non-CKD Group Research Articles

Initial Concentrations of miR-1 MicroRNA Precursor and High-Sensitivity Troponin in the Diagnosis of Non-ST Myocardial Infarction among Patients with and Those without Chronic Kidney Disease

Background: The early diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI) in patients with chronic kidney disease (CKD) remains a challenge. Methods: The study consecutively enrolled patients who had suffered from chest pain within 3 h whose electrocardiogram had no elevation in the ST segment. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m², and the diagnostic criteria for NSTEMI were defined according to the recommended guideline. Circulating microRNA-1 was collected and determined by quantitative real-time reverse transcription polymerase chain reaction. Results: A total of 456 patients with suspected NSTEMI were included. There were 115 patients in the CKD group, including 67 with NSTEMI, 20 with stable angina, 7 with unstable angina, 18 with heart failure, and 3 with other disorders. Compared with the NSTEMI group, the non-NSTEMI group just had significant differences in microRNA-1 and high-sensitivity cardiac troponin I (hs-cTnI) (both p < 0.05). The relative expression of microRNA-1 was significantly increased in the NSTEMI group as compared with that in the other disease groups (all p < 0.05). A receiver operating characteristic (ROC) curve analysis suggested that microRNA-1 and hs-cTnI had advantages in the early diagnosis of NSTEMI with CKD (AUC [area under the ROC curve] 0.879 and 0.812, respectively, both p < 0.05). Compared with that in the non-CKD group, the accuracy of microRNA-1 was almost as good in the CKD group (84.3 vs. 89.4%, p > 0.05). However, the diagnostic accuracy of hs-cTnI was significantly decreased (79.1 vs. 91.5%, p < 0.05), as was its specificity (75.0 vs. 95.5%, p < 0.05). There was no significant difference in the correlation between microRNA-1 and eGFR (p > 0.05), but a statistically significantly negative correlation between hs-cTnI and eGFR (p < 0.05). Conclusion: Circulating microRNA-1 is capable of early diagnosis of NSTEMI in patients with CKD suffering from chest pain.

Lung cancer outcome in the setting of chronic kidney disease: Does the glomerular filtration estimation formula matter?

BackgroundThe survival outcomes of lung cancer patients with coexisting chronic kidney disease (CKD) reported in the literature have been conflicting. We evaluate whether the survival of lung cancer patients with and without CKD differ significantly using two different formulas.MethodsA retrospective, multicenter, propensity‐matched study of lung cancer patients with and without CKD was conducted. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/minute. Kaplan–Meier survival analysis was used to determine survival differences between CKD and non‐CKD patients using the Cockcroft–Gault formula (CKD–CG) compared to the Chronic Kidney Disease Epidemiology Collaboration Formula (CKD‐EPI).ResultsBaseline clinical characteristics did not differ statistically significantly between the groups. The CKD‐CG formula demonstrated median survival of 10.61 months (95% confidence interval [CI] 9.33–11.89) for the non‐CKD group compared to 10.58 months (95% CI 9.03–12.13) for the CKD group (P = 0.76). The CKD‐EPI formula demonstrated median survival of 9.10 months (95% CI 8.01–10.20) for the non‐CKD group compared to 7.59 months (95% CI 6.50–8.68) for the CKD group (P = 0.19). Cox regression analysis using both models revealed that CKD is not an independent risk factor for mortality in lung cancer patients. Although the CKD‐EPI formula revealed an increased risk of mortality and the CKD‐CG formula revealed decreased survival, these results were not statistically significant.ConclusionLung cancer survival did not differ significantly between CKD and non‐CKD patients using either formula.

Food Consumption in Chronic Kidney Disease: Association With Sociodemographic and Geographical Variables and Comparison With Healthy Individuals

