Predialysis CKD Patients Research Articles

Periodontal Health of Pre-Dialysis Chronic Kidney Disease Patients in a Northeast Peninsular Malaysia Tertiary Hospital.

IntroductionChronic kidney disease (CKD) is associated with periodontal disease due to its hyperinflammatory state. Limited studies have explored the prevalence of periodontal disease among CKD patients in Malaysia.ObjectiveTo assess the periodontal status of pre-dialysis CKD patients in Hospital Universiti Sains Malaysia.MethodsA total of 46 pre-dialysis CKD patients who attended the nephrology clinic at Hospital Universiti Sains Malaysia were enrolled in this study. Periodontal examination was performed using the periodontal probing depth (PPD), clinical attachment loss (CAL) and plaque index.ResultsThe majority of the CKD patients were Malay (95.7%) and 80.4% were males. The mean age of the patients was 58.5 years. Using PPD measurement, 37 (74.0%) of the patients had mild periodontitis, 9 (20.0%) had moderate periodontitis and 3 (6.0%) had no periodontitis. Based on CAL measurement, 12 (26%) patients had mild periodontitis, 29 (63.0%) had moderate periodontitis and 5 (11%) had severe periodontitis. The mean (standard deviation [SD]) value of mild and moderate-to-severe periodontitis by PPD measurement were 4.26 (0.26) and 5.24 (0.36), respectively. The mean of mild and moderate-to-severe periodontitis by CAL measurement were 2.66 (0.62) and 4.98 (0.73), respectively. There was no correlation between the periodontal parameters and estimated glomerular filtration rate (PPD: r = −0.160, P = 0.914; CAL: r = −0.135, P = 0.372; plaque index: r = 0.005, P = 0.974).ConclusionThis study revealed a greater prevalence and severity of chronic periodontitis among CKD patients. Thus, the periodontal health of CKD patients’ needs to be screened and monitored.

FGF23 and the PTH response to paricalcitol in chronic kidney disease.

The parathyroid glands are endowed both with receptors responsive to FGF23 and to 1,25 vitamin D. Vitamin D receptor (VDR) activation, besides lowering PTH, also raises serum FGF23. FGF23 has been implicated in parathyroid resistance to VDR activation but the issue has never been investigated in predialysis CKD patients. In the Paricalcitol and Endothelial Functio in Chronic Kidney Disease (PENNY) study (NCT01680198), a 12-week randomized trial in stage G3-4 CKD patients (placebo n=44 and paricalcitol n=44), we measured PTH and the active form of FGF23 with no missing value across the trial. At baseline, serum FGF23 and PTH were inter-related (r=.54, P<.01). Paricalcitol reduced serum PTH (-75.1pg/mL, 95% CI: -90.4 to -59.8; P<.001) and increased FGF23 (+107pg/mL, 95% CI: 44-170pg/mL, P=.001). Changes in the Ca×P product in response to paricalcitol were closely related to simultaneous FGF23 changes in an analysis adjusted for changes in serum calcium and phosphate (P<.001). Of note, baseline FGF23, appropriately adjusted for baseline PTH, was unrelated with the PTH response to paricalcitol (r=-.06, P=.72). Placebo did not change neither PTH nor FGF23. Serum FGF23 and PTH are inter-related and changes in the Ca×P product induced by paricalcitol per se correlate with the FGF23 response to this drug. Independently of serum FGF23, the parathyroid glands of patients with moderate to severe CKD maintain an intact ability to respond to VDR activation.

Serum Klotho, Cardiovascular Events, and Mortality in Nondiabetic Chronic Kidney Disease

