Non-dialysis Chronic Kidney Disease Stage Research Articles

Lipid parameters, adipose tissue distribution and prognosis prediction in chronic kidney Disease patients

BackgroundLipid management in clinic is critical to the prevention and treatment of Chronic kidney disease (CKD), while the manifestations of lipid indicators vary in types and have flexible association with CKD prognosis.PurposeExplore the associations between the widely used indicators of lipid metabolism and their distribution in clinic and CKD prognosis; provide a reference for lipid management and inform treatment decisions for patients with non-dialysis CKD stage 3–5.MethodsThis is a retrospective cohort study utilizing the Self-Management Program for Patients with Chronic Kidney Disease Cohort (SMP-CKD) database of 794 individuals with CKD stages 3–5. It covers demographic data, clinical diagnosis and medical history collection, laboratory results, circulating lipid profiles and lipid distribution assessments. Primary endpoint was defined as a composite outcome(the initiation of chronic dialysis or renal transplantation, sustained decline of 40% or more in estimated glomerular filtration rate (eGFR), doubled of serum creatinine (SCr) from the baseline, eGFR less than 5 mL/min/1.73m2, or all-cause mortality). Exposure variables were circulating lipid profiles and lipid distribution measurements. Association were assessed using Relative risks (RRs) (95% confidence intervals (CIs)) computed by multivariate Poisson models combined with least absolute shrinkage and selection operator (LASSO) regression according to categories of lipid manifestations. The best model was selected via akaike information criterion (AIC), area under curve (AUC), receiver operating characteristic curve (ROC) and net reclassification index (NRI). Subgroup analysis and sensitivity analysis were performed to assess the interaction effects and robustness..Results255 individuals reached the composite outcome. Median follow-up duration was 2.03 [1.06, 3.19] years. Median age was 58.8 [48.7, 67.2] years with a median eGFR of 33.7 [17.6, 47.8] ml/min/1.73 m2. Five dataset were built after multiple imputation and five category-based Possion models were constructed for each dataset. Model 5 across five datasets had the best fitness with smallest AIC and largest AUC. The pooled results of Model 5 showed that total cholesterol (TC) (RR (95%CI) (per mmol/L) :1.143[1.023,1.278], P = 0.018) and percentage of body fat (PBF) (RR (95%CI) (per percentage):0.976[0.961,0.992], P = 0.003) were significant factors of composite outcome. The results indicated that comprehensive consideration of lipid metabolism and fat distribution is more critical in the prediction of CKD prognosis..ConclusionComprehensive consideration of lipid manifestations is optimal in predicting the prognosis of individuals with non-dialysis CKD stages 3–5.

Electrochemical Skin Conductance by Sudoscan in Non-Dialysis Chronic Kidney Disease Patients.

Peripheral neuropathy is prevalent among patients with chronic kidney disease (CKD). Sudoscan non-invasively detects polyneuropathy by measuring electrochemical skin conductance (ESC). We conducted a study on sudomotor function in CKD patients across various stages based on their estimated glomerular filtration rate (eGFR). In this cross-sectional study of 700 CKD patients, all underwent Sudoscan. Pathological ESC was defined as hands < 40 μS or feet < 50 μS. Clinical neuropathy scores including Michigan Neuropathy Screening Instrument (MNSI) and Douleur Neuropathique en 4 questionnaire (DN4) were obtained. Among participants, 344 had diabetes and 356 did not. Hands and feet ESC decreased with CKD progression (median (IQR) in stage 1-2, 3, 4-5: 54.0 (39.0-68.0), 45.5 (30.0-63.0), 41.8 (26.5-60.5), p trend < 0.001; 64.5 (53.5-74.0), 60.5 (43.0-72.5), 55.0 (39.0-69.8), p trend < 0.001). Pathological hands and feet ESC increased in later CKD stages (stage 1-2, 3, 4-5: 26.6%, 40.9%, 45.7%, p trend < 0.001; 21.7%, 34.0%, 40.6%, p trend < 0.001). Positive hands and feet ESC-eGFR correlation existed irrespective of diabetes. Diabetic patients had lower hands and feet ESC than non-diabetics as CKD progressed. However, multivariate regression found no significant ESC-eGFR association. Sudoscan correlated with clinical neuropathy scores. Pathological sudomotor function was common in non-dialysis CKD stages 4-5. Diabetic patients had worse function. Sudomotor dysfunction progressed with renal disease but eGFR was not an independent risk factor.

Risk factors for COVID-19 hospitalization and mortality in patients with chronic kidney disease: a nationwide cohort study.

