New-onset Chronic Kidney Disease Research Articles

Commentary on “Effective testicular germ cell tumor therapy on renal function.” Cost NG, Adibi M, Lubahn JD et al, Department of Urology, University of Texas Southwestern Medical School, Dallas, TX: Urology 2012;80:641

ObjectiveTo assess the pre- and post-therapy glomerular filtration rate in patients with testicular germ cell tumors to determine its effect on the natural history of renal function. MethodsWe reviewed an institutional database of patients with testicular germ cell tumor, with pre- and post-therapy serum creatinine levels available. The renal function was estimated using a calculated glomerular filtration rate. We compared the patients treated without chemotherapy (orchiectomy with or without radiotherapy or retroperitoneal lymph node dissection) with those who received systemic chemotherapy. We analyzed the data for the outcome of new-onset chronic kidney disease (CKD) stage 3 between these groups. Kaplan-Meier curves were constructed and compared using a log-rank test. ResultsA total of 144 patients were reviewed. The testicular germ cell tumor stage distribution was stage I in 78 (54.2%), stage II in 28 (19.4%), and stage III in 38 (26.4%). Overall, the median creatinine and estimated glomerular filtration rate at diagnosis was 0.9mg/dL (range 0.5-1.5) and 104.0mL/min/1.73m2 (range 58.7-235), respectively. Of the 144 patients, 102 (70.8%) had CKD stage 0-1, 41 (28.5%) stage 2, and 1 (0.7%) stage 3. The median creatinine and estimated glomerular filtration rate at the last follow-up visit was 1.0mg/dL (range 0.6-2.6) and 95.5mL/min/1.73m2 (range 31.5-167.6), respectively. This difference between the pre- and post-therapy estimated glomerular filtration rate was significant (P<0.01). A total of 81 patients (56.3%) received chemotherapy (median 4 cycles, range 1-12), and 63 (43.7%) were treated without chemotherapy. Of the 81 patients who received chemotherapy, 8 (9.9%) developed new-onset CKD 3 compared with none in the nonchemotherapy group (P =0.01). ConclusionPatients with testicular germ cell tumor receiving chemotherapy experienced a significant decrease in the estimated glomerular filtration rate and had a significantly increased risk of developing CKD stage 3 compared with those treated without chemotherapy. These findings offer insight into the long-term risks of testicular germ cell tumor survivorship and will be useful in counseling patients.

Hypertension and the development of new onset chronic kidney disease over a 10 year period: a retrospective cohort study in a primary care setting in Malaysia.

BackgroundLittle is known about the rate of progression to chronic kidney disease (CKD) among hypertensive patients, particularly at the primary care level. This study aims to examine risk factors associated with new onset CKD among hypertensive patients attending a primary care clinic.MethodsThis is a 10-year retrospective cohort study of 460 patients with hypertension who were on treatment. Patient information was collected from patient records. CKD was defined as a glomerular filtration rate <60 ml/min per 1.73 m2 (Cockcroft-Gault equation). Multiple logistic regression statistics was used to test the association in newly diagnosed CKD.ResultsThe incidence of new CKD was 30.9% (n = 142) with an annual rate of 3%. In multivariate logistic regression analysis, factors associated with development of new onset of CKD among hypertensive patients were older age (odds ratio [OR] 1.123, 95% confidence interval [CI] 1.078-1.169), presence of diabetes (OR 2.621, 95% CI 1.490-4.608), lower baseline eGFR (OR 1.041, 95% CI 0.943-0.979) and baseline hyperuricaemia (OR 1.004, 95% CI 1.001-1.007).ConclusionsThe progression to new onset CKD is high among urban multiethnic hypertensive patients in a primary care population. Hence every effort is needed to detect the presence of new onset CKD earlier. Hypertensive patients who are older, with underlying diabetes, hyperuricaemia and lower baseline eGFR are associated with the development of CKD in this population.

914 METABOLIC DISORDERS PREDICT NEW ONSET OF CHRONIC KIDNEY DISEASE IN THE JAPANESE GENERAL POPULATION

Purpose: Metabolic syndrome (MetS) and chronic kidney disease (CKD) are important cardiovascular risks. We investigated the predictive values of MetS and its components for new onset of CKD. Methods: Consecutive 10048 subjects with normal estimated glomerular filtration rate (eGFR; ≥60 mL/min/1.73m2) who visited our hospital for a physical check-up (male = 65.1%, 53.7 ± 11.2 year-old) were enrolled and followed up for 1644 days (median) with the endpoint being the development of CKD (eGFR < 60 mL/min/1.73m2). Subjects with obesity (body mass index ≥25 kg/m2) were defined as having MetS if they have two or more of the following disorders; (1) triglycerides ≥150 mg/dl and/or high density-lipoprotein cholesterol < 40 mg/dl and/or use of anti-dyslipidemic medication, (2) systolic blood pressure ≥130mmHg and/or diastolic blood pressure ≥85mmHg and/or use of antihypertensive medication, and (3) fasting plasma glucose ≥110 mg/dl and/or use of anti-diabetic medication. Results: During the follow-up, CKD developed in 902 subjects (20.4 per 1000 person-year). The incidence was more frequent in subjects with (28.2 per 1000 person-year) than without MetS (19.7 per 1000 person-year, p < 0.01). The incidence of CKD was increased with increasing the number of metabolic disorders in individuals at baseline. In multivariate Cox hazard analysis, Mets was an independent predictor of the new onset of CKD after adjustment for known risk factors. Similar results were obtained in subanalysis using subjects without any medications (n = 8309). Conclusions: MetS and its components are important predictors for new onset of CKD. Prediction of the onset of CKD may lead to effective prevention of CKD and relating cardiovascular disease.

