Kidney Disease Stage Research Articles

FC 126: Association Between Circulating Levels of 25-Hydroxyvitamin D and Metalloproteinase-10 (MMP 10) in Patients With Type 2 Diabetes Mellitus. Cross-Sectional Study

Abstract BACKGROUND AND AIMS Matrix metalloproteinases (MMP) play an important role in diabetic kidney disease (DKD) (1). MMP-10 levels have been shown to increase progressively starting from the early stages of DKD (2). Vitamin D (vitD) deficit is associated with a higher risk of microangiopathy in diabetes. In humans, vitD status correlates inversely with MMP-9 circulating levels and VitD supplementation is associated with a decrease in these levels (3). In vitro, studies demonstrated reduced expression of MMP-10 after an exposure to vitD (4). However, no studies have yet assessed how vitD status is related to MMP-10 circulating levels. We aimed (1) to evaluate the association between the serum levels of 25-hydroxyvitamin D [25(OH)D3] and MMP-10 in a cohort of type 2 diabetes (T2D) patients and (2) to study a potential effect of chronic kidney disease (CKD) stage or estimated glomerular filtration rate (eGFRcr) on this association. METHOD The cross-sectional association between MMP-10 and 25(OH)D3 levels (>30 ng/mL, normal; 20–30 ng/mL, insufficiency; <20 ng/mL, deficiency; and relevant cut-offs 45 and 15 ng/mL) was investigated, by multivariate linear regression analysis after MMP-10 logarithm transformation, in 256 T2D patients recruited (2009–2016) in the Clinica Universidad de Navarra (Spain). Study protocol was approved by the Ethical Committee (2021.183TFG). Covariates were smoking habit, body adiposity percentage estimated by CUN-BAE formula, CKD stage and vitD3 supplement use. Age and sex were already included in the CKD-EPI formula. Interactions and collinearities were also analysed. Statistical analysis was performed using STATA software and two-tailed P-values <0.05 were considered statistically significant. RESULTS Characteristics of patients are given in Table 1. VitD deficit was significantly (P <0.001) more prevalent in patients with CKD (61%) compared with those without CKD (40%). MMP-10 showed a significant negative correlation with 25(OH)D3 (rho = –0.246; P <0.001), which remained significant including only CKD patients (rho = –0.283; P <0.001) and stronger above 45 ng/mL (rho = –0.7308, P <0.001) or moderate between 30 and 45 ng/mL (rho = –0.3290, P = 0.0045) (Fig. 1). In the fully adjusted model, MMP-10 was negatively associated (P = 0.019) with severe vitD deficiency [estimated coefficient –0.86 (–0.76 to –0.97)]. There was no interaction between covariates and 25(OH)D levels and collinearities were also discarded. CONCLUSION In T2D patients, circulating MMP-10 was inversely associated with serum 25(OH)D3 levels, especially in those patients with CKD and at the extremes of vitD level range. These results suggest that higher values of 25(OH)D3 should be targeted in these patients. The efficacy of vitD supplementation in reducing circulating MMP-10 levels should be further examined.

