Predialysis Stages Of Chronic Kidney Disease Research Articles

#761 Effect of ketoanalogue-supplemented very low protein diet in the need to initiate renal replacement in chronic kidney disease patients

Abstract Background and Aims Chronic kidney disease (CKD) is a global concern, with increasing complications and potential end-stage renal disease. Protein intake restriction is crucial for conservative therapy. Investigators have theorized on the nephroprotective effect of either a very low-protein diet (VLPD) with ketoanalogues (KAA) or a low-protein diet (LPD); this was however not confirmed by the Modification of Diet in Renal Disease (MDRD) randomized clinical trial (RCT). This meta-analysis aims to evaluate the effect of VLPD supplemented with KAA on RRT need and disease progression among CKD patients. Method A systematic literature search was conducted up to January 3, 2024 for trials in the following databases: PUBMED/MEDLINE, Ovid MEDLINE, Google Scholar, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science and ClincalTrials.gov. Studies that compared VLPD supplemented with KAA to LPD in pre-dialysis CKD patients demonstrating outcomes such as the need for RRT, CKD progression, and all-cause mortality were included. A total of four studies were included in the final analysis. The number of individuals requiring and not requiring RRT on follow-up were computed and analyzed using fixed effects model; while CKD progression and mortality were analyzed using random effects models. Results Four studies (738 participants) investigated patients who needed RRT, CKD progression, and all-cause mortality on follow-up between those on VLPD with KAA and LPD. In Fig. 1, VLPD with KAA reduced the need of RRT by 36% (Odds Ratio 0.64, 95% CI: 0.45 to 0.93, P = 0.02), and decreased the incidence of CKD progression (Fig. 2) by 65% (Odds Ratio 0.35, 95% CI: 0.14 to 0.87, P = 0.02). Three studies (531 participants) reported on all-cause mortality (Fig. 3), and our analysis did not show a significant effect on all-cause mortality (OR 1.46, 95% CI: 0.72 to 2.96, P = 0.29). There was no significant heterogeneity among the studies. Conclusion The investigators conclude that the present meta-analysis of 4 RCTs demonstrates that the use of VLPD supplemented with KAA reduced the need for RRT initiation and progression of CKD among pre-dialysis CKD Stage 4-5 patients when compared to those on the conventional LPD regimen. Therefore, protein restriction diets especially VLPD with KAA should be considered and offered in eligible CKD patients as part of their supportive management.

#2085 Testosterone and markers of nutritional status correlate with leptin in chronic kidney disease

Abstract Background and Aims Leptin, the anorexic hormone, also appears to have a proatherogenic effect, contributing to the development of cardiovascular morbidity and mortality. Current data on factors related to serum leptin levels in different stages of chronic kidney disease (CKD) are inconsistent. The aim of this study was to evaluate the determinants of leptin level in pre-dialysis stage of CKD. Method We performed a cross-sectional study, including 73 patients, mean age 67 (60-78) years, 38% diabetic, with GFR 31 ± 20.85 ml/min per 1.73 m(2). We followed the correlations of leptin with inflammatory, nutritional, lipid markers, testosterone and others by univariate analysis and subsequently determined the strongest predictor for leptin level by multivariate analysis. Results Table. Correlation between the parameters and leptin in CKD pre-dialysis group. In the CKD pre-dialysis patients the best predictors for leptin level were body mass index, adipose tissue mass, lean tissue mass (for each p < 0.001) and testosterone (p < 0.001). Blood glucose (p = 0.013) was also a significant determinant of leptin level in pre-dialysis CKD patients. Conclusion In pre-dialysis CKD patients, testosterone levels together with nutritional markers are the best predictive markers for leptin levels. The management of these determinants can influence the level of leptin in CKD pre-dialysis patients and future research will determine if it can influence the atherosclerotic process.

