Non-dialysis Chronic Kidney Disease Research Articles

Effects of additional physical exercise on the nutritional status and disease progression during the low-protein diet in Chronic Kidney Disease Patients: a systematic review and meta-analysis.

Low-protein diet (LPD) is the core of dietary and nutritional therapy for non-dialysis chronic kidney disease (CKD) patients. In addition, physical exercise could prevent and treat various illnesses and chronic diseases. The objective of the study was to search for and appraise evidence on the effect of additional physical exercise on patients' nutritional status and indicators of disease progression when compared with the LPD alone. PubMed Central, Embase, Cochrane, and Web of Knowledge for randomized controlled trials (published between January 1, 1956 and May 17, 2023) were searched. A total of 8698 identified studies, 9 were eligible and were included in our analysis (N = 250 participants). Compared with the LPD alone, additional physical exercise reduced serum creatinine by a mean of -0.21 mg/dL (95% CI -0.39 to -0.03) in CKD patients. Similarly, blood pressure decreased after physical exercise, with systolic blood pressure decreasing by -7.05 mm Hg (95% CI -13.13 to -0.96) and diastolic blood pressure decreasing by -5.31 mm Hg (95% CI -7.99 to -2.62). Subgroup analyses revealed that resistance exercise (RE) was effective in decreasing estimated glomerular filtration rate (eGFR) of -1.71 mL/min per 1.73 m² (95% CI -3.29 to -0.14). In addition, the VO2peak increasing by 2.41 mL/kg/min (95% CI 0.13 to 4.70) when physical exercise was continued for 24 weeks. The above results suggest that the LPD with additional physical exercise care is more beneficial for patients with CKD.

Relationships of Weight Change from 20 Years of Age with the Risks of All-Cause and Cardiovascular Mortality in Patients with Chronic Kidney Disease.

Weight changes from a young age are known to be associated with poor life outcomes in the general population. However, little is known about the association between weight change from a young age and life expectancy in patients with chronic kidney disease (CKD). Data of 2,806 nondialysis CKD patients who participated in the Fukuoka Kidney Disease Registry (FKR) Study, a multicenter observational study, were analyzed. The primary outcome was all-cause death, whereas the secondary outcome was cardiovascular mortality. The covariate of interest was weight change, defined as the difference between body weight at study enrollment and at 20 years old. Cox proportional-hazards models were used to estimate the risks of mortality for participants with weight changes of ≥ 5 or ＜5 kg compared with those with stable weights. During the 5-year observation period, 243 participants died from all causes and 62 from cardiovascular disease. The risk of all-cause mortality in the weight-loss group was significantly higher than that in the stable-weight group (multivariable-adjusted hazard ratio, 2.11; 95% confidence interval [CI], 1.52-2.93). Conversely, the risk of cardiovascular mortality in the weight-loss group was significantly higher than that in the stable-weight group (multivariable-adjusted hazard ratio, 2.48; 95% CI, 1.32-4.64). However, no significant association was observed between weight gain and the risks of all-cause and cardiovascular mortalities. Weight loss from 20 years of age was found to be associated with higher risks of all-cause and cardiovascular mortalities in patients with CKD.

Cross-sectional relationship between dietary protein intake, energy intake and protein energy wasting in chronic kidney disease patients.

The potential threshold for dietary energy intake (DEI) that might prevent protein-energy wasting (PEW) in chronic kidney disease (CKD) is uncertain. The subjects were non-dialysis CKD patients aged ≥ 14 years who were hospitalised from September 2019 to July 2022. PEW was measured by subjective global assessment. DEI and dietary protein intake (DPI) were obtained by 3-d diet recalls. Patients were divided into adequate DEI group and inadequate DEI group according to DEI ≥ 30 or < 30 kcal/kg/d. Logistic regression analysis and restricted cubic spline were used in this study. We enrolled 409 patients, with 53·8 % had hypertension and 18·6 % had diabetes. The DEI and DPI were 27·63 (sd 5·79) kcal/kg/d and 1·00 (0·90, 1·20) g/kg/d, respectively. 69·2 % of participants are in the inadequate DEI group. Malnutrition occurred in 18·6 % of patients. Comparing with patients in the adequate DEI group, those in the inadequate DEI group had significantly lower total lymphocyte count, serum cholesterol and LDL-cholesterol and a higher prevalence of PEW. For every 1 kcal/kg/d increase in DEI, the incidence of PEW was reduced by 12·0 % (OR: 0·880, 95 % CI: 0·830, 0·933, P < 0·001). There was a nonlinear curve relationship between DEI and PEW (overall P < 0·001), and DEI ≥ 27·6 kcal/kg/d may have a preventive effect on PEW in CKD. Low DPI was also significantly associated with malnutrition, but not when DEI was adequate. Decreased energy intake may be a more important factor of PEW in CKD than protein intake.

The association between transferrin saturation and all-cause mortality in chronic kidney disease: findings from Korean Cohort Study for Outcome in Patients with Chronic Kidney Disease.

Transferrin saturation (TSAT) has been used as an indicator of iron deficiency. However, there is no consensus regarding its optimal range for patient with chronic kidney disease (CKD). We aimed to analyze the effect of TSAT on the prognosis of patients with non-dialysis CKD (NDCKD). From 2011 to 2016, 2157 NDCKD patients with baseline TSAT measurements were followed for 10 years. Patients were divided into three groups based on baseline TSAT values: <25%, ≥25% and <45%, and ≥45%. All-cause mortality and 4-point major adverse cardiovascular events (MACE) were analyzed using multivariable Cox regression analysis. Other iron biomarkers and mortality were also analyzed. During a mean follow-up of 7.1 ± 2.9 years, 182 of a total of 2,157 patients (8.4%) died. Compared with the TSAT ≥25% and <45% group, the TSAT <25% group showed significantly increased all-cause mortality (hazard ratio [HR], 1.44; 95% confidence interval (CI), 1.02-2.03; p = 0.04). The occurrence of 4-point MACE was significantly increased in univariable analysis in the TSAT <25% group (HR, 1.48; 95% CI, 1.02-2.15; p = 0.04), but it was not significant in the multivariable analysis (HR, 1.38; 95% CI, 0.89-2.15; p = 0.15). Tertile comparisons of the iron-to-log-ferritin ratio showed increased mortality in the first tertile group. TSAT <25% is an independent risk factor for all-cause mortality in patients with NDCKD and care should be taken to prevent TSAT values of <25%. Other indicators, such as serum iron and iron-to-log-ferritin ratio, may also be used to assess iron deficiency.

Clinical Impacts of Urinary Neutrophil Gelatinase-Associated Lipocalin in Patients With Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention.