Serum creatinine and the search for new biomarkers of acute kidney injury (AKI): the story continues

AKI: the problem The term ‘ acute kidney injury ’ (AKI) currently identifi es a wide spectrum of clinical conditions ranging from a minimal elevation in serum creatinine levels to the requirement for renal replacement therapy. Therefore AKI includes both slight injury and/or a severe impairment in renal function, a condition formerly known as acute renal failure (ARF). AKI is a global problem which occurs less frequently in the community than in the hospital, where is commonly found on pediatric, oncology and surgical wards, with the highest frequency in the intensive care unit (ICU). It has been estimated that severe AKI requiring admission to an ICU occurs in about 10 patients per 100,000 per year, whereas AKI affects up to 30 % of all ICU admissions usually as a manifestation of a multi-organ failure syndrome (1) . Patients with chronic kidney disease (CKD) are particularly susceptible to AKI and AKI in turn may act as a cause of new-onset CKD or a promoter of underlying CKD progression. A rough estimate of the yearly incidence of end stage renal disease (ESRD) due to AKI is about 0.3 per 100,000 (2) , and CKD can be detected in an average of 30 % of AKI survivors (3) . Irrespective of its nature, AKI affects both short-term and long-term cardiovascular outcomes and the in-hospital mortality currently remains dramatic (4) . The early identifi cation and correct diagnosis is therefore crucial to establish appropriate therapeutic measures in a timely manner, saving costs and improving patients ’ outcomes and quality of life.

Effect of Testicular Germ Cell Tumor Therapy on Renal Function

To assess the pre- and post-therapy glomerular filtration rate in patients with testicular germ cell tumors to determine its effect on the natural history of renal function. We reviewed an institutional database of patients with testicular germ cell tumor, with pre- and post-therapy serum creatinine levels available. The renal function was estimated using a calculated glomerular filtration rate. We compared the patients treated without chemotherapy (orchiectomy with or without radiotherapy or retroperitoneal lymph node dissection) with those who received systemic chemotherapy. We analyzed the data for the outcome of new-onset chronic kidney disease (CKD) stage 3 between these groups. Kaplan-Meier curves were constructed and compared using a log-rank test. A total of 144 patients were reviewed. The testicular germ cell tumor stage distribution was stage I in 78 (54.2%), stage II in 28 (19.4%), and stage III in 38 (26.4%). Overall, the median creatinine and estimated glomerular filtration rate at diagnosis was 0.9 mg/dL (range 0.5-1.5) and 104.0 mL/min/1.73 m(2) (range 58.7-235), respectively. Of the 144 patients, 102 (70.8%) had CKD stage 0-1, 41 (28.5%) stage 2, and 1 (0.7%) stage 3. The median creatinine and estimated glomerular filtration rate at the last follow-up visit was 1.0 mg/dL (range 0.6-2.6) and 95.5 mL/min/1.73 m(2) (range 31.5-167.6), respectively. This difference between the pre- and post-therapy estimated glomerular filtration rate was significant (P < .01). A total of 81 patients (56.3%) received chemotherapy (median 4 cycles, range 1-12), and 63 (43.7%) were treated without chemotherapy. Of the 81 patients who received chemotherapy, 8 (9.9%) developed new-onset CKD 3 compared with none in the nonchemotherapy group (P = .01). Patients with testicular germ cell tumor receiving chemotherapy experienced a significant decrease in the estimated glomerular filtration rate and had a significantly increased risk of developing CKD stage 3 compared with those treated without chemotherapy. These findings offer insight into the long-term risks of testicular germ cell tumor survivorship and will be useful in counseling patients.

44 ONGOING KIDNEY IMPAIRMENT IN JAPANESE PATIENTS WITH PRIMARY ALDOSTERONISM: PREDICTORS OF NEW-ONSET CHRONIC KIDNEY DISEASE AFTER ADRENALECTOMY