#331 Vascular and lipid profile interplays in pediatric CKD patients

Abstract Background and Aims Chronic kidney disease (CKD) is characterized by irreversible kidney damage and/or progressive loss of function. Children with CKD often have additional CVD risk factors, including hypertension and dyslipidemia. They may have myocardial abnormalities and early atherosclerosis evidence, such as coronary artery calcification, abnormal flow-mediated dilation, increased carotid intima-medial thickness (CIMT), and increased aortic stiffness. These abnormalities seem to be, in part, related to the degree of uremia. This study aimed at assessing the interrelationship between vascular status and lipid profile abnormalities in different stages of CKD in pediatric patients. Method This cross-sectional study was done on 99 patients: 33 with stage 5 CKD on regular hemodialysis & 33 pre-dialysis CKD stage 2-4 on conservative management & 33 age and sex matched controls. Anthropometric measures, blood pressure readings, and a lipid profile were done to all groups. Intima media thickness was measured using B-mode ultrasound doppler in both the common and internal carotid arteries (CCA, ICA). Which is a non-invasive way to measure the artery walls and track the early impacts of the atherosclerotic process. Results There was an obvious increase in blood pressure the percentiles in all CKD patients in relation to controls. The waist-to-hip ratio in CKD 2-4 patients was significantly higher than in CKD 5 patients, and both were higher than the controls, with means (±SD) of 1.01 (0.19), 0.88 (0.10), and 0.86 (0.05), respectively. Except for high-density lipoproteins (HDL), the lipid profile, including triglycerides, cholesterol, and low-density lipoproteins (LDL), were all significantly increased when comparing CKD 2-4 to CKD 5, and both higher than the controls: 170.45 (42.04), 166.00 (45.57), and 100.88 (26.19) for triglycerides (p 0.001). The right and left ICA and CCA showed a significant increase in the intimal thickness being higher in the CKD 5 group than the CKD 2-4 and both higher than the controls. On studying the correlation between the duration of CKD in years and other variables, we found a positive correlation with triglycerides (r = 0.409 & p = 0.001) and right CCA IMT (r = 0.271 & p = 0.028); however, the HDL (r = −0.326 & p = 0.007) revealed a negative correlation in all CKD patients. The HDL level showed an inverse correlation with right CCA and ICA. Conclusion Patients with CKD have an increased waist-to-hip ratio, dyslipidemia, and increased carotid IMT, which are factors that lead to the early development of atherosclerosis. Special care should be directed to CKD patients, especially those in stages 2-4, to control their lipid profile and postpone the development of atherosclerosis as much as possible.

Role of telemedical technologies at all stages of treatment of nephrological patients

BACKGROUND: Patients who, due to great distance or for other reasons, are unable to visit the medical center, must be provided with high quality and accessible medical care. Quality assurance and improvement of two-way communication between the patient and the medical staff must be ensured. The work is conducted at https://nefrocentr.ru.
 AIM: The study aims at improving the efficiency and quality of medical care for patients of nephrological profile, i.e. patients with chronic kidney disease (CKD) of grade IIIbV (pre-dialysis stages), patients undergoing renal replacement therapy (hemodialysis and peritoneal dialysis), and renal transplant recipients to reduce emergency hospitalizations and mortality and improve overall survival, as well as developing and implementing telerehabilitation and improving quality of life.
 METHODS: The Telenephrocenter platform was created with the support of the Moscow Health Department, the Moscow Center for Innovative Technologies, and the Moscow Social Development Complex (Grant project No. 25-12-1/22 for the creation of a digital ecosystem for the Moscow Nephrology Cluster to promote alternative models of home nephrology care for patients with grades IIIb-IV-V CKD and kidney donor recipients).
 
 Application and improvement of existing online platforms for remote monitoring: video consultations, use of questionnaires and health assessment scales, therapy correction, dialysis program, and group telerehabilitation.
 Creation of educational video tutorials for patients to improve literacy with the further formation of a library of knowledge to teach the rules of life, nutrition, self-control, physical activity, hygiene, therapy, and peritoneal dialysis procedures.
 Telepatronage and follow-up of patients on peritoneal dialysis.
 
 RESULTS: The system is a multidimensional information base that allows collecting data on the patients health status outside of the medical facility. Over 150 patients after autologous kidney transplantation, 80 patients on peritoneal dialysis, 25 patients on hemodialysis, and 23 patients on pre-dialysis CKD stages are under remote monitoring. The system enables the doctor to adjust the prescription of drugs, provide an urgent response to patients problems, and select the correct algorithm for behavior in a critical situation. Monitoring is based on questionnaires to which the patient answers according to a schedule set by the doctor. The questionnaire contains a set of symptoms that the patient chooses based on the intensity of the color. The aggregate of the responses forms a heat map of health status, which, when viewed remotely, allows the doctor to determine whether the patient has a problem and what kind of problem he or she has. Thus, the doctor makes informed decisions about further treatment. The resource allows patients to review a wide range of information material. Online consultations for patients, i.e. tele-educational activities for groups of nephrological patients depending on the type of pathology with the development of video tutorials from doctors on major problems and side-effects, are conducted. The effectiveness of the ongoing therapy (drug therapy and renal replacement therapy) is assessed remotely to adjust, cancel, and select the drug therapy. Weekly classes on physical rehabilitation and dietary support and nutrition are offered in an online format.
 CONCLUSIONS: The creation of the digital ecosystem of the Moscow nephrology cluster to provide telesupport to all nephrology patients plays an important role in everyday life. The ability to get quality timely care allows for quality control of patients. Questionnaires, including assessment of the psychological state of patients, provide early detection of complications after correction of immunosuppressive therapy and increase patients adherence to therapy. Conducting online patient schools on dietary and physical activity modification helps to reduce anxiety and improve mood, increase physical activity, form good eating habits, and adjust dietary intake. These conclusions are based on weekly monitoring of patient diaries.