MO962: C-Peptide and Epicardial Adipose Tissue in Chronic Kidney Disease

Abstract BACKGROUND AND AIMS Recent studies suggest that C-peptide (CP) may exhibit characteristics of a hormone and show physiological functions in various tissues. Moreover, it has been proposed that CP could be involved in the regulation of lipolysis, adiponectin release and function of mesenchymal stem cells in adipose tissue. However, there is a certain controversy regarding reported effects of the CP. Its beneficial effects have been demonstrated in long-term complication in type 1 diabetes mellitus (T1DM). Substitution of CP in T1DM improves glomerular hyperfiltration, hypertrophy and proteinuria. In contrast to this, CP in T2DM shows proinflammatory and proatherogenic effects. The aim of this study was to find the association between CP, epicardial adipose tissue (EAT) and vascular calcifications in diabetic subjects under insulin treatment on dialysis. METHOD This is a retrospective study of 62 consecutive chronic kidney disease (CKD) stages 5D patients awaiting kidney transplantation referred for risk stratification. Computer tomography (CT) was used to assess quantify coronary artery calcium (CAC) and to measure EAT volume. CAC was considered present if a minimum of three contiguous pixels with an attenuation of ≥130 Hounsfield Units (HU) were detected along the course of a coronary artery. CAC scores were calculated using the method described by Agatston. EAT was identified as a hypodense area surrounding the myocardium and limited by pericardium. The pericardium was traced manually from the mid-left atrium to the left ventricular apex interpolating slices of 10 mm thickness; the application of an attenuation threshold in the range of -250 to -30 HU effectively excluded myocardium, coronary arteries, coronary calcium, aorta and blood pool, leaving in evidence the EAT alone. Demographic and anthropometrics data were collected on all patients through record review. RESULTS Demographic, clinical and laboratorial characteristics of patients enrolled in the study are resume in the Table 1. Young women and smoking were more prevalent; none of the analytical parameters were correlated with CP. Subjects with higher BMI exhibited higher levels of CP (P 0.03). EAT was strongly correlated with higher levels of CP (P 0.03). EAT was significantly correlated with severity of CAC scores (P 0.01). No correlation was found between CP and CAC. CONCLUSION As a marker of insulin reserve, CP can be used to evaluate insulin needs and overdose in dialysis patients and to avoid its lipogenic effects. New and novel hypoglycemic therapies may help in this issue. While EAT was correlated to CP, this was not associated with vascular calcification (CAC); this final observation may be related to the lower levels of vascular damage observed in CKD patients from kidney transplantation waiting list. More studies are needed to explore this association and utility.

MO977: Circulating CD14++CD16+MONocytes, NK Cells and LYMPHOcyte Subsets Correlate with Conventional and Novel Deformation Related Indices of Left Ventricular Function in Kidney Transplant Recipients with no Established Cardiovascular Disease

Abstract BACKGROUND AND AIMS Kidney transplant recipients (KTRs) carry a significant burden of cardiovascular disease (CVD), despite improvement of patterns of left ventricular (LV) remodeling following kidney transplantation. Kidney allograft dysfunction and the immunosuppressed milieu play a major adverse role in myocardial structural changes in asymptomatic KTRs. An intricate relationship exists between immune system responses with heart failure syndromes, manifesting among others with aberrant activity and counts of proinflammatory CD16+monocytes, of natural killer (NK) cells and T regulatory cells (Tregs). The associations of immune cell subpopulations with subclinical markers of CVD remain to be determined in KTRs. The aim of our study was to investigate potential correlations between blood levels of specific immune cells subsets with conventional and novel deformation related indices of LV function in KTRs. METHOD 31 stable KTRs (mean age 58 ± 9.28 years, 67% males, 13% diabetics) without established CVD were enrolled. Control population included 17 chronic kidney disease (CKD) stage 3 patients without history of CVD. Additional exclusion criteria were history of malignancy, autoimmune disease and active or chronic infections. The peripheral blood immune cell subsets CD14++CD16-, CD14++CD16+and CD14+CD16++ absolute values and percentages out of total monocytes and NK cells (CD3+CD16+56+), CD3-CD19+B lymphocytes, CD3+CD4+T cells, CD3+CD8+T cells and Tregs (CD4+CD25+FoxP3+) absolute values and percentages out of total lymphocytes were measured by flow cytometry. Simultaneously, conventional (left atrial volume index (LAVI), LV mass index (LVMI), E/E’) and novel 2D speckle tracking (2DST) echocardiographic indices of LV function [global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), TWIST AND UNTWIST] were assessed. RESULTS KTRs had a mean eGFR of 58 ± 18 mL/min/1.73 m2 (CKD-EPI) and mean 24-h proteinuria (PER) 707 ± -1185 mg/24 h. Total lymphocytes, B-cells, T-cells and CD8+T cells counts correlated positively with eGFR (P < 0.05). Increased non-classical CD14+CD16++ monocytes were associated with proteinuria levels (P < 0.01) whereas an inverse correlation was observed between the percentage of classical CD14++CD16- monocytes with PER (P < 0.05). When compared with CKD patients, KTRs displayed higher CD14++CD16- and lower CD14+CD16++ monocytes counts, a lower percentage of NK cells and T cells and lower Tregs (significant differences presented in Table 1). Regarding classical indices of LV function, increased total monocytes were associated with elevated LAVI (P < 0.05), whereas an increased percentage of the intermediate CD14++CD16+monocytes correlated positively with an increased E/E’ value. Increased NK cells were associated with more negative GCS values (P < 0.05). No significant correlations were observed between the rest immune cells with the classical or novel LV dysfunction indices. CONCLUSION Alterations of immune cells subsets correlate with subclinical markers of LV dysfunction in KTRs with no established CVD. Future research is required to evaluate the role of immune subpopulations as tools to identify KTRs who are at the highest risk for complications and guide interventions.

