Presence Of Chronic Kidney Disease Research Articles

Retinal artery/arteriole occlusion risks after endovascular treatment for unruptured intracranial aneurysm

BackgroundTo evaluate the association between retinal artery/arteriole occlusion (RAO) and unruptured intracranial aneurysm (UIA).MethodsIncident UIA patients from a nationwide cohort (n=253 240) were categorised into three groups based on subsequent...

#3106 The prevalence and degree of hyperkalaemia in adult patients with chronic kidney disease, in Durban, South Africa

Abstract Background and Aims Hyperkalaemia is a known risk factor for the development of cardiac rhythm disturbances and sudden cardiac death. The presence of chronic kidney disease (CKD) is also an independent risk factor for cardiovascular complications. The prevalence of hyperkalaemia in patients with CKD has previously varied widely between studies. The prevalence of hyperkalaemia in the patients attending the renal clinic at Inkosi Albert Luthuli Central Hospital (IALCH) has not been previously determined. This study aimed to discover the prevalence of hyperkalaemia in patients attending the renal clinic at IALCH, as well as the degree of severity amongst the patients in whom hyperkalaemia was present. Demographic and other variables were also assessed for an association with hyperkalaemia. Method A retrospective review of outpatients attending the renal clinic at IALCH from 1 October 2016 until 30 September 2017. Demographic and clinical characteristics were retrieved and descriptive statistical methods and logistic regression analysis were performed. Results The study consisted of 200 patients, of whom the majority were female (n=120, 60%). The prevalence of hyperkalaemia amongst these patients was found to be 16%. In those with stage 3 CKD, the prevalence of hyperkalaemia was 7.69%. In those with stage 4 CKD, the prevalence of hyperkalaemia was 20.5% and in those with stage 5 CKD the prevalence was 17.3%. There were no statistically significant associations between hyperkalaemia and demographic variables, nor with dietician intervention. There was a significant association with the use of sodium polystyrene sulfonate. Conclusion CKD is a growing burden in the developing world. With CKD comes metabolic and other derangements, including electrolyte abnormalities as well as increased cardiovascular risk. Hyperkalaemia is associated with worsening CKD. In addition, hyperkalaemia puts patients at risk of cardiac dysrhythmias and sudden cardiac death. Pharmacological measures to manage CVD risk should be weighed up against the risk of hyperkalaemia related complications. Potassium lowering agents should be considered to allow for optimal CVD management in the setting of hyperkalaemia in CKD.

Predictive Analysis for Personalized Machine: Leveraging Patient Data for Enhanced Healthcare

This research explores predictive analysis for personalized machine: leveraging patient data for enhanced healthcare. By leveraging the power of information and analytics, the healthcare industry can be driven towards a more patient-centric, proactive model that enhances outcomes and improve the overall quality of care. The objectives of the study are to: determine the significance and challenges of predictive analytics in healthcare, ascertain the data analytics techniques used in healthcare to enhance patient care, find out how predictive analytics can be applied for enhanced healthcare, and determine the ethical considerations associated with healthcare predictive analytics. This study employs the case study approach and experimental design. The study analyzes case studies of real-time deployment of predictive analytics models in healthcare centers, examines how these models enhance the healthcare delivery in those centers. Experiments were also conducted to understand how predictive analytics works. The C4.5 learning algorithm was employed to predict the presence of chronic kidney disease (CKD) in patients and differentiate between those not affected by the condition. The C4.5 classifier shows reasonable strength, evident in the large number of rightly classified occurrences (396) and a low misclassification of only 4 occurrences. This is further demonstrated by a low error rate of 0.37, as shown in table 5. The prevalence of this algorithm is emphasized by the large value of KS (0.97), indicating the classifier’s ground-breaking accuracy and performance. The performance of C4.5, featured by its minimal execution time and accuracy, puts it as a decent classifier. This characteristic makes it specifically well-suited for application in the healthcare sector, particularly for tasks involving prediction and classification. The application of data analytics methods for predictive analysis holds significant benefits in the health sector, as it gives us the power to predict and address potential threats to human health, covering different age groups, from the young ones to the elderly. This proactive method enables early disease detection, helping in timely interventions and contributing to better decision-making.

