Risk Of Kidney Failure Research Articles

#4727 FLOZINATION: A ROLLING QUALITY IMPROVEMENT PROGRAMME

Abstract Background and Aims Sodium glucose linked transporter-2 inhibitors (SGLT2i) reduce renal and cardiovascular end points in people with chronic kidney disease (CKD), both with and without diabetes. Despite exciting data from the CREDENCE and DAPA-CKD trials, implementation of new evidence to every day clinical practice can be challenging. We present the results of a rolling quality improvement project regarding SGLT2i prescription. The aim of the project was to support clinicians in the evidence based prescribing of SGLT2i for CKD. Method Three renal units who share a single electronic clinical database agreed a joint protocol and staged implementation programme. These tertiary referral renal units cover a population of around 2.3 million people. The important timeline regarding SGLT2i licensing and interventions is shown in Figure 1. Interventions were as follows: 1. Identification of patients meeting the licensing criteria for prescription of canagliflozin for CKD with diabetes. 2. Addition of an alert to the electronic patient record. 3. SGLT2i protocol developed and advertised via poster in outpatient clinic sites. 4. Evaluation of clinician attitude to prescribing. 5. Measurement of number of patients meeting the licensing criteria for prescription of dapagliflozin for CKD with and without diabetes. Measurement of SGLT2i prescription was audited from the electronic record. Results In the first wave of the programme, 326 patients were identified as suitable under the initial licensing criteria for canagliflozin, and electronic alerts were added to the records of these patients. When measuring number of patients who may be suitable under the dapagliflozin licensing, there were 562 patients with diabetes and 5262 without diabetes. In a survey of clinician attitudes, 94% suggested they felt well equipped to prescribe SGLT2i. Prescribing of SGLT2i across time is shown in Figure 2. 1146 patients have been prescribed SGLT2i. Age was 64±13 years, and the majority were male (68%) with type 2 diabetes mellitus (61%). Most (73.6%) were treated with angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB). More than half (54%) of patients live in areas with high levels of socio-economic deprivation (Scottish Index of Multiple Deprivation quintiles 1 or 2). Estimated glomerular filtration rate was 40.9±23.5ml/min/1.73 m2 and Kidney Failure Risk Equation (KFRE) 5 year risk of end stage kidney disease (ESKD) was 23.2±28.2%. In comparison with the general outpatient clinic population, the distribution of socioeconomic deprivation was similar, but a higher proportion were female (46%). Conclusion An iterative quality improvement project was designed around the evolving drug licensing of SGLT2i and capitalised on local strengths, including an effective and well used clinical electronic database shared across renal units. Clinicians have been supported in SGLT2i prescribing with highly visible clinical protocols, and electronic alerts to highlight candidate patients. A high level of SGLT2i prescribing has been achieved in a population at high risk of ESKD. Further interventions should focus on prescribing in groups where gaps have been identified – such as women and those without diabetes. Other units would be recommended to capitalise on existing strengths, exploit the use of clinical databases, and ensure protocols are inclusive and well-advertised in order to optimise evidence based treatment of CKD.

#4918 IS THE KIDNEY FAILURE RISK EQUATION VALID IN PREDICTING END STAGE KIDNEY DISEASE IN ADULTS WITH GLOMERULOPATHIES?

