Non-dialysis Chronic Kidney Disease Research Articles

Retinal Neurovascular Impairment in Non-diabetic and Non-dialytic Chronic Kidney Disease Patients.

Background: Widespread neural and microvascular injuries are common in chronic kidney disease (CKD), increasing risks of neurovascular complications and mortality. Early detection of such changes helps assess the risks of neurovascular complications for CKD patients. As an extension of central nervous system, the retina provides a characteristic window to observe neurovascular alterations in CKD. This study aimed to determine the presence of retinal neurovascular impairment in different stages of CKD.Methods: One hundred fifteen non-diabetic and non-dialytic CKD patients of all stages and a control group of 35 healthy subjects were included. Retinal neural and microvascular parameters were obtained by optical coherence tomography angiography (OCTA) examination.Results: CKD 1–2 group (versus control group) had greater odds of having decreased retinal ganglion cell-inner plexiform layer thickness (GC-IPLt) (odds ratio [OR]: 0.92; 95% confidence interval [CI]: 0.86–0.98), increased ganglion cell complex-focal loss volume (GCC-FLV) (OR: 3.51; 95% CI: 1.27–9.67), and GCC-global loss volume (GCC-GLV) (OR: 2.48; 95% CI: 1.27–4.82). The presence of advanced stages of CKD (CKD 3–5 group versus CKD 1–2 group) had greater odds of having decreased retinal vessel density in superficial vascular plexus (SVP)-WholeImage (OR: 0.77, 95% CI: 0.63–0.92), SVP-ParaFovea (OR: 0.83, 95% CI: 0.71–0.97), SVP-ParaFovea (OR: 0.76, 95% CI: 0.63–0.91), deep vascular plexus (DVP)-WholeImage (OR: 0.89, 95% CI: 0.81–0.98), DVP-ParaFovea (OR: 0.88, 95% CI: 0.78–0.99), and DVP-PeriFovea (OR: 0.90, 95% CI: 0.83–0.98). Besides, stepwise multivariate linear regression among CKD patients showed that β2-microglobulin was negatively associated with GC-IPLt (β: –0.294; 95% CI: –0.469 ∼ –0.118), and parathyroid hormone was positively associated with increased GCC-FLV (β: 0.004; 95% CI: 0.002∼0.006) and GCC-GLV (β: 0.007; 95% CI: 0.004∼0.01). Urine protein to creatinine ratio was positively associated with increased GCC-FLV (β: 0.003; 95% CI: 0.001∼0.004) and GCC-GLV (β: 0.003; 95% CI: 0.001∼0.006).Conclusion: Retinal neuronal impairment is present in early stages of CKD (stages 1–2), and it is associated with accumulation of uremic toxins and higher UACR, while retinal microvascular hypoperfusion, which is associated with worse eGFR, was only observed in relatively advanced stages of CKD (stages 3–5). The results highlight the importance of monitoring retinal neurovascular impairment in different stages of CKD.

