Severity Of CKD Research Articles

Quantitative assessment of lumbar spine bone marrow in patients with different severity of CKD by IDEAL-IQ magnetic resonance sequence.

BackgroundChronic kidney disease (CKD) has a significant negative impact on bone health. Bone marrow is an essential component of bone, mainly composed of trabecular bone and fat. The IDEAL-IQ sequence of MRI allows indirect quantification of trabecular bone mass by R2* and direct quantification of bone marrow fat content by FF map, respectively.ObjectiveOur objective was to explore the association of CKD severity with bone marrow using IDEAL-IQ and whether mineral and bone metabolism markers alter this association.MethodWe recruited 68 CKD patients in this cross-sectional research (15 with CKD stages 3-4, 26 with stage 5, and 27 with stage 5d). All patients underwent lumbar spine IDEAL-IQ, BMD, and several bone metabolism markers (iPTH, 25-(OH)-VitD, calcium and phosphorus). Multiple linear regression analysis was used to examine the association of CKD severity with MRI measurements (R2* and FF).ResultsMore severe CKD was associated with a higher R2* value [CKD 5d versus 3-4: 30.077 s-1 (95% CI: 12.937, 47.217), P for trend < 0.001], and this association was attenuated when iPTH was introduced [CKD 5d versus 3-4: 19.660 s-1 (95% CI: 0.205, 39.114), P for trend = 0.042]. Furthermore, iPTH had an association with R2* value [iPTH (pg/mL): 0.033 s-1 (95% CI: 0.001, 0.064), P = 0.041]. Besides, FF was mainly affected by age and BMI, but not CKD.ConclusionsThe bone marrow R2* value measured by IDEAL-IQ sequence is associated with CKD severity and iPTH. The R2* of IDEAL-IQ has the potential to reflect lumbar bone changes in patients with CKD.

Kidney dysfunction is a significant risk factor for 30-day postoperative complications following shoulder arthroplasty

BackgroundThe objective of this study was to investigate estimated glomerular filtration rate levels as an independent risk factor for short-term complications within 30 days of shoulder arthroplasty (SA). MethodsThe American College of Surgeons National Surgical Quality Improvement database was queried for all patients who underwent SA between 2015 and 2019. The study population was then divided into 6 cohorts based on estimated glomerular filtration rate values of <15 (stage 5 CKD), 15-30 (stage 4 CKD), 30-60 (stage 3 CKD), 60-90, 90-120 (reference cohort), and 120-155. Multivariate logistic regression was conducted to investigate the association between glomerular function and postoperative complications within 30 days of SA. Major complications included cardiac, renal, and respiratory complications, as well as reoperation, readmission, and mortality. Minor complications included urinary tract infection, pneumonia, and transfusion within 72 hours. ResultsThis study included a total of 19,681 patients. An increasing rate of overall complications was observed as the severity of CKD progressed from stage 3 (9.9%) to stage 4 (21.2%) and to stage 5 (21.3%). A similar pattern was seen for major complications (6.2%, 10.3%, 11.7%), minor complications (5.3%, 13.0%, 13.8%), and postoperative anemia requiring transfusion (3.2%, 10.3%, 10.6%). An adjusted multivariate logistic regression analysis showed that the stage 5 CKD cohort had a greater risk of developing the following complications than the reference cohort: overall complications (odds ratio [OR], 3.6; P = .015), minor complications (OR, 5.8; P = .003), renal complications (OR, 27.2; P = .005), and postoperative anemia requiring transfusion (OR, 12.8; P < .001). The stage 4 CKD cohort was also observed to have a greater risk of developing the following complications than the reference group: overall complications (OR, 2.6; P < .001), minor complications (OR, 2.9; P < .001), postoperative anemia requiring transfusion (OR, 4.5; P < .001), nonhome discharge (OR, 1.6; P = .026), and hospital readmission (OR, 2.2; P = .015). Similarly, the stage 3 CKD cohort had a greater risk of developing the following complications than the reference group: overall complications (OR, 1.3; P = .004), major complications (OR, 1.3; P = .035), minor complications (OR, 1.3; P = .038), postoperative anemia requiring transfusion (OR, 1.5; P = .014), and hospital readmission (OR, 1.3; P = .028). ConclusionThis study identified a significant association between increasing severity of CKD (from stage 3 to 5) and increased overall complication rates within 30 days of SA. Patients with the stage 5 CKD cohort status had much higher odds of developing minor complications, overall complications, and postoperative anemia requiring transfusion than those with earlier stages of CKD (stage 3 and 4).

