MDRD Equation Research Articles

RENAL DAMAGE. WHAT FORMULA DO WE USE?: 7A.05

Renal markers of organ damage include serum creatinine levels (sCr), estimates of creatinine clearance by the Cockcroft-Gault (CG) formula or of glomerular filtration rate by the MDRD formula. These estimated values are a more precise index of the cardiovascular risk accompanying renal dysfunction. A new equation, the CKD-EPI equation, has been validated. The aim of our study was to show the impact of the difference methods used to identify renal damage (RD). Methods: We analysed data from 1.847 patients in Nephrology care. 1.766 (95.6%) have the complete data to calculate the different estimation formulae. RD was study using sCr levels, estimated glomerular filtration rate using MDRD and CKD-EPI formulae, and estimated creatinine clearance using CG and body surface corrected CG formulae. We considered RD when 4 or 5 methods were positive, while we considered no RD when one or none method shows RD. Results: RD prevalence according to the different methods was: a) sCr levels 53.3%, b) MDRD 63.1%, c)CKD-EPI 61.3%, d) CG 57.9%, and e) body-surface corrected CG 60%. Distribution of patients according to the number of RD methods resulting in RD was: none 34%, one 2.2%, two 3.6%, three 2.8%, four 8.8%, and five 48.5%. So, for our analysis we consider without RD 36.2% of patients and with RD 57.3%, 6.4% of patients were excluded because they have 2 or 3 RD positive methods. Sensibility and specificity of the difference methods used was: a) to sCr levels 88.4% and 99.7%, b) to MDRD 100% and 97%, c) to CKD-EPI 100% and 100%, d) to CG 96.4% and 98%, and to body-surface corrected CG 99.4% and 99.1%. Conclusions: RD prevalence depends on the method used, existing a variability near to 10% between methods. Use of sCr levels to determinate the presence of RD have a high specificity but the lower sensibility. The best formula according to our study was CKD-EPI, followed by body-surface corrected CG. MDRD and CG equations showed intermediate specificity and sensibility.

Clinical diognostic value of serum Cystatin C and MDRD equation for chronic kidney disease

Objective To study the clinical value of Cys-C and MDRD equation in the patient with CKD.GFR was estimated by Cys-C and MDRD equation.To study the correlation between Cys-C and MDRD equation.Methods According to the value of GFR of the patient with CKD,divided them into five groups.To study the correlation between Cys-C and GFR.To explore the correlation between Cys-C and Sc.Results Cys-C was correlated with Scr.There was negative correlation between Cys-C and GFR.When renal function slightly injured,Cys-C was higher sensitivity than Scr.Conclusion It is reliable to detect Cys-C by enzyme linked immunosorbent assay(ELISA).It is dependable to judge renal function by the level of Cys-C.Cys-C can be a sensitive marker to reflect GFR.GFR was estimated by Cys-C and MDRD equation.It was correlation between Cys-C and MDRD equation. Key words: Chronic kidney disease(CKD); Glomerular filtration rate(GFR); Cystatin C(Cys-C); MDRD equation

Insuffisance rénale aiguë liée aux produits de contraste iodés

Acute kidney injury is a common complication after contrast administration in radiology or cardiology. It increases morbidity and in-hospital but also long-term mortality. The pathophysiology is complex, there is an association of direct cellular toxicity of contrast agents and medullary ischemia secondary to alterations in intra-renal hemodynamics and to an increase in metabolic activity. Many risk factors have been identified and should be checked prior to injection, the most important being pre-existing renal failure which might be identified by calculating the estimated glomerular filtration rate with predictive equations such as Cockcroft-Gault or MDRD equations. When risk factors are present and contrast administration is really necessary, the only validated measure to reduce the risk of renal failure is still volume expansion. Other pharmacological interventions have interesting results, but a confirmation on a larger scale is necessary. The volume expansion is best performed intravenously by the isotonic saline or sodium bicarbonate.

Stages of 3,547 patients with chronic kidney disease and relevant factor analysis