Validation of a hyperkalemia prediction model in chronic kidney disease

Objective: To validate the accuracy and consistency of a previously established prediction model for the occurrence of hyperkalemia in non-dialytic chronic kidney disease (CKD) patients. Methods: All patients diagnosed with CKD from Outpatient Department of Shanghai Changzheng Hospital during the 4th quarter of 2020 were recruited. Demographic data, clinical characteristics and prediction model-related parameters of the patients were collected and analyzed. Receiver operating characteristic (ROC) curve was drawn to evaluate the effectiveness of the model, and the specificity and sensitivity were calculated based on the cut-off value of 4 obtained from the previous model. The improved Hanley method was used to compare the area under the curve (AUC) between the previously established model and current validation dataset. The calibration curve was drawn to verify the model calibration degree. Results: A total of 434 patients diagnosed with non-dialytic CKD were enrolled, among whom 233 were males and 201 were females, with an average age of (55±16) years. According to the measured serum potassium values, the prevalence of hyperkalemia was 7.6%. And 33 patients were allocated to the hyperkalemia group and 401 patients were to the normal potassium group. There was no significant difference in age and sex between the two groups (both P>0.05). A combination of hyperkalemia and heart failure (27.3% vs 3.7%, P<0.001), diabetes (42.4% vs 19.7%, P=0.002), and acidosis (51.5% vs 7.0%, P<0.001) were more frequently in the hyperkalemia group, compared with the normal serum potassium group. Patients in the hyperkalemia group were more likely to have a past history of serum potassium ≥5.0 mmol/L (48.5% vs 2.5%, P<0.001). For the drugs that could increase serum potassium levels, there was a significant correlation between Chinese herbal medicine and the occurrence of hyperkalemia, while renin-angiotensin-aldosterone system inhibitor (RAASi) and potassium supplementation showed no significant difference between the two groups. The results of ROC curve analysis showed that the AUC was 0.914, with the sensitivity of 84.8% and the specificity of 79.8% with the cut-off value of 4. The difference of AUC between the previously established risk assessment model of hyperkalemia in patients with non-dialytic CKD and current validation dataset was not statistically significant (Z=1.924, P=0.054), indicating the good accuracy and consistency of the prediction model. In the calibration curve, when the predicted risk of patients was below 0.4 or above 0.6, the prediction effect of the model was better. Conclusion: The previously-constructed hyperkalemia prediction model in non-dialytic CKD patients had good accuracy and consistency, and could be used to evaluate the risk of hyperkalemia in all stages of non-dialytic CKD patients.

Validity of Thai Nutritional Assessment Form and Nutrition Triage 2013 to Diagnose Malnutrition in Non-Dialytic Chronic Kidney Disease

Background: Malnutrition inflammation score (MIS) is a universal tool to assess the presence of malnutrition among patients with chronic kidney disease (CKD). An appropriate diagnosis coding for malnutrition affects hospital reimbursement in Thailand. The Nutrition Alert Form (NAF) and the Nutritional Triage (NT-2013) have been approved as standard nutrition assessment tools for general populations. Objective: To study the validity of the NAF and the NT-2013 among patients with MIS at non-dialytic CKD stages 3 to 5. Materials and Methods: A cross-sectional study was conducted among the patients with non-dialytic CKD stages 3 to 5. NAF, NT-2013, and MIS nutritional assessment tools were performed in all subjects. Cohen’s kappa statistics and Pearson’s correlation were used to determine the validity of NAF and NT-2013. Results: Two hundred seven participants were included in the present study. According to the MIS assessment classification, normal to mild, moderate, and severe malnutrition were diagnosed in 59.9%, 34.8%, and 5.3%, respectively. The correlation between NAF and NT-2013 when compared with MIS were r=0.619 and r=0.689 (p&lt;0.001), respectively. The sensitivity, specificity, and area under receiver operating characteristic (ROC) curve of assessment score to diagnose moderate to severe malnutrition were 47.6, 75.9, and 0.698 (95% CI 0.628 to 0.768) in NAF score greater than 5, and 100, 3.6, and 0.707 (95% CI 0.637 to 0.777) in NT-2013 score greater than 7, respectively. Conclusion: Among patients with CKD stages 3 to 5, the nutritional assessment tool NAF and NT-2013 correlated well with MIS. It seemed that NAF score is an alternative nutritional assessment tool with moderate sensitivity and specificity test, and NT-2013 score is suitable for a screening nutritional assessments tool to identify malnutrition with high sensitivity but very low specificity in a CKD population. Keywords: Nutritional assessment form (NAF); Nutritional Triage 2013 (NT-2013); Malnutrition inflammation score (MIS); Chronic kidney disease

Safety and immediate humoral response of COVID-19 vaccines in chronic kidney disease patients: the SENCOVAC study.