To describe the food consumption of individuals with chronic kidney disease (CKD) per sociodemographic and geographical characteristics and CKD treatment. In addition, we compared the food consumption of individuals with and without CKD. Cross-sectional study using data from the National Health Survey (Brazil 2013) that included 60,202 individuals. Food consumption was evaluated with the following food intake markers: (1) regular consumption of fruit, vegetables, beans, milk, sugar-sweetened beverages (SSBs), sweets, red meat, and chicken; (2) weekly intake of fish; and (3) consumption of meat or chicken with excess fat, excess salt, and alcoholic beverage. The prevalence of these indicators was described per sociodemographic (gender, age, educational level, and race/skin color) and geographical (location of residence and geographical regions) variables in CKD and non-CKD individuals. Unadjusted and multiple logistic regression models, adjusted by sociodemographic and geographical variables, were applied. 60,202 individuals were divided into 5 groups: (1) non-CKD (n 5 59,363), (2) non-dialysis-dependent (n 5 480), (3) dialysis (n 5 48), (4) renal transplanted (n 5 17), and (5) untreated CKD (n 5 294). Age, education level, and geographic region were associated with food markers. Comparisons among those with CKD by treatment group showed that the dialysis group had a lower regular consumption of beans, alcoholic beverages, and salt in excess. Upon further comparisons with the non-CKD group, the CKD group (especially that in dialysis) showed a significantly lower regular consumption of beans, red meat, SSBs, salt in excess, and alcoholic beverages. Except for SSBs, this difference was maintained after adjustment. Food consumption of the CKD individuals is influenced by sociodemographic and geographical characteristics. Food groups of which patients are normally advised to limit their dietary intake were those with the greatest difference between individuals with and without CKD and among the CKD treatments.

Chronic kidney disease following twin-to-twin transfusion syndrome-long-term outcomes.

Amongst other sequelae, acute kidney injury (AKI) is a well-recognised post-natal complication of twin-to-twin transfusion syndrome (TTTS). Despite this, there has been a lack of data reporting long-term renal outcomes. Our aim was to report the long-term renal outcomes of infants born with TTTS. We performed a retrospective case note review of all infants referred to our centre between 1998 and 2018 with a primary diagnosis of TTTS. Subjects with confirmed TTTS were divided into a chronic kidney disease (CKD) group and a non-CKD group for comparison. Twenty-six infants with TTTS were included for analysis. Eight (31%) subjects developed CKD. Within the CKD group, 50% went on to require long-term renal replacement therapy (RRT) of whom all underwent renal transplantation. For subjects who had neonatal AKI, cumulative survival rate before RRT at 5 and 10years was 79% and 70%, respectively. Subjects with CKD had a significantly higher incidence of AKI in the neonatal period and were more likely to be the donor twin. Gestational age at birth, gender, antenatal interventions and comorbidities did not affect long-term renal outcome between the two groups. This is the first long-term follow-up study demonstrating that CKD progressing to the need for RRT can develop after TTTS. Donor-twin status and neonatal AKI associated with adverse long-term outcomes warranting long-term surveillance in this group.

Comparison of atrial fibrillation in CKD and non-CKD populations: A cross-sectional analysis from the Kailuan study

ObjectivesTo compare clinical epidemiological features of atrial fibrillation (AF) in chronic kidney disease (CKD) and non-CKD populations. MethodsThis study included 88,312 adults aged ≥45 years old from the KAILUAN study. AF was ascertained with a 12-lead electrocardiogram. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 and/or proteinuria. Participants were categorized into non-CKD (eGFR > 60 mL/min/1.73 m2 without proteinuria, n = 66,725) and CKD (n = 21,578) groups. We evaluated the prevalence of AF in both groups, evaluated risk factors for AF using multivariable-adjusted logistic regression analysis. ResultsThe prevalence of AF among non-CKD and CKD participants was 0.26% and 1.00%, respectively. Multivariable-adjusted analysis showed that older age (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 1.07–1.10, P < 0.001), smoking (OR: 1.23, 95% CI: 1.07–1.57, P = 0.017), hypertension (OR: 2.14, 95% CI: 1.44–3.17, P < 0.001), diabetes (OR: 1.79, 95% CI: 1.10–2.89, P < 0.001), and larger waist circumference (OR: 1.03, 95% CI: 1.01–1.04, P < 0.001) were significantly associated with AF in the non-CKD group. In the CKD group, older age, smoking, larger waist circumference, reduced eGFR (OR: 0.97, 95% CI: 0.95–0.99, P < 0.001), proteinuria (OR: 2.01, 95% CI: 1.09–3.74, P < 0.001) and raised serum C-reactive protein (1.01, 1.00–1.03, P < 0.001) were significantly associated with AF. ConclusionsThe prevalence of AF in Chinese adults with CKD is higher than that among those without CKD. Risk factors for AF in non-CKD population were not the same compared with those in CKD population, kidney function and inflammatory markers were associated with the prevalence of AF.

