Renal Disease Formula Research Articles

Study of association between carboxymethyllysine and circulating soluble receptor for advanced glycation end products and cardiovascular dysfunction in nondiabetic chronic kidney disease

Objective The objective of this study was to evaluate the association between serum advanced glycation end products (AGEs) and their soluble receptors assessed on the basis of carboxymethyllysine (CML) and soluble receptor for advanced glycation end products (sRAGE) and the presence of cardiovascular dysfunction in nondiabetic chronic kidney disease (CKD) patients. Background AGE is involved in left ventricular hypertrophy (LVH) and myocardial damage, whereas sRAGE attenuates the progression of heart disease and prevents death in diabetic and nondiabetic CKD patients. Patients and methods Eighty nondiabetic CKD patients were subclassified according to estimated glomerular filtration rate (GFR) into two subgroups, CKD-3 patients with GFR between 30 and 59 ml/min/1.73 m2 and CKD-4 patients with GFR between 16 and 29 ml/min/1.73 m2 (CKD-4), using the modification of diet in renal disease formula. Our controls comprised 40 individuals with preserved kidney function of more than 90 ml/min/1.73 m2 matched by age and sex. Routine and specific investigations [serum CML and sRAGE measurement using enzyme-linked immunosorbent assay, carotid intima − media thickness (IMT) measurement using ultrasonographic scanning of the carotid artery, and conventional echocardiography] were performed. Results CML and sRAGE correlated negatively with estimated GFR (ml/min/1.73 m2) (r = −0.755 and − 0.668, respectively; P Conclusion AGEs assessed on the basis of CML can be a good predictor and a nontraditional risk factor for the occurrence of cardiovascular morbidity in nondiabetic CKD patients, whereas circulating sRAGE levels are associated in an inverse manner with carotid atherosclerosis and LVH.

Body Composition Analysis Allows the Prediction of Urinary Creatinine Excretion and of Renal Function in Chronic Kidney Disease Patients.

The aim of this study was to predict urinary creatinine excretion (UCr), creatinine clearance (CCr) and the glomerular filtration rate (GFR) from body composition analysis. Body cell mass (BCM) is the compartment which contains muscle mass, which is where creatinine is generated. BCM was measured with body impedance analysis in 165 chronic kidney disease (CKD) adult patients (72 women) with serum creatinine (SCr) 0.6–14.4 mg/dL. The GFR was measured (99mTc-DTPA) and was predicted using the Modification of Diet in Renal Disease (MDRD) formula. The other examined parameters were SCr, 24-h UCr and measured 24-h CCr (mCCr). A strict linear correlation was found between 24-h UCr and BCM (r = 0.772). Multiple linear regression (MR) indicated that UCr was positively correlated with BCM, body weight and male gender, and negatively correlated with age and SCr. UCr predicted using the MR equation (MR-UCr) was quite similar to 24-h UCr. CCr predicted from MR-UCr and SCr (MR-BCM-CCr) was very similar to mCCr with a high correlation (r = 0.950), concordance and a low prediction error (8.9 mL/min/1.73 m2). From the relationship between the GFR and the BCM/SCr ratio, we predicted the GFR (BCM GFR). The BCM GFR was very similar to the GFR with a high correlation (r = 0.906), concordance and a low prediction error (12.4 mL/min/1.73 m2). In CKD patients, UCr, CCr and the GFR can be predicted from body composition analysis.

The impact of kidney function on the efficacy and safety of pazopanib in metastatic renal cell carcinoma (mRCC) patients: CORE-URO-01 study.