BackgroundChronic kidney disease (CKD) patients are at high-risk for severe Covid-19. The multicentric, observational and prospective SENCOVAC study aims to describe the humoral response and safety of SARS-CoV-2 vaccines in CKD patients. Safety and immediate humoral response results are reported here.MethodsFour cohorts of patients were included: kidney transplant (KT) recipients, haemodialysis (HD), peritoneal dialysis (PD) and non-dialysis CKD patients from 50 Spanish centres. Adverse events after vaccine doses were recorded. At baseline and on day 28 after the last vaccine dose, anti-Spike antibodies were measured and compared between cohorts. Factors associated with development of anti-Spike antibodies were analyzed.Results1746 participants were recruited: 1116 HD, 171 PD, 176 non-dialysis CKD patients and 283 KT recipients. Most patients (98%) received mRNA vaccines. At least one vaccine reaction developed after the first dose in 763 (53.5%) and after the second dose in 741 (54.5%) of patients. Anti-Spike antibodies were measured in the first 301 patients. At 28 days, 95% of patients had developed antibodies: 79% of KT, 98% of HD, 99% of PD and 100% of non-dialysis CKD patients (p<0.001). In a multivariate adjusted analysis, absence of an antibody response was independently associated to KT (OR 20.56, p = 0.001) and to BNT162b2 vaccine (OR 6.03, p = 0.023).ConclusionThe rate of anti-Spike antibody development after vaccination in KT patients was low but in other CKD patients it approached 100%; suggesting that KT patients require persistent isolation measures and booster doses of a Covid-19 vaccine. Potential differences between Covid-19 vaccines should be explored in prospective controlled studies.

Diagnosis and Management of Depression in Patients With Kidney Disease

Depression disproportionately affects patients with kidney disease, including those with nondialysis chronic kidney disease, end-stage kidney disease requiring dialysis, and kidney transplant recipients. Patients across the spectrum of kidney disease should be screened for depression every 6 to 12 months using self-report questionnaires, followed by an interview with a clinician to confirm the presence of sadness or anhedonia when depressive symptoms are identified. Pharmacologic treatment with selective serotonin reuptake inhibitors has not consistently shown benefit compared with placebo and may be associated with serious adverse outcomes including cardiovascular events, bleeding, and fractures. However, based on the availability of alternative therapies, a watchful trial with close monitoring for therapeutic and adverse effects is reasonable. Several clinical trials have suggested that cognitive behavioral therapy and physical activity improve depressive symptoms when compared with a control group. Given the low risk associated with these therapies, they should be recommended to patients who have access and are amenable to such interventions. Future trials are needed to study therapeutic options for depression in nondialysis chronic kidney disease, peritoneal dialysis, or kidney transplant recipients, as well as alternative pharmacologic therapy and combination therapies. Given improvement in depressive symptoms with placebo in existing trials, inclusion of a control group is paramount.

Catastrophic Health Expenditure and Distress Financing Among Patients With Nondialysis Chronic Kidney Disease in Uddanam, India

Catastrophic Health Expenditure and Distress Financing Among Patients With Nondialysis Chronic Kidney Disease in Uddanam, India

Risk factors associated with uncontrolled blood pressure among patients with non-dialysis chronic kidney disease in Vietnam.

Uncontrolled blood pressure rates are high in patients with non-dialysis chronic kidney disease, worsening the disease progression and leading to end-stage renal disease. However, studies on uncontrolled blood pressure in patients with non-dialysis chronic kidney disease and its associated factors in Vietnam are scarce.Objectives: This study aimed at identifying uncontrolled blood pressure rates and risk factors associated with uncontrolled blood pressure among Vietnamese patients with non-dialysis chronic kidney disease. A cross-sectional, correlational study design was employed among 182 participants coming to follow up at two tertiary hospitals in Vietnam. The participants were selected by a convenience sampling technique. Data were collected using Participant Demographic Information Form, Clinical Characteristics Form, Alcohol Use Disorders Identification Test, Pittsburgh Sleep Quality Index, Charlson Comorbidity Index, and an automated office oscillometric upper arm device. Descriptive statistics, Chi-square, Fisher's Exact Test, and binary logistic regression were used to analyze the data. 63.2% of the participants could not control their BP less than 130/80 mmHg. Poor sleep quality (OR 2.076, 95%CI 1.059-4.073, p=.034) and severe comorbidities (OR 2.926, 95%CI 1.248-6.858, p=.013) were risk factors associated with uncontrolled blood pressure among Vietnamese patients with non-dialysis chronic kidney disease. Interestingly, the study found a high rate of awareness toward the importance of blood pressure control but a low rate of known blood pressure targets. Uncontrolled blood pressure rates among Vietnamese patients with non-dialysis chronic kidney disease were high. Sleep quality and comorbidity severity were significantly associated with uncontrolled blood pressure in this population. To achieve blood pressure targets, nurses and other healthcare providers should pay more attention to the patients with poor sleep quality and severe comorbidities.