Background: Experimental studies indicate that Klotho deficiency is a pathogenic factor for CKD-related complications, including cardiovascular disease (CVD). However, the association between serum Klotho and clinical outcomes in nondiabetic CKD patients needs to be further clarified. We aimed to determine whether serum Klotho levels are associated with CVD events and mortality in predialysis CKD patients without diabetes. Methods: A total of 336 CKD stage 2–5 predialysis patients without diabetes were recruited and followed from the end of 2014 to January 2019 for CVD events and overall mortality. Serum Klotho was detected by ELISA and divided into quartiles (lowest, middle, second highest, and highest quartiles) according to their serum Klotho category. Results: After a median follow-up of 3.52 years (IQR 3.34–3.76), Kaplan-Meier analysis showed that, compared to participants with a Klotho level in the highest quartile (the reference category), those in the lowest Klotho quartile were associated with a higher all-cause mortality risk (HR = 7.05; 95% CI 1.59–31.25) and a higher CVD event risk (HR = 3.02; 95% CI 1.45–6.30). In addition, the middle Klotho quartile was also associated with CVD event risk (HR = 2.56; 95% CI 1.21–5.41). Moreover, in the multivariate-adjusted model, the lowest Klotho quartile remained significantly associated with all-cause mortality (HR = 5.17; 95% CI 1.07–24.96), and the middle Klotho quartile maintained a significant association with CVD event risk (HR = 2.32; 95% CI 1.03–5.21). Conclusion: These results suggest that lower serum Klotho levels are independently associated with overall mortality and CVD events in nondiabetic predialysis CKD patients.

Prevalence of abnormal serum 25-hydroxyvitamin D and its association with hemoglobin level in pre dialysis CKD patients: a cross-sectional study from Himalayan country

BackgroundCKD has been recognized as risk factors for 25(OH) D deficiency, and Low levels of 25(OH) D have been suggested to be a trigger factor of decreased level of Hb. However, there is lack of information about the magnitude of 25(OH) D deficiency and Hb level in Nepalese CKD patients. Therefore, the aim of present study was to investigate the prevalence of abnormal 25(OH) D in non-dialyzed CKD patients, and further to examine its association with Hb level.MethodsIn this cross-sectional study, we examined 172 clinically stable patients with an eGFR at CKD stage2–5 not on dialysis. Serum 25(OH) D, Hb, levels were evaluated as a core variables and the other variables such as age, sex, co-morbidities (HTN, DM), eGFR, Hb, iPTH, serum phosphate, albumin, calcium, and phosphate level were evaluated as a covariates. Serum 25(OH) D, Hb levels and the factors associated with 25(OH) D level were evaluated.ResultsThe estimated prevalence of abnormal 25(OH) D metabolite (< 30 ng/mL) in this predialysis patients were (87.8%), with 32 and 55.8% deficiency and insufficiency 25(OH) D metabolite, respectively. On regression analysis, serum 25(OH) D was positively associated with male subjects (P = 0.02), serum albumin(P = 0.002), and eGFR (P = 0.042), while inversely associated with age (P = 0.006), iPTH(P = 0.025). Hb concentration was found to be positively correlated with 25(OH) D (P < 0.05) in both univariate as well as in multivariate analysis.ConclusionA high prevalence of abnormal 25(OH) D metabolite was observed in early CKD patients. Our study shows that lower level of 25(OH) D level are associated with lower level of Hb and higher level of iPTH, and could play a role in the development of anemia and hyperparathyroidism.

SUN-291 PREDICTIVE FACTORS OF ESA HYPORESPONSIVENESS IN PRE-DIALYSIS CKD PATIENTS: SECONDARY ANALYSIS OF THE RADIANCE-CKD STUDY