#4277 EGF, GDF-15 AND NEOPTERIN AS PREDICTORS OF CHRONIC KIDNEY DISEASE PROGRESSION IN CHILDREN BY MEANS OF ARTIFICIAL NEURAL NETWORK MODELS

Abstract Background and Aims Progression of chronic kidney disease (CKD) is a compound process, where activation of immunocompetent cells and subclinical inflammation play pivotal role. Enhanced atrophy of the tubular cells, and finally, gradual fibrosis of tubulointerstitial tissue, are responsible for irreversible character of the disease. Multiple molecules influence above-mentioned processes. Growth differentiation factor (GDF)15, a member of TGF-β cytokine superfamily, is a marker of inflammation and an integrative signal in both acute and chronic stress conditions. Elevated serum concentrations of GDF15 were associated with increased risk of development and progression of CKD in adults, as well as with mortality in this group of patients. Our previous investigation revealed increased serum GDF15 concentrations in children on chronic dialysis. Epidermal growth factor (EGF), a tubule-specific protein, promotes proliferation, differentiation and migration of epithelial cells, and therefore, modulates regeneration of injured renal tubules. Decreased concentrations of EGF in urine were observed in variety of kidney diseases, including diabetic nephropathy, lupus nephritis or CKD. Our previous analysis of EGF serum concentrations in CKD children confirmed their decreased values on chronic dialysis. Neopterin is a product of activated monocytes and macrophages and serves as a marker of cell-mediated immunity. Elevated serum concentrations of neopterin were observed in CKD adult patients, our investigation revealed its increased values in children on chronic dialysis. None of the above mentioned markers was analyzed in the population of CKD children treated conservatively. Therefore, the aim of study was to assess the serum concentrations of EGF, GDF-15 and neopterin in children with CKD on conservative treatment and verify the usefulness of these markers in predicting CKD progression by means of artificial intelligence tools. Method The study group consisted of 153 children with pre-dialysis CKD stages 1-5 (stage 1 – 27 patients, stage 2 – 26 patients, stage 3 – 51 patients, stage 4 - 28 patients, stage 5 – 21 patients). EGF, GDF-15 and neopterin serum concentrations were assessed by ELISA. The patient database was implemented into the artificial neural network. In detail, the recursively selected subsets of input variables constituted the input layer of an artificial neural network built of perceptrons (multi-layer perceptron). Anthropometric data, biochemical parameters, EGF, GDF15 and neopterin were included into the model, serum creatinine and eGFR, as direct classifiers of CKD stage, were excluded. Various models were tested, regarding their accuracy, AUROC and Matthews correlation coefficient (MCC) values. Results EGF serum concentrations decreased gradually, whereas GDF15 and neopterin values rose systematically with CKD progression, keeping statistically significant inter-stage differences. Moreover, the most precise ANN model, among the tested artificial neural networks, contained EGF, GDF15 and neopterin as input parameters and classified patients into either CKD 1-3 or CKD 4-5 groups. This model has put new patients into appropriate classes with excellent Accuracy of 96.77%, AUROC 0.9169 and Matthews correlation coefficient (MCC) of 0.9157. Conclusion The presented model of an artificial neural network, with serum concentrations of EGF, GDF15 and neopterin as input parameters, may serve as a useful predictor of CKD progression in the pediatric population. It suggests the essential role of inflammatory processes, defined by newly discovered markers, in the renal function decline towards advanced stages of CKD in children.

Short-term safety and efficacy of escalating doses of atorvastatin for dyslipidemia in children with predialysis chronic kidney disease stage 2-5.

Dyslipidemia is a potentially modifiable risk factor in patients with chronic kidney disease (CKD). Information on the safety and efficacy of statins in pediatric CKD is limited. Patients with CKD stage 2-5 and aged 5-18years with low-density lipoprotein cholesterol (LDL-C) > 130mg/dL and/or non-high-density lipoprotein cholesterol (non-HDL-C) > 145mg/dL were enrolled from September 2019 to February 2021. All patients were administered atorvastatin 10mg/day, which was escalated to 20mg/day if LDL-C remained > 100mg/dL and/or non-HDL-C > 120mg/dL at 12weeks. Proportion of patients achieving target lipid levels (LDL-C ≤ 100mg/dL and non-HDL-C ≤ 120mg/dL) and adverse events were assessed at 24weeks. Of 31 patients enrolled, target lipid levels were achieved in 45.2% (95% CI 27.8-63.7%) at 24weeks; 22 patients required dose escalation to 20mg at 12weeks. There was no difference in median lipid level reduction with 10 (n = 9) versus 20mg/day (n = 22, P = 0.3). Higher baseline LDL-C (OR 1.06, 95% CI 1.00-1.11) and older age (OR 36.5, 95% CI 2.57-519.14) were independent predictors of failure to achieve target lipid levels with 10mg/day atorvastatin. None had persistent rise in AST/ALT > 3 times upper normal limit (UNL) or CPK > 10 times UNL. No differences were noted in adverse events due to atorvastatin 10 or 20mg/day. Atorvastatin (10-20mg/day) administered for 24weeks was safe and effectively reduced LDL-C and non-HDL-C in children with CKD stages 2-5. Patients with higher baseline LDL-C required higher doses to achieve the target. A higher resolution version of the Graphical abstract is available as Supplementary information.