FC005: Pace CKD: Qualitative and Quantitative Insights into the Economic Burden of CKD on Patients and Carers

Abstract BACKGROUND AND AIMS Chronic kidney disease (CKD) is likely to significantly affect the lives of patients and their carers, including increasing the economic burden. The relationship between CKD progression and these life impacts remains poorly characterized. The patient, carer and economic burden (PaCE) CKD study aims to enhance understanding of patient and carer experiences of CKD, including financial impact. METHOD In-depth, semi-structured, qualitative interviews were conducted with 20 patients with CKD and 19 informal carers in Australia, France, Germany, Italy, the UK and the USA. Participants were asked about their experiences with CKD and the associated economic burden. A quantitative online survey is ongoing, with 150–200 patients and 75–100 carers anticipated to participate per country. A Work Productivity and Activity Impairment (WPAI) questionnaire for patients and caregivers is being used to understand and estimate the financial burden of CKD on patients and caregivers. Patients are also being asked about their disease background, including the stage of CKD and treatment history. RESULTS In total, 20 patients and 19 carers participated in the qualitative interviews, with at least 3 patients and 3 carers included from each country. Eleven patients were male. Most patients were 75 years old or younger (18/20; overall range 30–81 years, overall mean 61.7 years). Patients reported their CKD stages: 3/20 stage 5; 2/20 stage 4–5; 2/20 stage 4; 2/20 stage 3–4; 8/20 stage 3; 1/20 stage 2; and 2/20 unknown. A third of patients underwent dialysis (7/20), including at least one patient from each country. Nine patients were working full- or part-time. Carers were 30–90 years old (mean 55.1 years), predominantly women (13/19) and were primarily relatives of the patient (8/19 partner, 5/19 daughter/son, 2/19 daughter-/son-in-law). More than half of the carers were employed (13/19 employed, 5/19 unemployed/retired, 1/19 unknown). Carer support varied between 4 and 35 h/week. Support included activities of daily living, visits to the hospital and emotional/psychological support; support was noted as more critical for patients with later-stage CKD. The degree of financial burden experienced by patients and carers varied between countries, potentially reflecting differences in local healthcare systems; however, the impact of reduced work hours on finances was consistent across all countries. Both patients and carers reported a loss of work hours, and in some cases, participants reported that they had to stop working. Patients who were employed reported lower productivity, and carers reported taking days off work without pay. Expenses related to the cost of managing CKD, including dietary needs, medical aids and hospital transport, further increased the economic burden. The extent of these impacts varied depending on the severity of CKD. Results from the quantitative survey will be presented at the congress. CONCLUSION Responses from qualitative interviews suggest that CKD increases the financial burden for both patients and carers, particularly as the disease progresses. When combined with data from the quantitative survey, these findings will provide important insights into the economic burden of CKD for patients and carers.

Comparison of peripapillary retinal nerve fiber layer and macular thickness in non-diabetic chronic kidney disease and controls.

ObjectiveThis study aimed to compare the peripapillary retinal nerve fiber layer (pRNFL) thickness and macular thickness (MT) between patients with non-diabetic chronic kidney disease (NDCKD) and controls, as well as between different stages of NDCKD. We also evaluated the correlation between pRNFL thickness and MT with duration of NDCKD.MethodsThis was a comparative cross-sectional study. Subjects were divided into NDCKD and control groups. Both pRNFL thickness and MT, including center subfield thickness (CST), average MT as well as average ganglion cell-inner plexiform layer (GC-IPL) were measured using spectral-domain optical coherence tomography. One-way ANCOVA test was used to compare the differences in pRNFL and MT between NDCKD and controls, as well as between the different stages of NDCKD. Spearman rank-order correlation coefficients were employed to determine the effects of NDCKD duration on pRNFL thickness and MT.ResultsA total of 132 subjects were recruited, 66 with NDCKD and 66 controls. There was a statistically significant difference in superior (110.74 ± 23.35 vs 117.36 ± 16.17 μm, p = 0.022), nasal (65.97 ± 12.90 vs 69.35 ± 10.17 μm, p = 0.006), inferior quadrant (117.44 ± 23.98 vs 126.15 ± 14.75 μm, p = 0.006), average pRNFL (90.36 ± 14.93 vs 95.42 ± 9.87 μm, p = 0.005), CST (231.89 ± 26.72 vs 243.30 ± 21.05 μm, p = 0.006), average MT (268.88 ± 20.21 vs 274.92 ± 12.79 μm, p = 0.020) and average GC-IPL (75.48 ± 12.44 vs 81.56 ± 6.48, p = 0.001) values between the NDCKD group and controls. The superior quadrant (p = 0.007), nasal quadrant (p = 0.030), inferior quadrant (p = 0.047), average pRNFL (p = 0.006), average MT (p = 0.001) and average GC-IPL (p = 0.001) differed significantly between different stages of NDCKD. There was no correlation between pRNFL thickness and MT with duration of NDCKD.ConclusionCST, average MT, average GC-IPL thickness, average pRNFL and all quadrants of pRNFL except the temporal quadrant were significantly thinner in NDCKD patients compared to controls. These changes were associated with the severity of CKD, but not its duration.

Shear Wave Elastography in the Evaluation of Renal Parenchymal Stiffness in Patients With Chronic Kidney Disease: A Meta-Analysis.