SERUM BICARBONATE: A NEW PREDICTOR FOR MORTALITY IN SEPSIS

SESSION TITLE: Critical Care Sepsis SESSION TYPE: Original Investigations PRESENTED ON: 10/07/2018 07:30 AM - 08:30 AM PURPOSE: Sepsis is the leading cause of death worldwide with a mortality rate of 30%. Despite being an important pathophysiological component, information on serum bicarbonate level and its predictive value in sepsis is limited. We hypothesize that lower serum bicarbonate level at presentation is a predictor of poor outcomes in patients admitted with a diagnosis of sepsis. METHODS: This is a single centered retrospective research study on patients admitted to MICU with a diagnosis of sepsis, severe sepsis and septic shock from 01/2013 till 12/2017. ICD 9 and ICD 10 codes were used to identify the patients. Patients were divided into 2 broad groups – non-CKD and CKD, in order to eliminate the bias caused by kidney disease. Each group was divided into 3 subgroups based on serum bicarbonate level at presentation - <22 meq/l, 22-28 meq/l and >28 meq/l. We compared the clinical outcomes between these sub-groups with primary endpoint being in-hospital mortality. Secondary endpoints were vasopressor requirements, days on mechanical ventilation, total ICU and hospital days. 2962 patients met the inclusion criteria of which 617 patients had CKD. RESULTS: In both CKD and non-CKD group, lower serum bicarbonate level (<22 meq/l) was associated with increased SOFA score (10.9; p<.0001/10.7; p<.0001), increased heart rate (98 bpm; p=0.0004/106 bpm; p<.0001), lower MAP (73; p=0.0164/74;p <.0001), lower body temperature (97.9 F; p=0.001/98.1 F; p<.0001) and elevated serum lactate level (3 mmol/l; p<.0001 /3.9 mmol/l; p<.0001). Patients (both CKD and non-CKD) with lower serum bicarbonate required more frequent use of vasopressor support (82.9%; p=0.0009/80.8%; p<.0001) and required it for longer duration (4.7 days; p=0.0046/3.9 days; p<.0001) compared to patients in higher serum bicarbonate sub-group (22-28 meq/l>28 meq/l).In the non-CKD group, patients with lower bicarbonate levels had a shorter MICU (9.4 days; p<.0001), overall hospital stay (18.4 days; p=0.0002) and average days on mechanical ventilation (8.8 days; p<.0001) while in the CKD group, this difference was not statistically significant. In the non-CKD group, serum bicarbonate level at presentation was a significant predictor of short term mortality (39.1%; p=0.0006) whereas in the CKD group (38.4%; p=0.6705), this difference was not statistically significant. CONCLUSIONS: Low serum bicarbonate level (<22 meq/l) at presentation can be used to predict increased short-term mortality in patients with no history of underlying CKD and possibly CKD. Low serum bicarbonate was associated with higher vasopressor requirement and increase in duration when compared to other subgroups independent of history of CKD. CLINICAL IMPLICATIONS: Low serum bicarbonate is commonly seen in patients with more severe sepsis and can be a strong predictor of poor clinical outcomes including mortality. DISCLOSURES: No relevant relationships by Evan Cassity, source=Web Response No relevant relationships by Said Chaaban, source=Web Response No relevant relationships by Prerna Dogra, source=Web Response No relevant relationships by Kamel Gharaibeh, source=Web Response No relevant relationships by Andrew Kelly, source=Web Response No relevant relationships by Peter Morris, source=Web Response No relevant relationships by Robin Paudel, source=Web Response No relevant relationships by Taj Rahman, source=Web Response

A18581 The association of metabolic syndrome and chronic kidney disease in patients with hypertension in China—a cross sectional study

Objectives: In a cross-sectional study, we investigated the metabolic syndrome in patients with hypertension and the association of chronic kidney disease (CKD) with metabolic syndrome. Methods: Totally 4286 patients with hypertension were enrolled from the out-patient clinic of 15 cities in China during 2017–2018. Results: The prevalence of CKD (estimated glomerular filtration rate < 60) was 12.74% in this population. There was no difference in the systolic blood pressure (SBP) between CKD and non-CKD (141.03 ± 20.53 vs 141.44 ± 17.34 mmHg, p = 0.621). Diastolic blood pressure (DBP) was higher in CKD patients (85.13 ± 15.15 vs 83.51 ± 12.05 mmHg, p = 0.005). BMI was higher in CKD patients (25.61 ± 5.97 vs 24.78 ± 3.66, p < 0.001). More patients were under lipid lowering medication in CKD group compared to non-CKD group (66.06% vs 49.51%, p < 0.001), but LDL-C level was much higher in CKD group (3.03 ± 1.69 vs 2.80 ± 1.00 mmol/L, p = 0.001). The prevalence of Diabetes Mellitus (DM) was higher in CKD group (28.33% vs 21.42%, p < 0.001) and HbA1C% was also higher in CKD with DM compared to non-CKD with DM (8.06 ± 2.11vs 7.58 ± 2.09, p = 0.055). After adjusting for age and gender, LDL-C (OR = 1.21, 95%CI 1.09–1.33, p < 0.001), DM (OR = 1.36, 95%CI 1.11–1.68, p = 0.004) and BMI (OR = 1.05, 95%CI 1.03–1.07, p < 0.001) remained strongly associated with the prevalence of CKD. Conclusion: In China, metabolic syndrome was not well managed in patients with hypertension especially in those with CKD. Metabolic syndrome was strongly associated with CKD even if the average BP was similar.