Perspective of General Practitioners on Management of Non-dialysis Chronic Kidney Disease - a Qualitative Study

Chronic Kidney Disease (CKD) is a common diagnosis in older age due to age dependent kidney function decline, as well as an increase in causative diseases like diabetes mellitus and arterial hypertension. The condition knows a long asymptomatic phase in the early stages, and only a small part of the patient will progress to end stage renal disease requiring renal replacement therapy. Patients with CKD are generally managed by General Practitioners (GPs). The aim of the study was to evaluate the perspectives of German GPs on management of patients with non-dialysis CKD. There were 5 focus group discussions with a maximum of 5 GPs (n = 22). The material was recorded and transcribed to be analyzed by content analysis. The most important treatment measures at the CKD were the optimization of causative diseases, medication adjustment and referral for nephrologist consultation. GPs stressed the individual management of their CKD patients. GPs reported that their decisions about CKD management were based on Individual patient factors such as high age or multimorbidity.

Erythropoietin therapy improves endothelial function in patients with non-dialysis chronic kidney disease and anemia (EARNEST-CKD): A clinical study.

Background:This study investigated whether administering erythropoiesis-stimulating agents (ESAs) improves endothelial function in patients with non-dialysis chronic kidney disease (CKD) and anemia.Methods:This single-center, prospective, single-arm comparison study enrolled patients with non-dialysis CKD (stages 4-5) and hemoglobin levels <10 g/dL. ESA administration followed the Kidney Disease: Improving Global Outcomes guideline. The primary endpoint was the change in flow-mediated dilatation after ESA administration in individual patients. The secondary endpoints were changes in 6-minute walk test results, blood pressure, New York Heart Association class, and echocardiographic parameters. The echocardiographic parameters examined included chamber quantification, Doppler parameters, and systolic and diastolic function parameters.Results:Initially, 13 patients were screened, but 2 discontinued due to either heart failure or voluntary withdrawal. The mean flow-mediated dilatation values significantly increased by 10.59% (from 1.36% ± 1.91% to 11.95% ± 8.11%, P = .001). Echocardiographic findings showed that the left ventricular mass index decreased by 11.9 g/m2 (from 105.8 ± 16.3 to 93.9 ± 19.5 g/m2, P = .006), and the left atrial volume index decreased by 10.8 mL/m2 (from 50.1 ± 11.3 to 39.3 ± 11.3 mL/m2, P = .004) after 12 weeks of ESA administration. There were no significant differences between pre- and post-ESA treatment 6-minute walk test results. No significant side effects were observed during the study period.Conclusions:This is the first clinical study to demonstrate that an ESA improves endothelial dysfunction, left ventricular hypertrophy, and left atrial volume in patients with non-dialysis CKD. Thus, ESAs may be considered as adjunctive therapy for reducing cardiovascular risk in these patients.

