reduction in fluid overload symptoms (p<0.05). However, pre- and post-quality-of-life scores did not show significant differences (p=0.051) with the effect of education intervention.Conclusions: The results revealed a significant reduction in fluid overload symptoms after the educational intervention, indicating a positive impact on fluid management. However, the same intervention did not demonstrate an observable improvement in the patient's quality of life, emphasizing the need to explore the underlying reasons for remaining QOL unchanged. Since health education intervention has shown a positive impact on fluid status management of CKD patients undergoing HD, it would be beneficial to conduct such intervention across DU in Sri Lanka after further studies.

The Relationship Between Anemia and Parathyroid Hormone Levels in Patients With Kidney Failure Undergoing Hemodialysis Treatment in Georgia.

Chronic kidney disease (CKD) and its associated complications, such as anemia and secondary hyperparathyroidism (SHPT), pose significant challenges to global healthcare systems. This study explores the demographic and clinical characteristics of 284 kidney failure (KF) patients undergoing hemodialysis, in an effort to shed light on the possible association between anemia and SHPT. A proven connection between the two could theoretically influence the management plans for CKD patients, with the hopes of achieving lower morbidity and/or mortality in this patient group. A retrospective, cross-sectional, real-world data analytical study was conducted at a hemodialysis center in Tbilisi, Georgia, encompassing a sample size of n = 284 patients on maintenance hemodialysis. The data analyzed was extracted from patients' medical records. According to our results, the prevalence of anemia was strikingly high at 82.04%, underlining its substantial burden within this patient population.Our analysis revealed a notable systemic association between anemia and SHPT, particularly when considering hemodialysis vintage. However, our final analysis model revealed no statistically significant association between anemia and intact parathyroid hormone (iPTH) levels. Conclusion:Our study revealed a significant systemic relationship between anemia and SHPTwhen hemodialysis duration was considered, despite initial analyses showing no direct association. Future research should focus on longitudinal and multi-center studies to better understand this relationship, aiming to enhance the care and management of CKD patients on hemodialysis.

Combining telemedicine and in-person visits to deliver care to patients with severe chronic kidney disease (CKD): Lessons learned from COVID-19.

Telemedicine has been widely used to deliver healthcare to outpatients during the COVID-19 pandemic. The effectiveness of this modality is unclear in patients with a pre-dialysis stage of chronic kidney disease (CKD). This study aims to describe the clinical characteristics and management of CKD patients receiving telemedicine care during the COVID-19 pandemic. A retrospective single-center cohort study enrolled outpatients with pre-dialytic stage of CKD from March 9 to June 21, 2020. Telemedicine was proposed for all patients with a stable CKD to reduce the risk of in-hospital transmission whereas in-person visit was performed for patients requiring urgent evaluation. In a 15-week period, 97 patients received 116 nephrological visits. According to the modality of healthcare delivery, the patients were subdivided into telemedicine (66%) and in-person visit (34%) groups. Mean age of all CKD patients was 72.8 ± 12.5 years and males were 50.5% of the population. The average estimated glomerular filtration rate (eGFR) was 14.6±6 mL/min. Patients evaluated by telemedicine had better kidney function (GFR, 16.2±6.4 vs. 13.6±5.9 mL/min/1.73m2; p=0.037), a lower body mass index (BMI) (24.1 ± 1.7 vs. 30.6 ± 5.7; p=0.019), and a lower risk of CKD progression (51.1 vs. 25.4%, p=0.017) than patients requiring in-person visit. Telemedicine-visit patients experienced a significantly lower number of pharmacological changes than patients managed in the ambulatory setting. Telemedicine was also used to conduct 20% of educational meetings on the choice of dialysis modality and 18.9% of pre-eligibility visits for kidney transplantation. Telemedicine made it possible to provide care to and maintain close monitoring of 2/3 of patients with pre-dialytic stage of CKD during the COVID-19 pandemic.

The heart rate non-dipping pattern was associated with target organ damage in patients with chronic kidney disease.

