Chronic Kidney Disease Patients Stages Research Articles

Menstrual Abnormalities and Associated Hormone Profile In Chronic Kidney Disease Stage 5 Patients

Background: Although menstrual abnormalities and associated hormonal dysregulations are very common in the reproductive age group of Chronic Kidney Disease (CKD) patients, this remains a neglected area. This field had been poorly explored in last ten years worldwide and a few research regarding this area in Bangladesh as well. Aim: To evaluate menstrual abnormalities occurring in CKD stage 5 (CKD5)patients undergoing twice-weekly and thriceweekly maintenance hemodialysis (HD) also in non-dialytic CKD5 patients and to provide more detail information on hormone profile (FSH, LH, Prolactin, Estradiol) of these patients. Materials and method: This obsevational study was conducted in the Department of Nephrology, DMCH, the sample population was also collected from BSMMU and NIKDU from April 2017 to March 2018. A total of 51 CKD stage 5 patients were enrolled in this study. Among them, 34 patients were dialytic (17 of them were taking twice weekly HD and 17 of them were taking thrice weekly HD) and 17 non-dialytic patients at reproductive age were evaluated. Detailed menstrual histories, thorough clinical examinations as well as investigations were done in all the patients. Serum FSH, LH, Estradiol, and Prolactin were evaluated using chemiluminescence immunoassay in the Department of Microbiology of BSMMU. Statistical analysis of the study was done by SPSS-24. The confidence interval was considered at 95% level. P-value <0.05 was considered statistically significant. Results: 100% of non-dialytic CKD5 women had menstrual disorders (72% of patients had secondary amenorrhea, 18% had oligomenorrhoea and 10% had menometrorrhagia). And 73.52% of patients in the HD group had menstrual disorders (29% patients had regular menstruation, 28.5% had secondary amenorrhea, 23.5% had oligomenorrhoea and 19% had menometrorrhagia). With continuation of HD amenorrhea disappeared in 43% of patients in the thrice-weekly HD group, also 22.22% patients in the twice-weekly HD group regained menstruation. Serum LH and prolactin levels were significantly higher in the non-HD group compared to the HD group (p<0.05). Estradiol levels were also higher in HD patients than the non-HD patients. LH and Prolactin levels were also higher in the twice-weekly HD group compared to the thrice-weekly HD group. In the secondary amenorrheic group, serum FSH, LH, Prolactin levels were significantly higher than the other groups having menstrual disorder (p<0.05). Conclusion: Menstrual abnormalities and associated hormonal dysregulations were significantly lower in thriceweekly HD patients compared to the twice-weekly HD patients and significantly lower in twice-weekly HD patients compared to the non-dialytic CKD5 patients. Besides, it is suggested that long-duration dialysis might improve menstrual disorders in such patients as prolactin, LH levels gradually decreased with longer duration of dialysis. J Bangladesh Coll Phys Surg 2022; 40: 45-51

Plasma Kynurenine: A Promising Marker for the Assessment of Renal Functions.

Background:Chronic kidney disease (CKD) is a worldwide issue due to the high prevalence and the serious complications, including death. Kidney functions are routinely evaluated by measuring creatinine levels, which are influenced by many factors (age, sex, diet, race, and body mass). Kynurenine is the first stable metabolite in the kynurenine pathway, which is activated in the course of CKD. Kynurenine levels in plasma can be correlated to kidney functions in CKD patients. We investigated the relationship between kynurenine levels and kidney functions indicators, and the influence of some variables (sex, age, and preexisting hypertension or diabetes) on its levels in CKD patients.Material And Methods:The study included 66 CKD patients in stages 3 to 5 seen at Tishreen University Hospital, and 22 subjects served as control. Kynurenine levels were measured by using a kynurenine ELISA kit (IDK® immundiagnostik).Results:Kynurenine levels were significantly increased with the increase in CKD stage (P < .001), and were correlated with eGFR (r = −.631, P < .001), creatinine levels (r = −.464, P < .001), and urea levels (r = .528, P < .001). Kynurenine plasma levels were not influenced by age, sex, diabetes, and hypertension in CKD patients.Conclusion:Kynurenine is a promising marker for estimating kidney functions, and its relation with kidney functions is not affected by age, sex, and presence of hypertension or diabetes in CKD patients.