BackgroundChronic kidney disease (CKD) is a progressive loss of renal function, mainly due to hypertension, diabetes, and primary kidney disease. The histopathological findings are that of glomerulosclerosis, tubulointerstitial fibrosis and loss of renal parenchyma characterized. Therefrom, CKD can lead to higher morbidity and mortality. Patients with CKD have multiple risk factors, and the prevention work is complicated and arduous. Therefore, it is important to quantify the severity of CKD. The aim of this study is to investigate the value of shear wave elastography (SWE) in the evaluating renal parenchymal stiffness in patients with CKD.MethodsWe carried out the systematic search of databases for publications in PubMed, Embase and Cochrane Library on SWE evaluating renal fibrosis in patients with CKD. The Endnote X9, STATA 16, Review Manager 5.3 and other software were used to sort out documents, extract, integrate and analyze data.ResultsThe outcomes were utilized to appraise the diagnostic accuracy of SWE and diagnose the CKD with renal fibrosis. A total of 405 patients were enrolled and their data analysis results were as follows: summary of sensitivity (S-SEN) 84% (95% confidence interval (CI): 80-87%); specificity (S-SPE) 80% (95% CI: 76-84%); summary of DLR (digital light radiography) positive (DLR-P) 4.29 (95% CI: 3.43 - 5.37); and DLR negative (DLR-N) 0.20 (95% CI: 0.16 - 0.25). The corresponding areas under the curves of diagnostic odds ratio (DOR) and summary receiver operating characteristic curve (SROC) were 21.50 (95% CI: 14.69 - 31.46) and 89% (95% CI: 86-92%), respectively.ConclusionsSWE is highly accurate and has clinical significance for evaluating renal fibrosis, especially when the shear modulus value is used as the threshold.

Thyroid Function Test in Patients with Chronic Kidney Disease

Background: Kidneys have a significant role in the metabolism, degradation and excretion of thyroid hormones. Both thyroid hormones and kidney functions have a multifaceted mutual interdependence.&#x0D; Objectives: To find out the possible association between the severity of chronic kidney disease and thyroid dysfunction; To estimate the correlation between thyroid dysfunction and various stages of chronic kidney disease.&#x0D; Materials and Methods: A prospective Cross-sectional study was done on 50 patients with Chronic kidney disease who were not on dialysis and fulfilled all the inclusion criteria at Saveetha medical college over a period of 6 months. Free T3, Free T4 and TSH levels were estimated for those patients.&#x0D; Results: Results of this study showed that majority of subjects included in our study were in the age group of 50-60 years with Male predominance. Out of 50 patients included in our study, 8 patients(16%) were found to hypothyroidism; 5 patients (10%) were having subclinical hypothyroidism; 20 patients (40%) were having low T3 syndrome and 17 patients (34%) were having normal functioning thyroid gland. Staging of CKD was done in relation to the glomerular filtration rate .Most of the patients(n=20) were in Stage 5 of Chronic kidney disease out of which 18 patients were having thyroid disorders.&#x0D; Conclusion: There is a positive correlation between the severity of CKD and thyroid dysfunction. Hence a routine thyroid function status should be evaluated in each and every patient of CKD to reduce the morbidity and mortality rate of CKD patients as well as reduce the social burden and health expenditure.

A Retrospective Evaluation of Patients Hospitalized in the Internal Medicine Department at the Turkey Recep Tayyip Erdogan Somalia Mogadishu Training and Research Hospital

Introduction:&#x0D; Data on patient diagnosis and treatment experiences are minimal in internal medicine clinics in Somalia. This study intends to examine the diagnostic distributions, demographic characteristics, and clinical effects of hospitalized patients treated at Mogadishu Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital.&#x0D; Method:&#x0D; The demographic characteristics, diagnosis, duration of hospital stay and mortality rates of patients hospitalized at Turkey Recep Tayyip Erdogan Somalia Mogadishu Training and Research Hospital between January 2017 and June 2019 were analyzed.&#x0D; Results:&#x0D; The study included 3,246 patients, 1,759 (54.2%) males and 1,487 (45.8%) females with an average age of 50.82±19.25 (18-101) years. When evaluating hospitalization indications, the most common causes of hospitalization were chronic (29.4%) and acute kidney failure (14.8%) and other complications associated with these conditions. Other important diseases requiring hospitalization were diabetes mellitus-related conditions (11.9%), anemia (5.2%), hypertensive complications (3.5%), respiratory diseases (4.2%), contagious hepatitis (2.1%), cancer-related hospitalization situations (3.6%), infectious diseases (3.3%), respiratory diseases (3%), and cardiovascular diseases (3%).&#x0D; Patient mortality rates were 38.6% in the general intensive care unit, 35.9% in emergency intensive care unit and 25.5% in the internal medicine department. Higher mortality rates were observed in emergency and general intensive care patients relative to patients in the internal medicine ward [OR:7.4 (5.7-9.7), OR: 10.4 (8.2-13.3)].&#x0D; Conclusion: In fragile healthcare systems like Somalia, morbidity and mortality are very high, and potential implementation of successful primary care management plans will dramatically minimize the burden associated with healthcare by reducing the incidence and severity of CKD, DM, HT, and CVD.