We performed the study to investigate the association between heart rate (HR) non-dipping pattern and target organ damage in patients with chronic kidney disease (CKD) and hypertension. In this cross-sectional study, 447 patients with CKD and hypertension were enrolled. 24h ambulatory blood pressure monitoring was conducted. Linear regression and logistic regression analysis were conducted to investigate the association between HR non-dipping pattern and target organ damage, including estimated glomerular filtration rate (eGFR), left ventricular mass index (LVMI), and left ventricular hypertrophy (LVH). Overall, 261 patients (58.4%) followed non-dipping patterns of HR. HR non-dipping pattern remained to be significantly associated with reduced eGFR (β: -0.384; 95% CI: -0.719 to -0.050; p = 0.025) and the higher prevalence of CKD stages 4-5 (OR: 2.141; 95% CI: 1.153 to 3.977; p = 0.016). Meanwhile, HR non-dipping pattern was independently associated with LVMI (β: 0.021; 95% CI: 0.000 to 0.041; p = 0.049) and LVH (OR: 1.78; 95% CI: 1.07 to 2.96; p = 0.027) after adjusting for confounding factors. HR non-dipping pattern was independently associated with impaired renal function and cardiac damage. Non-dipping HR deserves further attention and needs to be detected and treated during the management of CKD patients.

#1395 Management of CKD patients and HK, as its main complication: degree of adoption of the multi-society consensus on CKD and HK in Spain

Abstract Background and Aims The high incidence, morbidity and mortality of Chronic Kidney Disease (CKD) makes it a public health problem, due to the difficulties in its early detection and management. Hyperkalemia (HK) is a common complication of CKD, also associated with high morbidity and mortality, impacting on the management of patients with CKD and leading sometimes to deoptimization of their treatment. It has been shown that the development of multidisciplinary consensus contributes to improving patient management. With this objective, the multi-society consensus documents –Information and consensus document for the detection and management of chronic kidney disease (2022)- and –Recommendations for the management of hyperkalemia in the emergency department (2022)- have been published. The aim of this study is to analyze the degree of adoption of the recommendations of both consensus in clinical practice in Spain, in order to identify potential areas of improvement in the management of CKD patients with HK. Method This study is based on the perceptions obtained through the discussion on the applicability of the national consensus documents for the management of CKD and HK. To this end, two medical education programs focused on CKD and HK, respectively, were carried out to discuss the applicability of both consensuses. In total, 41 meetings were held (14 from ERC and 27 from HK) from April 2022 to April 2023, involving a total of 542 healthcare professionals (HCPs) (nephrologists and emergency physicians). The main hypothesis was that neither the consensuses are being followed regularly in Spanish clinical practice. All responses were coded numerically, and a national mean was created based on the meeting means. Results The majority of nephrologists who participated in the discussion of the consensus analysis consider that CKD is underdiagnosed (77%), and that the detection of albuminuria is not routinely performed in Primary Care (PC) (72%). Furthermore, half of the nephrologists point out that referrals from PC do not meet the recommended criteria. In relation to treatment, almost 90% of nephrologists would follow the recommendations for the use of RAASi (renin angiotensin aldosterone system inhibitors) and Dapagliflozin very frequently. Regarding HK (a complication of CKD), 42% of HCPs considered that 30-40% of patients with CKD and/or HF suffered a second episode of HK. In relation to its management, only 21% of HCPs considered that the recommendations to maintain treatment with RAASis were followed. Of those who modified it, more than 50% did not consider reintroducing it or considered it little. 33% of HCPs did not show willingness to use the new antihyperkalemia treatments upon discharge. 50% of the participants said they did not have access to them. Regarding follow-up, 54% considered that it should be done by PC specialists. Conclusion The recommendations specified in the CKD and HK management consensuses are being applied less than desired in Spanish clinical practice. Especially highlighting the lack of detection of albuminuria and non-compliance with the referral criteria in patients with CKD, which is consistent with the high underdiagnosis described in Spain. Furthermore, the recommendation of not to modifying the RAASi treatment for the management of HK is not regularly adopted, despite of its impact on the morbidity and mortality of these patients. This information could help to guide future interventions that aim to improve the diagnosis and management of patients with CKD and/or HK.

