Risk Of Impaired Renal Function Research Articles

Role of Contrast-Enhanced Ultrasound (CEUS) in Native Kidney Pathology: Limits and Fields of Action.

Gray scale ultrasound has an important diagnostic role in native kidney disease. Low cost, absence of ionizing radiation and nephrotoxicity, short performance time, and repeatability even at the bedside, are the major advantages of this technique. The introduction of contrast enhancement ultrasound (CEUS) in daily clinical practice has significantly reduced the use of contrast enhancement computed tomography (CECT) and contrast enhancement magnetic resonance (CEMR), especially in patients with renal disease. Although there are many situations in which CECT and CEMRI are primarily indicated, their use may be limited by the administration of the contrast medium, which may involve a risk of renal function impairment, especially in the elderly, and in patients with acute kidney injury (AKI) and moderate to severe chronic kidney disease (CKD). In these cases, CEUS can be a valid diagnostic choice. To date, numerous publications have highlighted the role of CEUS in the study of parenchymal micro-vascularization and renal pathology by full integration with second level imaging methods (CECT and CEMRI) both in patients with normal renal function and with diseased kidneys. The aim of this review is to offer an updated overview of the limitations and potential applications of CEUS in native kidney disease.

Primary IgA nephropathy with nephrotic-range proteinuria in Chinese children.

To investigate the clinicopathological features and outcomes of primary IgA nephropathy with nephrotic-range proteinuria in Chinese children. Patients with biopsy-proven IgA nephropathy and nephrotic-range proteinuria between January 2011 and December 2017 were included, and their proteinuria and renal function were followed up. A total of 90 patients were enrolled, and 21.1% (19/90) of them had decreased renal function at diagnosis. Complete remission, partial remission, and no response of proteinuria occurred in 88.6% (70/79), 10.1% (8/79), and 1.3% (1/79), respectively, of the 79 patients who were followed up for 6 to 104 months. 73.7% (14/19) of the patients with decreased renal function at diagnosis recovered to normal level while 26.3% (5/19) of them did not recover or progressed to end-stage renal disease. Two patients with normal renal function at diagnosis progressed to renal insufficiency during follow-up period. By multivariate analysis, the risk for renal function deterioration was significantly higher in the partial remission and no response groups than in the complete remission group. Remission of proteinuria was important for improving renal prognosis in children with IgA nephropathy and nephrotic-range proteinuria. The outcomes for pediatric patients appeared to be better than that reported in adults.

Sodium-Glucose Cotransporter2 Inhibitors in Patients with Non-Diabetic Chronic Kidney Disease.

Sodium-glucose cotransporter2 (SGLT2) inhibitors can reduce cardiovascular morbidity and mortality in patients with type2 diabetes. Furthermore, recent clinical studies have revealed that SGLT2 inhibitors decrease the risk of renal function impairment in patients with type2 diabetes. However, the effects of SGLT2 inhibitors on non-diabetic chronic kidney disease (CKD) remains unclear. Regarding long-term clinical outcomes, the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF) trial explicitly showed improvements in cardiovascular outcomes in patients presenting with heart failure, even in the absence of diabetes. The reduction in heart failure in patients without diabetes was confirmed following empagliflozin administration in the EMPagliflozin outcomE tRial in patients with chrOnic heart failure with Reduced ejection fraction (EMPEROR-Reduced) trial. A recent systematic review and meta-analysis of DAPA-HF and EMPEROR-Reduced showed improvements in the composite renal endpoint regardless of the presence of diabetes or baseline estimated glomerular filtration rate. The Dapagliflozin and Prevention of Adverse outcomes in Chronic Kidney Disease (DAPA-CKD) trial evaluated patients with CKD with or without type2 diabetes, irrespective of whether SGLT2 inhibitor dapagliflozin was added for renin-angiotensin system blockade as background renoprotective therapy. In this trial, dapagliflozin reduced the hazard ratio for a composite renal and cardiovascular death endpoint in patients with CKD attributed to various causes, with or without type2 diabetes.

Renal function impairment in cervical cancer patients treated with cisplatin-based chemoradiation: A review of medical records in a Zimbabwean outpatient department.

