Modification Of Diet In Renal Disease Research Articles

The liver-kidney axis: Is serum leptin a potential link in non-alcoholic fatty liver disease-associated chronic kidney disease?

Background and study aimsNon-alcoholic fatty liver disease (NAFLD) is an independent risk factor for chronic kidney disease (CKD). Previous studies argued that leptin levels increase significantly with the progression of CKD. But the association between leptin and CKD has not been investigated in patients with NAFLD. Therefore, we conducted this study to establish whether increased leptin level is associated with CKD in NAFLD patients. Patients and methodsIn our prospective study with a follow up period of six months thirty-five teetotaller biopsy-proven NAFLD patients were divided as groups with mild, versus advanced, fibrosis. Liver fibrosis was also assessed with Fibroscan. Serum leptin levels were measured by radioimmunoassay. For insulin resistance we used the homeostasis model assessment method (HOMA-IR). For the kidney function, we used the abbreviated formula Modification of Diet in Renal Disease (MDRD) formula, which estimates GFR. For statistical analysis, Student’s-t test, Mann-Whitney test, linear regression-binary logistic regression analyses and the ROC curve analysis were used. ResultsAdvanced fibrosis and increased HOMA-IR were risk factors for decreased eGFR. Leptin correlated inversely with advanced fibrosis (p: 0.03) and low leptin was a risk factor for CKD (p: 0.02). In ROC curve analysis, advanced fibrosis and low leptin were risk factors for decreased eGFR (p: 0.007 and 0.004, respectively). Low leptin level was dependently associated with decreased eGFR. ConclusionAdvanced fibrosis in NAFLD patients is a risk factor for CKD. Leptin correlated inversely with advanced fibrosis. Unlike the previous studies, which were not performed in NAFLD patients, we found decreased leptin in NAFLD patients with decreased eGFR. Low leptin level was found to be a dependent predictor for differentiating NAFLD patients with high risk for CKD.

Antiphospholipid Syndrome in Renal Allograft Recipients-A Long-Term Multicenter Analysis.

The aim of the study was to assess renal allograft function and survival in recipients with APS. Retrospective, multicenter study included 19 adult renal recipients with definite APS (primary or lupus-related) from three Polish transplant centers. Renal allograft function was assessed using serum creatinine concentration (SCr1) at 3rd month post-transplant and at the end of the observation (SCr2) and glomerular filtration rate (GFR) was estimated based on modification of diet in renal disease (MDRD) formula. General linear model was used to assess 12 month GFR change over time. Kaplan-Meier curves and restricted mean survival time were used for allograft survival. Matched control group consisted of 21 stable renal recipients without history of thrombosis and without anticoagulation/antiplatelet treatment. The study group differs in induction therapy (p = 0.019), high-urgency procedure (p = 0.04), proteinuria (p = 0.0058), primary disease (lupus) (p < 0.0001), re-transplantation in primary APS (p = 0.0046) and shorter time since engraftment to SCr2 (p = 0.016). Primary APS was more often diagnosed post-transplant (p = 0.0005). Allograft biopsy revealed thrombotic microangiopathy (TMA) with acute rejection (AR) or isolated AR vs AR or chronic rejection in controls but did not reach significance (p = 0.054). Renal allograft function was inferior in the study group but did not reach significance: mean SCr2 (mg/dL) was 2.18 ± 1.41 and 1.5 ± 0.68 in controls, respectively, p = 0.27; mean GFR2 (ml/min/1.73m2) was 39.9 ± 20.83 and 51.23 ± 19.03, respectively, p = 0.102. Renal allograft duration was inferior in patients with APS and was (in years) 11.22 ± 1.44 vs. 14.36 ± 0.42, respectively, p = 0.037, in patients with primary APS (p = 0.021), in patients with APS diagnosed post-transplant (p = 0.012) but not in lupus-related APS (p = ns). Fifteen year renal allograft survival was inferior in APS vs. controls (73,86% vs. 90.48%, respectively, p = 0.049). Recipients with APS are at higher risk for allograft loss due to immune and non-immune causes. Renal allograft survival was inferior in recipients with APS and renal function remains impaired but stable.

Management of high recurrent urolithiasis patients: the long term interdisciplinary approach is the key

Background: Urolithiasis is a pathology that can be highly recurrent, leading to frequent urological interventions, even with specific management. Objective: We want to verify, whether an interdisciplinary long-term approach during a single day-care program decreases the recurrences rate requiring urological intervention. Design, Setting, and participants: Patients with recurrent stone events were included in a prospective study of 18 months of interdisciplinary management. During the first day (T0), a team of health professionals diagnoses the lithogenic process and analyzes the causes of recurrences to determine preventive measures. Then, patients were re-evaluated at 6 and 18 months later to check the recurrences of stone events and the efficacy of preventive measures. Primary endpoints were urological intervention and urinary tract infection rates at baseline and 6 and 18–months. Secondary endpoints were blood and urine parameters changes and quality of life assessed by an open-ended survey. Outcome measurements and statistical analysis: the rate of recurrence and urological intervention was checked before the interdisciplinary day (T0) and at 18 months (T18). Blood and urine samples were analyzed to evaluate the lithogenic process, such as the 24h urine, morning urine, and eGFR. Statistical analyses were performed with Statistica 10. Results and limitations: Out of 157 patients included in the study between 2007 and 2010, 82 (52%) came back 18 months later. After 18 months, 83% did not show any recurrences. The frequency of surgical intervention was 0.65(0.21-1.42) intervention per year before the management and reach 0(0-0) after 18 months (p<0.0001). The 24h diuresis volume was improved from 2.00 (1.50-2.50) to 2.33(1.80-3.05) L/d (p<0.01). Initial extreme values of pH have shown a significant improvement for both initial acid (<5.5, p<0.001), and alkaline (>6.5, p<0.01) pH. Modification of Diet in Renal Disease (MDRD) was stable (81+-23 VS 80+-22 ml/min/1.73m2 (p>0.05)). However, all parameters of 24h urine, as calciuria and oxaluria, did not show significant change. Conclusion: The long-term interdisciplinary management of the recurrent stone former was useful to reduce recurrences and decrease uro-logical intervention.