To investigate the prevalence and distribution of chronic kidney disease(CKD) in Second Xiangya Hospital of Central South University. We retrospectively analyzed the medical records of 3547 CKD patients (>or=14 years old) admitted to Second Xiangya Hospital for the 1st time from January 2003 to December 2008. Glomerular filtration rate (GFR) was estimated by using the MDRD equation abbreviated [eGFR=186.3*SCr-1.154*age-0.203*0.742 (for women) mL/min.1.73 m2]. Data of patients' gender, age, admission number, etiologic and functional diagnose, course of disease, blood pressure, hemoglobin, urine, renal function, blood albumin, and kidney ultra-B were collected. (1) The most common causes for CKD were primary glomerulonephritis(55.20%), hypertension (14.55%) and diabetes (11.78%). The composition of the causes during this 6 years was not significantly different (P>0.05). The proportion of chronic glomerulonephritis declined while that of hypertensive nephropathy and diabetic nephropathy increased as time passed. (2) Patients were respectively distributed from stage 3 to stage 5 at the following percentages: 11.59% (stage 3), 23.03% (stage 4), and 65.38% (stage 5). Middle-aged and young patients (41 years<age<60 years) accounted for 39.24% of the CKD patients.Elderly patients (age>60 years) accounted for 36.88% of the CKD patients. Chronic glomerulonephritis was often seen at 21-40 and 41-60 year olds. Patients with lupus nephritis were younger, 48.35% of whom were 21-40 years old. On the contrary, patients with hypertensive nephropathy and diabetic nephropathy were much older. They were mainly seen in older than 40 year groups. (3) Obstructive nephropathy and gout nephropathy occurred mainly in men while it seemed much easier for women to suffer from lupus nephritis. (4) The majority of CKD patients was accompanied by anemia (94.28%) and hypertension (56.91%), and the incidence and degree of anemia and hypertension increased as CKD developed (P<0.005). The top 3 causes of CKD are chronic glomerulonephritis, hypertensive nephropathy, and diabetic nephropathy. The proportion of hypertensive nephropathy and diabetic nephropathy is on the rise. Elderly people are the high risk group for CKD.

982 NO IMPACT OF TUMOR LOCATION ON THE RESIDUAL RENAL FUNTION AFTER NEPHRON-SPARING SURGERY IN THE PATIENTS WITH RENAL TUMORS

You have accessJournal of UrologyKidney Cancer: Localized II1 Apr 2010982 NO IMPACT OF TUMOR LOCATION ON THE RESIDUAL RENAL FUNTION AFTER NEPHRON-SPARING SURGERY IN THE PATIENTS WITH RENAL TUMORS Jumpei Iizuka, Tsunenori Kondo, Yasunobu Hashimoto, Hirohito Kobayashi, and Kazunari Tanabe Jumpei IizukaJumpei Iizuka More articles by this author , Tsunenori KondoTsunenori Kondo More articles by this author , Yasunobu HashimotoYasunobu Hashimoto More articles by this author , Hirohito KobayashiHirohito Kobayashi More articles by this author , and Kazunari TanabeKazunari Tanabe More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1951AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Nephron-sparing surgery (NSS) has become a golden standard for small renal masses. Ninety-five percent of tumors of 4cm or less are resected with NSS in our department at present. In this study, we analyzed residual renal function after NSS according to the tumor location. We also examined the surgical difficulty of NSS as well. METHODS From July 2003 until April 2009, 599 patients underwent curative surgery for renal tumor. Of these, 193 patients who underwent NSS were the subjects of this study. The indication for NSS was elective in 125 patients and imperative in 68. Tumor location was categorized with three factors, including the circumferential location (anterior, posterior, inner-side and outer-side), the location along the long axis (upper, mid, lower), the depth (exophytic, endophytic), and the hilar location. We compared operation time, blood loss, total ischemic time□@(TIT), perioperative complications, and reduction rate of renal function 1-year after surgery according to the tumor location. Renal function was assessed using the estimated glomerular filtration rate (e-GFR) calculated using the MDRD equation recently modified for Japanese patients, as regulated by The Japanese Society of Nephrology. RESULTS The all tumors were excised completely without a positive surgical margin. There was no local recurrence found after NSS. Mean tumor size was 33.2□}21.6 mm (range, 8-200 mm). Twenty-tree patients underwent laparoscopic NSS and 160 patients underwent open NSS included ex-vivo NSS followed by autotransplantation. Histological study showed RCC in 171 patients and benign tumors in 22. With respect to operation results, the operation time and the blood loss were higher in inner-side tumors than the other circumferential locations (p<0.05). Hilar or endophtic tumors resulted in the prolonged operation time, and TIT, and increased blood loss. Buried tumors enhanced the surgical difficulty. In contrast to surgical results, any location factors did not negatively influence the residual renal function. CONCLUSIONS Hilar or inner-side tumors increase the technical difficulty of NSS but did not compromise the residual renal function. Thus the indication of NSS should be extended aggressively to the hilar, buried, or inner-side tumors. Tokyo, Japan© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e381-e382 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jumpei Iizuka More articles by this author Tsunenori Kondo More articles by this author Yasunobu Hashimoto More articles by this author Hirohito Kobayashi More articles by this author Kazunari Tanabe More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