#1485 Hypertension management of CKD patients referred to Hypertension Excellence centres in 27 countries: on behalf of the ESH Hypertension and Kidney WG

Abstract Background and Aims Real-life management of hypertensive patients with chronic kidney disease (CKD) is unclear and may vary across countries. Our aim was to identify unmet needs and heterogeneity of management in this population of patients in Europe and the Middle-East through our network of European Society of Hypertension (ESH) Excellence Centers. Method A survey was conducted in 2023 by the ESH to assess management of CKD patients referred to ESH-Hypertension Excellence Centres (ESH-ECs) at first referral visit. The questionnaire contained 64 questions with which ESH-ECs representatives were asked to estimate pre-existing CKD management quality and data for their management are reported here. Results Overall, 88 ESH-ECs from 27 countries participated (fully completed surveys: 66/88 (75.0%)). ESH-ECs reported that 28% (median, interquartile range: 15-50%) had pre-existing CKD, of whom 10% (5- 30%) were previously referred to a nephrologist, while 30% (15-40%) had resistant hypertension. The reported rate of previous recent (<6 months) estimated glomerular filtration rate (eGFR) and urine Albumin- Creatinine Ratio (UACR) testing were 80% (50-95%) and 30% (15-50%), respectively. The reported use of renin-angiotensin system blockers was 80% (70-90%). When a nephrologist was part of the ESH-EC teams the reported rates for SGLT2 inhibitors (27.5% (20-40%) vs 15% (10-25), p = 0.003), GLP1-RA (10% (10-20%) vs 5% (5-10%), p = 0.003) and mineralocorticoid receptor antagonists (20% (10-30%) vs 15% (10-20%), p = 0.05) use were greater as compared to ESH-ECs without nephrologist participation. The rate of reported resistant hypertension, recent eGFR and UACR results and management of CKD patients prior to referral varied widely across centres in Europe countries and in the Middle East. Conclusion Our results indicate deficits regarding CKD screening, use of nephroprotective drugs and referral to nephrologists before referral to ESH-ECs but results varied widely across centres. This information can be used to build specific programs to improve care in hypertensives with CKD.

Screening and management of hypertensive patients with chronic kidney disease referred to Hypertension Excellence Centres among 27 countries. A pilot survey based on questionnaire.

Real-life management of hypertensive patients with chronic kidney disease (CKD) is unclear. A survey was conducted in 2023 by the European Society of Hypertension (ESH) to assess management of CKD patients referred to ESH-Hypertension Excellence Centres (ESH-ECs) at first referral visit. The questionnaire contained 64 questions with which ESH-ECs representatives were asked to estimate preexisting CKD management quality. Overall, 88 ESH-ECs from 27 countries participated (fully completed surveys: 66/88 [75.0%]). ESH-ECs reported that 28% (median, interquartile range: 15-50%) had preexisting CKD, with 10% of them (5-30%) previously referred to a nephrologist, while 30% (15-40%) had resistant hypertension. The reported rate of previous recent (<6 months) estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) testing were 80% (50-95%) and 30% (15-50%), respectively. The reported use of renin-angiotensin system blockers was 80% (70-90%). When a nephrologist was part of the ESH-EC teams the reported rates SGLT2 inhibitors (27.5% [20-40%] vs. 15% [10-25], P = 0.003), GLP1-RA (10% [10-20%] vs. 5% [5-10%], P = 0.003) and mineralocorticoid receptor antagonists (20% [10-30%] vs. 15% [10-20%], P = 0.05) use were greater as compared to ESH-ECs without nephrologist participation. The rate of reported resistant hypertension, recent eGFR and UACR results and management of CKD patients prior to referral varied widely across countries. Our estimation indicates deficits regarding CKD screening, use of nephroprotective drugs and referral to nephrologists before referral to ESH-ECs but results varied widely across countries. This information can be used to build specific programs to improve care in hypertensives with CKD.

Consensus Statement from India on the Renal Benefits of ARNi, SGLT-2i, and Bisoprolol in Chronic Kidney Disease.

Chronic kidney disease (CKD) is a major contributor to morbidity and mortality in India. CKD often coexists with heart failure (HF), diabetes, and hypertension. All these comorbidities are risk factors for renal impairment. HF and CKD are pathophysiologically intertwined, and the deterioration of one can worsen the prognosis of the other. There is a need for safe renal pharmacological therapies that target both CKD and HF and are also useful in hypertension and diabetes. Neurohormonal activation achieved through the activation of the sympathetic nervous system (SNS), the renin-angiotensin-aldosterone system (RAAS), and the natriuretic peptide system (NPS) is fundamental in the pathogenesis and progression of CKD and HF. Angiotensin receptor neprilysin inhibitor (ARNi), sodium-glucose cotransporter 2 inhibitors (SGLT-2i), and selective β1-blocker (B1B) bisoprolol suppress this neurohormonal activation. They also have many other cardiorenal benefits across a wide range of CKD patients with or without concomitant HF, diabetes, or hypertension. This consensus statement from India explores the place of ARNi, SGLT-2i, and bisoprolol in the management of CKD patients with or without HF and other comorbidities.