Abstract Background and Aims The Kidney Failure Risk Equation (KFRE) is a clinical tool that predicts the 2- and 5- year risk of progression to end stage kidney disease (ESKD) in patients with chronic kidney disease (CKD) stages 3a-5. The equation's accuracy and its predictive performance in subjects with glomerulopathies were not properly evaluated and validated. The current study examined the 4 variable KFRE in subjects with advanced CKD from glomerulopathy etiologies by evaluating discrimination and calibration at 2 and 5 years. Method This retrospective, single-center, cohort study included 558 subjects who were diagnosed by kidney biopsy with primary or secondary glomerulopathies between 1st January 2008 and 31st December 2016 and followed until 31st December 2021 for a mean follow-up time of 85.3 (95%CI 78.9 to 91.8) months. Patients with inadequate biopsy samples, histological findings other than glomerulopathy, those with missing data, and those with eGFR > 60 ml/min/1.73 m2 were excluded. The 4-variable KFRE using eGFR, urinary albumin to creatinine ratio (uACR), age, and sex was calculated using the data from the first visit. The primary outcome of the study was the need for renal replacement therapy (RRT) initiation (dialysis or kidney transplant). The area under the receiver operator characteristic curve (AUC) and calibration plots were used to measure discrimination and calibration of the KFRE in specific glomerulopathy etiologies: IgA nephropathy, diabetic nephropathy, amyloidosis, endocapillary and crescentic glomerulonephritis, lupus nephritis, minimal change disease, membranous nephropathy, focal segmental glomerulosclerosis and membranoproliferative glomerulonephritis. Results In this cohort, most of the patients were males (57.7%) and the median age was 53 (95%CI 53 to 57) years. The median eGFR was 30,5 (95%CI 28 to 32,6) ml/min/ 1.73 m2 and the median uACR 1932 (95% CI 1633 to 2200) mg/g. The most common glomerulopathies were IgA nephropathy (21.3%), diabetic nephropathy (13.4%), and membrano-proliferative glomerulonephritis (9.5%). The median 2-year and 5-year KFRE score was 2.2 (95%CI 1.8 to 2.7) % and 18.9 (95%CI 17.8 to 19.7) % respectively. During the first 2 years of follow-up 154 (27.5%) subjects needed RRT and 93 (16.6%) subjects died, while 218 (39%) started RRT and 108 (19.3%) died within 5 years from the kidney biopsy. The 4-variable KFRE provided good discrimination in the whole cohort with an AUC of 0.728 (95% CI 0.686-0.770) for predicting ESRD at 2-years and 0.725 (95% CI 0.686-0.767) at 5 years (Figure 1A). There was also a good to excellent discrimination of 2-years and 5-years KFRE across all glomerulopathy etiologies, with statistically significant p-values (p<0.05), with the exception of diabetic nephropathy and endocapillary GN which had a non-significant AUC (Figure 2). Calibration plots were adequate both overall and across glomerulopathy etiologies; however, the predicted risks for kidney failure were overestimated across CKD etiologies, especially in those with low to moderate risk in the 2-years model. Notably the calibration plot for the 5-years KFRE showed that the predicted risk was near the observed risk across all glomerulopathies (Figure 1B). Conclusion The 4 variable-KFRE seems to be a good predictive tool in patients with glomerulopathies both for 2 and 5-years, except for diabetic nephropathy and endocapillary glomerulonephritis.

#5059 EXTERNAL VALIDATION OF THE KFRE AND GRAMS PREDICTION MODELS FOR DEATH AND KRT IN A SPANISH POPULATION WITH ADVANCED CHRONIC KIDNEY DISEASE

Abstract Background and Aims The Kidney Failure Risk Equation (KFRE) is used to predict the risk of kidney replacement therapy (KRT) initiation in the following 2 and 5 years, in patients with chronic kidney disease (CKD) stages G3-G5. The Grams model is applied exclusively to stage G4-G5 patients who have a higher risk of dying or requiring KRT. This model predicts both events, KRT and death, at 2 and 4 years, but unlike the KFRE, it considers the patient's death as a competing event with respect to the start of RRT. It has been suggested that the Grams model makes a more accurate prediction of the onset of KRT in the long term, since by including mortality as a competing event it does not overestimate the risk of KRT. However, there are few external validations of the Grams model to predict mortality in patients with CKD G4+. We performed an external validation of both models with respect to the start of KRT and mortality in a Spanish population with CKD G4+, followed up prospectively during 4-9 years. Method We conducted a prospective cohort analysis of incident patients followed in the Advanced Chronic Kidney Disease clinic of the Hospital Universitario Fundación Alcorcón, Spain between 1-1-2014 and 31-12-2018 who had CKD G4-G5. Clinical data was registered prospectively in a database at each visit to the clinic. Follow-up ended on 31-12-2022. For each patient, the follow-up time ranged from 4 to 9 years. The outcomes were: observed incidence of KRT (haemodialysis, peritoneal dialysis, or pre-emptive kidney transplantation) by 2, 4 and 5 years and death at 2 and 4 years before starting KRT. The predictors used in the study were calculated at the time of initial clinic referral and included the 2-year and 4-year Grams’ calculator risk scores (Grams-2 and Grams-4, respectively) for KRT and death and the 2-year and 5-year 4-variable KFRE scores for KRT (KFRE-2 and KFRE-5 respectively). We performed calibration and discrimination analyses to evaluate the performance of both predictive models. Discrimination was assessed by calculating the area under the ROC curve (C-statistic with 95% confidence interval). Calibration was assessed by using the Hosmer-Lemeshow test, through calculation of the slope and intercept, and visually by generating a calibration plot, evaluating the level of agreement between predicted probabilities versus observed outcomes. Overall model performance was evaluated using the Brier score as a composite measure of both model discrimination and calibration. Results We studied 347 patients, 31.1% were women, with a mean age of 72.1 ± 12.7 years, 52.4% with cardiovascular disease and 58.8% diabetics. At the start, the mean eGFR was 20.7 ± 5.0 ml/min and the median urine albumin-creatinine ratio was 327 (IQR 52-1118) mg/g. At 2, 4 and 5 years the percentage of patients who required KRT was 20.2%, 38.3% and 45.7% respectively, while 12.7% and 23.6% died at 2 and 4 years respectively, before starting KRT. For KTR both models had an excellent discrimination. For KFRE-2 and Grams-2 the AUC was 0.896 (95% CI 0.858-0.933) and 0.904 (95% CI 0.866-0.941) respectively, for Grams-4 the AUC was 0.842 (95% CI 0.801-0.884), and for KFRE-5 the AUC was 0.805 (95% CI 0.751-0.859). For death before KTR the Grams model demonstrated an acceptable discrimination, with an AUC of 0.726 (95% CI 0.646-0.806) and 0.749 (95% CI 0.690-0.809) for Grams-2 and Grams-4 respectively. There was excellent calibration for KRT for both models, the Hosmer-Lemeshow test presented a p>0.05 in all cases, the Brier score was less than 0.20. The adjustment was very precise and only in the event of estimated risks greater than 70% at 2 and 4 years is the observed risk overestimated. The calibration of the Grams model to estimate mortality before starting KTR was also excellent, although for estimated risks greater than 50% at 4 years the observed risk is underestimated. Conclusion In a Spanish cohort of patients with CKD G4+, the Grams and KFRE models adequately estimate the risk of KRT. The Grams model provides an acceptable estimate of the risk of death before starting KRT at both 2 and 4 years. It can be considered for treatment planning and information for patients with CKD G4+.