Vacinação Contra a COVID-19 numa Rede de Clínicas de Hemodiálise em Portugal: Uma Experiência Promissora

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) responsible for coronavirus disease 2019 (COVID-19) seriously affected Portugal, particularly in the elderly population with a high number of comorbidities, including patients with chronic kidney disease in stage 5 (CKD-5D) undergoing a regular dialysis program. The aims of this study were to identify the impact of vaccination on the incidence of new daily cases and mortality in the CKD-5D population. Prospective, observational study, involving patients with CKD-5D from 38 NephroCare clinics, Portugal. Daily SARS-CoV-2 infections and mortality among these patients was compared with the incidence in the general population. Three periods were analysed: before vaccination, during the vaccination process, and a third period after complete vaccination with the Pfizer-BioNTech' Comirnaty® vaccine. The primary outcome was infection by the SARS-CoV-2 virus and the secondary outcome was death associated with the infection. A total of 4617 patients (average of 69.37 years of age) were analysed. During the first period, there was a significantly higher COVID-19 incidence of 14.9% in patients with CKD-5D compared with the general population (7.9%; p < 0.001). During the fifteen days after the complete vaccination, results reverted to a significant decrease in COVID-19 cases was observed (p < 0.001). The mortality rate among CKD-5D was significantly higher than in the general population (p < 0.001). A high incidence rate of infection was observed in CKD-5D patients, probably due to several factors such as advanced age, number of comorbidities, inability to remain in confinement, among others. After vaccination there was a significant reduction of new cases. Vaccination significantly reduced SARS-CoV-2 infection in patients with CKD-5D.

Regulation of Mitochondrial Homeostasis and Nrf2 in Kidney Disease: Timing Is Critical.

Abnormal regulation of mitochondrial homeostasis plays a critical role in the progression of renal disease. Recent studies have shown that activation of nuclear factor erythroid 2-related factor 2 (Nrf2) has time-dependent protective effects, which can be explained by the differing regulation of mitochondrial homeostasis during the various stages of kidney disease. In this review, we summarize the mechanisms whereby mitochondrial homeostasis is regulated and the nature of the dysregulation of mitochondrial homeostasis in renal disease. In addition, we summarize the dual roles of Nrf2 in kidney disease by discussing the studies that have shown the importance of the timing of its activation in the regulation of mitochondrial homeostasis. This should provide a theoretical basis for therapeutic strategies aimed at activating Nrf2 in kidney disease.

The effect of renin\u2013angiotensin\u2013aldosterone system inhibitors on continuous and binary kidney outcomes in subgroups of patients with diabetes: a meta-analysis of randomized clinical trials

IntroductionDiabetic nephropathy is the leading cause of kidney failure. Clinical practice guidelines recommend prescribing renin–angiotensin aldosterone system inhibitors (RAASi) to prevent diabetic nephropathy at any stage. We conducted this systematic review and meta-analysis to compare the effects of RAASi with placebo and other antihypertensive agents in adults with diabetes on continuous and binary kidney outcomes to provide a comprehensive review of the class effect of RAASi on several subgroups.MethodsA systematic electronic search to identify randomized clinical trials of a duration of ≥ 12 months that recruited ≥ 50 adult participants with type 1 or 2 diabetes with any stage of chronic kidney disease and proteinuria was conducted in MEDLINE, CINAHL, EMBASE, and Cochrane library with no language restriction. Studies were screened against the inclusion and exclusion criteria by two reviewers independently.ResultsIn this meta-analysis, evidence was drawn from 26,551 patients with diabetes from 46 studies. Our analysis shows that RAASi were better than placebo in reducing SrCr (the raw mean difference [RMD] = -13.4 μmol/L; 95%CI: -16.78; -10.01) and albuminuria levels (standardized mean difference [SMD] = -1; 95%CI: -1.57, -0.44, I2 = 96%). When compared to other active treatments, RAASi did not reduce SrCr (RMD = 0.03 μmol/L; 95%CI: -6.4, 6.10, I2 = 76%), caused a non-significant reduction of GFR levels (RMD = -1.21 mL/min; 95%CI: -4.52, 2.09, I2 = 86%), and resulted in modest reduction of albuminuria levels (SMD = -0.55; 95%CI: -0.95, -0.16, I2 = 90%). RAASi were superior to placebo in reducing the risks of kidney failure (OR = 0.74; 95%CI: 0.56, 0.97) and doubling of serum creatinine levels (SrCr; OR = 0.71; 95%CI: 0.55, 0.91), but not in promoting the regression of albuminuria (OR = 3.00; 95%CI: 0.96, 9.37). RAASi, however, were not superior to other antihypertensives in reducing the risks of these outcomes. Patients with type 2 diabetes, macroalbuminuria and longer duration of diabetes had less risk of developing kidney failure in placebo-controlled trials, while longer duration of diabetes, normal kidney function, and hypertension increased the probability of achieving regression of albuminuria in active-controlled trials.ConclusionWhile our findings revealed the non-superiority of RAASi over other antihypertensives and portrayed a class effect on several subgroups of study participants, it raised a challenging question on whether RAASi deserve their place as first-line therapy in managing diabetic nephropathy.