e16063 Background: Pazopanibhas been approved for treatment of patients (pts) with mRCC based on the prospective randomized trial that enrolled only pts with adequate renal parameters. There are no data on the toxicity profile and efficacy of pazopanib in pts with renal insufficiency (RI).The aim of this study is to investigate the effect of renal function on treatment outcomes in pts treated with pazopanib for mRCC. Methods: We retrospectively analyzed the data of the mRCC pts treated with pazopanib with respect to renal function in eleven Italian institutions from January 2010 to June 2016. Baseline glomerular filtration rate (GFR) was calculated using the Modification of Diet in Renal Disease (MDRD) formula at the time of therapy initiation. Pts with MDRD < 60 mL/min/1.73 m2 (group 1) were compared with pts with MDRD ≥60 mL/min/1.73 m2(group 2) in terms of response rates, progression free survival (PFS), overall survival (OS) and side effects. Results: One hundred and twenty-ninepts with mRCC were included in this study: 70 pts in group 1 and 59 pts in group 2. 67% of pts were male, median age was 66 years (34-83) and median CrCl was 49 ml/min (6.3-59.5) in group 1. In group 2, 64% of pts were male, median age was 65 years (38-80), and median CrCl was 64 ml/min (58.1-137.1) Pts with MDRD < 60 were more likely to have had a previous nephrectomy (84.3% vs 79.7%). No difference between the 2 groups was observed in terms of outcomes: PFS was 9.6 months (0.6–56.9) and 9.0 months (0.4–60.1), OS was 16.1 months (1.3–56.9) and 17.0 months (1.2–60.1), for MDRD < 60 group and MDRD ≥60 respectively. The disease control rate was 85.8% in group 1, and 72.9% in group 2. About grade 1-2 toxicity, no difference between the 2 groups was reported (67.1% vs 67.8%) while a higher incidence of grade 3-4 toxicity was evident in the group 1 (25.7% vs 18.6%). Conclusions: RI was commonly observed in pts with mRCC. Renal function at therapy initiation does not adversely affect the efficacy and safety of pazopanib. More frequent monitoring of side-effects in patients with RI is recommended.

Renal failure in cancer patients: results from the national cancer registry of Abidjan, Côte d’Ivoire

Background: Renal failure (RF) is a risk factor for morbidity and mortality in cancer patients. the national cancer registry of Abidjan, during the period from January 2012 to December 2015. The diagnosis of RF was confirmed based on a measured glomerular filtration rate (GFR) < 60 mL/min obtained using the Modification in Diet of Renal Disease (MDRD) formula. A comparison of patients with (n = 131) or without (n = 136) RF, followed by a logistic regression analysis, made it possible to identify the risk factors for RF. in the group without RF (P = 0.003). The etiologies of RF were urinary tract obstruction (41.2%), administration of platinum salts (19.8%) and water losses (12.2%). In multivariate analysis, age (P = 0.009), presence of hypertension (P = 0.02), uterine cancer (P = 0.0001) and prostate cancer (P = 0.014) were associated with the risk of RF in cancer patients. Factors such as male gender (P = 0.007), HIV infection (P = 0.021), GFR<15 mL/min (P = 0.002), and hemoglobin level <8 g/dL (P = 0.041) were associated with mortality in cancer patients with RF.

Quantification of renal function following stereotactic body radiotherapy for pancreatic cancer: secondary dosimetric analysis of a prospective clinical trial

BackgroundThis is the first known study examining renal function following stereotactic body radiotherapy (SBRT) for pancreatic head adenocarcinoma.MethodsThirty-eight borderline-resectable/unresectable patients, part of an ongoing prospective trial, underwent 3 cycles of gemcitabine/5-fluorouracil followed by SBRT (5 daily fractions of 5/6/7/8 Gy) and concurrent nelfinavir. Thereafter, in resectable cases, surgery was performed within 4–8 weeks. The last available pre-SBRT creatinine was recorded, along with the highest post-SBRT value. Glomerular filtration rate (GFR) was calculated by the commonly-utilized Modification of Diet in Renal Disease formula. GFR decline was defined as the post-SBRT nadir GFR minus the pre-SBRT GFR. Correlations with the V5–V30, and mean/maximum kidney doses was performed. Statistics included Pearson correlation, Mann-Whitney, and Fisher’s exact tests.ResultsThe median total kidney volume was 355 cm3. Median dosimetric values were as follows: V5 (209 cm3), V10 (103 cm3), V15 (9 cm3), V20 (0 cm3), V25 (0 cm3); and mean (6.7 Gy) & maximum kidney dose (18.3 Gy). Median GFR change was −23 (range, −105 to 25) mL/min/1.73 cm2. Of all dosimetric parameters, only V5 was significantly associated with changes in GFR (Pearson r = −0.40, p = 0.012). In patients with V5 < 210 cm3, median GFR change was −11.8 mL/min/1.73 cm2, as compared with −37.1 mL/min/1.73 cm2 change in those with V5 ≥ 210 cm3 (p = 0.02). A GFR change < −23 mL/min/1.73 cm2 was observed in 6/20 (30%) patients with V5 < 210 cm3, versus 15/18 (83%) of those with V5 ≥ 210 cm3. Patients with V5 ≥ 210 cm3 were over ten times as likely to have GFR change < −23 mL/min/1.73 cm2 (p = 0.003). Using linear regression, GFR change ≈ −0.1748 × V5(cm3) + 8.63.ConclusionsIn the first known analysis of renal function after pancreatic SBRT, evaluating patients on a prospective study, V5 ≥ 210 cm3 was associated with a post-SBRT GFR decline of >23 mL/min/1.73 cm2. If V5 is kept <210 cm3, median GFR decline was only 11.8 mL/min/1.73 cm2. Further validation is needed to ascertain definite dose-volume parameters and examine late renal decline.