994 CHANGE IN GFR AFTER RADICAL NEPHRECTOMY: WHEN DO PATIENTS REACH A NEW BASELINE?

You have accessJournal of UrologyKidney Cancer: Localized II1 Apr 2010994 CHANGE IN GFR AFTER RADICAL NEPHRECTOMY: WHEN DO PATIENTS REACH A NEW BASELINE? Michael Garcia-Roig, Michael Gorin, Vincent Bird, and Janice Santos Michael Garcia-RoigMichael Garcia-Roig More articles by this author , Michael GorinMichael Gorin More articles by this author , Vincent BirdVincent Bird More articles by this author , and Janice SantosJanice Santos More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1963AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients undergoing radical nephrectomy generally experience a modest but significant postoperative decrease in GFR. Several factors can impact renal function overall such as age, sex, and comorbidities. We evaluated postoperative estimated GFR (eGFR) in patients with multiple comorbidities who underwent radical nephrectomy. Our aim is to determine the time to a new baseline GFR. In addition, we evaluated independent factors for their potential impact on this rate of change. METHODS Pre and postoperative data were retrospectively collected for 289 patients who underwent radical nephrectomy. GFR was estimated with the MDRD equation preoperatively, and at 1, 3, 6, and 12 months postoperatively. Paired two-tailed student t-test was used to determine statistical significance between data points in time. RESULTS The mean age at time of nephrectomy was 63 years. For all patients, a statistically significant decline in eGFR at postoperative month 1 was observed: 66.8 mL/min preoperatively to 54.7 mL/min at 1 month (P<0.0001). The eGFR achieved at 1 month represents a new plateau as followup eGFRs at 3, 6, and 12 months did not differ significantly from this value. In performing subgroup analysis, this trend was also found in patients both greater than and less than 50 years of age, with ASA scores 2 and 3, and for patients with diabetes, hypertension, coronary artery disease (CAD), and chronic kidney disease (CKD) stages 1-5. Changes in eGFR for subgroups at one month can be found in Table 1. Table 1. Mean Change in eGFR at 1 Month Post Radical Nephrectomy n Mean Age Baseline eGFR (mL/min) Mean change eGFR (mL/min) 95% CI for Mean Change % Change eGFR p All Patients 160⁎ 63 66.3 -11.6 -14.70--8.45 -17.5 <0.0001 Male 94 64 68.9 -14.5 -13.17--16.04 -21.0 <0.0001 Female 65 61 62.5 -7.4 -17.90--11.05 -11.2 0.013 > 50 yo 131 68 65.2 -11.3 -14.80--7.90 -17.3 <0.0001 < 50 yo 27 41 71.5 -13.0 -21.14--5.07 -18.3 0.02 ASA 2 53 56 67.4 -10.3 -16.47--4.17 -15.3 0.001 ASA 3 53 69 62.6 -11.0 -15.10--6.84 -17.6 <0.0001 CAD 38 68 62.4 -15.0 -19.89--10.13 -24.0 <0.0001 DM 33 67 60.9 -11.0 -16.56--5.39 -18.1 <0.0001 HTN 105 65 65.2 -13.0 -16.75--9.32 -19.9 <0.0001 DM+ HTN 27 67 59.7 -11.8 -17.36--6.28 -19.8 <0.0001 CKD 1 24 57 109.1 -28.8 -4.15--1.6 -26.4 <0.0001 CKD 2 68 61 74.1 -15.1 -1.88--1.13 -20.4 <0.0001 % CKD 3 60 67 47.3 -2.74 -6.49-1.01 -5.8 0.149 CKD 4 4 73 25.2 -0.35 -1.45-0.759 -1.4 0.391 CKD 5 4 54 5.7 2.08 -3.03-7.18 36.5 0.286 ⁎ This number reflects the total number of patients for which data was available both preoperatively and at one month. CONCLUSIONS In a population of nephrectomized patients with a mean age of 63, a significant decrease in eGFR was observed in the first postoperative month. Thereafter eGFR reached a plateau. This same trend was observed regardless of sex, ASA score, or comorbidities. In our studied population, females had smaller change in eGFR postoperatively. In addition, patients with CKD 1 underwent the largest change in eGFR. Among the comorbities evaluated, patients with CAD were found to have the largest decline in GFR. Miami, FL© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e386-e387 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Garcia-Roig More articles by this author Michael Gorin More articles by this author Vincent Bird More articles by this author Janice Santos More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