HYPERTENSION MANAGEMENT OF CKD PATIENTS REFERRED TO HYPERTENSION EXCELLENCE CENTRES IN 27 COUNTRIES; ON BEHALF OF THE ESH HYPERTENSION AND KIDNEY WORKING GROUP

Objective: Real-life management of hypertensive patients with chronic kidney disease (CKD) is unclear and may vary across countries. Our aim was to identify unmet needs and heterogeneity of management in this population of patients in Europe and the Midlle-East through our network of European Society of Hypertension (ESH) Excellence Centers. Design and method: A survey was conducted in 2023 by the ESH to assess management of CKD patients referred to ESH-Hypertension Excellence Centres (ESH-ECs) at first referral visit. The questionnaire contained 64 questions with which ESH-ECs representatives were asked to estimate pre-existing CKD management quality and data for their management are reported here. Results: Overall, 88 ESH-ECs from 27 countries participated (fully completed surveys: 66/88 (75.0%). ESH-ECs reported that 28% (median, interquartile range: 15-50%) had pre-existing CKD, of whom 10% (5-30%) were previously referred to a nephrologist, while 30% (15-40%) had resistant hypertension. The reported rate of previous recent (&lt;6 months) estimated glomerular filtration rate (eGFR) and urine Albumin-Creatinine Ratio (UACR) testing were 80% (50-95%) and 30% (15-50%), respectively. The reported use of renin-angiotensin system blockers was 80% (70-90%). When a nephrologist was part of the ESH-EC teams the reported rates for SGLT2 inhibitors (27.5% (20-40%) vs 15% (10-25), p=0.003), GLP1-RA (10% (10-20%) vs 5% (5-10%), p=0.003) and mineralocorticoid receptor antagonists (20% (10-30%) vs 15% (10-20%), p=0.05) use were greater as compared to ESH-ECs without nephrologist participation. The rate of reported resistant hypertension, recent eGFR and UACR results and management of CKD patients prior to referral varied widely across centres in Europe countries and in the Middle-East. Conclusions: Our results indicate deficits regarding CKD screening, use of nephroprotective drugs and referral to nephrologists before referral to ESH-ECs but results varied widely across centres. This information can be used to build specific programs to improve care in hypertensives with CKD.

Educating patients about health helps slow the progression of chronic kidney disease in the eastern region of India

Abstract Background: Chronic kidney disease (CKD) poses a well-documented burden, necessitating patient awareness of the importance of healthy lifestyle modifications to mitigate co-morbidities and mortality risks. Objective: This study aimed to assess the effectiveness of education-based conservative management in mitigating disease progression among CKD patients in the eastern region of India. Materials and Methods: A total of 248 CKD patients receiving outpatient department and inpatient department care at the nephrology and dialysis department of Belle Vue Clinic, Kolkata, West Bengal, India, were included in the study. Comprehensive data encompassing demographic details, socioeconomic status, clinical co-morbidities, and conservative management interventions via patient education were examined. The study compared the rise in creatinine levels with adherence to five key factors: dietary restrictions, medication compliance, follow-up appointments with physicians, management of co-morbidities, and adherence to lifestyle modifications. Each strategy was graded on a scale of 0, 1, or 2 based on compliance, with 0 indicating minimal or no compliance, 1 indicating moderate compliance, and 2 indicating strong compliance. Results: In this study, several factors were linked to elevated creatinine levels among CKD patients, including being in the middle-age range, male gender, living predominantly in urban areas, and working in business or service occupations. Additionally, a higher prevalence of co-existing conditions such as diabetes mellitus and hypertension was noted among CKD patients, along with documented instances of polycystic kidney disease, obstructive uropathy, and renal cell carcinoma. After educating CKD patients, those who scored 8–10 on compliance exhibited a decrease in creatinine elevation (0.35 mg/dL) among 120 cases from January 2022 to June 2023. Conversely, those with scores ranging from 5 to 7 (81 cases) showed moderate creatinine elevation (1.24 mg/dL), while those with scores of 0–4 (47 cases) demonstrated higher levels of creatinine elevation (5.48 mg/dL). Conclusion: This study concludes that the conservative management of CKD patients educates individuals about primary prevention of the disorder and provides a comprehensive understanding of secondary and tertiary prevention strategies. This cost-effective approach significantly impacts physical, mental, social, and psychological adjustment behaviors.