No role for patient body weight on renal function assessment for drug dosing.

To evaluate the ability of body-weight-driven renal function assessment (RFA) formulae to predict on-target elimination rate ranges for gentamicin in patients with varying degrees of renal function. A 6 year retrospective pharmacokinetic study was conducted at a university teaching hospital. A total of 85 patients met the inclusion criteria and 127 pharmacokinetic files were analysed from patients on medical-surgical wards (53%) and medical-surgical ICUs (13%) receiving intravenous gentamicin for treatment, as well as those for patients receiving it for surgical prophylaxis (34%). Each RFA formula was examined against standard dosing tables for gentamicin. A table of acceptable elimination rates was generated using a traditional peak of 8 mg/L and trough between 0.5 and 2 mg/L associated with each of the dosing interval extensions. The ability of each RFA formula to select on-target elimination rates was evaluated. The RFA formula assuming a normalized body weight of 72 kg and a modified creatinine reagent adjustment factor of 90% provided the most accurate on-target elimination rate selection. This method was superior to dosing interval selection based on the Modification in Diet Renal Disease (MDRD) formula, Sanford's guide method, as well as the Cockcroft-Gault formulae using total body weight, ideal body weight or lean body weight ( P < 0.0001). Based on the use of gentamicin as a surrogate guide for renally adjusted drugs, these results support dosing interval selection based on a normalized body weight method and a formula reagent adjustment factor of 90% within the Cockcroft-Gault formula.

Renal function improves with the treatment of hypothyroidism

ABSTRACTBackground: It has been known that thyroid hormones may affect renal function. In this study, we aimed to investigate the effect of levothyroxine replacement on renal function in hypothyroid patients before and after treatment. Methods: We retrospectively investigated free T3 (fT3), free T4 (fT4), TSH, creatinine, and eGFR measurements during both hypothyroid and euthyroid states of hypothyroid patients. The eGFR was calculated using the simplified Modification of Diet in Renal Disease formula. Results: fT3, fT4, and eGFR measurements increased, meanwhile creatinine and TSH levels decreased significantly after euthyroidism was achieved with levothyroxine treatment (p < 0.0001 for all). The correlation analyses revealed that ∆creatinine and ∆TSH levels were significantly correlated before and after levothyroxine treatment (r: 0.288, p < 0.0001). ∆eGFR and ∆TSH levels were significantly correlated before and after LT4 treatment (r: −0.272, p < 0.0001). Conclusion: In this study, we evaluated creatinine and eGFR levels in patients with hypothyroidism and found out that renal function improved in most patients after euthyroidism was achieved. In some patients, above-normal creatinine levels completely returned to normal once the patients became euthyroid.

Effect of 48-week pegylated interferon \u03b1-2a or nucleos(t)ide analogue therapy on renal function in Chinese patients with chronic hepatitis B