Inflammation and Adverse Outcomes in Patients With Acute Ischemic Stroke With and Without Chronic Kidney Disease.

Elevated white blood cell count, fibrinogen levels, and lower levels of albumin signify higher systemic inflammatory response, hypercoagulable state, and poorer nutritional status, respectively. However, a consistent conclusion could not be drawn on whether the association between inflammatory markers and cardiovascular disease was affected by the presence of chronic kidney disease (CKD). We aimed to explore the association between inflammation and adverse outcomes in patients with acute ischemic stroke (AIS), as well as whether this association differs due to the presence of CKD. This research was based on the Third China National Stroke Registry. The main adverse outcomes were poor functional outcome, stroke recurrence, and combined vascular event after 1 year. Inflammation was defined as the worst quartile of at least 2 of the aforementioned 3 markers. Finally, 8493 patients with AIS were enrolled in this study. The adjusted odds ratios/hazard ratios and 95% CIs of inflammation were 1.58 (1.34-1.86) for poor functional outcomes, 1.25 (1.06-1.47) for stroke recurrence, and 1.25 (1.06-1.46) for combined vascular event. The association between inflammation and adverse outcomes existed only in patients with AIS without CKD, although the interaction between CKD and inflammation was not statistically significant. (P for interaction >0.05). Inflammation, which was defined as a combination of fibrinogen, white blood cell count, and albumin, was associated with all 1-year adverse outcomes among patients with AIS. Routine assessment of these biomarkers could become a potential part of the clinical evaluation for patients with AIS, especially those without CKD, aiding clinicians in risk stratification and treatment decision-making.

Influence of fluid accumulation on major adverse kidney events in critically ill patients – an observational cohort study

BackgroundFluid accumulation (FA) is known to be associated with acute kidney injury (AKI) during intensive care unit (ICU) stay but data on mid-term renal outcome is scarce. The aim of this study was to investigate the association between FA at ICU day 3 and major adverse kidney events in the first 30 days after ICU admission (MAKE30).MethodsRetrospective, single-center cohort study including adult ICU patients with sufficient data to compute FA and MAKE30. We defined FA as a positive cumulative fluid balance greater than 5% of bodyweight. The association between FA and MAKE30, including its sub-components, as well as the serum creatinine trajectories during ICU stay were examined. In addition, we performed a sensitivity analysis for the stage of AKI and the presence of chronic kidney disease (CKD).ResultsOut of 13,326 included patients, 1,100 (8.3%) met the FA definition. FA at ICU day 3 was significantly associated with MAKE30 (adjusted odds ratio [aOR] 1.96; 95% confidence interval [CI] 1.67–2.30; p < 0.001) and all sub-components: need for renal replacement therapy (aOR 3.83; 95%CI 3.02–4.84), persistent renal dysfunction (aOR 1.72; 95%CI 1.40–2.12), and 30-day mortality (aOR 1.70; 95%CI 1.38–2.09), p all < 0.001. The sensitivity analysis showed an association of FA with MAKE30 independent from a pre-existing CKD, but exclusively in patients with AKI stage 3. Furthermore, FA was independently associated with the creatinine trajectory over the whole observation period.ConclusionsFluid accumulation is significantly associated with MAKE30 in critically ill patients. This association is independent from pre-existing CKD and strongest in patients with AKI stage 3.

Prevalence and determinants of post-COVID-19 syndrome among patients 6 months post-discharge from a teaching hospital in South India.

The coronavirus disease 2019 (COVID-19) infection has affected millions of people worldwide in the last 4 years. Among those infected, the long-term COVID-19 syndrome, in which symptoms of COVID-19 persist for a variable period, is posing new challenges to the health system, but few studies are available in India that examine the post-COVID-19 syndrome, that is, 6 months and beyond COVID-19 infection. This study aimed to find the prevalence and determinants of post-COVID-19 syndrome among patients 6 months and beyond their infection. This cross-sectional study was conducted among 300 patients who were admitted and discharged from Government Medical College, Thrissur, at least 6 months before with a diagnosis of COVID-19 infection. The data collection was performed using a semi-structured interview schedule through a telephonic interview. The analysis was performed using the Statistical Package for the Social Sciences (SPSS) software. 21% of the patients studied had at least one persistent symptom at the end of 6 months, and 4.1% had more than one symptom. Among the symptoms persisting most commonly were fatigue (11%) and dyspnea (7.7%). Other than persisting symptoms, 21% of patients developed exertional dyspnea and 19% developed sleep disturbances during the 6 months after discharge. The factors that were associated with persistent symptoms in univariate analysis were increasing age, presence of chronic obstructive pulmonary disease (COPD), presence of chronic kidney disease (CKD), and admission to the intensive care unit (ICU). The study concludes that one-fifth of the patients still suffer from post-COVID-19 syndrome even 6 months after the COVID-19 infection. Our health systems should be prepared for the long-term management of COVID-19-infected people and prepare policies for the same.