An Approach for Personalized Dynamic Assessment of Chronic Kidney Disease Progression Using Joint Model.

Chronic kidney disease (CKD) poses significant challenges to public health and healthcare systems, demanding a comprehensive understanding of its progressive nature. Prior methods have often fallen short in capturing the dynamic and individual variability of renal function. This study aims to address this gap by introducing a novel approach for the individualized assessment of CKD progression. A cohort of 1042 patients, comprising 700 with stage 3a and 342 with stage 3b to stage 5 CKD, treated at a veteran general hospital in Taiwan from 2006 to 2019, was included in the study. A comprehensive dataset spanning 12 years, consisting of clinical measurements, was collected and analyzed using joint models to predict the progression to hemodialysis treatment. The study reveals that the estimated glomerular filtration rate (eGFR) can be considered an endogenous factor influenced by innate biochemical markers. Serum creatinine, blood pressure, and urinary protein excretion emerged as valuable factors for predicting CKD progression. The joint model, combining longitudinal and survival analyses, demonstrated predictive versatility across various CKD severities. This innovative approach enhances conventional models by concurrently incorporating both longitudinal and survival analyses and provides a nuanced understanding of the variables influencing renal function in CKD patients. This personalized model enables a more precise assessment of renal failure risk, tailored to each patient's unique clinical profile. The findings contribute to improving the management of CKD patients and provide a foundation for personalized healthcare interventions in the context of renal diseases.

General practitioners' representation of early-stage CKD is a barrier to adequate management and patient empowerment: a phenomenological study.

In high-income countries, chronic kidney disease (CKD) affects over 10% of the population. Identifying these patients early is a priority, especially as new treatments are available to reduce the risk of cardiovascular and renal morbidity. We aimed at understanding the management and care pathway of patients with early-to-moderate CKD defined as an estimated glomerular filtration rate (eGFR) ≥ 45mL/min/1.73m2 (CKD-EPI), by analyzing the experience of general practitioners in a region in France. This qualitative semiopragmatic phenomenological study analyzed in-depth interviews held with a purposive sample (age, gender, training, type of practice, rural/urban context) of 24 general practitioners, with triangulation of research until data saturation. From diagnostic, etiological and prognostic viewpoints, the general practitioners enrolledin our study perceived CKD as a complex, poorly-defined clinical entity in asymptomatic and multimorbid patients. They distinguished it from a rare condition they considered as 'mainly renal'. The fact that they did not perceive early-stage CKD as a disease was a hindrance to patient care, which should protect the kidneys with a preventive approach. Indeed, general practitioners perceived CKD patient management as a pathway requiring a personalized, integrative model, common to all chronic diseases, without necessarily involving a nephrologist, at least in the early stages. This study shows how the general practitioners' representations influence their attitudes and interventions. Clarifying the concept of early-stage CKD by taking factors like age and etiology into account would facilitate personalized management of this heterogeneous, often multimorbid, population. Finally, organizational models to support patient empowerment in an integrative care pathway must be established andvalidated.

Relationship Between Health Locus of Control (HLC) and Self Management in Chronic Kidney Disease Patients Undergoing Hemodialysis

Chronic Kidney Disease (CKD) is a progressive and irreversible global public health problem that causes functional/structural abnormalities of the kidneys for 3 months. Hemodialysis is a kidney replacement therapy that can cause physical and psychological stress that will affect the quality of life. Aims to determine the relationship between HLC and self-management in CKD patients undergoing hemodialysis at Arifin Achmad Hospital, Riau Province. This study uses a correlational description design with a cross-sectional study approach. The results of the analysis using the Pearson test found that there was a relationship between internal HLC and partnership, problem-solving, and emotional management, but no relationship was found with self-care in CKD patients undergoing hemodialysis. There is no relationship between chance HLC and powerful others HLC with self-management indicators, namely partnership, problem-solving, self-care, and emotional management of CKD patients undergoing hemodialysis.