Analysis of oxidative stress, inflammation and endothelial function following intravenous iron in chronic kidney disease in the Iron and Heart Trial

Iron deficiency commonly affects patients with chronic kidney disease and has an important burden in disease trajectory and quality of life; nonetheless current guidelines do not advocate treatment of iron-deficiency without anemia in this patient group. Concerns exist regarding the potential effects of intravenous iron on oxidative stress, inflammation, and endothelial function. As part of a multicenter double-blinded randomized controlled clinical trial, we examined the effects of a single dose of intravenous iron vs. placebo on biomarkers of oxidative stress, inflammation and endothelial function in non-anemic iron deficient patients (serum ferritin < 100 μg/L and/or transferrin saturation < 20%) with chronic kidney disease (stage 3b-5). Fifty-four individuals were randomized to receive ferric derisomaltose (n = 26) or placebo (n = 28). Ferric derisomaltose was associated with a non-significant decrease in mean F2-isoprostane and no effect on thiobarbituric acid reactive substances when compared to placebo throughout follow up. No effect on inflammatory markers was observed. A modest but statistically significant rise in E-selectin was noted in the intravenous iron group at 1 month and 3 month follow-up (p = 0.030 and p = 0.002 respectively). These results suggest ferric derisomaltose administration in non-dialysis dependent chronic kidney disease patients who are iron deficient does not induce prolonged oxidative stress or inflammation. Larger trials are required to quantify the benefit of intravenous iron administration in this patient group.

Prevalence, progression, and management of advanced chronic kidney disease in a cohort of people living with HIV.

Advanced kidney disease is an emerging problem in people living with HIV despite sustained viral suppression. We performed a prospective cohort study to identify people living with HIV with advanced kidney disease according to the Kidney Disease Improving Global Outcomes criteria and to assess disease progression over a 48-week period following the offer of targeted multidisciplinary management. From our cohort of 3090 individuals, 55 (1.8%, 95% confidence interval [CI] 1.31-2.25) fulfilled the inclusion criteria. Most were male (83.6%), and the median (interquartile range [IQR]) age was 58 (53.25-66.75) years. Nadir CD4 T-cell count was 135.5 (IQR 43.5-262.75) cells/μl, current CD4 T-cell count was 574 (IQR 438.5-816) cells/μl, and 96% had maintained HIV viral suppression. The most frequent comorbidity was arterial hypertension (85.5%). Inadequate antiretroviral dose was detected in three individuals (5.5%), and drug-drug interactions were recorded in eight (14.5%), mainly involving the use of cobicistat (n=5 [9%]). Four individuals (7%) required modification of their concomitant treatment. Seven (13%) had to start or resume follow-up with a nephrologist. Nine participants (16.4%) experienced an improvement in kidney disease stage, three individuals (5.5%) underwent renal transplantation, and one (2%) started haemodialysis. Our results show that a multidisciplinary approach, including a critical review of treatment and evaluation of specific requirements, could be useful for anticipating drug-drug interactions and toxicities and for reducing death and hospitalization in people living with HIV with advanced kidney disease.

