Predialysis Patients Research Articles

Urine albumin and serum uric acid are important determinants of serum 25 hydroxyvitamin D level in pre-dialysis chronic kidney disease patients

Low serum 25 hydroxyvitamin D (25 OH D) is common among chronic kidney disease (CKD) patients. This cross-sectional study is looking for the different factors associated with serum 25 OH D among pre-dialysis CKD. 1624 adult stage 3–5 CKD patients were studied beside 200 normal control subjects. All candidates were tested for body mass index (BMI), estimated glomerular filtration rate (eGFR), calcium (Ca), phosphorus (P), parathormone (PTH), 25 OH D, albumin, and uric acid (UA), and urine albumin/creatinine ratio (ACR). Multivariate linear regression analysis was done to determine predictors of 25 OH D. 98.6% of CKD patients have inadequate level of 25 OH D vs 48% of normal subjects. Serum 25 OH D was significantly lower in CKD patients (mean ± S.D = 16.54 ± 5.8 vs 37.79 ± 3.58 ng/mL for CKD vs control group respectively, p < .001). Serum level of 25 OH D has significant positive correlation with Ca (r = 0.337, p < .001), and significant negative correlation with P, PTH, UA, and ACR (r = −0.440, −0. 679, −0.724, and −0.781respectively, p < .001 in all). The independent predictors of 25 OH D were Ca, P, UA, PTH, and ACR (R square = 0.7, β = −0.087, −0.226, −0.313, −0.253, and −0.33 respectively, p < .001 in all). In conclusion, pre-dialysis CKD patients frequently suffer low 25 OH D. Among the different abnormalities related to CKD, urine albumin excretion rate and UA are the most important predictors of 25 OH D in these patients.

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.

Диета с ограничением белка: история, лечение преддиализных больных, влияние на режим заместительной почечной терапии. Обзор литературы

Диета с ограничением белка: история, лечение преддиализных больных, влияние на режим заместительной почечной терапии. Обзор литературы

Qu’est-ce qui influence le choix de la dialyse péritonéale chez les patients ? une étude qualitative.

L’objectif de cette étude était d’identifier les facteurs qui influencent le choix de la dialyse péritonéale (DP) chez les patients insuffisants rénaux, dans un centre de dialyse en France offrant un dispositif d’éducation thérapeutique du patient (ETP) aux patients en pré-dialyse. Pour ce faire, nous avons mené trente six entretiens semi-directifs avec des patients, des médecins de l’équipe d’ETP et un cadre de santé. Nous avons également observé dix séances d’ETP afin d’explorer la nature des interactions entre les patients, leurs accompagnants et l’équipe soignante. Nos résultats révèlent que les facteurs qui poussent les patients à choisir la DP sont l’influence des proches, les préférences personnelles, l’influence des médecins, l’ETP à travers l’information transmise par les éducatrices. En plus de l’influence de ces facteurs dans la construction du choix des patients à s’orienter vers une méthode de dialyse, il pourrait être encore plus productif d’intégrer des patients ressources dans les dispositifs d’ETP grâce au partage de leur expérience de patients traités en dialyse avec les patients en pré-dialyse.&#x0D; &#x0D; Cette revue est mise à disposition selon les termes de la Licence Creative Commons Attribution 4.0 International.

Quantifying cognitive dysfunction across the spectrum of end-stage kidney disease: A systematic review and meta-analysis.

