Prevalence Of Chronic Renal Insufficiency Research Articles

PO-03-229 DISTINCT ROLES FOR ELECTROCARDIOGRAPHIC VS. ECHOCARDIOGRAPHIC LVH IN SCA RISK STRATIFICATION

In a pilot study, we have reported that ECG and echocardiographic LVH convey distinct risk information in patients with SCA, reflecting electrical vs anatomic remodeling. In fact, a subgroup of SCA cases manifest with isolated ECG LVH, without anatomic remodeling. To test this finding in a larger sample and evaluate determinants of isolated ECG LVH in individuals who suffer SCA. In a large, prospective population-based study in the Northwest US (catchment population, one million), cases of SCA were compared to controls recruited from the same geographical area. A novel archive of SCA cases that underwent both ECG and Echo prior and unrelated to their SCA event was analyzed. The independent association of ECG LVH and Echo LVH with SCA was tested. We also compared characteristics of individuals with isolated ECG LVH vs. anatomic LVH separately in cases as well as controls. SCA Cases (n=626; 68 ± 14 years; 62% male), compared to controls (n= 477; 67 ± 11 years; 65% male) were more likely to have both ECG LVH (18% vs. 10%; p<0.001) and echocardiographic LVH (34.0% vs. 17%; p<0.001). However, there was poor agreement between the tests (kappa statistic = 0.18). A large subgroup of patients with ECG LVH (52%) did not have Echo LVH; conversely 74% of patients with echocardiographic LVH did not have ECG LVH. In multivariate analysis, ECG LVH was significantly associated with SCA (OR 1.6; 95% CI 1.1-2.3; p=0.03) independent of Echo LVH (OR 2.0; 95% CI 1.4–2.7; p=0.001). In cases, comprehensive comparisons of demographics, most co-morbidities and medications between isolated ECG LVH (n=53) and Echo LVH (n=214) did not reveal any significant differences. Prevalence of chronic renal insufficiency (38% vs. 58%, p=0.04) and LV ejection fraction <35% (13% vs. 27%, p=0.03) was moderately lower in cases with isolated ECG LVH. We confirm that ECG LVH and Echo LVH confer independent increased risk of SCA and should be considered separately in risk prediction algorithms. Isolated ECG LVH did not segregate with distinct demographic or clinical findings, suggesting that a special genetic contribution to development of ECG LVH should be investigated.

THIRSTY FOR FRUCTOSE: Arginine Vasopressin, Fructose, and the Pathogenesis of Metabolic and Renal Disease.

We review the pathways by which arginine vasopressin (AVP) and hydration influence the sequelae of the metabolic syndrome induced by high fructose consumption. AVP and inadequate hydration have been shown to worsen the severity of two phenotypes associated with metabolic syndrome induced by high fructose intake–enhanced lipogenesis and insulin resistance. These findings have implications for those who frequently consume sweeteners such as high fructose corn syrup (HFCS). Patients with metabolic syndrome are at higher risk for microalbuminuria and/or chronic kidney disease; however, it is difficult to discriminate the detrimental renal effects of the metabolic syndrome from those of hypertension, impaired glucose metabolism, and obesity. It is not surprising the prevalence of chronic renal insufficiency is growing hand in hand with obesity, insulin resistance, and metabolic syndrome in those who consume large amounts of fructose. Higher AVP levels and low hydration status worsen the renal insufficiency found in patients with metabolic syndrome. This inter-relationship has public health consequences, especially among underserved populations who perform physical labor in environments that place them at risk for dehydration. MesoAmerican endemic nephropathy is a type of chronic kidney disease highly prevalent in hot ambient climates from southwest Mexico through Latin America. There is growing evidence that this public health crisis is being spurred by greater fructose consumption in the face of dehydration and increased dehydration-dependent vasopressin secretion. Work is needed at unraveling the mechanism(s) by which fructose consumption and increased AVP levels can worsen the renal disease associated with components of the metabolic syndrome.

Time trends of pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension.