Several studies have demonstrated an increased risk of severe coronavirus disease 2019 (COVID-19) in chronic kidney disease (CKD) patients. However, few have investigated the impact of CKD stage and dialysis modality. The primary aim of this study was to investigate the association between CKD stage, dialysis modality and risk of severe COVID-19. Secondly, we aimed to study the impact of comorbidities and drugs on the risk of severe COVID-19 in the CKD population. This nationwide observational study was based on data from the Swedish Renal Registry and three other national registries. Patients with non-dialysis CKD stage 3b-5 or dialysis on 1 January 2020 were included and followed until 31 December 2021. The primary outcome was COVID-19 hospitalization; the secondary outcome was COVID-19 mortality. Associations were investigated using logistic regression models, adjusting for confounders. The study population comprised 7856 non-dialysis CKD patients and 4018 dialysis patients. The adjusted odds ratios (aOR) for COVID-19 hospitalization and mortality were highest in the dialysis group [aOR 2.24, 95% confidence interval (CI) 1.79-2.81; aOR 3.10, Cl 95% 2.03-4.74], followed by CKD 4 (aOR 1.33, 95% CI 1.05-1.68; aOR 1.66, Cl 95% 1.07-2.57), as compared with CKD 3b. No difference in COVID-19 outcomes was observed between patients on hemodialysis and peritoneal dialysis. Overall comorbidity burden was one of the strongest risk factors for severe COVID-19 and the risk was also increased in patients prescribed insulin, proton pump inhibitors, diuretics, antiplatelets or immunosuppressants. Worsening CKD stage and comorbidity are independent risk factors for severe COVID-19 in the Swedish CKD population.

Comparing Left Ventricular Diastolic Function between Peritoneal Dialysis and Non-Dialysis Patients with Stage 5 Chronic Kidney Disease: A Propensity Score-Matched Analysis.

Patients with chronic kidney disease (CKD) have a high incidence of left ventricular diastolic dysfunction (LVDD), which increases the risk of heart failure and mortality. We assessed fluid overload as an independent risk factor for LVDD in patients with decreased kidney function and compared its impact on the E/e' ratio as a parameter for assessing left ventricular diastolic functions between patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and those with non-dialysis CKD stage 5 (CKD5) using propensity score matching (PSM). After PSM, 222 patients (CAPD, n = 111; CKD5, n = 111) were included. Fluid balance was assessed using bio-impedance spectroscopy and LVDD was determined by echocardiography based on an E/e' ratio of >15. The CKD5 group had a significantly higher E/e' ratio (p = 0.002), while fluid overload (OH/ECW) did not differ significantly between the groups. In the CAPD group, there were no significant differences in OH/ECW between patients with and without LVDD (p = 0.517). However, in the CKD5 group, patients with LVDD showed a significantly higher OH/ECW (p = 0.001). In a regression analysis investigating factors associated with the E/e' ratio, OH/ECW was not significantly associated with the E/e' ratio in the CAPD group (p = 0.087), but in the CKD5 group, it was independently correlated (p = 0.047). The factors closely associated with LVDD varied depending on dialysis dependence. While fluid overload independently influenced LVDD in non-dialysis patients, it was not statistically significant in patients with CAPD. Early assessment and management of volume status are crucial in addressing LVDD in patients with advanced-stage CKD.

#5529 RED BLOOD CELL TRANSFUSION RATES IN THE INTERNATIONAL DOPPS PROGRAM (2012–2022): HEMODIALYSIS, PERITONEAL DIALYSIS, AND NON-DIALYSIS CKD POPULATIONS

