Pre-dialysis Chronic Kidney Disease Patients Research Articles

Evaluation of Left Ventricular Flow Kinetic Energy by Four-Dimensional Blood Flow MRI in Nondialysis Chronic Kidney Disease Patients.

Chronic kidney disease (CKD) is associated with increased, and early cardiovascular disease risk. Changes in hemodynamics within the left ventricle (LV) respond to cardiac remodeling. The LV hemodynamics in nondialysis CKD patients are not clearly understood. To use four-dimensional blood flow MRI (4D flow MRI) to explore changes in LV kinetic energy (KE) and the relationship between LV KE and LV remodeling in CKD patients. Retrospective. 98 predialysis CKD patients (Stage 3: n = 21, stage 4: n = 21, and stage 5: n = 56) and 16 age- and sex-matched healthy controls. 3.0 T/balanced steady-state free precession (SSFP) cine sequence, 4D flow MRI with a fast field echo sequence, T1 mapping with a modified Look-Locker SSFP sequence, and T2 mapping with a gradient recalled and spin echo sequence. Demographic characteristics (age, sex, height, weight, blood pressure, heart rate, aortic regurgitation, and mitral regurgitation) and laboratory data (eGFR, Creatinine, hemoglobin, ferritin, transferrin saturation, potassium, and carbon dioxide bonding capacity) were extracted from patient records. Myocardial T1, T2, LV ejection fraction, end diastolic volume (EDV), end systolic volume, LV flow components (direct flow, delayed ejection, retained inflow, and residual volume) and KE parameters (peak systolic, systolic, diastolic, peak E-wave, peak A-wave, E/A ratio, and global) were assessed. The KE parameters were normalized to EDV (KEiEDV). Parameters were compared between disease stage in CKD patients, and between CKD patients and healthy controls. Differences in clinical and imaging parameters between groups were compared using one-way ANOVA, Kruskal Walls and Mann-Whitney U tests, chi-square test, and Fisher's exact test. Pearson or Spearman's correlation coefficients and multiple linear regression analysis were used to compare the correlation between LV KE and other clinical and functional parameters. A P-value of <0.05 was considered significant. Compared with healthy controls, peak systolic (24.76 ± 5.40 μJ/mL vs. 31.86 ± 13.18 μJ/mL), systolic (11.62 ± 2.29 μJ/mL vs. 15.27 ± 5.10 μJ/mL), diastolic (7.95 ± 1.92 μJ/mL vs. 13.33 ± 5.15 μJ/mL), peak A-wave (15.95 ± 4.86 μJ/mL vs. 31.98 ± 14.51 μJ/mL), and global KEiEDV (9.40 ± 1.64 μJ/mL vs. 14.02 ± 4.14 μJ/mL) were significantly increased and the KEiEDV E/A ratio (1.16 ± 0.67 vs. 0.69 ± 0.53) was significantly decreased in CKD patients. As the CKD stage progressed, both diastolic KEiEDV (10.45 ± 4.30 μJ/mL vs. 12.28 ± 4.85 μJ/mL vs. 14.80 ± 5.06 μJ/mL) and peak E-wave KEiEDV (15.30 ± 7.06 μJ/mL vs. 14.69 ± 8.20 μJ/mL vs. 19.33 ± 8.29 μJ/mL) increased significantly. In multiple regression analysis, global KEiEDV (β* = 0.505; β* = 0.328), and proportion of direct flow (β* = -0.376; β* = -0.410) demonstrated an independent association with T1 and T2 times. 4D flow MRI-derived LV KE parameters show altered LV adaptations in CKD patients and correlate independently with T1 and T2 mapping that may represent myocardial fibrosis and edema. Stage 3.

