Chronic Kidney Disease Outcomes Research Articles

Factors influencing the occurrence of hyperuricemia and poor cardiac and renal outcomes in chronic kidney disease.

The aim of our study was to analyze the factors influencing the occurrence of hyperuricemia and poor cardiac and renal outcomes in chronic kidney disease (CKD). One hundred and sixteen patients with CKD admitted to our hospital from January 2022 to September 2022 were picked as the subjects. Fasting venous blood of these subjects was collected to value the serum uric acid (SUA) levels on an automatic biochemical analyzer. Patients were then grouped as the CKD-only group (n=80) and hyperuricemia group (n=36), according to the SUA results, or the good prognosis group (n=88) and poor prognosis group (n=28), according to the presence of cardiovascular diseases. The changes in laboratory indexes and clinical data were analyzed and compared. Multivariate logistic regression analysis was used to analyze the risk factors for combined hyperuricemia and the risk factors for poor cardiac and renal outcomes in patients with CKD. The correlation between SUA level and cardiac and renal indexes was analyzed by Pearson analysis. Patients in the CKD hyperuricemia group had markedly higher content of systolic blood pressure (SBP), diastolic blood pressure (DBP), B-type natriuretic peptide (BNP), urinary retinol-binding protein (RBP), urinary N-acetyl-β-D glucosidase (NAG), much higher proportion of heart failure episodes history, and much lower content of total cholesterol (TC), albumin (Alb), hemoglobin (Hb), urinary α1-microglobulin (α1-MG), and glomerular filtration rate (eGFR) than the CKD-only group (p < 0.05). SUA, BNP, SBP, and history of heart failure episodes were independent risk factors for combined hyperuricemia in CKD patients (p < 0.05). Besides, eGFR, albumin, and hemoglobin were independent protective factors for combined hyperuricemia in CKD patients (p < 0.05). Compared with the good prognosis group, the content of BNP, SBP, DBP, urinary RBP, urinary NAG, and SUA was much higher, the proportion of heart failure episodes history was obviously higher, and the levels of Alb, Hb, TC, eGFR, and urinary α1-MG were sharply lower in the poor prognosis group (p < 0.05). SUA, BNP, SBP, and history of heart failure episodes were independent risk factors for poor cardiac and renal outcomes (p < 0.05), and eGFR was an independent protective factor for poor cardiac and renal outcomes in patients with CKD (p < 0.05). The SUA level in CKD patients was positively correlated with BNP and SBP (r=0.463, 0.215, p < 0.05), but negatively correlated with eGFR (r=0.463, 0.215, p < 0.05). The serum SUA level was elevated with the aggravation of the CKD stage. High serum SUA level is a risk factor for the development of hyperuricemia and poor cardio-renal outcomes in CKD patients, suggesting that early monitoring of changes in SUA levels may help assess the risk of cardio-renal outcomes in CKD patients.

The significance of determining biomarkers of inflammation in chronic kidney failure

Background/Aim. Inflammation is the main cause of the onset, progression, and outcome of chronic kidney disease (CKD). The aim of the study was to examine the predictive value of inflammatory biomarkers in patients with CKD stages I?V and their association with parameters characteristic of CKD. Methods. A cross-sectional study analyzed 117 adult patients with CKD who were divided into two groups according to the glomerular filtration rate (GFR): Group 1, with normal to mild impairment of renal function (GFR ? 60 mL/min/1.73 m2), stages I and II, and Group 2 with moderate and severe impairment of renal function (GFR &lt; 60 mL/min/1.73 m2), stages III, IV, and V, who have not started dialysis treatment. In addition to standard laboratory analyses, we determined derived parameters in patients, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and system inflammation response index (SIRI), as markers of inflammation. Results. A statistically significant difference between Groups 1 and 2 was observed for body mass index (p &lt; 0.003), for platelets, hemoglobin, creatinine, urea, acidum uricum, iron, phosphorus, parathyroid hormone, and proteinuria 24 hrs (p &lt; 0.001), for calcium (p &lt; 0.031) and leukocytes (p &lt; 0.030). By analyzing the values of NLR, PLR, SII, and SIRI in patients with CKD, a statistically significant difference (p &lt; 0.001) was observed between the groups; the values were elevated in Group 2. NLR, PLR, and SII showed statistical significance for essential parameters in CKD (C-reactive protein, creatinine, GFR, hemoglobin, calcium, phosphorus, parathyroid hormone) and SIRI showed statistical significance for phosphorus in Group 2. The most sensitive was NLR at 87.7%, and PLR had the highest specificity, at 81.7%, with cut-off values for PLR ? 151.75, NLR ? 2.06, SII ? 493.57, and SIRI ? 0.739. Conclusion. Our results indicate that the detection of biomarkers NLR, PLR, SII, and SIRI could have a significant role in predicting inflammation in patients with CKD and would contribute to the timely recognition of patients at risk of developing complications.