Systemic microvascular endothelial function with arteriovenous fistula creation in chronic kidney disease.

Background:This study aimed to determine changes in microvascular endothelial function with upper arm arteriovenous fistula (AVF) creation and maturation in patients with chronic kidney disease (CKD).Materials and Methods:This prospective cross-sectional study was performed at Hospital Universiti Sains Malaysia, a tertiary hospital in Malaysia. Forty CKD patients (stage 4–5) who were scheduled for elective AVF creation over the upper extremity for maintenance hemodialysis were recruited using convenience sampling method. Microvascular endothelial-dependent vasodilation was measured using laser Doppler flowmetry and the process of iontophoresis preoperatively and postoperatively at weeks 2 and 6. Fistula maturation was assessed at week 6.Results:Thirty-two patients had successful AVF maturation. Endothelial-dependent vasodilation (acetylcholine (Ach)% was higher (246.48 [standard deviation (SD) 209.38] vs. 104.95 [SD 43.29], P = 0.001) while systolic blood pressure was lower (142.25 [SD 21.50] vs. 162.25 [SD 13.26], P = 0.017) in this group as compared to unsuccessful AVF group. No significant changes were seen in overall microvascular endothelial-dependent vasodilation during the 6-week study period (day 0, 246.48 [SD 209.38]; week 2, 201.14 [SD 198.19]; and week 6, 203.53 [SD 145.89]).Conclusion:Upper arm AVF creation does not affect microvascular endothelial function up to 6 weeks post operation and may not contribute to the success of AVF maturation. However, the lower microvascular endothelial-dependent vasodilation and higher systolic blood pressure in unsuccessful AVF subjects need to be further studied.

Inflammation and physical dysfunction: responses to moderate intensity exercise in chronic kidney disease.

People with chronic kidney disease (CKD) experience skeletal muscle wasting, reduced levels of physical function and performance, and chronic systemic inflammation. While it is known that a relationship exists between inflammation and muscle wasting, the association between inflammation and physical function or performance in CKD has not been well studied. Exercise has anti-inflammatory effects, but little is known regarding the effect of moderate intensity exercise. This study aimed to (i) compare systemic and intramuscular inflammation between CKD stage G3b-5 and non-CKD controls; (ii) establish whether a relationship exists between physical performance, exercise capacity and inflammation in CKD; (iii) determine changes in systemic and intramuscular inflammation following 12 weeks of exercise; and (iv) investigate whether improving inflammatory status via training contributes to improvements in physical performance and muscle mass. This is a secondary analysis of previously collected data. CKD patients stages G3b-5 (n=84, n=43 males) and non-CKD controls (n=26, n=17 males) underwent tests of physical performance, exercise capacity, muscle strength and muscle size. In addition, a subgroup of CKD participants underwent 12 weeks of exercise training, randomized to aerobic (AE, n=21) or combined (CE, n=20) training. Plasma and intramuscular inflammation and myostatin were measured at rest and following exercise. Tumour necrosis factor-α was negatively associated with lower $^{^{^{.}}}{\rm V}$O2Peak (P=0.01), Rectus femoris-cross sectional area (P=0.002) and incremental shuttle walk test performance (P<0.001). Interleukin-6 was negatively associated with sit-to-stand 60 performances (P=0.006) and hand grip strength (P=0.001). Unaccustomed exercise created an intramuscular inflammatory response that was attenuated following 12 weeks of training. Exercise training did not reduce systemic inflammation, but AE training did significantly reduce mature myostatin levels (P=0.02). Changes in inflammation were not associated with changes in physical performance. Systemic inflammation may contribute to reduced physical function in CKD. Twelve weeks of exercise training was unable to reduce the level of chronic systemic inflammation in these patients, but did reduce plasma myostatin concentrations. Further research is required to further investigate this.