Chronic Kidney Disease and Adverse Pregnancy Outcomes: A Systematic Review and Meta-analysis

Abstract Objective Chronic kidney disease (CKD) has been linked with adverse pregnancy outcomes, but few studies have examined the influence of cause and severity. The aim of this meta-analysis was to synthesize the evidence on CKD and adverse pregnancy outcome, by cause and severity of CKD where reported. Data sources We searched PubMed, Embase, and Web of Science from inception to May 2021. Study selection and Data Extraction: Studies reporting associations between CKD and adverse pregnancy outcomes were included according to pre-defined eligibility criteria (PROSPERO protocol registration: CRD42020211925). Two reviewers independently screened titles, abstracts, and full-text articles and performed data extraction. The certainty of the evidence was assessed using the GRADE approach. Main Outcomes and Measures: We used random-effects meta-analyses to calculate pooled estimates. Primary outcomes included pre-eclampsia, Caesarean section (CS), preterm birth (PTB &amp;lt;37 wk.) and small for gestational age (SGA). Results In total, 31 studies were included. The certainty of the evidence was deemed to be ‘very low' for all outcomes using the GRADE approach as expected given the observational study design. Pre-pregnancy CKD was associated with pre-eclampsia [pooled adjusted odds ratio (aOR)=2.58 (1.33-5.01)], CS [aOR=1.65 (1.21-2.25)], PTB [aOR=1.73 (1.31-2.27)] and SGA [aOR= 1.93 (1.06-3.52)]. Subgroup analyses suggested that different causes of CKD had differing risks for adverse pregnancy outcomes, and later stages of CKD, compared to earlier stages, were associated with higher odds of pre-eclampsia [crude OR = 2.77 (1.73-4.44)], PTB [4.21 (2.99-5.92)], and SGA [2.43 (1.33-4.46)]. Conclusions CKD was associated with a higher risk of adverse pregnancy outcomes, and the degree of risk varied by cause and severity. These findings highlight the need for further studies of a more robust quality evaluating the effects of cause and severity of kidney disease on adverse pregnancy outcomes. Key messages Pre-pregnancy CKD was associated with higher risk of adverse pregnancy outcomes. The risk of adverse pregnancy outcomes varied by CKD cause and severity.

Chronic kidney disease diagnosis using decision tree algorithms

BackgroundChronic Kidney Disease (CKD), i.e., gradual decrease in the renal function spanning over a duration of several months to years without any major symptoms, is a life-threatening disease. It progresses in six stages according to the severity level. It is categorized into various stages based on the Glomerular Filtration Rate (GFR), which in turn utilizes several attributes, like age, sex, race and Serum Creatinine. Among multiple available models for estimating GFR value, Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), which is a linear model, has been found to be quite efficient because it allows detecting all CKD stages.MethodsEarly detection and cure of CKD is extremely desirable as it can lead to the prevention of unwanted consequences. Machine learning methods are being extensively advocated for early detection of symptoms and diagnosis of several diseases recently. With the same motivation, the aim of this study is to predict the various stages of CKD using machine learning classification algorithms on the dataset obtained from the medical records of affected people. Specifically, we have used the Random Forest and J48 algorithms to obtain a sustainable and practicable model to detect various stages of CKD with comprehensive medical accuracy.ResultsComparative analysis of the results revealed that J48 predicted CKD in all stages better than random forest with an accuracy of 85.5%. The study also showed that J48 shows improved performance over Random Forest.ConclusionsThe study concluded that it may be used to build an automated system for the detection of severity of CKD.

A prospective study on thyroid functions in chronic kidney disease patients: In tertiary care centre

Background and Objectives: Unusual thyroid function tests are frequent in chronic kidney disease patients. The kidneys play an important role in thyroid hormone metabolism by converting T4 to T3 (the active metabolite). Low plasma free T3 in ESRD is a marker of inflammation and endothelial activation, and it has been linked to an increased risk of death from any cause. The present study has been conducted to look for biochemical abnormalities in thyroid function tests in chronic kidney disease, as well as to correlate the severity of CKD and changes in thyroid indices. Methods: In a cross-sectional study, thyroid function tests [TT3, TT4, FT4, TSH] were estimated by CLIA in 60 patients of chronic kidney disease who were in various stages. Symptoms of hypothyroidism, thyroid hormone abnormalities and CKD stage were analyzed using Chi-square test and ANOVA tests. Results: Among the mean age was 48.8 ± 12.2 years, of which 38 were male and 22 females. The mean value of TT3 in CKD stage 3, 4, 5 were 1.01±0.39; 1.05± 0.6; 0.95±1.09 µg/mL respectively. (p= 0.02 Significant). The mean value of TT4 in CKD stage 3, 4, 5 were 6.3± 2.4; 5.5± 1.5; 5.11 ± 1.01 µIU/ml, respectively. (p=0.71 Not significant). Conclusions: Total T3 and total T4 levels were found to decrease progressively as the stage of CKD increased. There was no statistically significant relationship between TT4 and CKD stage. The prevalence of thyroid dysfunction and the stage of chronic kidney disease were found to be significantly related. The severity of renal failure increases the prevalence of thyroid hormone abnormalities; the levels of thyroid profile, i.e. T3, T4, and TSH, decrease as the severity of renal failure increases. Thyroid hormone abnormalities could represent a risk factor for cardiovascular disease and might also be implicated in kidney disease progression.