Kidney Issues Associated with COVID-19 Disease

Infection with SARS-CoV-2 and the resulting COVID-19 can cause both lung and kidney damage. SARS-CoV-2 can directly infect renal cells expressing ACE2 receptors, resulting in kidney damage, and acute kidney injury (AKI) has been reported in COVID-19 hospitalized patients. The pathophysiology of COVID-19-associated AKI is multifactorial. Local and systemic inflammation, immune system dysregulation, blood coagulation disorders, and activation of the renin-angiotensin-aldosterone system (RAAS) are factors that contribute to the development of AKI in COVID 19 disease. COVID-19 patients with kidney involvement have a poor prognosis, and patients with chronic kidney disease (CKD) infected with SARS-CoV-2 have an increased mortality risk. CKD patients with COVID-19 may develop end-stage renal disease (ESRD) requiring dialysis. In particular, patients infected with SARS-CoV-2 and requiring dialysis, as well as patients who have undergone kidney transplantation, have an increased risk of mortality and require special consideration. Nephrologists and infectious disease specialists face several clinical dilemmas in the prophylaxis and treatment of CKD patients with COVID-19. This entry presents recent data showing the effects of COVID-19 on the kidneys and CKD patients and the challenges in the management of CKD patients with COVID-19, and discusses treatment strategies for these patients.

#3794 AUTOPHAGY PATHWAY ACTIVATION IN IMMUNE-INFLAMMATORY CELLS OF PERITONEAL DIALYSIS PATIENTS

Abstract Background and Aims The better understanding of the biological pathways related to chronic kidney disease (CKD) may be useful for the identification of new therapeutic targets to improve the management of CKD patients. High-throughput technologies with innovative bioinformatics approaches for data analysis are very useful to achieve this objective. Method We reinterrogated our previous gene expression microarray data obtained from peripheral mononuclear cells (PBMCs) of 5 healthy subjects (HS), 9 chronic kidney disease patients with KDOQI stage II-III (CKD) and 10 CKD patients undergoing peritoneal dialysis treatment (PD). Advanced statistical and machine learning methods, including support vector machine learning and partial least squares discriminant analysis, were used for bioinformatics. Western blot and flow cytometry, then, was used to validate these results in an independent study group (10 HS, 10 CKD and 15 PD). Results Statistical analysis revealed that the transcriptomic profile of PD was significantly different from HS and CKD. Instead, no significant differences were observed between HS and CKD. A total of 348 genes (p&amp;lt;0.0001, FDR&amp;lt;5%) were able to differentiate PD patients from the other two study groups. Autophagy resulted one of the most up-regulated pathways in PD and the autophagy related 5 (ATG5), a gene encoding for a key protein involved in autophagic vesicle formation, was the top discriminative transcript (as demonstrated also by the VIP score). Western blot for ATG5 and LC3BII, main phagosome proteins, performed on the validation cohort, confirmed the activation of autophagy pathway only in PBMC of PD patients. Conclusion Our high-throughput data demonstrated, for the first time, that the autophagy pathway is activated in immune-cells of PD patients. This condition may significantly impact their immune-response and -homeostasis and, probably, it represents the last attempt of these circulating cells to avoid apoptosis.

Protein energy wasting in pre-dialysis chronic kidney disease patients in Benin City, Nigeria: A cross-sectional study.

Protein energy wasting (PEW) is common among chronic kidney disease (CKD) patients, especially those with advanced stage. It worsens frailty, sarcopenia and debility in CKD patients. Despite the importance of PEW, it is not routinely assessed during management of CKD patients in Nigeria. The prevalence of PEW and its associated factors were determined in pre-dialysis CKD patients. This was a cross-sectional study that involved 250 pre-dialysis CKD patients and 125 age- and sex- matched healthy controls. Body mass index (BMI), subjective global assessment (SGA) scores and serum albumin levels were used in PEW assessment. The factors associated with PEW were identified. P-value of < 0.05 was taken as significant. The mean age of CKD and control group were 52.3±16.0 years and 50.5±16.0 years, respectively. The prevalence of low BMI, hypoalbuminaemia and malnutrition defined by SGA in pre-dialysis CKD patients were 42.4%, 62.0% and 74.8%, respectively. The overall prevalence of PEW among the pre-dialysis CKD patients was 33.3%. On multiple logistic regression, the factors associated with PEW in CKD were being middle aged (adjusted odds ratio: 12.50; confidence interval: 3.42-45.00; p <0.001), depression (adjusted odds ratio: 2.34; confidence interval: 1.02-5.40; p = 0.046) and CKD stage 5 (adjusted odds ratio: 12.83; confidence interval: 3.53-46.60; p <0.001). PEW is common in pre-dialysis CKD patients and it was associated with middle age, depression and advanced CKD. Early intervention aimed at addressing depression in early stages of CKD may prevent PEW and improve overall outcome in CKD patients.