Should the presence of chronic kidney disease preclude intravenous contrast administration when considering computed tomography imaging?

Should the presence of chronic kidney disease preclude intravenous contrast administration when considering computed tomography imaging?

Early Versus Late Periprosthetic Joint Infection After Total Knee Arthroplasty: Do Patient Differences Exist?

BackgroundPeriprosthetic joint infection (PJI) is a devastating complication following total knee arthroplasty (TKA). Little evidence exists comparing those with early versus late PJI. The purpose of the study was to determine comorbidity profile differences between patients developing early and late PJI. MethodsThere were 72,659 patients undergoing primary TKA from 2009 to 2021, who were identified from a commercial claims and encounters database. Subjects diagnosed with PJI were categorized as either ‘early’ (within 90 days of index procedure) or ‘late’ (> 2 years after index arthroplasty). Non-infected patients within these periods served as control groups following 4:1 propensity score matching on other extraneous variables. Logistic regression analyses were performed comparing comorbidities between groups. ResultsPatients were significantly younger in the late compared to the early infection group (58.1 versus 62.4 years, P < .001). When compared to those with early PJI, patients who had chronic kidney disease (13.3 versus 4.1%; OR [odds ratio] 5.17, P = .002), malignancy (20.4 versus 10.5%; OR 2.53, P = .009), uncomplicated diabetes (40.8 versus 30.6%; OR 2.00, P = .01), rheumatoid arthritis (9.2 versus 3.3%; OR 2.66, P = .046), and hypertension (88.8 versus 81.6%; OR 2.17, P = .04), were all significant predictors of developing a late PJI. ConclusionsWhen compared to patients diagnosed with early PJI following primary TKA, the presence of chronic kidney disease, malignancy, uncomplicated diabetes, rheumatoid arthritis, and hypertension, were independent risk factors for the development of late PJI. Younger patients who have these comorbidities may be targets for preoperative optimization interventions that minimize the risk of PJI.

Atrioventricular block secondary to transient causes and long-term recurrence after an index event.

Atrioventricular block (AVB) secondary to transient causes can recover with its correction. However, studies assessing predictors of recovery and long-term recurrence are lacking. Patients with advanced or complete AVB who had a reversible cause admitted in a single expert center were retrospectively studied. Patients with AVB secondary to acute coronary syndromes were excluded from analysis. In a population of 162 patients, the main factors associated with recovery of rhythm without a permanent pacemaker (PPM) implantation were the presence of chronic kidney disease (CKD) on dialysis (OR 7.6; CI 95% 1.2-47.5 (p=.03)); greater serum potassium levels (OR 2.3; CI 95% 1.28-4.0 (p<.01)), higher dosage of bradycardic drugs (OR 2.2; CI 95% 1.13-4.4 (p=.02)), the association between different bradycardic drugs (OR 9.0; CI 95% 2.02-40.3 (p<.01)) and between drug therapy and hyperkaliemia (OR 5.2; CI 95% 1.8-15.1 (p<.01)). There was an overall high burden of conductions abnormalities which did not correlate with recovery of rhythm (OR 0.5; CI 95% 0.19-1.5 (p=.23)). In 29 patients (17.9%) there was a correction of the AVB. During a maximum follow-up of 130 months, 24 patients (82.8%) had a recurrence which warranted a PPM. In the overall cohort only five patients (3%) had sustained recovery of rhythm. Recovery of AVB was mainly observed with higher doses of drug therapy, higher serum potassium levels or a combination of factors and regardless of baseline conduction abnormalities. The high rate of recurrence during follow-up warrants a close follow-up or PPM implantation at index admission.