You have accessJournal of UrologyAdrenal: Surgery + Tumors/Benign and Malignant Disease (Physiology and Pharmacology)1 Apr 201244 ONGOING KIDNEY IMPAIRMENT IN JAPANESE PATIENTS WITH PRIMARY ALDOSTERONISM: PREDICTORS OF NEW-ONSET CHRONIC KIDNEY DISEASE AFTER ADRENALECTOMY Takanobu Utsumi, Atsushi Okato, Takeshi Namekawa, Tomokazu Sazuka, Mitsuru Yanagisawa, Kazuyoshi Nakamura, Takahito Suyama, Shinichi Sakamoto, Koji Kawamura, Naoto Kamiya, Takashi Imamoto, Naoki Nihei, Yukio Naya, Hiroyoshi Suzuki, and Tomohiko Ichikawa Takanobu UtsumiTakanobu Utsumi Chiba, Japan More articles by this author , Atsushi OkatoAtsushi Okato Chiba, Japan More articles by this author , Takeshi NamekawaTakeshi Namekawa Chiba, Japan More articles by this author , Tomokazu SazukaTomokazu Sazuka Chiba, Japan More articles by this author , Mitsuru YanagisawaMitsuru Yanagisawa Chiba, Japan More articles by this author , Kazuyoshi NakamuraKazuyoshi Nakamura Chiba, Japan More articles by this author , Takahito SuyamaTakahito Suyama Chiba, Japan More articles by this author , Shinichi SakamotoShinichi Sakamoto Chiba, Japan More articles by this author , Koji KawamuraKoji Kawamura Chiba, Japan More articles by this author , Naoto KamiyaNaoto Kamiya Sakura, Japan More articles by this author , Takashi ImamotoTakashi Imamoto Chiba, Japan More articles by this author , Naoki NiheiNaoki Nihei Chiba, Japan More articles by this author , Yukio NayaYukio Naya Ichihara, Japan More articles by this author , Hiroyoshi SuzukiHiroyoshi Suzuki Sakura, Japan More articles by this author , and Tomohiko IchikawaTomohiko Ichikawa Chiba, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.088AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Inappropriately high aldosterone levels impair renal function in patients with primary aldosteronism (PA), because hyperaldosteronism is associated with glomerular hyperfiltration and reduced glomerular filtration rate. Aldosterone excess, such as in PA, thus probably contributes to the development of chronic kidney disease (CKD). While CKD develops postoperatively with estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2, subtle kidney impairment is often masked by hyperfiltration before surgery. Interpreting renal function in patients with PA can therefore be difficult using conventional preoperative eGFR. This study investigated postoperative changes in renal function for all PA patients, to identify predictors of postoperative CKD development in patients without pre-existing CKD. METHODS This retrospective study included 78 Japanese patients with PA who underwent unilateral adrenalectomy between 1990 and 2011. Patients followed for <1 year were excluded. As eGFR is known to be limited by differences in creatinine generation among ethnicities, values were obtained using a new 3-variable Japanese equation that was developed and validated in a Japanese population: eGFR (ml/min/1.73 m2) = 194 × (serum creatinine)−1.094 × (age)−0.287 × 0.739 (if female). Changes in eGFR were compared by 1-way ANOVA, with multiple comparisons using the Bonferroni method. Uni- and multivariate analyses were performed to identify clinical predictors for CKD within 1 year after surgery. RESULTS Patients with preoperative eGFR ≥60 ml/min/1.73 m2 showed a significant decrease in postoperative eGFR, while patients with preoperative eGFR <60 ml/min/1.73 m2 showed no significant postoperative decrease. Of the 66 patients without pre-existing CKD, 24 developed CKD within 1 year postoperatively. In all patients with new-onset CKD, preoperative eGFR was 60-89 ml/min/1.73 m2. Multivariate analysis identified preoperative eGFR as an independent predictor of new-onset CKD. Based on univariate analysis, additional factors associated with new-onset CKD included older age and medical history of hyperlipidemia (P<0.05). CONCLUSIONS Patients with preoperative eGFR of 60-89 ml/min/1.73 m2 showed a higher proportion of new-onset CKD after surgery. Clinicians should be attentive to patients at greater risk of significant declines in renal function after adrenalectomy. These data may offer indications for early intervention to prevent declines in renal function. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e19 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Takanobu Utsumi Chiba, Japan More articles by this author Atsushi Okato Chiba, Japan More articles by this author Takeshi Namekawa Chiba, Japan More articles by this author Tomokazu Sazuka Chiba, Japan More articles by this author Mitsuru Yanagisawa Chiba, Japan More articles by this author Kazuyoshi Nakamura Chiba, Japan More articles by this author Takahito Suyama Chiba, Japan More articles by this author Shinichi Sakamoto Chiba, Japan More articles by this author Koji Kawamura Chiba, Japan More articles by this author Naoto Kamiya Sakura, Japan More articles by this author Takashi Imamoto Chiba, Japan More articles by this author Naoki Nihei Chiba, Japan More articles by this author Yukio Naya Ichihara, Japan More articles by this author Hiroyoshi Suzuki Sakura, Japan More articles by this author Tomohiko Ichikawa Chiba, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