Thyroid Dysfunction and Chronic Kidney Disease: A Study Among the Northeastern Population of India.

Chronic kidney disease (CKD) is a multifaceted non-communicable disease characterized by a progressive decline in kidney function ultimately requiring renal replacement therapy (RRT) in most patients. Due to the high cost and availability of a limited number of donors, the majority of patients dependon dialysis and conservative management. Thyroid hormones are indispensable for the growth, development, and homeostasis of our body. The kidney plays an important role in the metabolism, degradation, and excretion of thyroid hormones. Various studies have revealed significant dysfunction in thyroid hormone status in CKD patients, but the results are inconsistent. To evaluate and compare the thyroid hormone status in CKD patients with healthy controls along with a comparison of thyroid hormones in CKD patients on regular hemodialysis with those on conservative management. The present cross-sectional study involved 100 subjectsof both sexes between 40 and 70 years of age, out of which 50 were patients of stage 5 CKDwith no previous history of any thyroid disorders, while 50 apparently healthy subjects served as control. Of the CKD patients,52% were on regular hemodialysis while 48% were receiving conservative care. The participants were investigated for various biochemical parameters like blood urea, serum creatinine, total triiodothyronine (TT3), total thyroxine (TT4), and thyroid stimulating hormone (TSH). The estimated glomerular filtration rate (eGFR) was calculated using a modification of diet in renal disease (MDRD) 4 variable formula. The thyroid profiles were also compared between patients of CKD receiving conservative management and those on maintenance hemodialysis. Of the total sample, 35 (70%) were male and 15 (30%) were female in each of the case and control groups. The mean ageof CKD patients and the control group was 55.32 ± 9.62 years and 54.48 ± 9.63 years, respectively. TT3 was reduced in all50 CKD patients. TT4 was normal in 31 (62%), reduced in 18 (36%), and high in one (2%) case. TSH was high in 38 (76%) cases, while reduced in one (2%) and normal in 11 (22%) cases. The mean blood level of TT3 and TT4 showed a statistically significant reduction (P < 0.0001 for each), while the TSH level showed a significant increase with a p-value of 0.0002 in CKD patients compared to controls. The mean blood urea and serum creatinine levels were statistically increased in cases than in controls (P < 0.0001). The thyroid hormone status revealed a significant difference between CKD patients on maintenance hemodialysis compared to those on conservative care with a p-value of 0.0005 for TT3, 0.0006 for TT4, and 0.0055 for TSH. Patients with CKD were at risk of thyroid hypofunction irrespective of their mode of treatment. This study highlights the clinically relevant interactions between renal and thyroid function, which may be helpful to clinicians for optimal diagnosis and management of CKD patients.

Factors in nephrologists' decision to treat pre-dialysis CKD patients with vitamin D insufficiency and SHPT: A discrete choice experiment.