Erythropoiesis-Stimulating Agents [ESA] hyporesponsiveness is related to poor renal outcome in management of renal anemia; however, it is difficult to predict which patients will be hyporesponsive. We previously reported on the RADIANCE-CKD study, a multicenter, open-label, randomized controlled study to evaluate renal outcome by different target hemoglobin [Hb] levels using epoetin beta pegol [CERA] in pre-dialysis CKD patients with poor response to ESA (ASN 2018). The aim of the present study was to predict the patients with ESA hyporesponsiveness among pre-dialysis CKD patients. Pre-dialysis CKD patients (362 patients) with poor response to ESA were randomly assigned to an intensive treatment group (I-group; target Hb level of ≥11 g/dl) or a conservative treatment group (C-group; target Hb level of baseline Hb ±1g/dl). The primary renal composite endpoint was a transition to renal replacement therapy, reduction of eGFR to <6 ml/min/1.73 m2, or >30% reduction of eGFR. In the 3-month landmark analysis, the incidence of renal outcome was evaluated in 3 categories of Hb levels (<10, 10 to <11, ≥11 g/dl) according to tertiles of ESA dose. ESA hyporesponsiveness patients (HYPO) were defined as achieved Hb level <11 g/dl with high tertile and achieved Hb level <10 g/dl with mid-tertile in I-group. The predictive factors of hyporesponsiveness patients were then assessed using a logistic regression model and estimated area under the receiver operating characteristic (ROC) curve. Mean age was 74.7 years and 58.6% of patients were male. Mean baseline eGFR in I-group and C-group were 15.3 and 15.9 ml/min/1.73 m2, respectively. Kaplan-Meier analysis and Cox proportional hazards analysis showed no significant difference in the primary end point between the two groups (99 and 109 events) during the 21-month observation period. In the 3-month landmark analysis, achieved Hb level and required ESA dose were higher in I-group. The incidence of the renal composite endpoint had a tendency to increase in accordance with decrease of Hb levels regardless of the ESA dose in both groups. A total of 30 (54.5%) HYPO patients had the renal composite endpoint, as compared with 54 (50.9%) non-HYPO. Based on the logistic regression analysis, 19 background characteristics (age, BW, eGFR, Alb, ferritin, Hb, CRP, etc.) and 14 biomarkers (IL-6, Hepcidin, TGFβ, CD147, PTH, 25Vitamin-D, etc.) were evaluated as predictive factors of HYPO. The obtained area under the ROC curve (AUC) was 0.88, with sensitivity of 84% and specificity of 84%. Using a branch-and-bound algorithm to find the highest likelihood score statistic for 6 variables, the selected variables were age, Hb, Hepcidin, TGFβ, CD147, and PTH; then, the estimated AUC was 0.82. The patients with ESA hyporesponsiveness among Japanese CKD patients can be predicted based on clinical characteristics and biomarkers in pre-dialysis.

MON-265 ANAEMIA, MEAN CORPUSCULAR VOLUME AND MORTALITY AMONG A BLACK CKD POPULATION IN SOUTH AFRICA

The burden of chronic kidney disease is increasing globally and prompt identification; coupled with improved management of CKD patients have increased the population of pre-dialysis patients. However, CKD patients in less resourced countries may not have optimal care and the current survival pattern of pre-dialysis CKD patients is not well characterized. We, therefore, aimed to evaluate the predictors of survival among black pre-dialysis CKD patients in Johannesburg. We conducted a cohort study of 256 consecutive consenting Black non-dialysis requiring CKD patients attending the renal outpatient clinic of Charlotte Maxeke Academic Hospital from 1st June 2016 to 1st December 2016 and were followed up till 31 December 2017. Socio-demographic and clinical information of the participants were obtained using a self -administered pro forma, and participants were followed up at clinic visits every one to three months or by telephone. Descriptive statistics, Kaplan-Meier curves and Cox proportional hazard regression analyses were conducted to evaluate factors affecting the survival of the participants. The mean age of the participants was 52.8±14.3 years and 49.5% were females, and 51.9% were males. During a median follow up of 18 months, the mortality rate was 1.12 per 100 person-years. The death rate increased with worsening haemoglobin level from 0.96 among patients with mild anaemia to 4.29 per 100-person-years among patients with severe anaemia. Anaemic patients with GFR < 30mls/min had significantly increased risk of death (HR 11.51, 95% CI 1.62–78.32, P < 0.001). Participants with hyperphosphatemia had about 2.6-fold increased hazard of death (HR, 2.60; 95%CI, 1.09-6.20, P =0.02). Tabled 1VariableAll (n=256)Alive (n=216)Dead (n=40)P-valueAge (years)52.8±14.352.7±14.653.4±12.90.79Gender n (%)Male133 (52.0)110 (50.9)23 (57.5)0.27Female123 (48.0)106 (49.1)17 (42.5)Hb (g/dl)12.2± 2.712.6± 2.59.7± 2.7<0.0001Median MCV (fl)88 (83-92)88 (84-93)85 (82-89)0.009Ferritin ng/mL104 (57-198)99 (56-179)211 (100-394)<0.0001BMI (kg/m2)29.9±6.430.0±6.529.1± 6.50.43 Open table in a new tab Mortality in pre-dialysis CKD patients was associated with anaemia and hyperphosphatemia. Clinical interventions targeted at preventing these conditions may improve outcomes among this group of CKD patients

EGFR and coronary artery calcification in chronic kidney disease.