Evaluation of Folic Acid Deficiency Anaemia in Predialysis Chronic Kidney Disease Patients: A Hospital-based Study

Background: Chronic kidney disease (CKD) is defined as decreasing kidney function for more than 3 months. Anemia is a common complication of CKD due to a decrease in the hormone erythropoietin related to hemoglobin levels. Folic acid helps with the process of nucleoprotein synthesis and erythropoiesis maintenance.Objectives: The aim of the study was to determine the folic acid level in predialytic anaemic chronic kidney disease patients. Methodology: It was a cross-sectional study conducted in the department of Nephrology of Eastern Medical College &amp; Hospital from September 2020 to August 2021 on predialysis CKD anaemic patient of stage-3 to stage-5. A total of 100 subjects were selected by purposive sampling. The age group was 18 to 70 years. Results: Among the 100 subjects mild, Moderate and Severe aneamia were found in 27%, 44% and 29% respectively. Maximum cases showed normocytic normochromic anaeamia (54%) and 7% cases showed macrocytic aneamia. Serum folic acid levels were found to have decreased in 1 (16.7%), 2 (8.33%) and 7 (10.0%) cases and increased in 2 (33.3%), 5 (20.83%) and 21 (30.0%) cases in stage-3, stage-4 and stage-5 respectively. Conclusion: Anemia is a frequent complication of chronic kidney disease. Inadequate production of erythropoietin by the failing kidneys leads to decreased stimulation of the bone marrow to produce red blood cells. Folic acid deficiency may represent an influential factor in renal anemia. Eastern Med Coll J. July 2023; 8 (2): 13-18

Prevalence, Risk Factors, and Management of Metabolic Acidosis in Chronic Kidney Disease Patients: A Multicenter Retrospective Study in Malaysia.

Background Metabolic acidosis in chronic kidney disease (CKD) patients has lately gained attention due to the growing evidence of its treatment benefits. This study aims to provide baseline data on the prevalence, risk factors, and current management of metabolic acidosis among the pre-dialysis adult Malaysian CKD population. Methodology This multicenter cross-sectional retrospective study involved pre-dialysis CKD patients above 18 years old on regular nephrology clinic follow-up at three Malaysian government hospitals with nephrology subspecialty. Demographic data, clinical information, laboratory data, and a list of concomitant medications were collected. Factors associated with the occurrence of metabolic acidosis were identified via multiple logistic regression. Results Six hundred and fifty-seven CKD patients were screened for this study, in which only39.4% (n=259) had available bicarbonate levels. From this, a total of 86.1% (n=223) had metabolic acidosis.Higher estimated glomerular filtration rate (odds ratio (OR) 0.96, 95% confidence interval (CI) 0.93-1.00, p=0.043) and those with cardiovascular disease (OR 0.33, 95% CI 0.15-0.73; p=0.007) were significantly associated with lower odds of metabolic acidosis. There were 43.0% (n=96) on alkali therapy with sodium bicarbonate solution being the most common (n=91, 94.8%). Among those receiving alkali therapy, only 19.8% (n=19) achieved bicarbonate levels of ≥ 22 mEq/L. Conclusion Our study showed that metabolic acidosis was highly prevalent, although few achieved target levels despite supplementation, supporting the need for focused management of metabolic acidosis in the CKD population.

Circulating osteoprotegerin levels and cardiovascular outcomes in patients with pre-dialysis chronic kidney disease: results from the KNOW-CKD study.

While the relationship between circulating osteoprotegerin (OPG) and cardiovascular events is well-established in the general population, its association with cardiovascular risks in chronic kidney disease (CKD) patients remains less robust. This study hypothesized that elevated circulating OPG levels might be associated with an increased risk of major adverse cardiac events (MACE) in CKD patients, a total of 2,109 patients with CKD stages 1 through pre-dialysis 5 from the KNOW-CKD cohort were categorized into quartiles based on serum OPG levels. The primary outcome of the study was 3-point MACE, defined as a composite of nonfatal myocardial infarction, nonfatal stroke, or cardiac death. The median follow-up duration was 7.9years. The cumulative incidence of 3-point MACE significantly varied across serum OPG levels in Kaplan-Meier curve analysis (P < 0.001, log-rank test), with the highest incidence observed in the 4th quartile. Cox regression analysis indicated that, relative to the 1st quartile, the risk of 3-point MACE was significantly higher in the 3rd (adjusted hazard ratio 2.901, 95% confidence interval 1.009 to 8.341) and the 4th quartiles (adjusted hazard ratio 4.347, 95% confidence interval 1.410 to 13.395). In conclusion, elevated circulating OPG levels are associated with adverse cardiovascular outcomes in pre-dialysis CKD patients.

Plant-based diets in patients with chronic kidney disease.