Little is known about the most important factors that inform a nephrologist's decision to treat (DTT) pre-dialysis chronic kidney disease (CKD) patients with vitamin D insufficiency (VDI) and secondary hyperparathyroidism (SHPT). The objective of this study was to identify such factors and their relative importance in the DTT with a vitamin D therapy. A web-based, adaptive design conjoint analysis discrete-choice survey was developed to study factors that informed the DTT among a sample of 200 nephrologists located throughout the United States. Based on literature review and clinician input, eight attributes were selected that could influence a provider's DTT: age, race, CKD stage, serum 25-hydroxyvitamin D (25D), parathyroid hormone (PTH), serum calcium (Ca), serum phosphorus (P), and history of comorbidities. Respondents were asked to select one patient profile most suitable for treatment from three profiles with varying attribute levels. Each attribute's relative importance score was computed using hierarchical-Bayesian statistics to measure the influence of each factor where higher scores represented greater DTT consideration. The pooled analysis revealed the four most important factors: serum 25D (31.4%), serum Ca (22.7%), plasma PTH (11.5%) levels, and history of comorbidities (8.5%). Age (8.2%), serum P (7.7%), CKD stage (5.7%), and race (4.4%) were relatively less important. Patients' 25D and Ca levels contributed to more than half of nephrologists' DTT, with the consideration of PTH levels being less of a factor. Further understanding of the driving forces behind the factors that inform the DTT may help to standardize the management of CKD patients with SHPT and VDI and improve outcomes.

Non-invasive evaluation of the pathological and functional characteristics of chronic kidney disease by diffusion kurtosis imaging and intravoxel incoherent motion imaging: comparison with conventional DWI.

To explore the diagnostic performance of diffusion kurtosis imaging (DKI) and incoherent intravoxel movement (IVIM) in evaluating the clinical and pathological characteristics in chronic kidney disease (CKD) compared to conventional diffusion-weighted imaging (DWI). Forty-nine CKD patients and 24 healthy volunteers were included in this retrospective study from September 2020 to September 2021. All participants underwent MRI examinations before percutaneous renal biopsy. Coronal T2WI, axial T1WI and T2WI, and DWI (including IVIM and DKI) sequences obtained in one scan. We measured the apparent diffusion coefficient (ADC), true diffusion coefficient (Dt), pseudo-diffusion coefficient (Dp), perfusion fraction (fp), mean kurtosis (MK), and mean diffusivity (MD) values. One-way analysis of variance, correlation analysis, and receiver operating characteristic curve analysis were used in our study. Cortex and medulla ADC, MK, Dt, fp were significantly different between the healthy volunteers and CKD stages 1-2 (all p < 0.05). All diffusion parameters showed significant differences between CKD stages 1-2 and CKD stages 3-5 (all p < 0.05). Except for the uncorrelation between MDMedulla and vascular lesion score, all other diffusion parameters were low-to-moderately related to clinical and pathological indicators. fpMedulla was the best parameter to differentiate healthy volunteers from CKD stages 1-2. MKCortex was the best parameter to differentiate CKD stages 1-2 from that CKD stages 3-5. Renal cortex and medulla fp, Dt, and MK can provide more valuable information than ADC values for the evaluation of clinical and pathological characteristics of CKD patients, and thus can provide auxiliary diagnosis for fibrosis assessment and clinical management of CKD patients. IVIM and DKI can provide more diagnostic valuable information for CKD patients than conventional DWI.

A Retrospective Study of the Perioperative Period Management of Joint Arthroplasty in Patients with Chronic Kidney Disease.

With the rising prevalence of chronic kidney disease (CKD) and the increasing demand for joint arthroplasty, the management of CKD patients in the perioperative period of joint arthroplasty has become an issue worthy of attention for orthopedic surgeons. This study aimed to explore comprehensive perioperative period management strategies for CKD patients. From March 2017 to August 2022, 62 patients who underwent joint arthroplasty in our hospital were included in a retrospective study, including 31 CKD patients (mean age 69.8± 13.4 years old) and 31 non-CKD patients (mean age 69.4± 14.2 years old). The outcome indicators were analyzed, including serum urea, serum creatinine, blood uric acid, hematocrit, and hemoglobin. All patients included in the retrospective study had an average preoperative preparation time of 4.3± 2.6 days and an average hospitalization time of 11.0 ± 7.3 days. There were no significant differences in the changes in the serum urea values between the preoperative and postoperative measurements in the CKD patients or in the serum creatinine values and blood uric acid values (P> 0.05). The hemoglobin value in postoperative measurements was lower than in preoperative measurements in the CKD patients (P< 0.05). The hematocrit value in postoperative measurements was lower than in preoperative measurements in the CKD patients (P< 0.001). Patients with CKD have distinct characteristics compared to non-CKD patients, and they generally have a higher risk for postoperative complications and adverse events. Recognition of risk factors, suitable timing of surgery, the undertaking of protective strategies, and proper management of complications are vital for managing CKD patients in the perioperative period of joint arthroplasty.