Chronic kidney disease (CKD) is associated with poor prognosis in patients undergoing percutaneous coronary intervention (PCI). Urinary neutrophil gelatinase-associated lipocalin (NGAL) is a biomarker for renal injury. However, the association between urinary NGAL concentrations and renal and cardiovascular events in patients with CKD undergoing PCI has not been elucidated. This study investigated the clinical impact of urinary NGAL concentrations on renal and cardiovascular outcomes in patients with non-dialysis CKD undergoing PCI.Methods and Results: We enrolled 124 patients with non-dialysis CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2) undergoing elective PCI. Patients were divided into low and high NGAL groups based on the median urinary NGAL concentration measured the day before PCI. Patients were monitored for renal and cardiovascular events during the 2-year follow-up period. Kaplan-Meier analyses showed that the incidence of renal and cardiovascular events was higher in the high than low NGAL group (log-rank P<0.001 and P=0.032, respectively). Multivariate Cox proportional hazards analyses revealed that urinary NGAL was an independent risk factor for renal (hazard ratio [HR] 4.790; 95% confidence interval [CI] 1.537-14.924; P=0.007) and cardiovascular (HR 2.938; 95% CI 1.034-8.347; P=0.043) events. Urinary NGAL could be a novel and informative biomarker for predicting subsequent renal and cardiovascular events in patients with CKD undergoing elective PCI.

Factors associated with risk analysis for asymptomatic left ventricular diastolic dysfunction in nondialysis patients with chronic kidney disease

Heart failure (HF) constitutes a major determinant of outcome in chronic kidney disease (CKD) patients. The main pattern of HF in CKD patients is preserved ejection fraction (HFpEF), and left ventricular diastolic dysfunction (LVDD) is a frequent pathophysiological mechanism and specific preclinical manifestation of HFpEF. Therefore, exploring and intervention of the factors associated with risk for LVDD is of great importance in reducing the morbidity and mortality of cardiovascular disease (CVD) complications in CKD patients. We designed this retrospective cross-sectional study to collect clinical and echocardiographic data from 339 nondialysis CKD patients without obvious symptoms of HF to analyze the proportion of asymptomatic left ventricular diastolic dysfunction (ALVDD) and its related factors associated with risk by multivariate logistic regression analysis. Among the 339 nondialysis CKD patients, 92.04% had ALVDD. With the progression of CKD stage, the proportion of ALVDD gradually increased. The multivariate logistic regression analysis revealed that increased age (OR 1.237; 95% confidence interval (CI) 1.108–1.381, per year), diabetic nephropathy (DN) and hypertensive nephropathy (HTN) (OR 25.000; 95% CI 1.355–48.645, DN and HTN vs chronic interstitial nephritis), progression of CKD stage (OR 2.785; 95% CI 1.228–6.315, per stage), increased mean arterial pressure (OR 1.154; 95% CI 1.051–1.268, per mmHg), increased urinary protein (OR 2.825; 95% CI 1.484–5.405, per g/24 h), and low blood calcium (OR 0.072; 95% CI 0.006–0.859, per mmol/L) were factors associated with risk for ALVDD in nondialysis CKD patients after adjusting for other confounding factors. Therefore, dynamic monitoring of these factors associated with risk, timely diagnosis and treatment of ALVDD can delay the progression to symptomatic HF, which is of great importance for reducing CVD mortality, and improving the prognosis and quality of life in CKD patients.

#1839 Evaluating the severity of restless legs syndrome in chronic kidney disease patients across different renal replacement therapies

Abstract Background and Aims Restless Legs Syndrome (RLS) is increasingly recognized as a significant comorbidity in chronic kidney disease (CKD) patients. This cross-sectional study evaluates the risk and severity of RLS in CKD patients across various renal replacement therapies (RRT). Method A total of 167 CKD patients were assessed, including those on hemodialysis (HD) (39%), peritoneal dialysis (PD) (22%), with kidney transplants (19%), and those with non-dialyzed CKD stages IV-V (20%)—the International Restless Legs Syndrome Study Group (IRLS) questionnaire measured RLS severity. Severity scales were categorized into mild (0-10), moderate (11-20), severe (21-30), and very severe (31-40). PTH, P, Ca, ALP, and Mg serum concentrations, as well as vascular calcification, were measured as MBD biomarkers. The Adragaos score was applied to graphs of the hands and pelvis to evaluate vascular calcification. Statistical analyses focused on differences in RLS severity across RRT modalities and associated risk factors. Results The cohort comprised 82 males and 85 females, averaging 58 years. Primary disease etiologies included nephroangiosclerosis (24%), diabetic nephropathy (12%), chronic pyelonephritis (24%), chronic glomerulonephritis (24%), and ADPKD (7%). RLS prevalence was 53.8%, with significant differences in IRLS scores across groups (p ≤ 0.001). HD patients showed a mean IRLS score of 21.8 ± 12.3, with 55% reporting severe or severe symptoms. PD patients scored 16.06 ± 13.02; non-dialyzed CKD patients scored 6.41 ± 6.04; and transplant recipients scored 3.1 ± 4.7. No correlation was found between RLS severity and age or time on RRT. However, significant correlations were observed between RLS severity with HD modality, and the high Adragaos score. Multivariate analysis showed high serum phosphorus p=0.018 and markers of inflammation as a risk factor for RLS severity (CRP levels p=0.034; ferritin (p=0.048). Conclusion This study underscores the disproportionately higher severity of RLS in HD patients, necessitating tailored management strategies for this subgroup. The significant association between RLS severity and calcification and inflammation markers in CKD patients, particularly those on HD, suggests that RLS severity should be a key consideration in the clinical management of CKD. Addressing RLS in these patients may improve their quality of life and influence the outcomes of their renal replacement therapy.