#4175 PERFORMANCES OF THE 5-YEAR KIDNEY FAILURE RISK EQUATION IN A TERTIARY SINGLE CENTER CHRONIC KIDNEY DISEASE COHORT (CKD CAREMEAU)

Abstract Background and Aims Chronic kidney disease (CKD) is a common disease with a heterogeneous course. The Kidney Failure Risk Equation (KFRE) is designed to predict 5-year End stage renal disease (ESRD). This score has shown poor performance in predicting 5-years ESRD in elderly patients, probably because of a competitive risk with death. Indeed, patients with type 2 diabetes are numerous and older than non-diabetic patients, with higher risks of death, and thus à higher competitive risk. In this context, we aimed to evaluate the performance of the KFRE score at 5 years, in a cohort from a tertiary center, according to diabetic status. Method The CKD Caremeau (CKDC) cohort is a single-center tertiary cohort of adults seen by a nephrologist for CKD. We studied CKDC patients included between January 2008 and December 2017 and followed them. We excluded patients younger than 45 years. KFRE score covariates were collected at the first visit, and Renal replacement therapy (RRT) (dialysis or kidney transplantation) and death before ESRD were collected during follow-up through December 2022. Multiple imputation (Monte Carlo) was used for missing albuminuria. Score performance was calculated with discrimination (area under curve (AUC)) and calibration (observed versus predicted risks), according to diabetic status, at 5 years. Results Of the 3046 patients included, 1288 (42%) had diabetes. 558 (18%) albuminuria were missing and imputed. For diabetic patients, median follow-up time was 5.3 [3.0–7.6] years, median age was 73 [66–80] years, 843 (65%) patients were males, median eGFR was 38 [27–50], median albuminuria was 204 [57–671] mg/g, 177 (14%) developed ESRD, and 398 (30%) died, with a median 5-years KFRE score of 4 [0.65–17.6] %. For non-diabetic patients, median time of follow-up was 5.5 [3.3–8.2] years, median age was 72 [63–81] years old, 1027 (58%) were males, median eGFR was 40 [27–53], median albuminuria was 113 [38–399] mg/g, 205 (12%) experimented ESRD, and 501 (29%) died, with a median 5-year KFRE score of 2 [0.18–14] %. Discrimination was not modified by diabetic status at 5 years (p = 0.67). Calibration was also unaffected by diabetic status, with an overall overestimation at 5 years. Conclusion The performance of the KFRE score was not modified by diabetic status, meaning that age is probably more important than diabetic status for the competitive risk of death in CKD patients.

Chronic kidney disease in the elderly and frail patient: perspectives with opinions and comments.