How does clinical profile and outcome differ in patients with Chronic Kidney Disease undergoing percutaneous coronary revascularization according to the severity of CKD? – CHANNEL Study

BackgroundChronic kidney disease (CKD) is an independent risk factor for the development of coronary artery disease. We evaluated outcomes amongst patients of CKD undergoing percutaneous coronary intervention (PCI) as assessed on severity of CKD based on estimated glomerular filtration rate (eGFR) at the time of PCI. Method and materialsWe analyzed 100 consecutive CKD patients who underwent PCI and were followed up for 1 year; an observational, prospective, open-label study. Multivariate and Receiver operator characteristics (ROC) analysis was used to determine the cut point ofeGFR for predicting 4-P major adverse cardiac events (MACE) outcomes defined as the composite of Cardiovascular (CV) mortality, heart failure hospitalization (HHF), repeat revascularization and non-fatal MI over 1 year follow up. ResultsAccording to eGFR cut-off value derived from ROC, patients were divided in to two groups based on eGFR cut-off of 36.25 mL/min/1.73 m2. Majority of patients (79%) were in Group 1 (eGFR >36.25 mL/min/1.73 m2). Group 2 had Lower HbA1C, hemoglobin and elevated level of urea as compared to group:1 (p=0.002,<0.0001 respectively). All-cause mortality had trend forbeing higher (6.3 vs. 19%) in group:2, but statistically non-significant (p = 0.17). Lower baseline LVEF (39 ± 10.08%) across the cohort was independent predictor of higher risk for HHF. eGFR <36.25 mL/mim/1.73 m2 was the most robust predictor of MACE, carrying a 3-fold increase in risk of 4-P MACE with significant association (0.69, CI 0.59 to 0.78, p = 0.0009). ConclusionsLower baseline eGFR was associated with higher incidence of 4 P MACE with best cut-off being eGFR <36.25 mL/min/1.73 m2. Lower Baseline LVEF was independent predictor from HHF across the cohort.

MO138ASSOCIATION OF NT-PROBNP WITH OBESITY IN CKD PATIENTS

Abstract Background and Aims Obesity is associated with lower circulating levels of N-terminal pro-BNP (NT-proBNP) both in the general population and in patients with heart failure. In asymptomatic patients with CKD, NT-proBNP levels are generally elevated. The prevalence of obesity is markedly increasing among patients with CKD. However, whether obesity affects NT-proBNP levels and thresholds for increased risk of clinical outcomes is unclear. Method We examined the associations between NT-proBNP and obesity in 408 stage 3–5 CKD patients (268 men and 140 women; mean age 65±13 years) free of heart failure at baseline, who were categorized into 3 groups according to body mass index (BMI; kg/m2) as normal (&amp;lt;24.0), overweight (24.0–27.9), and obese (≥28.0). Multivariate Cox proportional hazards models were used to compare the risk associations of NT-proBNP with the composite of ESKD (needing chronic dialysis or kidney transplantation) or all-cause mortality across BMI categories. Results NT-proBNP levels were significantly lower in obese patients than in normal weight and overweight subjects (P &amp;lt;0.001). Within each CKD stage, NT-proBNP levels decreased with increasing BMI. In a multivariate analysis, NT-proBNP was inversely associated with obesity, as well as BMI and its fat and lean body mass components (all P &amp;lt;0.001), independent of demographics, comorbidities, and severity of CKD. During a median follow-up of 2.2 years, 117 patients progressed to ESKD and 46 patients died. Overall, higher NT-proBNP levels were independently associated with ESKD or death (HR, 1.52; 95% CI, 1.22–1.89). Specifically, higher NT-proBNP levels were consistently associated with poor outcomes in all BMI categories (P for interaction = 0.096). Conclusion Obese CKD patients have significantly lower NT-proBNP levels. Nevertheless, BMI category did not modify the relationship between NT-proBNP and clinical outcomes. Increased risk may be seen at relatively lower levels of NT-proBNP in obese CKD patients.