Chronic kidney disease correlates with increased risk of pulmonary tuberculosis before initiating renal replacement therapy: A cohort study in Taiwan.

This study aimed to assess the association between chronic kidney disease (CKD) and the risk of pulmonary tuberculosis (TB) before initiating renal replacement therapy (RRT) in Taiwan.Total 16,052 subjects newly diagnosed with CKD between 2000 and 2012 were included in the CKD group, and 31,949 randomly selected subjects who did not have CKD formed the non-CKD group. Subjects with a history of pulmonary TB or RRT, including dialysis and renal transplantation, before the index date were excluded. We determined the incidence of pulmonary TB at the end of 2013. A multivariable Cox proportional hazards regression model was used to assess the hazard ratio (HR) and 95% confidence interval (CI) for the risk of developing pulmonary TB associated with CKD.The overall incidence of pulmonary TB was 1.47-fold greater in the CKD group compared to that in the non-CKD group (4.94 vs 3.35 per 1000 person-years, 95% CI 1.39, 1.56). Multivariable Cox proportional hazards regression analysis showed that the adjusted HR of pulmonary TB was 1.45-fold higher in the CKD group (95% CI 1.27, 1.64) than in the non-CKD group. Male sex (adjusted HR 2.04), age (increase per one year, adjusted HR 1.05), chronic obstructive pulmonary disease (adjusted HR 1.54), and diabetes mellitus (adjusted HR 1.34) were also associated with pulmonary TB.CKD is associated with an increased risk of developing pulmonary TB before the initiation of RRT.

Robotic Partial Nephrectomy in Patients with Chronic Kidney Disease: Objective Measurement of Short- and Long-Term Renal Functional Outcomes.

Minimal literature informs the use of robotic partial nephrectomy (RPN) in patients with chronic kidney disease (CKD). Therefore, we evaluated the renal functional outcomes in CKD patients undergoing RPN. We reviewed a prospective database of patients undergoing RPN 2010 to 2015 and identified 182 patients who had preoperative and postoperative nuclear renal scintigraphy (at 2 and 12 months postop). Preoperative and 12-month postoperative eGFR (mL/min/1.73 m2, by MDRD) were calculated. CKD was defined as eGFR ≤60 mL/min/1.73 m2 (CKD stages III and IV). Changes in creatinine, eGFR, and split function on mercaptoacetyltriglycine (MAG)-3 scan were compared by baseline CKD status. Correlations between pre- and postoperative eGFR were calculated. Of 182 patients, 30 (16.5%) had baseline CKD. Preoperative eGFR was 48.5 and 99.0 in CKD and non-CKD patients, respectively (p < 0.001). From preoperation to 12 months postoperation, eGFR decreased by 2.8 and 1.1 mL/min/1.73 m2, respectively (p = 0.6). On MAG-3 scan, the contribution of the surgical kidney to overall renal function decreased by 5.0% and 4.8% (p = 0.9) in the CKD and non-CKD cohorts, respectively. When comparing renal scans at 2 and 12 months postoperation, in both groups the surgical kidney significantly recovered (both p < 0.001) and the patterns of kidney function recovery was similar in both groups (CKD +2.0%, non-CKD +1.4%, p = 0.6). On long-term follow-up (>2 years), eGFR did not change significantly in either the CKD or non-CKD group (-2.8 vs -1.1 mL/min/1.73 m2, p = 0.6). On pathology, tumors were more frequently malignant in CKD vs non-CKD patients (93.3% vs 73.2%, p = 0.02) and of higher Fuhrman Grade (grade ≥3: 49.7% vs 28.1%, p < 0.001). RPN is a reasonable treatment option in patients with CKD, as it did not lead to a greater decline in renal function contributed by the surgical kidney. The patterns of kidney function recovery after surgery are similar between patients with and without CKD.