There is a potential increase in risk of renal function impairment among patients with invasive cervical cancer (ICC) who are HIV-positive and treated with cisplatin-based concurrent chemoradiation (CCRT). This concern is due to overlapping nephrotoxicity of the drugs, and nephropathy from the diseases themselves. There is limited literature available for the short-term renal outcomes for HIV-positive patients with ICC during routine clinical management. This study aimed to assess if HIV-infection increased the risk of renal impairment in ICC patients treated with CCRT, and explore the respective risk factors. This was a retrospective review of records of ICC patients treated with at least one cycle of weekly cisplatin during CCRT at the Parirenyatwa Radiotherapy Center from January 2017-December 2018. The RIFLE criteria were used to classify renal impairment. Analyses were performed with Fisher's Exact tests, Wilcoxon rank sum tests. Odds ratios (OR) were generated using logistic regression. All statistical tests were 2-sided at a 5% level of significance. Seventy-two eligible patients were identified, 32 (44.44%) were HIV-positive. HIV-positive patients were younger (p = 0.002), had lower albumin levels (p = 0.014) and received lower cisplatin doses (p = 0.044). The mean percent reduction in estimated glomerular filtration rate (eGFR) from baseline was -19% (95% CI: -25.9% to -13.2%) for all patients. Thirty-one (43.1%) patients experienced renal impairment, 50% and 37.5% of HIV-positive and -negative patients respectively (p = 0.287). HIV-infection was associated with an adjusted OR of 1.16 (95% CI 0.35-3.43, p = 0.769). Baseline eGFR< 60ml/min was the only independent predictor of renal impairment, OR 0.25 (95% CI: 0.07-0.85). Baseline eGFR<60ml/min was also associated with receipt of lower cisplatin doses (p = 0.044). HIV-infection was not associated with elevated risk of renal impairment. Patients with an eGFR<60ml/min appear to be managed more cautiously reducing their risk for renal impairment during cisplatin therapy. The high prevalence of renal impairment in this population suggests the need for optimization of pre-treatment protocols.

РОЛЬ ИММУННОФЛЮОРЕСЦЕНЦИИ В ДИАГНОСТИКЕИ ОПРЕДЕЛЕНИИ ПРОГНОЗА ГЛОМЕРУЛОПАТИЙ СЭКСТРАКАПИЛЛЯРНОЙ ПРОЛИФЕРАЦИЕЙ

Objective. To evaluate the immune complex expression detected by immunofluorescence in order to establish the diagnosis and predict the course of glomerulopathies with extracapillary proliferation. Material and methods. A total of 165 kidney biopsies with extracapillary proliferation were analyzed by light and luminescent microscopy. Results. The immunofluorescence expression and its prognostic significance in glomerulopathies were described in the study. IgG deposits in IgA nephropathy increased the risk of impaired renal function by 2.68 times (95% CI 1.13-6.33). In pauci-immune glomerulonephritis, IgGs were associated with a higher segmental glomerulosclerosis percentage (p=0.020), the absence of IgM increased the risk of progression by 3.15 times (95% CI 1.43-6.94). IgM was more often detected in IgA nephropathy than in IgA vasculitis (p=0.049). Conclusion. Kidney biopsy assessment using immunofluorescence is important for the diagnosis and prognosis of glomerulopathies with extracapillary proliferation.

Renal Function in Children with β-Thalassemia Major Treated with Iron Chelating Agent