A Klotho-Based Machine Learning Model for Prediction of both Kidney and Cardiovascular Outcomes in Chronic Kidney Disease

Introduction: This study aimed to develop and validate machine learning (ML) models based on serum Klotho for predicting end-stage kidney disease (ESKD) and cardiovascular disease (CVD) in patients with chronic kidney disease (CKD). Methods: Five different ML models were trained to predict the risk of ESKD and CVD at three different time points (3, 5, and 8 years) using a cohort of 400 non-dialysis CKD patients. The dataset was divided into a training set (70%) and an internal validation set (30%). These models were informed by data comprising 47 clinical features, including serum Klotho. The best-performing model was selected and used to identify risk factors for each outcome. Model performance was assessed using various metrics. Results: The findings showed that the least absolute shrinkage and selection operator regression model had the highest accuracy (C-index = 0.71) in predicting ESKD. The features mainly included in this model were estimated glomerular filtration rate, 24-h urinary microalbumin, serum albumin, phosphate, parathyroid hormone, and serum Klotho, which achieved the highest area under the curve (AUC) of 0.930 (95% CI: 0.897–0.962). In addition, for the CVD risk prediction, the random survival forest model with the highest accuracy (C-index = 0.66) was selected and achieved the highest AUC of 0.782 (95% CI: 0.633–0.930). The features mainly included in this model were age, history of primary hypertension, calcium, tumor necrosis factor-alpha, and serum Klotho. Conclusion: We successfully developed and validated Klotho-based ML risk prediction models for CVD and ESKD in CKD patients with good performance, indicating their high clinical utility.

High sodium intake and fluid overhydration predict cardiac structural and functional impairments in chronic kidney disease.

High sodium intake and fluid overhydration are common factors of and strongly associated with adverse outcomes in chronic kidney disease (CKD) patients. Yet, their effects on cardiac dysfunction remain unclear. The study aimed to explore the impact of salt and volume overload on cardiac alterations in non-dialysis CKD. In all, 409 patients with CKD stages 1-4 (G1-G4) were enrolled. Daily salt intake (DSI) was estimated by 24-h urinary sodium excretion. Volume status was evaluated by the ratio of extracellular water (ECW) to total body water (TBW) measured by body composition monitor. Recruited patients were categorized into four groups according to DSI (6 g/day) and median ECW/TBW (0.439). Echocardiographic and body composition parameters and clinical indicators were compared. Associations between echocardiographic findings and basic characteristics were performed by Spearman's correlations. Univariate and multivariate binary logistic regression analysis were used to determine the associations between DSI and ECW/TBW in the study groups and the incidence of left ventricular hypertrophy (LVH) and elevated left ventricular filling pressure (ELVFP). In addition, the subgroup effects of DSI and ECW/TBW on cardiac abnormalities were estimated using Cox regression. Of the enrolled patients with CKD, the median urinary protein was 0.94 (0.28-3.14) g/d and estimated glomerular filtration rate (eGFR) was 92.05 (IQR: 64.52-110.99) mL/min/1.73 m2. The distributions of CKD stages G1-G4 in the four groups was significantly different (p = 0.020). Furthermore, compared to group 1 (low DSI and low ECW/TBW), group 4 (high DSI and high ECW/TBW) showed a 2.396-fold (95%CI: 1.171-4.902; p = 0.017) excess risk of LVH and/or ELVFP incidence after adjusting for important CKD and cardiovascular disease risk factors. Moreover, combined with eGFR, DSI and ECW/TBW could identify patients with higher cardiac dysfunction risk estimates with an AUC of 0.704 (sensitivity: 75.2%, specificity: 61.0%). The specificity increased to 85.7% in those with nephrotic proteinuria (AUC = 0.713). The magnitude of these associations was consistent across subgroups analyses. The combination of high DSI (>6 g/d) and high ECW/TBW (>0.439) independently predicted a greater risk of LVH or ELVFP incidence in non-dialysis CKD patients. Moreover, the inclusion of eGFR and proteinuria improved the risk stratification ability of DSI and ECW/TBW in cardiac impairments in CKD.

Implications of Untreated Hypertension on Chronic Kidney Disease: A Literature Review

The untreated progression of hypertension holds significant implications for the development and progression of chronic kidney disease (CKD). Therefore, necessitating the implementation of strategic hypertension management measures to mitigate its impact on CKD. This review highlights the necessity of precise diagnostic methodologies that employ oscillometric equipment and advocates for pharmacological interventions, the incorporation of combination therapies such as the "Polypill" to effectively control hypertension, and lifestyle adjustments. The pivotal role of the renin-angiotensin-aldosterone system (RAAS) in hypertension is acknowledged, noting the importance of stringent blood pressure regulation and the utilization of RAAS-blocking agents to attenuate its association with CKD. A comprehensive analysis is provided on the effects of various classes of antihypertensive medications on renal function, encompassing diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), calcium channel blockers (CCBs), and nonsteroidal mineralocorticoid receptor antagonists. Additionally, both non-invasive and invasive therapeutic modalities for managing resistant hypertension in CKD patients are examined, alongside discussions on prognostic indicators and outcomes across different stages of CKD. Lifestyle modifications such as sodium restriction, weight management, and moderation of alcohol intake are assessed for their influence on CKD prognosis. The review also extensively delves into the impact of ethnicity on the prevalence and outcomes of hypertension-induced CKD, highlighting disparities and distinctive trends among diverse ethnic cohorts including Indian, African American, Middle Eastern, Chinese, Pacific Islander, Native American, and Hispanic populations. Additionally, this study addresses the intricate relationship between cardiovascular abnormalities and CKD, the significance of gastrointestinal disorders, and the importance of multidisciplinary approaches in CKD management. Furthermore, insights are provided into the significance of neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for identifying renal injury and CKD progression, alongside factors influencing adverse prognosis and life expectancy in CKD patients. This study accentuates the importance of tailored treatment assessments and interventions to address varied patterns and obstacles within ethnic groups, with the aim of optimizing CKD management strategies and reducing health disparitie

