Risk Factors For Renal Impairment Research Articles

Blood concentration monitoring and renal function changes during gentamicin administration for infective endocarditis: a retrospective observational study

BackgroundEstablished guidelines for monitoring gentamicin blood concentration are lacking; therefore, we focused on improving pharmacological interventions and ensuring their safety. We aimed to optimize gentamicin administration for infective endocarditis (IE) treatment.MethodsThe study involved adult patients diagnosed with IE and treated with gentamicin from January 2014 to December 2022. Clinical presentation and drug therapy regimen were comprehensively evaluated. We performed a retrospective chart review of the frequency of gentamicin dose adjustments and changes in renal function while on gentamicin. In addition, we attempted to extract risk factors for renal impairment using univariate analysis.ResultsOn average, a 7.1% decline [changed to − 6.7 ± 20.4 (standard deviation) mL/min/1.73 m2] in the estimated glomerular filtration rate was observed after gentamicin administration, but it was statistically insignificant. Notably, 58% of patients required dosage adjustments, with a subset requiring multiple adjustments. Among the cases in which dosage adjustments were made, 61% were within the first week of treatment. There were no patients with gentamicin levels below the target peak concentration. Furthermore, no independent risk factors were identified in patients requiring dose reduction.ConclusionsDose adjustment was necessary in many cases after treatment initiation. The time to dose adjustment varied widely. These findings highlight the importance of consistent blood concentration monitoring in patients of all demographics, at least weekly, and underscore that routine peak concentration assessments may not be essential when a 3 μg/mL target is maintained. This study provides information on monitoring gentamicin blood level, which can improve IE treatment safety.

Egyptian patients with axial spondyloarthritis: The frequency and predictors of renal impairment

Aim of the workTo determine the frequency of and risk factors for renal impairment in patients with axial spondyloarthritis (axSpA). Patients and methodsFifty axSpA patients participated in this study. In accordance with the Kidney Disease Outcomes Quality Initiative (K/DOQI) criteria, patients were split into two groups: group 1comprised renal impairment and group 2 comprised non-renal impairment. The ankylosing spondylitis (AS) disease activity score (ASDAS), Bath AS disease activity index (BASDAI) and estimated glomerular filtration rate were assessed. ResultsThe mean age of patients was 38.9 ± 11.7 years, males were 54 % and the disease duration was 11.36 ± 6.1 years. The mean ASDAS score was 5.58 ± 1.38 and BASDAI was 5.18 ± 1.55. The eGFR was 76.4 ± 36.2 ml/min/1.73 m2 and 28 % had positive human leucocytic antigen (HLA-B27). 80 % were receiving biologic therapy. Nephropathy by ultrasound and renal impairment were detected in 34 % and 52 % of the cases respectively. The cumulative dose of non-steroidal anti-inflammatory drugs (NSAIDs), C-reactive protein, erythrocyte sedimentation rate, low density cholesterol, blood urea nitrogen, creatinine, proteinuria, ASDAS and BASDAI were significantly higher in those with renal impairment(p = 0.0001, p = 0.0001, p = 0.001, p = 0.035, p = 0.0001, p = 0.0001, p = 0.0001, p = 0.001, p = 0.001 respectively) while the eGFR and high density lipoprotein were significantly lower (p = 0.001and p = 0.02). Only the cumulative dose of NSAIDs was a significantly independent variable influencing the development of renal impairment (OR=1.01, CI; 1.001–1.02, p = 0.024) at cut-off level > 1166.3 g. ConclusionsRenal impairment is frequent in axSpA patients with decreased eGFR and high disease activity. The cumulative dose of NSAIDs is a significant predictor of renal impairment.

Risk factors for renal impairment after liver transplantation in Mongolia: a retrospective single-center study.