Dietary protein restriction has been considered to be a nutritional-related strategy to reduce risk for end-stage kidney disease among patients with non-dialysis-dependent chronic kidney disease (CKD). However, there is insufficient evidence to recommend a particular type of protein to slow down the CKD progression. Recently, various plant-based diets could demonstrate some additional benefits such as a blood pressure-lowering effect, a reduction of metabolic acidosis as well as hyperphosphatemia, and gut-derived uremic toxins. Furthermore, the former concerns about the risk of undernutrition and hyperkalemia observed with plant-based diets may be inconsistent in real clinical practice. In this review, we summarize the current evidence of the proposed pleiotropic effects of plant-based diets and their associations with clinical outcomes among pre-dialysis CKD patients.

Factors Related to the Occurrence of Anemia in Pre-Dialysis Chronic Kidney Disease Patients at Prof. Dr. I Goesti Ngoerah Gede Ngoerah Hospital, 2020-2022

Background: Patients with chronic kidney disease (CKD) are most commonly found to develop complications such as anemia. This complication is caused by deficiencies of erythropoietin, iron, folic acid, and vitamin B12. The prevalence of anemia is associated with patient's glomerular filtration rate (GFR), age, gender, and erythrocyte index. Aims: The aim of this study is to report prevalence of anemia in CKD pre-dialysis patients and factors related to the incidence of anemia in CKD pre-dialysis patients at Prof. Dr. I Goesti Ngoerah Gede Ngoerah Hospital in 2020-2022. Methods: This research is descriptive analytical with a cross-sectional approach by using medical record data of pre-dialysis CKD patients from the Prof. Dr. I Goesti Ngoerah Gede Ngoerah Hospital which obtained a sample of 712 patients. Results: It was found that cases of anemia in pre-dialysis CKD patients were mostly found in women (75%), age group ≥65 years (73.6%), and stage IV (88.2%) and V (94.1%). Pre-dialysis CKD patients stage ≥III (stage III-V) were 1.6 times more likely to develop anemia compared to patients with stages I and II (OR 1.641, 95% CI: 1.175-2.293; p=0.004), as well as female gender 1,6 times more likely to suffer from anemia compared to male patients (OR 1.610, 95% CI: 1.138-2.277; p=0.007). Conclusion: The overview of anemia cases in CKD pre-dialysis patients were dominated by men, age group ≥65 years, and stage V. Prevalence of anemia increases when the patient is stage ≥III (stage III-V) and female. Keywords: Chronic Kidney Disease, anemia, pre-dialysis, age, gender, stage

The role of native vitamin D treatment in the clinical assessment of osteoporosis in patients with chronic kidney disease

The prevalence of vitamin D deficiency is high in patients with chronic kidney disease (CKD). Vitamin D deficiency is associated with various bone disorders such as osteoporosis by affecting bone mineralization. Current international guidelines recommend vitamin D supplementation in CKD as well as in the general population. However, the effect of various forms of vitamin D on bone health in CKD remains unclear. Few randomized controlled studies have evaluated the effects of vitamin D supplementation on bone mineral density and bone turnover markers; however, the findings of these studies are heterogeneous. This review aimed to present comprehensive and current findings on the effects of native vitamin D supplementation on bone biomarkers and bone mineral density in CKD. We infered that native vitamin D treatment could improve some bone biomarkers, particularly in predialysis CKD patients with severe vitamin D deficiency. Our findings also draw attention to the fact that vitamin D is an important factor in treatment. However, it is essential to design better-quality and comprehensive controlled studies to obtain clear findings.

Efficacy and Safety of a High-Energy, Low-Protein Formula Replacement Meal for Pre-Dialysis Chronic Kidney Disease Patients: A Randomized Controlled Trial

High-energy, low-protein formulas (HE-LPFs) are commonly used as oral nutritional supplements (ONSs) to help provide extra calories to patients who are adhering to a low-protein diet (LPD) after diagnosis with chronic kidney disease (CKD). This randomized controlled trial aimed to evaluate the efficacy and safety of an HE-LPF as either a partial or a total replacement for one meal in pre-dialysis CKD patients. Stage 4–5 CKD patients received either a once-daily HE-LPF (HE-LPF group) or normal food (control group) for a period of 4 weeks while following an LPD. Overall, 73 patients who completed the study were included in the intention-to-treat population. After analyzing the 3-day food records, the HE-LPF group experienced a significant decrease in the percentage of energy derived from protein (p &lt; 0.05) and an increase in the percentage of energy derived from fat (p &lt; 0.05) compared to the control group. The two groups had no significant differences in body weight, body composition, grip strength, renal function, electrolytes, or metabolic markers. The HE-LPF group had a high adherence (94.9% at week 4), and no adverse effects were observed. HE-LPFs are safe to employ as meal replacements for pre-dialysis CKD patients adhering to an LPD.