Структура кардиоваскулярных нарушений у детей с хронической болезнью почек

Objective. To study the structure of cardiovascular pathology in children with chronic kidney disease (CKD). Patients and methods. 74 children were examined, including 40 patients on dialysis and 34 patients at the predialysis stage of CKD. The following parameters were determined: the thickness of the interventricular septum and the posterior wall of the left ventricle (LV), the final systolic and final diastolic LV size, shock volume, ejection fraction. The myocardial mass index (LVMI) and the relative wall thickness (RWT) of the LV were calculated according to the following formulas. Results. According to echocardiography data in children receiving dialysis, LV myocardial hypertrophy was observed in the majority of children – 17 (42.5%, p < 0.001), of which in 35.3% of cases (6 children) concentric remodeling was detected (RWT ≥0.45, LVH within 90 g/m2), in 41.2% of cases (in 7 patients), concentric hypertrophy was determined (RWT ≥0.45, LVMI 111.7 ± 11.4 g/m2), eccentric hypertrophy was detected in 23.5% of patients (in 4 – RWT ≤0.45, IMLJ 115.6 ± 11.9 g/m2); systolic dysfunction was found in 10 (25%) children with stage 5d CKD, in 8 (20%) – diastolic dysfunction, in 5 (12.5%) – the valvular damage. In 19 (55.9%) children with the predialysis stage, there is a normal LV geometry (RWT <45 with normal LV), in 15 (44.1%) – concentric remodeling (RWT >45 with normal LVMI). Conclusion. CKD in children, as in adults, is associated with the highest risk of accelerated development of cardiovascular pathology. Cardiovascular pathology in CKD is manifested mainly by LV myocardial hypertrophy. LV hypertrophy, being an important risk factor for arrhythmias and heart failure, is especially characteristic of patients with dialysis for,m of CKD. Key words: cardiovascular disorders, chronic kidney disease

Abstract 14703: Short Term Safety and Efficacy of Escalating Doses of Atorvastatin for Dyslipidemia in Children With Predialysis Chronic Kidney Disease Stage 2-5

Introduction: Dyslipidemia is a potentially modifiable risk factor in patients with chronic kidney disease (CKD). Information on safety and efficacy of statins in pediatric CKD is limited. Methods: Patients with CKD stage 2-5, aged 5- 18 years with low density lipoprotein cholesterol (LDL-C) >130mg/dL and/or non-high density lipoprotein cholesterol (non HDL-C) >145mg/dL were enrolled from September 2019 to February 2021. All patients were administered atorvastatin 10 mg/day, and escalated to 20 mg/day if LDL-C>100 mg/dL and/or non-HDL >120mg/dL at 12 weeks. Proportion of patients achieving target lipid levels (LDL-C ≤100 mg/dL and non HDL-C ≤120mg/dL), change in lipid and adverse effects were assessed at 24 weeks. Wilcoxon sign rank test was used to assess percentage change in lipid. Results: Of the 31 patients enrolled, target lipid levels were achieved in 45.2% patients (95% CI 27.8%-63.7%) at 24-week; 22 patients required dose escalation to 20 mg at 12 weeks. There was no difference in median reduction in lipid levels with 10 mg/day (n=9) versus 20 mg/day (n=22; p=0.3). Higher baseline LDL-C (OR 1.06, 95% CI 1.00 to 1.11) and older age (OR 36.50 95% CI 2.57 to 519.14) were independent predictors of failure to achieve target lipid levels with 10 mg/day atorvastatin. None had persistent rise in AST/ALT >3 times upper normal limit (UNL) or CPK >10 times UNL. No differences were noted in the adverse effects of atorvastatin 10 mg/day and 20 mg/day. Conclusions: Atorvastatin (10-20 mg/day) administered for 24 weeks was safe and effectively reduced LDL-C and non HDL-C in children with CKD stage 2-5. Patients with higher baseline LDL-C required higher doses to achieve the target.