Chronic thromboembolic pulmonary hypertension is considered as a rare but severe complication after acute pulmonary embolism and is potentially curable by pulmonary endarterectomy. We aimed to evaluate, over an 11-year period, time trends of in-hospital outcomes of pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension patients and to investigate predictors of the in-hospital course. We analyzed data on the characteristics, comorbidities, treatments, and in-hospital outcomes for all chronic thromboembolic pulmonary hypertension patients treated with pulmonary endarterectomy in the German nationwide inpatient sample between 2006 and 2016. Overall, 1398 inpatients were included. Annual number of pulmonary endarterectomy increased from 67 in 2006 to 194 in 2016 (P < 0.001), in parallel with a significant decrease of in-hospital mortality (10.9% in 2008 to 1.5% in 2016; P < 0.001). Patients’ characteristics shifted slightly toward older age and higher prevalence of chronic renal insufficiency and obesity over time, whereas duration of hospital stay decreased over time. Independent predictors of in-hospital mortality were age (OR 1.03 (95%CI: 1.01–1.05); P = 0.001), right heart failure (2.55 (1.37–4.76); P = 0.003), in-hospital complications such as ischemic stroke (6.87 (1.06–44.70); P = 0.044) and bleeding events like hemopneumothorax (24.93 (6.18–100.57); P < 0.001). Annual pulmonary endarterectomy volumes per center below 10 annual procedures were associated with higher rates of adverse in-hospital outcomes. Annual numbers of chronic thromboembolic pulmonary hypertension patients treated with pulmonary endarterectomy increased markedly in Germany between 2006 and 2016, in parallel with a decrease of in-hospital mortality. Our findings suggest that perioperative management of pulmonary endarterectomy, institutional experience, and patient selection is crucial and has improved over time.

Time trends of pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension

Abstract Background and purpose Chronic thromboembolic pulmonary hypertension (CTEPH) is considered as a rare but severe complication after acute pulmonary embolism (PE) and is potentially curable by pulmonary endarterectomy (PEA). We aimed to evaluate, over an 11-year period, time trends of in-hospital outcomes of PEA in CTEPH patients in the German nationwide inpatient sample. Methods and results We analyzed data on the characteristics, comorbidities, treatments and in-hospital outcomes for all CTEPH patients treated with PEA in Germany between 2006 and 2016. Overall, 1,398 inpatients were included. The annual number of PEA increased from 67 in 2006 to 194 in 2016 (β 0.69 [95% CI 0.51 to 0.86]; p&amp;lt;0.001) in parallel with a significant decrease of in-hospital mortality (10.9% in 2008 to 1.5% in 2016; β −1.85 [95% CI: −2.46 to −1.24]; p&amp;lt;0.001). Patients' characteristics shifted slightly towards older age and higher prevalence of chronic renal insufficiency and obesity over time, whereas duration of hospital stay decreased over time. Independent predictors of in-hospital mortality were age and right heart failure, and in-hospital complications such as ischemic stroke and bleeding events. Conclusions The number of CTEPH patients treated with PEA increased markedly in Germany between 2006 and 2016, in parallel with a decrease of in-hospital mortality. Our findings may suggest that the perioperative management of PEA and the general patients' selection have improved over time and might draw more attention to predictors for in-hospital mortality for CTEPH patients hospitalized for PEA. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was supported by the German Federal Ministry of Education and Research (BMBF 01EO1503).