Chronic kidney disease is common in elderly and frail people. The importance of age in staging chronic kidney disease is discussed as well as the possible constraints of staging what is actually a 'continuum' of disease progression. Frailty is a biological state characterized by the decline of several physiological systems and strongly correlated with adverse health outcomes, including mortality. Frailty is measured by the Comprehensive Geriatric Assessment, which focuses on quantitative rating scales that determine not only the clinical profile and pathological risk of frail individuals, but also their residual capacities, functional status, and quality of life. There is circumstantial evidence that Comprehensive Geriatric Assessment can improve both survival and quality of life in elderly chronic kidney disease patients. Despite the long list of emerging risk factors and markers of chronic kidney disease progression, it is the authors' opinion that a single biochemical parameter can hardly cover the complexity of chronic kidney disease in elderly and frail patients. Among the numerous clinical scores proposed, the European Renal Best Practice guidelines recommend the Renal Epidemiology and Information Network score and the Kidney Failure Risk Equations. The former provides a reasonable estimate of short-term mortality risk, the latter provides the risk of chronic kidney disease progression. In conclusion, the elderly individual with advanced chronic kidney disease is often comorbid and frail with peculiarities in terms of disease grading, clinical assessment and monitoring. The time has come to reshape the care of this growing number of patients by focusing on multidisciplinary teams both in the hospital and in the community.

Utility of the Kidney Failure Risk Equation and Estimated GFR for Estimating Time to Kidney Failure in Advanced CKD

The Kidney Failure Risk Equation (KFRE) predicts the 2-year risk of kidney failure for patients with chronic kidney disease (CKD). Translating KFRE-predicted risk or estimated glomerular filtration rate (eGFR) into time to kidney failure could inform decision making for patients approaching kidney failure. Retrospective cohort. CKD Outcomes and Practice Patterns Study (CKDOPPS) cohort of patients with an eGFR<60mL/min/1.73m2 from 34 US nephrology practices (2013-2021). 2-year KFRE risk or eGFR. Kidney failure defined as initiation of dialysis or kidney transplantation. Accelerated failure time (Weibull) models used to estimate the median, 25th, and 75th percentile times to kidney failure starting from KFRE values of 20%, 40%, and 50%, and from eGFR values of 20, 15, and 10mL/min/1.73m2. We examined variability in time to kidney failure by age, sex, race, diabetes status, albuminuria, and blood pressure. Overall, 1,641 participants were included (mean age 69±13 years; median eGFR of 28mL/min/1.73m2 [IQR 20-37mL/min/1.73 m2]). Over a median follow-up period of 19 months (IQR, 12-30 months), 268 participants developed kidney failure, and 180 died before reaching kidney failure. The median estimated time to kidney failure was widely variable across patient characteristics from an eGFR of 20mL/min/1.73m2 and was shorter for younger age, male sex, Black (versus non-Black), diabetes (vs no diabetes), higher albuminuria, and higher blood pressure. Estimated times to kidney failure were comparably less variable across these characteristics for KFRE thresholds and eGFR of 15 or 10mL/min/1.73m2. Inability to account for competing risks when estimating time to kidney failure. Among those with eGFR<15mL/min/1.73m2 or KFRE risk>40%), both KFRE risk and eGFR showed similar relationships with time to kidney failure. Our results demonstrate that estimating time to kidney failure in advanced CKD can inform clinical decisions and patient counseling on prognosis, regardless of whether estimates are based on eGFR or the KFRE. Clinicians often talk to patients with advanced chronic kidney disease about the level of kidney function expressed as the estimated glomerular filtration rate (eGFR) and about the risk of developing kidney failure, which can be estimated using the Kidney Failure Risk Equation (KFRE). In a cohort of patients with advanced chronic kidney disease, we examined how eGFR and KFRE risk predictions corresponded to the time patients had until reaching kidney failure. Among those with eGFR<15mL/min/1.73m2 or KFRE risk > 40%), both KFRE risk and eGFR showed similar relationships with time to kidney failure. Estimating time to kidney failure in advanced CKD using either eGFR or KFRE can inform clinical decisions and patient counseling on prognosis.

Facilitating Medical Care for Latinx Individuals at Risk for CKD: A Pilot Intervention