Pregnancy associated TMA in 13-year-old patient successfully treated with Eculizumab: case report

BackgroundThis report introduces an unusual cause of kidney failure in a previously healthy pediatric patient. She developed thrombotic microangiopathy (TMA) that was diagnosed post-partum, requiring dialysis and eculizumab, with eventual recovery of kidney function ([chronic kidney disease (CKD) stage 3].Case presentationThe patient was induced at term due to preeclampsia, with delivery complicated by severe postpartum hemorrhage from uterine atony. She continued to have severe hypertension post-delivery and further developed acute kidney injury (AKI) with decreased urinary output and respiratory distress requiring dialysis therapy. Labs revealed hemolysis with elevated lactate dehydrogenase, low haptoglobin, anemia, and thrombocytopenia, but otherwise unremarkable immunology labs. Once clinically stabilized the patient underwent kidney biopsy, which was consistent with TMA. Treatment was initiated with eculizumab, a monoclonal antibody for terminal complement blockade. Her clinical status improved (including markers of hemolysis and inflammation) with kidney replacement therapy and complement blockade. On discharge, she had increasing urine output and was prescribed 3 day per week hemodialysis and twice monthly eculizumab infusions. By 6 weeks post-delivery, hemodialysis was discontinued and her eculizumab was weaned to monthly infusions. Eculizumab was discontinued at 12 months postpartum. Genetic testing for mutations of the complement system was negative. The patient has residual stage 3 CKD with stable kidney function, requiring two agents for blood pressure control, including an ACE inhibitor for antiproteinuric effect.ConclusionsThis case report showcases an unusual cause of renal failure in a pediatric patient due to TMA in the post-partum period. She required intermittent hemodialysis (iHD) for a brief period, however she was treated successfully with eculizumab that was able to be weaned off 1 year after delivery. She has residual stage 3 CKD and no further signs or symptoms of TMA.

Diagnosis of diabetic nephropathy and chronic kidney disease in prepubertal children with type 1 diabetes mellitus

The state of renal function in children with type 1 diabetes mellitus and small, up to 5 years old, disease experience was studied. The aim of the study was to determine the indicators of the initial stages of the formation of diabetic nephropathy and chronic kidney disease. A prospective cohort study of a group of 46 prepubertal patients with type 1 diabetes mellitus and less than 5 years of illness was carried out. Diabetic nephropathy at the stage of microalbuminuria was detected already in 8% of children. Signs of the first, preclinical stage of chronic kidney disease, manifested by hyperfiltration, were found in 20% of patients, impaired tubular functions — in 28%. A moderate decrease in glomerular filtration rate corresponding to stage 2 of chronic kidney disease was observed in 4% of children with diabetes. An increase in the concentration of endothelial growth factor in the blood serum and the morning portion of urine, as well as monocyte chemoattractant protein-1 in the blood serum are sensitive highly specific markers of the formation of chronic kidney disease in patients of prepubertal age with a history of diabetes mellitus of less than 5 years. The relationship between the characteristics of the course of diabetes mellitus with endothelial growth factor and monocyte chemoattractant protein-1 was not revealed, which reflects the independent mechanism of the influence of neoangiogenesis and the reaction of non-infectious inflammation on the formation of diabetic nephropathy and chronic kidney disease. The relationship between vascular endothelial growth factor and monocyte chemoattractant protein-1 with the formation of early signs of chronic kidney disease and diabetic nephropathy has been revealed. The results obtained can be used for early diagnosis of diabetic nephropathy and the formation of a risk group for kidney damage in children with diabetes mellitus.

Oral anticoagulation in patients with atrial fibrillation and end-stage kidney disease

Atrial fibrillation is highly prevalent in patients with end -stage kidney disease. For patients with atrial fibrillation but normal kidney function, the net clinical benefit of oral anticoagulation with vitamin K antagonists and non -vitamin K oral anticoagulants in preventing stroke against the hemorrhagic risk is well -known. However, dialysis patients present unique risk factors that increase ischemic stroke and bleeding events that are not included in the traditional risk scores. These points, in addition to the pharmacokinetic issues related to the use of oral anticoagulants in end -stage kidney disease, raise the question of the safety of these drugs, making it difficult to predict whether the benefit outweighs the risk. Data on this topic in chronic kidney disease stages 4, 5, and 5D patients is sparse and the clinical guidelines are also inconsistent in which is the best approach for these patients. This review gives an overview of the state of the art on this topic, specifically the recommendations of the newest guidelines, then discusses the various risk scores and their pitfalls, and finally summarizes the current knowledge on the possible benefits of Non -vitamin K oral anticoagulants versus Vitamin K antagonists in dialysis patients.