Removal of ethnicity adjustment for creatinine-based estimated glomerular filtration rate equations.

Creatinine-based estimated glomerular filtration rate equations (eGFRcreatinine) are used to measure excretory kidney function in clinical practice. Despite inter and intra-patient variability, eGFRcreatinine has excellent clinical utility and provides the basis for the classification system for chronic kidney disease (CKD), for kidney function monitoring, treatment interventions and referral pathways. The 4-variable modification of diet in renal disease (MDRD) eGFRcreatinine equation was introduced in 2000 and recommended by the National Institute for Health and Care Excellence (NICE) in 2008. Subsequently, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) eGFRcreatinine equation was introduced in 2009 and is more accurate than MDRD in patients with mild and moderate CKD. In 2014, NICE recommended that CKD-EPI eGFRcreatinine replace MDRD eGFRcreatinine in routine clinical practice across England. Both equations originally incorporated adjustments for age, gender and ethnicity. However, the evidence for ethnicity adjustment has been increasingly questioned, and in 2021 NICE recommended that kidney function should be estimated by CKD-EPI eGFRcreatinine without using ethnicity adjustment. Recently, a CKD-EPI equation has been presented without ethnicity adjustment; however, this has not been validated outside of North America and NICE continues to recommend CKD-EPI 2009. We review the status of eGFRcreatinine in clinical practice, including the limitations of eGFRcreatinine and the rationale for removal of ethnicity adjustment and the potential impact of this change on clinical care for patients with kidney disease.

The Effect of Acute Aerobic Exercise on Biomarkers of Renal Health and Filtration in Moderate-CKD

ABSTRACT Purpose: Efficacy of exercise to improve renal health and filtration remains understudied in adults with moderate-stages (stages G3a-b) of chronic kidney disease (CKD). Acute exercise may contribute clinically relevant information for exercise-related augmentation of renal health and filtration in CKD. Urine epidermal growth factor (uEGF) and cystatin C (CyC) are proposed to be more direct biomarkers of renal health and filtration. This study aimed to determine the influence of continuous moderate-intensity exercise (CMIE) and high-intensity interval exercise (HIIE) on traditional and novel biomarkers of renal health and filtration in moderate-stages of CKD. Methods: Twenty CKD participants completed 30 minutes of both CMIE and HIIE. Blood and urine samples were obtained pre, 1-hour, and 24-hours post-exercise. Traditional—serum creatinine (sCr) urine creatinine, novel—uEGF, uEGF ratio (uEGFr), and CyC. Estimates of glomerular filtration rate (eGFR)—modification of diet in renal disease (MDRD) and the CKD-Epidemiology (CKD-EPI)—responses were compared pre, 1 hr, and 24 hr post-exercise. Results: Relative to pre-exercise measures, uEGF remained unchanged in both exercise conditions. However, uEGFr was 5.4% greater 24-hours after HIIE (P = .05), while uEGFr remained unchanged with CMIE. sCr decreased 6 to 19% 1-hour post-exercise in both conditions (P = .009). On average renal filtration increased in eGFR-MDRD (7.2 ± 2.0 ml/min/1.73 m2) (P = .007) and eGFR-CKD-EPI (8.6 ± 2.3 ml/min/1.73 m2) 1-hour post-exercise (P = .009). Conclusion: By clinical estimates, renal filtration in CKD was not normalized but transiently improved regardless of exercise condition, with HIIE eliciting transient improvements in renal health.

Clinical Relevance of a Vancomycin 24 h Area under the Concentration-Time Curve Values Using Different Renal Function Equations in Bayesian Dosing Software.

With the updated 2020 vancomycin therapeutic drug monitoring (TDM) guidelines suggesting a ratio of area under the curve over 24 h to a minimum inhibitory concentration (AUC24/MIC) as a target from the Infectious Diseases Society of America, an accurate estimation of AUC24 has become more critical. We aim to compare the AUC24 using Bayesian dosing software according to various estimated glomerular filtration rate (eGFR) equations in order to analyze the clinical impact of eGFR in vancomycin TDM. We reviewed the TDM dataset of 214 adult patients and analyzed the AUC24 values from various renal function equations, including the Cockcroft-Gault (C-G), the modification of diet in renal disease (MDRD), the chronic kidney disease epidemiology collaboration (CKD-EPI), and the revised Lund−Malmö. The AUC24/MIC results (assuming a MIC of 1 mg/L) were divided into three groups as follows: <400, 400−600, and >600. Additionally, we compared the group agreement between the C-G and the three eGFR formulas. Although there was a statistically significant difference in the AUC24 of the MDRD and the CKD-EPI formulas compared to the C-G, the group concordance rate of the eGFR formula was 95.2−100%, which indicates no clinical significance. The clinical impact of the eGFR formula type on drug dosing recommendations in vancomycin TDM using Bayesian software was insignificant in clinical practice.