Latinx individuals are at a higher risk for kidney failure than non-Latinx White individuals; however, they are less likely to receive pre-kidney failure medical care. The objective of this study was to determine the feasibility and acceptability of a community health worker (CHW) intervention that facilitated access to medical care for Latinx individuals. Single-arm prospective study. Latinx adults were found to have albuminuria or risk factors for kidney disease at community screening events in Austin, Texas. A 6-month CHW intervention that facilitated the following: (1) obtaining medical insurance; (2) medical care coordination with primary and nephrology care; (3) kidney disease education; and (4) connection with local resources to address health-related social needs. Recruitment, retention, medical care linkage, and participant and CHW-reported satisfaction with the intervention. Of the 173 individuals who attended the 2 community screening events, 49 agreed to participate in the study, of whom, 51% were men with a mean±standard deviation (SD) age of 45±14 years, and all self-identified as Mexican or Chicano. The mean±SD estimated glomerular filtration rate (eGFR) was 110±21mL/min/1.73m2 and 41% of the participants reported a urine albumin-creatinine ratio of≥30mg/g. Among those enrolled, 28 of the 49 (57%) completed at least 1 CHW visit, and 20 of 49 (41%) completed the intervention. 7 individuals who needed assistance with insurance obtained insurance, and 15 of 20 (75%) scheduled an appointment with a primary care physician within 180 days. Participants reported that the US health care previously seemed inaccessible but gained insurance, the ability to navigate the system, and the ability to help others in their community to access medical care because of the program. Small sample size and a single community may limit generalizability. We reported the acceptability of a CHW intervention. We encountered challenges with feasibility and identified strategies to overcome them. Studies are needed to test the effect of CHW interventions on outcomes and kidney health disparities. National Kidney Foundation young investigator research grant to Dr Novick. Latinx individuals are at a higher risk for kidney failure than non-Latinx White individuals; however, they are less likely to receive pre-kidney failure medical care. We piloted a community health worker intervention that connected people with risk factors or showed evidence of kidney dysfunction at community screening events with medical care. Our findings indicate the acceptability of the intervention. We encountered challenges with feasibility and identified strategies to overcome them.

Urine analysis and nutrition status among elderly in Griya Werdha, Surabaya

Background. Aging is a natural process in the body that everyone will experience as they get older. However, aging is not the same in each individual due to several differences such as diet, lifestyle, genetics, and overall health. Therefore, the Surabaya city government is trying to help elderly people who do not have any caregivers by scouting and gathering them at Griya Werdha. Objective. This study aimed to provide a feeding program for the elderly and determine the risk of kidney failure experienced by the elderly living in Griya Werdha. Materials and Methods. This research was a cross-sectional study with 44 elderlies as the samples. The data collected included elderlies’ blood pressure, weight, height, and urine. Moreover, the elderly were also interviewed on food waste, exercise habits, and sleeping habits using questionnaires. Data were analyzed using binary logistic regression and the chi-square test to find the association between the variables. Results. The results showed a significant association was found between education and blood in the urine (p=0.036) and the association was not found between education and nutritional status (P=0.392) also systole blood pressure (P=0.373). Association also was not found between glucose in urine (P=0.522), positive leukocyte (0.184), positive blood in the urine (P=0.671), and the risk of CKD. Conclusions. In conclusion, the elderly with low education can be at risk for certain diseases.

Sodium-glucose cotransporter-2 inhibitors and kidney outcomes in real-world type 2 diabetes populations: A systematic review and meta-analysis of observational studies.

To conduct a systematic review of observational studies to explore the real-world kidney benefits of sodium-glucose cotransporter-2 (SGLT2) inhibitors in a large and diverse population of adults with type 2 diabetes (T2D). We searched MEDLINE, EMBASE and Web of Science for observational studies that investigated kidney disease progression in adults with T2D treated with SGLT2 inhibitors compared to other glucose-lowering therapies. Studies published from database inception to July 2022 were independently reviewed by two authors and evaluated using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. A random-effects meta-analysis was performed on studies with comparable outcome data, reported as hazard ratios (HRs) with 95% confidence intervals (CIs). We identified 34 studies performed across 15 countries with a total population of 1 494 373 for inclusion. In the meta-analysis of 20 studies, SGLT2 inhibitors were associated with a 46% lower risk of kidney failure events compared with other glucose-lowering drugs (HR 0.54, 95% CI 0.47-0.63). This finding was consistent across multiple sensitivity analyses and was independent of baseline estimated glomerular filtration rate (eGFR) or albuminuria status. SGLT2 inhibitors were associated with a lower risk of kidney failure when compared with dipeptidyl peptidase-4 inhibitors and a combination of other glucose-lowering drug classes (HR 0.50, 95% CI 0.38-0.67 and HR 0.51, 95% CI 0.44-0.59, respectively). However, when compared to glucagon-like peptide 1 receptor agonists there was no statistically significant difference in the risk of kidney failure (HR 0.93, 95% CI 0.80-1.09). The reno-protective benefits of SGLT2 inhibitors apply to a broad population of adults with T2D treated in routine clinical practice, including those at lower risk of kidney events with normal eGFR and without albuminuria. These findings support the early use of SGLT2 inhibitors in T2D for preservation of kidney health.