Cognitive dysfunction is reportedly highly prevalent among chronic kidney disease (CKD) patients. A variety of screening tools and neuropsychiatric batteries are used to quantify the magnitude and nature of this dysfunction. Our objective is to summarize the neurocognitive testing used, and determine what degree cognitive dysfunction is reported in CKD patients. All study designs published in English that contained participants who were either pre-dialysis patients, haemodialysis (HD) or peritoneal dialysis (PD) patients or renal transplant recipients were considered. Reported comparative non-CKD control data was also collected. All study designs were included. The search period encompassed articles from 1980 to May 2018. This review is registered with PROSPERO (CRD42018096568). Of the 1711 articles screened, 148 articles were relevant and used in the meta-analysis. Commonly used assessments were The Mini-Mental State Examination (MMSE), The Modified Mini-Mental State Examination, the Trails Making Tests (TMT) forms A and B and components of the Wechsler Adult Intelligence Scale: Digit Span and Digit Symbol. Means for all assessments were adjusted using a random effects model to account for the differences in variance. Adjusted mean MMSE scores were significantly lower for both pre-dialysis (26.08, n = 17 073) and HD (26.31, n = 3314) patients when compared to non-CKD controls (28.21, n = 5226). PD (58.01 s, n = 859) and HD (56.04 s, n = 2344) patients also took significantly longer to complete the Trails Making Task A than non-CKD controls (37.62 s, n = 4809). Patients with CKD, especially pre-dialysis and those requiring dialysis, are likely to exhibit impairments in cognition that can be identified with specific screening neuropsychological assessments.

Mild cognitive impairment in older adults with pre-dialysis patients with chronic kidney disease: Prevalence and association with physical function.

Chronic kidney disease (CKD) is a risk factor for declining cognitive and physical function. However, the prevalence of mild cognitive impairment (MCI) and its relationship with physical function is not clear. Therefore, our aim was to evaluate the prevalence of MCI and the relationship between MCI and physical function among older adults with pre-dialysis CKD. We conducted a cross-sectional study of 120 patients, aged ≥65 years (mean age, 77.3 years), with pre-dialysis CKD but without probable dementia (Mini Mental State Examination <24). MCI was evaluated using the Japanese version of the Montreal Cognitive Assessment (MoCA-J). For analysis, patients were classified into two cognitive function groups: normal (MoCA-J ≥ 26) and MCI (MoCA-J < 26). Physical, clinical, and biochemical parameters were compared between the groups. Logistic and linear regression analyses were used to evaluate the specific association between cognitive and physical function. Seventy-five (62.5%) patients belonged to the MCI group. Significant differences between the two groups were identified for gait speed, balance, age, and haemoglobin concentration. After adjustment for covariates, only gait speed was significantly associated with MCI (odds ratio, 0.06; 95% confidence interval, 0.009-0,411). The prevalence of MCI among older adults with pre-dialysis CKD was as high as 62.5%. The association between MCI and reduced gait speed supports the possible interaction between physical and cognitive functions and the need for early screening.

Prevalence of autonomic dysfunction among pre-dialysis chronic kidney disease patients in a tertiary hospital, South East Nigeria.

Autonomic dysfunction (AD) has been recognized as an important contributor to the poor outcome in chronic kidney disease (CKD) patients. Several studies have reported abnormalities in heart rate variability (HRV) among these patients. To determine the prevalence of Autonomic Dysfunction (AD) in pre-dialysis Chronic Kidney Disease (CKD) patients in a tertiary hospital in South East Nigeria. A cross sectional study of eighty chronic kidney disease patients attending the renal unit out-patient in the University of Nigeria Teaching Hospital (UNTH) Enugu was carried out. Forty subjects, drawn randomly, who had no kidney disease served as control. Autonomic function was assessed with non - invasive cardiovascular tests including, measurement of resting tachycardia, orthostatic hypotension, heart rate response (HRR) to standing test, heart rate response to Vasalva manoeuvre and heart rate response to respiration. With the battery of 5 tests used to assess AD, the frequency of autonomic dysfunction in pre-dialysis chronic kidney disease patients was 51.3% compared to 7.5% in the control group. Heart rate response to standing was the most sensitive test to detect AD in this group of subjects. AD is a common problem among pre-dialysis CKD patients in Nigeria.

Role of dietary phosphate restriction in chronic kidney disease.