Impact of “Black Race” Coefficient in Estimation of Glomerular Filtration Rate on Our Community and Medical Education

Introduction: The use of race in estimation of glomerular filtration rate (eGFR) started a critical national conversation on numerous areas of medicine touched by racism; with a call for removal of race from calculation of eGFR. We scrutinized use of “Black race” coefficient in Modification of Diet in Renal Disease (MDRD) eGFR calculation and consequence of its use on our local community in SW Michigan. Methods: A cross-sectional analysis of de-identified electronic health record data from routine outpatient primary care visits, from January 1, 2019, to December 31, 2019, included variables such as age, race, gender, serum creatinine levels, and calculated eGFRs (if any), using χ2 tests for association and Wald-approximation 95% confidence interval. During the data collection period in 2019, both hospital systems and the outpatient clinic site were all using MDRD. Results: eGFR and associated CKD stage were calculated for 131,863 patients. χ2 tests found significant differences in rates of CKD stages 3, 4, and 5 between “Black” and “not Black.” And, the 95% confidence interval for the proportion of Black patients who would advance to the next stage of CKD upon ignoring “Black race” (using Wald-approximated confidence interval for binomial proportion) is between 41.1% and 43.0%. Discussion: The eGFR calculations which place Black patients in lower CKD stages initially may deprive them of important treatment and referral early in their disease course. Removal of the Black race coefficient allows for referral to a nephrologist, Medicare coverage, and the potential need for transplant and/or dialysis. Conclusion: Our analysis demonstrates the impact removal of “black race” coefficient from MDRD eGFR calculation could have on our community.

Evaluation of Serum Lipoprotein (a) Levels and Novel Lipid Indices in Patients with Chronic Kidney DiseaseA Case-control Study

Introduction: Majority of Chronic Kidney Disease (CKD) patients are more likely to die of cardiovascular complications, before reaching End Stage Renal Disease (ESRD). Although there are many risk factors contributing to pathogenesis of cardiovascular disease in CKD subjects, dyslipidemia represents one of the modifiable risk factors. American Heart Association has recommended that CKD patients should be classified in the highest risk group for developing cardiovascular events. Kidney Disease: Improving Global Outcome (KDIGO) recommends, these patients should be evaluated for dyslipidemia and for treatment to reduce the risk of cardiovascular events. Aim: To evaluate serum Lipoprotein (a) {Lp(a)} levels and assess the significance of novel lipid indices in non dialysis patients of CKD. Materials and Methods: This analytical case-control study was conducted from January 2016 to June 2016 at Government Stanley Medical College and Hospital, Chennai, Tamil Nadu, India. It included 70 non dialysis CKD subjects and 70 healthy control subjects, adhering to inclusion and exclusion criteria. Fasting Blood Samples (FBS) were collected and analysed for: Fasting blood glucose, Fasting Lipid Profile, Serum Lp(a). Serum Lp(a) was estimated by immunoturbidimetry method and lipid profile by enzymatic method. Estimated Glomerular Filtration Rate (eGFR) was calculated using Modification of Diet in Renal Disease (MDRD) formula and staging of CKD subjects was done, based on KDIGO guidelines. Novel lipid indices were calculated using appropriate formula. Statistical analysis of the tabulated data was done using Social Sciences of the Statistical Package (SPSS) software. Results: There were significant differences in the levels of FBS, Triglycerides (TG), Lp(a) between controls and non dialysis CKD subjects (p&lt;0.001). Among Lipid Indices, Atherogenic Index of Plasma (AIP) and Lipid Tetrad Index (LTI) values were significantly higher in CKD subjects compared to controls (p&lt;0.001), but there was no significant difference was seen in Atherogenic Coefficient (AC), Castelli’s Risk Index-I (CRI-I) and CRI-II values. AIP and LTI showed significant positive correlation with Lp(a). LTI had the highest Positive Predictive Value (PPV) (77.8%) and Negative Predictive Value (NPV) (72.7%); AIP had PPV of 65.3% and NPV of 66.2%. Conclusion: The present study concludes that, among lipid indices, AIP and LTI are the most suitable for assessment of atherogenicity in non dialysis CKD. In developing countries like India, owing to high cost of tests like Serum Lp(a), novel lipid index AIP can serve as a cost-effective screening tool for monitoring cardiovascular disease risk in CKD patients.

Association between Decreased Estimated Glomerular Filtration Rates and Long-term Mortality in Korean Patients with Acute Myocardial Infarction.