Hip fracture in patients with non-dialysis chronic kidney disease stage 5

Hip fracture is a significant health problem and is associated with increased mortality. Patients with chronic kidney disease (CKD) are more at risk of hip fracture than the general population, but the hip fracture risk is not evident among non-dialysis CKD stage 5 patients. This study aims to assess the risk of hip fracture in patients with non-dialysis CKD stage 5 comparing to those with CKD stages 1–4. Patients with non-dialysis CKD stage 5 and CKD stages 1–4 were retrieved from Taiwan longitudinal health insurance database 2011–2014. All patients were followed to the end of 2018 for the development of hip fractures. We analyze the risk of hip fracture of propensity score-matched patients with CKD stage 5 compared to patients with CKD stages 1–4 using stepwise Cox regression and competing risks regression. We analyzed 5649 propensity score-matched non-dialysis CKD 1–4 patients and non-dialysis CKD 5 patients between 2011 and 2014. All patients were followed to the end of 2018, 229 (4.1%) of CKD 1–4 patients in 21,899 patient-year, and 290 (5.1%) of CKD 5 patients had hip fractures in 18,137 patient-year. CKD 5 patients had a higher risk of hip fracture than patients with CKD stages 1–4. The adjusted HR was 1.53 (95% CI 1.08–1.54) in the Cox regression with adjustments for age, gender, comorbidity, and history of fracture. In the competing risks regression, the subdistribution hazard ratio was 1.29 (95% CI 1.08–1.54). Female gender, age, history of fractures, and Charlson–Deyo comorbidity index were independently associated with increased hip fracture risks. Non-dialysis CKD 5 patients had a higher risk of hip fracture than patients with CKD stages 1–4. This association is independent of patients’ age, female gender, history of fractures, and comorbidities.

Effect of chronic kidney disease on outcomes following proximal humerus fragility fracture surgery in diabetic patients: A nationwide population-based cohort study.

The proximal humerus fracture (PHF) is the third most common fragility fracture. Diabetes mellitus (DM) and chronic kidney disease (CKD) are both risks for fragility fractures; however, the interplay of DM and CKD makes treatment outcomes unpredictable. This study aimed to investigate and compare early and late outcomes following proximal humerus fracture fixation surgery in diabetic patients with different renal function conditions. DM patients receiving PHF fixation surgery during 1998-2013 were recruited from Taiwan's National Health Insurance Research Database. According to their renal function, patients were divided into three study groups: non-chronic kidney disease (CKD), non-dialysis CKD, and dialysis. Outcomes of interest were early and late perioperative outcomes. Early outcomes included in-hospital newly-onset morbidities. Late outcomes included infection, revision, readmission, and all-cause mortality. This study included a total of 10,850 diabetic patients: 2152 had CKD (non-dialysis CKD group), 196 underwent permanent dialysis (dialysis group), and the remaining 8502 did not have CKD (non-CKD group). During a mean follow-up of 5.56 years, the dialysis group showed the highest risk of overall infection, all-cause revision, readmission, and mortality compared to the non-dialysis CKD group and non-CKD group. Furthermore, subgroup analysis showed that CKD patients had a higher risk of surgical infection following PHF surgery than non-CKD patients in cases with a traffic accident or fewer comorbidities (Charlson Comorbidity Index, CCI <3) (P for interaction: 0.086 and 0.096, respectively). Also, CKD patients had an even higher mortality risk after PHF surgery than non-CKD patients, in females, those living in higher urbanization areas, or with more comorbidities (CCI ≥3) (P for interaction: 0.011, 0.057, and 0.069, respectively). CKD was associated with elevated risks for infection, revision, readmission, and mortality after PHF fixation surgery in diabetic patients. These findings should be taken into consideration when caring for diabetic patients.

Chronic kidney disease and cognitive impairment.

Chronic kidney disease (CKD) affects 25% of people over the age of 70. Neurocognitive disorders (NCDs) are frequent in patients with CKD and affect 30% to 60% of patients treated by haemodialysis. The link between CKD and NCD is explained by common risk factors, such as hypertension and diabetes, but also by CKD-specific risk factors through vascular, degenerative, and toxic mechanisms. In patients with non-dialysed CKD, albuminuria is more strongly linked to the occurrence of NCD than glomerular filtration rate. Vascular dementia is the main cause of NCDs in patients with CKD, but the incidence of Alzheimer's disease has also been found to be higher in patients with end-stage renal disease (ESRD) than in the general population. Executive functions, orientation and attention are the most frequently affected cognitive domains in patients with CKD. The occurrence of NCDs in older patients with CKD could be prevented by controlling blood pressure or by using anticoagulant drugs in the case of atrial fibrillation, which is particularly frequent in patients with CKD, in order to prevent cerebrovascular lesions. Nephrological care could also influence the occurrence of neurological complications. Anticholinesterase drugs and memantine should be used with caution in patients with CKD, as most of these drugs accumulate due to a low glomerular filtration rate. Due to the poor prognosis of patients with NCD and ESRD treated by dialysis or kidney transplantation, a cognitive assessment should be proposed in older patients with severe CKD in order to discuss the initiation and type of renal replacement therapy with both patients and caregivers.