The independent association between eGFR and coronary artery calcification (CAC) is complex and not clear. The aim of this study was to investigate the relationship between eGFR calculated from different equations and CAC in predialysis CKD patients in Korea. In this cross-sectional study, we analysed 1533 patients from the KNOW-CKD cohort. eGFR was calculated by a four-variable MDRD equation (eGFRMDRD ), CKD-EPI creatinine equations (eGFRCr ), CKD-EPI cystatin C equation (eGFRCys ) and CKD-EPI creatinine-cystatin equation (eGFRCrCys ). Participants were divided into eGFR categories (<30, 30-59, 60-89, ≥90mL/min/1.73m2 ). CACS (coronary artery calcium score) was measured using cardiac computed tomography. CAC was defined as CACS >100. Coronary artery calcification was found in 334 (21.8%) patients and was more prevalent in the lower eGFR groups (P<0.001). In multivariate Tobit regression, CACS increased gradually as eGFRCrCys decreased (P for trend=0.034). In multivariate logistic regression, there were gradual associations between lower eGFR and CAC when an eGFRCys or eGFRCrCys was used. The adjusted OR for CAC in the group with eGFR <30mL/min/1.73m2 compared to the group with eGFR ≥90mL/min/1.73m2 was 2.64 (95% CI, 1.09-3.60) when eGFRCrCys was used. Of the four eGFR formulas, only adding eGFRCrCys significantly improved CAC prediction models without eGFR (P=0.046). There was a gradual and independent association between low eGFR and CAC in a predialysis CKD cohort in Korea. eGFRCrCys predicted CAC better than other equations in this population.

Hypothalamic Energy Regulatory Peptides in Chronic Kidney Disease.

Loss of appetite affects one-third of patients with CKD and is the leading cause of malnutrition in this population. Orexigenic Agouti-related peptide (AgRP) with neuropeptide-Y (NPY) and anorexigenic melanocyte-stimulating hormone-α (MSH-α) with cocaine- and amphetamine-regulated transcript (CART) are known to regulate appetite. In this study, we aimed to evaluate the levels of these peptides in CKD patients compared to healthy subjects and demonstrate the effects of dialysis treatment and erythropoiesis-stimulating agent (ESA) therapy. The cross-sectional study is composed of consecutive inclusion of 20 healthy individuals, 20 predialysis CKD patients, 20 HD, and 20 peritoneal dialysis (PD) patients. Exclusion criteria were an active infection, history of malignancy, hypo- or hyperthyroidism, and diabetes. Patients on dialysis had targeted Kt/Vs. Demographic features and BMIs of the four groups were similar. Levels of AgRP, NPY, AMSH, and CART were significantly different between groups. Nondialysis CKD patients had significantly lower hypothalamic hormones compared to healthy individuals, HD and PD patients (P = 0.02, P = 0.03, and P = 0.07 for AgRP; P = 0.02, P = 0.01, and P = 0.09 for NPY; P = 0.02, P = 0.02, and P = 0.03 for AMSH; P = 0.02, P = 0.005, and P = 0.030 for CART). Dialysis patients with or without ESA treatment had similar hormone levels (P = 0.13 for AgRP; P = 0.11 for NPY; P = 0.23 for AMSH, and P = 019 for CART). Predialysis CKD patients have lower orexigenic and presumably indirectly lower anorexigenic peptides compared to healthy subjects and dialysis patients. ESA treatment does not affect these hypothalamic peptides in dialysis patients.

Significance of urinary C-megalin excretion in vitamin D metabolism in pre-dialysis CKD patients