662 THE IMPACT OF SURGICAL OR SYSTEMIC THERAPY FOR TESTICULAR GERM CELL MALIGNANCY ON RENAL FUNCTION

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease I1 Apr 2012662 THE IMPACT OF SURGICAL OR SYSTEMIC THERAPY FOR TESTICULAR GERM CELL MALIGNANCY ON RENAL FUNCTION Nicholas Cost, Mehrad Adibi, Jessica Lubahn, Adam Romman, Ganesh Raj, Arthur Sagalowsky, and Vitaly Margulis Nicholas CostNicholas Cost Dallas, TX More articles by this author , Mehrad AdibiMehrad Adibi Dallas, TX More articles by this author , Jessica LubahnJessica Lubahn Dallas, TX More articles by this author , Adam RommanAdam Romman Dallas, TX More articles by this author , Ganesh RajGanesh Raj Dallas, TX More articles by this author , Arthur SagalowskyArthur Sagalowsky Dallas, TX More articles by this author , and Vitaly MargulisVitaly Margulis Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.743AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite the good prognosis of patients with testicular germ cell tumors (T-GCTs), the therapy needed to achieve cure may induce long term morbidity. Data from other malignancies suggests that developing chronic kidney disease (CKD) affects long-term renal, cardiovascular and survival outcomes. Thus, we assessed patients treated for T-GCT to determine the effect of therapy on the natural history of renal function. METHODS We reviewed an institutional database of T-GCT patients and included those >13yrs old with available pre and post-therapy serum Creatinine (Cr). We recorded Cr before starting therapy and at last follow-up. Renal function was estimated with a calculated Glomerular Filtration Rate (eGFR). Patients were classified according to CKD staging. We compared those managed with surgery-only to those also treated with chemotherapy (CT). RESULTS 144 patients were reviewed. T-GCT stage distribution was: I-78 (54.2%), II-28 (19.4%) and III-38 (26.4%). The median Cr and eGFR at diagnosis were 0.9 (0.5 to 1.5) and 104.0 (58.7 to 235) respectively. 102 (70.8%) were CKD 0 to I, 41 (28.5%) CKD II and 1 (0.7%) CKD III. The median Cr and eGFR at last followup were 1.0 (0.6 to 2.6), and 95.5 (31.5 to 167.6), respectively. This difference between the pre and post-therapy eGFR was significant, p<0.01. The median eGFR change was -2.1 (-148 to 58). 81 (56.3%) patients received CT, median 4 cycles (1 to 12), and 63 (43.8%) were treated without CT, Table I. We observed that 8 (9.9%) of the CT treated patients developed new-onset CKD III, compared to none in the non-CT group, p=0.01. This increased risk with CT was related to an increasing number of CT cycles with 8.1% of those given 1 to 4 cycles developing CKD III vs. 15.8% of those given >4 cycles, p=0.02. Also, while there was an increase in new-onset CKD III with increasing T-GCT stage (2.6% Stage I, 3.6% Stage II and 13.2% Stage III), this was not statistically significant. CONCLUSIONS Patients with T-GCT treated with CT suffered a significant decrease in eGFR and were at a significantly increased risk of developing CKD III compared to those managed without CT. This is important as we assess for the long-term risks of T-GCT survivorship, and is useful in counseling patients on the risks of therapy. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e270 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicholas Cost Dallas, TX More articles by this author Mehrad Adibi Dallas, TX More articles by this author Jessica Lubahn Dallas, TX More articles by this author Adam Romman Dallas, TX More articles by this author Ganesh Raj Dallas, TX More articles by this author Arthur Sagalowsky Dallas, TX More articles by this author Vitaly Margulis Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

80 ACUTE KIDNEY INJURY WITHIN 30 DAYS OF NEPHRECTOMY

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes II1 Apr 201280 ACUTE KIDNEY INJURY WITHIN 30 DAYS OF NEPHRECTOMY Brian Le, Amanda Chi, James M. Dupree, Lee Zhao, John Cashy, and Shilajit Kundu Brian LeBrian Le Chicago, IL More articles by this author , Amanda ChiAmanda Chi Chicago, IL More articles by this author , James M. DupreeJames M. Dupree Chicago, IL More articles by this author , Lee ZhaoLee Zhao Chicago, IL More articles by this author , John CashyJohn Cashy Chicago, IL More articles by this author , and Shilajit KunduShilajit Kundu Chicago, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.126AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Little has been published on acute kidney injury (AKI) in the immediate postoperative period following radical (RN) and partial (PN) nephrectomy. Nevertheless, AKI carries with it significant morbidity, cost and potential mortality. Studies by Cho et al. have described post-operative acute kidney injury as a potent risk factor for new-onset chronic kidney disease after radical nephrectomy. Previous studies, reported AKI rate ranges from 1.3% in PN and 0.4% in RN (Stephenson, 2004), to 5.4% in PN (Pasticer, 2006) and 34% in RN (Cho 2011). This study aims to identify frequency of and preoperative risk factors for AKI in the nephrectomy population using a nationwide outcomes database. METHODS Using 2005 to 2009 data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), patients who underwent PN or RN without preoperative diagnosis of renal failure were identified. Patients with postoperative rise in serum creatinine of > 2mg/dl, were diagnosed with renal failure or who required new dialysis were defined as having AKI. We examined the risk factors that may contribute to AKI within 30 days of operation. Comparative analysis was conducted using Chi-square and Fischer exact tests. RESULTS 2435 PN (27.3%) or RN (72.7%) patients met inclusion criteria, 58 (2.38%) of which had AKI postoperatively (1.80% for PN vs. 2.84% for RN). Compared to the non-AKI group, the AKI group had longer operation time (218 minutes vs 183, p = 0.04), were more likely to have hypertension requiring medication (OR 2.21, p = 0.01), and have undergone percutaneous coronary intervention (OR 2.32, p = 0.04). Although statistically insignificant, AKI patients tended to have higher preoperative creatinine, (1.72 vs 1.49, p = 0.14), more blood transfused (1.26 vs 0.44, p = 0.14), longer smoking history (22 vs 14 pack years, p = 0.09), and be male (OR 1.66, p = 0.08). Other factors looked at, but not significantly associated with AKI were history of peripheral vascular disease requiring revascularization or amputation, angina within 1 month prior to surgery, previous cardiac surgery, congestive heart failure 30 days prior to surgery, and smoking within 1 year prior to surgery. CONCLUSIONS AKI within 30 days post nephrectomy is rare, occurring in 2.38% of cases. Associated factors include longer operative time, history of hypertension requiring medication, and previous percutaneous coronary intervention. Further studies are needed assess the costs and long-term ramifications of AKI. References Cho et al., 2011 : Post-operative acute kidney injury in patients with renal cell carcinoma is a potent risk factor for new-onset chronic kidney disease after radical nephrectomy. Nephrol. Dial. Transplant2011; 26: 3496. Google Scholar Pasticier et al., 2006 : Nephron-sparing surgery for renal cell carcinoma: detailed analysis of complications over a 15-year period. European Urology2006; 49: 485. Google Scholar Stephenson et al., 2004 : Complications of radical and partial nephrectomy in a large contemporary cohort. J Urology2004; 171: 130. Link, Google Scholar © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e34 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brian Le Chicago, IL More articles by this author Amanda Chi Chicago, IL More articles by this author James M. Dupree Chicago, IL More articles by this author Lee Zhao Chicago, IL More articles by this author John Cashy Chicago, IL More articles by this author Shilajit Kundu Chicago, IL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Do albuminuria and hs-CRP add to the International Diabetes Federation definition of the metabolic syndrome in predicting outcome?