519 IDENTIFICATION OF NEPHROMETRIC VARIABLES PREDICTIVE OF RENAL IMPAIRMENT FOLLOWING PARTIAL NEPHRECTOMY

You have accessJournal of UrologyKidney Cancer: Evaluation and Staging I1 Apr 2010519 IDENTIFICATION OF NEPHROMETRIC VARIABLES PREDICTIVE OF RENAL IMPAIRMENT FOLLOWING PARTIAL NEPHRECTOMY Eugene Cha, Bryan Jeun, Casey Ng, Michael Herman, James Wysock, James DiPietro, Danielle Shehorn, George Shih, Gerald Wang, and Douglas Scherr Eugene ChaEugene Cha More articles by this author , Bryan JeunBryan Jeun More articles by this author , Casey NgCasey Ng More articles by this author , Michael HermanMichael Herman More articles by this author , James WysockJames Wysock More articles by this author , James DiPietroJames DiPietro More articles by this author , Danielle ShehornDanielle Shehorn More articles by this author , George ShihGeorge Shih More articles by this author , Gerald WangGerald Wang More articles by this author , and Douglas ScherrDouglas Scherr More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.595AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We used objective nephrometric criteria on preoperative CT scans to identify variables associated with postoperative renal impairment following partial nephrectomy for renal cortical tumors. METHODS We investigated all patients who underwent a partial nephrectomy for renal cortical tumors at our institution from years 2006 to the present. Of 187 patients during that time span, 58 patients had preoperative CT scans available for evaluation. We calculated the preoperative and postoperative glomerular filtration rates (GFR) as determined by the 4 variable MDRD equation. Renal impairment was defined as a 20% or greater reduction from the preoperative GFR after partial nephrectomy. We subsequently examined 11 distinct criteria on preoperative CT scans to attempt to predict the degree of postoperative renal impairment. Some of these criteria include tumor volume as determined by an ellipsoid formula, endophytic or exophytic distance of tumor relative to renal parenchyma, tumor proximity to collecting system and to renal vessels, tumor laterality, and interlobar location. We also analyzed renal artery clamp times and surgical technique with respect to changes in GFR as well as common risk factors including smoking history, hypertension, diabetes mellitus, or previous history of renal insufficiency. RESULTS Of the 58 patients in our cohort, 16 met our criteria for renal impairment (27.1%). Tumor diameter and endophytic distance were significantly associated with postoperative renal impairment > 20% (p=0.03 and 0.04, respectively). Renal impairment was also associated with interlobar location and tumor volume, though not statistically significant (p=0.08 and p=0.09, respectively). With regard to known risk factors for renal insufficiency, we found no correlation between postoperative renal impairment and history of diabetes, hypertension, smoking and preoperative renal insufficiency. When subdivided by open versus laparoscopic approaches, the cohorts appeared to be well matched in terms of tumor volume (57.2 vs. 27.1 mL, p= 0.35), renal artery clamp time (31.1 vs 34.8 min, p=0.86) and percent reduction in GFR (35.7 vs 32.5, p =0.85). CONCLUSIONS Using an objective nephrometric system based on preoperative CT criteria, tumor diameter and endophytic distance were associated with postoperative renal impairment > 20% after partial nephrectomy. The inclusion of these indices in radiology reports may assist the urologist in the expectant management of renal function during the postoperative period. New York, NY© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e205 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eugene Cha More articles by this author Bryan Jeun More articles by this author Casey Ng More articles by this author Michael Herman More articles by this author James Wysock More articles by this author James DiPietro More articles by this author Danielle Shehorn More articles by this author George Shih More articles by this author Gerald Wang More articles by this author Douglas Scherr More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

323: An Ethnic Chinese Coefficient for the Re-Expressed MDRD Equation Using Standardized Creatinine

323: An Ethnic Chinese Coefficient for the Re-Expressed MDRD Equation Using Standardized Creatinine

Concordancia en pacientes críticos entre las ecuaciones diseñadas para la estimación del filtrado glomerular y el aclaramiento de creatinina en orina de 24 h

Objective To study the behavior of the different equations used to estimate glomerular filtration rate (GFR) applied to critical care patients compared to the standard method: 24-hour creatinine clearance (24-CrCl). Design Retrospective analysis of data base from a previous observational prospective study. Setting Polyvalent ICU in a tertiary Hospital. Population All adult patients admitted to our Unit during the study who had a bladder catheter inserted. Anuric patients were excluded. Interventions We measured 24-CrCl and estimated GFR by MDRD, modified Jelliffe (JF), Mayo-Clinic (CM) and Cockroft-Gault (C-G) equations. Variables To evaluate degree of agreement, we grouped patients regarding 24-CrCl as normal (>70), moderate dysfunction (69–50) or severe renal dysfunction (< 50 mL/min/1.73 m 2). Results 307 patients, aged 54±18, 69.7% males. Measured 24-CrCl was 109.2±78.2 mL/min/1.73 m 2 and the estimate one 95.5±56.7 for JF, 87.4±53.4 for C-G, 86.9±55.9 for MDRD and 85.6±39.9 for CM. The difference was significant (p<0.001) for all estimates but lower for (13.7±53.2 mL/min/1.73 m 2) than C-G (21.9±58.3), CM (23.6±59.6) or MDRD (22.3±60.4). Correlation coefficient was 0.73 for JF, 0.67 C-G or CM and 0.64 for MDRD. The degree of agreement was only fair for all measures (Kappa 0.55 for JF or MDRD, 0.51 for C-G and 0.5 for CM). Conclusions Modified Jelliffe equation showed higher agreement with 24-CrCl than Cockroft-Gault, MDRD or Mayo-Clinic equations when used in critically ill patients. However, when exact measurement is needed, none of the equations can be considered adequate and in these cases, the CrCl should be calculated.