Renal impairment (RI) is a frequent complication of liver cirrhosis and is associated with increased mortality and morbidity. Liver transplantation (LT) serves as an effective treatment method for patients with cirrhosis who have impaired renal function. However, renal function often declines after LT, influenced by various factors. This study aimed to investigate the factors contributing to RI following LT in our cases. We analyzed the demographic data, preoperative and perioperative parameters, and postoperative outcomes of patients who underwent LT at the First Central Hospital of Mongolia from September 2011 to December 2022. Renal function was assessed by measuring the glomerular filtration rate using the Cockcroft-Gault creatinine clearance formula pretransplantation and at 24 hours, 72 hours, 7 days, 14 days, and 28 days post-LT. Several factors increased the risk of RI among recipients. These included female sex (odds ratio [OR], 3.06; 95% confidence interval [CI], 1.58-5.91), Child-Turcotte-Pugh (CTP) scores of B and C (OR, 4.23; 95% CI, 0.92-19.41 and OR, 7.68; 95% CI, 1.67-35.30, respectively), preoperative continuous renal replacement therapy (CRRT; OR, 5.86; 95% CI, 1.1-31.21), and a high graft-to-recipient weight ratio (GRWR; OR, 3.45; 95% CI, 1.23-9.63). Additionally, the survival rates for recipients with RI post-LT were 93.4% at 1 year and 78.1% at 3 years. Female sex, a high CTP score, preoperative CRRT, and high GRWR were identified as risk factors for RI after LT in Mongolia.

Association between chronic intestinal failure etiology and eGFR trajectory in adults receiving home parenteral nutrition: A retrospective longitudinal cohort study.

Patients with chronic intestinal failure (CIF) are at increased risk of developing renal impairment. The aim of this study was to evaluate the occurrence of chronic kidney disease (CKD) in patients dependent on home parenteral nutrition (HPN) and assess risk factors for renal impairment, including patients with all mechanisms of CIF. This was a cohort study of patients initiated on HPN between March 1, 2015, and March 1, 2020, at a national UK IF Reference Centre. Patients were followed from their first discharge with HPN until HPN cessation or the end of follow-up on December 31, 2021. There were 357 patients included in the analysis. Median follow-up time was 4.7 years. At baseline, >40% of patients had renal impairment, with 15.4% fulfilling the criteria for CKD. Mean estimated glomerular filtration rate (eGFR) decreased significantly during the first year after initiation of HPN from 93.32 ml/min/1.73 m2 to 86.30 ml/min/1.73 m2 at the first year of follow-up (P = 0.002), with sequential stabilization of renal function. Increased age at HPN initiation and renal impairment at baseline were associated with decreased eGFR. By the end of follow-up, 6.7% patients developed renal calculi and 26.1% fulfilled the criteria for CKD. This is the largest study of renal function in patients receiving long-term HPN. After the first year following HPN initiation, the rate of decline in eGFR was similar to that expected in the general population. These findings should reassure patients and clinicians that close monitoring of renal function can lead to good outcomes.

Consensus Statement from India on the Renal Benefits of ARNi, SGLT-2i, and Bisoprolol in Chronic Kidney Disease.

Chronic kidney disease (CKD) is a major contributor to morbidity and mortality in India. CKD often coexists with heart failure (HF), diabetes, and hypertension. All these comorbidities are risk factors for renal impairment. HF and CKD are pathophysiologically intertwined, and the deterioration of one can worsen the prognosis of the other. There is a need for safe renal pharmacological therapies that target both CKD and HF and are also useful in hypertension and diabetes. Neurohormonal activation achieved through the activation of the sympathetic nervous system (SNS), the renin-angiotensin-aldosterone system (RAAS), and the natriuretic peptide system (NPS) is fundamental in the pathogenesis and progression of CKD and HF. Angiotensin receptor neprilysin inhibitor (ARNi), sodium-glucose cotransporter 2 inhibitors (SGLT-2i), and selective β1-blocker (B1B) bisoprolol suppress this neurohormonal activation. They also have many other cardiorenal benefits across a wide range of CKD patients with or without concomitant HF, diabetes, or hypertension. This consensus statement from India explores the place of ARNi, SGLT-2i, and bisoprolol in the management of CKD patients with or without HF and other comorbidities.

Decline in measured glomerular filtration rate is associated with simple renal cyst in Chinese patients with type 2 diabetes.