To investigate the added value of elevated urinary albumin excretion (UAE) and high high-sensitive C-reactive protein (hs-CRP) in predicting new-onset type 2 diabetes mellitus (T2DM), cardiovascular disease (CVD) and chronic kidney disease (CKD) in addition to the present metabolic syndrome (MetS) defining criteria. The PREVEND Study is a prospective population-based cohort study in the Netherlands, including 8592 participants. The MetS was defined according to the 2004 International Diabetes Federation criteria, elevated UAE as albuminuria ≥ 30 mg/24 h and high hs-CRP as ≥ 3 mg/L. At follow-up, subjects without MetS when compared to subjects with MetS had a lower incidence of T2DM, CVD as well as CKD (2.5 versus 15.5; 4.1 versus 10.3 and 5.8 versus 11.2%, all P < 0.001). In subjects with MetS, the incidence of all three outcomes was higher among subjects with elevated albuminuria versus subjects with normoalbuminuria (all P < 0.01). The incidence of all outcomes was also higher among subjects with high hs-CRP versus subjects without elevated hs-CRP but only significant for CKD (P = 0.002). Multivariate analysis including elevated UAE, hs-CRP and the variables defining the MetS showed that elevated albuminuria was independently associated with the risk for new-onset T2DM, CVD and CKD, whereas high hs-CRP was only independently associated with new-onset CVD and CKD. Our data show that elevated UAE has added value to the present MetS defining variables in predicting new-onset T2DM, CVD and CKD, whereas hs-CRP adds to predicting new-onset CVD and CKD, but not T2DM.

Association between asymptomatic hyperuricemia and new-onset chronic kidney disease in Japanese male workers: a long-term retrospective cohort study

BackgroundHyperuricemia is prevalent in patients with chronic kidney disease (CKD). We explored the hypothesis that asymptmatic hyperuricemia may be associated with new-onset CKD.MethodsThe participants were all male factory workers in Kanagawa, Japan (n = 1,285). All were over 40 years of age and had undergone annual health examinations from 1990 to 2007. Individuals with a history of gouty attacks were excluded from the study. A retrospective cohort study was conducted by following the estimated glomerular filtration rate (eGFR) for each participant over a maximum period of 18 years. The endpoint was new-onset CKD defined as eGFR < 60 mL/min/1.73 m2. The associations between new-onset CKD and the presence of hyperuricemia, low serum high-density lipoprotein cholesterol, hypertension, diabetes, and obesity were analyzed.ResultsThe mean (± standard deviation) follow-up period was 95.2 (± 66.7) months, and new-onset CKD was observed in 100 participants (7.8%) during this follow-up. Cox proportional hazards model revealed that the hazard ratio of new-onset CKD due to hyperuricemia, low serum high-density lipoprotein cholesterol, hypertension and obesity were 3.99 (95% confidence interval: 2.59-6.15), 1.69 (1.00-2.86), 2.00 (1.29-3.11) and 1.35 (0.87-2.10), respectively. Concerning hyperuricemia, low serum high-density lipoprotein cholesterol, hypertension and obesity, the log-rank tests showed P values of < 0.01, 0.01, < 0.01 and < 0.01, respectively.ConclusionThe results of this study suggest that asymptomatic hyperuricemia is a predictive factor for new-onset CKD for Japanese male workers.

Is partial nephrectomy a better surgical option for the treatment of renal cell carcinoma?