Valor pronóstico del filtrado glomerular en el síndrome coronario agudo: ¿índice de Cockcroft o ecuación MDRD?

Background and objectives One third of patients with a coronary event show kidney failure. Our aim is to establish the relationship between kidney failure and mortality in patients diagnosed of acute coronary syndrome (ACS) through Cockcroft Index (C-G) and MDRD-4 equation, analyzing which of them is better for prognostic stratification. Patients and method Prospective study of 445 patients admitted consecutively between 2006 and 2007 with a high risk of ACS, dividing the sample depending on his kidney function at admission in <60 mL/min/1,73 m 2 and ≥60 mL/min/1,73 m 2 through C-G and modification of diet in renal disease study gruop 4 (MDRD-4) and other variables. We performed a multivariate logistic regression for both of them, analysing the relationship with mortality in the following six months after admission. Results Renal failure was present in 27.9% (creatinine<1,1 mg/dl); 30,5% (C-G) and 22,6% (MDRD-4). Glomerular filtration (GF) was 81,6±35,2 mL/min (C-G) and 77,2±26,1 mL/min/1,73 m 2 (MDRD-4). Patients with GF<60 mL/min showed high mortality, Odds ratio 2,652; p = 0,024 (IC 95%, 1,140 – 6,166) for C-G and 3,372; p = 0,001 (IC 95%, 1,637 – 6,954) for MDRD-4. Conclusion Renal failure increases the risk to die in the following six months after an ACS. The estimation through Cockcroft Index and/or MDRD-4 equation depends on the population characteristics and is indifferent with GF between 60 and 80 mL/min.

Renal Functional Outcomes After Cryoablation of Small Renal Masses

Renal function outcomes after renal cryosurgery have not been widely scrutinized. We report 2-year renal function outcomes from a single-center cohort of patients who were treated with cryoablation for small renal masses. We performed a retrospective review of our laparoscopic and percutaneous renal cryoablation experience between January 2003 and April 2007. Global renal function was assessed using measured serum creatinine and estimated glomerular filtration rate (eGFR) (MDRD equation). Chronic kidney disease (CKD) was defined as a serum creatinine level >2.0 mg/dL or eGFR <60 mL/min/1.73 m(2). Sixty-two patients were included in the analysis. Mean follow-up was 30 months (range 13-63 mos). Mean tumor size was 2.33 cm (range 1-4.6 cm). Comorbid conditions were prevalent: 77% hypertension, 35% hyperlipidemia, 31% diabetes mellitus, 39% tobacco use, and 32% heart disease (coronary artery disease/congestive heart failure). Based on eGFR calculations, preoperative CKD was noted in 17 of 62 (27%) patients. De novo CKD was noted in 5 of 45 (11%) patients. Patients in whom de novo CKD developed had lower pretreatment eGFR (71.0 vs 98.4 60 mL/min/1.73 m(2), P = 0.03) and larger tumor size (2.94 vs 2.19 cm, P = 0.04) compared with patients who were maintaining normal renal function. When CKD was defined as creatinine level >2.0 mg/dL, only one and six patients were identified with preoperative and de novo CKD, respectively. In a cohort of renal cryosurgery patients who were characterized by highly prevalent medical comorbidities, renal function was generally well maintained, with a low rate of de novo CKD based on eGFR calculations. A serum creatinine level >2.0 mg/dL was a less sensitive measure of CKD.

Abstract B135: Mortality risks and life-shortening effect of hepatitis C virus infection: A prospective cohort study of 487,369 adults in Taiwan