The influence of optimal blood pressure control on the progression of chronic kidney disease

Background/Aim: Chronic kidney disease (CKD) has seen a rapid increase worldwide in recent decades, now recognised as a global health issue of the 21st century. Optimal, continuous control of hypertension represents a crucial part of treatment capable of slowing the progression of CKD. The aim of this study was to demonstrate that optimal regulation blood pressure control in patients with essential and secondary hypertension, along with CKD, slows the progression of CKD. Methods: The research was conducted at the University Clinical Centre of the Republic of Srpska, Banja Luka, Internal Clinic Nephrology Department. A retrospective-prospective study was blind for patients and lasted for 24 months. It included 97 patients, aged 18 and above, of both genders, hypertensive, in the 3rd or 4th stage of CKD (creatinine clearance of 15-59 mL/min). Assess the outcome of CKD, a "complex (undesirable) clinical outcome" was taken - one of three fundamental clinically undesirable events: double increase in serum creatinine values at the end of 24 months, onset of terminal renal insufficiency, or patient death. Patients were classified into three groups: I group - 30 patients with essential hypertension and CKD with optimally regulated blood pressure; II group - 32 patients with secondary hypertension and CKD with optimally regulated blood pressure; III control group - 35 patients with hypertension of various causes and CKD who did not achieve target blood pressure values. Blood pressure control was measured from month 0 to month 24 - once a month. Laboratory tests were taken every 3 months (red blood cells, haemoglobin, glycaemia, cholesterol, urea, creatinine, uric acid, sodium, potassium in serum and urine). Results: There was a highly statistically significant difference in glomerular filtration rate in the first group compared to the third group and in the second group compared to the third group. No statistically significant difference in glomerular filtration rate between the first and second groups was observed, where good blood pressure regulation was achieved. Conclusion: Optimal blood pressure control in the examined groups, regardless of the cause of CKD, was responsible for slowing the progression of CKD compared to the group with unregulated blood pressure.

Evaluating the renoprotective effectiveness of sodium-glucose co-transporter 2 inhibitor therapy in patients with chronic kidney disease: A prospective study

Background/Aim. Chronic kidney disease (CKD) is a global health concern associated with increased cardio-vascular risks and premature mortality. Proteinuria is a key prognostic indicator for CKD outcome. Sodium-glucose cotransporter 2 (SGLT2) inhibitors show potential for reducing proteinuria and slowing CKD progression. The aim of the study was to determine the impact of SGLT2 inhibitor therapy on CKD patients by evaluating the changes in the level of serum creatinine (sCr), 24-hour (24h) urine protein (UP), estimated glomerular filtration rate (GFR), and blood pressure (BP). Methods. This prospective study monitored 79 patients with CKD on therapy with SGLT2 inhibitors, who were followed up for one year. Patients received an SGLT2 inhibitor (dapagliflozin) once daily (10 mg), and assessment of specific parameters was conducted at baseline, 6 months, and 1 year later during the therapy. The study evaluated the levels of sCr, 24h UP, GFR, systolic BP (BPs), diastolic BP (BPd), uric acid (UA), total cholesterol (TC), triglycerides (Tg), low-density lipoprotein (LDL) cholesterol, sodium (Na+), and potassium (K+). Results. Over the one-year follow-up, significant changes were seen in UA levels (5.36, 4.99, 4.94 mg/dL, respectively; p = 0.032), 24h UP (662.60, 574.11, 417.09 mg/dL, respectively; p = 0.028), as well as BPs (128.44, 125.64, 126.12 mmHg, respectively; p = 0.026). No significant variations were observed in GFR, BPd, sCr, TC, Tg, LDL, and K+ levels. Na+ levels displayed a notable decrease (148.21, 147.57, 146.41 mmol/L, respectively; p = 0.021). Conclusion. The study suggests a potential benefit of SGLT2 inhibitors in managing CKD.

Significance of Chronic Kidney Disease on Morbidity and Mortality in Hospitalized Patients With COVID-19.