Abstract Background and Aims Anemia is a common complication of chronic kidney disease (CKD), and affects the majority of patients on hemodialysis (HD) and peritoneal dialysis (PD). Consequences of anemia include lower quality of life, increased healthcare utilization, and greater mortality risk. Current international guidelines recommend treating patients with iron and erythropoiesis-stimulating agents (ESAs) to a target hemoglobin (Hb) range, and avoiding red blood cell transfusions (RBCT) when possible, given the associated short- and long-term adverse consequences including hyperkalemia and allosensitization. A description of contemporary RBCT rates – after the 2012 KDIGO guideline changes – across the spectrum of CKD and different geographies is lacking. In this analysis, we estimated RBCT rates in non-dialysis CKD (ND-CKD), PD, and HD patients in a multinational setting, overall and stratified by Hb levels. Method We used data from 3 ongoing prospective cohort studies from the Dialysis Outcomes and Practice Patterns Study (DOPPS) Program: 2443 Stage 3–4 ND-CKD patients from 2 countries in CKDopps phases 1–2 (2013–2022), 3557 PD patients from 6 countries in PDOPPS phase 1 (2014–2018), and 22,771 HD patients from 20 countries in DOPPS phases 5–7 (2012–2022). Within each study, patients were randomly selected from stratified national samples of clinics, representative of a snapshot in time at study entry. Prospective information on RBCT receipt (yes/no) was captured at the patient-month level; thus, multiple events per patient were considered in the rate calculation, if they occurred in different months. RBCT rates were calculated as a count of the total patient-months with an RBCT event divided by the total patient-months with RBCT data available. Rates (per patient-month) were converted to per 100 patient-years, with 95% confidence intervals estimated by Poisson regression. RBCT rates are presented in each population (ND-CKD, PD, HD) across strata of interest, including CKD stage, country/region, and baseline Hb levels. Results Mean age (years) of the cohort was 68.6 for ND-CKD, 59.1 for PD, and 63.2 for HD. Mean (std dev) baseline Hb levels (g/dL) were 12.1 (1.9) in ND-CKD compared to 10.9 (1.7) in PD and 10.9 (1.5) in HD. Median [IQR] months of follow up (with RBCT data available) was 17 [6, 27] for ND-CKD, 16 [9, 20] for PD, and 8 [4, 19] for HD. Table 1 shows crude RBCT rates (per 100 patient-years) in the ND-CKD, PD, and HD populations, overall, by CKD stage and country/region. For ND-CKD, the RBCT rate was 6.7 (95% CI: 5.9, 7.6) overall, including 7.0 in the US and 5.5 in Brazil. RBCT rates increased with ND-CKD stage, from 2.2 in Stage 3a to 4.5 in Stage 3b to 8.5 in Stage 4. For PD, the RBCT rate was 20.3 (95% CI: 19.1, 21.6), higher than in ND-CKD, with substantial variation across countries, from 7.3 in the UK to 45.6 in Thailand. For HD, the RBCT rate was 23.9 (95% CI: 23.3, 24.5), also higher than in ND-CKD, with international variation observed. In the HD cohort, RBCT rates were lower in China (6.3) compared to the US (21.9), Canada (34.4), and the Gulf Cooperation Council region (34.8). Within HD-Europe, RBCT rates were highest in Belgium (48.1) and Sweden (42.4), and lowest in Germany (15.4), France (19.0), and Italy (20.4). Table 2 shows crude RBCT rates by baseline Hb levels. In all 3 cohorts (ND-CKD, PD, HD), RBCT rates appeared higher among patients with lower versus higher baseline Hb levels. In the PD and HD populations, patients with baseline Hb &amp;lt;8 g/dL had RBCT rates &amp;gt;100. Conclusion Our multinational study used uniform and standardized data collection tools, procedures, and processes to estimate RBCT rates in the post-2012 era following the revision of international guidelines. As expected, we observed higher RBCT rates in the PD and HD (vs. ND-CKD) populations, and higher RBCT rates among patients with lower baseline Hb levels. Interestingly, we also observed substantial international variation in RBCT rates in all 3 cohorts (ND-CKD, PD, HD). Further research is needed to better understand the reasons why RBCT use is higher or lower in certain countries, and to investigate predisposing and modifiable risk factors for RBCT. Funding: GSK (study 218930)

Interaction Effect of Phase Angle and Age on Femoral Neck Bone Mineral Density in Patients with Non-Dialysis Chronic Kidney Disease Stage 5.

Background: Low bone mass is common in malnourished patients with chronic kidney disease (CKD) and can lead to a higher risk of fractures. Elderly and CKD patients have the same risk factors for protein-energy wasting, sarcopenia, and osteoporosis. Here, we investigated the association between phase angle (PhA) and bone mineral density (BMD) in dialysis-naïve patients with CKD stage 5 (CKD5) and identified a statistical relationship between PhA and age, which affects bone density. Methods: Bio-impedance spectroscopy for evaluating body composition and PhA and dual-energy X-ray absorptiometry for determining the BMD were simultaneously performed in 167 consecutive patients (mean age, 59.65 ± 13.98 years; women, 40.1%). Two-way analysis of variance (ANOVA) was conducted to assess the potential interaction effect of PhA and age on femoral neck BMD (FN-BMD). Results: Our results showed that PhA and age were independently associated with FN-BMD and T-score in multiple linear regressions analyses. A significant interaction effect of PhA and age on FN-BMD was found on two-way ANOVA (p = 0.028). The average BMD values for the first and second tertiles of the PhA were higher in the young versus elderly group, whereas patients in the elderly group had higher BMD in the third tertiles. Conclusions: A relationship was noted between PhA and BMD in patients with advanced-stage CKD. The effect of PhA level on FN-BMD differed between elderly and young patients. Our study suggested that higher PhA levels could be a marker explaining the maintenance of good bone health in elderly patients with CKD5. Further longitudinal analyses are needed to determine whether PhA predicts the risk of CKD-MBD-related fractures during CKD progression.