A reduced estimated glomerular filtration rate (eGFR) is a predictor for mortality in patients with acute myocardial infarction (AMI). This study aimed to compare mortality according to the GFR and eGFR calculation methods during long-term clinical follow-ups. Using the Korean Acute Myocardial Infarction Registry-National Institutes of Health Data, 13,021 patients with AMI were included in this study. Patients were divided into the surviving (n=11,503, 88.3%) and deceased (n=1,518, 11.7%) groups. Clinical characteristics, cardiovascular risk factors, and 3-year mortality-related factors were analyzed. eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations. The surviving group was younger than the deceased group (62.6±12.4 vs. 73.6±10.5 years, p<0.001), whereas the deceased group had higher hypertension and diabetes prevalences than the surviving group. A high Killip class was more frequently observed in the deceased group. eGFR was significantly lower in the deceased group (82.2±24.1 vs. 55.2±28.6 ml/min/1.73 m2, p<0.001). Multivariate analysis revealed that low eGFR was an independent risk factor for mortality during the 3-year follow-up. The CKD-EPI equation was more useful for predicting mortality than the MDRD equation (0.766; 95% confidence interval [CI], 0.753-0.779 vs. 0.738; 95% CI, 0.724-0.753; p=0.001). Decreased renal function was a significant predictor of mortality after 3 years in patients with AMI. The CKD-EPI equation was more useful for predicting mortality than the MDRD equation.

Can CBC Profile and Liver Function Test Predict Chronic Kidney Disease among a Normal Population?

Kidney disorders are mainly diagnosed after a major decline in the renal function. Chronic kidney disease (CKD) is one of the most common disorders of the urinary system defined by gradual reduction of renal function. Considering the silent nature and late diagnosis of this problem, this study aims to investigate the prevalence of CKD and its association with Complete Blood Count (CBC) profile and liver function tests. Out of the total population enrolled in the Tabari cohort study, 5822 subjects without history of diabetes mellitus, hypertension, cardiac disease, renal failure, cancer, and pathologic obesity were selected. Glomerular filtration rate (GFR) was calculated using creatinine clearance as well as Modification of Diet in Renal Disease (MDRD) equation. CKD was defined as GFR decline less than 60 ml/min/1.73 m2 regardless of its main cause. Prevalence of CKD in total population as well as men and women was 20.2%, 16.8%, and 23.1%, respectively. Multivariate models showed the odds ratios for third and fourth quartiles of Mean corpuscular volume (MCV) and also for the fourth quartile of the lymphocyte count as of 0.78 (0.64, 0.95), 0.81 (0.67, 0.99), and 1.22 (1.01, 1.47), respectively. Corresponding odds ratios for the fourth, third, and second quartiles of Blood Urea Nitrogen (BUN) were 1.42 (1.14, 1.77), 1.76 (1.42, 2.19), and 2.79 (2.27, 3.43), respectively. This study showed a high prevalence of CKD among the normal residents (without major underlying diseases and excessive obesity) in the north of Iran, especially among women. In addition, low MCV, low lymphocyte, and high BUN were detected as predictors of this disorder.

Особенности органо- сохраняющего лечения пациентов старшей возрастной группы с локализованным почечно-клеточным раком

Imaging diagnostics becomes more widespread, the incidence of incidental renal cell carcinoma (RCC) among older adults is increasing each year. Although nephron-sparing surgery are the standard of care for localized RCC, the potential risk of perioperative complications and readmission rates are higher among older patients.To compare the main perioperative indicators, as well as oncological and functional results in the treatment of localized RCC in in older patients and middle-aged patients MATERIALS AND METHODS: From 2016 to August 2021 at the N.I. Pirogov Russian National Research Medical University on the basis of N.I. Pirogov City Clinical Hospital No. 1 we performed 134 laparoscopic PN. The 1st group included patients from 55 to 69 years old - 96 (71.6%) and 2nd group - 70 years and older - 38 (28.4%). The physical status was assessed according to the ASA (American Society of Anesthesiologists) classification and the Charlson comorbidity index (IC) was calculated. Glomerular filtration rate (GFR) was estimated using the MDRD (Modification of diet in renal disease) formula.Length of the operation in patients in 1st group was 133.1 minutes. (60-250), in 2nd group 139.3 (50-240), the median time of warm ischemia was 12.4 (7-33) and 12.7 (6-22) minutes, the median blood loss volume was 123.3 and 135.1 ml, respectively. Complications, according to the Clavien-Dindo classification, were in 21 (21.9%) cases in patients from 55 to 69 years old and in 9 (23.7%) in patients 70 years and older. The median GFR for MDRD in the postoperative period for groups I and II was 57.4 and 50.5 ml/min/1.73 m2. The median follow-up time was 26 (4-66) months. A positive surgical margin was observed in 2 (2.1%) cases in the 1st group and in 1 (2,6%) in 2nd group. The median follow-up time was 26 (4-66) months.Nephron-sparing surgery is safety in patients 70 years and older and the main intraoperative and oncological results are comparable to the group of middle-aged patients. Age itself is not a contraindication to surgical treatment.

Comparison of three equations for estimating glomerular filtration rate as predictors of cisplatin-related acute kidney injury in lung cancer patients with normal renal function.