Abstract Background: There has been emerging knowledge on the serious burden of diseases attributable to Hepatitis C carriers (HCV). However, the extent of the life time risk of HCV, when independently assessed, is as yet fully understood, particularly regarding associated risk factors that are amenable to reductions. Objectives: We assessed the mortality risks and life-shortening effect of HCV, along with its associated risk factors, based on following up a large healthy cohort in Taiwan. Methods: The cohort, consisting of 487,369 subjects, participated in a standardized medical screening program since 1994. Based on the hepatitis carrier status (either HBV or HCV or both), three sub-cohorts were created. As of 2007, 16,920 deaths were identified, including 1,383 liver cancer and 631 cirrhosis, with average follow up of 8.5 years. Hazard ratio (RR) was calculated using Cox proportionate hazard model. National prevalence was arrived at by standardizing age and educational status, a surrogate for socioeconomic status (SES) to those in Taiwan. Glomerular Filtration Rate (GFR) was calculated by MDRD equation. Results: National Prevalence for HCV: 3.6% above age 20, and 6.6% above age 40 (male 6.0% and female 7.3%) increased with age and with lower SES. Rates of diabetes, hypertension, obesity, and HDL among HCV+ participants were significantly higher, but total cholesterol and triglycerides were lower. They had 35% more chronic kidney disease (CKD), with 54% more proteinuria and 13% more reduced GFR (13%). Cohort mortality results: HCV+ male participants had 7.37 years shorter than the total cohort at age 20, compared to 3.36 years for HBV+. In contrast to one out of 7 deaths (13.7%) in the total cohort was liver related, one out of two in the HCV+ sub-cohort. With HR for all-cause being 2.42, 58.7% of the deaths were HCV-related, larger than HBV counterparts (36.7%). The number of HCV related cirrhosis was 1/4 (28%) that of HCC, and HCV related risk, 10.74, was slightly smaller than that for HCC, 14.56. Nearly one out of 10 HCV+ coexisted with HBV (8.9%), and the risk became synergistic, with 2/3 of them dying from liver-related causes. Kidney cancer (5.46), diabetes (2.31), and stroke (1.91) were also significantly increased. In the order of ranking All Cause mortality risks among HCV+ subjects, diabetes (4.5), proteinuria (4.1), smoking (3.5), obesity (3.3), drinking (3.2) and hypertension (2.9) were all significantly increased. Conclusion: The life expectancy of HCV+ carriers was shortened by 7.37–8.45 years. While the main effect was liver cancer and cirrhosis, HCV also involved kidney damage, producing proteinuria and reduced GFR, and led to an increased mortality from diabetes and stroke. The ranking order of reducible HCV risks were diabetes, CKD including proteinuria, smoking, obesity, drinking and hypertension. Citation Information: Cancer Prev Res 2010;3(1 Suppl):B135.

Differences between the CKD-EPI and the MDRD equations when estimating the glomerular filtration rate in hypertensive patients

To analyze the agreement in glomerular filtration rate (GFR) estimated with CKD-EPI and MDRD-IDMS equations in a cohort of hypertensive patients. We included consecutively 478 hypertensive patients, mean age 57.58 yr (SD: 12.34), 68.3% males. The estimation of GFR was performed with MDRD-IDMS and CKD-EPI equations and we analyzed the agreement between them. The estimation of GFR with CKD-EPI was 4.37 (95%:3.73-4.19) mL/min/1,73 m2 higher than MDRD-IDMS, overall and by gender (males 3.99; females 5.04). In patients under 65 years the difference was greater, 6.55 (95%:5.95-7.15) mL/min/1.73 m2 in both men 6.07 and women 6.48. However, we found no significant difference over 65 years. Intraclass correlation coefficient was 0.904 (95% CI:0.886-0.919), 0.897 men and 0.917 women and Kappa index 0.848 (95% CI :0.795-0.889), 0.845 men and 0.852 women. CKD-EPI equation estimated a higher GFR in hypertensive patients under 65 years and reclassified in stage 1 patients classified in stage 2 by MDRD-IDMS.

El filtrado glomerular reducido según las fórmulas de Cockcroft-Gault y MDRD no siempre predice la morbimortalidad cardiovascular en los pacientes hipertensos atendidos en atención primaria

A decrease in renal function is associated with cardiovascular morbidity and mortality. The aim of this study was to analyse the association of cardiovascular morbidity and mortality with baseline glomerular filtration rate (GFR), calculated according to the Cockcroft-Gault and MDRD formulas, with the incidence of major adverse cardiovascular events (MACEs) in a cohort of hypertensive individuals followed for 12 years. We performed a prospective study of a random sample of 223 hypertensive patients free of MACEs, who were followed in an urban Primary Care Centre. GFR was estimated using both formulas. MACEs were considered as the onset of ischaemic heart disease, heart failure, heart attacks, peripheral vascular disease or cardiovascular death. Data were analysed using the life-table method and Cox regression modeling. The median follow-up was 10.7 (interquartile range, 6.5-12.1) years. Follow-up was completed in 191 participants (85.7%). The cumulative survival was 64.7% (95% Confidence Interval (CI), 57.9-71.6). The incidence of MACEs during the follow-up period was 3.6 (95% CI, 2.7-4.4) per 100 subject-years. The final multivariable model showed that the most predictive variables of MACEs in the study population were the presence of diabetes mellitus and the estimation of GFR ≥60 ml/min/1.73 m2 by MDRD equation. There was a relationship between the occurrence of MACEs and an estimated GFR by MDRD above 60 ml/min/1.73 m2 at study entry, inversely to what was expected. GFR estimated by the C-G formula was not associated with cardiovascular risk.

Prevalence of chronic renal disease in Spain: results of the EPIRCE study.