Patients with comorbid illnesses are at risk for worse outcomes with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; COVID-19). Our research examined patients with chronic kidney disease (CKD) to establish whether it remains an independent risk factor for mortality and morbidity in patients with COVID-19. We conducted a retrospective cohort study using an electronic patient database in 2020. An observational dataset from 149 hospitals comprising a United States-based health system (HCA Healthcare) was analyzed. Hospitalized patients (N=11 086), aged 18 and above, with a COVID-19 polymerase chain reaction positive result between January 1, 2020, and September 1, 2020, were included in the initial data set.Primary outcomes were in-hospital death or discharge to hospice in patients with COVID-19. Secondary outcomes were individual components of the primary outcome including intensive care unit (ICU) admission, ventilator dependency, development of acute kidney injury (AKI), and in-hospital death. Baseline patient characteristics were recorded, including demographic variables and comorbidities. A total of 11 086 patients were included in the analysis. The study group included patients with CKD (5543 patients). Patients in the control group (5543 patients) were propensity matched for age, race, sex, and ethnicity. The primary outcome of in-hospital death or discharge to hospice was observed in 20.96% of patients with CKD compared to 11.91% of the control group with an odds ratio of 1.58 (confidence interval 1.37-1.80). ICU admission was required for 37.20% of patients in the CKD group and 21.63% of patients in the control group (P < .001). Ventilator dependency was found in 14.41% of patients in the CKD group and 8.59% of patients in the control group (P < .01). Development of AKI was seen in 5.65% of patients in the CKD group and 2.90% of patients in the control group (P < .01). A logistic regression model confirmed an independent association between underlying CKD and in-hospital death or discharge to hospice in patients with COVID-19. Our study confirms an independent association between underlying CKD and poor outcomes among hospitalized patients with COVID-19, including in-hospital death or discharge to hospice.

Impact of hemoglobin adducts of ethylene oxide on the prevalence and prognosis of chronic kidney disease in US adults: an analysis from NHANES 2013-2016.

Animal experiments have shown that high exposure to ethylene oxide (EO) can cause multiple system damages including the renal system. Recent studies have reported associations between exposure to EO and cancer, dyslipidemia, diabetes, and cardiovascular disease. However, the impact of exposure to EO on the prevalence and prognosis of chronic kidney disease (CKD) in humans is scarcely investigated. The study was designed to investigate the associations between EO exposure and incidence and prognosis of CKD among 2900 US adults. Exposure to EO was measured by detecting the levels of hemoglobin adducts of EO (HbEO). The diagnosis of CKD was made according to an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 and/or a urinary albumin-to-creatinine ratio (UACR) > 30 mg/g. Prognosis of CKD was assessed based on the evaluation system initiated by KDIGO that consists of eGFR and UACR. Survey-weighted generalized linear models and proportional odds models were constructed to assess the associations between HbEO and prevalence and prognosis of CKD, with odds ratios (ORs) and proportional odds ratios (PORs) and their 95% confidence intervals (CIs) reported, respectively. Restricted cubic spline (RCS) function was performed to depict the correlation between HbEO and CKD. The weighted median (interquartile range) of HbEO was 31.3 (23.1-60.3) pmol/g Hb. A total of 491 participants (16.9%) were diagnosed with CKD, and 153 participants (5.31%) were identified to be at high or very high risk. Referred to the first tertile of HbEO, the adjusted ORs (95% CIs) for CKD in the second and third tertile were 1.46 (0.85, 2.50) and 1.69 (1.00, 2.85), and the adjusted PORs (95% CIs) for prognosis of CKD in the second and third tertile were 1.37 (0.94, 1.99) and 1.58 (1.10, 2.26). When HbEO was analyzed as a continuous variable, the adjusted OR (95% CI) for CKD and POR (95% CI for prognosis of CKD were 1.24 (0.97, 1.58) and 1.22 (1.01, 1.47), respectively. RCS analysis revealed a non-linear positive correlation between HbEO and prevalence of CKD (P for nonlinearity < 0.05). Subgroup analysis indicated smoking status had a significant impact on this association, which remained significant among never smokers but lost significance among smokers. Among US adults, increased EO exposure was independently related to increased CKD prevalence and poor CKD outcomes, which was established in never smokers but not among ever smokers.

Functional iron deficiency anemia was associated with higher mortality in chronic kidney disease patients: the NHANES III follow-up study

Anemia, a common complication of chronic kidney disease (CKD), is associated with poor prognosis. However, it is not completely clear whether this association is caused by anemia per se or other comorbidities. Whether different types of iron deficiency anemia can predict the outcomes of CKD remains unclear. The dataset from NHANES III was analyzed and Cox multivariate regression models and propensity score matching (PSM) method were used to evaluate the effect of anemia on mortality. Of 4103 patients with CKD, 14.6% had anemia. Among those with anemia, 38.8% had absolute iron deficiency (AID), and 19.8% had functional iron deficiency (FID). During the median follow-up time of 13.8 years, 2964 deaths and 804 cardiovascular deaths were observed. Anemia was robustly associated with a high risk of all-cause mortality in CKD patients after adjusting covariates by two multivariate regression models (Model 1: HR = 1.485, 95%CI:1.340–1.647, p < 0.001; Model 2: HR = 1.391, 95%CI:1.250–1.546, p < 0.001). In the PSM cohort, anemia was still an independent risk factor for all-cause mortality (Model 1: HR = 1.443, 95%CI: 1.256–1.656, p < 0.001; Model 2: HR = 1.357, 95%CI:1.177–1.564, p < 0.001). In the CKD population, anemia patients with FID had the highest risk of mortality than the other anemia groups (p < 0.05), while AID had a mortality rate similar to those without anemia (p > 0.05). In conclusion, anemia was associated with a worse prognosis in patients with CKD, which may be attributed to the higher mortality risk of FID rather than AID. AID wasn’t associated with a higher mortality rate compared with CKD patients without anemia.