Effectiveness of iron-based phosphate binders in reduction of hyperphosphataemia in chronic kidney disease patients

Background: Ferric citrate is novel iron-based phosphate-binding drug for management of hyperphosphataemia and iron-deficiency anaemia in chronic kidney disease (CKD) patients. Objectives: To evaluate impact of ferric citrate therapy on reduction of phosphate levels and improvement in haematological parameters in CKD stages 3-5. Methods: This analytical, observational study was conducted at Kathmandu Medical College Teaching Hospital from 2020 July-December after ethical clearance using convenience sampling method. Non-dialysis dependent patients at CKD stages 3-5, having hyperphosphataemia (serum phosphate &gt;=4.6mg/dL) and anaemia (serum haemoglobin &lt;12 gm%, transferrin saturation &lt;=30%, ferritin &lt;=300ng/mL) were administered with 2gm twice daily dose of ferric citrate for 12 weeks and evaluated on outcomes in terms of reduction in serum phosphate levels and improvement in haematological parameters as study endpoints. Data were entered in Microsoft Excel and analysed in SPSS v.25. Significance level was set at p &lt;0.05. Results: Of 84 study participants, majority had CKD stage 4 (46, 54.76%). A significant reduction (p &lt;0.001) in mean serum phosphate levels of 6.21 ± 1.062 mg/dL from baseline to 4.89 ± 1.100 mg/dL in 12-weeks was observed. Patients with CKD stages 3, 4, and 5 had mean reduction of 1.67 (p = 0.005), 1.40 (p &lt;0.001), and 1.04 mg/dL (p = 0.002) of serum Phosphate level respectively. Significant (p &lt;0.001) improvements in hemoglobin level, serum iron, ferritin, total iron binding capacity, and transferrin saturation were reported. Conclusion: Ferric citrate is effective and well-tolerated phosphate-binder to improve hyperphosphataemia and iron deficiency anaemia in non-dialysis CKD stage 3, 4, and 5.

Relationships between Sclerostin, Leptin and Metabolic Parameters in Non-Dialysis Chronic Kidney Disease Males.

Sclerostin is an inhibitor of the Wnt-beta-catenin pathway. The relationship between sclerostin and adipose tissue or between sclerostin and nutritional status has been the subject of research interest in the last decade. Sclerostin concentrations are elevated in patients with chronic kidney disease (CKD). Leptin is an adipocytokine which inhibits food intake by stimulating the satiety center in the hypothalamus. Leptin concentrations rise with the reduction of eGFR (glomerular filtration rate). The aim of this study was to investigate the possible association between sclerostin and leptin, between sclerostin and selected poor prognostic factors of CKD progression, and between sclerostin and nutritional parameters in non-dialysis CKD male patients. 101 men with non-dialysis CKD stage 3-5 were included in the study. Bioimpedance spectroscopy (BIS) was used to measure body composition. Blood samples were drawn to measure the serum concentrations of sclerostin, leptin, creatinine, hemoglobin (Hgb), parathormone (PTH), inflammatory markers, and markers of nutritional status. We also measured homeostatic model assessment of insulin resistance (HOMA-IR) as well as blood pressure. We observed a significant, positive relationship between sclerostin and age, leptin, and glycated hemoglobin (HgbA1c) concentrations. A significant, negative association was observed between sclerostin and eGFR. Sclerostin is associated with leptin in non-dialysis CKD male patients. Sclerostin is also related to metabolic disturbances such as hyperglycemia in this population.

Statin uses in adults with non-dialysis advanced chronic kidney disease: Focus on clinical outcomes of infectious and cardiovascular diseases.