For many decades, radical nephrectomy (RN) has been the gold standard for the treatment of localized renal cell carcinoma (RCC). However, emerging evidence suggests that RN is a significant risk factor for the development of new-onset chronic kidney disease (CKD) or worsening of pre-existing CKD and leads to more cardiovascular events and worse survival [1–4]. Renal excision increases the risk factors for CKD by favoring arterial hypertension, proteinuria, hyperparathyroidism, anemia and metabolic acidosis. Patients are more likely to die of competing risks such as cardiovascular death than to die of the cancer itself. Owing to the higher risk of CKD following RN, the status of RN has been called into question. Other contributing factors are an increased incidental detection of small (<4 cm) renal masses with a significant proportion of benign tumors, the possibility of late recurrence of RCC in the contralateral kidney and the equal oncologic efficacy as partial nephrectomy (PN) for renal tumors less than 4 cm [5,6] and tumors between 4 and 7 cm [7,8]. A study in patients with localized RCC of 4 cm or less and a normal contralateral kidney showed that compared with PN, RN was associated with decreased overall survival (OS) in young patients (<65 years) with small renal masses [9].

Uric Acid Levels Predict Future Development of Chronic Kidney Disease

Aims: Increased uric acid levels are associated with kidney dysfunction. We tested the hypothesis that uric acid level predicts future development of chronic kidney disease (CKD) in the general population. Methods: For this study, we enrolled 7,078 consecutive subjects with normal estimated glomerular filtration rates (eGFR; ≧60 ml/min/1.73 m²) who visited our hospital for a yearly health checkup (age: 52.8 ± 10.7 years; female: 35.8%). Subjects underwent a routine physical examination and laboratory assessment of cardiovascular disease risk factors at enrollment, and were followed up for 1,694 days (median) with the endpoint being the development of CKD (eGFR <60 ml/min/1.73 m²). The impact of uric acid and other cardiovascular risk factors at baseline on the future development of CKD were assessed. Results: During the follow-up period, 417 male (9.2%) and 151 female subjects (6.0%) developed CKD. Univariate logistic regression analysis revealed a significant association between the onset of CKD and age, male gender, body mass index, blood pressure, fasting plasma glucose, dyslipidemia and uric acid. Multiple logistic regression analysis revealed that new-onset CKD was independently correlated with the baseline uric acid level after adjustment for possible factors. Subanalysis showed similar results in subjects with normal uric acid levels (male: ≤7.0 mg/dl; female: ≤6.0 mg/dl; n = 6,223). Conclusion: Uric acid is an independent predictor of future development of CKD. Whether preventing an increase in uric acid levels reduces the incidence of CKD must be clarified by prospective follow-up studies.

Post-operative acute kidney injury in patients with renal cell carcinoma is a potent risk factor for new-onset chronic kidney disease after radical nephrectomy

Radical nephrectomy is a significant risk factor for chronic kidney disease (CKD). There are few reports on the renal outcome of acute kidney injury (AKI) after radical nephrectomy. The aim of this study was to determine the incidence of AKI and whether post-operative AKI is associated with new-onset CKD after radical nephrectomy for renal cell cancer (RCC). We conducted a retrospective study of 519 adult patients (>40 years old) with normal renal function who underwent unilateral radical nephrectomy for a solitary renal cortical tumour and were pathologically diagnosed with RCC between January 2000 and February 2007. Post-operative AKI was classed using risk, injury, failure, loss and end-stage kidney disease (RIFLE) criteria. CKD was defined as a decrease in estimated glomerular filtration rate (GFR) to <60 mL/min/1.73 m(2). According to the RIFLE criteria, 165 of 175 patients fell into the AKI risk category, 8 patients fell into the AKI injury category and 2 patients fell into the AKI failure category. Multivariate analysis revealed that older age [odds ratio (OR) 1.02, 95% confidence interval (CI) 1.00-1.05], male gender (OR 3.13, 95% CI 1.91-5.12), higher body mass index (OR 1.08, 95% CI 1.01-1.15), smaller RCC size (OR 0.87, 95% CI 0.81-0.93) and higher preoperative GFR (OR 1.04, 95% CI 1.03-1.06) were independent risk factors for post-operative AKI. CKD was more prevalent in the AKI risk group than in patients without AKI 1 year after surgery (54.7% versus 43.9%, respectively; P = 0.006) and 3 years after surgery (50% versus 32%, respectively; P = 0.003). Patients who experienced post-operative AKI had a 4.24-fold higher risk of new-onset CKD after multiple adjustments were made to the data (95% CI 2.28-7.89, P < 0.001). AKI after radical nephrectomy in patients with RCC is a potent risk factor for new-onset CKD. Prevention of post-operative AKI is essential for reducing the incidence of CKD after nephrectomy.