Emerging Preventive Strategies in Chronic Kidney Disease: Recent Evidence and Gaps in Knowledge.

Chronic kidney disease (CKD) is increasingly prevalent worldwide and is associated with increased cardiovascular risk. New therapeutic options to slow CKD progression and reduce cardiovascular morbidity and mortality have recently emerged. This review highlights recent evidence and gaps in knowledge in emerging CKD preventive strategies. EMPA-Kidney trial found that empagliflozin, a sodium-glucose co-transporter 2 inhibitor (SGLT2i) led to 28% lower risk of progression of kidney disease or death from cardiovascular causes, compared to placebo. This reinforced the previous findings from DAPA-CKD and CREDENCE trials and led to inclusion of SGLT2i as the cornerstone of CKD preventive therapy in both diabetic and non-diabetic CKD. Finerenone, a selective nonsteroidal mineralocorticoid receptor antagonist, slowed diabetic kidney disease progression by 23% compared to placebo in a pool analysis of FIDELIO-DKD and FIGARO-DKD trials. Non-pharmacological interventions, including low protein diet, and early CKD detection and risk stratification strategies based on novel biomarkers have also gained momentum. Ongoing efforts to explore the wealth of molecular mechanisms in CKD, added to integrative omics modeling are well posed to lead to novel therapeutic targets in kidney care. While breakthrough pharmacological interventions continue to improve outcomes in CKD, the heterogeneity of kidney diseases warrants additional investigation. Further research into specific kidney disease mechanisms will facilitate the identification of patient populations most likely to benefit from targeted interventions.

CKD-Associated Pruritus and Clinical Outcomes in Nondialysis CKD

Itching is a frequent symptom experienced by people with chronic kidney disease (CKD). We investigated the associations of CKD-associated pruritus (CKD-aP) with clinical outcomes. This was a longitudinal cohort study. Patients from Brazil, France, and the United States enrolled in the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps) from 2013 to 2021, an international prospective cohort study of adults with nondialysis dependent CKD, and an estimated glomerular filtration rate (eGFR) of<60 mL/min/1.73 m2 were included. CKD-aP was self-reported by response to the question: "During the past 4 weeks, to what extent were you bothered by itchy skin?" The outcomes were as follows: CKD progression, kidney replacement therapy (KRT) initiation, mortality, hospitalization, cardiovascular events, infection events. Associations with time-to-event outcomes were investigated using Cox proportional hazards models adjusted for potential confounders. There were 4,410 patients from 91 clinics with a median age of 69 years and a median eGFR at patient questionnaire completion of 29 (21-38) mL/min/1.73 m2. The proportion of patients not at all, somewhat, moderately, very much, and extremely bothered by itchy skin was 49%, 27%, 13%, 7%, and 3%, respectively. Patients with more advanced stages of CKD, older age, and greater comorbidities reported to be more likely bothered by itchy skin. Among patients at least moderately bothered, 23% were prescribed at least 1 pharmacotherapy (35% in the United States, 19% in France, 4% in Brazil), including antihistamine (10%), gabapentin (6%), topical corticosteroids (4%), pregabalin (3%), or sedating antihistamine (3%). The HR (95% CI) for patients extremely (vs not at all) bothered was 1.74 (1.11-2.73) for all-cause mortality, 1.56 (1.11-2.18) for all-cause hospitalization, and 1.84 (1.22-2.75) for cardiovascular events. As CKD-aP severity increased, patients also had higher rates of infection events (P= 0.04); CKD-aP severity was not associated with KRT initiation (P= 0.20) or CKD progression (P= 0.87). The limitations were 25% nonresponse rate, recall bias, and residual confounding factors. These results demonstrate a strong association between severe itch and clinical outcomes, providing the nephrology community new insights into the possible adverse consequences of CKD-aP in individuals with nondialysis CKD, and warrant further exploration. Chronic kidney disease-associated pruritus (CKD-aP) is a common disturbing symptom of chronic kidney disease (CKD). This article analyzes longitudinal data from the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps) to describe prevalence of CKD-aP in 4,410 individuals with nondialysis CKD, and its association with clinical outcomes. We found that 51% of the surveyed population were bothered by pruritus. CKD-aP was more prevalent in those with more advanced stages of CKD, older age, and with more comorbid conditions. Compared to those not at all bothered by pruritus, those who were extremely bothered had a higher risk of all-cause mortality, hospitalizations, and cardiovascular events. Severity of CKD-aP was not associated with CKD progression or initiation of kidney replacement therapy.