#2320 The impact of interventions for people with chronic kidney disease on health-related quality of life: a systematic review

Abstract Background and Aims Health-related quality of life (HRQoL) is poorer for those with chronic kidney disease (CKD) than the general population and worsens as CKD progresses. Evidence is mixed as to which interventions improve HRQoL for those with CKD, and HRQoL is often under-reported in randomised controlled trials where it is most commonly a secondary outcome. Reviews including HRQoL as an outcome have thus far focused on the impact per intervention, therefore we aimed to ascertain which interventions, of any type, have an impact on HRQoL outcomes for those with non-dialysis dependent CKD (NDD-CKD). Method The protocol was prospectively registered on PROSPERO (CRD42022364474) and PRISMA guidelines were followed. Inclusion criteria were randomised controlled trials in an NDD-CKD population (excluding transplant recipients), any intervention type, usual care/placebo comparators, using validated and reported HRQoL outcomes measures. Databases searched were Embase, Medline, PsychINFO, CINAHL plus, Web of Science, PubMed, and Google Scholar, with reference searching of included studies. Reports were independently screened by two researchers who also performed data extraction and quality assessment (using the Cochrane Risk of Bias 2.0 tool). Synthesis was undertaken using Synthesis without Meta-analysis (SWiM) methods. Conversion to one-sided p-values, synthesising outcomes in albatross plots and combining p-values via Fisher's method was performed using the metap package in R. HRQoL measures were broken down into physical, mental, kidney disease symptoms, adverse effects of kidney disease, burden of kidney disease, overall kidney disease, and overall HRQoL domains for analysis. Results Searches yielded 8983 records, and 39 studies met inclusion criteria, with a total of 11,940 participants. Nine groups were formed based on type of intervention, with data synthesis possible in the eight groups with more than one study (Fig. 1). 26 (66%) studies were rated as having high risk of bias, largely due to frequent lack of blinding and HRQoL being a patient reported outcome. 37 studies had sufficient data for presentation in albatross plots (Fig. 2). Using combined p-values for all HRQoL outcomes in each group of studies, benefit to HRQoL in at least one study was shown for education interventions (p &amp;lt; 0.001, seven studies, none with low risk of bias), exercise interventions (p &amp;lt; 0.001, eight studies, all with high risk of bias), medications to treat CKD-related anaemia (p &amp;lt; 0.001, eight studies, four with low risk of bias), nutritional interventions (p &amp;lt; 0.001, four studies, all with high risk of bias) and weight loss interventions (p &amp;lt; 0.001, two studies, one with low risk of bias). No benefit to HRQoL was shown for medications aimed at slowing CKD progression (p = 0.492, five studies), medications for depression (p = 0.266, two studies) and medications to treat acidosis (p = 0.99, two studies). Conclusion This review identified several interventions with evidence of benefit to HRQoL for people with NDD-CKD, including medications to treat anaemia and weight loss interventions. Studies of education, exercise and nutritional interventions showed potential benefit, but with high risk of bias. Further high-quality randomised controlled trials of interventions for people with NDD-CKD should include and report HRQoL outcomes, in addition to targeting potentially modifiable determinants of HRQoL in these groups.

#2285 Potentially modifiable factors influencing longitudinal health-related quality of life for those with chronic kidney disease in the NURTuRE-CKD cohort

Abstract Background and Aims Factors affecting poor health-related quality of life (HRQoL) for people with chronic kidney disease (CKD) have been previously described in literature, and worse HRQoL is associated with CKD progression and death. Little emphasis has been placed on which factors may be potentially modifiable, and longitudinal HRQoL outcome analyses in non-dialysis dependent CKD cohorts are few in number. Baseline analysis of the NURTuRE-CKD cohort identified several associations between these factors and HRQoL and these associations can now be examined with longitudinal data. Method The NURTuRE-CKD cohort study recruited 2996 participants with non-dialysis dependent CKD between 2017-2019, collecting biochemical, anthropometric, sociodemographic, medical history and patient reported outcome measure (PROM) data. Face-to-face follow-up repeated these measures. Longitudinal worsening overall HRQoL was the main outcome of interest, represented by mapped EQ-5D-3L index value and visual analogue score (VAS). Multivariable linear mixed effects models were fitted in R using the lmer and lmerTest packages. Models for index value were fit separately for each independent variable of interest and collated, as well as fitting models with all variables of interest. Models were adjusted for available confounders, repeated measures and follow-up time. P-values were adjusted for multiple testing using false discovery rate correction. Results 2054/2996 (68.6%) had complete HRQoL data at follow-up, of whom most had CKD stage G3a-G4 (n = 1597, 77.8%). 1817 (88.5%) were white and 1196 (58.2%) were male. Mean age was 63.7 (SD ±14.5) years and the mean number of comorbidities was 3.7 (SD ±2.2). Median (IQR) time between baseline and follow-up was 518 (410) days. At follow-up, mean mapped EQ-5D-3L index value was 0.72 (SD ±0.3) and mean VAS score was 70.4/100 (SD ±20.6). 1595 (77.7%) reported problems in at least one EQ-5D-5L dimension, with 255 (12.4%) developing issues since baseline. 1203 (58.6%) reported worse HRQoL index values at follow up and 910 (44.3%) reported worse VAS. The dimension with the highest number of newly reported issues at follow-up was ‘usual activities’ with 301 (14.7%). Multivariable linear mixed methods models showed independent associations with worse HRQoL (Figs 1 and 2) for those on ten or more medications (β −0.118, CI −0.137 to −0.100, p &amp;lt; 0.001), current smokers (β −0.036, CI −0.067 to −0.006, p = 0.0.012), obesity (β-0.059, CI −0.080 to-0.039, p &amp;lt; 0.001), haemoglobin of &amp;lt;100g/L (β-0.044, CI −0.073 to-0.016, p = 0.014), hospital anxiety and depression scale scores of 8 or above for anxiety (β-0.146, CI −0.161 to-0.130, p &amp;lt; 0.001) and depression (β-0.202, CI-0.219 to −0.186, p &amp;lt; 0.001), worse health literacy (β −0.099, CI −0.136 to −0.063, p &amp;lt; 0.001), and pain (β −0.148, CI −0.161 to −0.135, p ≤ 0.001), weakness (β −0.106, CI −0.120 to −0.092, p &amp;lt; 0.001) and shortness of breath symptoms (β −0.074, CI −0.087 to −0.060, p &amp;lt; 0.001). Conclusion Potentially modifiable factors influencing longitudinal worsening of HRQoL for people with CKD include polypharmacy, smoking, obesity, anaemia, depression and anxiety, limited health literacy, pain, weakness and shortness of breath symptoms. This highlights the need for high quality randomised controlled trials to test interventions addressing these factors with reported HRQoL outcomes. Further work in this cohort is required, examining a third timepoint for HRQoL and linked clinical outcome data.