Lipoprotein(a) and the Risk for Recurrent Atherosclerotic Cardiovascular Events Among Adults With CKD: The Chronic Renal Insufficiency Cohort (CRIC) Study

Many adults with chronic kidney disease (CKD) and atherosclerotic cardiovascular disease (ASCVD) have high lipoprotein(a) levels. It is unclear whether high lipoprotein(a) levels confer an increased risk for recurrent ASCVD events in this population. We estimated the risk for recurrent ASCVD events associated with lipoprotein(a) in adults with CKD and prevalent ASCVD. Observational cohort study. We included 1,439 adults with CKD and prevalent ASCVD not on dialysis enrolled in the Chronic Renal Insufficiency Cohort study between 2003 and2008. Baseline lipoprotein(a) mass concentration, measured using a latex-enhanced immunoturbidimetric assay. Recurrent ASCVD events (primary outcome), kidney failure, and death (exploratory outcomes) through2019. We used Cox proportional-hazards regression models to estimate adjusted HR (aHRs) and 95% CIs. Among participants included in the current analysis (mean age 61.6 years, median lipoprotein(a) 29.4 mg/dL [25th-75th percentiles 9.9-70.9 mg/dL]), 641 had a recurrent ASCVD event, 510 developed kidney failure, and 845 died over a median follow-up of 6.6 years. The aHR for ASCVD events associated with 1 standard deviation (SD) higher log-transformed lipoprotein(a) was 1.04 (95% CI, 0.95-1.15). In subgroup analyses, 1 SD higher log-lipoprotein(a) was associated with an increased risk for ASCVD events in participants without diabetes (aHR, 1.23; 95% CI, 1.02-1.48), but there was no evidence of an association among those with diabetes (aHR, 0.99; 95% CI, 0.88-1.10, P comparing aHRs=0.031). The aHR associated with 1 SD higher log-lipoprotein(a) in the overall study population was 1.16 (95% CI, 1.04-1.28) for kidney failure and 1.02 (95% CI, 0.94-1.11) for death. Lipoprotein(a) was not available in molar concentration. Lipoprotein(a) was not associated with the risk for recurrent ASCVD events in adults with CKD, although it was associated with a risk for kidney failure.

Seeds of moringa (Moringa oleifera) and mucuna (Mucuna pruriens L.) modulate biochemical indices of L-NAME-induced hypertension in rats: A comparative study

Hypertension is a prevalent cardiovascular condition that affects millions of people worldwide. It is characterized by abnormally high blood pressure in the arteries, leading to an increased risk of heart disease, stroke, and kidney failure. Hypertension management often involves the use of pharmaceutical drugs, which can have adverse side effects. Hence, there is a growing interest in alternative therapies, such as herbal medicine, for the management of hypertension. This present study investigated the cardioprotective properties of moringa (Moringa oleifera) and mucuna (Mucuna pruriens L.) seeds at 5 and 10% dietary inclusions and also establish the most potent seed. The blood pressure of the rats were measured at the last day of treatment. Also, the heart acetylcholinesterase (AChE) and monoamine oxidase (MAO) activities were determined, as well as the redox status of the rats. This study shows a reduction in blood pressure, AChE and MAO activities of hypertensive rats treated with the moringa and mucuna seeds. Furthermore, an increase in non-protein thiol (NP-SH) with a concomitant reduction in level of lipid peroxidation was also recorded. In addition, the mucuna seed is recorded to have a more cardioprotective property when compared with moringa seed. This study, therefore, revealed the mechanism of action of moringa seed and mucuna seed against l-NAME-induced hypertension or cardiotoxicity which could be linked to the antioxidant activity and modulation of AChE and MAO activities.

Implementation of a culturally competent APOL1 genetic testing programme into living donor evaluation: A two-site, non-randomised, pre–post trial design

IntroductionWhile living donor (LD) kidney transplantation is the optimal treatment for patients with kidney failure, LDs assume a higher risk of future kidney failure themselves. LDs of African ancestry have...

Management of Cardiogenic Shock: Present and Future.

Management of Cardiogenic Shock: Present and Future.

Care of the Patient With Abnormal Kidney Test Results.

Blood and urine tests are commonly performed by clinicians in both ambulatory and hospital settings that detect chronic and acute kidney disease. Thresholds for these tests have been established that signal the presence and severity of kidney injury or dysfunction. In the appropriate clinical context of a patient's history and physical examination, an abnormal test result should trigger specific actions for clinicians, including reviewing patient medication use, follow-up testing, prescribing lifestyle modifications, and specialist referral. Tests for kidney disease can also be used to determine the future risk for kidney failure as well as cardiovascular death.

Editorial introductions.