BACKGROUND: Thalassemia is a disorder of inherited blood and inticated by the abnormal hemoglobin. Transfusion and iron chelation are part of thalassemia management. Iron chelating agent reduces complications due to the excess iron as a result of repeated transfusions, hence, increasing the survival rate. However, prolonged intake of iron chelating agent may increase the risk of renal function impairment. To date, evaluation of renal function in children with β-thalassemia in Medan has never been reported. The objective of this study was to evaluate renal function and other factors in children with β-thalassemia.METHODS: Fourty-five children with β-thalassemia was recruited in this study. Renal function, represented by estimated glomerular filtration rate (eGFR)and serum ferritin levels were examined. The measurement of eGFR was using Schwartz method.RESULTS: Decreased eGFR observed in some the children (2 patients) with β-thalassemia major treated with iron chelating agent. None of the factors examined had association with serum creatinine level. Children's age and duration of iron chelating agent intake had positive correlation with their eGFR (r=0.506, p&lt;0.001 and r=0.518, p&lt;0.001, respectively). However, serum ferritin levels was not a predictor for renal function impairment.CONCLUSION: Most of children with β-thalassemia major treated with iron chelating agent have normal renal function, nevertheless, decreased renal function is observed in few children. Highlighted, renal function examinations should be performed routinely as iron chelating agent administration is a long-term therapy in children with β-thalassemia major.KEYWORDS: β-thalassemia major, renal function, serum ferritin levels, iron chelating agent

Comparison of a Significant Decline in the Glomerular Filtration Rate between Ileal Conduit and Ileal Neobladder Urinary Diversions after Radical Cystectomy: A Propensity Score-Matched Analysis

Urinary diversion after radical cystectomy is associated with a risk of renal function impairment. A significant decline in the glomerular filtration rate (GFR) (i.e., a ≥30% decline in baseline GFR after 12 months) is associated with long-term renal function impairment. We compared the significant GFR decline between ileal conduit and ileal neobladder urinary diversions 12 months after radical cystectomy. We retrospectively included radical cystectomy patients. Propensity score-matched analysis was performed. The primary outcome was the incidence of a significant GFR decline in ileal conduit urinary diversion (ileal conduit group) and ileal neobladder urinary diversion (ileal neobladder group) 12 months after radical cystectomy. The secondary outcomes were the change of GFR and the incidence of end-stage renal disease (ESRD) in the two groups. After propensity score matching, the ileal conduit and neobladder groups had 117 patients each. The incidence of a significant GFR decline was not significantly different between ileal conduit and ileal neobladder groups (12.0% vs. 13.7%, p = 0.845). The change of GFR and ESRD incidence were not significantly different between the two groups (−8.4% vs. −9.7%, p = 0.480; 4.3% vs. 5.1%, p > 0.999, respectively). These results can provide important information on appropriate selection of the urinary diversion type in radical cystectomy.

Evolution of renal function in patients with severe intestinal failure on home parenteral nutrition.

BackgroundKidney disease is a frequent but underestimated complication in patients suffering from intestinal failure (IF) treated by long-term home parenteral nutrition (HPN). The evolution in glomerular filtration rate (GFR) over time is poorly characterized. The current equations for estimating GFR have limited precision. No study has specifically investigated the reliability of recent creatinine-based estimated GFR (eGFR) equations in this population. The aim of this study was to evaluate the renal function decline under home parenteral nutrition (HPN) with a gold standard method and compare the performances of routinely used eGFR equations.MethodsForty patients with HPN and two or more GFR measurements were retrospectively studied. The renal function decline was calculated by the slope drawn between the successive measured GFRs (mGFRs). The performances of the Modification of Diet in Renal Disease, Chronic Kidney Disease Epidemiology Collaboration, full age spectrum and revised Lund–Malmö equations were compared with reference methods (inulin or iohexol clearance).ResultsThe mean mGFR was 78 ± 28 mL/min/1.73 m2. The annual decline of mGFR was −1.9 mL/min/1.73 m2/year. No predisposing factor was identified to predict impairment in renal function. eGFR formulas grossly overestimated mGFR and had a low level of accuracy.ConclusionsPatients with IF are at significant risk for impaired renal function. In this population, the tested eGFR equations were inaccurate. However, monitoring kidney function with mGFR remains important in these patients, as their GFR regularly declines and no specific risk factor has yet been identified.

Efficiency and Safety of The Retrograde Intrarenal Surgery in Younger Compared to Elderly Patients.