#2380 A multicenter and randomized study of a VLPD supplemented with ketoanalogues in patients with advanced CKD in Spain. Adherence study

Abstract Background and Aims Clinical guidelines recommend a very low-protein diet (VLPD) supplemented with ketoanalogues (KAs) for patients with advanced chronic kidney disease (CKD) to reduce progression (evidence 1A) and improve the quality of life (evidence 1C). However, there is no prior experience with this nutritional intervention in Spain. Method A multicenter, randomized, and controlled study that evaluated adherence to a VLPD supplemented with KAs (Ernamin®) in non-dialysis dependent CKD patients, estimated using the Morisky scale. Secondary objectives included assessing the effect of VLPD + KAs on kidney function, urine protein, albumin levels and other metabolic and nutritional parameters, including changes in body composition stores, at months 0, 1, 3, 6, and 9. Results Preliminary data from 33 patients (67% men; mean age 68 ± 10; GFR 16.7 ± 3.9 ml/min/1.73 m2), randomized into 2 groups, are presented. The VLPD group showed good acceptance and tolerance of the diet and supplement, with medium or high adherence in 80% of patients from the first month, maintained throughout the study (Figure). The use of VLPD was associated with a decrease in phosphorus levels (−0.4 mg/dl VLPD vs. 0.09 mg/dl LPD, P = 0.027) and C-reactive protein (CRP) levels (−2 mg/dl VLPD vs. 0.33 mg/dl LPD), an increase in calcium levels (0.3 mg/dl VLPD vs. −0.2 mg/dl LPD, P = 0.015), and an increase in muscle mass (LTM) measured by bioimpedance (3.7 kg VLPD vs. −0.6 kg LPD, P = 0.03). Stability in weight, fat mass, extracellular volume, albumin levels, and MIS scale was observed during the follow-up. Estimated glomerular filtration rate, and urine protein remained unchanged in both groups. Conclusion Protein restriction associated with KAs shows good short-term tolerance and acceptance. This study confirms several effects associated with VLPD supplemented with KAs, including an anti-inflammatory effect, the preservation of nutritional status, and a better control of phosphate levels. These data suggest safe protein intake restriction with stabilization of protein stores.

#596 The Borg Scale—efficient and safe for exercise prescription in self-administered balance and strength exercise in patients with CKD

Abstract Background and Aims With the continued rise in chronic kidney disease (CKD), there is a critical need for sustainable, home-based exercise interventions. While supervised, centre-based exercise improves physical performance in CKD patients, unsupervised, self-administered exercise poses challenges in ensuring adherence, safety, and efficacy. This study investigates the Borg Rating of Perceived Exertion (RPE) scale, a subjective measure of exertion, as a method for prescribing and monitoring the intensity of balance and strength exercise in non-dialysis dependent CKD patients. The aims of this study were: Method This sub study of the RENEXC-trial included 148 patients with CKD stages 3-5, with a mean age of 66 ± 14 years and mean measured GFR of 22 ± 8 ml/min/1.73 m2. Patients were prescribed 90 minutes/week of balance or strength exercise at a Borg RPE of 13-17 (corresponding to an exercise intensity of somewhat hard to very hard), along with 60 minutes/week of endurance exercise. Exercise programs were individually prescribed by a physiotherapist according to randomization and each patient's baseline performance and were performed at home or in a gym according to the patient's preference. Duration and RPE of the performed exercise were reported in an exercise diary. Progress was monitored by the physiotherapist through phone contact, every week for the first three months of the study and every other week for the rest of the study year. The continuous follow up provided motivation and enabled adjustments of the exercise program to maintain the goal RPE, adapt intensity and the weekly duration of exercise. Outcome measures included the Berg Balance Scale (BBS) and Functional Reach Test (FRT), the 30-second sit-to-stand test (30STS) and isometric quadriceps strength (IQS). Balance and strength measures were evaluated at baseline and after 12 months of exercise. Previous publications of the RENEXC-trial showed no difference between patients who performed balance exercise and patients who performed strength exercise; therefore, this sub-study analysed all included patients as one group. Results Of 148 participants, 112 completed the study. At 12 months, 79% reported performed exercise, with 86% of these patients adhering to the prescribed intensity. The median (25th-75th percentile) exercise intensity was a RPE of 14 (13-15) on the Borg scale, and the median (min-max) exercise duration was 48 (0-241) minutes/week. Only 18% of the patients reached the 90-minute/week target. No exercise-related incidents were reported. Significant improvements were noted in BBS (p = 0.0464), FRT (p = 0.009), 30STS (p = 0.047), and IQS (right/left p = 0.022 / p = 0.049). Conclusion The Borg RPE scale is an effective and safe method for prescribing and monitoring self-administered balance and strength exercise in patients with CKD. Using the Borg scale for prescribing and monitoring exercise intensity during balance and strength exercise resulted in a good level of adherence to the 12-months exercise program and the prescribed exercise intensity. As no exercise related incidents were reported, we conclude that the self-administered exercise was safe to perform. Significant improvements in balance and strength were observed with a moderate to high exercise intensity prescription within a wide range of performed weekly duration of exercise, suggesting the Borg scale's value in exercise prescription in both well- and deconditioned patients with CKD. These findings show that the integration of the Borg scale into routine exercise prescription in people with CKD can promote patient autonomy and efficient resource utilization in healthcare.

#2856 Sleep disturbances in non-dialysis dependent chronic kidney disease—The CKD-REIN cohort study

Abstract Background and Aims Sleep disturbances are common in patients on dialysis, but little is known about their prevalence and determinants in earlier chronic kidney disease (CKD) stages. We assessed the prevalence of insomnia, excessive daytime sleepiness (EDS), and sleep apnea, and studied their relation with kidney function, before and after accounting for various other potential determinants in patients with moderate or severe CKD. Method This study included 2657 nephrology outpatients with non-dialysis dependent CKD (mean age, 67 ± 12 years; 66% men; mean eGFR, 33 ± 12 mL/min/1.73 m2) from the French CKD-REIN (CKD-Renal Epidemiology and Information Network) cohort study who completed the Basic Nordic Sleep Questionnaire at baseline. Insomnia was defined as having badly or rather badly been sleeping, or having had difficulties falling asleep or awakened too early without being able to fall asleep again at least 3 times per week, over the past 3 months. And EDS, as feeling excessively sleepy during daytime at least 3 times per week over the past 3 months. Sleep apnea with or without continuous positive airway pressure use were identified from medical records. For each sleep disturbance, we assessed the crude prevalence by sex and by estimated glomerular filtration rate (eGFR) categories. We estimated adjusted odds ratios (OR) with 95% confidence interval (95% CI) associated with eGFR decrease (per 10 mL/min/1.73 m2) and urinary albumin-to-creatinine ratio (ACR) categories (A1-A3), as well as with age, sex, education (years), smoking, alcohol consumption, physical activity (estimated by the Global Physical Activity Questionnaire), performance score in Instrumental Activities of Daily Living [IADL], obesity, diabetes, cardiovascular disease, depression, patient-reported cramps, itching and stress or worry about CKD, and relevant drug use. Results Overall prevalence of insomnia, EDS, and sleep apnea were 23%, 15%, and 14%, respectively, with differences between women and men for insomnia, 30% vs 19%, EDS, 17% vs 13%, and sleep apnea, 10% vs 17%, respectively (all P-values &amp;lt;.001). Crude prevalence of EDS significantly increased with decreasing eGFR category (without interaction with sex), but not those for insomnia and sleep apnea (Figure). ACR categories were not associated with either sleep disturbances. In multivariable analyses, factors significantly associated with higher prevalence of insomnia included female sex, smoking, low physical activity, depression, and thyroid hormone use. There were also strong dose-response relations between insomnia prevalence and to what extend patients reported being bothered by cramps or itching, or stressed/worried about CKD. The crude relation of eGFR with EDS tended to weaken (ORs [95% CI], 1.10 [0.99-1.22] per 10 mL/min decrease, p-value 0.09) in multivariable analysis, which showed higher ORs associated with past smoking, depression, lower IADL score, insomnia, and betablocker use, as well as dose-response relations with itching, and stress/worry about CKD. Factors significantly associated with increased prevalence of sleep apnea included male sex, alcohol consumption, lower IADL score, obesity, depression, and cardiovascular disease. Conclusion This analysis of baseline data from the CKD-REIN cohort shows that, in patients with non-dialysis dependent CKD, EDS alone appeared to be related to kidney function level. The study, however, suggests the potential role of modifiable CKD-related symptoms, cramps and itching, and of being stressed or worried about CKD, in addition to that well-documented for behavioral and clinical risk factors, and drugs in the risk of insomnia and EDS.