Особенности CAKUT-синдрома (врожденных аномалий развития мочевыделительной системы): клинический случай

A clinical observation of a child with a severe combined defect of the reproductive system and reproductive system (cAKuT syndrome) is presented. cAKuT syndrome accounts for more than 20% of birth defects. congenital anomalies of the urinary system account for 40–50% of cases of end-stage renal disease in children and 7% in adults worldwide. early diagnosis and treatment of cAKuT syndrome in children is one of the most important tasks of pediatric nephrology at present. It is necessary to monitor the course of the disease and assess the rate of development of unfavorable outcomes of chronic kidney disease. clinical observation of cAKuT syndrome is to optimize the therapeutic tactics of the underlying disease and reduce the disability of the child population.

Long-term Patiromer Use and Outcomes Among US Veterans With Hyperkalemia and CKD: A Propensity-Matched Cohort Study

Patiromer is a potassium binder approved for the long-term management of hyperkalemia. Although patiromer use among patients with advanced chronic kidney disease (CKD) has been shown to reduce the discontinuation of renin-angiotensin-aldosterone system inhibition therapy, it remains unclear whether patiromer can improve clinical outcomes. The aim of this study was to examine the association of long-term patiromer use with clinical outcomes among hyperkalemic patients with CKD. This was a longitudinal observational study. We evaluated a national cohort of 854,217 US Veterans who had at least 1 serum potassium measurement of≥5.1 mEq/L and were treated at US Department of Veterans Affairs health care facilities between January 2016 and September 2019. The exposure was long-term patiromer use. The outcomes were as follows: (1) composite endpoint of kidney failure with replacement therapy (KFRT) or all-cause death and (2) all-cause death including the post-KFRT period. Cox proportional Fine-Graysubdistributionhazard models were used in a propensity-matched cohort. Among 2,004 patients who ever used patiromer during the study period (0.2% of the cohort), 666 met the criteria for long-term patiromer use. We matched 308 long-term patiromer users to 308 nonusers based on propensity scores. The median estimated glomerular filtration rate was 23.5mL/min/1.73m2, and the median potassium level was 5.2 mEq/L. Approximately 45% were on renin-angiotensin system inhibitor(s) at baseline. During follow-up, 93 patients developed KFRT, and 134 patients died. Long-term patiromer users, when compared to nonusers, experienced a 26% lower risk of the composite outcome (HR, 0.74; 95% CI, 0.53-1.01; P=0.06) and a 41% lower risk of all-cause mortality (HR, 0.59; 95% CI, 0.41-0.84; P=0.003). The study cohort included mostly male veterans with relatively short follow-up periods. Long-term patiromer use was associated with a lower risk of all-cause mortality among patients with CKD and hyperkalemia. Long-term potassium binder use for hyperkalemia may improve clinical outcomes in CKD. Hyperkalemia is a common complication of chronic kidney disease (CKD) and can result in the discontinuation of renin-angiotensin-aldosterone system inhibition therapy, a cornerstone of CKD management. Patiromer is a new potassium binder approved for the long-term management of hyperkalemia, but it remains unclear whether patiromer can improve clinical outcomes. We examined a cohort of US Veterans with hyperkalemia between January 2016 and September 2019 and found that patiromer use was uncommon for treating hyperkalemia during this study period. We then matched 308 long-term patiromer users and 308 nonusers based on propensity scores. Long-term patiromer users, when compared to nonusers, experienced a 26% lower risk of the composite outcome and a 41% lower risk of all-cause mortality. These findings indicate that long-term potassium binder use for hyperkalemia may improve clinical outcomes in CKD.

Changes of electrocardiography in clinical outcomes of chronic kidney disease: a retrospective study

Chronic Kidney disease (CKD) is a well-established major public health problem globally. CKD has been associated with increased morbidity, mortality, and rate of hospitalization, CKD is associated with increased risk of CVDs and associated mortality. Patients with CKD have multiple comorbidities and they have well-established risks that increase the risk of CVDs that may progress to end-stage renal disease (ESRD), where the kidneys are as of now not ready to satisfy the needs of the body. Both CKD and ESRD are related to an expanded gamble of cardiovascular infections (CVDs). Electrocardiographic (ECG) changes are extremely normal in patients with renal illness, particularly in those cases who have laid out CVDs. The ECG irregularities can have a likely relationship with the different reasons for CKD and can be related to different clinical results. This study aims to compare ECG abnormalities in 310 patients with CKD compared to 111 patients without CKD. The average age of the patients was 58±13.2 years with 88 females and 199 males and 250 patients having end-stage renal failure (ESRD). The resulting data showed that ECG changes revealed that 21 patients had ischemia changes (IHD), 15 had q-wave positive changes, and 65 had left ventricular hypertrophy (LVH). In conclusion, the ECG is recommended as a routine investigation in CKD/ESRD patients with DM and HTN. Moreover, evaluations should be performed based on physical examination and plans of care even when the ECG finding is negative.