Comparative Evaluation of General Oral and Periodontal Health Status of Chronic Kidney Disease (CKD) patients in Various Stages admitted to Sharif Medical and Dental College, Lahore, and Healthy Controls

Objective: To assess the general oral and periodontal health status of chronic kidney disease patients in various stages and compare it to healthy controls. Methodology: A Cross-sectional comparative study was conducted in Sharif Medical and Dental College, Lahore on 50 patients with chronic kidney disease and 58 controls for the time duration of one year. Data collection was based on the Community Periodontal Index of Treatment Needs and Decayed Missing and Filled index. Results: There was a significant association between stage of kidney disease and periodontal health (p= ≤0.001) and general oral health as determined by the DMFT index (≤0.001). There was a significant difference in the scores of decayed teeth between the controls and stage 3 (0.042), stage 5 (≤0.001) and stage 4 (p= 0.001). The difference in the scores of missing teeth was significant between controls and stage 5 (p=≤0.001) and stage 4 (p=0.001). Similar was the case for decayed missing and filled teeth index scores for controls and stage 3 (p=0.013), stage 5 (≤0.001) and stage 4 (≤0.001). Conclusion: Bleeding gums were most common in stage 3 while pocket depths of 4-5mm were highest in stage 4 and 5 patients. Pocket depth of 4 to 5mm was the most prevalent periodontal problem in controls. In the controls, more individuals had a high DMFT score in comparison to low scores. The scores of decayed teeth and decayed missing filled index were significantly different among the controls and stages 3, 5 and 4 while for missing teeth score, the difference was significant between controls and stages 4 and 5. Keywords: Periodontal health, Community periodontal index for treatment needs (CPITN), Decayed missing and filled teeth (DMFT) index, chronic kidney disease.

Assessment of Stiffness of Large to Small Arteries in Multistage Renal Disease Model: A Numerical Study

Arterial stiffness (AS), as assessed via pulse wave velocity (PWV), is a major biomarker for cardiovascular risk assessment in patients with chronic kidney disease (CKD). However, the mechanisms responsible for the changes in PWV in the presence of kidney disease are not yet fully elucidated. In the present study, we aimed to investigate the direct effects attributable to biomechanical changes in the arterial tree caused by staged renal removal, independent of any biochemical or compensatory effects. Particularly, we simulated arterial pressure and flow using a previously validated one-dimensional (1-D) model of the cardiovascular system with different kidney configurations: two kidneys (2KDN), one single kidney (1KDN), no kidneys (0KDN), and a transplanted kidney (TX) attached to the external iliac artery. We evaluated the respective variations in blood pressure (BP), as well as AS of large-, medium-, and small-sized arteries via carotid-femoral PWV (cfPWV), carotid-radial PWV (crPWV), and radial-digital PWV (rdPWV), respectively. Our results showed that BP was increased in 1KDN and 0KDN, and that systolic BP values were restored in the TX configuration. Furthermore, a rise was reported in all PWVs for all tested configurations. The relative difference in stiffness from 2KDN to 0KDN was higher in the case of crPWV (15%) in comparison with the increase observed for cfPWV (11%). In TX, we observed a restoration of the PWVs to values close to 1KDN. Globally, it was demonstrated that alterations of the outflow boundaries to the renal arteries with staged kidney removal led to changes in BP and central and peripheral PWV in line with previously reported clinical data. Our findings suggest that the PWV variations observed in clinical practice with different stages of kidney disease may be partially attributed to biomechanical alterations of the arterial tree and their effect on BP.

The Maintained Glycemic Target Goal and Renal Function Are Associated with Cardiovascular and Renal Outcomes in Diabetic Patients Following Stent-Supported Angioplasty for Renovascular Atherosclerotic Disease.