To determine the outcomes of retrograde ıntrarenal surgery (RIRS) and its complications in both young and elderly patients. An observational study. Departments of Urology, University of Health Sciences, Ankara Research and Training Hospital, Ankara, and Çorum Hitit University, Çorum, Turkey from April 2019 to January 2020. Patients with kidney stones up to 3 cm in maximal diameter on computarised tomography (CT) scan, were divided into two groups according to age (<60 vs.≥60 years ). RIRS was performed. Demographics, clinical data, and complications were recorded and compared. Mean age of 78 patients was 52.47 ±13.28 years. There were no significant difference in gender, American Society of Anesthesiology (ASA) scores, operation time, number of multiple sessions, success rates of outcome and complication rates between groups. At the end of the first session, stone-free rates were 91.1% vs 87.9% in younger and elderly groups, respectively; while, after the second session, all patients were stone-free in both groups. Fever, hematuria (macroscopic, more than 24 hours), and perirenal hematoma were the observed complications. Postoperative hematocrit levels significantly decreased without any need of transfusion; there were significant differences in the preoperative and postoperative creatinine levels ( p=0.002) in the older group. RIRS is a safe and effective method for treating kidney stones up to 3 centimeter diameter in all age groups. Although hemorrhagic events are mostly clinically unremarkable, there is a risk of renal function impairment in older (≥60 years) patients. Preoperative hydration and postoperative close follow-up is important. Key Words: Retrograde ıntrarenal surgery, Elderly, Effectiveness, Safety.

LCZ696 and preservation of renal function in heart failure: A meta-analysis of 6 randomized trials.

Patients with heart failure (HF) are prone to combine with renal insufficiency. Recently, LCZ696 has been used in the treatment of HF, but whether LCZ696 is better than angiotensin converting enzyme inhibitors/angiotensin receptor antagonists (ACEI/ARB) in renal protection for HF patients has not been investigated. Therefore, we conducted a meta-analysis focusing on LCZ696 and its role in preservation of renal function in HF patients. Embase, PubMed, the Cochrane Library and ClinicalTrials.gov databases were electronically searched for available randomized controlled trials (RCTs). HF patients taking LCZ696 or ACEI/ARB were assessed for renal adverse events. The last search date was Sep 20, 2019. A total of 14959 patients from 6 trials were included in this meta-analysis. As compared to ACEI/ARB, LCZ696 significantly reduced the risk of renal function deterioration (odds ratio 0.77, 95% confidence interval 0.61-0.97, P = 0.02). In summary, LCZ696 may have superior renal protection in HF patients compared with ACEI/ARB.

The risk of renal function deterioration in abdominal aortic stent graft patients with and without previous kidney function failure – an analysis of risk factors

PurposeKidney failure influences the treatment outcomes of abdominal aortic aneurysm (AAA). A prospective study of renal function before and after aortic stent-graft treatment was performed. Special attention was paid to the influence of preoperative kidney function as well as the impact of the radiological follow-up.Material and methodsA total of 214 endovascularly treated AAA patients were included. In all cases, pre- and postope-rative estimated glomerular filtration rate (eGFR) and serum creatinine were noted. Patients were prospectively followed up for a minimum of two years.ResultsThe baseline eGFR was 69.38 ± 16.29 ml/min/1.73 m2. Chronic kidney disease at baseline was noted in 29% of patients. In the direct postoperative period, acute kidney injury was identified in 8.4% of cases. Additional endo-vascular procedures within two years of observation were performed in 5.6% of cases, and over the two years of follow-up, in the study group from one to six angio-computed tomographic scans (angio-CT) per patient were performed. The mean eGFR value after the 24-month follow-up was significantly lower than the preoperative value. Among the factors influencing kidney function, an angio-CT during the same hospital stay of the primary stent-graft procedures was identified. The type of stent-graft, contrast volume during the primary procedure, need for reintervention, concomitant disease presence, and statin use did not show statistical significance.ConclusionsAngio-CT followed by stent-graft implantation over a short time interval (within the same hospitalisation) significantly worsened renal function in the late follow-up and should be avoided in elective AAA cases.