BackgroundControversy remains as to whether antiviral agents contribute to renal dysfunction in patients with chronic hepatitis B virus (HBV) infection. Thus, the aim of study was to analyze the changes in renal function of chronic hepatitis B (CHB) patients in response to anti-HBV therapy and the association with treatments.MethodWe performed a retrospective observational cohort study to investigate factors associated with renal function in 249 Chinese CHB patients who were treated with pegylated interferon α-2a (PEG-IFN-α-2a) or nucleos(t)ide analogues for 48 weeks. Changes of estimated glomerular filtration rate (eGFR), which was computed with both the Chronic Kidney Disease Epidemiology Collaboration and the Modification of Diet in Renal Disease formulas, were tested by repeated measures One-way analysis of variance within groups. A linear mixed effects model for repeated measures was also used to evaluate the association between baseline information and eGFR changes over time in all enrolled patients. The model considered the baseline age, sex, HBV DNA, aminotransferase, blood urea nitrogen, treatment group, time, and group-by-time interaction as fixed effects and incorporated random effects for individual subjects.ResultsThe eGFR increased in patients given PEG-IFN-α-2a, decreased in patients given adefovir, but remained stable in patients given entecavir. Age and blood urea nitrogen were significant negative predictive factors for eGFR changes.ConclusionIn real-life study, PEG-IFN-α-2a therapy in CHB patients increased eGFR, thus may associate with renoprotective effects when compared with adefovir or entecavir therapies.

Evaluation of renal function in a specific population of living kidney donors.

The increase in candidates for kidney transplant has led to growth in the number of living donor transplants. Therefore, studies that adequately evaluate the possible long-term consequences of elective transplant nephrectomy are needed. To evaluate the possible long-term adverse effects of transplant nephrectomy on the renal function of living kidney donors. A cross-sectional study. Thirty-three living kidney donors registered in the transplant programme of a centre in Alagoas, Brazil. Demographic characteristics, anthropometric measures, clinical data and biomarkers (creatinine, eGFR, microalbuminuria, cholesterol and triglycerides) were measured. Creatinine clearance was calculated using the Cockcroft-Gault and Modification of Diet in Renal Disease formulae. Of the 33 individuals, 63.63% were female, and the median age was 45 years. Additionally, 24.24% of these individuals had altered blood pressure, 39.39% had altered abdominal circumference (AC) and 36.36% were obese, with a body mass index ≥30. Furthermore, 33.33% of these individuals had elevated triglyceride levels. The average eGFR was 97.33 (33.03-175.9) ml/min/1.73 m2 (CG) and 84.14 (29.4-131) ml/min/1.73 m2 (MDRD). The microalbuminuria level was altered in 12.12% patients. Kidney donation is unquestionably a safe procedure. However, a better understanding of the long-term consequences of living donor kidney transplantation is still needed. This knowledge may have important implications for the follow-up of these patients. Our study has demonstrated a non-negligible presence of an early marker of glomerular injury and a decrease in the GFR of some patients, thereby reinforcing the proposal for long-term follow-up of living kidney donors.

Nephrectomy-induced reduced renal function and the health-related quality of life of living kidney donors.

To evaluate the health impact of nephrectomy on living kidney donors (LKDs) by comparing the health-related quality of life (HrQOL) scores measured by Short Form-36 (SF36) between those with and without postdonation renal function impairment (PRFI). Eighty-two LKDs (47 females, mean age=50.2±11.2years) were prospectively recruited to participate in a SF-36 HrQOL survey. Chart review, individual baseline, and postoperative renal function (eGFR) was determined using the Modification of Diet in Renal Disease formula. PRFI was defined as eGFR<60mL/min/1.73m2 or proteinuria. Mean SF-36 domain scores were compared between those with and without PRFI. After a median follow-up of 5.7years, the prevalence of postdonation comorbidities was 29.3% (n=24) PRFI, 25.6% (n=21) hypertension, 6.1% (n=5) diabetes, and 3.7% (n=3) heart disease, and no LKDs developed end-stage renal disease. Mean eGFR before and after donor nephrectomy was 95.5±23.4 and 71.0±17.3mL/min/1.73m2 (P<.01). Mean SF-36 scores of LKDs were not significantly different between those with and without PRFI in all the domains (all P>.05). Similarly, the proportion of LKDs with PRFI did not differ significantly between the patients with SF-36 domain scores above and below the published reference values. Nephrectomy-induced PRFI may not have a significant impact on the HrQOL of the LKD population with a low proportion of other major comorbidities such as diabetes and ischemic heart disease.

Kidney dysfunction and cerebral microbleeds in neurologically healthy adults.