Impact of statin-ezetimibe combination on coronary atheroma plaque in patients with and without chronic kidney disease — Sub-analysis of PRECISE-IVUS trial

BackgroundChronic kidney disease (CKD) deteriorates the prognosis of patients undergoing percutaneous coronary intervention (PCI). Because coronary artery disease (CAD) is the major cause of death in CKD patients, cardiovascular risk reduction has been clinically important in CKD. We hypothesized intensive lipid-lowering with statin/ezetimibe attenuated coronary atherosclerotic development even in patients with CKD. MethodsIn the prospective, randomized, controlled, multicenter PRECISE-IVUS trial, 246 patients undergoing intravascular ultrasound (IVUS)-guided PCI were randomly assigned to receive atorvastatin/ezetimibe combination or atorvastatin alone (the dosage of atorvastatin was up-titrated to achieve the level of low-density lipoprotein cholesterol < 70 mg/dL). Serial volumetric IVUS findings obtained at baseline and 9–12 month follow-up to quantify the coronary plaque response in 202 patients were compared stratified by the presence or absence of CKD. ResultsCKD was observed in 52 patients (26%) among 202 enrolled patients. Compared with the non-CKD group, the CKD group was significantly older (71.5 ± 8.6 years vs. 64.4 ± 9.6 years, P < 0.001) with similar prevalence of comorbid coronary risk factors and lipid profiles. Similar to the non-CKD group (−1.4 [−2.8 to −0.1]% vs. −0.2 [−1.7 to 1.0]%, P = 0.002), the atorvastatin/ezetimibe combination significantly reduced ∆PAV compared with atorvastatin alone even in the CKD group (−2.6 [−5.6 to −0.4]% vs. −0.9 [−2.4 to 0.2]%, P = 0.04). ConclusionsAs with non-CKD, intensive lipid-lowering therapy with atorvastatin/ezetimibe demonstrated stronger coronary plaque regression effect even in patients with CKD compared with atorvastatin monotherapy.Trial registration: NCT01043380 (ClinicalTrials.gov).

Outcomes of endoscopic submucosal dissection for gastric epithelial neoplasm in chronic kidney disease patients: propensity score-matched case–control analysis

Little is known about the outcomes of gastric endoscopic submucosal dissection (ESD) in patients with chronic kidney disease (CKD). We compared the efficacy and safety of ESD between CKD and non-CKD patients. From January 2005 to December 2014, 102 CKD patients underwent ESD for gastric neoplasms at a tertiary medical institution were reviewed retrospectively. A propensity score-matched control group (102 patients) was selected from non-CKD patients to compare clinical outcomes between CKD and non-CKD patients. En bloc resection (96.1%) and curative resection (88.2%) rates in the CKD group did not significantly differ from those in the non-CKD group. Median procedure times (25.0 vs. 21.5min, p = 0.734) and perforation risk (p = 0.480) were similar between groups. The CKD group showed a tendency towards more bleeding events (p = 0.052) and had a significantly longer hospital stay (p = 0.001). In a subgroup analysis, stage 3 CKD patients exhibited a bleeding risk comparable to that exhibited by non-CKD patients (HR 1.35; 95% CI 0.36-5.06; p = 0.654), whereas stage 4 (HR 5.79; 95% CI 1.52-22.0; p = 0.010) and stage 5 (HR 4.80; 95% CI 1.58-14.6; p = 0.006) patients showed higher bleeding risks than non-CKD patients. In a multivariate analysis, stage 4/5 CKD was a significant predictor for bleeding risk (HR 4.99; 95% CI 1.32-18.8; p = 0.018). ESD for gastric epithelial neoplasms can be performed in stage 3 CKD patients with comparable efficacy and safety to that performed in non-CKD patients. Stage 4 and 5 CKD patients should be closely monitored for bleeding events after ESD.

Effects of chronic kidney disease on clinical outcomes in patients with peripheral artery disease undergoing endovascular treatment: Analysis from the K-VIS ELLA registry

ObjectivesChronic kidney disease (CKD) is a risk factor for peripheral artery disease (PAD), but the impact of CKD in PAD patients who received endovascular treatment (EVT) is not well studied. Aim of this study is to clarify the impact of CKD in patients with PAD in real EVT era. MethodsUsing the Korean Vascular Intervention Society (K-VIS) endovascular therapy in lower limb artery disease registry (ELLA) registry, we analyzed 3434 patients who underwent EVT. Baseline characteristics, in-hospital events, and overall- and major adverse limb events (MALE)-free survival were analyzed. Results2739 patients (3548 target limbs) were included. 272 patients featured CKD (9.9%). Limbs in CKD patients had higher Rutherford scores, higher prevalence of critical limb ischemia (CLI). There were no differences in technical success rates in non-CKD vs. CKD group comparison and non-severe CKD vs. severe CKD group comparison (p = 0.050, 0.581, respectively). In-hospital death (p < 0.001) and short-term unexpected amputation (p = 0.028) were more frequent in the CKD group. The short-term outcome differences between severe and non-severe CKD were insignificant. Kaplan–Meier curves favored overall and MALE-free survival in non-CKD patients compared with CKD patients, but there was no difference in overall- or MALE-free survival between non-severe CKD and severe CKD groups. ConclusionPAD patients with CKD showed worse short-term mortality, short-term unexpected amputation outcome, and overall- and MALE-free survival than those without CKD in real EVT era. These findings might provide additive prognostic information for PAD patients with CKD who will be treated with EVT.