Current Opinion in Nephrology and Hypertension was launched in 1992. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of nephrology and hypertension is divided into 12 sections that are each reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Agnes B FogoAgnes B FogoProfessor Agnes Borge Fogo completed her medical training at Vanderbilt University Medical School, USA. She has remained at Vanderbilt for residency in pathology and fellowship in renal pathology and experimental kidney disease models. Her main research interests are focused on potential regression of chronic kidney disease and tubular-glomerular crosstalk in this process, pursued with funding from the National Institutes of Health and other sources. She is also dedicated to diagnostic renal pathology and has created an online Atlas of Renal Pathology with the American Journal of Kidney Disease and the National Kidney Foundation. She has also authored two books on renal pathology. Prof. Fogo enjoys teaching renal pathology and received the Robert G. Narins award from the American Society of Nephrology in 2011 as well as the Roscoe R. Robinson award from the International Society of Nephrology in 2019, for her contributions in teaching. She is currently President of the ISN and the John L. Shapiro Professor of Pathology, Microbiology and Immunology, Professor of Medicine and Paediatrics and Director of the Renal/Electron Microscopy Laboratory at Vanderbilt University Medical Center, Nashville, Tennessee, USA. Navdeep TangriNavdeep TangriDr Tangri is an attending physician and Professor in the Division of Nephrology, Department of Internal Medicine, and the Rady Faculty of Community Health Sciences at the University of Manitoba, Winnipeg, Canada. Dr Tangri's research program is clinical, translational, and focused on improving clinical decision making for patients with advanced chronic kidney disease. He developed and validated the Kidney Failure Risk Equation to predict the need for dialysis in patients with CKD and is presently engaged in multiple validation and implementation exercises to increase the uptake of the KFRE. In addition, Dr Tangri is conducting a large prospective study on frailty, physical and cognitive function in advanced CKD, as well as leading a multinational randomized trial on the safety and efficacy of a new therapy in this population. He has published over 300 manuscripts, presented at multiple national and international scientific meetings, and is a recipient of the CIHR New Investigator Award and a CIHR Foundation grant.

Chronic kidney disease awareness and updates on the management of diabetic kidney disease

AbstractThe prevalence of chronic kidney disease (CKD) is rising worldwide and is a major contributor to morbidity and mortality. It is estimated to affect over 800 million people globally.CKD and its complications carry a substantial financial burden to the NHS in both primary and secondary care. The lack of public awareness of CKD and its complications leads to a reduction in planned follow‐up attendance; clinician awareness of the biomarkers of CKD and progression is still lacking. Measures to improve awareness are needed.Diabetes mellitus remains the single most common cause of progressive renal impairment and over 40% of patients with diabetes will develop diabetic kidney disease in their lifetime. A multidisciplinary approach to management and early intervention are therefore key to halt the progress of diabetic kidney disease. The National Institute for Health and Care Excellence has set clear guidelines for the management of diabetic kidney disease, highlighting newer therapeutic agents like SGLT2 inhibitors. New guidelines are also in place for referral to secondary care involving the Kidney Failure Risk Equation, as it identifies patients at increased risk of progressing to end stage kidney disease.Without robust measures for early detection and management of CKD, progression to kidney failure may occur, exacerbating the increase in cardiovascular disease, premature deaths and poor quality of life. This article is a call to action for the optimal and timely management of CKD. Copyright © 2023 John Wiley &amp; Sons.

Hypertension: Causes, Symptoms, Treatment and Prevention

Hypertension "the silent killer is a common and significant disorder that can lead to many health complications. World health organization (WHO) declared the hypertension as the major cause of early mortality as it is directly or indirectly associated with risks of cardiovascular disorders, stroke, angina, kidney failure, diabetes and many more. The major causes of hypertension include obesity, decrease in physical activities, smoking and alcohol consumption. High blood pressure, possibly related to the age associated with the hearing impairment because of the subsequent vasoconstriction. After arthritis and hypertension, hearing loss is one of the most continual health issues of the older persons. Demographic factors and lifestyles are usually the variable factors due to which prevalence of arterial hypertension differs worldwide. These factors include nutritional habits and physical activities. A large number of antihypertensive and lipid-lowering drugs are being used to treat hypertension but it has been proved that changes in lifestyle are an easy way to treat hypertension

Epidemiology, Outcomes, and Complement Gene Variants in Secondary Thrombotic Microangiopathies.