Characteristics and prognosis of acute renal failure on dialysis in ANCA vasculitis

Renal involvement in ANCA (Anti Neutrophil Cytoplasmic Antigen) vasculitis is common and is associated with increased mortality with a significant risk of progression to end-stage renal disease. The aim of this study is to investigate the epidemiological, clinicopathological, therapeutic and evolutionary characteristics of patients with ANCA vasculitis with acute renal injury, and to evaluate the impact of haemodialysis in the acute phase on mortality and renal recovery. Secondary objectives are to investigate other risk factors that impact on overall and renal survival. 31 patients were included; the mean follow-up time was 30 months. The mean age was 68.52 years, and the sex ratio 0.72. All patients had acute renal failure, with histology revealing a mixed form in 45% of cases and a sclerotic form in 12.9% of cases. Pulmonary involvement was found in 58% of cases. 71% of patients had ANCA with anti-myeloperoxydase specificity, and 25.8% anti-proteinase3 specificity. 32.2% of patients required haemodialysis, of which 60% were weaned. As initial treatment, 58.1% of patients received cyclophosphamide and 35.5% rituximab. The relapse rate was 6.5%. Infectious and cardiovascular complications affected more than half of the patients. The mortality rate was 19.35%. Comparing the two groups of patients dialysed in the acute phase and not dialysed, it appears that the overall and renal mortality was comparable. The progression to end-stage renal failure was higher in the dialysis patients. In a multivariate study, the presence of chronic kidney disease in the history and pulmonary involvement were associated with higher mortality.

Associations of carotid atherosclerosis with cognitive function and brain health: Findings from a UK tri-ethnic cohort study (Southall and Brent Revisited)

BackgroundCognitive function has an important role in determining the quality of life of older adults. Cardiovascular disease (CVD) is common in older people and may compromise cognitive performance; however, the extent to which this is related to carotid atherosclerosis is unclear. AimWe investigated associations between carotid atherosclerosis and cognitive function and neuroimaging markers of brain health in a UK multi-ethnic community-based sample including older people of European, South Asian, and African-Caribbean ethnicity. MethodsCarotid plaques and intima-media thickness (cIMT) were assessed using ultrasound in 985 people (mean age 73.2y, 56 % male). Associations of carotid atherosclerosis with cognitive function (memory, executive function, language and CSI-D, a global measure of cognitive state) and neuroimaging measures (total brain volume, hippocampal volume, white matter (WM) lesion volume and coalescence score) were analysed using regression analyses, with and without adjustment for potential confounders using two models: 1) adjustment for age, sex, and ethnicity; 2) model 1 plus education, physical activity category, body mass index, hypertension, diabetes, total and high density lipoprotein cholesterol, atrial fibrillation, smoking, previous CVD, alcohol consumption, and presence of chronic kidney disease. ResultsPeople with carotid plaque or higher cIMT had lower CSI-D score, poorer memory poorer executive function and higher WM lesion volume and coalescence. Language was poorer in people with plaque but was not correlated with cIMT. Associations with plaque were preserved after full adjustment (model 2) but relationships for cIMT were attenuated. Associations with other plaque characteristics were generally unconvincing after adjustment. ConclusionsThis multi-ethnic cohort study provides evidence that presence of carotid plaque, is associated with poorer cognitive function and brain health.

Isolated hypoaldosteronism is a cause of hypovolemic but not euvolemic hyponatremia.