Physical exercise in kidney disease: A commonly undervalued treatment modality.

Physical inactivity has been identified as a risk factor for multiple disorders and a strong association exists between chronic kidney disease (CKD) and a sedentary lifestyle. Even though physical activity is crucial in the development and progression of disease, the general focus of the current medical practice is the pharmacological perspective of diseases with inadequate emphasis on lifestyle intervention. In this narrative review we explain the pathophysiological mechanisms underlying the beneficial effects of physical exercise on CKD in addition to discussing the clinical studies and trials centred on physical exercise in patients with CKD. Physical activity influences several pathophysiological mechanisms including inflammation, oxidative stress, vascular function, immune response and macromolecular metabolism. While exercise can initially induce stress responses like inflammation and oxidative stress, long-term physical activity leads to protective countermeasures and overall improved health. Trials in pre-dialysis CKD patients show that exercise can lead to reductions in body weight, inflammation markers and fasting plasma glucose. Furthermore, it improves patients' functional capacity, cardiorespiratory fitness and quality of life. The effects of exercise on kidney function have been inconsistent in these trials. In haemodialysis, peritoneal dialysis and kidney transplant patients exercise interventions improve cardiorespiratory fitness, walking capacity and quality of life. Combined training shows the best performance to increase peak oxygen uptake in haemodialysis patients. In kidney transplant recipients, exercise improves walking performance, quality of life and potentially arterial stiffness. However, exercise does not affect glucose metabolism, serum cholesterol and inflammation biomarkers. Long-term, adequately powered trials are needed to determine the long-term feasibility, and effects on quality of life and major clinical outcomes, including mortality and cardiovascular risk, in all CKD stages and particularly in kidney transplant patients, a scarcely investigated population. Physical exercise plays a crucial role in ameliorating inflammation, oxidative stress, vascular function, immune response and macromolecular metabolism, and contributes significantly to the quality of life for patients with CKD, irrespective of the treatment and stage. Its direct impact on kidney function remains uncertain. Further extensive, long-term trials to conclusively determine the effect of exercise on major clinical outcomes such as mortality and cardiovascular risk remain a research priority.

The role of a low protein diet supplemented with ketoanalogues on kidney progression in pre-dialysis chronic kidney disease patients

In slowing kidney progression, numerous pre-dialysis chronic kidney disease (CKD) patients could not adhere to the well-established dietary pattern, including a very low protein diet, 0.3–0.4 g/kg/day, plus a full dose ketoanalogues (KAs) of amino acids. We evaluated the role of a low protein diet (LPD), 0.6–0.8 g/kg/day, combined with KAs (LPD–KAs) on CKD progression. We extracted data in the retrospective cohort using electronic medical records (n = 38,005). Participants with LPD–KAs for longer than six months were identified. An unmatched control group, LPD alone, was retrieved from the same database. Cox proportional hazard models were performed to examine the associations between LPD–KAs and outcomes. The primary outcome was either a rapid estimated glomerular filtration rate (eGFR) decline > 5 mL/min/1.73m2/year or commencing dialysis. Other secondary outcomes include changes in proteinuria, serum albumin, and other metabolic profiles were also assessed. A total of 1042 patients were finally recruited (LPD–KAs = 543). Although patients with LPD–KAs had significantly lower eGFR and a prevalence of diabetes, age, and dietary protein intake were comparable between LPD–KAs (0.7 ± 0.2 g/kg/day) and LPD alone groups (0.7 ± 0.3 g/kg/day, p = 0.49). During a median follow-up of 32.9 months, patients treated with LPD–KAs had a significantly lower risk of kidney function decline (HR 0.13; 95% CI 0.09–0.19, p < 0.001) and dialysis initiation (HR 0.24; 95% CI 0.12–0.49, p < 0.001) than LPD alone after adjusting for confounders. The annual rate of eGFR decline in patients receiving LPD–KAs was 4.5 [3.4–5.5] mL/min/1.73m2 compared with 7.7 [6.0–9.4] mL/min/1.73m2 in LPD alone (p = 0.001). According to KAs dose–response analysis, the daily dose of ≤ 5 tablets was conversely associated with a higher risk of the primary endpoint, whereas the association disappeared among patients receiving a dose of > 6 tablets. The spot urine protein creatinine ratio and serum phosphate levels were not significantly different between groups. LPD–KAs could retard kidney progression compared with LPD alone. This favorable effect was significant among CKD patients receiving a daily KAs dose of more than six tablets. Future randomized controlled trials should be performed to verify these findings.