MO254PREGNANCY OUTCOMES AND COMPLICATIONS IN PATIENTS WITH CHRONIC GLOMERULONEPHRITIS*

Abstract Background and Aims Pregnancy in patients with chronic glomerulonephritis (CGN) is associated with higher risk of complications and unfavorable outcomes compared to the general population. The aim of the study was to determine the incidence of pregnancy complications and outcomes in patients with preexisting CGN. Method 126 pregnancies in 119 women with CGN and CKD 1-4 stages: 1 st. – 86 patients, 2 st. – 17, 3 st. – 20, 4 st. – 3 and 20 pregnancies in 20 age-matching healthy women were included. Patients with secondary CGN, multiple pregnancy, pregnancy after IVF were excluded. A kidney biopsy was performed in 18 of 119 (15.1%) women: 15 – before conception and 3 – after delivery. IgA-nephropathy was detected in 11 of 18 (61.1%) patients, MCD/FSGS – in 4 (22.2%), MPGN – in 3 (16.7%). The incidence of unfavorable pregnancy outcome, preeclampsia (PE), preterm delivery, cesarean section (CS), low birth weight (LBW &amp;lt; 2500 g), small for gestational age (SGA) newborn (birth weight &amp;lt; 10th percentile), mean term of delivery, mean birth weight, frequency of treatment in neonatal intensive care unit (NICU) and achieving of end-stage kidney disease in mothers after delivery were evaluated. Results CKD was first diagnosed during pregnancy in 34.1% women with CGN. The incidence of adverse pregnancy outcomes, preterm delivery, LBW, SGA, and treatment in the NICU did not differ between groups, while the frequency of PE and CS were higher, and mean gestational age at delivery, birth weight were lower in the CGN group compared to the healthy control (Table). Severe PE was observed in 6 of 32 (18.7%) patients with PE and CGN. The incidence of PE increased in advanced stages of CKD, but the differences were not significant: 19.8% - in CKD1, 35.3% - CKD2, 35% - CKD3, 66.7% - CKD4, p=0.112. The frequency of PE depended on the presence of baseline nephrotic-range proteinuria (NPU) and chronic arterial hypertension (AH): PE was observed in women w/o NPU and w/o AH in 8.3% cases, w/o NPU and with AH – in 39%, with NPU and w/o AH – in 44,4%, with NPU and with AH – in 43.8%, p=0.00048. Preterm delivery, CS and LBW were more common in women with chronic renal failure, and their frequency increased with increasing severity of CKD: CKD1 – 3.5%, 21.2%, 3.5% resp.; CKD2 – 6.7%, 53.3%, 20%; CKD3 – 40%, 70%, 40%; CKD4 – 100%, 100%, 100% (p&amp;lt;0.0001, for all characteristics). We found differences in gestational age at delivery depending on the stages of CKD: in CKD1 it was 38.9 ± 1.3 wks, CKD2 – 38.2 ± 2.1 wks, CKD3 – 36.3 ± 3.5 wks, CKD4 – 32.4 wks (one child), p=0.00013. The proportion of newborns requiring intensive care was higher in mothers with CKD3 (30%) and CKD4 (100%) compared with CKD1 (0%) and CKD2 (13.3%), p&amp;lt;0.0001. Five of 126 (4%) patients in CGN group achieved stage 5 CKD with average postpartum follow-up period of 92.6 ± 20.5 months; 4 women had CKD3 during pregnancy, one – CKD1. Now 2 patients are treated with regular hemodialysis, 3 - live with kidney transplant. Conclusion Chronic glomerulonephritis has a negative effect on pregnancy course, increasing the incidence of PE and CS and contributing to reduce gestational age and birth weight. Incidence of preterm delivery, CS, LBW and proportion of newborns treated in NICU were highest in patients with CKD 3-4.

The Study of Hemodialysis on the Change Rate of Serum Osteopontin, Sialic Acid, and Nitric Oxide Levels

Objective : Chronic renal failure (CRF) is one of the most prevalent diseases of human societies, especially in Iraq. Despite all advances that have been made so far, hemodialysis with all its complications is being applied as the novel treatment strategy for such individuals.Osteopontin (OPN) is a multi-functional secreted glycoprotein that plays a crucial role in and inflammatory process.Our aim was to ascertain whether circulating osteopontin,sialic acid ,and NO levels are altered in patients with CRF before and after dialysis.Design and Methods: A total of 126 patients with HD were enrolled in this study. Serum OPN levels were measured using a commercial enzymelinked immunosorbent assay kit.Results: Osteopontin and Sialic acid levels were significantly higher in haemodialysed CKD patients than predialysed CKD patients and normal healthy controls. The levels of NO was significantly lower in CRF patients pre HD when compared with healthy controls and significantly increased in post HD as compared to pre HD. Conclusion: In our study, OPN SA, NO were found to be a valuable marker of severity of CKD.

Correction.

Ali Ziaolhagh and Christos Argyropoulos: SGLT2 Inhibitors across the Spectrum of Severity of CKD. Clin J Am Soc Nephrol 15: [1386–1388][1], 2020; published ahead of print October 7, 2020, doi: <https://doi.org/10.2215/CJN.13430820> In [Figure 1A and B][2], the kidney failure category was

Electrophysiological evaluation of peripheral neuropathy in chronic kidney disease patients: A study from tertiary care centre, Maharashtra

ntroduction: CKD has turned a major cause of morbidity and mortality. The prevalence of peripheral neuropathy is directly proportional to duration and severity of CKD. Peripheral neuropathy becomes evident after the patient reaches stage 4 CKD, but electrophysiological evidences occurs earlier. NCS is an important means of evaluating the functional integrity of peripheral nerves and has implications regarding clinical course and prognosis. Objectives: To study electrophysiological findings of peripheral neuropathy in CKD patients Methodology: The present study was a cross sectional; descriptive study was conducted in October 2016 to October 2018. Data analysed by using SPSS 23.0 version. Clinical and neurological examinations were done and blood investigations were performed following which NCS was done. Results: Out of 90 subjects, majority were from 45-54 years age group (26). 70% were male and 30% were females. Total 10 (11.11%) patients showed pure sensory type of PN. Total 47 (52.22%) patients showed sensory-motor type of PN. sensory-motor type of PN was the predominant type (52.22%) found in study followed by pure sensory type of PN (11.11%). Pure axonal sensory motor pattern of PN found in 15 (25%) patients in preHD group, 11 (36.66%) patients in HD group. The difference between the pre-HD and HD groups were statistically significant for the median nerve amplitude, common peroneal nerve CV, posterior tibial nerve CV, posterior tibial nerve distal latency and sural nerve distal latency (p &lt; 0.05). Conclusion:Peripheral neuropathy is very common in CKD, more common in dialysis patients as compared to predialysis patients. It’s frequency and severity increase as the duration of disease and stage of CKD increases. Sensory motor type of neuropathy is more common than pure sensory type of neuropathy.Pure axonal sensory motor and mixed (axonal + demyelinating) sensory motor neuropathy are common patterns of PN in CKD.