Impact of Chronic Kidney Disease on Outcomes After Percutaneous Coronary Intervention for Chronic Total Occlusions (from the Japanese Multicenter Registry)

The impact of chronic kidney disease (CKD) and potential pharmacologic intervention on clinical outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) remains unknown. A total of 1,463 patients underwent successful CTO-PCI between August 2004 and December 2014. Major adverse cardiovascular events (MACE) defined as the composite of all-cause death, myocardial infarction and target lesion revascularization, cardiac death, and stent thrombosis were compared between patients with and without CKD (555 and 908 patients, respectively). The results demonstrated higher risks of MACE (log-rank p = 0.015), all-cause death (log-rank p <0.001), and cardiac death (log-rank p <0.001) in the CKD group compared with the non-CKD group. Multivariable analyses demonstrated that CKD was an independent predictor for MACE (hazard ratio 1.23, 95% confidence interval 1.02 to 1.47, p = 0.03). With regard to pharmacotherapy, statin use was associated with significantly lower rates of MACE in the CKD group (log-rank p = 0.003). In conclusion, the presence of CKD would be an important predictor of long-term clinical outcomes in patients who underwent CTO-PCI, and use of statin may influence in reducing the adverse clinical outcomes.

Preoperative chronic kidney disease to predict oncological outcomes after radical cystectomy in patients with muscle-invasive bladder cancer.

427 Background: Chronic kidney disease (CKD) is common in elderly patients with bladder cancer. In addition, increasing evidence has suggested that preoperative renal insufficiency indicates poor prognosis in bladder cancer. We aimed to evaluate the impact of CKD on oncologic outcomes in muscle-invasive bladder cancer patients who underwent radical cystectomy. Methods: A total of 581 patients who underwent radical cystectomy at four medical centers between January 1995 and February 2017 were examined retrospectively. We investigated oncologic outcomes, including progression-free, cancer-specific, and overall survival (PFS, CSS, and OS, respectively) stratified by preoperative CKD status (CKD vs. non-CKD). We performed a Cox proportional hazards regression analysis using inverse probability of treatment weighting (IPTW) to evaluate the impact of preoperative CKD on prognosis and developed the prognostic factor-based risk stratification nomogram. Results: Of the 581 patients, 215 (37%) were diagnosed with CKD before radical cystectomy. Before the background adjustment, PFS, CSS, and OS after radical cystectomy were significantly lower in the CKD group compared to the non-CKD group. Background-adjusted IPTW analysis showed that preoperative CKD was significantly associated with poor PFS, CSS, and OS after radical cystectomy. The nomogram for predicting 5-year PFS and OS probability showed significant correlation with actual PFS and OS ( c-index = 0.73 and 0.77, respectively). Conclusions: Muscle-invasive bladder cancer patients with preoperative CKD had a significantly lower survival probability than those without CKD.

Risk factors for new-onset chronic kidney disease in patients who have received a liver transplant.

The aim of the present study was to analyze the risk factors for new-onset chronic kidney disease (CKD) in patients who have received a liver transplant. A total of 190 patients who underwent liver transplantation between March 2001 and January 2015 were followed up, and analyzed retrospectively. Sex, age, primary disease, preoperative laboratory findings (hemoglobin, albumin, creatinine and glomerular filtration rate), surgical approach, blood loss during the surgery and transfusion volume, postoperative complications, and the average levels of calcineurin inhibitors (CNIs) (from liver transplantation to the onset of CKD) were analyzed. In total, 40 patients developed new-onset CKD after transplantation. Clinical data in the new-onset CKD group were compared with the non-CKD group. A χ2 test, t-test and logistic regression analysis were performed using SPSS 17.0 software. The incidence of new-onset CKD after liver transplantation was 21.1%. Renal pathology included IgA nephropathy, hepatitis B virus-associated nephropathy, membranous proliferative glomerulonephritis, focal segmental glomerular sclerosis and cryoglobulinemia-associated renal injury. Among the CKD patients, 85.7% had tubulointerstitial damage. Univariate analysis showed that preoperative renal function, hemoglobin, intraoperative blood loss and transfusion volume, postoperative acute kidney injury, average levels of CNIs, and hypertension were risk factors for new-onset CKD after liver transplantation. Logistic regression analysis showed that preoperative glomerular filtration rate [odds ratio (OR)=0.980, P=0.041], hemoglobin (OR=0.972, P=0.034), average levels of CNIs (OR=1.364, P=0.015) and hypertension (OR=4.833, P=0.048)] were independent risk factors for new-onset CKD. The incidence of new-onset CKD in patients who received liver transplantation was high. The main risk factors were identified to be preoperative glomerular filtration rate, hemoglobin, postoperative average levels of CNIs and hypertension.