From heart failure and kidney dysfunction to cardiorenal syndrome: TMAO may be a bridge

The study of trimethylamine oxide (TMAO), a metabolite of gut microbiota, and heart failure and chronic kidney disease has made preliminary achievements and been summarized by many researchers, but its research in the field of cardiorenal syndrome is just beginning. TMAO is derived from the trimethylamine (TMA) that is produced by the gut microbiota after consumption of carnitine and choline and is then transformed by flavin-containing monooxygenase (FMO) in the liver. Numerous research results have shown that TMAO not only participates in the pathophysiological progression of heart and renal diseases but also significantly affects outcomes in chronic heart failure (CHF) and chronic kidney disease (CKD), besides influencing the general health of populations. Elevated circulating TMAO levels are associated with adverse cardiovascular events such as HF, myocardial infarction, and stroke, patients with CKD have a poor prognosis as well. However, no study has confirmed an association between TMAO and cardiorenal syndrome (CRS). As a syndrome in which heart and kidney diseases intersect, CRS is often overlooked by clinicians. Here, we summarize the research on TMAO in HF and kidney disease and review the existing biomarkers of CRS. At the same time, we introduced the relationship between exercise and gut microbiota, and appropriately explored the possible mechanisms by which exercise affects gut microbiota. Finally, we discuss whether TMAO can serve as a biomarker of CRS, with the aim of providing new strategies for the detection, prognostic, and treatment evaluation of CRS.

Abstract 15660: Mitral Regurgitation in Patients With Chronic Kidney Disease: Results From the Chronic Renal Insufficiency Cohort Study

Background: Mitral regurgitation (MR) is more common in patients with chronic kidney disease (CKD) compared to the general population, However, longitudinal associations of MR and adverse outcomes in CKD, such as mortality and heart failure (HF), have not been well studied yet. Hypothesis/Aim: We aim to investigate the prevalence of MR and its association with mortality, incidence of HF, and atrial fibrillation (AF) in patients with CKD. Methods: We studied patients with CKD who had an echocardiography exam (2008-2013) in the Chronic Renal Insufficiency Cohort (CRIC) study. Independent t-tests and Chi-square tests were used to compare clinical and echocardiographic characteristics in patients with vs. without MR. The degree of MR was quantified using effective regurgitant orifice area (EROA) from apical-four chamber view and further categorized as trace, mild and moderate/severe. Kaplan-Meier (KM) Curves and Cox hazard models were used to estimate the association of MR degree and EROA with mortality, incidence of HF and AF. Results: Among a total of 2951 patients with CKD, 2167 (73.4%) patients had MR (EROA, 0.14±0.19 cm 2 ) with degrees of trace, mild, and moderate /severe MR comprising 54.3%, 12.5%, and 6.6%, respectively. Patients with MR were more likely to be female (47.39 vs. 42.73%), non-White race (51.8 vs. 46.8%), and have worse B-type Natriuretic Peptide (NTproBNP; 524.86 vs. 271.66 pg/ml) and left ventricular ejection fraction (53.7 vs. 55.8%) compared to those without MR. When stratified by estimated glomerular filtration rate (eGFR; 60-45, 45-30, &lt;30 ml/min/1.73 m 2 ), the group in the lowest eGFR category (n=703) had the highest prevalence of moderate/severe MR (9.2%, p &lt;0.05). KM Curves showed patients with CKD and moderate/sever MR had higher incidence of HF and AF than those with CKD and absent, trace, or mild MR ( p &lt;0.01). EROA was associated with the incidence of AF (hazard ratio [HR] = 1.08, p &lt;0.01) and HF (HR=1.06, p &lt;0.01), independent of age, sex, race, traditional cardiovascular risk factors, urine albumin-to-creatinine ratio, eGFR and NTproBNP, but not mortality. Conclusion: In patients with CKD, MR is independently associated with HF and AF, highlighting the importance of MR-specific interventions to improve cardiovascular outcomes.

Abstract 12836: Safety and Efficacy of Left Atrial Appendage Occlusion in Patients With Chronic Kidney Disease: A Meta-Analysis

Introduction: Left atrial appendage occlusion (LAAO) has been recognized as an alternative to preventing thromboembolic stroke in selected patients with non-valvular atrial fibrillation (AF). However, limited evidence exists regarding the safety of LAAO in patients with chronic kidney disease (CKD). This meta-analysis aims to evaluate the safety and efficacy of LAAO in CKD patients. Methods: We conducted a comprehensive search across various electronic databases, including PubMed, Embase, and the Cochrane Library, to identify relevant studies comparing the outcomes of CKD and non-CKD patients undergoing LAAO. The outcomes of interest included procedural success, in-hospital mortality, major bleeding, stroke, transient ischemic attack (TIA), and pericardial effusion/tamponade. The outcomes were pooled using the Hartung-Knapp-Sidik-Jonkman random-effects model, and the results were expressed as odds ratios (OR) with their corresponding 95% confidence intervals (CI). Results: Seven studies involving 38,184 patients (5,742 CKD, 32,442 non-CKD) were included in the final analysis. The rate of procedural success (98.4% vs. 97.2%, OR 1.64, 95% CI: 0.78-3.45, p=0.19) was similar between both groups. Regarding procedural complications, there were no significant differences in terms of the risk of in-hospital mortality (OR 1.87, 95% CI: 0.60-5.82, p=0.28), stroke (OR 2.19, 95% CI: 0.76-6.29, p=0.15), TIA (OR 1.64, 95% CI: 0.78-3.45, p=0.19), major bleeding (OR 1.85, 95% CI: 0.78-4.42, p=0.16), or pericardial effusion/tamponade (OR 1.23, 95% CI: 0.76-2.00, p=0.39) between the two patient groups. Conclusions: Our study demonstrates comparable safety and efficacy of LAAO in patients with CKD compared to those without CKD. Further large prospective studies are warranted to confirm these findings.