Cisplatin-associated acute kidney injury is a common clinical event that causes increased morbidity and mortality in cancer patients even if they are categorized as having normal functioning kidneys. We aimed to determine predictive factors that can predict acute kidney injury associated with cisplatin therapy in patients with normal renal function by comparison of pre-chemotherapy estimated glomerular filtration rates calculated separately by Cockcroft and Gault (CG), the Modification of Diet in Renal Disease (MDRD), and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPİ) equations and accompanying patient-associated factors. A total of 200 patients diagnosed with lung cancer and determined to have normal functioning kidneys and considered cisplatin eligible by the attending physician before chemotherapy were included in this retrospective study. Acute kidney injury after cisplatin chemotherapy (c-AKI) was determined according to the National Cancer Institute's Common Terminology Criteria for Adverse Events v4.03. Pre-chemotherapy serum laboratory parameters and clinico-histopathological characteristics of patients were recorded from the hospital electronic system. The optimal cut-off for eGFR methods was determined by the area under the receiver operating characteristic curve (ROC-AUC) analysis. Predictive factor analysis for c-AKI was performed by regression analyses. C-AKI developed in 39 (19.5%) patients. In the univariate analysis, a significant correlation was observed between c-AKI and high body mass index (BMI) before treatment, older age (>62.5), female gender, eGFR by MDRD (≤94.5 mL/min) and eGFR by CKD-EPI (≤91.5 mL/min). There was no relation between eGFR by CG and c-AKI. Two different multivariate models were established. Model 1 showed that female gender (odds ratio [OR] =4.90, 95% confidence interval [CI]: 1.52-15.79, P = 0.008) and eGFR by MDRD less than or equal to 94.5 mL/min (OR = 3.52, 95% CI: 1.68-7.38, P = 0.001) were predictive markers for c-AKI. In Multivariate Model 2, female gender (OR = 5.51, 95% CI: 1.70-17.83, P = 0.004) and eGFR by CKD-EPI less than or equal to 91.5 mL/min (OR = 3.52, 95% CI: 1.67-7.42, P = 0.001) were found to be predictive markers for c-AKI. This study revealed that eGFR calculated based on MDRD (≤94.5 mL/min/m2) or CKD-EPI (≤91.5 mL/min/m2) before chemotherapy indicates a strong tendency for c-AKI. In addition, we detected a high risk of c-AKI for females compared to their counterparts. Although eGFR 60 mL/min is considered the threshold level to accept patients as cisplatin-eligible, we recommend close follow-up of high-risk patients for cisplatin nephrotoxicity we detected in our models.

Comparison of Race-Based and Non-Race-Based Glomerular Filtration Rate Equations for the Assessment of Renal Functional Risk Before Nephrectomy

To compare the performance of race-based and race-neutral estimated glomerular filtration rate (eGFR) calculators in patients undergoing kidney surgery. Analysis of institutional kidneys surgeries from 2006-2021 was conducted. Demographics, serum creatinine (SCr), protein dipstick, and creatinine clearance (CrCl) were assessed within 1 week prior to surgery. SCr was used to calculate eGFR using 3 models: Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI 2009), and CKD-EPI 2021. Patients were classified based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria for CKD staging and prognosis, with urine CrCl treated as benchmark for analysis. Receiver operating characteristic (ROC) analysis evaluated accuracy of eGFR calculators' binary discrimination of eGFR less than 60 mL/min. CKD stage agreement between eGFR and urine CrCl was assessed. A total of 554 kidney surgeries in 336 patients had necessary laboratory data for analysis. The cohort was 62% male, with a median age of 47. Within this cohort, 8.1% (n=45) were Black, and 80% (n=441) were White. glomerular filtration rate (GFR) from 24-hour urine CrCl normalized by BSA did not vary significantly from eGFR by SCr based calculators. The proportion of patients with eGFR <60 significantly differed when using Modification of Diet in Renal Disease, CKD-EPI 2009, and CKD-EPI 2021 equations when compared to CrCl (P<.001). Still, they performed equivalently in the staging of CKD, as well as in predicting GFR of less than 60, and classifying CKD prognosis of "moderately increased or higher". A race-neutral eGFR calculator can perform equivalently to established eGFR calculators, with the added benefit of mitigating biases that account for racial disparities in nephrectomy decision making.

The role of blood pressure control in the prevention of cardiorenal disease in patients with chronic kidney disease.

Optimal blood pressure (BP) control has been debated between two schools of thought: standard BP control to a goal of systolic BP (SBP) <140 mmHg and intensive BP control with a goal of <120 mmHg. Currently only three randomized controlled trials (RCTs) have been performed to address this question, which will be included in this review: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Study Group (2010), the Systolic Blood Pressure Intervention Trial (SPRINT; 2015) and the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial, performed in Chinese participants in 2021 [1–3]. Further insights into BP management to prevent cardiovascular disease (CVD) events in patients with chronic kidney disease (CKD) will also be reviewed here. Unfortunately, there is less data from RCTs for determining optimal BP levels to prevent renal disease progression. Only three studies in non-diabetic CKD—SPRINT, the Modification of Diet in Renal Disease (MDRD) study and the African American Study of Kidney Disease and Hypertension (AASK)—and no studies in patients with CKD due to type 2 diabetes mellitus (T2DM) have been performed to investigate this problem and, to date, the ideal management protocol for clinicians is lacking. In this review we will also include investigations from historically important studies focusing on control of BP and its effects in patients with CKD, including the MDRD study (1993), the AASK study (2001) and the Ramipril Efficacy In Nephropathy 2 (REIN-2) study (2005) [4–6]. The study of CKD patients in the SPRINT study [7] also provides an important perspective on the importance of more intensive BP control on cardiovascular events. It is also important to note that despite the same body of evidence from these clinical studies, guideline committees have come up with different recommendations for target BP, further complicating the question of optimal BP targets. This opinion paper is targeted towards NDT readers with an interest in kidney disease in relation to BP goals and cardiovascular outcomes.