Background: Statins are commonly used for cardiovascular disease (CVD) prevention. Observational studies reported the effects on sepsis prevention and mortality improvement. Patients with chronic kidney disease (CKD) are at high risk for CVD and infectious diseases. Limited information is available for statin use in patients with non-dialysis CKD stage V. Method: The retrospective observational study included patients with non-dialysis CKD stage V, with either de novo statin use or none. Patients who were prior statin users and had prior cardiovascular events were excluded. The key outcomes were infection-related hospitalization, major adverse cardiovascular events (MACE) (non-fatal myocardial infarction, hospitalization for heart failure, or non-fatal stroke), and all-cause mortality. The data were retrieved from the Chang Gung Research Database (CGRD) from January 2001 to December 2019. Analyses were conducted with Cox proportional hazard regression models in the propensity score matching (PSM) cohort. Result: A total of 20,352 patients with CKD stage V were included (1,431 patients were defined as de novo statin users). After PSM, 1,318 statin users were compared with 1,318 statin non-users. The infection-related hospitalization (IRH) rate was 79.3 versus 94.3 per 1,000 person-years in statin users and statin non-users, respectively [hazard ratio (HR) 0.83, 95% confidence interval (CI) 0.74–0.93, p = 0.002]. The incidence of MACE was 38.9 versus 55.9 per 1,000 person-years in statin users and non-users, respectively (HR, 0.72; 95% CI 0.62–0.83, p < 0.001). The all-cause mortality did not differ between statin users and non-users, but statin users had lower infection-related mortality than non-users (HR, 0.59; 95% CI 0.38–0.92, p = 0.019). Conclusion: De novo use of statin in patients with non-dialysis CKD stage V reduced the incidence of cardiovascular events, hospitalization, and mortality for infectious disease. The study results reinforced the benefits of statin in a wide range of patients with renal impairment before maintenance dialysis.

Comparing Prescribing Practices of Statin Therapy in Atherosclerotic Cardiovascular Disease Patients with Varying Levels of Chronic Kidney Disease

Lead Author's Financial Disclosures Nothing to disclose. Study Funding None. Background/Synopsis Evidence supporting high-intensity statin therapy in patients with atherosclerotic cardiovascular disease (ASCVD) and advanced chronic kidney disease (CKD), not on dialysis, is not robust. Cardiovascular risk reduction from statin therapy within this population is predominantly derived from post-hoc subgroup analysis of larger trials. This subset of ASCVD patients is often at higher risk for medication-related adverse effects, secondary to reduced renal clearance, polypharmacy, and high prevalence of co-morbidities. This increased risk may result in provider hesitation and under prescribing of high-intensity statin therapy among ASCVD patients. Of the available high-intensity statins atorvastatin does not require renal dose adjustments although rosuvastatin does. On a population level, prescribing of statins among patients with ASCVD and CKD has improved in recent years but remains sub-optimal. Results from this study can provide insight into whether providers are following guideline recommendations and package labeled dosing when prescribing statin therapy in a real-world setting. Objective/Purpose This study aims to evaluate real-world prescribing patterns of statin-therapy among ASCVD patients with non-dialysis dependent Stage 4-5 CKD and Stage 3a and 3b CKD. Methods This study is a retrospective, cross-sectional observational study and has been reviewed by the Colorado Multiple Institutional Review Board as exempt. Patients with a diagnosis of clinical ASCVD, non-dialysis dependent CKD stage 3a-5, and prescribed a statin between 1/1/2020-9/30/2021 were identified. The primary outcome will be prescribing ahigh-intensityy statin among patients with eGFR <30 mL/min compared to patients with eGFR 30-<60 mL/min. Secondary outcomes will include differences in mean LDL-C between the two groups and proportion of patients on FDA approved dosing of rosuvastatin. A chi-square test will be used for qualitative data and a student t-test for quantitative data. Results A total of 6000 patients have been identified and will be evaluated for inclusion into this study. Results are currently in progress. Conclusions Will be presented. Nothing to disclose.

MO488: Serum P-CRESYL Sulfate Level is an Independent Marker of Peripheral Arterial Stiffness as Assessed Using Brachial-Ankle Pulse Wave Velocity in Patients With Non-Dialysis Chronic Kidney Disease Stage 3–5

Abstract BACKGROUND AND AIMS p-cresyl sulfate (PCS) is associated with inflammation and its contribution to cardiovascular damage in patients with chronic kidney disease (CKD). The brachial-ankle pulse wave velocity (baPWV) is a simple marker to assess the peripheral artery stiffness (PAS) and is a useful marker to predict future cardiovascular events. The aim of this study was to determine the relationship between serum PCS levels and PAS measured by baPWV values in patients with CKD stage 3–5. METHOD Fasting blood samples and baseline characteristics were obtained from 160 CKD stage 3–5 patients. Automatic pulse wave analyzer (VaSera VS-1000) to measure baPWV values, and both sides of baPWV value that was &amp;gt;18.0 m/s were determined as PAS. Serum total PCS levels were determined by high-performance liquid chromatography–mass spectrometry. RESULTS In the study cohort, 54 patients (33.8%) were in the PAS group. When compared with those in the control group, the PAS group had a high prevalence of hypertension (P = .021), older age (P &amp;lt; .001), lower height (P = .033) and body weight (P = .012), higher systolic blood pressure (P &amp;lt; .001), diastolic blood pressure (P = .008), serum calcium–phosphorus product levels (P = .030) and PCS levels (P = .008). The multivariable logistic regression analysis revealed that serum levels of PCS {odds ratio (OR): 1.098, [95% confidence interval (95% CI): 1.029–1.171]; P = .005}, advanced age (OR: 1.105, 95% CI: 1.055–1.159; P &amp;lt; .001) and diastolic blood pressure (OR: 1.058, 95% CI: 1.002–1.118; P = .043) were independently associated with PAS in patients with CKD stage 3–5. CONCLUSION Higher serum PCS levels, diastolic blood pressure and advanced age were associated with PAS in patients with CKD stage 3–5.