Hypoaldosteronism is characterized by hyperkalemia, and/or hypovolemic hyponatremia (HH), often accompanied by metabolic acidosis. HH is typical of hypoaldosteronism, whereas euvolemic hyponatremia (EH) is not. The purpose of the current study is to describe the characteristics of hyponatremia in hypoaldosteronism and elucidate whether EH can be considered part of the disease's spectrum. In a hypoaldosteronism cohort, we analyzed the factors associated with hyponatremia, comparing the characteristics of EH and HH and their associated factors. Correlation analyses of mineralocorticoid biomarkers, such as the transtubular potassium gradient (TTKG), the urinary Na+/K+ ratio (UNa+/UK+) with serum, and urinary electrolytes were performed in both types of hyponatremia. Of 112 hypoaldosteronism episodes, 77.7% were ≥65 years old, 44.6% were women, and 80 (71.4%) had hyponatremia. Hyponatremia was negatively associated with the presence of chronic kidney disease, and positively with a hypovolemic state, malnutrition, a prior history of hyponatremia, and glucocorticoid therapy. HH: 61/80 and EH: 19/80 episodes. HH was associated with an age ≥65 years and the use of diuretics, as well as factors related to an aldosterone deficit and/or mineralocorticoid resistance. In HH but not in EH, urinary potassium was correlated with the TTKG, and urinary sodium with both the TTKG and the UNa+/UK+. Both HH and EH can be observed in hypoaldosteronism. However, only the former would be related to insufficient mineralocorticoid activity. Isolated hypoaldosteronism is a poorly understood and underdiagnosed endocrinological disorder, classically recognized only when hyperkalemia is present. The development of hypovolemic hyponatremia, however, is also easily explained by the physiopathology of the disorder. The current study addresses the features of hyponatremia when found in the context of mineralocorticoid insufficiency, and confirms an association between hypovolemic hyponatremia and isolated hypoaldosteronism. Thus, the clinical spectrum of hypoaldosteronism is extended to include hypovolemic hyponatremia as a frequent manifestation of the disorder.

Critical Endpoints In Dynamic Follow-Up Of Anemia Patients With Percutaneous Coronary Intervention For Acute Coronary Syndrome

Introduction — Identifying critical endpoints during long-term follow-up of patients with coronary artery disease (CAD) and anemia after percutaneous coronary intervention (PCI) would allow optimizing management tactics for this group of patients. Objective — To investigate the risks of developing adverse cardiovascular complications in patients with anemia who underwent revascularization for acute coronary syndrome (ACS) and to assess the most significant factors affecting outcomes. Material and Methods — The study included 298 patients with CAD who had undergone PCI at least two years before enrollment. A survey of patients and a retrospective analysis of their medical records were conducted. The outcome was a composite endpoint (death, myocardial infarction, stroke, transient ischemic attack). Kaplan-Meier curves were constructed to assess the effect of anemia on outcomes. To identify predictors of an adverse outcome, a Cox regression model was built. Results — In the group of patients with ACS who underwent PCI, the incidence of anemia was 8.4%. The incidence of the composite endpoint in patients with anemia was 51.6%, which was significantly different from its value in patients without anemia after 400 days of follow-up (logrank test, p&lt;0.008). After day 1,200, both groups exhibited similar dynamics of adverse outcomes. The following factors were statistically significantly linked to the risk of death within 24 months after PCI: left ventricular ejection fraction (p=0.002), anemia (p=0.009), and chronic kidney disease (p=0.02). Conclusion — We demonstrated that anemia influenced the development of adverse outcomes from day 400 to day 1,200 of a follow-up. Some factors, such as left ventricular ejection fraction and the presence of chronic kidney disease, also had a high predictive power for adverse events.

Thromboelastography-Guided Anticoagulation in Critically Ill COVID-19 Patients: Mortality and Bleeding Outcomes

Hypercoagulability in COVID-19 patients was associated with increased mortality risk during the pandemic. This retrospective, observational study investigated whether the use of a thromboelastography (TEG)-guided anticoagulation protocol could decrease death and bleeding in critically ill COVID-19 patients. A TEG-guided protocol was instituted in one of two intensive care units. Primary outcomes of composite scores were the following: (0) major bleed and death; (1) death without major bleed; (2) major bleed without death; and (3) no bleed or death. Out of 134 patients, 67 in the TEG group were propensity matched to 67 in the comparator group based on age, gender, body mass index, presence of chronic kidney disease, cardiovascular disease, diabetes, and duration of non-invasive ventilation. There were no significant differences in rates of composite outcomes of bleeding or death in patients managed with or without a TEG-guided protocol (p = 0.22, Bowker symmetry testing). Out of the 67 patients in the TEG group, the TEG protocol led to anticoagulation change in 26 patients. Death was lower in this TEG-changed group (54%) compared to the comparator group (81%), although not significant (p = 0.07). TEG-guided protocol use did not reduce composite outcomes of death and bleeding, Future studies may further elucidate potential benefits.