Simple renal cysts (SRC) are associated with age, hypertension and hyperuricemia, which are risk factors of renal impairment. This study aimed to investigate the prevalence of SRC and its association with measured glomerular filtration rate (mGFR) in patients with type 2 diabetes mellitus in China. A total of 3,552 patients with type 2 diabetes mellitus admitted to Shanghai Sixth People's Hospital from January 2012 to December 2016 were investigated. All participants were diagnosed as SRC by color Doppler, and all participants were measured for GFR by using dynamic renal scintigraphy with technetium-99m-diethylene triamine peta-acetic acid. The prevalence of SRC was 17.4% (619 cases). Participants with SRC had significantly lower mGFR values than those without SRC (86.16 ± 26.20 vs 94.88 ± 23.98 mL/min/1.73 m2 , P < 0.001). In 478 participants with unilateral renal cyst, the mGFR of the kidney affected by SRC was significantly lower than that of the unaffected kidney (43.32 ± 13.74 vs 44.18 ± 13.34 mL/min/1.73 m2 , P = 0.014). The participants were divided into four groups according to the quartiles of mGFR level (≥109.50, 93.80-109.49, 76.90-93.79 and <76.90 mL/min/1.73 m2 ). The prevalence of SRC gradually increased with decreasing mGFR level (12.9, 13.9, 16.6 and 27.8%, respectively; P trend <0.01). After adjusting for age, sex, duration of diabetes, hypertension and other potential confounders, the logistic regression showed that SRC was an independent risk factor for impaired GFR (<60 mL/min/1.73 m2 ; odds ratio 1.656; 95% confidence interval 1.451-1.890, P < 0.001). SRC is an independent risk factor for the decrease of mGFR in Chinese diabetes patients, and could affect the renal GFR measured by dynamic renal scintigraphy on the SRC side.

Renal safety of zoledronic acid in patients with osteoporosis: a retrospective study.

This study aimed to investigate the renal safety of Zoledronic Acid (ZOL) in patients with osteoporosis (OP). A total of 1379 patients (baseline estimated glomerular filtration rate, eGFR ≥ 60 mL/min/1.73 m2) with primary OP who received ZOL from January 2008 to October 2020 at our hospital were retrospectively analyzed. Baseline and the changes in renal function within 1 year following infusions were collected, the incidence of renal impairment (eGFR < 60 mL/min/1.73 m2 or a > 25% reduction in the eGFR from baseline) was noted and the risk factors were analyzed. Furthermore, the changes in renal function between a 3-year consecutive infusion and a single infusion of ZOL were compared. Renal impairment occurred in 8.05% of patients, who with a significantly higher age, Charlson Comorbidity Index (CCI), smoking history, combination of hypertension or diabetes mellitus and worse renal function indicators (all P < 0.05). Binary logistic regression analysis showed that higher CCI (≥5) or smoking history or the baseline eGFR <90 mL/min/1.73 m2 were the risk factors for renal impairment (all P < 0.05). Patients of 3-year continuous infusion group had a significantly greater drop in the eGFR levels than the single infusion group after 1 year of infusion(s) (P < 0.05). Attention should be given to possible potential renal impairment following ZOL infusion in clinical practice for the management of OP, particularly in patients with higher CCI (≥5) or smoking history or the baseline eGFR <90 mL/min/1.73 m2. Continuous infusion of ZOL exerts a significant impact on renal function when compared to single infusion and intensive monitoring of renal function is necessary.

Prevalence and risk factors for impaired renal function among Asian patients with nonalcoholic fatty liver disease

BackgroundNonalcoholic fatty liver disease (NAFLD) is associated with impaired renal function, and both diseases often occur alongside other metabolic disorders. However, the prevalence and risk factors for impaired renal function in patients with NAFLD remain unclear. The objective of this study was to identify the prevalence and risk factors for renal impairment in NAFLD patients. MethodsAll adults aged 18–70 years with ultrasound-diagnosed NAFLD and transient elastography examination from eight Asian centers were enrolled in this prospective study. Liver fibrosis and cirrhosis were assessed by FibroScan-aspartate aminotransferase (FAST), Agile 3+ and Agile 4 scores. Impaired renal function and chronic kidney disease (CKD) were defined by an estimated glomerular filtration rate (eGFR) with value of < 90 mL/min/1.73 m2 and < 60 mL/min/1.73 m2, respectively, as estimated by the CKD-Epidemiology Collaboration (CKD-EPI) equation. ResultsAmong 529 included NAFLD patients, the prevalence rates of impaired renal function and CKD were 37.4% and 4.9%, respectively. In multivariate analysis, a moderate-high risk of advanced liver fibrosis and cirrhosis according to Agile 3+ and Agile 4 scores were independent risk factors for CKD (P< 0.05). Furthermore, increased fasting plasma glucose (FPG) and blood pressure were significantly associated with impaired renal function after controlling for the other components of metabolic syndrome (P< 0.05). Compared with patients with normoglycemia, those with prediabetes [FPG ≥ 5.6 mmol/L or hemoglobin A1c (HbA1c) ≥ 5.7%] were more likely to have impaired renal function (P< 0.05). ConclusionsAgile 3+ and Agile 4 are reliable for identifying NAFLD patients with high risk of CKD. Early glycemic control in the prediabetic stage might have a potential renoprotective role in these patients.