Association between N-terminal Pro-Brain Natriuretic Peptide levels, glomerular filtration rate, and heart failure in the Multi-Ethnic Study of Atherosclerosis.

Background:This study examined the complementary prognostic role of NT-proBNP and eGFR for predicting heart failure (HF) in adults with and without chronic kidney disease (CKD) defined as eGFR<60 ml/min/1.73m2.Methods:We used data from the Multi-Ethnic Study of Atherosclerosis, a cohort of 6814 adults without baseline clinical cardiovascular disease. Five-year risk prediction of HF based on clinical HF risk variables (HFRV) plus NT-proBNP, eGFR or both was assessed using the C-statistic and the net reclassification index (NRI) after stratifying by CKD status.Results:Mean age at baseline was 62.3±10.3 years and CKD were present in 5.9%. A total of 39 and 180 HF events occurred in participants with and without CKD, respectively. Among adults with CKD, the C-statistic for HF risk prediction increased significantly (P =0.04) from 0.71 (95% CI 0.64, 0.78) with HFRV alone to 0.78 (95% CI 0.71, 0.85) with addition of NT-proBNP. In the non-CKD group, the C-statistic increased from 0.77 (95% CI 0.74, 0.80) with HFRV alone to 0.83 (95% CI 0.80, 0.85) with addition of NT-proBNP. Further addition of eGFR to the model did not alter the C-statistic regardless of CKD status. NRI improved by 23.1% and 10.2% in CKD and non-CKD, respectively, with the addition of NT-proBNP alone and findings were similar when both eGFR and NT-proBNP were both added to model.Conclusions:In adults without clinical cardiovascular disease, the addition of NT-proBNP but not eGFR to established HFRV improves HF risk prediction in adults with and without CKD.

Associations between Body Mass Index and Chronic Kidney Disease in Type 2 Diabetes Mellitus Patients: Findings from the Northeast of Thailand.

BackgroundChronic kidney disease (CKD) has emerged as a public health burden globally. Obesity and long-term hyperglycaemia can initiate the renal vascular complications in patients with type 2 diabetes mellitus (T2DM). This study aimed to investigate the association of body mass index (BMI) with the CKD in patients with T2DM.MethodsThis study has used retrospective medical records, biochemical reports, and anthropometric measurements of 3,580 T2DM patients which were collected between January to December 2015 from a district hospital in Thailand. CKD was defined according to the measurement of estimated glomerular filtration rate (<60 mL/min/1.73 m2). Multiple logistic regression analysis was used to explore the association between BMI and CKD in patients with T2DM.ResultsThe mean age of the participants was 60.86±9.67 years, 53.68% had poor glycaemic control, and 45.21% were overweight. About one-in-four (23.26%) T2DM patients had CKD. The mean BMI of non-CKD group was slightly higher (25.30 kg/m2 vs. 24.30 kg/m2) when compared with CKD patients. Multivariable analysis showed that older age, female sex, hypertension, and microalbuminuria were associated with the presence of CKD. No association was observed between CKD and poorly controlled glycosylated hemoglobin or hypercholesterolemia. Adjusted analysis further showed overweight and obesity were negatively associated with CKD (adjusted odds ratio [AOR], 0.73; 95% confidence interval [CI], 0.58 to 0.93) and (AOR, 0.53; 95% CI, 0.35 to 0.81), respectively.ConclusionThe negative association of BMI with CKD could reflect the reverse causality. Lower BMI might not lead a diabetic patient to develop CKD, but there are possibilities that CKD leads the patient to experience reduced BMI.