Serum 1,25(OH)2D and 24,25(OH)2D are decreased in CKD. Megalin in proximal tubular epithelial cells reabsorbs glomerular-filtered 25(OH)D-DBP complex to convert 25(OH)D to 1,25(OH)2D and 24,25(OH)2D. Urinary C-megalin excretion is increased via exocytosis from injured nephrons overloaded with megalin-mediated protein metabolism. This study investigated the significance of urinary C-megalin excretion in vitamin D metabolism in 153 pre-dialysis CKD patients. Urinary C-megalin was positively associated with urinary protein, β2MG and α1MG, and exhibited negative correlations with serum 25(OH)D, 1,25(OH)2D and 24,25(OH)2D. Multiple regression analysis showed that urinary C-megalin had a significantly negative association with 25(OH)D. Serum 1,25(OH)2D and 24,25(OH)2D, as well as 1,25(OH)2D/25(OH)D and 24,25(OH)2D/25(OH)D ratios, showed positive correlations with eGFR. Additionally, wholePTH was positively associated with 1,25(OH)2D/25(OH)D and 1,25(OH)2D/24,25(OH)2D, while FGF23 was positively associated with 24,25(OH)2D/25(OH)D and negatively with 1,25(OH)2D/24,25(OH)2D. Urinary C-megalin emerged as an independent factor positively associated with 1,25(OH)2D/25(OH)D and 1,25(OH)2D/24,25(OH)2D. Although 1,25(OH)2D and 24,25(OH)2D are decreased in CKD patient serum, our findings suggest that PTH and FGF23 retain their effects to regulate vitamin D metabolism even in the kidneys of these patients, while production of 1,25(OH)2D and 24,25(OH)2D from 25(OH)D is restricted due to either impairment of megalin-mediated reabsorption of the 25(OH)D-DBP complex or reduced renal mass.

The cartonectin levels at different stages of chronic kidney disease and related factors

Introduction: Cartonectin was defined as a new adipokine released from rat and human adipocyte tissues, which is also known as CORS 26 or CTRP3 protein. Although there are several studies investigating the effects of cartonectin with obesity, anti-inflammatory mechanisms, and cardioprotective effects, there is no study about the effects of cartonectin in patients with chronic kidney disease yet. We aimed to investigate cartonectin levels in predialysis and dialysis patient groups, in other words, at different stages of chronic kidney disease, by comparing with the control group. In addition, we aimed to discuss the probable causes of the differences between the patient groups that would be determined, together with the factors that might be effective.Methods: A total of 150 patients, including 47 hemodialysis patients, 73 predialysis CKD patients, and 30 healthy individuals were enrolled in the study. Serum cartonectin levels were determined by using enzyme-linked immunosorbent assay (ELISA) method.Findings: Serum cartonectin levels were found to be significantly higher in the hemodialysis patient group compared to predialysis group and healthy individuals (p < 0.01). Furthermore, serum cartonectin levels were found to be negatively correlated with GFR, BMI, glucose, LDL, and platelet levels, whereas a positive correlation was observed with creatinine levels.Discussion: In our study, we found that the cartonectin levels increased as GFR decreased and were significantly higher in hemodialysis patients. Cartonectin is structurally closely related to adiponectin. It is remarkable that the level of cartonectin is also high in hemodialysis patients, like adiponectin.

Carotid Intima Media Thickness Measurements in Nigerian Pre-dialysis CKD Patients

Carotid Intima Media Thickness Measurements in Nigerian Pre-dialysis CKD Patients

Inflammation and nutritional status assessment by malnutrition inflammation score and its outcome in pre-dialysis chronic kidney disease patients

Malnutrition-inflammation complex syndrome (MICS), hyperhomocysteinemia, calcium and phosphate levels derangement have been predicted as important contributing factors for the progression of cardiovascular burden. Among patients with earlier stage of CKD, hypoalbuminaemia and inflammation deliberated as non-traditional cardiovascular risk factors, which add more burden to circulatory disease, mortality and rapid advancement to CKD stage 5. The aim of the study is to evaluate inflammation and nutritional status of CKD patients not on dialysis using Malnutrition inflammation score (MIS) and to verify the association with mortality in the follow-up period. In this prospective cohort study 129 (66 males, 63 females) pre-dialysis CKD patients enrolled between June 2013 to August 2014 and censored until March 2017. Malnutrition and Inflammation assessed using Malnutrition inflammation score. Blood urea nitrogen, serum creatinine, albumin, Interleukin - 6, highly sensitive C reactive protein (hsCRP), total cholesterol and anthropometric data were analyzed. The Malnutrition inflammation score in pre-dialysis CKD patients ranged from 0 to 18 with the median score of two. During 36 or more months of follow-up, there were 30 (23.2%) deaths, 35 (27%) patients initiated on hemodialysis, one (0.7%) patient was initiated on peritoneal dialysis, two (1.4%) patients underwent renal transplantation and two (1.4%) patients were lost for follow-up. In this study, 33% had varying degree of malnutrition and inflammation. Patients who had MIS ≥7 had significant increase in IL-6 (p=0.003) and HsCRP levels (p<0.001) when compared with other tertiles of MIS. ROC curve analysis of MIS showed 56.5% sensitivity and 81% specificity in predicting death rate (AUC 0.709; 95% CI 0.604-0.815, p<0.001). Kaplan-Meier survival analysis showed MIS ≥7 had a strong association (log rank test, p<0.001) with mortality during 36 and more months of follow-up time. In unadjusted analyses, MIS (HR 1.140; 95% CI 1.054-1.233; p<0.05) and HsCRP (HR 2.369; 95% CI 1.779-3.154; p<0.001) found to be predictors of mortality. MIS and HsCRP remained predictors of mortality even after adjustments. This study shows MIS is an important factor that determines mortality in pre-dialysis CKD patients during 36 and more months of follow-up time. Patients with MIS ≥7 have high risk for mortality and needs close monitoring. In clinical setting application of MIS has a greater utilization in pre-dialysis CKD patients. Further research with longitudinal assessment of MIS and its association with outcomes are warranted. Pre-dialysis CKD patients should be assessed for their nutritional status and inflammation using MIS regularly to prevent malnutrition and its associated complications through appropriate medical and nutritional intervention.