A simple model for predicting incidence of chronic kidney disease in HIV-infected patients

Human immunodeficiency virus (HIV)-infected individuals have concurrent risk factors for chronic kidney disease (CKD), but there are no prediction models to quantify the effect of multiple factors on the development of incident CKD. A 1-year prognostic model was developed using prospective data between January 2008 and March 2009, from a derivation cohort of 623 patients with an estimated glomerular filtration rate (eGFR) exceeding 60ml/min/1.73m(2) at baseline. Incident CKD was defined as both an eGFR falling below 60ml/min/1.73m(2) and a decrease in eGFR of at least 25% during the period. Continuous variables were divided into categories using the mean value of the whole cohort. Multivariate logistic regression was used to determine baseline categories associated with incident CKD. The model was tested with prospective data between April 2009 and March 2010, from a validation cohort of 534 patients exceeding 60ml/min/1.73m(2) at baseline, consisting of part of the derivation cohort and newly enrolled patients. The discriminative ability was evaluated using the area under the receiver operating characteristic (AROC) curve. Eighteen subjects developed incident CKD (2.9%). In a multivariate logistic regression analysis of the derivation cohort, 5 variables (age, CD4 cell count, diabetes, proteinuria, and eGFR at baseline) were independently associated with the incidence of CKD. The AROC curve was 0.841 (95% CI 0.799-0.894) in the validation cohort. This prediction model may be a useful tool for identifying HIV-infected individuals with a high likelihood of new-onset CKD.

The Development of Chronic Kidney Disease in Japanese Patients with Non-alcoholic Fatty Liver Disease

Objective Chronic kidney disease (CKD) is present in patients with nonalcoholic fatty liver disease (NAFLD). The aim of this retrospective study was to assess the cumulative development incidence and predictive factors for new onset of CKD in Japanese patients with NAFLD. Methods A total of 5,561 NAFLD patients without CKD were enrolled. CKD was defined as either an estimated glomerular filtration rate of <60 mL/min/1.73 m(2) or dipstick proteinuria (≥+1). A blood sample and a urine sample were taken for routine analyses during follow-up. The mean observation period was 5.5 years. The primary goal is the new development of CKD. Independent factors associated with new development of CKD were analyzed by using the Kaplan-Meyer method and the Cox proportional hazards model. Results Of 5.561 NAFLD patients, 263 patients developed CKD. The cumulative development rate of CKD was 3.1% at the 5th year and 12.2% at the 10th year. Multivariate Cox proportional hazards analysis showed that CKD development in patients with NAFLD occurred when patient had low level of GFR of 60-75 mL/min/1.73 m(2) [hazard ratio:2.75; 95% confidence interval (CI)=1.93-3.94; p<0.001], age of ≥50 years (hazard ratio: 2.67; 95% CI=2.06-3.46; p<0.001), diabetes (hazard ratio: 1.92; 95% CI=1.45-2.54; p<0.001), hypertension (hazard ratio: 1.69; 95% CI=1.25-2.29; p<0.001), and elevated serum gamma-glutamyltransferase of ≥109 IU/L (hazard ratio: 1.35; 95% CI=1.02-1.78; p=0.038). Conclusion Our retrospective study indicates that the annual incidence of CKD in Japanese patients with NAFLD is about 1.2%. Five factors of low eGFR level, aging, type 2 diabetes, hypertension, and elevated gamma-glutamyltransferase, increases the risk of the development of CKD.

Investigation of clinical factors associated with development of chronic kidney disease and eGFR decline in Japanese patients with type 2 diabetes mellitus

The aim of our study was to investigate clinical factors associated with the development of chronic kidney disease (CKD) in Japanese type 2 diabetes patients diagnosed by the new equation established by the Japanese Society of Nephrology. We analyzed data collected from 653 Japanese patients with type 2 diabetes who were followed at Juntendo University Hospital for 2 years to determine the risk factors for new-onset CKD and 2-year eGFR decline from the baseline. CKD developed de novo in 56 diabetic patients, whereas 288 patients showed no signs of CKD at the end of the 2-year follow-up period. The 2-year cumulative incidence of newly diagnosed cases with CKD was 8.6%. Of these, the transition rate to albuminuria was 73.2%, the proportion of patients who developed low eGFR (<60 ml/min/1.73 m2) was 19.7%, and the proportion of patients with both albuminuria and low eGFR was 7.1%. Multiple logistic regression analysis showed that age (odds ratio = 1.97, P < 0.001), mean blood pressure (odds ratio = 1.56, P = 0.024), HbA1c (odds ratio = 1.21, P = 0.039) and urinary albumin-to-creatinine ratio (UACR) (odds ratio = 2.65 P < 0.001) were independent predictors for new-onset CKD, and multiple linear regression analysis identified HbA1c and BMI as independent predictors for subsequent eGFR decline (β = −0.94, P < 0.001 and β = −0.24, P = 0.035, respectively). Age, mean blood pressure, HbA1c and albuminuria are independent risk factors for new onset of CKD with type 2 diabetes. In addition, HbA1c and BMI are associated with a future eGFR decline in type 2 diabetes.

Chronic Kidney Disease and That Risk Factor In Patients Alive More Than 10 Years After Allogenic Hematopoietic Stem Cell Transplantation.