#1490 Long-term health outcomes in non-dialysis dependent chronic kidney disease patients with cognitive impairment or dementia

Abstract Background and Aims A decline in cognitive function, with a spectrum ranging from mild cognitive impairment to dementia (CI-D), is common in patients with chronic kidney diseases (CKD), rendering them frailer. Whether the coexistence of CKD and CI-D increases the health risk profile remains unclear. Our work aims to clarify how this association increases adverse outcomes for CKD patients (stages 3-5). Method This retrospective observational cohort study was conducted on CKD patients (stages 3-5) from the Global Collaborative Network (GCN) of the TriNetX research platform between 2004 and 2024. TriNetX provides access to anonymized electronic medical records from over half a million CKD patients in large healthcare organizations (HCOs) across the world. Our report includes patients from 110 HCOs with different demographic backgrounds. The study compared outcomes of patients with CKD stages 3-5, aged 18-70 years, with and without pre-existent CI-D (diagnosed within 5 years). The two cohorts were propensity score-matched (PSM) for age, sex, ethnicity, comorbidities (neurological, haematological, musculoskeletal, respiratory including smoking history, oncological, cardiovascular, gastroenterological and endocrine conditions) and CKD stage. The proportional hazard assumption was tested using the generalized Schoenfeld approach built in the TriNetX platform. A 95% confidence interval (95% CI) was considered evidence of statistical significance throughout the analyses. Kaplan- Meier (KM) was used for survival probability. Statistical significance was defined as p-value &amp;lt; 0.05. Outcome events were included from 1 day after the index event (CKD diagnosis) until 3650 days after. Results Of the total of 503,298 CKD patients, 7,891 had a co-existent diagnosis of CI-D made within 5 years (prevalence rate 1.56%). A PSM generated a matched cohort of 7,890 patients each. The mean age of the cohort was 60.7 ± 7.0 years, with a predominance of white ethnicity (53.7%) and an equal male-to-female ratio. Standardized difference (Std diff) was used to evaluate the balance of baseline characteristics in the PSM populations. Generally, Std diff &amp;lt; 0.1 is considered a small difference and all comorbidities fell below this threshold after PSM (Table 1). The comparison of the outcomes at follow-up between the matched cohorts is illustrated in Table 2. CKD patients with concomitant CI-D had higher all-cause mortality (18.4% vs 12.1%, p &amp;lt; 0.0001), a higher risk of cerebrovascular disease (10.8% vs 7.8%), malnutrition (6.7% vs 4.3%), mood disorders (13.7% vs 8.9%), anxiety (13.2% vs 10.9%), encephalopathy (9.6% vs 4.5%), epilepsy (4.3% vs 1.3%). All findings were statistically significant with a p &amp;lt; 0.0001. Proportional hazard models showed that CI-D was a strong risk factor associated with all-cause mortality (HR: 1.761; 95% CI (1.621-1.913, p &amp;lt; 0.0001)) and other cerebrovascular and mental health illnesses. Conclusion Our “real-world data” demonstrate that a concomitant CI-D diagnosis is a strong risk factor for negative health outcomes and mortality in patients with CKD stages 3-5. These results highlight the need for routine cognitive assessments in patients with advanced CKD to deliver personalised care.

#108 Mineral and bone disorders during chronic kidney disease

Abstract Background and Aims The objectives of our work were to describe mineral and bone disorders in patients with chronic kidney disease (CKD) not yet at the dialysis stage and to assess the compliance of phosphocalcic balance indicators with international KDIGO recommendations Method It was a retrospective study conducted over a 10-month period (01 November 2018 to 31 August 2019) in the nephrology and haemodialysis department of the Renaissance University Hospital in Ndjamena. We have included all patients followed up in the unit for non-dialysis CKD, aged over 18 years and consenting to participate to this study. Results A total of 387 patients files were collected, 82 of which have been taken on. The average age of the patients was 52.7 (± 15.8) years, with a male predominance (67.1%). The comorbidities were arterial hypertension (71.9%) and diabetes (24.4%). CKD has predominated in stage V (55%), followed by stage III (23%). Clinical signs were mainly diffuse bone pain (37.8%), pruritus (8.5%), muscle pain (7.3%) and insomnia (8.5%). Disorders in phosphocalcic metabolism have been noticed in stage IV (11.9% and 10.7%) and stage V (40.5% and 34.5%) for hypocalcaemia and hyperphosphataemia. Secondary hyperparathyroidism and 25 OH vitamin D deficiency were respectively 28.8% and 40.5% in stage V CKD. Compliance with international KDIGO recommendations was 59.7%, 53.7% and 37% respectively for serum calcium, serum phosphorus and parathyroid hormone. Radiological fractures were observed in 4.9% of patients. The management of these disorders has focused on calcium carbonate (52.4%), native vitamin D (64.6%) and Cinacalcet (6.1%) administration. Hypocalcaemia (p = 0.005) and hyperphosphataemia (p = 0.0001) were higher in stage V patients, with a significant difference. Conclusion The treatment of mineral and bone disorders has way to go for the majority of patients, due to lack of resources and the exorbitant cost of treatment. Prevention of mineral and bone disorders is a fundamental pillar of CKD treatment for our patients.