Фармакоэкономический анализ применения лекарственного препарата дапаглифлозин у пациентов с хронической болезнью почек и сахарным диабетом 2-го типа в Российской Федерации

Background. The economic costs associated with chronic kidney disease (CKD) are a significant burden on the health care system. The use of dapagliflozin is a breakthrough strategy in the management of patients with CKD and type 2 diabetes mellitus (T2DM) to slow the progression of the disease and reduce healthcare costs. Aim. To evaluate the clinical and economic efficiency of dapagliflozin in patients with T2DM and CKD in the Russian Federation. Materials and methods. A cost-effectiveness/utility analysis was carried out. The calculation of direct costs was carried out in a model adapted to the conditions of healthcare in the Russian Federation by using Russian cost indicators and characteristics of the patient population. Results. Dapagliflozin in addition to standard therapy compared with standard therapy will provide an additional average of 0.253 life years and 0.219 quality-adjusted life years per patient with stage 2–4 CKD and T2DM during 10 years of therapy. Cost reduction in case of using dapagliflozin and standard therapy compared with standard therapy alone amounted to an average of 49,350 rubles per patient. Dapagliflozin and standard therapy compared with standard therapy alone on the modeling horizon of 10 years allows to extend the stay in the pre-dialysis stages of CKD by an average of 7 months per patient. The use of dapagliflozin in 1000 targeted patients for 10 years will help to avoid 26 hospitalizations for heart failure (NNT – 39), as well as prevent 44 cases of acute kidney injury (NNT – 23) and 51 deaths from all causes (NNT – 20). Probabilistic sensitivity analysis showed the robustness of the results to changes in parameters of cost of therapy, clinical efficacy and usefulness of the studied medical interventions. Conclusion. Intensification of standard CKD therapy with dapagliflozin in patients with T2DM is clinically and economically justified.

POS-247 ASSOCIATION BETWEEN SERUM MAGNESIUM LEVELS AND ABDOMINAL AORTA CALCIFICATION IN PATIENT WITH PRE-DIALYSIS CHRONIC KIDNEY DISEASE

Several studies have revealed the relationship between serum magnesium levels and vascular calcification in chronic kidney disease patients .Despite excellent predictability of abdominal aorta calcification for cardiovascular disease events, the relationship between serum magnesium levels and abdominal aorta calcification, as evaluated by quantitative methods, in pre-dialysis patients remains unclear. This study aimed to determine the abdominal aorta calcification volume using computerized tomography and its association with serum magnesium levels in pre-dialysis chronic kidney disease stage 5 patients.

Стоит ли назначать малобелковую диету пожилому пациенту с хронической болезнью почек?

There are no clear dietary recommendations for patients over 70 years of age, while stages 3-5 of chronic kidney disease (CKD) and protein-energy wasting (PEW) is common among this category of patients. Nutritional status is known to be one of the significant factors influencing the prognosis of patients receiving renal replacement therapy. The aim of the research was the analysis of the mechanisms of PEW, methods for assessing the nutritional status and effectiveness of diets with different protein content in patients with CKD based on literature data. Material and methods. The research material was the scientific literature presented in the domestic and international (eLIBRARY, PubMed, Google Scholar) databases, as well as clinical recommendations for the management of geriatric patients with CKD, dietary recommendations for patients with anorexia and other conditions. Results. The studies devoted to the mechanisms of PEW were analyzed. One of the leading causes of this condition is anorexia, in the pathogenesis of which uremic toxins, inflammation and hormonal disorders are involved (hormones such as gastrin, cholecystokinin, leptin, insulin, testosterone and others may be involved in the pathogenesis). A number of studies have shown that limiting protein to 0.6 g/kg day could significantly reduce uremic dyspepsia risk and slow CKD progression. At the same time, several researchers gave data on the ineffectiveness of a low-protein diet in patients with CKD and diabetes mellitus and a significant risk of malnutrition. Subjective global assessment, the mini nutrition assessment and the geriatric nutritional risk index can be distinguished among the methods of assessing nutritional status. Conclusion. Research data on the effectiveness of a low-protein diet in elderly patients with stage 3B-5 CKD are contradictory. PEW in CKD is common and largely determines survival; the mechanism of PEW is complex. The study of the optimal nutritional diet for elderly patients with predialysis stages of CKD still remains an urgent problem.

Clinical and economic analysis of using dapagliflozin in patients with chronic kidney disease in the Russian Federation