The effects of oral sodium bicarbonate supplementation on anthropometric measures in patients with chronic kidney disease: A systematic review and meta-analysis of randomized clinical trials.

Metabolic acidosis (MA) may play a key role in the pathogenesis of protein-energy wasting (PEW) in patients with chronic kidney disease (CKD). To present a comprehensive synthesis of the effect of oral sodium bicarbonate (SB) supplementation on anthropometric measures in patients with CKD, a systematic review was undertaken in PubMed/MEDLINE, Web of Science, Cochrane CENTRAL, and Google Scholar, of relevant articles published prior to September 2022. The summary statistics of effect size, nonstandardized weighted mean difference (WMD), and 95% confidence interval (CI) were used to compare the effects of SB supplementation on anthropometric parameters vs. control group. To detect probable sources of heterogeneity, a series of predefined subgroup analyses were conducted. In total, 17 studies with 21 treatment arms, including 2203 participants (1149 cases, 1054 controls), met our inclusion criteria and were included in the meta-analysis. SB supplementation had no significant effect on body weight (BW), midarm muscle circumference (MAMC), or lean body mass (LBM) in patients with CKD. There was a significant increase in body mass index (BMI) (MD: 0.59 kg/m2, 95% CI: 0.25 to 0.93, p = 0.001) after SB supplementation in the overall analysis. In subgroup analysis, LBM was increased in studies that were ≥ 24-week duration (MD: 1.81 kg, 95% CI: 0.81 to 2.81) and in participants with BMI lower than 27 kg/m2 (MD: 1.81 mg/L, 95% CI: 0.81 to 2.81). SB supplementation may yield increases in BMI in predialysis CKD patients. However, our findings did not support the beneficial effects of SB supplementation on other anthropometric outcomes. There is an evident need for long-term high-quality interventions to confirm these findings.

Effect of Non-Surgical Periodontal Therapy on Renal Function Among Pre-Dialysis Chronic Kidney Disease Patients

Background: Association between chronic kidney disease (CKD) and periodontitis has been established. The aim of this study was to determine the effect of non-surgical periodontal therapy (NSPT) on renal function among pre-dialysis CKD patients. Methods: This is an intervention study involving 120 CKD participants. 60 CKD participants constituted the intervention group while 60 CKD participants constituted the control group. Blood samples were collected from all participants at baseline and after 3 months for the measurement of high sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), and serum creatinine for the estimation of glomerular filtration rate (eGFR). Periodontal clinical examination was performed in all participants at six sites per tooth by the researcher for the measurement of Probing Pocket Depth (PPD) and Clinical Attachment Loss (CAL). The intervention group received NSPT (scaling and root planning) and oral hygiene motivation while the control group received only oral hygiene motivation only. Re-evaluation was done after 3 months. Results: In this study, three months post NSPT, PPD reduced from 5.44mm to 3.17mm (P &lt; 0.01) and CAL from 6.29mm to 4.29mm (P &lt; 0.01) in the intervention group. There was also a statistically significant reduction in the mean values of hsCRP and IL-6 at 3 months post NSPT in the intervention group (p&lt;0.01). However, there was no reduction observed in the control group (p=0.59 and 0.66) respectively. Estimated GFR (eGFR) for the intervention group improved from 40.55 mL/min/1.73m2 to 43.22 mL/min/1.73m2 three months post NSPT (P &lt; 0.01). Conclusion: This study demonstrates the potential beneficial effects of NSPT on renal function among pre-dialysis CKD participants as estimated by improvement in eGFR.

The Microbiome and Protein Carbamylation: Potential Targets for Protein-Restricted Diets Supplemented with Ketoanalogues in Predialysis Chronic Kidney Disease.