IntroductionCerebral microbleed (CMB) is a potent risk factor for overt cerebrovascular disease. Although some studies indicated the possible role of renal dysfunction as a risk factor of CMB, the findings could not be generalized. This study aimed to investigate the association between renal dysfunction and cerebral microbleed (CMB) in neurologically healthy adults.Materials and methodsA total of 2,518 subjects who underwent brain MRI as part of health screening were involved in the study. CMBs were defined as well-demarcated focal areas of low signal intensity with associated blooming on the T2-weighted MRI measuring less than 5mm in diameter. The glomerular filtration rate (GFR) was estimated using the Modification of Diet in Renal Disease formula. Kidney function was classified as normal (≥90), mild (60 to 89.9), moderate (30 to 59.9), and severe (<30 mL/min/1.73 m2) renal dysfunction according to the GFR.ResultsThe mean age of the participants was 57.5 ± 8.3 years (ranged 40 to 79), and 1,367 subjects (54.3%) were male. The mean GFR level was 81.5 ± 15.5, and the prevalence of CMB was 4.1% (n = 103). Subjects with CMB demonstrated a higher proportion of moderate-to-severe renal dysfunction than those without CMB (15.5% vs. 5.0%, p < 0.001). In the multivariate logistic regression analysis, moderate-to-severe renal dysfunction showed a significant association with CMB (adjusted odd ratio = 2.63; p = 0.008). Furthermore, a decrease in the GFR level was associated with an increasing trend of the presence of CMB (p for trend = 0.031) and number of CMB lesions (p for trend = 0.003).ConclusionsRenal dysfunction was significantly associated with the presence of CMB in neurologically healthy adults. More studies are needed to evaluate if treatment of kidney disease and risk factor modification may prevent further progress of CMB.

Renal safety of lithium in HIV-infected patients established on tenofovir disoproxil fumarate containing antiretroviral therapy: analysis from a randomized placebo-controlled trial

BackgroundThe prevalence of bipolar disorder in HIV-infected patients is higher than the general population. Lithium is the most effective mood stabiliser, while tenofovir disoproxil fumarate (TDF) is frequently used as part of combination antiretroviral therapy (ART). Both TDF and lithium are associated with renal tubular toxicity, which could be additive, or a pharmacokinetic interaction may occur at renal transporters with a decrease in TDF elimination.ObjectiveWe report on the change in estimated glomerular filtration rate (eGFR) using the modification of diet in renal disease formula in participants who received ART including TDF and were enrolled in a 24 week randomised trial of lithium versus placebo in patients with HIV-associated neurocognitive impairment.MethodsWe included HIV-infected adults with cognitive impairment established on ART for at least 6 months with a suppressed viral load attending public sector ART clinics in Cape Town, South Africa. We excluded participants with an eGFR <60 mL/min and treated with medications predisposing to lithium toxicity. We reviewed participants weekly for the first month for adverse events followed by 4 weekly visits for renal function assessment, adverse event monitoring and adherence. Lithium dose was titrated to achieve the maintenance target plasma concentration of between 0.6 and 1.0 mmol/L. Sham lithium concentrations were generated for participants receiving placebo.ResultsWe included 23 participants allocated to the lithium arm and 30 participants allocated to the placebo arm. Baseline characteristics were not statistically different with a mean age of 37.7 and 40.8 years, a median time on ART of 33 and 40 months and an eGFR of 139.3 and 131.0 mL/min in the lithium and placebo arms respectively. There was no statistical significant difference in the reduction in eGFR or increase in potassium between the two arms during the 24 weeks.ConclusionsWe found that 24-week treatment of HIV-infected patients with lithium and TDF did not result in increased nephrotoxicity.Trial registration The study was registered on the Pan African Clinical Trials Registry (PACTR) with the identifier number PACTR201310000635418. Registered 11 October 2013 before the first participant was enrolled

Effects of functional tricuspid regurgitation on renal function and long-term prognosis in patients with heart failure.