The evolution of type 2 diabetes management: glycemic control and beyond with SGLT-2 inhibitors and GLP-1 receptor agonists.

Diabetes mellitus (DM) is one of the most prevalent diseases encountered by the primary care physician on a daily basis. Complications associated with DM can include nephropathy, neuropathy, and retinopathy ("microvascular complications"), along with cardiovascular disease (CVD), which can include myocardial infarction (MI) and strokes ("macrovascular complications"). In the 1990s, landmark clinical trials demonstrated that intensive glycemic control can reduce the risk of developing microvascular complications, but reduction in macrovascular complications with intensive glycemic control was not clearly demonstrated. At this point, intensive glycemic control became the standard of care (SOC). In the 2000s, additional trials evaluating the effect of intensive glycemic control in patients with type 2 diabetes mellitus (T2D) and established CVD, or risk factors for CVD, subsequently failed to identify a macrovascular benefit from intensive glycemic control, and one of the trials was terminated early because of an increase in the risk of mortality observed among patients assigned to receive intensive glycemic control. These results led to less strict glycemic targets being recommended in older patients, particularly those with established CVD. In 2007, everything changed after a report surfaced suggesting that rosiglitazone was associated with a significant increase in the risk of MI, as well as an increase in the risk of cardiovascular death that was of borderline significance. As a result, in 2008, the FDA mandated that all new diabetes medications must exclude an unacceptable level of risk for atherosclerotic cardiovascular disease (ASCVD) prior to drug approval, and thus undergo additional cardiovascular safety trials. Accordingly, through these trials, some of the newer agents, particularly sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA), were demonstrated to reduce the risk of major adverse cardiovascular events (MACEs), independent of their effect on glycemic control. These findings subsequently led to further trials to evaluate the effects of some of these therapies on the risk of chronic kidney disease (CKD) progression, as well as adverse heart failure-related outcomes. SGLT-2 inhibitors have been demonstrated to reduce the risk of CKD progression, as well as a reduction in the risk of cardiovascular death or hospitalization secondary to heart failure in patients with both reduced ejection and preserved ejection fractions. A trial evaluating the effects of GLP-1RA on CKD outcomes is ongoing. The aim of this narrative review article, compiled by identifying relevant studies via the utilization of PubMed, is to provide a broad overview over the various clinical trials and analyses that have led to current diabetes management guidelines, and ultimately, help guide primary care physicians in selecting therapies that will not only improve glycemic control and reduce the risk of microvascular complications, but also reduce the risk of macrovascular disease in their patients with T2D.

Protein Biomarkers and Major Cardiovascular Events in Older People With Advanced CKD: The European Quality (EQUAL) Study

Rationale & ObjectiveCardiovascular disease is the leading cause of morbidity and mortality in chronic kidney disease (CKD). We investigated 184 inflammatory and cardiovascular proteins to determine their potential as biomarkers for major cardiovascular events (MACE). Study DesignEQUAL is an observational cohort study which enrolled people aged ≥65 years with an estimated glomerular filtration rate ≤20 ml/min/1.73m2. Setting & ParticipantsRecruited participants were split into Discovery (n=611) and Replication cohorts (n=292). ExposureOne hundred and eighty four blood protein levels measured at the baseline visit, each protein was analysed individually. OutcomeMACE. Analytical ApproachCox proportional hazard models adjusted for age, sex, eGFR, previous MACE and country were used to determine the risk of MACE. Proteins with false discovery rate adjusted P values <0.05 in the Discovery cohort were tested in the Replication cohort. Sensitivity analyses were performed, adjusting for traditional risk factors, CKD-specific risk factors and level of proteinuria, and with atherosclerotic and non-atherosclerotic MACE segregated. ResultsDuring 2.9 years median follow-up, 349 people (39%) experienced a MACE. Forty-eight proteins were associated with MACE in the Discovery cohort; 9 of these were reproduced in the Replication cohort. Three of these proteins maintained a strong association with MACE after adjustment for traditional and CKD-specific risk factors, and proteinuria. Tenascin (TNC), fibroblast growth factor-23 (FGF-23) and V-set and Immunoglobulin Domain containing protein 2 (VSIG2) were associated with both atherosclerotic and non-atherosclerotic MACE. All replicated proteins except carbonic anhydrase 1 and carbonic anhydrase 3 were associated with non-atherosclerotic MACE. LimitationsSingle protein concentration measurements and limited follow up time. ConclusionsOur findings corroborate previously reported relationships between FGF-23, vascular cell adhesion protein-1, TNC and placental growth factor with cardiovascular outcomes in CKD. We identify 5 proteins not previously linked with MACE in CKD, that may be targets for future therapies.