The identification of complement defects as major drivers of primary atypical hemolytic uremic syndrome (HUS) has transformed the landscape of thrombotic microangiopathies (TMAs), leading to the development of targeted therapies and better patient outcomes. By contrast, little is known about the presentation, genetics, and outcomes of TMA associated with specific diseases or conditions, also referred to as secondary TMA. In this study, we assessed the relative incidence, clinical and genetic spectra, and long-term outcomes of secondary TMA versus other TMAs in consecutive patients hospitalized with a first episode of TMA from 2009 to 2019 at two European reference centers. During the study period, 336 patients were hospitalized with a first episode of TMA. Etiologies included atypical HUS in 49 patients (15%), thrombotic thrombocytopenic purpura (TTP) in 29 (9%), shigatoxin-associated HUS in 70 (21%), and secondary TMA in 188 (56%). The main causes of secondary TMA were hematopoietic stem-cell transplantation ( n =56, 30%), solid-organ transplantation ( n =44, 23%), and malignant hypertension ( n =25, 13%). Rare variants in complement genes were identified in 32 of 49 patients (65%) with atypical HUS and eight of 64 patients (13%) with secondary TMA; pathogenic or likely pathogenic variants were found in 24 of 49 (49%) and two of 64 (3%) of them, respectively ( P < 0.001). After a median follow-up of 1157 days, death or kidney failure occurred in 14 (29%), eight (28%), five (7%), and 121 (64%) patients with atypical HUS, TTP, shigatoxin-associated HUS, and secondary TMA, respectively. Unadjusted and adjusted Cox regressions showed that patients with secondary TMA had the highest risk of death or kidney failure (unadjusted hazard ratio [HR], 3.35; 95% confidence interval [CI], 1.85 to 6.07; P < 0.001; adjusted HR, 4.11; 95% CI, 2.00 to 8.46; P < 0.001; considering atypical HUS as reference). Secondary TMAs represent the main cause of TMA and are independently associated with a high risk of death and progression to kidney failure.

The kidney failure risk equation predicts kidney failure: Validation in an Australian cohort.

Predicting progression to kidney failure for patients with chronic kidney disease is essential for patient and clinicians' management decisions, patient prognosis, and service planning. The Tangri et al Kidney Failure Risk Equation (KFRE) was developed to predict the outcome of kidney failure. The KFRE has not been independently validated in an Australian Cohort. Using data linkage of the Tasmanian Chronic Kidney Disease study (CKD.TASlink) and the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), we externally validated the KFRE. We validated the 4, 6, and 8-variable KFRE at both 2 and 5 years. We assessed model fit (goodness of fit), discrimination (Harell's C statistic), and calibration (observed vs predicted survival). There were 18 170 in the cohort with 12 861 participants with 2 years and 8182 with 5 years outcomes. Of these 2607 people died and 285 progressed to kidney replacement therapy. The KFRE has excellent discrimination with C statistics of 0.96-0.98 at 2 years and 0.95-0.96 at 5 years. The calibration was adequate with well-performing Brier scores (0.004-0.01 at 2 years, 0.01-0.03 at 5 years) however the calibration curves, whilst adequate, indicate that predicted outcomes are systematically worse than observed. This external validation study demonstrates the KFRE performs well in an Australian population and can be used by clinicians and service planners for individualised risk prediction.

Renal Histopathology Associated With Kidney Failure and Mortality in Patients With Lupus Nephritis: A Long-Term Real-World Data Study.

Lupus nephritis (LN), a common manifestation of systemic lupus erythematosus, is associated with a higher risk of kidney failure and death. The renal pathology of LN helps elucidate the severity of inflammation and the extent of irreversible damage. We aimed to identify histologic variables that correlate with risks of kidney failure and mortality. Between 2006 and 2019, a total of 526 patients with LN were enrolled. Renal pathology was classified according to the International Society of Nephrology/Renal Pathology Society classification. Components of activity and chronicity indices were analyzed to determine which variables correlated with an increased risk of kidney failure and death, with the adjustment of potential confounders. During the follow-up period (median 7.5, IQR 3.5-10.7 years), 58 patients progressed to kidney failure and 64 died. In the multivariate Cox regression analysis, tubular atrophy (hazard ratio [HR] 2.28, 95% CI 1.66-3.14) and tubulointerstitial inflammation (HR 3.13, 95% CI 1.34-7.33) predicted kidney failure. The renal outcome was even worse if tubular atrophy and tubulointerstitial inflammation coexisted (10-year kidney survival rate: 63.22%). The presence of cellular crescents was associated with an increased risk of death in male patients with LN (HR 1.91, 95% CI 1.02-3.57), whereas the presence of fibrous crescents predicted death in female patients with LN (HR 5.70, 95% CI 1.61-20.25). Histologic variables of renal biopsy in LN could be regarded as prognostic indicators for kidney failure and mortality.