Association of Patient Characteristics and Insurance Type with Multiple Myeloma Care Patterns

Background: Studies reporting disparities inmultiple myeloma (MM) care patterns are mostly limited to Medicare Parts A &amp; B beneficiaries. Moreover, little is known about access to triplet regimens and expensive prescription oral medications such as lenalidomide. Objective: To examine the use of novel triplet regimens and lenalidomide in induction therapy, as well as stem cell transplantation (SCT) by race and social determinants of health (SDOH), among patients with newly diagnosed MM. Methods: This retrospective cohort study used Taussig Cancer Center's Myeloma Patient Registry to identify adults with newly diagnosed MM between January 1, 2017- December 31, 2021, and treated in northeast Ohio. Patients who had at least 1 year of follow-up since the initial MM diagnosis were included. Electronic health records and Surescripts dispensed prescription data were used to capture during the first year after initial MM diagnosis 1) prescription fill for lenalidomide and 2) use of any triplet regimens (including bortezomib, lenalidomide, and dexamethasone; bortezomib, cyclophosphamide, and dexamethasone; carfilzomib, lenalidomide, and dexamethasone; daratumumab, lenalidomide, and dexamethasone; ixazomib, lenalidomide, and dexamethasone; and bortezomib, thalidomide, and dexamethasone), and 3) receipt of SCT during the study follow-up. Multivariable logistic regression models were used to examine the association between patient race, sex, age at initial diagnosis, insurance type, area deprivation index (ADI), Eastern Cooperative Oncology Group (ECOG) Performance Status, Charlson comorbidity index (CCI), diagnosis year, treatment location, and the outcomes of interest. Lenalidomide model was also adjusted for the presence of chronic kidney disease (CKD). Results: We identified 569 patients with a median age of 66 years (IQR, 59-73), median CCI of 2 (IQR, 0-5), and median ECOG of 1 (IQR, 0-1); 55% were male, 76% White, 23% Black, 1.1% other races. The majority had Medicare (51%); 38% had private insurance, 8.3% had Medicaid, and 1.8% were self-paying or had other payors. Overall, 73% had at least one fill for lenalidomide (76% in White, 68% in Black, and 50% in patients with other racial backgrounds, p=0.07) and 64% received any triplet regimen (64% White, 65% Black, 83% other races, p=0.7); 48% received SCT (54% White, 28% Black, 33% other races, p&amp;lt;0.001). Compared to Medicare, private insurance (adjusted odds ratio [AOR]=0.47, 95% confidence interval [CI], 0.26-0.84) and self-pay or other payors (AOR=0.16, 95% CI, 0.04-0.76) had lower odds of prescription fill for lenalidomide; Medicaid did not have significantly different odds (AOR=0.41, 95% CI, 0.17-1.02). One year increase in age (AOR=0.94, 95% CI, 0.92-0.97) and CKD (AOR=0.26, 95% CI, 0.15-0.45) were associated with lower odds of lenalidomide use. Race and treatment facility location were not associated with lenalidomide fill. Compared to Medicare beneficiaries, those self-paying or with other payors (AOR=0.14, 95% CI, 0.03-0.53) had lower odds of any triplet regimen use; privately insured (AOR=0.65, 95% CI, 0.39-1.09) and those with Medicaid (AOR=0.65, 95% CI, 0.30-1.43) did not have significantly different odds. One unit increase in CCI (AOR=1.16, 95% CI, 1.08-1.24) and in the year of diagnosis (AOR=1.15, 95% CI, 1.01-1.30) were associated with higher odds of triplet regimen use, while a 1-year increase in age was associated with 3% lower odds (AOR=0.97, 95% CI, 0.95-0.998). Race and treatment facility location were not associated with triplet regimen use. Compared to White individuals, Black patients had lower odds of receiving SCT (AOR=0.46, 95% CI, 0.25-0.83). One year increase in age was associated with an 11% decrease (AOR=0.89, 95% CI, 0.86-0.92) and 1 unit increase in CCI with a 13% decrease (AOR=0.87, 95% CI 0.81-0.94) in the odds of SCT, while a more recent year of diagnosis was linked to higher odds of SCT (AOR=1.30, 95% CI, 1.12-1.51). Patients treated at regional hospitals also had lower odds of SCT (AOR=0.26, 95% CI, 0.12-0.55), compared to Taussig Cancer Center and satellite family health centers. Insurance type was not associated with SCT. Conclusions: Care for MM varies based on race, insurance type, and location of treatment facility. Strategies are needed to reduce non-preference based variations in MM treatment, including via examination of patient out-of-pocket costs, pre-authorization criteria, and other SDOH.