MO499: Incidence of Cause-Specific Cardiovascular Events in Men and Women With CKD

Abstract BACKGROUND AND AIMS Men are at higher risk of cardiovascular disease (CVD) than women in the general population, and chronic kidney disease (CKD) is a well-established cardiovascular (CV) risk factor [1–4]. However, the incidence of cause-specific CV events in men and women with CKD is poorly documented. METHOD All hospitalization and death reports for CV events of the 3033 patients (1983 men and 1050 women) with non-dialysis CKD (stage 3–5) included in the French CKD-REIN Cohort were reviewed and classified by cause using criteria from the Cardiovascular and Stroke Endpoint Definitions for Clinical Trials [5]. Cause-specific Cox proportional hazard models were used to estimate hazard ratios for death and each fatal or nonfatal CV event according to gender. RESULTS At baseline, in men (mean age: 68 years; mean eGFR 33 mL/min/1.73 m²), the prevalence of atheromatous CVD was 30% for coronary artery disease, 14% for cerebrovascular disease and 17% for lower limb artery disease, and that of non-atheromatous CVD was 14% for heart failure and 13% for atrial fibrillation. In women (65 years old, 32 mL/min/1.73 m²), these prevalences were 15%, 7%, 9%, 11% and 9%, respectively. During a median follow-up of 5 (IQR: 3–5) years, 98 men and 43 women died from CVD {i.e. 1.3 [95% confidence interval (95% CI): 1.0–1.5] versus 1.0 (0.7–1.3)/100 person-years}, including 53% versus 46% from heart failure, 31% versus 19% from sudden death, and 16% versus 35% from other cardiovascular causes, respectively. Crude incidence rates of death or hospitalization for coronary artery disease and lower limb artery disease were higher in men than in women, slightly higher for CV death, cerebrovascular disease and atrial fibrillation, but similar for both genders for heart failure (Fig. 1). History of CVD was strongly associated with subsequent CV events of any type. In multivariable analyses, gender was no longer associated with any cause-specific CV event, whereas a lower eGFR was significantly associated with an increased risk of coronary artery disease and heart failure, but not with other CV events (Table 1). CONCLUSION In patients with moderate or advanced CKD, the burden of atheromatous CVD is higher in men than in women and explained by their higher prevalence of cardiovascular risk factors, but that for heart failure and atrial fibrillation appears to be similar for both genders.

MO526: Renal Function in Patients With Non-Dialysis Kidney Disease Treated With Ferric Carboxymaltose

Abstract BACKGROUND AND AIMS Iron deficiency anemia occurs in most patients with non-dialysis chronic kidney disease (ND-CKD). Several studies have suggested the efficacy and safety of ferric carboxymaltose (FCM) in this group of patients, but none have shown a positive impact on renal function. The aim our study was to investigate the impact of FCM on renal function in ND-CKD patients. METHOD Prospective observational study of ND-CKD stages 3 to 5 patients, with anemia and iron deficiency [ferritin level &amp;lt;100 µg/L or &amp;lt;200 µg/L with transferrin saturation (TSAT) &amp;lt;20%], treated with FCM from 01 January 2019 to 31 June 2021. FCM was administrated as a single IV infusion. Patients were categorized into two cohorts according to the dose of FCM received: 500 mg or 1000 mg. Clinical and analytical data were compared among groups at baseline and 24 weeks after infusion. Renal function was assessed using estimated glomerular filtration rate (eGFR), calculated using the CKD-EPI formula. Statistical analysis was executed using SPSS (Version 23 for Mac OSX). RESULTS The mean age of 140 patients was 77.31 ± 9.68 years, 62 (44.3%) were male, 86 (61.4%) were diabetic, 84 (60%) had congestive heart failure and 121 (86.4%) had hypertension. Thirty-five (25%) patients had CKD stage 3, 74 (52.9%) had stage 4 and 31 (22.1%) had stage 5. Seventy-eight (55.7%) patients were treated with 1000 mg of FCM. There were no gender, comorbidity, CKD etiology or stage differences among groups. Patients treated with 1000 mg were younger (74.36 ± 13.59 versus 78.44 ± 9.28 years, P = .046). At baseline, mean Hb was 10.4 ± 1.35, 10.27 ± 1.47 and 10.54 ± 1.2 g/dL and mean eGFR was 26.18 ± 17.167, 23.55 ± 4.17 and 28.71 ± 19.43 mL/min/1.73 m2 for the whole group, 1000 mg and 500 mg cohorts. At 24 weeks, Hb showed an increase of 1.24 ± 1.78 (P = .001), 1.54 ± 1.99 (P = .001) and 0.86 ± 1.4 g/dL (P = .001), and eGFR an increase of 1.13 ± 6.49 (P = .041) and 1.55 ± 6.87 mL/min/1.73 m2 (P = .049) for the whole group and 1000 mg cohort, but not 500 mg cohort. A Pearson correlation was performed and revealed a positive correlation between the variation of Hb and eGFR during the study follow-up period (r = .283, P = .001 and r = .310, P = .008) in the same groups. CONCLUSION In addition to the effectiveness in correcting iron deficiency anemia in patients with ND-CKD, our results suggest a positive impact on renal function of higher doses of FCM after 6 months of administration.