Role of hepcidin as a biomarker for iron status and its effect on anemia management in patients with chronic kidney disease (stage II-Iv) after HCV treatment

Abstract Background Anemia is a severe complication of chronic kidney disease (CKD) that is seen in more than 80% of patients with impaired renal function. Although there are many mechanisms involved in the pathogenesis of anemia of renal disease, the primary cause is the inadequate production of erythropoietin by the damaged kidneys. Aim of the work to assess hepcidin level in non dialysis patients (CKD stage 4 &amp;5) treated from Hepatitis C virus and its relation to iron parameters. Patients and Methods This study was conducted on 20 CKD patients (stage 4 and 5) treated from hepatitis C virus. All candidates included in this study subjected to careful history taking, full clinical examination and investigations (including complete blood count, renal chemistry, HCVAb, serum iron, total iron binding capacity, TSAT%, ferritin and hsCRP. Serum hepcidin was analyzed by ELISA technique. Results Serum hepcidin was 26.35±7.26; 40% in stage III, 37.8% in stage IV and 22.2% in stage V. There was statistically significant difference between GFR stages according to Hb., Drug intake ACE inhibitor/ARB, Plt., Creatinine, BUN, Iron, TIBC, Ferritin, T SAT%, CRP and Serum Hepcidin. We showed significant correlations between serum hepcidin and TIC, Iron, TIBC, Ferritin and TSAT%. Conclusion Median hepcidin value is elevated in nondialysis CKD patients due to increased inflammation and decreased clearance of hepcidin. Furthermore, iron status modifies serum hepcidin level and its association with Hb. Increased hepcidin level leads to iron-restricted erythropoiesis and recombinant human EPO (rhEPO) resistance by inhibiting iron absorption from gut and iron recycling from macrophages. Hence, elevated hepcidin can predict need for parenteral iron to overcome hepcidin-mediated iron-restricted erythropoiesis and need for relatively higher rhEPO doses to suppress hepcidin.

Change in Physical Activity and Function in Patients with Baseline Advanced Non-Dialysis CKD

Change in Physical Activity and Function in Patients with Baseline Advanced Non-Dialysis CKD

The Association Between the Adherence of Self-Management and Prognosis of Non-Dialysis CKD Stages 3-5 Patients

The Association Between the Adherence of Self-Management and Prognosis of Non-Dialysis CKD Stages 3-5 Patients