#2219 Glycemic control and adverse outcomes in patients with diabetes and CKD stage 4-5: a nationwide cohort study

Abstract Background and Aims Although poor glycemic control is strongly associated with adverse clinical outcomes, few studies have evaluated their risk across the full glycemic spectrum in patients with moderate to advanced chronic kidney disease (CKD). Guidelines for HbA1c targets are mainly derived from extrapolation of trials conducted in people with normal or mildly reduced kidney function. In non-dialysis CKD individualized targets are recommended, often aiming for less strict glycemic control, due to lack of evidence for the efficacy of lower HbA1c, and potentially greater harm. In this study, we analyzed long-term outcomes across the full spectrum of HbA1c in CKD stage 4-5. Method Using data from the Swedish Renal Registry, we included patients with diabetes and CKD stages 4-5. Adjusted cause-specific Cox models were used to analyze associations between the one-year baseline mean HbA1c level (&amp;lt;43, 43-52 [reference], 53-64, 65-74, 75-89, ≥90 mmol/mol) and the occurrence of major adverse cardiovascular events (MACE, a composite of cardiovascular death, hospitalization for myocardial infarction or stroke), kidney replacement therapy (KRT), all-cause mortality, and hospitalization/death due to hypoglycemia. Results We included 2571 patients (71 years, 64% men, eGFR 20 mL/min per 1.73m², HbA1c 59.7 mmol/mol [7.6%], 75% insulin users). At baseline, patients with a higher HbA1c level were younger, had a higher prevalence of cardiovascular disease and were more likely prescribed insulin. Kidney function and malnutrition-inflammation markers were, however, not different between groups. Over a median follow-up of 4.9 [4.6;5.2] years, 939 (37%) KRT, 1078 (42%) MACE, and 1523 (59%) deaths occurred. Increasing HbA1c was gradually associated with the risk of MACE (adjusted HR from 0.76 [95% CI: 0.60-0.96] for HbA1c &amp;lt;43 mmol/mol to 1.39 [1.01-1.92] for HbA1c ≥ 90 mmol/mol) (Fig.). In contrast, a J-shaped relationship was observed for the risk of all-cause mortality. Compared to the reference group (43-52 mmol/mol; 5-year absolute risk 52% [48-56]), a HbA1c &amp;lt;43 mmol/mol was not associated with a higher mortality (adjusted HR 1.03 [0.86-1.23], 5-year absolute risk 57% [51-63]), while any HbA1c above 75 mmol/mol was associated with a higher risk of death. The risks of KRT and severe hypoglycemia were not different across HbA1c levels. Conclusion In CKD stage 4-5, HbA1c above the general recommendation for non-CKD patients (43-52 mmol/mol) is associated with a higher risk of MACE and all-cause mortality, but not KRT, without increased risk of severe hypoglycemia. This suggests that targeting a lower HbA1c, together with other cardio-reno-metabolic prevention strategies, might contribute to improve health outcomes in this very high-risk population.

#2770 Evaluation of the effect of IV iron therapy on eGFR and Pro-BNP in patients with chronic kidney disease and heart failure with preserved EF

Abstract Background and Aims Iron replacement in treating heart failure (HF) is an issue whose importance has been better understood in recent years. Although controversies exist, randomized controlled studies have shown that IV iron treatment reduces mortality and improves symptomatology in heart failure with low EF (HFrEF). IV iron has not dramatically affected survival in heart failure with preserved EF (HFpEF). However, there is data that it might reduce symptoms and hospitalizations. For patients with chronic kidney disease (CKD) and HF, around 60% of them have HFpEF. Major heart failure and iron studies have often been performed on patients with low EF. Furthermore, in some of these studies, GFR values were not reported, and in the others, GFR was often &amp;gt; 60 ml/minute. We planned this study to evaluate the effects of IV iron therapy on eGFR and Pro-BNP levels in non-dialysis CKD patients with HFpEF. Method This study was conducted between January 2022 and December 2023. Patients with iron deficiency anemia, stage 2-5ND chronic kidney disease, and those with Pro-BNP values of 1000 and above were selected. Two independent cardiologists evaluated them, and the diagnosis of heart failure was confirmed. Patients were given one dose of 500 or 1000 mg of FCM. Control values were obtained at the 1-month follow-up. Hospitalized or transfused patients, cases with primary hematological disease, and cases with conditions affecting ferritin levels were excluded. Patients whose RAAS blockade, SGLT-2 inhibitor, and diuretic doses were changed, were excluded from the analysis. No patients received ESA or HIF stabilizers. Demographic and clinical data of the patients were recorded. The patients' creatinine, eGFR, hemoglobin, ferritin, and pro-BNP levels were evaluated before and after iron treatment Results Seventy-four patients were recruited. Forty-seven patients were women. The average age was 68 ± 11 years. Forty-eight of the patients had diabetes (64.9%) and 47 (63.5%) had coronary artery disease. The etiology of HFpEF was diastolic heart failure in 45 patients (60%). Other patients had valve disease, HFmEF, HFimpEF, isolated right-sided HF, and mixed types of HFpEF. After IV iron treatment, an increase of 3 ± 1 ml/min in GFR and 1.1 ± 0.1 g/dL in hemoglobin was detected. ProBNP levels decreased by 46%. All findings were statistically significant. The findings are summarized in Table 1. Conclusion The decrease in ProBNP levels was similar to the HFrEF literature. No positive or negative effects of iron on GFR were observed in the REVOKE and FIND-CKD studies, which compared oral and IV iron in CKD patients. The small but significant increase in GFR in our study could be attributed to the improvement of cardiac function. However, the small number of patients and the short follow-up period make it difficult to reach a definitive conclusion on this issue. We have shown that IV iron treatment significantly reduces Pro-BNP levels in CKD patients with HFpEF. IV iron has no adverse effects on renal function in the short term, and there is little signal of potential positive effects. Longer-term studies, preferably randomized with oral iron, with appropriate sample size, are needed to evaluate how IV iron affects end-points such as HF symptom score, hospitalization, eGFR slope, need for renal replacement, and mortality in this patient group. Strengths Well-selected patient group, a high Pro-BNP cut-off point, re-evaluation of each patient by the cardiologists Limitations Relatively small cohort, short follow-up period