18 F]PSMA-1007 renal uptake parameters: Reproducibility and relationship to estimated glomerular filtration rate.

Scintigraphy with technetium-99m-labelled dimercaptosuccinic acid ([99m Tc]Tc-DMSA) is widely used for renal cortical imaging. Uptake of [99m Tc]Tc-DMSA has been shown to correlate with glomerular filtration rate (GFR). Prostate-specific membrane antigen (PSMA) radiopharmaceuticals used for positron emission tomography (PET) show high renal uptake and are being investigated for renal imaging. [68 Ga]Ga-PSMA-11 PET parameters have been shown to correlate with estimated GFR (eGFR). The aim of this study was to investigate the relationship between renal [18 F]PSMA-1007 uptake and eGFR. Hundred and eighty-five patients underwent PET imaging at 1 and 2 h after injection of 4.0 ± 0.2 MBq [18 F]PSMA-1007. Serum creatinine levels were measured and GFR estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations. Fifteen patients were excluded due to missing or incorrect data. Thus, data from 170 patients were analyzed. Kidneys were segmented in the PET images using a convolutional neural network with manual correction. For each kidney, mean standardized uptake value (SUVmean ) and segmentation volume in millilitres were measured. Linear regression analyses were performed with eGFR as the outcome variable. Variation in the eGFR values was explained to a significant degree by SUVmean and renal segmentation volume in both the 1and 2 himages. This correlation was stronger for CKD-EPI eGFR (1 h R2 = 0.64; 2 h R2 = 0.64) than for MDRD eGFR (1 h R2 = 0.47; 2 h R2 = 0.45). Renal [18 F]PSMA-1007 uptake parameters correlate with eGFR and are indicative of renal cortical function.

Limited Long-Term Benefit of Upfront Autologous Stem Cell Transplant on Survival in Severe Renal Impairment in Multiple Myeloma in Novel Drug Era, a Retrospective Multi-Center Study in China

Background Renal impairment (RI) is a common complication of multiple myeloma (MM) affecting approximately 20%-30% of the patients at diagnosis. The presence of severe RI is associated with an increased risk of early death and poor prognosis in myeloma. The impact of autologous stem cell transplant (ASCT) on outcome in severe RI patients remains controversial. Therefore, we performed a retrospective real-world analysis to clarify the effect of ASCT on the survival of MM patients with severe RI. Methods Clinical data of 337 MM patients with severe RI at diagnosis were collected from three centers in China from April 2004 to January 2020. Severe RI was defined as an increase creatinine ＞177 umol/L (or 2mg/L) or an estimated glomerular filtration rate ≤40 ml/min/1.73 m2 using the simplified modification of diet in renal disease (MDRD) formula. RI caused by other confirmed pathological diagnosis except for tubular nephropathy was excluded. We excluded patients underwent salvage ASCT (6 cases), patients older than 65 years (107 cases), and traditional introduction therapy (2 cases). At last, there were 232 cases for analysis, containing 59 cases received ASCT. All enrolled patients were treated with novel-agent introduction. Patients were divided into the ASCT group and the non-ASCT group. Hematological and renal response were assessed based on the International Myeloma Working Group (IMWG) criteria. Results The median age for all patients at diagnosis was 55 years old (range: 37-65 years old). 37% presented with free light chain myeloma. There were 4 patients underwent double-ASCT in the ASCT group. All dialysis patients in ASCT group were off dialysis after induction therapy. Baseline profiles between ASCT and non-ASCT group were matched in sex, M-protein isotype, ISS stage, and induction therapy. More patients were on dialysis at diagnosis in non-ASCT group (34.7% vs 19.3%, P=0.04). There were 59/159 patients presented unfavorable cytogenetic abnormality (del(17p), t(4;14), t(14;16)), including 40 cases (34.2%) in non-ASCT group and 19 cases (41.3%) in ASCT group (P=0.47). The 1q amplification presented 21.4% in non-ASCT group and 22.2% in ASCT group (P=0.56). In terms of hematological response, at least VGPR accounts for 88.1% in the ASCT group and 50.3% in the non-ASCT group (P<0.001). The overall renal response was significantly higher in the ASCT group than that in the non-ASCT group (94.9% vs 54.3%, P<0.001). There was the similar tendency for at least renal PR between ASCT and non-ASCT groups (88.1% vs 41.3%, P<0.001). The transplant-related mortality (within 3 months after ASCT) was 6.8%. Early mortality within 1 year was 6.7% in the ASCT group and 19.8% in the non-ASCT group (P=0.002). The median follow-up for all patients was 37.6 months (range: 1-157 months) and the median overall survival (OS) was 49.5 months (95% CI：42-57 months). In the ASCT group, the median OS was much longer than ASCT group (57.3 months vs 42.8 months, P =0.052). But there was no difference in PFS between the two groups (36.9 months vs 26.5 , p=0.348). As the log-rank test didn't hold the proportional hazards assumption, it would have low power. We use the two-stage landmark analysis to further determine the effect of ASCT on survival. In landmark analysis, 3-year PFS rate in ASCT group was significantly higher (54.0% vs 41.9%, P=0.024). Within 5-year follow-up, OS was significantly longer in the ASCT group than that in non-ASCT group (OR=0.61, 95%CI: 0.39-0.97, P=0.04). Beyond the 5-year time point, OS was similar between the two groups (OR=1.59, 95%CI: 0.60-4.20, P=0.35). In univariate analysis, at least renal MR, at least hematological VGPR, PLT＞100×109/L, and BMPC ≥60% were correlated with longer OS. In multivariate analysis, at least renal MR (HR=0.61, 95%CI: 0.39-0.96, P=0.031), at least hematological VGPR (HR=0.41, 95%CI: 0.27-0.63, P<0.001), and PLT＞100×109/L (HR=0.43, 95%CI: 0.28-0.66, P<0.001) were independent predictor of OS. Although upfront ASCT could remarkably prolong OS in severe RI myeloma, it was not confirmed in multivariate analysis. Conclusions In the novel agent era, role of upfront ASCT in myeloma with severe RI remains uncertain. In our analysis, it seems the benefit of the OS from novel-drug induction and upfront ASCT was observed in the first 5-year, but the long-term survival benefit was limited. Instead, deep hematological response and renal recovery was strong predictors for OS.