Patients with type 2 diabetes mellitus (T2DM) constitute a large proportion of patients with atherosclerotic renal artery stenosis (ARAS). However, the mechanism of impaired renal function and hypertension in this subset of patients is multifactorial. We aimed to investigate whether, in diabetic patients, renal function (RF), systolic (SBP) and diastolic blood pressure (DBP) values following stent-supported angioplasty (PTA) for ARAS have an impact on cardiovascular and renal outcomes. Methods: The study group included 93 patients with T2DM and resistant hypertension who underwent PTA for ARAS. The pre- and post-procedure (6 to 12, and 24 months) values of SBP, DBP, eGFR and glycaemia were obtained. The prospective follow-up of median 44 months was performed for combined outcome: major cardiac and cerebral events (MACCE) and progression to renal replacement therapy (RRT). Results: MACCE-RRT occurred in 46 (49.5%) patients, with higher incidence in patients with higher values of SBP (147.8 ± 25.8 vs. 136.7 ± 15.8 mmHg, p = 0.006), DBP (80.8 ± 13.3 vs. 74.4 ± 12.3 mmHg, p = 0.009), chronic kidney disease in stages 3B to 5 (p = 0.029) and those who have not obtained target glycemic goals compared to well-maintained T2DM (p = 0.007) at 24-months. On multivariate Cox analysis, well-maintained T2DM targets [Hazard Ratio (HR):0.27; 95% Confidence Interval (CI):0.13–0.57; p < 0.001], eGFR below 45 mL/min/m2 (HR: 2.20; 95%CI: 1.20–4.04; p = 0.011), previous stroke (HR:2.52; 95%CI:1.19–5.34; p = 0.015) retained their associations with MACCE-RRT, while BP values were not associated with the outcome. Conclusions: The post-procedural RF, maintained glycemic target goal and previous stroke are vital for the outcome in patients undergoing PTA for renovascular disease in diabetic patients.

Associations between dietary patterns and stages of chronic kidney disease

BackgroundStudies have revealed that patients with chronic kidney disease (CKD) have dietary patterns different from those of the general population. However, no studies have compared the dietary patterns of between patients with early-stages (stages 1–3a) and late-stages (stages 3b–5) of CKD. Our objective was to investigate the associations between dietary patterns in early and late-stage CKD.MethodsWe analyzed 4480 participants with CKD at various stages based on the data recorded between 2007 and 2016 from the database of the American National Health and Nutrition Examination Survey.ResultsIn total, 3683 and 797 participants had early and late-stage CKD, respectively. Through principal components analysis, the dietary intake dimension was reduced from 63 variables to 3 dietary patterns. We adopted logistic regression for analysis. The three dietary patterns are as follows: (1) saturated fatty acids and mono-unsaturated fatty acids (MUFA); (2) vitamins and minerals; and (3) cholesterols and polyunsaturated fatty acids (PUFA). These 3 patterns explained > 50% of dietary nutrient intake. Results indicated that among participants with dietary patterns 2 (vitamins and minerals) and 3 (cholesterols and PUFA), those with low intakes were more likely to have late-stage CKD. The odds ratios for patterns 2 and 3 were 1.74 (95% CI: 1.21–2.50) and 1.66 (95% CI: 1.13–2.43), respectively.ConclusionsThis study revealed that intakes of vitamins and minerals and cholesterols and PUFA were associated with the stages of CKD.

290 Dietary Phosphorus Restriction in Early Stages of Chronic Kidney Disease Improves Renal Function, and Controls CKD-MBD and Cardiovascular Risk Factors

290 Dietary Phosphorus Restriction in Early Stages of Chronic Kidney Disease Improves Renal Function, and Controls CKD-MBD and Cardiovascular Risk Factors

173 Application of Artificial Intelligence to Predict Survival in Patients With Chronic Kidney Disease (CKD) Stage 4-5

173 Application of Artificial Intelligence to Predict Survival in Patients With Chronic Kidney Disease (CKD) Stage 4-5

Low-grade proteinuria and atherosclerotic cardiovascular disease: A transition study of patients with diabetic kidney disease.