Associations of Electrocardiographic Abnormalities in Stable Type 2 Diabetes Subjects: Experience from a Tertiary Health Facility in South Eastern Nigeria

Introduction: Cardiovascular abnormalities are prevalent in the setting of diabetes mellitus, even among stable subjects, necessitating the need for a regular cardiovascular disease screening for this group of patients. Electrocardiogram is a simple and reliable screening test for cardiovascular abnormalities that could be easily accessible even in resource poor and rural settings. This study was carried out to determine the association between cardiovascular risk factors and electrocardiographic abnormalities in stable type 2 diabetes subjects in South Eastern Nigeria.&#x0D; Materials and Methods: One hundred and thirty-six stable adults with type 2 diabetes mellitus were recruited consecutively from the out-patient diabetes clinic of Nnamdi Azikiwe University Teaching Hospital in South Eastern Nigeria. They were assessed for the risk factors for cardiovascular diseases that included smoking, obesity, dyslipidaemia, poor glycaemic control, hypertension, lack of exercise, presence of chronic kidney disease and metabolic syndrome. They also had a 12 lead electrocardiogram done. Results were analyzed using SPSS version 25. P value of ˂ 0.05 was considered significant.&#x0D; Result: A total of 128 subjects had complete results and were analyzed. There were 63 males and 65 females with a mean age of 58.43 ± 12.85 years and mean diabetes duration of 9.03 ± 7.36 years. A total of 45.3% of the subjects had electrocardiographic abnormalities. Hypertension was present in 54.9%, dyslipidaemia in 91.4%, central obesity in 74.3%, metabolic syndrome in 76.6% and chronic kidney disease in 57.9% of the subjects. Significant association was found between smoking and occurrence of AV block (p = 0.008), central obesity and QRS axis abnormality (p = 0.002), dyslipidaemia and ST segment abnormality (p = 0.001) and lack of exercise and ST segment abnormality (p = 0.000). No significant association was found between age, sex of the subjects, duration of DM, treatment modality for DM, level of glycaemic control, hypertension, presence of CKD and metabolic syndrome and any of the electrocardiographic abnormalities.&#x0D; Conclusion: Electrocardiographic abnormalities are common in stable type 2 diabetic subjects. There was significant association between smoking habit, central obesity, dyslipidaemia, lack of exercise and ECG abnormalities that included AV block, QRS axis and ST segment abnormalities.

CHA2DS2-VASc score as a predictor of clinical outcomes in hospitalized patients with and without chronic kidney disease

BackgroundHigh CHA2DS2-VASc score (Congestive heart failure, Hypertension, Age > 75 years, Diabetes mellitus, prior Stroke or transient ischemic attack or thromboembolism, Vascular disease, Age 65–74 and Sex category) was associated with adverse clinical outcomes in different settings.The aim of the present study was to evaluate the association between CHA2DS2-VASc score and R2CHA2DS2-VASc score (which includes renal impairment) with in-hospital mortality and length of hospital stay in patients hospitalized in an internal medicine ward.MethodsWe enrolled 983 consecutive patients admitted during 3 years in an internal medicine ward. R2CHA2DS2-VASc score was calculated by adding 2 points to CHA2DS2-VASc for the presence of chronic kidney disease (CKD), defined according to K-DOQI. The primary outcome was a composite of all-cause mortality and length of hospital stay > 10 days.ResultsPatients with CKD stages 3–5 presented with increased CHA2DS2-VASc vs stages 1–2 (p < 0.001). The composite outcome occurred in 47.3% of inpatients. Multivariable linear logistic regression analyses adjusted for presence of infectious diseases and cancer, with the occurrence of composite outcome showed an adjusted OR of 1.349 (95% CI 1.248–1.462) and 1.254 (95% CI 1.179–1.336) for CHA2DS2-VASc and R2CHA2DS2-VASc scores, respectively. No differences were found in the association between CHA2DS2-VASc and R2CHA2DS2-VASc scores with the composite outcome (AUC 0.631 vs 0.630), and furthermore, adding the presence/absence of infectious diseases during hospitalization and positive cancer history to the models increased the AUC (0.667 and 0.663).ConclusionsIncrementally higher CHA2DS2-VASc score is associated with increased length of hospital stay and mortality in patients hospitalized in an internal medicine ward, regardless of the presence of CKD.Graphical abstract