A Study of Lipid Profile in Chronic Kidney Disease Patients

Background and Aim: Chronic kidney disease patients are more likely to develop cardiovascular diseases caused by atherosclerosis accelerated rate and variety of other factors, of which they exhibit the abnormality of lipid profile atherogonic characteristics. The current study aim was to investigate the lipid profile abnormalities pattern in non-diabetic chronic kidney disease patients and to evaluate the association between the lipid profile alteration extent and renal impairment degree. Methods: This cross-sectional study was carried out on 118 chronic disease patients in the Department of Nephrology, Shaikh Zayed Hospital Lahore during the period, from August 2020 to May 2021. All the patients were carefully chosen based on their eligibility criteria. A history was taken, clinical investigation was performed, and biochemical tests were conducted. Blood was drawn for lipid profile analysis after 9 hours abstaining. The Institutional Ethical Committee approved the study and informed consent was taken from each individual. Chronic Kidney Disease as defined by the KDOQI Criteria Kidney damage for three months, defined as functional kidney abnormalities with or without decreased GFR, manifested by either: Pathological abnormalities; kidney damage markers such as changes in blood or urine composition, or abnormalities in imaging tests. GFR of less than 60 mL/min/1.73m2 for 3 months, with or without kidney damage. SPSS version 20 was used for data analysis. Results: The study included 118 patients, 79 (66.9%) of whom were males and 39 (33.1%) were females. The mean age of patients was 49.46 + 9.35 years with an age range of 28 to 78 years. Stage 5CKD patients were 23 who underwent dialysis. Chronic kidney disease patients had lower HDL and higher levels of triglyceride whereas, with chronic kidney disease stage progression, the HDL and TGL levels increased. In both stages 4 and 5 CKD, there is a positive correlation between triglyceride levels and serum phosphorous and TGL and calcium had inverse correlation. Dialysis patients' lipid profiles do not differ from those of non-dialysis patients. Conclusion: Our study found that patients with non-diabetic CKD have high triglyceride levels, low HDL, and had LDL and total cholesterol unchanged levels. As the CKD stage advances and GFR declines, triglyceride increases, and HDL decreases. TGL and serum phosphorous had a positive association in chronic kidney disease stage 4 and 5 whereas TGL and serum calcium had an inverse correlation in stages 4 and 5. Moreover, no significant difference between dialysed and non-dialysed chronic kidney disease patients’ lipid profiles was observed. Keywords: Chronic Kidney Disease; Lipid Profile; Lipid Profile Abnormalities

Neutrophil Lymphocyte Ratio and C-Reactive Protein in Nondialysis Chronic Kidney Disease

Background: Chronic kidney disease (CKD) occurs when a disease or condition impairs kidney function, causing kidney damage to worsen over several months. Inflammatory markers such as C-reactive protein (CRP), Interleukine are widely used in CKD. However, those traditional biomarkers have their limitations because of its measurement is costly or inaccessible. Recently, the Neutrophil-to-lymphocyte ratio (NLR) was reported to be associated with inflammation in End-stage renal disease (ESRD). Its measurement is simpler and cheaper4.5. The aim of the present study was to determine whether NLR is associated with CRP in CKD patients.&#x0D; Methods: This cross-sectional and observational analytic study was conducted 12 consecutive Pre Hemodialysis patients ESRD between Mei 2021 and Augustus 2021. Subjects were divided into two groups according to the results of the examination of the CRP and NLR levels. Then analyzed whether there is have a correlation.&#x0D; Results: The composite endpoint was observed in 12 patients with ESRD; it was found that both of the values of NLR and CRP were equally increased in ESRD patients, although they were not statistically significant.&#x0D; Conclusion: The present study demonstrated that a high NLR in ESDR and suggesting that NLR may be a useful marker for the prediction of infection in patients with CKD.

Non-valvular Atrial Fibrillation in CKD: Role of Vitamin K Antagonists and Direct Oral Anticoagulants. A Narrative Review.

Atrial fibrillation (AF) is the most common arrhythmia in chronic kidney disease (CKD), with a close bidirectional relationship between the two entities. The presence of CKD in AF increases the risk of thromboembolic events, mortality and bleeding. Vitamin K antagonists (VKA) have been the mainstay of treatment for the prevention of thromboembolic events in AF until recently, with confirmed benefits in AF patients with stage 3 CKD. However, the risk-benefit profile of VKA in patients with AF and stages 4–5 CKD is controversial due to the lack of evidence from randomized controlled trials. Treatment with VKA in CKD patients has been associated with conditions such as poorer anticoagulation quality, increased risk of bleeding, faster progression of vascular/valvular calcification and higher risk of calciphylaxis. Direct oral anticoagulants (DOACs) have shown equal or greater efficacy in stroke/systemic embolism prevention, and a better safety profile than VKA in post-hoc analysis of the pivotal randomized controlled trials in patients with non-valvular AF and stage 3 CKD, yet evidence of its risk-benefit profile in more advanced stages of CKD is scarce. Observational studies associate DOACs with a good safety/effectiveness profile compared to VKA in non-dialysis CKD patients. Further, DOACs have been associated with a lower risk of acute kidney injury and CKD development/progression than VKA. This narrative review summarizes the evidence of the efficacy and safety of warfarin and DOACs in patients with AF at different CKD stages, as well as their effects on renal function, vascular/valvular calcification and bone health.