Prevalence, clinical predictors, and prognostic impact of chronic renal insufficiency in very old Chinese patients with coronary artery disease

An aging population leads to the increased prevalence of coronary artery disease (CAD) and chronic renal insufficiency (CRI). Nevertheless, the prevalence, clinical predictors, and prognostic impact of CRI in very old Chinese patients with CAD are unclear. Baseline characteristics were obtained from 1,050 old patients with CAD. The endpoint was all-cause mortality during the mean follow-up period of 417 days. The median age of the subjects was 86 years (range 60-104 years). CRI was present in 372 patients (35.4%). Age [hazard ratio (HR) 1.032, 95% confidence interval (95% CI) 1.010-1.054], chronic heart failure (CHF) (HR 2.361, 95% CI 1.747-3.191), hypertension (HR 1.878, 95% CI 1.291-2.731), hemoglobin (HR 0.973, 95% CI 0.965-0.981), serum albumin (HR 0.954, 95% CI 0.912-0.995), HDL-C (HR 0.371, 95% CI 0.238-0.580), and LDL-C levels (HR 0.795, 95% CI 0.656-0.965) were independent predictors of CRI (all P < 0.05). In addition, CRI was independently associated with mortality in patients with CAD (HR 1.366, 95% CI 1.024-1.822, P = 0.034). Age (HR 1.036, 95% CI 1.015-1.059), acute myocardial infarction (AMI; HR 1.795, 95% CI 1.239-2.602), CHF New York Heart Association class IV (HR 1.691, 95% CI 1.187-2.410), heart rate (HR 1.019, 95% CI 1.011-1.026), hemoglobin (HR 0.982, 95% CI 0.975-0.990), and serum albumin levels (HR 0.905, 95% CI 0.874-0.938) were also independently related to mortality in CAD patients (all P < 0.05). A high prevalence of CRI with a high associated mortality rate existed in very old Chinese patients with CAD. CRI was an independent risk factor of adverse prognosis for these patients, and multiple predictors could be used to identify CAD patients at increased risk for CRI or poor survival.

Association of Hyponatremia in Acute Stroke Stage with Three-Year Mortality in Patients with First-Ever Ischemic Stroke

Background: Hyponatremia is the most common electrolyte disorder in hospitalized patients, and is frequently a marker of a significant underlying disease. The prognostic value of hyponatremia in patients with acute first-ever ischemic stroke is not known. We aimed to analyze whether hyponatremia in the acute stroke stage contributed to the risk of mortality or recurrent stroke in these patients. Methods: We studied 925 patients presenting with acute first-ever ischemic stroke between 2002 and 2004. Sodium levels were obtained on arrival at the emergency room within 3 days of acute stroke onset. Hyponatremia was defined as a serum sodium concentration of 134 mmol/l or less. Clinical presentation, stroke risk factors, associated medical disease, and outcome were recorded. All patients were followed for 3 years for survival analysis. A multivariate Cox proportional hazards model was used to identify risk factors for 3-year mortality in these patients. We also constructed Kaplan-Meier survival curves, and compared groups with hyponatremia and normonatremia by means of log rank tests for significant differences. Results: Among the patients with acute first-ever ischemic stroke, 107 (11.6%) were hyponatremic. Among stroke risk factors, the prevalence of diabetes mellitus was significantly higher among hyponatremic patients (p < 0.001). Prevalence of chronic renal insufficiency was also higher in the hyponatremic group (p = 0.002). Clinical presentations, such as the length of acute ward stay, initial impaired consciousness, and clinical course in acute stroke were similar among normo- and hyponatremic patients. Among the complications, pneumonia and urinary tract infection were significantly higher in hyponatremic than in normonatremic patients. After multivariate logistic regression analysis, diabetes mellitus and chronic renal insufficiency were associated with hyponatremia in these patients. Kaplan-Meier analysis indicated that the survival rate was significantly lower in hyponatremic patients than in normonatremic patients (log rank test; p value <0.001). After multivariate Cox proportional hazards model analysis, hyponatremia was a significant predictor of 3-year mortality in these patients after adjustment for related variables (p value = 0.003, hazard ratio = 2.23, 95% confidence interval: 1.30–3.82). Conclusion: Hyponatremia in the acute stroke stage is a predictor of 3-year mortality in patients with acute first-ever ischemic stroke that is independent of other clinical predictors of adverse outcome.