#2755 NURTuRE-CKD: outcomes by primary renal diagnosis

Abstract Background and Aims Chronic kidney disease (CKD) represents a major global healthcare challenge, affecting approximately 850 million people worldwide [1], and is an independent risk factor for the progression to kidney replacement therapy (KRT) and all-cause mortality [2]. However, CKD encompasses various causes, each with unique pathophysiology and rates of progression [3]. Here we describe the outcomes from NURTuRE-CKD, an ongoing, multicenter prospective cohort study of 2996 non-dialysis CKD patients, by primary renal diagnosis, aiming to describe the differing rates of progression, ESKD and mortality by CKD cause and provide insights into those at greatest risk. Method Patients with an eGFR of 15–59 mL/min/1.73 m2 or eGFR ≥60 mL/min/1.73 m2 with a uACR &amp;gt;30 mg/mmol were enrolled, in addition to 86 controls. The full study design and methods of NURTuRE-CKD have previously been reported [4]. Outcomes: ESKD, eGFR &amp;lt;15 mL/min/1.73 m2, Transplantation, initiation of KRT, all-cause mortality and serial eGFR data were sourced from the UK Renal Registry. ESKD was defined as initiation of KRT or eGFR &amp;lt;15 mL/min/1.73 m2. Rate of progression was determined via eGFR slope. ERA diagnostic categories were used for primary renal diagnoses, with ‘glomerular diseases’ split into glomerulonephritis (GN) and vasculitis. The Chi-squared test was used to compare categorical variables, and the Kruskal-Wallis test for continuous variables. A multivariable Cox proportional hazards regression analysis predicting the time to ESKD by primary diagnosis was undertaken, using vasculitis as the reference category. Model 2 included adjustments for baseline eGFR. Results Table 1 depicts both the baseline characteristics and outcomes by the 8 diagnosis categories. Average follow-up duration was 53.8 months, not significantly different between the groups, but all other baseline variables differed significantly. The hypertensive/renovascular group were oldest and familial group youngest at 71 and 53 years, respectively. At baseline the diabetic nephropathy (DN) group had the lowest eGFR 28 ml/min/1.73 m2 and highest uACR 88.3 mg/mmol. However, the familial group had the steepest pre-enrolment eGFR decline slope. Delta eGFR during the follow-up period was steepest in the familial group and DN groups at −3.4 and −3.0 ml/min/1.73 m2, respectively, whereas the vasculitis group had slowest progression −0.7 ml/min/1.73 m2. Overall rate of ESKD was 24.7%; lower in the vasculitis (14%), systemic disease (17.7%) and tubulointerstitial (18.8%) groups, and higher in the DN (36.7%) and familial (31.6%) groups. All-cause mortality was greatest in the DN group at 40.4%. Despite being the fastest progressors defined by eGFR slope, the familial group had the lowest mortality rate (5.2%), but they were of younger age and had a high rate of kidney transplantation (10.1%). Unadjusted HRs for ESKD, were significantly higher for all diagnoses except tubulointerstitial and systemic diseases compared to the vasculitis group; DN evidenced the highest hazard ratio at 3.15 (2.18-4.55). When adjusted for baseline eGFR, HRs for the glomerulonephritis 2.04 (1.89-4.03), diabetes 1.5 (1.04-2.16) and familial 2.76 (1.89-4.03) remained significantly higher. Conclusion Rates of progression and incidence of clinically meaningful outcomes differ between CKD causes in NURTuRE. Those with DN and familial conditions had faster eGFR decline and had higher rates of ESKD, with associations persisting despite controlling for baseline eGFR. Recognising that CKD progresses at different rates is crucial, not only for providing personalised care, but also key to understanding differing pathophysiologic mechanisms of progression. NURTuRE-CKD will also explore novel biomarkers, with the aim of illuminating mechanisms of progression, improving risk prediction and highlighting novel drug targets.

#2264 Efficacy and safety of oral iron supplementation with liposomal iron in non-dialysis chronic kidney disease patients with iron deficiency

Abstract Background and Aims Iron deficiency (ID) is very common in patients with non-dialysis dependent chronic kidney disease (NDD-CKD). In these patients, oral iron supplementation is recommended as first-line treatment for ID. However, the efficacy of oral iron supplementation is frequently impaired by a higher incidence of adverse gastrointestinal side effects. Liposomal iron is a compound with ferric pyrophosphate enclosed in a phospholipid nucleus, providing high gastrointestinal absorption and bioavailability and a lower incidence of side effects. However, few data are available on its efficacy in patients with NDD-CKD. Method This single-arm pilot study was carried out in in patients with NDD-CKD stages 1-5 and ID, defined as serum ferritin (SF)&amp;lt;100 ng/mL and/or transferrin saturation (TSAT)&amp;lt; 20%, consecutively seen in two Nephrology units (Naples and Bari) from 01/12/2022 to 01/04/2023. We assessed the efficacy of six months of liposomal iron therapy in correcting ID across three visits after baseline (month 1, 3 and 6). All patients received liposomal iron (30 mg/day twice daily for the first month followed by 30 mg daily for the remaining five months). The primary endpoints were the achievement of SF ≥100 ng/mL and TSAT ≥20%. Secondary outcomes were hemoglobin (Hb) changes and safety of liposomal iron; adherence to the iron supplementation was assessed by monthly pill counting. Changes of continuous variables during the study were analyzed by linear mixed models assuming an unstructured covariance matrix; this was done to take into account the correlation between repeated measures and missing points for patients not completing the study. Change of prevalence of corrected SF and TSAT values from baseline to month 1, 3 and 6 was analyzed by McNemar test. Results 38 patients (65.3 ± 15.2 years, 52.6% males, 35.1% diabetes, eGFR 38.5 ± 28.8 mL/min/1.73 m2) received at least one dose of liposomal iron (safety population). Efficacy population included 34 patients with at least one control visit after baseline. Clinical characteristics of patients enrolled in the two clinics did not differ. In efficacy population, baseline SF was 44 (IQR 19-82) ng/mL and TSAT 14.3 ± 5.9%, corresponding to a percentage of SF&amp;lt;100 ng/mL of 78.9%, and TSAT&amp;lt;20% in 89.5%; 64.7% had both parameters below the cut-offs. Anemia (defined as Hb&amp;lt;12 g/dL in women and &amp;lt;13 g/dL in men) was detected in 22/34 patients. Liposomal iron induced a progressive increase of TSAT from 14.3 ± 5.9%, at baseline to 20.0 ± 7.6% at month-6 (P = 0.009) whereas no difference was detected for SF (Fig. 1A and 1C). Accordingly, at the end of study, the prevalence of TSAT&amp;gt;20% significantly increased from 11.8% to 50.0% (P = 0.002) while correction of SF, mildly improved (from 23.5% to 30.0%, P = 0.214, Fig. 1B and 1D). When patients were stratified by anemia, a significant improvement of TSAT was observed in anemic patients (from 13.3 ± 5.8% to 20.2 ± 8.1%, P = 0.012), whereas no significant improvement was found in patients without anemia (P = 0.093). Adherence to iron supplementation was 100% in patients completing the study. Hb values did not significantly increase at month-6 in either anemic (+0.60 ± 1.39 g/dL, P = 0.258) or non-anemic (+0.08 ± 0.78 g/dL, P = 1.0) patients. In safety population (n = 38), 7 patients dropped out (18.4%). In particular, treatment was discontinued in 4 patients in the first month (2 for diarrhea, 1 for dyspepsia and constipation, and 1 for death), 1 patient after 3 months (switch to intravenous iron for symptomatic anemia), and 2 after five months (1 for dyspepsia and 1 for death). Conclusion The use of liposomal iron in patients with NDD-CKD is associated with a partial correction of functional ID (TSAT&amp;lt;20%), with no significant effect on iron storage. The small sample size prevents any causative conclusion, though it may provide some insights into using these compounds in patients with CKD.