Patients with progressive chronic kidney disease (CKD) develop positive phosphate balance that is associated with increased cardiovascular risk and mortality. Modification of dietary phosphate is a commonly used strategy to improve outcomes but is complicated by the need for adequate dietary protein. Surprisingly, the evidence for patient-level benefits from phosphate restriction is tenuous, and the justification for using any phosphate binder for pre-dialysis patients is questionable. The evidence for dietary phosphate modification was reviewed, along with the possible role of a smart phone application (app) that provides information on phosphate, sodium, potassium and nutrients in over 50 000 Australian foods. A pilot study of healthy participants assigned to dietetic advice and standard diet sheets, or dietetic advice, diet sheets and use of the smart phone app was performed. Following baseline studies, 25 participants commenced the sodium and phosphate restricted diet. After 2 weeks, both groups showed non-significant trends to reduction in urinary phosphate and sodium. App users referred to information on the app more frequently than the control group participants referred to written instructions, found referring to the app more convenient, felt they learned more new information, were more motivated to maintain the diet and were more likely to recommend their information source to family or friends (all P < 0.05). Maintaining phosphate balance remains an important goal of CKD management, although diets incorporating very low phosphate and protein contents may worsen patient outcomes. For selected patients, a smart phone app may improve dietary acceptance and compliance.

A Quality Improvement Intervention to Improve the Efficiency of Arteriovenous Access Placement for Pre-Dialysis Inpatients.

The authors aimed to improve the rate of pre-dialysis arteriovenous (AV) access placement for hospitalized patients with advanced chronic kidney disease. The authors developed and implemented a protocol for hospitalized adult patients with an estimated glomerular filtration rate <20 mL/min to streamline the workflow for obtaining AV access. The protocol was piloted on 5 inpatient medical services over 3 months at 1 institution. Specific-Measurable-Achievable-Realistic-Timely (SMART) aims, Fishbone diagrams, Plan-Do-Study-Act cycles, and run charts were used to assess the process and outcomes of the intervention. There were 22 patients in the baseline group and 27 patients in the intervention group. Pre-dialysis AV access increased from 23% to 46%. Length of stay did not differ significantly between the baseline group (8.31 days) and the intervention group (8.4 days). Pathways can improve pre-dialysis AV access without significantly increasing length of stay.

Clinical Pharmacology of Antihypertensive Therapy for the Treatment of Hypertension in CKD.

CKD is common and frequently complicated with hypertension both predialysis and in ESKD. As a major modifiable risk factor for cardiovascular disease in this high-risk population, treatment of hypertension in CKD is important. We review the mechanisms and indications for the major classes of antihypertensive drugs, including angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, β-adrenergic blocking agents, dihydropyridine calcium channel blockers, thiazide diuretics, loop diuretics, mineralocorticoid receptor blockers, direct vasodilators, and centrally acting α-agonists. Recent evidence suggests that β-adrenergic blocking agents may have a greater role in patients on dialysis and that thiazide diuretics may have a greater role in patients with advanced CKD. We conclude with sharing our general prescribing algorithm for both patients with predialysis CKD and patients with ESKD on dialysis.

Examination of attitudes towards transplantation among patients with chronic renal failure

The patients' attitudes towards kidney transplantation are significantly affected by the acceptance of the treatment to have a better quality of life. Exploration of the cognitive-emotional relation in patients with chronic renal failure. Our study included 285 kidney patients. We investigated three groups of patients: predialysis, dialysis and transplantation patients. In the framework of a pre-examination we have created an attitudinal questionnaire (85 items) that can be used to describe the cognitive and emotional attitude of kidney patients towards their illness and to measure scales. Negative attitudes towards transplantation were reported in dialysis and predialysis patients. In contrast, patients who had already undergone surgery were particularly positive about kidney transplantation. Many patients refuse transplantation which correlates with attitudes towards illness and healing. Our results showed that the exploration of the patients' cognitive emotional relation along with the medical diagnosis would have a better adherence towards the kidney substitutional treatment which ensures a better quality of life. Orv Hetil. 2018; 159(46): 1898-1904.