Comparison of glomerular filtration rate estimating formulas among Japanese adults without kidney disease

BackgroundPrevious studies have proposed different formulas of estimating glomerular filtration rate (eGFR) among clinical patients. The comprehensive comparison of eGFR formulas is not well established in a Japanese population. We compared eGFR values and chronic kidney disease (CKD) classification of nine different eGFR in a Japanese general population sample. MethodsWe analyzed 469 Japanese community-dwelling adults (184 men) without any self-reported kidney disease. GFR estimated using the 4- and 6-parameter Modification of Diet in Renal Disease (MDRD) formulas (MDRD4 and MDRD6); the CKD-EPI formulas based on creatinine with (CKD-EPI-2009) and without race coefficient (CKD-EPI-2021), on cystatin C (CKD-EPI-Cys), on both (CKD-EPI-CreCys); the Japanese creatinine-based formula (JPN-Cre), cystatin C-based formula (JPN-Cys), and modified CKD-EPI formula (JPN-CKD-EPI). CKD stages were defined by KDIGO guidelines (eGFR < 60 ml/min/1.73 m2). ResultseGFRJPN-Cre (mean = 71.2; SD = 14.3) were much lower than eGFRCKD-EPI-2021 (mean = 94.2; SD = 12.7), while eGFRJPN-Cys (mean = 102.8; SD = 24.2) was comparable to the MDRD and CKD-EPI formulas. The difference between eGFRCKD-EPI-2021 and eGFRJPN-Cre showed a V-shaped distribution across eGFR levels, indicating complex errors between these formulas. We observed very low agreement in CKD classification between eGFRJPN-Cre and the eGFRCKD-EPI-2021 (kappa = 0.13; 95% confidence interval: 0.06, 0.23). ConclusionsJPN-Cre was substantially different from the CKD-EPI formula without race term (CKD-EPI-2021), which means that it is impossible to recalibrate those with a simple coefficient. Although a comparison with measured GFR should be necessary, choice of the estimation method needs caution in clinical decision-making and academic research.

Determinants of Chronic Kidney Disease among Diabetes Mellitus Patients at Gatundu Level 5 Hospital, Kiambu County, Kenya

The prevalence of chronic kidney disease (CKD) is rising alarmingly throughout the world, and it is one of the major public health menace due to the significant morbidity and mortality it is associated with. The burden of CKD inexplicably affects low-income nations like Kenya, where the two main public health concerns for the CKD growth rate are hypertension and diabetes mellitus. The aim of this study was to identify the determinants of chronic kidney disease diabetes mellitus patients and also assess their awareness, perspectives and prevalence of CKD. A hospital based cross-sectional study design was conducted at a rural hospital in central Kenya among adult (≥18 years) diabetes mellitus patients. Sample size was determined using Yamane Taro formula. Informed written consent was obtained from each participant and data was collected by interview and chart review; Glomerular filtration rate (GFR) was estimated from serum creatinine using modification of diet in renal disease (MDRD) formula, while CKD was defined as eGFR of less than 60mls/min/1.73m2 for more than three months. Multivariate logistic regression was used to identify independent determinants of CKD and a p-value of &lt;0.05 was considered to be statistically significant. Majority of the participants (43.42%) were aged between50-60 years and 95 (62.5%) of them were females. Participants with history of high blood pressure had a 129.4 %(AOR;1.29495% CI, 2.401-.698) risk of having CKD, while those who did not perform physical exercises were found to be 123.3% (AOR 1.233, 95% CL,1.889-.805) times more likely to have CKD Only 39 (25.8%) of the participants had average awareness about CKD and its risk factors. The overall unadjusted prevalence of CKD among diabetic patients was 78.2% (n= 119, 95% CI). The researcher found that existing history of hypertension, lack of physical exercises, family history of kidney disease, rural residency and low levels of education were independent determinants associated ......