Prevalencia de enfermedad renal crónica en pacientes con diabetes tipo 2 mediante determinación del filtrado glomerular y su relación con el riesgo cardiovascular

Background and objectiveThe aim of this study was: to estimate the prevalence of chronic renal insufficiency (CRI) in diabetic type 2 (DM2) patients treated in Primary Care based on the estimated glomerular filtration rate (GFe); to determine associated factors with CRI, and to evaluate the relationship of GF rate and risk of cardiovascular disease. Patients and methodsThis was a descriptive cross-sectional study. We included 500 medical histories randomly selected in a total of 2,950 DM2 patients. We registered sociodemographic data, comorbidities, cardiovascular risk factors and laboratory data. CRI definition was based on GFe rate and classified according to the K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease. ResultsThe prevalence of CRI was 23.2%. There were 51.6% females and the mean age was 66.2 years; 70,4% had hypertension and 67% dyslipidemia. The presence of CRI was related with older age, females, smoking habit, plasma creatinine value, microalbuminuria, and history of hypertension, dyslipidemia and cardiovascular disease. After analysing the data according to the category of GF rate, only the significant relationship with smoking habit disappeared. Multivariate statistic analysis supports a relation with older age, female gender, dyslipidemia and heart disease. ConclusionsWe confirm a high prevalence of CRI in DM2 patients and their relationship with the presence of cardiovascular disease.

Dyslipidemia in renal disease: Causes, consequences and treatment

The prevalence of chronic renal insufficiency and its complications, including dyslipidemia, is increasing. Although the characteristics of dyslipidemia in chronic renal insufficiency and its pathophysiology are well known, its cardiovascular and renal impact and the most effective therapeutic approach are poorly defined.

Optimizing the pharmacoinvasive approach to acute ST-segment elevation myocardial infarction: use of half-dose thrombolytic therapy in combination with glycoprotein IIb/IIIa receptor inhibitors compared with full-dose thrombolytic therapy in the setting of routine urgent post-thrombolytic percutaneous coronary intervention

presentation, hemodynamics, and in-hospital outcome were compared. A composite of cardiogenic shock or death was considered to equate to hemodynamic status of these patients. Results: COPD patients were older (Pb.001), more of female gender (Pb.001), and smokers (Pb.001). They had higher prevalence of chronic renal insufficiency (Pb.001), hypertension (P=.001), and diabetes mellitus (P=.01). COPD patients had higher rates of in-hospital mortality and cardiogenic shock (Pb.0001). After multivariate analysis, COPD remained the strongest independent predictor of the composite end point of death and cardiogenic shock (Pb.001). Conclusion: COPD is the strongest, independent predictor of hemodynamic compromise resulting in death or cardiogenic shock in patients presenting with acute MI. This observation suggests that the hemodynamic and pulmonary consequences of COPD reduce the capacity of the circulatory system to adjust to the effects of acute MI.

Impact of Chronic Obstructive Pulmonary Disease on Acute-Phase Outcome of Myocardial Infarction

Several reports have alluded to the adverse effect of chronic obstructive pulmonary disease (COPD) on long-term prognosis of patients with myocardial infarction (MI). Little information is available, however, regarding the effects of a decrease in cardiopulmonary reserve imposed by COPD on in-hospital outcome of acute MI. This study aimed to evaluate the impact of COPD on acute-phase outcome of patients with acute MI. From a cohort of 3,249 consecutive patients with ST-elevation MI who underwent primary or rescue percutaneous coronary intervention, 365 patients were identified as having coexistent COPD. Their clinical presentation and in-hospital outcome were compared to those of 2,884 patients without COPD. The primary end point was a composite of in-hospital death or cardiogenic shock on presentation. Patients with COPD were older (p <0.001), more often women (p <0.001), and smokers (p <0.001). They had higher prevalence of chronic renal insufficiency (p <0.001), systemic hypertension (p = 0.001), and diabetes mellitus (p = 0.01). Patients with COPD had higher rates of the composite end point of death or cardiogenic shock (p <0.0001). After multivariate analysis, COPD remained a strong independent predictor of the composite end point of death or cardiogenic shock (p = 0.008). In conclusion, COPD is a very strong predictor of hemodynamic compromise resulting in death or cardiogenic shock in patients presenting with ST-elevation MI. This observation suggests that hemodynamic and pulmonary consequences of COPD decrease the capacity of the circulatory system to adjust to the effects of acute MI. Recognition of the potential for combined therapy is vital.