The relationship between obstructive sleep apnea and risk of renal impairment in patients with hypertension, a longitudinal study

ObjectiveAssociation of obstructive sleep apnea (OSA) with renal damage is undetermined, especially in the population with hypertension, a high-risk group for chronic kidney disease. Therefore, we aimed to explore whether OSA is an independent risk factor for renal impairment in patients with hypertension, by considering the effects of gender, age, obesity and OSA severity. MethodsThe longitudinal observational study included patients with hypertension and suspected OSA without renal damage at baseline who visited Hypertension Center between January 2011 and December 2018, and followed up till renal outcomes, death, loss to follow-up, or May 31, 2022, using annual health check-ups, hospital readmission or out-patient visits. Main renal outcome was chronic kidney disease (CKD), defined as estimated glomerular filtration rate <60 ml/min per 1.73 m2 and/or positive proteinuria. Cox proportional hazard models were used to evaluate the association, and repeated after propensity score matching. Sensitivity analysis were performed by excluding those with primary aldosteronism. Results7961 patients with hypertension were included with 5022 ones with OSA, and 82% were followed up. During median follow-up of 3.42 years, 1486 patients developed CKD. Per 1000 person-year incidence of CKD was 56.72 in OSA group. In Cox regression analysis, OSA and severe OSA group respectively showed 1.21 (95% CI: 1.08−1.35) and 1.27 (95% CI: 1.09−1.47) fold risk for CKD in total, compared with non-OSA group. Overall results remained consistent in propensity score matching and sensitivity analysis. ConclusionOSA is independently associated with higher risk of chronic kidney disease in hypertension.

Impact of Renal Function on the Prognosis of Patients Receiving Atezolizumab/Bevacizumab Combination Therapy and Lenvatinib Monotherapy for Unresectable Hepatocellular Carcinoma

Introduction: Several studies have reported kidney injury caused by immune checkpoint inhibitors, and proteinuria caused by vascular endothelial growth factor inhibitors for unresectable hepatocellular carcinoma (u-HCC). We investigated the relationship between renal function and prognosis in patients with u-HCC receiving atezolizumab and bevacizumab (AB) and lenvatinib (LEN) therapy. Methods: Fifty-one patients who received AB and 50 patients who received LEN therapy were included. We analyzed prognostic factors related to the overall survival (OS), and characteristics related to renal function. Results: In patients with AB therapy, OS was shorter in patients with baseline proteinuria of 1+ or higher, as assessed by urine dipstick test, compared to those with –/± (p = 0.024). There were many cases with two or more drugs with a high risk of renal dysfunction (p = 0.019) in patients with 1+ or higher. Furthermore, OS was shorter in the group with estimated glomerular filtration rate (eGFR) grade deterioration without urinary protein-creatinine ratio (UPCR) of 2 g/g·Cre or higher than in the other groups (p = 0.027). In the group where eGFR worsened without an increase in UPCR, there were many cases with a daily salt intake of 10 g or more (p = 0.027), three or more drugs with a high risk of renal dysfunction (p = 0.021), and a history of arteriosclerosis (p = 0.021). On the other hand, in patients with LEN therapy, OS tends to be shorter in patients with proteinuria of ± or higher, compared to those without (p = 0.074). There were many cases with a daily salt intake of 10 g or more in patients with ± or higher (p = 0.002). Conclusion: In patients receiving AB and LEN therapy, baseline proteinuria was associated with OS. Renal function deterioration without proteinuria was associated with a poor prognosis in AB therapy. Excessive salt intake, preexisting atherosclerotic disease, and drug with a high risk of renal dysfunction were risk factors for renal deterioration.