Are the Beck depression inventory score, SF 36 score and progression of the disease changing with education in chronic kidney disease patients?

Aim: Patient education is important for patients with predialysis chronic renal disease (CKD)because it can delay the progression of the disease to end-stage renal failure.Anxiety and depression may also contribute to the progression of the disease in patients with CKD. We evaluated the influences of education on progression ofCKD, the Short Form 36 Health Survey (SF36), and the Beck Depression Inventory (BDI) in predialysis CKD patients. Material and Methods: 121 patients with nondialysis stage 2-5 CKD were involved in this study. At the start of the study, the SF36 and BDI scoring were performed in all patients and their creatinine clearances were calculated. 31 patients were given education on CKD by the dialysis specialist nurse once a month. At the end of the sixth month, SF36 and BDI were rescored, and their creatinine clearances were recalculated. Results: There were no significant differences between the two groups regarding age, gender, creatinine clearance, and duration of chronic kidney disease. At the end of the sixth month, when the educated and uneducated patients were compared, while the increase of the creatinine level was significant in the two groups, the SF36 and BDI scores were found to be improved significantly in the study group. Conclusion: The results of this study suggested that patient education may improve the SF36 and BDI scores, but it does not affect the progression of the disease for at least six months in duration.

A comparison of quality of sleep between patients with chronic kidney disease not on hemodialysis and end-stage renal disease on hemodialysis in a developing country

Few studies have compared quality of sleep between pre-dialysis chronic kidney disease (pre-dialysis CKD) patients and end-stage renal disease patients on dialysis (ESRD) and have found inconsistent results. Objective of this study is to compare quality of sleep between patients with pre-dialysis CKD and ESRD in a developing country. This study was conducted in an out-patient department and hemodialysis unit of a tertiary care facility. Patients included had either pre-dialysis CKD or ESRD. Assessment of quality of sleep was done using Pittsburgh sleep quality index (PSQI). A total of 152 patients were included in the study. Out of these patients, 79 (52%) had ESRD and 73 (48%) had pre-dialysis CKD. Median PSQI score was 6 (IQR 3–8.8). Poor sleep quality (PSQI ≥5) was present in 100 (65.8%) patients. Only hemoglobin (β = −0.39, p < .01), depression (β = 0.56, p < .01) and history of cardiovascular disease (β = 0.22, p < .01) were associated with PSQI global score in a multiple linear regression analysis. There was no significant association between ESRD vs. pre-dialysis CKD and PSQI global scores and no significant co-relation between eGFR and global PSQI score (r = −0.34, p value .80) in pre-dialysis CKD patients. Poor sleep quality is common in patients with CKD including hemodialysis patients in a developing country, which is independent of kidney function in non-dialysis patients. There is no difference in quality of sleep between pre-dialysis CKD and ESRD patients.