Skeletal Muscle Mitochondrial Dysfunction Is Present in Patients with CKD before Initiation of Maintenance Hemodialysis.

Patients with CKD suffer from frailty and sarcopenia, which is associated with higher morbidity and mortality. Skeletal muscle mitochondria are important for physical function and could be a target to prevent frailty and sarcopenia. In this study, we tested the hypothesis that mitochondrial dysfunction is associated with the severity of CKD. We also evaluated the interaction between mitochondrial function and coexisting comorbidities, such as impaired physical performance, intermuscular adipose tissue infiltration, inflammation, and oxidative stress. Sixty-three participants were studied, including controls (n=21), patients with CKD not on maintenance hemodialysis (CKD 3-5; n=20), and patients on maintenance hemodialysis (n=22). We evaluated in vivo knee extensors mitochondrial function using 31P magnetic resonance spectroscopy to obtain the phosphocreatine recovery time constant, a measure of mitochondrial function. We measured physical performance using the 6-minute walk test, intermuscular adipose tissue infiltration with magnetic resonance imaging, and markers of inflammation and oxidative stress in plasma. In skeletal muscle biopsies from a select number of patients on maintenance hemodialysis, we also measured markers of mitochondrial dynamics (fusion and fission). We found a prolonged phosphocreatine recovery constant in patients on maintenance hemodialysis (53.3 [43.4-70.1] seconds, median [interquartile range]) and patients with CKD not on maintenance hemodialysis (41.5 [35.4-49.1] seconds) compared with controls (38.9 [32.5-46.0] seconds; P=0.001 among groups). Mitochondrial dysfunction was associated with poor physical performance (r=0.62; P=0.001), greater intermuscular adipose tissue (r=0.44; P=0.001), and increased markers of inflammation and oxidative stress (r=0.60; P=0.001). We found mitochondrial fragmentation and increased content of dynamin-related protein 1, a marker of mitochondrial fission, in skeletal muscles from patients on maintenance hemodialysis (0.86 [0.48-1.35] arbitrary units (A.U.), median [interquartile range]) compared with controls (0.60 [0.24-0.75] A.U.). Mitochondrial dysfunction is due to multifactorial etiologies and presents prior to the initiation of maintenance hemodialysis, including in patients with CKD stages 3-5.

Severe chronic kidney disease environment reduced calcium-sensing receptor expression in parathyroid glands of adenine-induced rats even without high phosphorus diet

BackgroundChronic kidney disease (CKD) disrupts mineral homeostasis and its main underlying cause is secondary hyperparathyroidism (SHPT). We previously reported that calcium-sensing receptor (CaSR) mRNA and protein expression in parathyroid glands (PTGs) significantly decreased in a CKD rat model induced by a 5/6 nephrectomy that were fed a high phosphorus diet. However, there was a significant difference in the severity of CKD between high phosphorus and adequate phosphorus diet groups. Thus, it was unclear whether CKD environment or the high phosphorus diet influenced CaSR expression, and the underlying mechanism remains largely unknown.MethodsCKD was induced in rats with 0.75% adenine-containing diet. CKD and control rats were maintained for 5 days and 2 weeks on diets with 0.7% or 1.3% phosphorus. For gene expression analysis, quantitative real-time polymerase chain reaction was performed with TaqMan probes. Protein expression was analyzed by immunohistochemistry.ResultsPTG CaSR expression significantly decreased in the presence of a severe CKD environment, even without the high phosphate load. Ki67 expressing cells in PTGs were significantly higher only in the CKD rats fed a high phosphorus diet. Furthermore, among the many genes that could affect CaSR expression, only vitamin D receptor (VDR) and glial cells missing 2 (Gcm2) showed significant changes. Moreover, Gcm2 was significantly reduced at an early stage without significant changes in serum calcium, phosphorus and 1,25(OH)2 vitamin D, and there was no significant reduction in CaSR and VDR expressions. Then, significantly elevated Ki67-positive cell numbers were also only observed in the early CKD PTGs with high-phosphorus diets.ConclusionsOur data suggest that the cause of the decreased PTG CaSR expression is the reduction in VDR and Gcm2 expression; Gcm2 may play a role in the onset and progression of SHPT.