MP32-08 AORTIC CALCIFICATION BURDEN IS ASSOCIATED WITH AN INCREASED RISK OF ACUTE KIDNEY INJURY IN PATIENTS WHO UNDERGOING RADICAL CYSTECTOMY: A MULTI-INSTITUTIONAL RETROSPECTIVE COHORT STUDY

You have accessJournal of UrologyCME1 Apr 2023MP32-08 AORTIC CALCIFICATION BURDEN IS ASSOCIATED WITH AN INCREASED RISK OF ACUTE KIDNEY INJURY IN PATIENTS WHO UNDERGOING RADICAL CYSTECTOMY: A MULTI-INSTITUTIONAL RETROSPECTIVE COHORT STUDY Naoki Fujita, Masaki Momota, Hirotaka Horiguchi, Shingo Hatakeyama, Hiroyuki Ito, Takahiro Yoneyam, Yasuhiro Hashimoto, Shoji Nishimura, Kazuaki Yoshikawa, and Chikara Ohyama Naoki FujitaNaoki Fujita More articles by this author , Masaki MomotaMasaki Momota More articles by this author , Hirotaka HoriguchiHirotaka Horiguchi More articles by this author , Shingo HatakeyamaShingo Hatakeyama More articles by this author , Hiroyuki ItoHiroyuki Ito More articles by this author , Takahiro YoneyamTakahiro Yoneyam More articles by this author , Yasuhiro HashimotoYasuhiro Hashimoto More articles by this author , Shoji NishimuraShoji Nishimura More articles by this author , Kazuaki YoshikawaKazuaki Yoshikawa More articles by this author , and Chikara OhyamaChikara Ohyama More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003265.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although acute kidney injury (AKI) is one of the frequent complications in patients undergoing radical cystectomy (RC), its risk factors remain unclear. As arterial degradation is suggested to be a risk factor for renal impairment, we hypothesized that preexisting aortic calcification may play a crucial role in AKI development. METHODS: This multi-institutional retrospective cohort study included 616 patients with muscle invasive bladder cancer who underwent RC between September 1998 and April 2022. Aortic calcification burden was quantified with aortic calcification index using preoperative computed tomography scan (ACI, %) (Fig. A). Patients were divided into two groups: lower ACI (ACI <25%) and higher ACI groups (ACI ≥25%). AKI was defined according to the KDIGO criteria. Multivariable logistic regression analysis was performed to evaluate the association between aortic calcification burden and the risk of AKI. RESULTS: Of 616 patients, 248 (40%) were classified as the higher ACI group and 335 (54%) developed to AKI (any stage). Rate of AKI development in the higher ACI group was significantly higher than that of the lower ACI group (Fig. B; p<0.001). ACI in patients who developed AKI was significantly higher than that in patients who did not (Fig. C; p<0.001). In univariable analyses, age, performance status, body mass index, hypertension, cardiovascular disease, renal function, neobladder reconstruction, and ACI were associated with AKI development (Table 1). After adjustment for these confounding variables, ACI was selected as a significant independent risk factor for AKI development (Table 2; odds ratio 1.534, p=0.023). CONCLUSIONS: High aortic calcification burden is a risk factor for AKI in patients who undergoing RC. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e443 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Naoki Fujita More articles by this author Masaki Momota More articles by this author Hirotaka Horiguchi More articles by this author Shingo Hatakeyama More articles by this author Hiroyuki Ito More articles by this author Takahiro Yoneyam More articles by this author Yasuhiro Hashimoto More articles by this author Shoji Nishimura More articles by this author Kazuaki Yoshikawa More articles by this author Chikara Ohyama More articles by this author Expand All Advertisement PDF downloadLoading ...