B type natriuretic peptide and troponin T as independent predictors of cardiovascular mortality in predialysis patients with chronic kidney disease

The use of cardiac biomarkers in prognostic purposes has been widely studied in the general population and the population of hemodialysis patients but not in patients with early-stage chronic kidney disease (peptide (BNP), N-terminal fragment of BNP (NTproBNP-a), troponin T (TnT), troponin I (TnI) CKD). The aim of this study was to determine the prognostic value of cardiac biomarkers [B-type natriuretic and highly sensitive C-reactive protein (hsCRP -a)] for cardiovascular mortality in asymptomatic predialysis CKD patients, stage IV and V. The study included 61 CKD patients (34 M, average age 62.6 ± 13.6 years, GFR 15.8±5.7 ml/min). All subjects underwent clinical evaluation, laboratory testing, echocardiographic examination and carotid artery ultrasound examination of the carotid arteries. During the period of follow-up (median 28 months), there were 18 deaths of which 9 were cardiovascular in origin. In a multivariate Cox regression analysis, BNP (p = 0.004), aortic calcification (p = 0.005), the TnT (0.018) and serum urea (p = 0.046) showed the independent predictive value for cardiovascular mortality. The optimal cut-off value of BNP for predicting _ cardiovascular mortality rate was 220.8 pg/ml. with a sensitivity of 85.7% and specificity of 78% (AUC = 0.831; p = 0.005) while the TnT cut off value of 0.05 ng / ml was also found to be significant with a sensitivity of 77.8% and a specificity of 78.8% (AUC = 0.798; p = 0.005). In stratified analysis, Kaplan-Meier curves showed _statistically significant differences in cardiovascular survival in patients with different levels of BNP (p = 0.024), TnT (p = 0.001) and NTproBNP (p = 0.033). As independent predictors of cardiovascular mortality, BNP and TnT can be used to stratify CV risk in asymptomatic patients with advanced HBS who have not started dialysis treatments yet.

International Network of Chronic Kidney Disease cohort studies (iNET-CKD): a global network of chronic kidney disease cohorts.

BackgroundChronic kidney disease (CKD) is a global health burden, yet it is still underrepresented within public health agendas in many countries. Studies focusing on the natural history of CKD are challenging to design and conduct, because of the long time-course of disease progression, a wide variation in etiologies, and a large amount of clinical variability among individuals with CKD. With the difference in health-related behaviors, healthcare delivery, genetics, and environmental exposures, this variability is greater across countries than within one locale and may not be captured effectively in a single study.MethodsStudies were invited to join the network. Prerequisites for membership included: 1) observational designs with a priori hypotheses and defined study objectives, patient-level information, prospective data acquisition and collection of bio-samples, all focused on predialysis CKD patients; 2) target sample sizes of 1,000 patients for adult cohorts and 300 for pediatric cohorts; and 3) minimum follow-up of three years. Participating studies were surveyed regarding design, data, and biosample resources.ResultsTwelve prospective cohort studies and two registries covering 21 countries were included. Participants age ranges from >2 to >70 years at inclusion, CKD severity ranges from stage 2 to stage 5. Patient data and biosamples (not available in the registry studies) are measured yearly or biennially. Many studies included multiple ethnicities; cohort size ranges from 400 to more than 13,000 participants. Studies’ areas of emphasis all include but are not limited to renal outcomes, such as progression to ESRD and death.ConclusionsiNET-CKD (International Network of CKD cohort studies) was established, to promote collaborative research, foster exchange of expertise, and create opportunities for research training. Participating studies have many commonalities that will facilitate comparative research; however, we also observed substantial differences. The diversity we observed across studies within this network will be able to be leveraged to identify genetic, behavioral, and health services factors associated with the course of CKD. With an emerging infrastructure to facilitate interactions among the investigators of iNET-CKD and a broadly defined research agenda, we are confident that there will be great opportunity for productive collaborative investigations involving cohorts of individuals with CKD.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0335-2) contains supplementary material, which is available to authorized users.

Chinese cohort study of chronic kidney disease: design and methods

Background Chronic kidney disease (CKD) is a common disorder associated with multiple adverse clinical consequences, especially cardiovascular risk and end-stage renal disease. A recent national survey demonstrated that CKD has become a leading health problem in China. There is an urgent need to implement an in-depth investigation of the CKD burden and also to explore underlying mechanisms of CKD progression and it association with adverse consequences. Methods The Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE) is the first national CKD cohort in China. It will enroll approximately 3 000 pre-dialysis CKD patients aged between 18 and 74 years and follow-up for at least 5 years. Questionnaires, anthropometric measures, laboratory tests, and biomaterials will be collected at baseline and annually. The principal clinical outcomes of the C-STRIDE consist of renal disease events, cardiovascular events, and death. Based on the longitudinal clinical data and biomaterials, the risk factors with CKD progression and other outcomes will be analyzed, and candidate markers and predicted models will be established. Conclusion The C-STRIDE would provide important evidence for underlying mechanisms of CKD progression, valuable information for clinical guidelines, and healthcare policies in China.