Diabetic kidney disease (DKD) is heterogeneous in terms of proteinuria. Patients with DKD who present with low-grade proteinuria are more likely to have nephrosclerosis rather than traditional diabetic nephropathy. The amount of proteinuria might reflect the underlying pathology of renal failure and influence the prognosis after dialysis initiation. Clinical implications of proteinuria at the start of dialysis have not been confirmed, while greater proteinuria is associated with higher risk of cardiovascular disease (CVD) in the predialysis stages of chronic kidney disease. We performed a retrospective multicenter cohort study enrolling incident hemodialysis patients with diabetes. Patients were stratified using proteinuria quartiles. We examined the association of proteinuria quartiles with types of subsequent CVD. Among the enrolled 361 patients, the estimated mean glomerular filtration rate and proteinuria was 5.4 mL/min/1.73 m2 and 6.3 g/gCr, respectively. Lower quartile of proteinuria (cut-offs: 3.0, 5.4, and 8.8 g/gCr) was significantly associated with male, older age, and history of atherosclerotic CVD including coronary artery disease, peripheral arterial disease, and cerebral infarction (Ptrend<0.05). Kidney size was smaller in patients with lower levels of proteinuria. Patients with higher levels of proteinuria were more likely to have proliferative diabetic retinopathy (Ptrend<0.05). Multivariate competing risk analysis revealed that the first quartile of proteinuria was associated with a greater risk of atherosclerotic CVD than the third quartile (subhazard ratio [95% confidence interval]: 2.04 [1.00–4.14]). This association was attenuated after additional adjustments for history of atherosclerotic CVD. Furthermore, patients with lower quartiles of proteinuria were more likely to die of atherosclerotic CVD than those with non-atherosclerotic CVD (Ptrend = 0.01). Diabetic patients with lower proteinuria at dialysis initiation were characterized by severer macroangiopathy, as shown by a more atrophic kidney and higher prevalence of past atherosclerotic CVD. Hence, they are at a high risk of developing atherosclerotic CVD.

Mortality and readmission rates among hospitalized COVID-19 patients with varying stages of chronic kidney disease: a multicenter retrospective cohort

Chronic kidney disease (CKD) has been recognized as a highly prevalent risk factor for both the severity of coronavirus disease 2019 (COVID-19) and COVID-19 associated adverse outcomes. In this multicenter observational cohort study, we aim to determine mortality and readmission rates of patients hospitalized for COVID-19 across varying CKD stages. We performed a multicenter cohort study among COVID-19 patients included in the Dutch COVIDPredict cohort. The cohort consists of hospitalized patients from March 2020 until July 2021 with PCR-confirmed SARS-CoV-2 infection or a highly suspected CT scan-based infection with a CORADS score ≥ 4. A total of 4151 hospitalized COVID-19 patients were included of who 389 had a history of CKD before admission. After adjusting for all confounding covariables, in patients with CKD stage 3a, stage 3b, stage 4 and patients with KTX (kidney transplantation), odds ratios of death and readmission compared to patients without CKD ranged from 1.96 to 8.94. We demonstrate an evident increased 12-week mortality and readmission rate in patients with chronic kidney disease. Besides justified concerns for kidney transplant patients, clinicians should also be aware of more severe COVID-19 outcomes and increased vulnerability in CKD patients.

Обоснование медикаментозной коррекции артериальной гипертензии у кошек с хронической болезнью почек

Systemic arterial hypertension is common among older animals and is regularly detected in cats with chronic kidney disease, diabetes mellitus, Cushing’s syndrome, hyperthyroidism, while it is not always secondary to an underlying systemic disease. As a result of the study, it was found that arterial hypertension can develop at any stage of chronic kidney disease, and can also be primary or idiopathic. In human medicine, it has been proved that the correction of hypertension at an early stage contributes to a significant reduction in the progression of renal destruction processes. Clinical signs of the disease appear at the stage of azotemia and uremia (in fact, the terminal stage of chronic kidney disease); however, systemic arterial hypertension can occur without specific symptoms. The prime targets of hypertensive damage are – heart, eyes, kidneys, brain. The main clinical manifestations of the chronic kidney disease are: polyuria, polydipsia, cachexia, pallor of the mucous membranes, loss of appetite, apathy, vomiting, gingivitis. Clinical rationale for the development of arterial hypertension in cats with chronic kidney disease are the following factors: age of the animal, breed and concomitant diseases: hyperthyroidism, diabetes mellitus, acromegaly, cushing's syndrome, FeLV and FIV, CKD, HCM. Comprehensive diagnostics is required to identify the causes of arterial hypertension, including history data, laboratory and instrumental research methods. Amlodipine, a calcium channel blocker, is currently the drug of choice for the pharmacological correction of arterial hypertension in cats. The use of this antihypertensive agent gives positive results and makes cats lives with CKD better.