Aim. To evaluate the clinical and economic efficiency of the use of dapagliflozin in patients with chronic kidney disease (CKD) stages 24 in Russian Federation.
 Materials and methods. Cost-effectiveness (utility) analysis has been carried out. Mathematical model has been developed, adapted to the healthcare system of the Russian Federation by using Russian cost and patients characteristics inputs. Life years (LYG) and quality-adjusted life years (QALY) were used as efficiency criteria. Only direct medical costs were taken into account. Cost-effectiveness (utility) analysis was carried out in the short-term (3 years) and long-term horizons (10 years).
 Results. The use of dapagliflozin in addition to standard therapy (ST) versus ST for CKD stage 24 in the short term (3 years) is cost effective: it allows you to additionally receive 0.042LYGs/0.035QALYs, while the incremental cost of an additional year of life is 827,399 rubles, an additional year of life adjusted for quality is 988,424 rubles, which does not exceed the threshold of willingness to pay according to World Health Organization recommendations 2 191,061 rubles. In the long term (10 years), the use of dapagliflozin in addition to ST will provide an additional 0.437LYGs/0.356QALYs and lead to a decrease of direct medical costs by 96,546 rubles on average for 1 patient. Thus, in the horizon of 10 years, the dapagliflozin + ST regimen is strictly preferred or dominant at the same time more effective and less costly.
 Conclusion. The use of dapagliflozin in addition to ST for the treatment of patients with CKD stages 24 in the long-term horizon (10 years) allows to extend the stay in the pre-dialysis stages of CKD by 8 months an average of 1 patient. Dapagliflozin therapy regimen and ST in a cohort of 1,000 patients with CKD stages 24 on the horizon of 10 years will avoid 30 hospitalizations due to heart failure (namber needed to treat NNT 34), 59 cases of acute kidney injury (NNT 18), 73 deaths from all causes (NNT 14).

Medication Prescription, Common Side-effects, and Nutritional Status are Associated in Patients With Chronic Kidney Disease

Chronic kidney disease (CKD) is associated with metabolic, nutritional, and extra-renal changes, as well as a high rate of comorbidities, which necessitates the prescription of numerous medications. Patients with CKD often experience poor nutritional status related to disease severity and prescribed medication; however, this association has not been investigated in depth. Therefore, this study aimed at investigating the association between prescribed medication and nutritional status in patients with CKD. Assessment of nutritional status was performed using anthropometric and functional measurements and by biochemical measures. Patient history and the number and type of currently prescribed medications were collected from patients' records. We evaluated the total number and the number of specific medicines with common or very common side-effects of nausea or xerostomia. Two hundred seventeen patients with CKD were included in this cross-sectional study (n=112 with pre-dialysis CKD stages 3-5, n=33 with hemodialysis, and n=72 with kidney transplant). On average, patients were prescribed nine medications concurrently. The number of prescribed medications was inversely associated with mid-upper arm circumference, skinfold thickness triceps, handgrip strength, serum albumin, and hemoglobin after adjustment for age, sex, and kidney function. Prescription of medications with nausea as a side-effect showed similar associations, whereas prescription of medications with xerostomia as a side-effect was associated with lower handgrip strength. Medication prescription was associated with poor nutritional status in patients with CKD, and monitoring of nutritional status in patients with CKD with long medication lists is warranted to identify and treat patients with poor nutritional status.

Low bone mineral density is associated with coronary arterial calcification progression and incident cardiovascular events in patients with chronic kidney disease.

ABSTRACTBackgroundAlthough it is well known that low bone mineral density (BMD) is associated with an increased risk of cardiovascular disease (CVD) and mortality in the general population, the prognostic role of bone mineral density (BMD) has not been established in the chronic kidney disease (CKD) population. Therefore we aimed to evaluate the association between BMD and the risk of CVD and cardiovascular mortality in patients with predialysis CKD.MethodsThis prospective cohort study was conducted with 1957 patients with predialysis CKD Stages 1–5. BMD was measured using dual-energy X-ray absorptiometry and coronary arterial calcification (CAC) scores were evaluated using coronary computed tomography. The primary outcome was a major adverse cardiovascular event (MACE).ResultsWhen patients were classified based on total hip BMD T-score tertiles stratified by sex, the lowest BMD tertile was significantly associated with an increased risk of MACE {hazard ratio 2.16 [95% confidence interval (CI) 1.25–3.74]; P = 0.006}. This association was also shown with BMD at the femur neck but not with BMD at lumbar spine. In the subgroup of 977 patients with follow-up CACs at their fourth year, 97 (9.9%) showed accelerated CAC progression (>50/year), and BMD was inversely associated with accelerated CAC progression even after adjusting for the baseline CAC score [odds ratio 0.75 (95% CI 0.58–0.99); P = 0.039]. In addition, baseline CAC was associated with an increased risk of MACEs after adjusting for total hip T-score.ConclusionsLow BMD was significantly associated with CAC progression and MACEs in patients with predialysis CKD.

Association between serum magnesium levels and abdominal aorta calcification in patients with pre-dialysis chronic kidney disease stage 5.