Role of novel cardiac biomarkers in prediction of cardiovascular risk in predialysis CKD patients by their correlations with left ventricular mass index

Introduction About 40% of CKD patients have cardiovascular disease (CVD) even before they become end-stage renal disease [1]. The use of traditional risk factors such as smoking, hypertension, diabetes mellitus and dyslipidemia, results in underestimation of CVD risk in patients with CKD including predialysis patients [2]. Patients with CKD have non-traditional

Profile of incident chronic kidney disease related-mineral bone disorders in chronic kidney disease Stage 4 and 5: A hospital based cross-sectional survey

Chronic kidney disease related-mineral bone disorder (CKD-MBD) has been poorly studied in pre-dialysis Indian CKD patients. We aimed to study the clinical, biochemical and extra skeletal manifestations of untreated CKD-MBD in pre-dialysis Stage 4 and 5 CKD patients attending nephrology out-patient clinic at a tertiary care hospital in South India. A hospital based cross-sectional survey including, demographic profile, history of CKD-MBD symptoms, measurement of serum calcium, phosphate, parathyroid hormone, 25 hydroxy vitamin D (25(OH) D) and alkaline phosphatase; lateral abdominal X-rays for abdominal aortic calcification (AAC) and echocardiography for valvular calcification (VC) was carried out. Of the 710 patients surveyed, 45% had no CKD-MBD related symptom. Prevalence of hypocalcemia, hyperphosphatemia, hyperparathyroidism (>150 pg/mL) and 25(OH) D levels <30 ng/mL was 66.3%, 59%, 89.3% and 74.7% respectively. Echocardiography was carried out in 471 patients; 96% of whom had VC (calcification score ≥1). Patients with VC were older and had lower 25(OH) D levels than those without. Lateral abdominal X-rays were obtained in 558 patients, 6.8% of whom were found to have AAC, which was associated with older age. Indian patients with incident CKD-MBD have a high prevalence of hypocalcemia, 25(OH) D deficiency and VC even prior to initiating dialysis while AAC does not appear to be common. The association between 25(OH) D deficiency and VC needs further exploration.

Disturbances of Wnt/ -catenin pathway and energy metabolism in early CKD: effect of phosphate binders

Mineral bone disorder (MBD) is an early complication of chronic kidney disease (CKD), with complex interactions in the bone-kidney-energy axis. These events lead to impaired bone remodelling, which in turn is associated with cardiovascular disease. Recently, we reported on a positive effect of phosphate binder treatment on bone remodelling markers and a reduction in serum FGF-23 levels in predialysis-CKD patients. The goal of the present study of this trial was to examine the effects of phosphate binders on energy-regulating hormones and Wnt pathway. In this present post hoc analysis of the above randomized, open-label, 8-week trial, which compared the effects of increasing doses of sevelamer-HCl or calcium acetate on various CKD-MBD parameters in 40 normophosphatemic CKD Stage 3-4 patients, we measured serum sclerostin, Dickkopf-1, leptin, adiponectin and serotonin concentrations. Serum sclerostin, Dickkopf-1 and leptin were elevated at baseline despite normal calcium, phosphorus levels and daily urinary phosphorus excretion. There were significant and positive correlations between sclerostin and FGF-23, as well between leptin and Dickkopf-1. Treatment with both phosphate binders led to a significant decrease in phosphate overload. However, sevelamer-HCl, but not with calcium acetate, led to a significant decrease in serum FGF-23, sclerostin and leptin, and to a significant increase in bone alkaline phosphatase levels. Early stages of CKD are associated with an impairment of the Wnt pathway, as reflected by elevated sclerostin, and a dysregulation of energy-regulating hormones. Many of these disturbances can be ameliorated by phosphate binder treatment, more with sevelamer-HCl than with calcium acetate.