Association between metabolic body composition status and risk for impaired renal function: A cross-sectional study

BackgroundThe risk for obesity-related disorders is proportional to the visceral region and had been observed to be highly related with impaired renal function. In the current study, we aimed to evaluate renal function impairment, according to sex, age, and different status of metabolic body composition.MethodsWe retrospectively collected from the medical records the basic information and metabolic titers of Chinese adults (13,373 men and 10,175 women) who underwent health checkup from 2013 to 2016. The population was divided into four groups, according to metabolic body composition, including metabolic healthy norms-weight (MHNW), metabolic healthy obesity (MHO), metabolic unhealthy norms-weight (MUNW), and metabolic unhealthy obesity (MUO). The categorical data were compared among the groups and logistic regression analyses were conducted to investigate the association between metabolic body composition status and risk for renal function impairment.ResultsAcross all ages in both sexes, the odds ratios (OR) for renal function impairment were higher in the MHO, MUNW, and MUO groups than in the MHNW group, except for women <45 years old in the MUNW group. However, after adjustment, the trend was no longer significant in all groups under 45 years old. For individuals >45 years old, the relatively high risk for renal function impairment remained significantly associated with the MUNW group (OR 2.95, 95% CI 2.02–4.30 in men and OR 1.95, 95% CI 1.35–2.82 in women) and MUO group (OR 2.33, 95% CI 1.82–3.00 in men and OR 2.67, 95% CI 2.04–3.48 in women).ConclusionImpaired renal function was independently associated with the status of metabolic obesity. However, the trend was only observed in individuals >45 years old, with significant sex difference.

Renal Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients with Liver Cirrhosis: A Nationwide Cohort Study.

Background The use of angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) carries a risk of renal function deterioration in cirrhotic patients with ascites. However, whether the long-term use of ACEis/ARBs is safe in cirrhotic patients without ascites remains unknown. Methods In this nationwide cohort study, we identified 311,361 newly diagnosed cirrhotic patients between January 1997 and December 2013. To avoid indication and immortal time biases, patients receiving regular ACEi/ARB therapy, defined as the ACEi/ARB cohort, were matched to patients receiving regular calcium channel blockers (CCBs), defined as the CCB cohort, at a ratio of 1 : 1 by age, sex, and propensity scores for comorbidities and medications (2,188 patients in each cohort). Cumulative incidence rates and multivariate analyses of end-stage renal disease (ESRD) risk were adjusted for competing mortality. Results The 10-year cumulative incidence rates of ESRD were 2.32% (95% confidence interval [CI]: 1.45–3.20) in the ACEi/ARB cohort and 1.70% (95% CI: 1.03–2.36) in the CCB cohort (P = 0.610). In multivariate analyses, ACEi/ARB use was not associated with a higher risk of ESRD in cirrhotic patients (hazard ratio [HR] = 1.15; 95% CI: 0.69–1.94, P = 0.591). In the sensitivity test, the 10-year cumulative incidence rates of ESRD in cirrhotic patients with ascites were 6.50% (95% CI: 0.54–12.46) and 1.24% (95% CI: 0.00–2.71) in ACEi/ARB and CCB cohorts, respectively (P = 0.090). Conclusions Long-term ACEi/ARB use was not associated with a higher risk of ESRD in cirrhotic patients. However, the risk of ESRD tended to increase in cirrhotic patients with ascites.

Utilization of HbA1c in Screening Living Kidney Donors With Prediabetes

ObjectivesTo study the outcome of living kidney donors with prediabetes and to evaluate the utilization of baseline HbA1c to identify donors at high risk for developing diabetes during the postdonation follow-up period. Patients and methodsLiving kidney donors with prospectively collected preoperative fasting glucose and HbA1c results were included in the study. Donors were categorized to the high-risk group when both results were in the prediabetic range, the low-risk group when only 1 result was in the prediabetic range, and the control group when both results were normal. ResultsNinety-three donors were followed for 75.9 ± 23.3 months. A higher proportion of donors in the high-risk group progressed to diabetes compared with donors in the low-risk and control groups (31.3% vs 6.5% vs 0.0%, respectively; P < .001). Donors with prediabetes were not at a higher risk for new-onset hypertension (4.4% vs 10.0% vs 7.7%, in control, low-risk, and high-risk groups, respectively; P = .519) or microproteinuria (7.3% vs 10.3% vs 0.0%, in control, low-risk, and high-risk groups, respectively; P = .478) and exhibited equivalent postdonation renal function compared with donors with normal glucose metabolism. ConclusionsHbA1c can identify donors with prediabetes who are at risk for progression to diabetes. Our results indicate that carefully accepted donors with prediabetes are not at increased risk of renal function deterioration in the immediate postdonation period.