#1514 Elevated FGF23 increases systolic, and diastolic blood pressure, and pulse pressure in non-dialysis CKD patients

Abstract Background and Aims Arterial stiffness is associated with high blood pressure. Elevated fibroblast growth factor 23 (FGF23) has been shown to produce changes in the phenotype of vascular smooth muscle cells that may cause an increase in arterial stiffness and an impairment of vascular function. Thus, we aimed to evaluate whether, in g5 non-dialysis CKD patients, higher concentration FGF23 is associated with elevated systolic (SBP), diastolic blood pressure (DBP), and pulse pressure (PP). Method We included 159 g5 non-dialysis CKD patients. Generalized additive models analyzed the association between intact FGF23, SBP, DBP, and PP. The body composition measurement was used to evaluate overhydration (OH). Given the potential non-linear relationship between iFGF23, with the other variables, iFGF23 was categorized into tertiles (T1 ≤ 389 pg/ml, T2 = 389—517 pg/ml, and T3 = &amp;gt;517 pg/ml). Results The mean age was 65.2 ± 14.7 years. 46% (n = 73) were female. The mean values of SBP and DBP were 158.8 ± 21.3 mmHg, and 87.2 ± 12.3 mmHg respectively, and the PP was 76.6 ± 20 mmHg. The median concentration of iFGF23 was 468.3 (268.8—904.9) pg/ml. It was observed a positive correlation between iFGF23 tertiles and SBP (p &amp;lt; 0.001), DBP (&amp;lt;0.01), PP (p = 0.02), and OH (p &amp;lt; 0.01) (Fig. 1). Multivariate generalized additive models showed an independent association of iFGF23 with SBP (Beta 5.16, CI 34-68), DBP (Beta 38.7, CI 24-53), and PP (Beta 36.3, CI 22.2-50.4). This association was not influenced by OH (%). Residual diuresis did not attenuate the association of iFGF23 with SBP, DBP, and PP. Conclusion Elevated FGF23 was associated with higher SBP, DBP, and PP in g5 non-dialysis CKD patients. This association was not modified by OH and residual diuresis.

#1186 Novel T-cell subsets as early non-invasive biomarkers of vascular damage in chronic kidney disease progression

Abstract Background and Aims The exploration of early biomarkers for diagnosing vascular alterations in CKD-MBD holds significant clinical potential. Previous evidence has demonstrated profound alterations in immune cell populations linked to vascular homeostasis in CKD dialysis patients. This study aimed to evaluate the utility of immune cell populations as early and progressive biomarkers for non-dialysis CKD patients, examining their correlation with vascular damage. Method A total of 43 non-dialysis CKD patients and 38 sex- and age-matched controls were included in the study. Patients were categorized into four groups based on their estimated glomerular filtration rate (eGFR): CKD-2/3a, CKD-3b, CKD-4, and CKD-5. The assessment of left carotid adventitial neovascularization and intima-media thickness (cIMT) was conducted using ultrasensitive ultrasonography without contrast, specifically employing Superb Microvascular Image (SMI) technology. Pulse wave velocity (PWV) was measured to determine aortic stiffness, utilizing the Complior Analyzer. Immunosescencent T-cells (CD4+CD28null), angiogenic T-cells (Tang) (CD3+CD31+CD184+) and their subsets (CD4+Tang, CD8+Tang and CD28nullTang) were quantified by flow cytometry in Peripheral Blood Mononuclear Cells. Results No significant differences in age and body mass index were observed between the control group and the four CKD stages. Notably, the values of estimated glomerular filtration rate (eGFR) exhibited a significant and progressive decrease, as indicated in the Table 1. Biochemical parameters related to CKD-MBD are also detailed in the same table. The carotid intima-media thickness (cIMT) was found to be significantly higher in CKD-5 compared to CKD 2-3a (CKD 2-3a = 0.66 ± 0.14 mm, CKD-5 = 0.80 ± 0.12 mm, p = 0.03). In patients at stage 4 of CKD, there was an increased number of adventitial vasa vasorum (control = 0.53 ± 1.33, CKD-4 = 1.67 ± 2.04, p = 0.0009) and a greater area of adventitial neovascularization in the carotid artery compared to the control group (control = 0.51 ± 1.31%, CKD-4 = 2.67 ± 2.27%, p = 0.0003). PWV was significantly higher in CKD-5 (control = 10.81 ± 2.01 m/s, CKD-5 = 12.91 ± 3.70 m/s, p = 0.045). Additionally, a significant correlation was observed between PWV and both the number of adventitial vasa vasorum at the carotid artery (r = 0.24, p = 0.028) and the area of adventitial neovascularization (r = 0.34, p = 0.002). CD4+CD28null T-cells were increased in CKD patients compared to control group (control = 24.99[5.52], CKD = 27.35[8.58], p = 0.004). Although no differences were found in total levels of Tang in CKD patients (control = 1.64 ± 0.89, CKD= 1.5 ± 1.02, p = 0.757), a strong negative correlation was observed across CKD stages (trend analysis for stages: r = −0.361, p = 0.017). Moreover, CKD patients had altered CD8+ and CD4+ Tang frequencies (CD4+Tang: control = 39.52[18.46], CKD = 33.60[12.84], p = 0.054; CD8+Tang: control = 40.03[14.38], CKD = 48.25[13.16], p = 0.012) and Tang CD28null were increased in CKD patients (control = 44.14[11.99], CKD = 48.62[12.08], p = 0.004). Finally, Tang frequency was significantly correlated with the number of adventitial vasa vasorum (r = 0.368, p = 0.032), area of adventitial neovascularization (r = −0.401, p = 0.019), PWV (r = −0.341, p = 0.048) and cIMT (r = −0.364, p = 0.034). Conclusion Carotid adventitial neovascularization, cIMT and PWV demonstrated an increase in advanced CKD stages, implying that they may possess limited clinical utility as early markers of vascular damage in the initial stages of CKD. Immunosenescence and vascular damage traits were found across the CKD spectrum. Altered Tang frequency may be considered a progressive biomarker of impaired vascular homeostasis in CKD.