1 NEUROPEPTIDEY LEVELS EFFECT ON BLOOD PRESSURE IN CHRONIC KIDNEY DISEASE PATIENTS WITH HYPERTENSION

Background: Impaired kidney function in Chronic Kidney Disease (CKD) results in increase sympathetic nerve activation, therefore CKD patients often experience hypertension (Ht). Increased sympathetic nerve tone is mediated by increment of sympathetic neurotransmitter which is Neuropeptide Y (NPY). Objective: this study aims to identify Neuropeptide (NPY) levels effect on blood pressure (BP) in CKD patients with hypertension and compare with healthy population. Methods: This case-control study involved 43 CKD patients with regular hemodialysis, 20 non-dialysis CKD stage 1-5 patients and 25 healthy controls. NPY levels were checked by enzyme-linked immunosorbent assay (ELISA). It said to be significant if p value &lt; 0.05. Results: This study shows that NPY levels have a significant effect on BP. Patients with Ht grade II had higher NPY levels (885.80 ng/L) than Ht grade I (423.18 ng/L) or controlled Ht (464.06 ng/L) (p=0.024), but it was higher in controlled (937.56 ng/L) than CKD patients (617.14 ng/L) (p=0.06). Conclusions:&gt; NPY levels affect BP. It seem displays a bidirectional effect in cardiovascular tissue, acting as a cardio-depressant and a cardio-stressor.; lowers BP in healthy populations but increases BP in CKD patients. Further research is needed to prove bidirectional effect of NPY levels and control other factors that influence BP, such as adherence to Ht medication, inflammation, and ages so that the results of this study can represent a large population.

Serum P-Cresyl Sulfate Level Is an Independent Marker of Peripheral Arterial Stiffness as Assessed Using Brachial-Ankle Pulse Wave Velocity in Patients with Non-Dialysis Chronic Kidney Disease Stage 3 to 5.

p-Cresyl sulfate (PCS) is a uremic toxin that causes cardiovascular injury and progression in patients with chronic kidney disease (CKD). Peripheral arterial stiffness (PAS) as measured using the brachial-ankle pulse wave velocity (baPWV) is considered a valuable predictor of cardiovascular event risk in the general population. The study investigated the correlation between serum PCS levels and PAS (baPWV > 18.0 m/s) in 160 patients with stage 3–5 CKD. Liquid chromatography–mass spectrometry was used to assay serum PCS levels. PAS was detected in 54 patients (33.8%), and it was linked to older age, a higher prevalence of hypertension, higher systolic and diastolic blood pressure, higher serum calcium–phosphorus product and PCS levels, and lower height and body weight. Multivariable logistic regression analysis for independent factors associated with PAS illustrated that, in addition to age and diastolic blood pressure, serum PCS levels exhibited an odds ratio (OR) of 1.098 (95% confidence interval = 1.029–1.171, p = 0.005). These findings demonstrated that serum PCS levels were associated with PAS among patients with stage 3–5 CKD.

Beliefs about medication and their association with adherence in Chinese patients with non-dialysis chronic kidney disease stages 3-5.