A Rare Genetic Defect of MBL2 Increased the Risk for Progression of IgA Nephropathy.

The aim of this study was to investigate the association between lectin pathway-related genetic variations and progression in IgA nephropathy. Biopsy-proven IgAN patients with eGFR ≥15 ml/min/1.73 m2 at baseline and a minimum follow-up of 12-months were enrolled. A total of 1,007 patients and 121 healthy controls were enrolled from two Chinese renal centers. The discovery cohort consisted of 606 patients, and the validation cohort consisted of 401 patients. First, promoters, all exons and their boundary regions of MBL2 and FCN2 were sequenced in 50 patients, and then 37 variations were identified. Of these variations, 7 expression-associated variations were selected and genotyped in the whole discovery cohort. We found that rs1800450 in MBL2 and rs7851696 in FCN2 were associated with an increased risk for ESRD as well as serum MBL or L-ficolin levels. However, only rs1800450 was successively validated for its association with ESRD (HR, 15.91; 3.27–77.34; P = 0.001) in the fully adjusted model in the validation cohort. In addition, 2.7% of patients, and 2.5% of healthy controls carried rs1800450-AA. IgAN patients with rs1800450-AA lacked expression of MBL in both serum and renal tissue and had more severe tubulointerstitial damage. Furthermore, a combined effect of rs1800450-AA with a previously reported clinical risk score was observed in which patients with both a high clinical risk score (≥1%) and rs1800450-AA had a strikingly increased 10-years ESRD risk by 37.1-fold (7.17 to 192.13-fold). In summary, IgAN patients carrying MBL2 rs1800450-AA have a high risk for renal function deterioration, probably due to inactivation of the complement MBL pathway.

Renal Disease in Patients with Severe Obesity

Obesity is associated with excess risk for impaired renal function (NEJM JW Gen Med Mar 1 2019 and BMJ 2019; 364:5301). This association is mediated in

Longitudinal association of carotid endothelial shear stress with renal function decline in aging adults with normal renal function: A population-based cohort study

The aim of this study was to investigate the associations between carotid wall shear stress (WSS) and renal function impairment (RFI) and albuminuria in aging adults. A total of 1,447 subjects aged 60 years and older with normal estimated glomerular filtration rate (eGFR ≥ 60 mL·min−1·1.72 m−2) and albumin/creatinine ratio (ACR < 30 mg·g−1) were enrolled between April 2007 and October 2009 in the Shandong area, China. Carotid WSS was assessed at baseline, and eGFR, which is based on serum creatinine and cystatin C, and ACR were assessed at baseline and at the annual follow-up visits. After an average of 62.9 months of follow-up, the reduction in eGFR and the increase in ACR were significantly higher in the Q1+2+3 group than the Q4 group, as classified by either the interquartile of the mean WSS or the interquartile of the peak WSS after adjustment for multi-variabilities, including the average blood pressures at every annual visit and baseline eGFR and ACR. For groups classified by mean WSS, the hazard ratios (95% confidence intervals) were 3.45 (1.36–8.75, p = 0.008) in the incident RFI and 3.24 3.22 (1.37–7.57, p = 0.009) in the incident albuminuria for the Q1+2+3 group compared with the Q4 group. Similar results were observed among groups classified by peak WSS. The Q1+2+3 group was associated with endothelial dysfunction and inflammation with respect to the Q4 group as classified by mean or peak WSS. The results indicate that carotid WSS plays an important role in RFI and albuminuria progression in aging adults. Lower WSS was associated with a higher risk of RFI and albuminuria compared with higher WSS.