Abstract 21100: Long-Term Clinical Outcomes of Patients With Chronic Kidney Disease and Critical Limb Ischemia Underwent Percutaneous Transluminal Angioplasty

Background: Critical limb ischemia (CLI) and chronic kidney disease (CKD) are associated with poor outcomes. We assessed the 5-year clinical outcomes of CKD versus non-CKD patients (pts) with CLI who underwent peripheral transluminal angioplasty (PTA). Methods: A total 765 consecutive CLI pts underwent PTA were analyzed. CKD is defined as either kidney damage or estimating glomerular filtration rate (GFR) &lt; 90 mL/min/m 2 . Kidney damage is defined as pathologic abnormalities or markers of damage, including abnormalities in blood or urine tests or imaging studies. Patients (pts) were divided into two groups according to the presence of CKD (CKD group: 465 pts, non-CKD group: 300 pts). To adjust for any potential confounders that could cause bias, propensity score matching (PSM) analysis was performed. Five-year clinical outcomes were assessed by Kaplan-Meier curved analysis and log rank test. Results: The CKD stage of study populations showed that 42% had mild, 21% moderate, 3% severe, and 32% kidney failure or dialysis. After PSM analysis, two matched groups (226 pairs, n= 452 pts) were generated and their baseline characteristics were balanced. During the 5-year clinical follow-up, there were no differences in the incidence of myocardial infarction, strokes and coronary or peripheral revascularization between the two groups. However, the incidence of total death and the above the ankle amputation were higher in the CKD group than the non-CKD group [Table]. Conclusion: CKD pts with CLI had higher incidence of mortality and amputation rate at 5 years following standard PTA compared with non-CKD pts. Improved therapies and special care are needed for this high-risk group of patients.

Preoperative chronic kidney disease predicts poor oncological outcomes after radical nephroureterectomy in patients with upper urinary tract urothelial carcinoma.

ObjectiveTo evaluate the impact of preoperative chronic kidney disease (CKD) on oncological outcomes in patients with upper tract urothelial carcinoma who underwent radical nephroureterectomy.MethodsA total of 426 patients who underwent radical nephroureterectomy at five medical centers between February 1995 and February 2017 were retrospectively examined. Oncological outcomes, including intravesical recurrence-free, visceral recurrence-free, cancer-specific, and overall survival rates (intravesical RFS, visceral RFS, CSS, and OS, respectively) stratified by preoperative CKD status (CKD vs. non-CKD) were investigated. Cox proportional hazards regression analysis was performed using inverse probability of treatment weighting (IPTW) to evaluate the impact of preoperative CKD on prognosis and a prognostic factor-based risk stratification nomogram was developed.ResultsOf the 426 patients, 250 (59%) were diagnosed with CKD before radical nephroureterectomy. Before the background adjustment, intravesical RFS, visceral RFS, CSS, and OS after radical nephroureterectomy were significantly shorter in the CKD group than in the non-CKD group. Background-adjusted IPTW analysis demonstrated that preoperative CKD was significantly associated with poor visceral RFS, CSS, and OS after radical nephroureterectomy. Intravesical RFS was not significantly associated with preoperative CKD. The nomogram for predicting 5-year visceral RFS and CSS probability demonstrated a significant correlation with actual visceral RFS and CSS (c-index = 0.85 and 0.83, respectively).ConclusionsUpper tract urothelial carcinoma patients with preoperative CKD had a significantly lower survival probability than those without CKD.

Increased risk of tinnitus in patients with chronic kidney disease: A nationwide, population-based cohort study.

Tinnitus mostly results from central and peripheral auditory pathology. Chronic kidney disease (CKD) is a major risk factor for cerebrovascular disease. However, no studies have evaluated the association between tinnitus and CKD. The aim of this study is to investigate the risk of tinnitus in patients with CKD. This retrospective cohort study was conducted using Taiwan National Health Insurance Research Database from 2000 to 2010. We established a CKD group (n = 185,430) and a non-CKD comparison group (n = 556,290) to investigate the incidence of tinnitus. Cox proportional hazard regression analysis was used to evaluate the effects of CKD on tinnitus risk. The results showed CKD significantly increased the risk of tinnitus (adjusted hazard ratio, 3.02; 95% CI, 2.655–3.456, P<0.001). A subgroup analysis revealed the increase in risk of tinnitus is more in CKD patients with heart failure (adjusted hazard ratio, 9.975; 95% CI, 5.001–18.752) and diabetes mellitus (adjusted hazard ratio, 3.712; 95% CI, 2.856–5.007). Furthermore, compared to non-CKD patients, the risk of tinnitus was increased 4.586-fold (95% CI, 2.399–6.7) in CKD patients with dialysis and 2.461-fold (95% CI, 1.033–3.454) in CKD patients without dialysis. This study is the first to report that CKD is associated with an increased risk of tinnitus. Among CKD cohort, patients with dialysis are at a higher risk of tinnitus than those without dialysis.