Chronic kidney disease (CKD) is an independent cardiovascular risk factor. The knowledge of prevalence in general population may help to early detection of CKD and prevent or delay its progression. Sociodemographic, baseline characteristics, and CKD prevalence (measured by centralized serum creatinine and MDRD equation) were evaluated in a randomly selected sample of general population aged 20 years or older, collected in all Spanish regions and stratified by habitat, age and sex according to 2001 census (n=2746). Univariate and multivariate logistic regression analyses were used to evaluate associations with CKD risk factors. Mean age was 49.5 years. The overall prevalence of Kidney Disease Outcomes Quality Initiative grades 3-5 CKD was 6.8%, with a 95% confidence interval (CI) of 5.4 to 8.2 (3.3% for age 40-64 years and 21.4% for age > 64 years). The prevalence estimates of CKD stages were: 0.99% for stage 1 (glomerular filtration rate [GFR] >or=90 ml/min per 1.73 m2 with proteinuria); 1.3% for stage 2 (GFR 60-89); 5.4% for stage 3a (GFR 45-59); 1.1% for stage 3b (GFR 30-44); 0.27% for stage 4 (GFR 15-29); and 0.03% for stage 5 (GFR < 15). An important prevalence of classical cardiovascular risk factors was observed: dyslipemia (29.3%), obesity (26.1%), hypertension (24.1%), diabetes (9.2%) and current smoking (25.5%). The independent predictor factors for CKD were age, obesity and previously diagnosed hypertension. The prevalence of CKD at any stage in general population from Spain is relatively high, especially in the elderly, and similar to countries of the same geographical area. Independently of age, two modifiable risks factors, hypertension and obesity, are associated with an increased prevalence of CKD.

Metabolic syndrome and chronic kidney disease in a rural adult population of Hunan province, China

To explore the relationship between metabolic syndrome and chronic kidney disease (CKD) in a rural adult population of Hunan province. 1953 residents (older than 18 years) from the same village were randomly selected, using a stratified, multistage sampling method. All residents were interviewed and tested for albuminuria with morning spot urine albumin to creatinine ratio (abnormal: >/= 30 mg/g), reduced renal function with estimated glomerular filtration rate by modified MDRD equation [abnormal: < 60 ml/min (1.73 m(2))]. The associations of kidney damage indicators with demographic characteristics (age, gender, smoking status), indicators on health (diabetes, hypertension) and metabolic syndrome traits were examined. Eligible data of 1709 subjects were enrolled in the study. After the adjustment of age, gender and other metabolic syndrome traits, participants with metabolic syndrome had a higher prevalence of CKD (19.3% vs. 13.2%, P < 0.001) than those without the syndrome. As the number of metabolic syndrome traits increased, so did the prevalence of CKD. There seemed to be a strong and independent association between metabolic syndrome and chronic kidney disease. For participants without hypertension and diabetes, metabolic syndrome was also associated with CKD (OR value 1.733, 95%CI: 1.20 - 2.41, P = 0.004). In these 1709 adults under this study from a village of southern China, metabolic syndrome seemed to be associated with CKD.

Prevalence and Severity of Chronic Kidney Disease and Anemia in the Nursing Home Population

Chronic kidney disease (CKD) is an emerging health concern and may have important implications for the management of older people with many other chronic conditions, such as the nursing home (NH) resident population. This study was designed to describe the prevalence of CKD and associated comorbidities in a representative sample of NH residents. Cross-sectional descriptive study as a component of a prospective observational study of CKD and anemia in the NH population. Eighty-two geographically representative NHs in the United States. Participants were 794 NH residents who had complete baseline data collected. Residents for whom consent was obtained underwent a record review focused on identifying a predefined set of comorbid conditions, clinical assessment, and blood and urine collections. Stage of CKD was based on estimated GFR (eGFR) using the MDRD equation: no CKD (eGFR > 60 mL/min/1.73 m(2)), Stage 3a (45-59), Stage 3b (30-44), and Stage 4/5 (< 30). Consent was obtained from 847 of 1626 residents screened; 32 were ineligible and 21 dropped out of the study; complete data were available for 794 residents. CKD was present in approximately 50% of residents; of these residents with CKD, 47.6% were stage 3a, 39.27% stage 3b, and 13.2% stage 4/5. Fifty percent of the population had anemia, and anemia was more common in those with CKD. The average number of comorbid conditions in the population was 5.3 (SD 2.2); the proportion of patients with multiple comorbid conditions, especially cardiovascular conditions, increased with increasing stage of CKD. Among those without CKD, 57% had 5 or more comorbidities in comparison to 87% of those with stage 4/5 CKD. In this representative sample of 794 US NH residents, 50% had clinical evidence of CKD. Patients with CKD, particularly those at later stages, were more likely to have cardiovascular comorbidities and anemia. The co-occurrence of these conditions in institutionalized populations may have important implications for the clinical management of this patient population, particularly as it relates to the potential for further renal complications.