Effect of pegylated interferon-α2b add-on therapy on renal function in chronic hepatitis B patients: A real-world experience.

Controversy remains as to pegylated interferon-α (PEG-IFNα) antiviral therapy to renal function in chronic hepatitis B (CHB) patients. The aim of this study was to evaluate the influence of PEG-IFNα2b (Y shape, 40 kD) add-on treatment for renal function in CHB patients who received entecavir therapy. This was a retrospective observational study to investigate factors related to renal function in 114 CHB patients who received PEG-IFNα2b add-on therapy to entecavir for 48 weeks. Changes of blood urea nitrogen (BUN), serum creatinine (sCr), and estimated glomerular filtration rate (eGFR), which was calculated with both Chronic Kidney Disease Epidemiology Collaboration and Modification of Diet in Renal Disease (MDRD) formulas, were analyzed by one-way analysis of variance. A linear mixed effects model for repeated measures was used to assess the correlation between baseline information and eGFR changes at 24 and 48 weeks of therapy. The model considered the baseline age, gender, body weight, viral load, hepatitis B surface antigen, BUN, sCr, and treatment strategy as fixed effects and incorporated random effects for individual subjects. BUN and sCr was decreased, while eGFR was increased at 12 weeks of therapy. Only eGFR maintained at 24 and 48 weeks of therapy. Patients with female gender, age ≥ 40 years, and baseline HBsAg level < 250 IU/mL showed significant improvement of renal function with PEG-IFNα2b add-on therapy. The linear mixed effects model revealed that female gender, baseline sCr, and PEG-IFNα2b add-on were significant positive predictors for eGFR elevation at 24 and 48 weeks of therapy. In real-world experience, PEG-IFNα2b add-on therapy might be associated with increased eGFR in CHB patients.

Diagnostic usefulness of spiroergometry and risk factors of long -COVID in patients with normal left ventricular ejection fraction

Abstract Background Recent evidence has shown that patients with acute SARS-CoV-2 infection might present symptoms of infection a long time after a recovery. Purpose To investigate the risk factors and assess the utility of spiroergometry parameters in differential diagnosing patients presenting the symptoms (dyspnea, fatique, pain in chest, muscle pain, cognitive impairment, taste and smell disturbances) persisting for a few months after recovery from COVID 19 (symptoms of long COVID). Methods and results The 146 patients (pts) with normal left ventricular ejection fraction and without respiratory diseases, hospitalised in Cardiology Department recovering from COVID-19 at three to six months after confirmed diagnosis were included. The clinical examination, laboratory results, echocardiography using Vivid E95–GE Healthcare, non-invasive body mass analysis using Body Composition Analyzer (Tanita Pro), spiroergometry using The MetaSoft® Studio application were analyzed. The subjects were divided into the two following groups: group demonstrating long COVID symptoms (i.e. suffering from one of the following dyspnea, fatique, pain in chest, muscle pain, cognitive impairment, taste or smell disturbances) [N=44 pts] and the group without long COVID symptoms [N=102 pts]. Pts with long COVID symptoms presented significantly higher age (58 versus [vs] 44 years; p&amp;lt;0.0001), higher metabolic age (53 vs 45 years; p=0.01), higher left atrial diameter (37 vs 35 mm; p=0.04), higher left ventricular mass index (LVMI) (83 vs 74 g/m2, p=0.03), higher E/E' (7.3 vs 6; p&amp;lt;0.001) compared to control group. In CPET long COVID pts presented lower forced vital capacity (FVC) (3.6 vs 4.3 L; p=0.009), lower maximal oxygen consumption measured during incremental exercise indexed per kilogram (VO2max) (21 vs 23 ml/min/kg; p=0.04), lower respiratory exchange ratio (RER) (1.0 vs 1.1; p=0.04); lower forced expiratory volume in one second (FEV1) (2.9 vs 3.25 L; p=0,03); higher ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC) (106 vs 100%; p=0.0002) – Figure 1, there were no significant changes in electrocardiogram between groups. The laboratory results pointed that pts with long COVID symptoms had also lower rate of red blood cells (RBC) (4,4 vs 4,6 mln; p=0.01); higher level of glucose (92 vs 90 mg%; p=0.02); lower glomerular filtration rate (GFR) estimate by Modification of Diet in Renal Disease (MDRD) (88 vs 95; p=0.02); higher level of hypersensitive cardiac Troponin T (hsTnT) (6.1 vs 3.9 ng/L; p=0.03). The parameters significant in univariate analyses were included to the multivariate model. The results of multiple logistic regression were as follows: age (OR 4.6, 95% CI: 1.7–11.5; p=0.001) and LVMI (OR 2.5, 95% CI: 1.0–6.6; p=0.04). Conclusions Persistent symptoms in long COVID can mimic those of cardiovascular disease. Spiroergometric parameters are useful in making a proper diagnosis. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Polish Mother's Memorial Hospital Research Institute