Impact of Cigarette Smoking on Serum Cystatin C and Creatinine Levels and MAU: A Case-Control Study

Background: Smoking-related hemodynamic events may adversely influence renal function. The aim of this study was to evaluate renal impairment biomarkers among healthy people influenced by cigarette smoke. Methods and Results: In this case-control study, 90 subjects were enrolled: 60 were smokers, and 30 were non-smokers (apparently healthy control). Serum CysC was measured using a semi-automated, specific protein analyzer Mispa-i2 (Germany). Serum creatinine and MAU were assayed in the fully automated biochemistry analyzer (Mindray BS380). The mean concentration of CysC was significantly higher in cigarette smokers than in non-smokers (0.793±0.125 vs. 0.619±0.103, P=0.000). Also, the mean of MAU and serum creatinine levels were significantly higher in cigarette smokers than in non-smokers (18.33±3.41 vs. 12.70±0.517, 1.06±0.161 vs. 0.810±0.058, respectively, P=0.000 in both cases). The mean concentration of CysC and MAU was significantly greater in heavy smokers than in light smokers (P=0.000 and P=0.001, respectively). Serum CysC and MAU levels were positively correlated with the age of cigarette smokers (r=0.734 and r=0.730, respectively; P=0.000 in both cases) and the duration of smoking (r=0.773 and r=0.790, respectively; P=0.000 in both cases). Conclusion: cigarette smoking increases the specific renal biomarkers considered risk factors for renal impairment. Using such inflammatory biomarkers as diagnostic tools can be a necessary precaution in the development of chronic kidney disease caused by smoking and in the avoidance of acute renal consequences linked to cigarette smoking.

Decline in kidney function greater with longer exposure to lithium

Research using data from two cohort studies in Sweden has concluded that after 10 years of exposure to lithium, risk of decline in kidney function in patients with bipolar disorder or schizoaffective disorder increases considerably compared with patients exposed for shorter periods or the general population. The study found that neither disorder is an independent risk factor for renal impairment. Results were published online Sept. 12, 2022, in Lancet Psychiatry.

Competitive interaction between smoking and chronic obstructive pulmonary disease for explaining renal function reduction in hypertensive patients.

Chronic kidney disease is a risk factor for cardiovascular events. Smoking and chronic obstructive pulmonary disease (COPD) are risk factors for renal impairment. The aim of this study was to test the combined effect of smoking and COPD on renal function decline in hypertensives. We enrolled 1728 hypertensives stratified by smoking status and presence/absence of COPD. To test the mutual effect modification by both smoking and COPD and e-GFR, we performed crude and adjusted linear regression analyses, these latter taking into account potential confounders. Smokers displayed significantly lower e-GFR values than non-smokers (90 ± 24 vs. 121 ± 35ml/min/1.73m2); this difference was confirmed when comparing e-GFR values between patients with/without COPD (81 ± 17 vs. 109 ± 32ml/min/1.73m2). Smoking and COPD were directly and significantly interrelated (Cramer's V coefficient = 0.200; P = < 0.001). At interaction analyses, smoking significantly modified the effect of COPD on e-GFR and COPD significantly modified the effect of smoking on e-GFR, indicating a competitive interaction between smoking and COPD in the appearance of renal damage. e-GFR was 35ml/min/1.73m2 lower in patients with COPD than in those without; this reduction was of higher magnitude than that found between COPD and COPD-free patients among smokers (19ml/min/1.73m2). Smoking and COPD competitively interact in the appearance of renal function decline. These results suggest to screen for kidney damageboth smokers and COPD patients, especially those with both conditions.

Diverting ileostomy is a risk factor for renal impairment during CAPOX therapy.

Temporary ileostomy is sometimes created after colorectal surgery and may cause renal impairment. However, the impact of ileostomy on renal function during adjuvant chemotherapy for colorectal cancer (CRC) remains unknown. The aim of the present study was to examine the effects of ileostomy on renal function during adjuvant chemotherapy. We examined 184 patients who received adjuvant CAPOX therapy (capecitabine and oxaliplatin) for CRC with or without ileostomy between January 2011 and December 2020 at the University of Tokyo Hospital. Clinicopathological factors, including renal function, were retrospectively reviewed in association with temporary ileostomy. Factors associated with reductions in the estimated glomerular filtration rate (eGFR) during CAPOX therapy were analyzed. Eighteen patients (10%) underwent temporary ileostomy. The maximum decrease in eGFR during CAPOX therapy was significantly higher in patients with than in those without ileostomy (-16.1 vs. -5.6mL/min/1.73m2, p = 0.003). A multivariate analysis identified ileostomy as one of factors independently associated with reductions in eGFR during CAPOX therapy (p = 0.003). The cumulative number of readmission due to dehydration was also higher in patients with ileostomy (33% vs. 1%, p < 0.001). Ileostomy significantly reduced eGFR during adjuvant CAPOX therapy. Therefore, renal function needs to be monitored during CAPOX therapy, particularly in patients with ileostomy.