Predictors of disease severity in SARS-CoV-2 omicron variant XBB sublineages and variants of interest.

The Omicron variant has been reported to present with milder disease compared with Delta, although this may be due to immunity from vaccination and prior exposure. Predictors of severity with recent strains have not been well characterized. We retrospectively examined consecutive cases of moderate-to-severe COVID-19 (defined as requiring supplemental oxygenation, intensive care or mortality) admitted to seven tertiary hospitals across Singapore in April 2023. Whole genome sequencing was performed on each isolate to determine the sublineage, while baseline clinical, laboratory data and outcomes were tabulated. We reviewed 182 patients with moderate-to-severe illness and 466 controls hospitalized at the same time. Advanced age and presence of chronic kidney disease predicted adverse outcome. Previously reported markers such as radiographic evidence of pneumonia, elevated C-reactive protein and serum creatinine levels at presentation also correlated with adverse outcomes. There were no observable differences in outcomes with any specific Omicron XBB sublineage. We did not find any specific Omicron XBB sublineage that was associated with worse outcomes. Larger multinational studies would be important to track the clinical evolution of the virus in its current endemic state.

Supplementation for sarcopenia in chronic kidney disease updated literature review

Sarcopenia is the loss of muscle mass and strength, common in elderly patients and worsened by the presence of chronic kidney disease (CKD), which has a progressive decrease in the number of nephrons. Anaerobic physical exercise and protein supplementation are important for maintaining strength and muscle mass. Dietary interventions, such as greater protein intake, are essential to preserve and increase muscle mass. Leucine appears to be the most powerful amino acid in stimulating muscle anabolism. Testosterone and L-carnitine supplementation may also be helpful, but there is controversy regarding their use. Omega 3, vitamin D and calcium are supplements that can increase muscle mass and improve muscle function in patients with sarcopenia associated with CKD, but their dosages are still debatable. This review article aims to describe oral supplementation for sarcopenia and the kidney changes that they may cause. In summary, physical activity and protein supplementation are fundamental in the treatment of sarcopenia in patients with CKD.

Factors associated with chronic kidney disease in patients with diabetes in French Guiana.

With over half of the population living under the poverty threshold, the social and health context in French Guiana is more difficult than in mainland France. The prevalence of diabetes is twice as great and end-stage renal failure is 45% higher than in mainland France. Our objective was to describe the profile of diabetic patients with chronic kidney disease in French Guiana and search for possible risk factors. We conducted a multicenter cross-sectional observational study based on the CODIAM cohort (Cohort of Diabetes in French Amazonia). We analyzed 1,287 patients followed up between May 2019 and June 2021 at Cayenne Hospital, Saint Laurent Hospital, and delocalized health centers. In our cohort, chronic kidney disease was present after an average of 12 years of diabetes. Compared with the French population, 41% of diabetic patients had chronic kidney disease (i.e., 12% more), and had an average age of 56 years (i.e., 10 years younger). Forty-eight per cent of these patients were obese (i.e., 7% more). Seventy-four per cent of patients were precarious and 45% were foreigners but neither was associated with chronic kidney disease, contrary to countries where the health system is not universal. Screening of patients with chronic kidney disease among diabetics in French Guiana remains a real challenge. Patients were younger and more obese than in other French territories. In this cohort, precariousness and immigration were not associated with the presence of chronic kidney disease. However, particular attention should be paid to hypertensive patients and those over 65 years of age, which are, with diabetes itself, the two most obvious risk factors for developing chronic kidney disease among diabetic patients in our territory.