A7470 The Use of Erythropoietin in Predialysis Patients in Indonesia and Its Effects In Creatinine and Blood Pressure Level

A7470 The Use of Erythropoietin in Predialysis Patients in Indonesia and Its Effects In Creatinine and Blood Pressure Level

Cost-Effectiveness Analysis for the Treatment of Hyperphosphatemia in Predialysis Patients: Calcium-Based versus Noncalcium-Based Phosphate Binders.

Background Hyperphosphatemia in chronic kidney disease (CKD) patients is often treated with calcium carbonate (CaCO3) despite the fact that CaCO3 is associated with increased calcium load and potentially increased cardiovascular risk. Alternative treatments with noncalcium-based phosphate binders do not increase the calcium load but are more costly. This study analyzes the cost-effectiveness of sevelamer versus CaCO3 for the treatment of hyperphosphatemia in stage III-V predialysis CKD patients in Malaysia. Methods A Markov decision model was adapted to simulate a hypothetical cohort of CKD patients requiring treatment for hyperphosphatemia. Survival was estimated by using efficacy data from the INDEPENDENT-CKD clinical trial. Cost data was obtained from Malaysian studies while health state utilities were derived from literature. Analysis was performed over lifetime duration from the perspective of the Ministry of Health Malaysia with 2013 as reference year. Results In the base case analysis, sevelamer treatment gained 6.37 life years (5.27 QALY) compared to 4.25 life years (3.54 QALY) with CaCO3. At 3% discount, lifetime costs were RM159,901 ($48,750) and RM77,139 ($23,518) on sevelamer and CaCO3, respectively. Incremental cost-effectiveness (ICER) of sevelamer versus CaCO3 was RM47,679 ($14,536) per QALY, which is less than the WHO threshold of three times GDP per capita (RM99,395) per QALY. Sensitivity analyses, both using scenario sensitivity analysis and probabilistic sensitivity analysis, showed the result to be robust. Conclusions Our study finds that sevelamer is potentially cost-effective compared to CaCO3, for the treatment of hyperphosphatemia in predialysis CKD III-V. We propose that sevelamer should be an option in the treatment of Malaysian predialysis patients with hyperphosphatemia, particularly those with high calcium load.

Effects of Statin Use in Advanced Chronic Kidney Disease Patients.

Although statin treatment is recommended for patients with chronic kidney disease (CKD) stages I–IV, its potential benefits have not been reported in advanced CKD patients. Non-diabetic patients with advanced CKD (pre-dialysis patients, estimated glomerular filtration rate <15 mL/min/1.73 m2) were enrolled from a National Health Insurance Research Database with a population of 23 million. Statin users and non-users were matched using propensity scoring and analyzed using Cox proportional hazards models, taking mortality as a competing risk with subsequent end-stage renal disease (ESRD) and statin doses as time-dependent variables. A total of 2551 statin users and 7653 matched statin non-users were identified from a total 14,452 patients with advanced CKD. Taking mortality as a competing risk, statin use did not increase the risk of new-onset diabetes mellitus (NODM) or decrease the risk of de novo major adverse cardiovascular events (MACE), but reduced all-cause mortality (hazard ratio (HR) = 0.59 [95% CI 0.42–0.84], p = 0.004) and sepsis-related mortality (HR = 0.53 [95% CI 0.32–0.87], p = 0.012). For advanced CKD patients, statin was neither associated with increased risks of developing NODM, nor with decreased risk of de novo MACE occurrence, but with a reduced risk of all-cause mortality, mainly septic deaths.