Renal dysfunction is common in heart failure. Recent evidence suggests a pivotal role for systemic venous congestion and functional tricuspid regurgitation (FTR) in the pathophysiology of renal dysfunction. We investigated the role of FTR as a determinant of renal dysfunction and a predictor of long-term prognosis in chronic systolic heart failure patients. Four hundred and thirteen consecutive patients (mean age 74.2 ± 11 years) with chronic heart failure and left ventricular ejection fraction below 50% were enrolled. The FTR severity was quantified by transthoracic echocardiography. Renal function was evaluated with the estimated glomerular filtration rate measured by the simplified Modification of Diet in Renal Disease formula. The association between moderate/severe FTR and renal dysfunction, and its impact on heart failure episodes and overall mortality were also assessed. The median follow-up was 36 months (range 1-144 months). Through multivariate analysis, the interaction between moderate/severe FTR with tricuspid annular plane systolic excursion less than 16 mm was found to be an independent determinant of renal dysfunction [odds ratio 1.2, 95% confidence interval (CI) 1.1-1.5, P = 0.04]. Moderate/severe FTR (hazard ratio 1.3, 95% CI 1.2-2.7, P = 0.02) and tricuspid annular plane systolic excursion below 16 mm (hazard ratio 1.2, 95% CI 1.0-3.7, P = 0.01) were significantly related to the heart failure episodes. Moreover, the Kaplan-Meier analysis showed a worse outcome in patients with moderate/severe FTR (log-rank test 8.6, P = 0.003). The combination of significant FTR and right ventricular dysfunction, but not FTR and right ventricular dysfunction alone, is independently associated with renal dysfunction. The presence of significant FTR is related to an excess event rate of heart failure and has significant impact on outcome.

Early low-dose erythropoiesis-stimulating agent therapy and progression of moderate chronic kidney disease: a randomized, placebo-controlled trial.

It is unknown whether early intervention with low-dose erythropoiesis-stimulating agents (ESAs) in non-anaemic patients delays progression of chronic kidney disease (CKD). In a single-blind, 24-month trial, adults with estimated glomerular filtration rate (eGFR) 30–59 mL/min/1.73 m2 and either Type 2 diabetes mellitus or previous kidney transplantation were randomized to low-dose continuous erythropoiesis receptor activator (CERA; monthly dose 30–75 µg; n = 115) or placebo (n = 120). The primary endpoint was the annual change in eGFR (abbreviated Modification of Diet in Renal Disease formula). Mean (standard deviation) eGFR was 40.7 (9.8) mL/min/1.73 m2 versus 39.8 (9.2) mL/min/1.73 m2 at baseline for CERA and placebo, respectively, and 39.0 (11.6) g/dL versus 39.7 (10.6) g/dL at the final visit. The median (interquartile range) annual reduction in eGFR was 0.5 (−2.2, 3.8) mL/min/1.73 m2 with CERA versus 0.4 (−2.0, 3.2) mL/min/1.73 m2 with placebo (P = 0.657). No significant difference in the annual change in eGFR was observed between treatment groups in the subpopulations with Type 2 diabetes or kidney transplant. Adverse events with a suspected relation to study drug occurred in 22.0% and 16.2% of patients randomized to CERA or placebo, respectively, and adverse events led to study drug discontinuation in 11.0% and 8.5% of patients. Patients with moderate CKD and Type 2 diabetes or previous kidney transplantation showed stable renal function that was unaffected by administration of low-dose ESA. In addition, there was no clinically meaningful effect of 2-year low-dose ESA treatment on albuminuria, an important surrogate marker of kidney injury.

Assessment of Prevalence of Chronic Kidney Disease and Its Predisposing Factors in Kerman City

Background: Chronic kidney disease (CKD) is a prevalent, progressive, and treatable disease. However, lack of enough data about its prevalence in Iran is a major obstacle for its early detection. In order to determine the prevalence of the disease in the country, it is necessary to conduct epidemiologic studies especially on populations with ethnic diversity; hence, this study aimed at determining the prevalence of CKD and its predisposing factors in an adult population aged 15 to 75 years old in Kerman city. Methods: This cross-sectional study was conducted on 988 adults aged 15 to 75 years in Kerman city, during year 2010. We collected data on the status of hypertension (HTN) and Diabetes Mellitus (DM) in all participants. Moreover, height, weight, and blood pressure of all participants were measured and a blood sample was taken for laboratory tests. In addition, a morning urine sample was taken to detect microalbuminuria and measure protein, and creatinine. Patients’ glomerular filtration rate (GFR) was calculated using modification of diet in renal disease (MDRD) formula, and the stage of the chronic kidney disease (CKD) was determined. Results: Of all the participants, 58% were female and the mean age (SD) of participants was 45 ± 16 years. Considering participants’ body mass index (BMI), 37% were overweight and 18% were obese. The prevalence of HTN and DM were 20% and 14%, respectively. Mean GFR (SD) was 67 ± 20 mL/min/1.73 m2. Overall, 91% of the participants were affected by some degree of CKD (stage 1:5%; stage 2: 55.1%; stage 3: 30.5%; stage 4: 0.4%). Prevalence of CKD that was defined through GFR 0.05). Conclusions: The findings of the present study showed that 91% of the adult population living in Kerman city was affected by some degrees of CKD and more than one-third were at stages 3 or 4. Prevalence of CKD that was defined through GFR < 60 cc/min was 30.9%. Since early detection of CKD could help adopt preventive measures and interventions, and prevent disease progression, policy makers must pay special attention to preventive programs, such as programs for life style modification, and design treatment plans for different risk factors, such as HTN, DM, and dyslipidemia.