BackgroundSeveral studies have revealed the relationship between serum magnesium levels and vascular calcification in chronic kidney disease patients. Despite excellent predictability of abdominal aorta calcification for cardiovascular disease events, the relationship between serum magnesium levels and abdominal aorta calcification, as evaluated by quantitative methods, in pre-dialysis patients remains unclear. This study aimed to determine the abdominal aorta calcification volume using computerized tomography and its association with serum magnesium levels in pre-dialysis chronic kidney disease stage 5 patients.MethodsThis single-center cross-sectional study included 100 consecutive patients with pre-dialysis chronic kidney disease stage 5 between January 2016 and May 2020 at Aichi Medical University Hospital, Japan. The relationships between serum magnesium levels and the abdominal aorta calcification volume were assessed using multiple linear regression models after adjusting for clinically relevant factors. We also assessed clinical factors that affect serum magnesium levels.ResultsThe mean serum magnesium level was 2.0 mg/dL (interquartile range, 1.8 to 2.3). Multivariate analyses revealed that a higher serum magnesium level (stand. β = -0.245, p = 0.010) was significantly associated with a reduced abdominal aorta calcification volume, and that a history of cardiovascular disease (stand. β = 0.3792, p < 0.001) and older age (stand. β = 0.278, p = 0.007) were significantly associated with an increased abdominal aorta calcification volume. Moreover, multivariate analysis showed that the use of proton pump inhibitor or potassium-competitive acid blocker was significantly associated with lower serum magnesium levels (stand. β = -0.246, p = 0.019).ConclusionsThe present study revealed that the higher Mg level was significantly associated with lower volume of abdominal aorta calcification in pre-dialysis chronic kidney disease stage 5 patients. Further studies should be undertaken to determine the appropriate magnesium level to suppress vascular calcification.

MO601THE ASSESSMENT OF NUTRITIONAL STATUS AND MORTALITY IN GERIATRIC PATIENTS WITH CKD 3B-5 STAGES

Abstract Background and Aims:. the prevalence of chronic kidney disease (CKD) increases with age–almost 50% of people over the age of 70 have stage 3-5 CKD. Geriatric patients with pre-dialysis stages of CKD are recommended to assess the risk of absolute probability of death of the patient both in the case of starting dialysis and without it. Malnutrition in this group of patients is the risk factor of mortality. The EQUAL study, a European Quality Study on treatment in advanced chronic kidney disease, showed that according to the Subjective Global Assessment Scale the majority of the geriatric patients with with incident glomerular filtration rate &amp;lt;20mL/min/1.73m 2 (nondialysis) had a normal nutritional status (SGA 6-7), 26% had moderate PEW (SGA 3-5), and less than 1% had severe PEW (SGA 1-2). The aim is to assess prevalence of protein-energy wasting (PEW) and the absolute risk of death over 5 years in the geriatric patients with advanced chronic kidney disease (CKD). Method Materials and methods: a study of 151 geriatric patients with stage 3B-5 CKD, average age 77 ±8.6. Patient inclusion criteria: age 60-90 years, CKD stage 3B-5 (GFR in CKD-EPI &amp;lt;= 45 ml / min / 1.73 m2. Patient exclusion criteria: oncological diseases; acute infections; severe mental illness (including alcoholism), any serious somatic diseases, according to the researcher. The patients were assessed by Subjective Global Assessment; to assess the estimated 5-year mortality rate, patient indicators were evaluated on the Banzal scale. All patients were evaluated for laboratory data (absolute number of lymphocytes, hemoglobin, red blood cells, creatinine, urea, total protein, blood albumin, total cholesterol, blood potassium, and proteinuria); The study group consisted of 105 patients with stage 3B CKD, 35 patients with stage 4 CKD, and 11 patients with stage 5 CKD. Results according to the SGA 66,7% of patients with CKD 3b stage have normal nutritional status, 26,6% patients are mild to moderate malnourishment, 6,7 % are malnourished. 60% of patients with CKD 4 stage have normal nutritional status, 31,2% patients had moderate PEW, 8,8% had severe PEW. In patients with CKD 5 72,7% had moderate PEW, 27,3% had severe PEW. The level of total protein in the blood serum is correlated with nutritional disorders on the SGA scale(r=-0.52) in geriatric patients with predialysis stages of CKD. During assessing the absolute risk of death within 5 years (Bansal Score) in 20.9% of patients with CKD3B, the estimated mortality rate was 40%, in 12.4% 54%, in 25.7% 69% and higher. All patients with stage 5 CKD had a mortality risk of 40% or higher. Indicators of the the Bansal scale significantly increased with a decrease in GFR (r= - 0.68, r=-0.46). The Banzal mortality index (r=0.32) significantly increased with increasing the level of serum phosphorus and uremia. Conclusion. The prevalence of nutritional disorders are observed in 33-40% of elderly patients with stage 3B-4 CKD and until 75% with stage 5CKD. During assessing the absolute risk of death over 5 years in the study population of geriatric patients with CKD stages 3B-5, a high risk on the Bansal scale (69% or higher) was observed in 25.7% with CKD stage 3B, 60%

POS-677 THE ASSESSMENT OF COMORBIDITY AND MORTALITY IN GERIATRIC PATIENTS WITH CKD 3b-5 STAGES

The prevalence of chronic kidney disease (CKD) increases dramatically with age–almost 50% of people over the age of 70 have stage 3-5 CKD. Among patients aged 65 and older, the risk of developing end-stage chronic renal failure (ESRD) exceeds the risk of death only in those with eGFR <15ml/min/1, 73m2. Geriatric patients with pre-dialysis stages of CKD are recommended to assess the risk of absolute probability of death of the patient both in the case of starting dialysis and without it. Preparation for renal replacement therapy (RRT) may take longer due to comorbidity and frailty.