Risk factors for renal impairment in patients with hematological cancer receiving antineoplastic treatment.

Antineoplastic treatments, mainly chemotherapy, affect the kidneys, causing toxicity, and can trigger acute and chronic kidney injuries. This study aimed to analyze the prevalence of renal disorders in patients with oncohematological neoplasms receiving antineoplastic treatment. This retrospective cohort study included 75 patients with hematological cancer who underwent chemotherapy between 2012 and 2018 in the Hematology Sector of the Walter Cantídeo University Hospital of the Federal University of Ceará. Sociodemographic and clinical data, blood biochemical assessment findings, and glomerular filtration rate (GFR) were analyzed using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. The data were tabulated; transferred to the Statistical Package for the Social Sciences software, version 20.0; and analyzed using Pearson's chi-square test or Fisher's exact test for categorical variables followed by a multinomial logistic regression model (p < 0.05). The prevalence of renal disorders was 52.4% according to the CKD-EPI equation for GFR events. There was a significant association between the decrease in GFRs and the following variables: female sex (p = 0.002), diagnosis of multiple myeloma (p = 0.008), start of treatment within 40days (p = 0.005), and the following antineoplastic treatments: cyclophosphamide, vincristine, and prednisone (p = 0.026); irarubicin (p = 0.032); azacytidine, dexamethasone, and cyclophosphamide (p < 0.001); zoledronic acid (p < 0.001); and pamidronate (p = 0.012). CALGB 8811 (p < 0.001) was inversely associated with a reduction in the GFR. The prevalence of renal disorders was high in patients with oncohematological neoplasms receiving antineoplastic treatment. This requires periodic monitoring of the evaluation of renal function since reductions in GFRs were significantly associated with different treatment protocols used.

Bone markers and renal functional status in healthy Nigeria adults

Background There is a dearth of reports on the relationship between bone metabolism and renal function in Nigeria. This study determined the association between bone-turnover markers and renal functional status in healthy Nigerian adults. Patients and methods This exploratory observational study consisted of 80 apparently healthy participants aged 22–50 years without known risk factors for renal impairment. Fasting samples were analyzed for biochemical bone-turnover markers, including serum osteocalcin, total alkaline phosphatase, 24-h urine-calcium excretion, parathyroid hormone (PTH), and 25-hydroxyvitamin D [25(OH)D]; and calcium, phosphate, and creatinine. The estimated glomerular-filtration rate (GFR) was calculated using the Cockcroft–Gault formula. Bone mineral density (BMD) was measured by Dual-energy X-ray Absorptiometry scan (DXA scan). Statistical analysis was carried out and P level less than 0.05 was regarded as significant. Results The mean age of study participants was 32.1±5.8 years with a mean GFR of 98.15±9.02 ml/min, mean serum 25(OH)D 51.53±15.45 mmol/l, and mean BMD/Z score 0.54±0.07)/0.20±1.02. None of the participants had osteoporosis or vitamin-D deficiency. There is a significant correlation between bone marker − osteocalcin and BMD, and PTH with BMD and GFR (P&lt;0.05). Also, a nonsignificant trend was observed between calcium excretion, 25(OH)D, and estimated GFR (P=0.07, P=0.08). Conclusion PTH may be an early marker of bone loss in renal dysfunction.

Uric Acid and Impairment of Renal Function in Non-diabetic Hypertensive Patients.