Long-term evaluation of kidney function in live-related kidney donors.

The consequences of live kidney donation on the donor health with main emphasis on postdonation blood pressure (BP), proteinuria, kidney size, and glomerular filtration rate (GFR) were evaluated. Twenty-five donors with minimum of six months postdonation duration were included in the study. Donor age at nephrectomy, duration postnephrectomy, systolic and diastolic BP measurement pre-and post-donation, postdonation, blood urea nitrogen, serum creatinine and 24-h proteinuria, blood sugar, two-dimensional echocardiogram were recorded. Kidney sizes pre-and post-donation were noted. GFR was calculated by chronic kidney disease epidemiology collaboration and modification of diet in renal disease formula and measured by diethylene triamine pentaacetic acid renogram in all donors pre-and post-donation. Twenty-one (84%) were female, and four (16%) were male. The mean age at donation was 46.24 ± 9.62 (28-65) years. Median duration postdonor nephrectomy was 26 (minimum 7 and maximum 228) months. There was a mean rise of 6.24 mm Hg in systolic and 4.20 mm Hg diastolic BP (P = 0.001). Remnant kidney size increased from 35.12 ± 6.80 to 42.32 ± 8.59 sq cm (P <0.0001). There was reduction of postdonation GFR from 94.50 ± 18.12 mL/min to 60.48 ± 14.32 mL/min after nephrectomy (P <0.0001). There was significant increase in remnant kidney GFR from 48.83 ± 7.79 mL/min to 60.48 ± 14.32 mL/min (P <0.0001). Two donors had hypertension postdonation while 23 did not. No donor developed postdonation proteinuria. A significant increase in the kidney size and GFR was evident in remnant native kidney in all. No mortality was observed.

SAT-023 - For diagnosis of acute kidney injury in decompensated cirrhosis the estimation of baseline serum creatinine using Modification of Diet in Renal Disease formula is not accurate enough

SAT-023 - For diagnosis of acute kidney injury in decompensated cirrhosis the estimation of baseline serum creatinine using Modification of Diet in Renal Disease formula is not accurate enough

Prevalence and risk factors of chronic kidney disease in an african semi-urban area: Results from a cross-sectional survey in Gueoul, Senegal.

Chronic kidney disease (CKD) is a public health priority worldwide; however, its prevalence and incidence are difficult to assess. In Africa, few studies have been conducted on the prevalence of CKD. This study sought to describe the epidemiological characteristics and profile of CKD, as well as the related risk factors in Guéoul, a semi-urban zone in Senegal. An observational, cross-sectional, and descriptive study was conducted in Guéoul city in Senegal from November 1, 2012, to December 10, 2012, according to the WHO STEPS approach. People older than 35 years living in Guéoul city were included in the study. Cardiovascular and renal disease risk factor screening was conducted for this population. Data were analyzed using the 3.5.1 version of Epi Info software. The significance level was a P <0.05. One thousand four hundred and eleven participants with a mean age of 48 ± 12.68 years and a sex ratio of 0.34 were included in the study (359 men/1052 women). The prevalence of renal disease was 36.5%. Sixty-eight people showed proteinuria greater than two cross with urinary dipsticks. Two hundred and six people had a glomerular filtration rate <60 mL/min, and among them, 201 were in stage III, two in stage IV, and three in stage V according to the modification of diet in renal disease formula. Ninety-eight participants had morphological abnormalities. Cardiovascular risk factors found among participants with renal disease were obesity (25.2%), hypertension (55.5%), diabetes (2.3%), and renal and metabolic syndrome (32.43%). Those that statistically significantly correlated with renal disease were obesity (P = 0.0001), hypertension (P = 0.0001), and diabetes (P = 0.021). This study assessed the extent of renal disease in the population of Guéoul city. Being aware of the prevalence of CKD in the general population of Senegal is mandatory for defining appropriate strategies for the management of these risk factors and progression of renal diseases.