In chronic kidney disease (CKD), metabolic derangements resulting from the interplay between decreasing renal excretory capacity and impaired gut function contribute to accelerating disease progression and enhancing the risk of complications. To protect residual kidney function and improve quality of life in conservatively managed predialysis CKD patients, current guidelines recommend protein-restricted diets supplemented with essential amino acids (EAAs) and their ketoanalogues (KAs). In clinical studies, such an approach improved nitrogen balance and other secondary metabolic disturbances, translating to clinical benefits, mainly the delayed initiation of dialysis. There is also increasing evidence that a protein-restricted diet supplemented with KAs slows down disease progression. In the present review article, recent insights into the role of KA/EAA-supplemented protein-restricted diets in delaying CKD progression are summarized, and possible mechanistic underpinnings, such as protein carbamylation and gut dysbiosis, are elucidated. Emerging evidence suggests that lowering urea levels may reduce protein carbamylation, which might contribute to decreased morbidity and mortality. Protein restriction, alone or in combination with KA/EAA supplementation, modulates gut dysbiosis and decreases the generation of gut-derived uremic toxins associated, e.g., with cardiovascular disease, inflammation, protein energy wasting, and disease progression. Future studies are warranted to assess the effects on the gut microbiome, the generation of uremic toxins, as well as markers of carbamylation.

Triiodothyronine and Protein Malnutrition Could Influence Pulse Wave Velocity in Pre-Dialysis Chronic Kidney Disease Patients.

Cardiovascular diseases (CVD) are the first cause of chronic kidney disease (CKD) mortality. For personalized improved medicine, detecting correctable markers of CVD can be considered a priority. The aim of this study was the evaluation of the impact of nutritional, hormonal and inflammatory markers on brachial-ankle Pulse Wave Velocity (PWV) in pre-dialysis CKD patients. A cross-sectional observational study was conducted on 68 pre-dialysis CKD patients (median age of 69 years, 41.2% with diabetes mellitus, 52.9% male). Laboratory data were collected, including levels of prolactin, triiodothyronine, TGF α, IL-6, and IL-1β. The high values of brachial-ankle PWV were associated with reduced muscle mass (p = 0.001, r = -0.44), low levels of total cholesterol (p = 0.04, r = -0.26), triglycerides (p = 0.03, r = -0.31), triiodothyronine (p = 0.04, r = -0.24), and prolactin (p = 0.02, r = -0.27). High PWV was associated with advanced age (p < 0.001, r = 0.19). In the multivariate analysis, reduced muscle mass (p = 0.018), low levels of triiodothyronine (p = 0.002), and triglycerides (p = 0.049) were significant predictors of PWV, but age (p < 0.001) remained an important factor. In conclusion, reduced triiodothyronine together with markers of malnutrition and age were associated with PWV in pre-dialysis CKD patients.

Factors associated with gait speed: results from the RolE of AST120 (Renamezin) in sarCOpenia preVEntion in pRe-dialYsis chronic kidney disease patients (RECOVERY) study.

Gait speed is an important measure of functional ability. This study aimed to investigate the factors associated with gait speed in patients with chronic kidney disease. The study focused on sarcopenic components, plasma uremic or inflammatory marker levels, and quality of life effects. The RolE of AST120 (Renamezin) in sarCOpenia preVEntion in pRe-dialYsis chronic kidney disease patients is a 48-week, randomized controlled, parallel-group, open-label, multicenter trial to determine the role of Renamezin (Daewon Pharmaceutical Co., Ltd.) in patients with chronic kidney disease. The participants were classified into four groups according to gait speed: ≤0.8, 0.8-1.0, ≤1.0-1.3, and ≥1.3 m/sec. Linear regression analysis was performed to identify the factors associated with gait speed. The group with a gait speed of ≤0.8 m/sec was the oldest and had the highest proportion of participants with low education level and medical aid. Participants with a gait speed of ≤0.8 m/sec showed the lowest physical and mental component scale scores. The interleukin-6 (IL-6) level tended to be the higher trend in the lowest gait speed group. In the multivariate linear regression analysis adjusted for age, sex, diabetes mellitus, and estimated glomerular filtration rate, insurance status, handgrip strength, IL-6 level, hemoglobin level, mental component scale score, and physical component scale score were significantly associated with gait speed. In conclusion, gait speed is associated with handgrip strength, IL-6 level, and various components of quality of life in predialysis chronic kidney disease patients.