Evaluation of COVID-19 Patients with Chronic Kidney Disease

Objectives: The present study seeks to provide insight into managing patients with chronic kidney disease (CKD) infected with COVID-19. Methods: Patients with COVID-19 with CKD were included in the study. The eligible patients were divided into four groups: 1) patients who were not on dialysis, 2) patients on maintenance dialysis, 3) patients who underwent dialysis following COVID-19, 4) patients with a history of a kidney transplant. After reviewing clinical charts, nursing records, laboratory findings, radiological reports, and other medical records of CKD patients with COVID-19 confirmed infection, clinical presentation, laboratory data, radiology findings, and results were extracted from documented medical records. The epidemiological, clinical, laboratory and outcome characteristics of the subgroups were evaluated and compared. Results: Seventy-eight patients were included into the study. Hypertension (50 cases, 72.5%), diabetes (44 cases, 63.8%), and Cardiovascular disease (26 cases, 38.2%) were the most common risk factors in the studied patients. Among all participants, 40 (52.6%) patients died. The most common symptom was dyspnea (56.6%), followed by dry cough (38.7%). Comparison of blood, inflammatory, biochemical, and clinical indices among the patients' groups show that LDH (P=0.022), AST (P=0.038), and ALT (P= 0.004) indices were significantly different between groups of patients. According to the results in Table 3, Unilateral ground-glass opacity (GGO) in the radiological findings of the Non-dialysis CKD group was significantly (P=0.50) higher than the other groups. Conclusion: It can be concluded that CKD is one of the critical factors that can cause poor prognosis in COVID-19 patients. J Microbiol Infect Dis 2021; 11(3):152-158.

Effects of blood urea nitrogen independent of the estimated glomerular filtration rate on the development of anemia in non-dialysis chronic kidney disease: The results of the KNOW-CKD study.

Anemia is a common complication of chronic kidney disease (CKD). Blood urea nitrogen (BUN) in CKD represents nitrogenous uremic toxin accumulation which could be involved in anemia of CKD. We investigated the effects of BUN independent of estimated glomerular filtration rate (eGFR) on anemia in non-dialysis CKD (NDCKD). This prospective study included 2,196 subjects enrolled in the KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD) cohort with BUN and hemoglobin level data. Initially, we investigated the association between BUN and hemoglobin level. To examine the impact of baseline BUN on the incident anemia, a longitudinal study was performed on 1,169 patients without anemia at study enrollment. BUN residuals were obtained from the fitted curve between BUN and eGFR. Anemia was defined as a hemoglobin level of <13.0 g/dL for men and <12.0 g/dL for women. BUN residuals were not related to eGFR but to daily protein intake (DPI), while BUN was related to both eGFR and DPI. BUN was inversely associated with hemoglobin level (β -0.03; 95% confidence interval [CI] -0.04, -0.03; P <0.001) in the multivariable linear regression analysis adjusted for multiple confounders including eGFR, and BUN residual used instead of BUN was also inversely associated with hemoglobin level (β -0.03; 95% CI -0.04, -0.02; P <0.001). Among the 1,169 subjects without anemia at baseline, 414 (35.4%) subjects newly developed anemia during the follow-up period of 37.5 ± 22.1 months. In the multivariable Cox regression analysis with adjustment, both high BUN level (Hazard ratio [HR] 1.02; 95% CI 1.01, 1.04; P = 0.002) and BUN residual used instead of BUN (HR 1.02; 95% CI 1.00, 1.04; P = 0.031) increased the risk of anemia development. Moreover, BUN, rather than eGFR, increased the risk of anemia development in patients with CKD stage 3 in the multivariable Cox regression. Higher BUN levels derived from inappropriately high protein intake relative to renal function were associated with low hemoglobin levels and the increased risk of anemia independent of eGFR in NDCKD patients.