Tumor necrosis factor-alpha is associated with mineral bone disorder and growth impairment in children with chronic kidney disease.

Mineral and bone disorder (MBD) and growth impairment are common complications of pediatric chronic kidney disease (CKD). Chronic inflammation detrimentally affects bone health and statural growth in non-CKD settings, but the impact of inflammation on CKD-MBD and growth in pediatric CKD remains poorly understood. This study assessed associations between inflammatory cytokines with biomarkers of CKD-MBD and statural growth in pediatric CKD. This is a cross-sectional study of children with predialysis CKD stages II-V. Cytokines (IL-1b, IL-4, IL-6, IL-8, IL-10, IL-12, IL-13, TNF-α, interferon-γ), bone alkaline phosphatase (BAP), and procollagen type 1 N-terminal propeptide (P1NP) were measured at the same time as standard CKD-MBD biomarkers. Associations between cytokines, CKD-MBD biomarkers, and height z-score were assessed using linear regression analysis. Among 63 children, 52.4% had stage 3 CKD, 76.2% non-glomerular CKD etiology, and 21% short stature. TNF-α was the only cytokine associated with parathyroid hormone (PTH) independent of glomerular filtration rate. After stratification by low, medium, and high TNF-α tertiles, significant differences in PTH, serum phosphorus, alkaline phosphatase, BAP, P1NP, and height z-score were found. In a multivariate analysis, TNF-α positively associated with phosphorus, PTH, and alkaline phosphatase and inversely associated with height z-score, independent of kidney function, age, sex, and active vitamin D analogue use. TNF-α is positively associated with biomarkers of CKD-MBD and inversely associated with height z-score, indicating that inflammation likely contributes to the development of CKD-MBD and growth impairment in pediatric CKD. Prospective studies to definitively assess causative effects of inflammation on bone health and growth in children with CKD are warranted.

Частота нарушений питания у пациентов пожилого и старческого возраста с хронической болезнью почек

The number of elderly patients with chronic kidney disease (CKD) has increased significantly in the recent decades. It was proved that one of the factors determining the survival and quality of life of geriatric patients with CKD is the nutritional status of patients. Protein-energy deficiency is widespread among elderly patients at the pre-dialysis stages of CKD, while no study of the nutritional status of this population of patients was conducted in Russia. The purpose was to study the prevalence of nutritional disorders in geriatric patients with CKD stage 3B–5. As a result of a survey of 190 patients aged 60 to 90 y. o. with CKD stages 3B–5 (GFR according to CKD-EPI &lt;= 45 ml/min/1,73 m2), we found that this patient population is dominated by mild and moderate eating disorders — their prevalence was 53.5%. Symptoms of protein-energy deficiency were observed in 16.4% of patients. No significant differences were found between the indicators of nutritional status and the CKD stage. The nutritional status indicators correlated with the severity of anemia and hypoproteinemia.

Patient-reported outcomes in chronic kidney disease

The review provides a definition of the concept of «patient-reported outcomes (PRO)». The main components of PRO include health-related quality of life (QoL), symptoms assessed by the patient, functional status, satisfaction with treatment. The review presents a description of the most frequently used questionnaires for assessing QoL in patients with chronic kidney disease (CKD). It has been shown that the physical component of QoL decreases in predialysis stages of CKD. As CKD progresses, the Physical Component Summary (PCS) of the SF-36 questionnaire deteriorates, as well as the scale scores of Physical functioning, Pain, General health, and Role limitations caused by Physical problems (RP). Among the CKD-specific QoL scales, a deterioration in the scores of Symptoms/Problems, Burden of Kidney Disease, Effects of kidney disease on daily life is observed. There are no convincing data in the literature in favor of a decrease in psychosocial aspects of QoL in patients with CKD. The review presents the definition of «comprehensive conservative care» proposed by the experts convened at the 2013 KDIGO Controversies Conference on Supportive Care. It has been shown that comprehensive conservative care can be a fairly effective method of choice for elderly patients with Stage 5 CKD. It has been demonstrated that a decrease in PCS is independently associated with CKD progression and an increased risk of death. However, the information on QoL in predialysis CKD is insufficient. The use of different questionnaires for QoL assessment complicates data comparison. Randomized clinical trials are practically absent, which reduces the value of the results obtained.