Comparison of nephrotoxicity between two gadolinium-contrasts, gadodiamide and gadopentetate in patients with mildly diminished renal failure.

Although gadolinium (Gd)-based contrast media have been found to be nephrotoxic, their nephrotoxicity, and the dependence of nephrotoxicity on chelate types, have not been assessed in patients with normal or mildly diminished renal failure. This prospective, randomized study compared the nephrotoxicity of low doses of the nonionic Gd-based contrast medium gadodiamide (Omniscan®) and the ionic Gd-based contrast medium gadopentetate (Magnevist®) in patients with serum creatinine < 1.6 mg/dL. Patients aged 20 to 80 years, weighing 45 to 70 kg and with normal or < 1.6 mg/dL Serum-creatinine in the 3 months prior to undergoing magnetic resonance imaging (MRI) of brain, were enrolled. Patients were randomized to receive 0.1 mol/kg gadodiamide or gadopentetate. Serum-creatinine, serum cystatin-C, estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) formula, and estimated creatinine clearance rate (eCCr) using the Cockcroft-Gault formula were measured just before and 16-80 hr after MRI. Groups were compared statistically by Mann-Whitney U-tests and Wilcoxon signed-rank tests. There were no significant differences in clinical characteristics between the gadodiamide (n = 43) and gadopentetate (n = 59) groups. Serum-creatinine, eGFR and eCCr before and 16-80 hr after MRI did not differ significantly within either group or between the two groups. Serum cystatin-C was significantly higher 16-80 hr after than before MRI only in the gadodiamide group (0.79 ± 0.21 vs. 0.74 ± 0.14 mg/L, p = 0.028). The ionic contrast medium, gadopentetate, did not affect renal function during MRI, whereas the nonionic contrast medium, gadodiamide, affected renal function transiently.

The Effect of Admission Renal Function on the Treatment and Outcome of Patients with Acute Coronary Syndrome

Background: Chronic kidney disease is a frequent comorbidity among patients with acute coronary syndrome (ACS). We aimed to evaluate treatment characteristics in ACS patients according to their renal function and to assess the effect of differences in therapy on clinical outcomes. Methods: Included were patients with ACS enrolled in the biennial Acute Coronary Syndrome Israeli Surveys (ACSIS) during 2000-2013. Excluded were patients with cardiogenic shock at presentation. The estimated glomerular filtration rate (eGFR) was calculated using the simplified Modification of Diet in Renal Disease (MDRD) formula. The distribution of the eGFRs was divided into 4 categories (<45, 45-59.9, 60-74.9, and ≥75 mL/min/1.73 m²). The primary endpoint was all-cause mortality at 1 year. Results: A total of 13,194 patients with ACS were included. Patients with a reduced eGFR were less likely to be admitted to a coronary care unit and had lower rates of coronary angiograms and subsequent percutaneous coronary interventions. Furthermore, as the eGFR was lower, the patients were less frequently treated with aspirin, clopidogrel, β-blockers, and ACE inhibitors/angiotensin receptor blockers. We demonstrated an inverse association between renal function and 1-year mortality, with the highest mortality rates observed in the group with the lowest eGFR (HR = 3.8, 95% CI 2.9-4.9, p < 0.0001). Differences in mortality remained significant following a multivariate analysis for all the baseline characteristics as well as for invasive and medical treatment (HR = 2.7, 95% CI 1.9-3.7, p < 0.0001). Conclusions: ACS patients with chronic kidney disease represent a high-risk group with an increased mortality risk. Despite this high risk, these patients are less frequently selected for an invasive treatment strategy and are less commonly treated with guideline-based medications. However, reduced renal function was associated with higher mortality regardless of the variations in therapy.