Iron Status Assessment in Chronic Kidney Disease Patients Preceding Dialysis: An Exploration of Anemia and Iron Deficiency

Objective: The most common kind of anemia, iron deficiency anemia (IDA), is very burdensome for those with chronic kidney disease (CKD). The incidence of IDA rises as renal function deteriorates. The incidence of IDA in CKD patients before the need for dialysis has not been well documented in Pakistan, even though the major cause of anemia in CKD individuals is a shortage of erythrocyte a hormone generated by the kidneys that stimulates red blood cell synthesis. This study's goal is to identify the incidence of IDA in people with kidney failure who are still not receiving dialysis. Methods: We included 188 pre-dialysis CKD patients, ages 18 to 75, of both sexes. Patients with apparent anemia-related reasons were eliminated. During OPD follow-up, it was then established what proportion of patients had IDA in their pre-dialysis CKD. Results: The patients who participated in the research had an average age of 46.03 years, with a standard deviation of 12.24 years. There were 188 patients in all, and 102 of them were men, making up around 54.26% of the sample. The study's 1.2 to 1 male-to-female ratio indicates that men were overrepresented. 73 people, or around 38.83% of the total patients in the research, were found to have iron deficiency anemia (IDA) among people with chronic kidney disease (CKD) who had not yet begun dialysis. Practical Implication: The causes of iron shortage in those with CKD are complicated by several variables, chief among them being decreased nutritional iron consumption and poor gastrointestinal absorption of iron, blood losses brought on by uremia-induced platelet disorder, and persistent inflammation related to CKD. As a result, owing to chronic inflammation causing a reactive rise in ferritin, individuals with CKD have much higher ferritin threshold levels for the absolute iron shortage. As a result, it is advised that patients with CKD before starting dialysis have blood ferritin levels below 100 µg/ml and over 200 µg/ml for those who are already receiving it Conclusions: According to the study, IDA occurs often in pre-dialysis CKD patients. By paying strict attention to the sources of IDA and replacing it, patients' outcomes may be improved. Keywords: anemia, dialysis, chronic kidney disease, erythrocyte, iron deficiency, hormone

Protein energy wasting in pre-dialysis chronic kidney disease patients in Benin City, Nigeria: A cross-sectional study.

Protein energy wasting (PEW) is common among chronic kidney disease (CKD) patients, especially those with advanced stage. It worsens frailty, sarcopenia and debility in CKD patients. Despite the importance of PEW, it is not routinely assessed during management of CKD patients in Nigeria. The prevalence of PEW and its associated factors were determined in pre-dialysis CKD patients. This was a cross-sectional study that involved 250 pre-dialysis CKD patients and 125 age- and sex- matched healthy controls. Body mass index (BMI), subjective global assessment (SGA) scores and serum albumin levels were used in PEW assessment. The factors associated with PEW were identified. P-value of < 0.05 was taken as significant. The mean age of CKD and control group were 52.3±16.0 years and 50.5±16.0 years, respectively. The prevalence of low BMI, hypoalbuminaemia and malnutrition defined by SGA in pre-dialysis CKD patients were 42.4%, 62.0% and 74.8%, respectively. The overall prevalence of PEW among the pre-dialysis CKD patients was 33.3%. On multiple logistic regression, the factors associated with PEW in CKD were being middle aged (adjusted odds ratio: 12.50; confidence interval: 3.42-45.00; p <0.001), depression (adjusted odds ratio: 2.34; confidence interval: 1.02-5.40; p = 0.046) and CKD stage 5 (adjusted odds ratio: 12.83; confidence interval: 3.53-46.60; p <0.001). PEW is common in pre-dialysis CKD patients and it was associated with middle age, depression and advanced CKD. Early intervention aimed at addressing depression in early stages of CKD may prevent PEW and improve overall outcome in CKD patients.