Abstract 5120: Cardiac Sympathetic Nerve Activity is Associated With the Progression of Cardiorenal Syndrome in Patients With Chronic Heart Failure: 10-Year Follow up Study

Background : Chronic heart failure (CHF) and renal dysfunction (RD) frequently coexist. Cardiac sympathetic nerve activity (CSNA) influences the clinical outcomes in CHF patients (pts), but there is no information available on the relation between CSNA and RD in CHF pts, so-called cardiorenal syndrome (CRS). Methods : We studied 101 CHF patients with left ventricular ejection fraction (LVEF) &lt; 40%. At the entry, I-123 MIBG imaging was performed, and washout rate (WR) was calculated from the chest anterior view images obtained at 20 and 200 min after isotope injection. Every year, estimated Glomerular Filtration Rate (GFR) by the MDRD equation was obtained in each patient. Results : GFR at the entry was significantly lower in pts with (n=49) than without abnormal WR (n=52) (more than 27%: the mean control WR +2SD) (59±18 vs 67±19 ml/min/1.73m 2 , p=0.029). With a mean follow-up of 7.3±3.5 yrs, GFR decreased from 64±19 to 50±21 ml/min/1.73m 2 , the median value of GFR depression rate (GFRdep) was 3.5%/year, and 31 of 101 pts died of cardiac death. GFRdep was also significantly greater in pts with than without abnormal WR (8.2 vs 2.5%/year, p&lt;0.01). There were no significant differences in gender, age, NYHA class, LVEF, or the content of anti-heart failure therapy between pts with and without WR≥27%. Cardiac death was significantly more frequently observed in pts with than without GFRdep≥3.5%/year (44 vs 16%, p&lt;0.01). The odds ratio of greater GFRdep for cardiac death was 3.8 (95%CI 1.7 to 8.5). Conclusion: In CHF pts, CSNA would be associated with the progression of RD. Furthermore, progression of RD had poor clinical outcome. Thus, CSNA might play an important role in the progression of CRS in CHF pts.

Aminoglycoside Clearance is a Good Estimate of Creatinine Clearance in Intensive Care Unit Patients

The aim of this study was to determine whether creatinine clearance can be estimated as well by clearance of gentamicin/tobramycin as by routine, non-invasive estimates in the intensive care unit. The volume of distribution and clearance values for gentamicin/tobramycin were obtained using first order kinetics and an estimate of creatinine clearance derived. Seven estimates of renal function (Cockroft-Gault, MDRD4 and MDRD6 equations, two- and 24-hour urine estimates, two equations utilising Cystatin C concentrations) were compared to the gentamicin/tobramycin clearance estimate in 100 intensive care unit patients. The gentamicin clearance estimate was at least as reliable as other estimates. The two-hour was less reliable than the 24-hour urine estimate. The Cockroft-Gault appeared to out-perform the MDRD equation estimates. The MDRD4 was not as reliable as the MDRD6 estimate. Cystatin C estimates appeared not as reliable as the gentamicin estimate of renal function. The gentamicin/tobramycin estimate is at least as good as other estimates and it is available sooner than most others. It should be used in all patients who are prescribed gentamicin. The two-hour urine and MDRD4 estimates should not be used in the intensive care unit.

Detection and prognostic impact of renal dysfunction in patients with chronic heart failure and normal serum creatinine

Accurate identification of renal dysfunction (RD) is crucial to risk stratification in chronic heart failure (CHF). Patients with CHF are at special risk of having RD despite normal serum creatinine (SCr), owing to a decreased Cr generation. At low levels of SCr, the equations estimating renal function are less accurate. This study was aimed to assess and compare the prognostic value of formulas estimating renal function in CHF patients with normal SCr. We studied 462 patients with systolic CHF and normal SCr. Creatinine clearance was estimated by the Cockcroft-Gault (eCrCl) and glomerular filtration rate by the 4-variable MDRD equation (eGFR); eCrCl normalized for body-surface area (eCrCl(BSA)) was calculated. The primary outcome was all-cause mortality at 2 years. Seventy five patients died. At multivariate Cox regression analysis, only eCrCl(BSA) was significantly associated with mortality (p = 0.006); eGFR (p = 0.24), eCrCl (p = 0.09) and BUN (p = 0.14) were not statistically significant predictors. The patients in the lowest eCrCl(BSA) quartile had an adjusted 2.1-fold (CI: 1.06-4.1) increased risk of mortality, compared with those in the referent quartile. Two-year survival was 70.4% in the lowest eCrCl(BSA) quartile and 89.7% in the referent quartile. Other independent predictors of mortality were ischemic etiology (RR: 2.16 [CI: 1.3-3.5], p = 0.0017), NYHA III/IV class (RR: 2.45 [CI: 1.51-3.97], p = 0.0003), LVEF <0.25 (RR: 3.38 [CI: 1.69-6.75], p = 0.014), and anemia (RR: 1.86 [CI: 1.16-2.99], p = 0.009). A sizeable proportion of CHF patients have prognostically significant RD despite normal SCr. Such patients represent a high-risk subgroup and can more accurately be identified by the CG formula corrected for BSA than the MDRD.