AbstractAbstract 3463 Introduction:Chronic kidney disease (CKD) is common in survivors of hematopoietic stem cell transplantation (SCT). However, evolution over time of kidney dysfunction and its association with post-SCT acute kidney injury (AKI) are unclear. Methods:A retrospective cohort study was performed in 86 myeloablative allogenic SCT patients who received SCT between 1990 and 1999 and lived without relapse for 10 years or more. CKD was defined as a sustained decrease in estimated GFR less than 60 ml/min/1.73 m2 at least for a period more than 3 months. Post-SCT AKI was classified into three stages according to the acute kidney injury network (AKIN) criteria within 100 days after SCT. Incidence of new-onset CKD was studied by 1-year interval along the course of follow-up. Cumulative CKD incidence was evaluated by the Kaplan-Meier analysis. The factors associated with CKD at the time of 10 years after SCT were examined using Cox regression analysis. Results:The incident of new CKD was the highest (10.5%) at the first year after SCT and then remained almost constant (2.3 to 3.5%) (Figure 1). The prevalence of CKD increased along the follow-up time (Table 1). The cumulative incidence of CKD increased according to increasing AKI stages with significant difference between stages ≥1 and no AKI (Figure 2). Cox regression showed that each AKIN stage was a significant predictor of CKD: stage 3: hazard ratio (HR) 12.7, 95% confidence interval (CI) 2.42–97.6; stage 2: HR 7.75, 95% CI 1.83–53.6; and stage 1: HR 4.36, 95% CI 1.06–29.5. Other predictors included total body irradiation (TBI) (HR, 4.00; 95% CI, 1.63–10.5) and age on SCT (HR, 1.08; 95% CI, 1.03–1.13). Conclusions:CKD accumulated among long-term survivors receiving myeloablative allogenic SCT. Post-SCT AKI, regardless of the AKIN stages, is the most significant risk of CKD in such SCT population. [Display omitted] [Display omitted] [Display omitted] Disclosures:No relevant conflicts of interest to declare.

Predicting renal functional outcomes after surgery for renal cortical tumours: a multifactorial analysis

To examine the functional outcomes after radical (RN) and partial nephrectomy (PN) stratified by variables before and after surgery, using estimated glomerular filtration rate (eGFR), as nephrectomy is the standard treatment for localized renal tumours, but the risk of developing chronic kidney disease (CKD) increases after surgery. We retrospectively analysed patients treated with PN or RN for renal cancer at one institution from 1988 to 2008. Chronic renal function before and after surgery was measured using the eGFR computed using the Modification of Diet in Renal Disease equation. Four outcomes were measured: (i) presence of new-onset renal insufficiency (eGFR <60 mL/min/1.73m(2)); (ii) the percentage change in eGFR; (iii) the change in CKD stage; and (iv) the presence of CKD upstaging. Regression models were used to determine the effect of surgical procedure (RN vs PN), access technique (open vs laparoscopic) and several preoperative characteristics on functional outcomes. In all, 276 patients met the inclusion criteria (174 RN and 102 PN) of whom 209 had a preoperative eGFR of >60 mL/min/1.73m(2). After >or=3 months from surgery, 108/209 (52%) patients developed new-onset eGFR of <60 mL/min/1.73m(2). On multivariate analysis, preoperative CKD stage (P < 0.001) and procedure (P= 0.001) were both independent predictors of all four functional outcomes measured. Also, hypertension was an independent predictor of CKD upstaging (P= 0.02). Surgical access technique was not an independent predictor of any of the renal functional outcomes measured. Patients undergoing renal surgery have a high rate of new-onset CKD afterward. After controlling for preoperative risk factors, patients undergoing RN are at greater risk of a decline in renal function. However, surgical access technique was not a significant predictor for renal impairment.

Metabolic Syndrome Predicts New Onset of Chronic Kidney Disease in 5,829 Patients With Type 2 Diabetes

OBJECTIVE—Type 2 diabetes is the leading cause of end-stage renal disease worldwide. Aside from hyperglycemia and hypertension, other metabolic factors may determine renal outcome. We examined risk associations of metabolic syndrome with new onset of chronic kidney disease (CKD) in 5,829 Chinese patients with type 2 diabetes enrolled between 1995 and 2005.RESEARCH DESIGN AND METHODS—Metabolic syndrome was defined by National Cholesterol Education Program Adult Treatment Panel III criteria with the Asian definition of obesity. Estimated glomerular filtration rate (eGFR) was calculated using the abbreviated Modification of Diet in Renal Disease formula modified for the Chinese population. New onset of CKD was defined as eGFR <60 ml/min per 1.73 m2 at the time of censor. Subjects with CKD at baseline were excluded from the analysis.RESULTS—After a median follow-up duration of 4.6 years (interquartile range: 1.9–7.3 years), 741 patients developed CKD. The multivariable-adjusted hazard ratio (HR) of CKD was 1.31 (95% CI 1.12–1.54, P = 0.001) for subjects with metabolic syndrome compared with those without metabolic syndrome. Relative to subjects with no other components of metabolic syndrome except for diabetes, those with two, three, four, and five metabolic syndrome components had HRs of an increased risk of CKD of 1.15 (0.83–1.60, P = 0.407) 1.32 (0.94–1.86, P = 0.112), 1.64 (1.17–2.32, P = 0.004), and 2.34 (1.54–3.54, P < 0.001), respectively. The metabolic syndrome traits of central obesity, hypertriglyceridemia, hypertension, and low BMI were independent predictors for CKD.CONCLUSIONS—The presence of metabolic syndrome independently predicts the development of CKD in subjects with type 2 diabetes.

Radical nephrectomy increases risk of new-onset chronic kidney disease

Radical nephrectomy increases risk of new-onset chronic kidney disease