Hyperuricemia is a risk factor for renal impairment. However, investigations focusing on patients with hypertension are limited and inconsistent. A single-center prospective cohort study of 411 Han Chinese non-diabetic hypertensive patients was conducted in Taiwan. The mean age of the participants was 62.0 ±14.4 years. The baseline estimated glomerular filtration rate and uric acid level were 86 mL/min/1.73 m2 and 6.2 mg/dL, respectively. All patients underwent serum biochemistry tests for creatinine levels every 3 months. Renal events were defined as >25% and >50% decline in estimated glomerular filtration rate. During an average follow-up period of 4.7 ± 2.9 years (median 4.0 years), a >25 and >50% decline in estimated glomerular filtration rate was noted in 52 and 11 patients, respectively. The multivariate Cox regression analysis revealed that a baseline uric acid level ≥8.0 mg/dL increased the risk of >25% decline (hazard ratio: 3.541; 95% confidence interval: 1.655–7.574, P = 0.001) and >50% decline (hazard ratio: 6.995; 95% confidence interval: 1.309–37.385, P = 0.023) in estimated glomerular filtration rate. Similarly, a baseline uric acid level ≥7.5 mg/dL was independently associated with >25% decline (hazard ratio: 2.789; 95% confidence interval: 1.399–5.560, P = 0.004) and >50% decline (hazard ratio: 6.653; 95% confidence interval: 1.395–31.737, P = 0.017). However, this was not demonstrated at baseline uric acid level ≥7.0 mg/dL. Our study suggests that hyperuricemia is an independent risk factor for the decline in renal function in patients with hypertension. Uric acid level ≥7.5 mg/dL may be considered as the optimal cutoff value for clinical practice in predicting the development of renal impairment.

Analysis of Risk Factors for High-dose Cisplatin-induced Renal Impairment in Head and Neck Cancer Patients.

Concurrent chemoradiotherapy with high-dose cisplatin (CDDP-RT) is the standard therapy for advanced head and neck cancer; however, due to CDDP-induced renal impairment, dose reduction or discontinuation is frequently required. Therefore, the identification of risk factors for renal impairment is of importance to improve the efficacy and safety of CDDP-RT. We retrospectively investigated risk factors for renal impairment in advanced head and neck cancer patients receiving CDDP-RT. Renal impairment was defined as a >25% decrease from baseline in estimated glomerular filtration rate within 14 days after CDDP administration in the first cycle. Of the 82 patients analyzed in this study, 21 (26%) patients developed renal impairment. Multivariate logistic regression analysis showed that concomitant use of a calcium channel blocker or lower hemoglobin levels significantly contributed to the increased risk of CDDP-induced renal impairment (odds ratio=3.60, 95% confidence interval=1.04-12.40; odds ratio=0.71, 95% confidence interval=0.50-0.99, respectively), while concomitant use of proton pump inhibitors was a factor associated with a decreased risk of CDDP-induced renal impairment (odds ratio=0.20, 95% confidence interval=0.04-0.86). Renal function of patients receiving calcium channel blocker or patients with lower hemoglobin levels should be monitored cautiously when receiving CDDP-RT.

Prevalence, incidence and predictors of renal impairment in persons with HIV receiving protease-inhibitors in rural Tanzania

ObjectiveRitonavir-boosted protease inhibitors (bPI) in people living with HIV (PLWH) have been associated with renal impairment. Limited data are available from rural sub-Saharan Africa.MethodsUsing data from the Kilombero and Ulanga Antiretroviral Cohort Study (KIULARCO) in rural Tanzania from 2005-01/2020, we assessed the prevalence of renal impairment (estimated glomerular filtration rate <60 mL/min/1.73m2) at the time of switch from first-line antiretroviral treatment (ART) to bPI-regimen and the incidence of renal impairment on bPI. We assessed risk factors for renal impairment using logistic and Cox regression models.ResultsRenal impairment was present in 52/687 PLWH (7.6%) at the switch to bPI. Among 556 participants with normal kidney function at switch, 41 (7.4%) developed renal impairment after a median time of 3.5 (IQR 1.6–5.1) years (incidence 22/1,000 person-years (95%CI 16.1–29.8)). Factors associated with renal impairment at switch were older age (adjusted odds ratio (aOR) 1.55 per 10 years; 95%CI 1.15–2.11), body mass index (BMI) <18.5 kg/m2 (aOR 2.80 versus ≥18kg/m2; 95%CI 1.28–6.14) and arterial hypertension (aOR 2.33; 95%CI 1.03–5.28). The risk of renal impairment was lower with increased duration of ART use (aOR 0.78 per one-year increase; 95%CI 0.67–0.91). The renal impairment incidence under bPI was associated with older age (adjusted hazard ratio 2.01 per 10 years; 95%CI 1.46–2.78).ConclusionsIn PLWH in rural sub-Saharan Africa, prevalence and incidence of renal impairment among those who were switched from first-line to bPI-regimens were high. We found associations between renal impairment and older age, arterial hypertension, low BMI and time on ART.