Pubertal development in children with chronic kidney disease

Impairment of pubertal growth and sexual maturation resulting in reduced adult height is an significant complication in children suffering from chronic kidney disease (CKD). Delayed puberty and reduced pubertal growth are most pronounced in children with pre-existing severe stunting before puberty, requiring long-term dialysis treatment, and in transplanted children with poor graft function and high glucocorticoid exposure. In pre-dialysis patients, therapeutic measures to improve pubertal growth are limited and mainly based on the preservation of renal function and the use of growth hormone treatment. In patients with end-stage CKD, early kidney transplantation with steroid withdrawal within 6 months of renal transplantation allows for normal pubertal development in the majority of patients. This review focuses on the underlying pathophysiology and strategies for improving height and development in these patients.

Prognostic Significance of Asymptomatic Brain Natriuretic Peptide Elevation at Nephrology Referral in Patients with Chronic Kidney Disease

Background: It is unclear whether asymptomatic elevation of brain natriuretic peptide (BNP) is associated with cardiovascular events (CVEs) or heart failure (HF) in predialysis chronic kidney disease (CKD) patients. Methods: We measured BNP in 482 asymptomatic predialysis patients with CKD stages 2–5 at nephrology referral between August 2004 and October 2010, and followed them prospectively to investigate the prognostic significance of BNP using Cox models and receiver operating characteristic (ROC) analyses. The primary composite end point was the time to death or the first nonfatal CVEs. Secondary end points included CVEs including sudden death, HF and all-cause death. Results: The median age was 67 years (male, 67.4%; diabetic nephropathy, 33.4%), and estimated glomerular filtration rate was 20.1 mL/min/1.73 m². The primary end point occurred in 92 patients. CVEs including sudden death, HF and all-cause death occurred in 66, 35, and 54 patients, respectively during a median follow-up period of 37.7 months. Multivariate analyses showed that BNP level was significantly associated with the primary end point (hazard ratio [HR] 1.241; 95% CI 1.020–1.511; p = 0.031), CVEs (HR 1.337; 95% CI 1.067–1.675; p = 0.012) and HF (HR 1.489; 95% CI 1.059–2.091; p = 0.022), but not associated with all-cause death (HR 1.081; 95% CI 0.829–1.410; p = 0.565). The ROC curves showed that the optimal predictive BNP levels for the primary end point, CVEs and HF were 92.5, 127.0, and 274.6 (pg/mL) respectively. Conclusion: Asymptomatic elevation of BNP is strongly predictive for CVEs and HF, which might help to integrate cardio-renal risk stratification in predialysis CKD patients.

Effectiveness of Web-Based Nutrition Education for Chronic Kidney Disease Patients

Background: In the early stages of chronic kidney disease (CKD), encouraging health behaviors can help prevent the progression of kidney disease leading to eventual kidney failure. The studies of health education using computer technology have been greatly developed, especially web-based nutrition education.Objective: To determine the effectiveness of a nutrition education website for CKD patients.Method: The design of this quasi-experimental research was a group pre-test/post-test. The participants were pre-dialysis CKD patients who were enrolled on the developed website www.banraktai.com. The participants were required to complete an eating behavior questionnaire and knowledge test. They accessed the website for eight weeks, and at week 8, they completed the eating behavior questionnaire and knowledge test again. The main outcomes were the changes in scores of nutrition knowledge and eating behavior that were compared between the baseline and after the intervention using the paired t-test. The correlation between nutrition knowledge scores and eating behavior scores was determined using Spearman’s correlation coefficient.Results: There were 44 participants that completed the study. The results showed that the participants had significant improvement in both knowledge scores and consumption behavior scores (p &lt; 0.001 and p = 0.041, respectively). However, there was no correlation between the nutrition knowledge scores and the eating behavior scores.Conclusions: Web-based nutrition education can improve knowledge scores but is not effective enough to encourage and motivate CKD patients to make eating behavior changes.

Patients' Perceptions and Factors Affecting Dialysis Modality Decisions.