Chronic Renal Insufficiency Found in 23%

Chronic Renal Insufficiency Found in 23%

Prevalencia estimada de insuficiencia renal crónica en España en pacientes con diabetes mellitus tipo 2

Background and objective The aim of this study was to estimate the current prevalence of Chronic Renal Insufficiency (RI) in ambulatory patients with type 2 Diabetes (T2DM) assisted in Endocrinology Departments all over Spain. Patients and methods This was an observational, cross sectional, multicenter study. From each participant the following data were retrospective collected: demographic, anthropometric, renal function, diabetes, cardiovascular risk factors, comorbidities and treatment. RI was defined by a glomerular filtration rate lower than 60 ml/min/1.73 m 2, using the shortened MDRD method. Results 541 patients with T2DM were included, 53% were men, the mean age (DS) was 63 years old (7.9) and the HbA 1c was 7.6 % (1.3). The prevalence (CI95%) of RI was 22.9% (19.4–26.7), higher than the previous estimate, witch was 5,7% (3.9–8.0, p<0,0001). The associated risk factor for RI were age (OR 2.07; 95%CI: 1.47–2.91 per each ten year period of increase), female gender (OR 2.25; 95%CI: 1.36–3.71) and hyperuricemia (OR 3.15; 95% CI: 1.56–6.37). There were no differences in the metabolic control between patients with RI vs those without RI. Conclusions 22.9% of T2DM ambulatory patients followed by endocrinologist had RI, but just a quarter of them had previously been diagnosed. The automated determination of creatinine clearance could increase the proportion of diagnosis and facilitate the improvement of the metabolic control in these patients.

Prevalence of Chronic Renal Insufficiency (CRI) and its Impact on Outcomes of Patients Undergoing Lower Extremity Endovascular Revascularization

Chronic renal insufficiency (CRI) is a common co-morbidity in patients undergoing lower extremity revascularization. Traditionally its prevalence has been reported based upon actual serum creatinine (Cr) value and its presence linked to worse outcomes. We examined the prevalence of CRI based upon creatinine clearance and assessed its impact on outcomes across various groups.

Effectiveness and cost-efficiency of phosphate binders in hemodialysis.

Health political backgroundIn 2006, the prevalence of chronic renal insufficiency in Germany was 91,718, of which 66,508 patients were on dialysis. The tendency is clearly growing.Scientific backgroundChronic renal insufficiency results in a disturbance of the mineral balance. It leads to hyperphosphataemia, which is the strongest independent risk factor for mortality in renal patients. Usually, a reduction in the phosphate intake through nutrition and the amount of phosphate filtered out during dialysis are not sufficient to reduce the serum phosphate values to the recommended value. Therefore, phosphate binders are used to bind ingested phosphate in the digestive tract in order to lower the phosphate concentration in the serum. Four different groups of phosphate binders are available: calcium- and aluminium salts are the traditional therapies. Sevelamer and Lanthanum are recent developments on the market. In varying doses, all phosphate binders are able to effectively lower phosphate concentrations. However, drug therapies have achieved recommended phosphate levels in only 50 percent of patients during the last years.Research questionsHow effective and efficient are the different phosphate binders in chronic renal insufficient patients?MethodsThe systematic literature search yielded 1,251 abstracts. Following a two-part selection process with predefined criteria 18 publications were included in the assessment.ResultsAll studies evaluated conclude that serum phosphate, serum calcium and intact parathyroid hormone can be controlled effectively with all phosphate binders. Only the number of episodes of hypercalcaemia is higher when using calcium-containing phosphatebinders compared to Sevelamer and Lanthanum. Regarding the mortality rate, the cardiovascular artery calcification and bone metabolism no definite conclusions can be drawn. In any case, the amount of calcification at study start seems to be crucial for the further development of the cardiovascular calcification. Economic studies show higher costs for Sevelamer and Lanthanum compared to calcium-containing phosphate binders.DiscussionOnly a few well documented primary studies on the effectiveness of phosphate binders are available. Particularly long-term studies with a robust study design and transparent documentation are lacking. Ten of the eleven primary studies included in this report were conducted in only 539 patients from five patient collectives.ConclusionsFrom a medical point of view, Sevelamer shows some superiority over calcium-containing phosphate binders based on the current data, at least for special indications. The validity of the present Health Technology Assessment (HTA) report is significantly limited due to the limited number of available publications, the low sample size of treated patients, as well as the fact that the majority of studies are based on the same patient collectives.Prospective long-term studies not funded by the industry with adequate sample sizes and comparable study designs are called for to make authoritative statements regarding the medical effectiveness and safety of Sevelamer and Lanthanum, as well as regarding their economic efficiency.