Effects of vitamin D on the renin-angiotensin system

The renin-angiotensin-aldosterone system (RAAS) is a complex endocrine system of enzymes, proteins and peptides that occupies a key position in the regulation of a number of important physiological processes, such as arterial pressure, water and electrolyte homeostasis. Its activity, flow and regulation are affected by a large number of mediators, substances and diseases one of which is vitamin D. Vitamin D is involved in the regulation of many physiological processes with great importance. Vitamin D deficiency is associated with an increased risk of impaired renal function, cardiovascular disease, diabetes mellitus, metabolic disorders, affecting RAAS and other pathways

Patients with hepatorenal syndrome may have better renal outcome after living donor liver transplantation comparing with patients with chronic kidney disease

Introduction: Hepatorenal syndrome (HRS) is one of the most severe complications of liver cirrhosis. Liver transplantation (LT), the ultimate curative treatment for end-stage liver disease, is needed to completely reverse HRS. However, risk of renal function deterioration after LT has been associated with pre-LT renal dysfunction. Several studies have reported outcome comparisons between patients with or without HRS. Here we compare the outcomes between LT patients with HRS or with chronic kidney disease (CKD). Method: Medical records of adult patients receiving living donor liver transplantation (LDLT) at Kaohsiung Chang Gung Memorial Hospital from July 2008 to September 2017 were reviewed. Patients with renal function impairment were enrolled. According to the diagnostic criteria of HRS, 12 patients were type 1, 19 patients were type 2, and 44 patients were CKD, respectively. And 67 patients with normal renal function were chosen for comparison. Result: The serum creatinine levels of the 3 groups with renal dysfunction at initial presentation had no significant differences. At the time of liver transplantation, the serum creatinine level of HRS type 2 group was better than CKD group (1.46mg/dL vs 2.32mg/dL, p = 0.002). There were no significant differences in creatinine level between HRS type 1 and 2, neither between HRS type 1 and CKD group. However, model for end-stage liver disease (MELD) score in HRS type 1 group was significantly higher than in CKD group. Two years later after LDLT, patients in CKD group had the highest serum creatinine level than in HRS type 1 and type 2 group (2.30mg/dL vs. 1.95mg/dL and 1.49mg/dL, p = 0.152 and 0.084, respectively). Conclusion: Despite higher pre-LT disease severity, patients with HRS still had slightly better renal outcome at two years after LDLT than patients with CKD.

Visceral obesity in Asian living kidney donors significantly impacts early renal function after donor nephrectomy.

Obesity may be a risk factor for kidney donors to develop reduced renal function. The Framingham heart study suggested that visceral adipose tissue (VAT) confers a more adverse metabolic profile compared with subcutaneous adipose tissue (SAT). Asians tend to have a higher VAT composition and it is unclear if their kidney function is affected differently. We hypothesized that Asian living kidney donors who have visceral obesity are at a higher risk of renal function deterioration 1year after donation. Between 2011 and 2014, we retrospectively evaluated data from 73 consecutive patients (52% male; mean age 44.9 ± 11.7years) before they underwent donor nephrectomy and at their 1year routine follow-up. VAT and SAT were measured at the level of the umbilicus on pre-operative computerized tomography (CT). Visceral obesity (VO) was defined as a VAT > 100cm [2] and patients were then further divided and compared in two subgroups: VAT > 100 and < 100cm [2]. Estimated glomerular filtration rate (eGFR, mL/min per 1.73m [2]) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation pre-operatively and 1year post-operatively. Both subgroups had similar baseline kidney function (P = NS) pre-operatively. At the 1year follow-up, patients with VO experienced a more significant decline of renal function (109 ± 9 to 89 ± 8mL/min per 1.73m2), compared to those without VO (111 ± 12 to 96 ± 11mL/min per 1.73m2, P = 0.013). VO was associated with a body mass index (BMI) > 25kg/m2 (P < 0.001), male gender (P < 0.001) and older age at the time of donor nephrectomy (48.0 vs 39.5years, P = 0.01). The presence of hypertension or hyperlipidaemia pre-operatively, choice of surgical approach, and post-operative complication rates, did not differ significantly between the subgroups. Visceral obesity as defined by VAT > 100cm2 at the level of the umbilicus on cross-sectional imaging, may have a significant impact on early renal function after donor nephrectomy. Adiposity markers, as measured by cross-sectional CT imaging, may be incorporated into routine pre-operative kidney donor workup.