DETERMINANT FACTORS OF SARCOPENIA AMONG PRE-DIALYSIS OUTPATIENTS IN A MALAYSIAN TERTIARY CARE CENTRE

Sarcopenia is an ageing condition characterised by a progressive and generalised loss of skeletal muscle mass and function. However, sarcopenia is not always related to advanced age in chronic kidney disease (CKD) but rather a consequence of accelerated protein catabolism. This study aimed to identify the prevalence of sarcopenia and its associated risk factors in pre-dialysis CKD patients. This cross-sectional study was conducted among 250 pre-dialysis CKD patients aged 18 years or older who attended the outpatient Renal Clinic in a tertiary hospital between  April to November 2019.  It was found that 59.2% of pre-dialysis CKD patients had slow gait speed, 52% had low handgrip strength, and 5.2% had low appendicular skeletal muscle mass index. The prevalence of sarcopenia in the studied group based on AWGS criteria was 5.2%, for which CKD stage 3-5 accounts for 0.4%, 0.8%, and 4% of the prevalence, respectively. Body mass index (AOR: 0.39, 95% CI: 0.166-0.912) and Modified Barthel Index score (AOR: 0.64, 95% CI: 0.470-0.884) were significantly associated with sarcopenia.to conclude, sarcopenia is prevalent in advanced-stage CKD and is related to low body mass index and a lack of functional independence. Controlling these two factors may delay sarcopenia progression in CKD patients. Given this, there is an urgent need to develop preventative and therapeutic approaches given the detrimental effects of sarcopenia on significant health outcomes in the CKD population. The effectiveness of dietary and exercise therapies to prevent sarcopenia in CKD should be explored.

The efficacy of combined treatment of secondary hyperthyroidism in pre-dialysis chronic kidney disease patients

Background. It is well known that chronic kidney disease (CKD) patients develop mineral and bone disturbances which lead to the development of renal osteodystrophy and its complications. Secondary hyperthyroidism is the main reason for the development of mineral and bone disoders in these patients. The purpose of the study was to evaluate the efficacy of combined therapy with Alfacalcidol and Quercetin in the treatment of secondary hyperthyroidism in pre-dialysis CKD patients. Materials and methods. 61 patients with CKD 3 and 4 stages aged 20–78 years were included in the study. Patients were divided into 2 groups: 35 patients received combined treatment with Alfacalcidol and Quercetin granules, and 26 patients received standard treatment with calcium carbonate. Indices of calcium, phosphorus, magnesium, and alkaline phosphatase were analyzed by photocolometry method and parathyroid hormone (PTH) by immune assay method. Statistical analysis was performed in the Statistica 5.0 program (StatSoft Inc., USA). Results. It was shown that intake of Alfacalcidol (0,25–0,5 mcg daily) and Quercetin granules 1.0 g three times per day provided normalization of calcium-phosphorous homeostasis, correction of hyperthyroidism but also has pronounced analgesic effect as compared with patients receiving monotherapy with calcium carbonate. Conclusions. Combined treatment with Alfacalcidol and Quercetin granules in predialysis CKD patients with secondary hyperthyroidism leads to calcium and phosphorus metabolism normalization, correction of secondary hyperthyroidism, and has an analgesic effect.

Factors in nephrologists' decision to treat pre-dialysis CKD patients with vitamin D insufficiency and SHPT: A discrete choice experiment.

Little is known about the most important factors that inform a nephrologist's decision to treat (DTT) pre-dialysis chronic kidney disease (CKD) patients with vitamin D insufficiency (VDI) and secondary hyperparathyroidism (SHPT). The objective of this study was to identify such factors and their relative importance in the DTT with a vitamin D therapy. A web-based, adaptive design conjoint analysis discrete-choice survey was developed to study factors that informed the DTT among a sample of 200 nephrologists located throughout the United States. Based on literature review and clinician input, eight attributes were selected that could influence a provider's DTT: age, race, CKD stage, serum 25-hydroxyvitamin D (25D), parathyroid hormone (PTH), serum calcium (Ca), serum phosphorus (P), and history of comorbidities. Respondents were asked to select one patient profile most suitable for treatment from three profiles with varying attribute levels. Each attribute's relative importance score was computed using hierarchical-Bayesian statistics to measure the influence of each factor where higher scores represented greater DTT consideration. The pooled analysis revealed the four most important factors: serum 25D (31.4%), serum Ca (22.7%), plasma PTH (11.5%) levels, and history of comorbidities (8.5%). Age (8.2%), serum P (7.7%), CKD stage (5.7%), and race (4.4%) were relatively less important. Patients' 25D and Ca levels contributed to more than half of nephrologists' DTT, with the consideration of PTH levels being less of a factor. Further understanding of the driving forces behind the factors that inform the DTT may help to standardize the management of CKD patients with SHPT and VDI and improve outcomes.