Home-based dialysis, including peritoneal dialysis (PD) and home hemodialysis (HHD), has been shown to be associated with lower costs and higher health-related quality of life than in-center HD. However, factors influencing the choice of dialysis modality, including gender, are still not well understood. A questionnaire was sent out to all dialysis patients in the western region of Sweden in order to investigate factors affecting choice of dialysis modality. Logistic regression was used to analyze the data. Patients were more likely to have home dialysis if they received predialysis information from 3 or more sources and, to a greater extent, perceived the information as comprehensive and of high quality. In addition, patients had a lower likelihood of receiving home dialysis with increasing age and if they lived closer to a dialysis center. Men had in comparison with women a greater likelihood of receiving home dialysis if they lived with a spouse. In-center dialysis patients more often believed that the social interaction and support provided through in-center HD treatment influenced the choice of dialysis modality. This study highlights the need for increased awareness of various factors that influence the choice of dialysis modality and the importance of giving repeated, comprehensive, high-quality information to dialysis and predialysis patients and their relatives. Information and support must be adapted to the needs of individual patients and their relatives if the intention is to improve patients' well-being and the proportion of patients using home dialysis.

Anthropometry-based Body Fat Percentage Predicts High hs-CRP in Chronic Kidney Disease Patients

BACKGROUND: Obesity is an important cardiovascular risk factor and associated with low grade inflammation in chronic kidney disease (CKD) patients. This study aims to assess the association between body fat with serum high sensitivity C-reactive protein (hs-CRP) level in CKD patients.METHODS: A cross-sectional study was performed in 71 CKD patients. Anthropometric measurements included body weight, height, body mass index (BMI), body fat percentage (BFP), skinfold thickness (SKF) of triceps and biceps were performed by trained physician. BFP was calculated using Kwok’s Formula and hs-CRP was measured by Particle enhanced Turbidimetry.RESULTS: The averaged BMI of our subjects was 25.8±4.4. There was no significant difference in BMI between pre-dialysis and hemodialysis CKD patients. Positive correlation was found between BFP and hs-CRP (r=0.266; p&lt;0.05), while there was no significant correlation between BMI and hs-CRP.CONCLUSION: Body fat percentage was associated with hs-CRP. Hence, it will be more beneficial to assess nutritional status in CKD using BFP rather than BMI alone since it was demonstrated to correlate with hs-CRP in our studyKEYWORDS: CKD, obesity, inflammation, body fat, hs-CRP

Evaluation and comparison of quality of life and its related factors in pre-dialysis and hemodialysis patients

Introduction: Chronic kidney disease (CKD) in advanced stages leads to some changes in lifestyle, health status, and personal functioning and consequently affects the patients’ quality of life. Objectives: Given the high prevalence of CKD in the country, this study aimed to determine quality of life and its related factors in this group of patients. Since there has been low focus on quality of life in pre-dialysis stage, this study compared the two groups of pre-dialysis and hemodialysis patients regarding quality of life. Patients and Methods: This descriptive analytical research was conducted as a cross-sectional study. Using convenience sampling method, we selected a total of 60 kidney failure patients in pre-dialysis stage that referred to nephrology clinics in Semnan and 60 hemodialysis patients who referred to the dialysis center of Kosar hospital in Semnan. Using SF-36 questionnaire and a demographic form, the required data was collected via interviews. Results: The results showed that the majority of patients had a moderate quality of life. Concerning demographic variables, quality of life had a significant relationship with age, gender, marital status, number of children, employment status, education level, income level, hemoglobin, underlying disease, duration of disease, and duration of dialysis. Moreover, patients in pre-dialysis stage had a better score than hemodialysis patients regarding the overall quality of life (P≤0.05). Conclusion: This study showed, a design a framework for care services provided by medical staffs and supports provided by insurance organizations and other institutions is necessary. The framework must help to improve quality of life of patients and prevent the deterioration of quality of life in advanced stages of the disease.