There is a scarcity of research into the impact of medication beliefs on adherence in patients with non-dialysis chronic kidney disease (CKD). This study is to determine the psychometric properties of the Chinese version of the Beliefs about Medicines Questionnaire (BMQ)-Specific among patients with non-dialysis CKD stages 3–5, and to assess the beliefs of CKD patients and their association with medication adherence.A cross-sectional study was conducted in CKD patients who recruited at the nephrology clinics of Xi’an Central Hospital, Xi’an, Shaanxi, China. The original BMQ-Specific was translated into Chinese. The internal consistency and test–retest reliability of the Chinese version of the BMQ-Specific scale were assessed, while exploratory and confirmatory factor analyses were also applied to determine its reliability and validity. The Kruskal–Wallis test and multiple ordered logistic regression were performed to identify the relationship between beliefs about and adherence to medication among CKD patients.This study recruited 248 patients. Cronbach's α values of the BMQ-Specific necessity and concern subscales were 0.826 and 0.820, respectively, with intraclass correlation coefficients of 0.784 and 0.732. Factor analysis showed that BMQ-Specific provided a good fit to the two-factor model. The adherence of patients was positively correlated with perceived necessity (r = 0.264, P < .001) and negatively correlated with concern (r = –0.294, P < .001). Medication adherence was significantly higher for the accepting group (high necessity and low concern scores) than for the ambivalent group (high necessity and concern scores; β = –0.880, 95% confidence interval [CI] = –1.475 to –0.285), skeptical group (low necessity and high concern scores; β = –2.620, 95% CI = –4.209 to –1.031) and indifferent group (low necessity and concern scores; β = –0.918, 95% CI = –1.724 to –0.112).The Chinese version of BMQ-Specific exhibited satisfactory reliability and validity for use in patients with non-dialysis CKD stages 3–5 and has been demonstrated to be a reliable screening tool for clinicians to use to predict and identify the non-adherence behaviors of patients.

Cardiac valve calcification prevalence and association with neutrophil-to-lymphocyte ratio in newly diagnosed patients with non-dialysis chronic kidney disease stage 3-5.

Cardiac valvular calcification (CVC) is the main cause of cardiovascular disease and all-cause death in patients with chronic kidney disease (CKD). However, the relationship between Neutrophil lymphocyte ratio (NLR) and CVC in patients with CKD is not clear. In this study, we aimed to investigate the prevalence of CVC in newly diagnosed patients with non-dialysis CKD stage 3-5 and evaluate the correlation between NLR and CVC. A total of 483 newly diagnosed patients with non-dialysis CKD stage 3-5 were included. According to the presence of CVC, these patients were retrospectively divided into two groups: CVC group and non-CVC group. CVC was found in 80 patients (16.56 %), 53 (10.97 %) of whom had only aortic valve calcification (AVC), 18 (3.73 %) had mitral valve calcification (MVC), and 9 (1.86 %) had both AVC and MVC. The level of NLR in the CVC group was significantly higher than that in the non-CVC group (p=0.002). Multivariate logistic regression analysis showed that NLR was an independent risk factor for CVC (95% CI 1.017~1.225, p=0.020). ROC curve analysis showed that the area under the curve of NLR for predicting CVC was 0.610 (95% CI 0.543-0.676, p=0.002). The best cut-off point of NLR was 3.340, with a sensitivity of 49.4 % and a specificity of 70.0 %. CVC is not uncommon in newly diagnosed patients with non-dialysis CKD stage 3-5, and NLR is an independent risk factor for CVC (Tab. 4, Fig. 1, Ref. 34).

Positive Correlation of Serum Resistin Level with Peripheral Artery Disease in Patients with Chronic Kidney Disease Stage 3 to 5.

Chronic kidney disease (CKD) is associated with higher risk of cardiovascular disease-related ischemic events, which includes peripheral arterial disease (PAD). PAD is a strong predictor of future cardiovascular events, which can cause significant morbidity and mortality. Resistin has been found to be involved in pathological processes leading to CVD. Therefore, we aim to investigate whether resistin level is correlated with PAD in patients with non-dialysis CKD stage 3 to 5. There were 240 CKD patients enrolled in this study. Ankle-brachial index (ABI) values were measured using the automated oscillometric method. An ABI value < 0.9 defined the low ABI group. Serum levels of human resistin were determined using a commercially available enzyme immunoassay. Thirty CKD patients (12.5%) were included in the low ABI group. Patients in the low ABI group were older and had higher resistin levels as well as higher diabetes mellitus, hypertension and habit of smoking, and lower estimated glomerular filtration rate than patients in the normal ABI group. After the adjustment for factors that were significantly associated with PAD by multivariate logistic regression analysis, age and serum resistin level were independent predictors of PAD. A high serum resistin level is an independent predictor of PAD in non-dialysis CKD stage 3 to 5.

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

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

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

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