Abstract 6278: Burden of Chronic Renal Insufficiency in the General Population and Added Predictive Power of GFR to BNP and NT-proBNP in Detection of Altered Ventricular Structure and Function

Background: Chronic renal insufficiency (CRI) is a strong predictor of increased mortality in the presence of heart failure (HF) and its prevalence has been increasing in the US. In addition, CRI is a major contributing factor to the progression of HF as it is associated with chronic volume overload, accelerated atherosclerosis and hypertension (HTN). The first aim of the current study was to evaluate the prevalence of CRI in an adult general population. The second aim was to address whether calculated glomerular filtration rate (cGFR) adds value to the cardiac biomarkers BNP and NT-proBNP in detecting early cardiac structural and functional impairments in the general population. Methods: From 1997 to 1999 medical history, physical examination, echocardiography, BNP (Biosite) and NT-proBNP (Roche) and serum creatinine (SCr) were obtained in 1,982 randomly selected residents of Olmsted County, MN &gt;= 45 years (range 45 – 96 years). GFR was calculated using the Cockroft Gault equation. CRI was defined as a GFR &lt; 60 ml/min. Cardiac structure and function were evaluated by in-depth echocardiographic examination. Results: The prevalence of cardiovascular co-morbidities was coronary atherosclerosis 12%, HTN 29.5% and diabetes mellitus 7.5%. The prevalence of CRI was 22.8% when cGFR was used for its detection. Importantly, by Chi-Square model, cGFR significantly increased the ability of BNP in detecting left ventricular hypertrophy (LVH) (p=0.004), increased relative wall thickness (p=0.0036), diastolic dysfunction (DDF) (p=0.0001) and HTN (p=0.0002). Similarly, when combined with NT-proBNP, cGFR increased the predictive power of detecting DDF (p=0.0001) and HTN (p=0.0366). Conclusion: This study reports a higher than predicted prevalence of CRI in this general US population equal to 23% and closely associated with the prevalence of HTN (29.5%). Importantly, this study also demonstrates that cGFR has additive predictive power when used in combination with two cardiac biomarkers of cardiac dysfunction and remodeling, BNP and NT-proBNP. These studies underscore the increasing burden of CRI in the general population and the utility of assessing cardiorenal function by combining renal and cardiac biomarkers in assessment of cardiac structure and function.

Prevalence of Chronic Renal Insufficiency and Ventricular Remodeling in the General Population

Prevalence of Chronic Renal Insufficiency and Ventricular Remodeling in the General Population

Chronic Renal Insufficiency in HIV-Infected Patients

The prevalence of chronic renal insufficiency in patients with HIV infection and the role of antiretroviral medications in its development are somewhat unclear. Tenofovir, in particular, is associated with renal dysfunction, but the significance of this in clinical practice has not been well defined. In this cross-sectional analysis from the EuroSIDA cohort study, investigators evaluated potential risk factors for chronic renal insufficiency among 4474 HIV-infected patients who had …

Diabetes and the Kidney

Diabetes and the Kidney

The incidence of end-stage renal disease is increasing faster than the prevalence of chronic renal insufficiency.