P0831HIGH SERUM ALKALINE PHOSPHATASE PREDICTS THE RISK OF CKD PROGRESSION: EFFECT NODIFICATION BY THE GFR

Abstract Background and Aims In the post-hoc analyses of the SUSTAIN and ASSURE trials (Kidney Blood Press Res. 2018;43:449-457), Apabetalone, an epigenetic modulator which lowers serum alkaline phosphatase (AlkPhos), stabilized the GFR in patients with cardiovascular disease and a GFR &amp;lt;60/ml/min/1.73m2. Analyzing the relationship between AlkPhos and renal outcomes in patients with established CKD is useful to preliminarily explore the biological hypothesis that AlkPhos is implicated in CKD progression. Method We investigated the relationship between AlkPhos and the risk for a combined renal end-point (30% GFR loss or dialysis/renal transplantation) in a cohort of 609 stage 3-5 CKD patients with an average GFR of 34.8±12.1ml/min/1.73 m2. Results Median AlkPhos levels were 91 IU/L (Interquartile range 71-117 IU/L) and in the vast majority of patients had values below 147 IU/L (the upper limit of the normal range). Over a median follow up of 3 years, two-hundred patients had the combined renal end-point. In an unadjusted analysis 1 ln increase in AlkPhos entailed a 49% risk excess for the renal end-point (HR: 1.49, 95% CI 1.11-2.01, P=0.008). Adjusting for traditional (age, gender, smoking, diabetes, total cholesterol, BMI, systolic BP, CV comorbidities) and CKD specific risk factors (hemoglobin, albumin, phosphate, and hs-CRP) did not modify the strength of this association (HR:1.48, 95% CI 1.08-2.02, P=0.016). Furthermore, In a fully adjusted analysis testing the GFR as an effect modifier of the AlkPhos - combined renal end point relationship showed a strong GFR- AlkPhos interaction (Figure). Indeed the risk for the combined renal end-point was gradually more pronounced at progressively more severe degrees of renal dysfunction, the HR being 0.94 (CI95% 0.60-1.47) at a GFR of 40 ml/min/m2 and 2.71 (CI95% 1.49-4.93) at 10 ml/min/1.73m2. Conclusion In patients with stage 3-5 CKD alkaline phosphatase within the normal range is associated with the risk for progression to ESRD and the GFR is an effect modifier of this relationship. Findings in this study are compatible with the hypothesis that within the normal range of this biomarker, the risk for CKD progression by alkaline phosphatase is amplified by the severity of CKD. These data are in keeping with post-hoc analyses of the SUSTAIN and ASSURE trials and provide circumstantial support to the hypothesis that interventions lowering serum alkaline phosphatase may mitigate CKD progression.

P1040PREGNANCY IN WOMEN WITH DIABETIC NEPHROPATHY: COMPLICATIONS AND OUTCOMES

Abstract Background and Aims Pregnancy in patients with diabetic nephropathy (DN) is characterized by an increased incidence of complications and adverse outcomes. The aim of the study was to determine the nature and incidence of pregnancy complications and maternal and fetal outcomes in women with DN. Method 61 pregnant women with diabetes mellitus (DM) type 1 and CKD 1-4 stages: 1 st. –29 patients, 2 st. - 19, 3-4 st. – 13 (age 29.7±4.9 years, DM duration 18.6 ± 5,3 years) and 72 pregnant patients with pre-existing (type 1) DM without CKD (age 28.2±4.8 years, DM duration 11.4 ±3.7 years) observed in 2010-2017 were included. The incidence of chronic arterial hypertension (AH), preeclampsia (PE), fetal macrosomia, fetal growth restriction, preterm delivery, cesarean section, stillbirth and the effect of pregnancy on kidney function were evaluated. Results Chronic AH was detected in 19.4% of women w/o CKD, in 10.3% – CKD 1 st, 17.6% – CKD2, 61.3% – CKD 3-4 (p &amp;lt 0.05 CKD3-4 vs CKD1). The incidence of PE in patients w/o CKD was 12.5% (2-3% for general population), with CKD 1 – 24.1%, CKD 2 – 41.2%, CKD 3-4 – 38.5% (p &amp;lt 0.001 when comparing all groups). Macrosomia was common in pregnant diabetic women w/o CKD (30.6%), patients with CKD 1 (41.4%) and CKD 2 (52.9%), but was not observed in CKD 3-4 (0%). In contrast, the incidence of fetal growth restriction was highest with CKD 3-4 (61.5%) compared women w/o CKD (5.6%) and with CKD1(13.8%) and CKD2 (11.8%), p &amp;lt 0.05.Preterm delivery was more common in women with CKD, and its frequency increased with increasing severity of CKD: w/o CKD – 18.1%, CKD 1 – 48.3%, CKD2 – 61.3%, CKD 3-4 –84.6% (p &amp;lt 0.05). Incidence of cesarean section was high and did not differ significantly between groups: w/o CKD – 62.5.1%, CKD 1 – 55.2%, CKD2 – 82.4%, CKD 3-4 –92.3% (p &amp;gt 0.05). Stillbirth was observed only with CKD stage 3-4 in 15.4% of cases.Four out of 13 (30.8%) patients with pre-existing CKD 3-4 and none of the patients with CKD1-2 reached stage 5 CKD and started regular hemodialysis with a median follow-up period of 43.3 months (min 29.7 - max. 81.5). Conclusion DN has a negative effect on pregnancy outcomes, increasing the frequency of preeclampsia, fetal growth restriction, preterm birth and stillbirth, however, fetal macrosomia practically does not occur with CKD 3-4. The rapid achievement of CKD 5D after delivery is typical for diabetic women with advanced stages of CKD.