The steady increase in end-stage renal disease (ESRD) incidence is a worldwide public health crisis. To determine whether the increasing incidence of ESRD in the United States is preceded by increased prevalence of chronic renal insufficiency. Birth cohort analysis. Nationally representative Second and Third National Health and Nutrition Examination Surveys (NHANES II [1976-1980] and III [1988-1994]) and nationally comprehensive U.S. Renal Data System registry. Adults, 20 to 74 years of age, surveyed in NHANES II (midpoint, 1978) and NHANES III (midpoint, 1991), and adults, 25 to 79 years of age, who developed ESRD in 1983 and 1996. Prevalent chronic renal insufficiency (estimated glomerular filtration rate, 15 to 59 mL/min per 1.73 m2) and new ESRD cases. From 1978 to 1991, the number of adults age 20 to 74 years with chronic renal insufficiency increased from 2.6 to 3.9 million, an increase in prevalence from 1970 to 2460 per 100 000 persons. However, the increased incidence of ESRD was even greater during this period. For every 1000 adults with chronic renal insufficiency in 1978, 9 new cases of ESRD developed in 1983, but every 1000 adults with chronic renal insufficiency in 1991 produced 16 new cases of ESRD in 1996 (relative risk, 1.7 [95% CI, 1.1 to 2.7]). We could not follow individual patients with chronic renal insufficiency for the development of ESRD, and we used estimated rather than measured glomerular filtration rate. During the period examined, growth in incident ESRD outpaced growth in prevalent chronic renal insufficiency, demonstrating that the ESRD epidemic in the United States is not merely a function of more cases of kidney disease. Future research should examine other potential contributors to ESRD growth, such as improved survival from nonrenal diseases and more liberal entry into treatment programs.

Pregnancy in Patients with Chronic Renal Insufficiency at Hospital de Clínicas of Porto Alegre, Brazil

Chronic renal insufficiency (CRI) decreases reproductive capability. The biggest challenge in monitoring pregnant women with renal disease is to keep the intrauterine environment favorable to the fetus. One of the common prognosis in this kind of pregnancy involves premature birth, restricted growth and mental retardation. Also, the risk of developing complications is higher for the mother. This study focuses on evaluating CRI patients' clinical conditions during pregnancy, checking fetal development and birth and verifying the prevalence of CRI in pregnant women attended at Hospital de Clínicas of Porto Alegre–Brazil (HCPA). This is a retrospective study with both a control and an case group of pregnant women with CRI who delivered their babies at HCPA from 1989 to 1999. The case group is composed of pregnant women with CRI, while the control group was paired according to maternal and gestational ages and to the time of the delivery, which should be the same both in the experimental and in the control group. Among the criteria usually used to identify CRI, we chose the creatinine level higher than 1.5 mg/dL. Significance was established in 0.05%. Our results demonstrate that the prevalence of CRI was 6/10,000 births. Average maternal age was 28. Sixty five per cent of the patients, in both the groups, underwent prenatal monitoring, 40% presented preeclampsia, 48% presented urinary infection. Among the CRI complications, 48% of the cases presented anemia and 56% presented systemic hypertension. Average hematocrit was 24% while hemoglobin was 6.7 g/dL, which leads us to the conclusion that patients presented anemia during pregnancy. Average creatinine was 4.61 mg/dL. It is relevant that 64% of the CRI cases migrated to a substitutive renal therapy method. As for the fetus evolution in the case group, we confirmed the findings of previous studies, such as larger number of premature births (newborns younger than 36 weeks in 60% of the cases), larger number of cesarean section (56%), lower weight at birth (1980 gr. in average), lower APGAR scores in the first and fifth minute (4.13 and 5.08, respectively) in comparison to the control group (7.52 and 8.63, respectively). We can state that babies born from CRI patients present underdevelopment. Also, mothers with CRI develop more complications during pregnancy.