Correlation of Carotid Artery Intima-Media Thickness with Age, Body Mass Index and Glomerular Filtration Rate in Chronic Kidney Disease Patients

Introduction: Ultrasound measurements of the intima media thickness (IMT) in the carotid arteries is a strong predictor for cardiovascular events both in the general and diseased population. Materials &amp; Methods: This cross-sectional analytic study was conducted to observe correlation of CIMT with age, body mass index (BMI) and glomerular filtration rate (GFR) in chronic kidney disease (CKD). The study was done in Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, on 80 chronic kidney disease patients, from July 2014 to June 2015. All the biochemical parameters were measured according to the standard laboratory techniques. Body mass index (BMI) was calculated by person’s body weight divided by height. Glomerular filtration rate (GFR) was calculated using the modification of diet in renal disease (MDRD) formula. CIMT measurement was done by duplex study of carotid vessels through high resolution B-mode ultrasound. Results: Mean age of the patients was 36.1±9.5 years. 20 (25%), 26 (32.5%) and 34 (42.5%) patients were in CKD stage 3, 4 and 5 respectively. Age, serum creatinine and GFR showed statistically significant difference among stage 3, 4 and 5 CKD patients (p&lt;0.001). However, no difference was evident in BMI and mean CIMT among stage 3, 4 and 5 CKD patients. Significant positive correlations were found between age and CIMT (r=+0.332; p=0.003) and BMI and CIMT (r=+0.294; p=0.008). However, no significant correlation was evident with estimated glomerular filtration rate (eGFR) and CIMT (r=–0.181; p=0.109). Conclusion: Age, serum creatinine and estimated glomerular filtration rate showed statistically significant difference among different stages of CKD patients (stage 3, 4 and 5). There were significant positive correlations found in between age and CIMT as well as BMI and CIMT in chronic kidney disease patients, with an exception to GFR and CIMT. Medicine Today 2021 Vol.33(2): 147-151

A study to compare hemoglobin levels and body mass index in normal and diagnosed diabetic stages of CKD patients visiting a tertiary care hospital

Chronic kidney disease (CKD) has become a worldwide community health problem in people with type, 2 diabetes obesity and long-term hyperglycemia may cause renal vascular complications. The aim of this study was to see if there was any connection between BMI, haemoglobin and CKD in DM patients. This case study was conducted in department of Medicine, Era′s Lucknow Medical College and Hospital, ERA University, Lucknow. The analysis was performed for 18 months.When compared to CKD patients, the non-CKD group's mean BMI was marginally higher. Older age, female sex, hypertension, and diet plant were all linked to the involvement of CKD in multivariable study. There was same connection between CKD and haemoglobin in this study. The negative relationship between BMI, Hb and CKD could indicate reverse causality. While a diabetic patient's BMI does not cause them to develop CKD, it is possible that CKD causes them to have a lower BMI and Hb level.

Role of hepcidin as a biomarker for iron status and its effect on anemia management in patients with chronic kidney disease (stage II-Iv) after HCV treatment

Abstract Background Anemia is a severe complication of chronic kidney disease (CKD) that is seen in more than 80% of patients with impaired renal function. Although there are many mechanisms involved in the pathogenesis of anemia of renal disease, the primary cause is the inadequate production of erythropoietin by the damaged kidneys. Aim of the work to assess hepcidin level in non dialysis patients (CKD stage 4 &amp;5) treated from Hepatitis C virus and its relation to iron parameters. Patients and Methods This study was conducted on 20 CKD patients (stage 4 and 5) treated from hepatitis C virus. All candidates included in this study subjected to careful history taking, full clinical examination and investigations (including complete blood count, renal chemistry, HCVAb, serum iron, total iron binding capacity, TSAT%, ferritin and hsCRP. Serum hepcidin was analyzed by ELISA technique. Results Serum hepcidin was 26.35±7.26; 40% in stage III, 37.8% in stage IV and 22.2% in stage V. There was statistically significant difference between GFR stages according to Hb., Drug intake ACE inhibitor/ARB, Plt., Creatinine, BUN, Iron, TIBC, Ferritin, T SAT%, CRP and Serum Hepcidin. We showed significant correlations between serum hepcidin and TIC, Iron, TIBC, Ferritin and TSAT%. Conclusion Median hepcidin value is elevated in nondialysis CKD patients due to increased inflammation and decreased clearance of hepcidin. Furthermore, iron status modifies serum hepcidin level and its association with Hb. Increased hepcidin level leads to iron-restricted erythropoiesis and recombinant human EPO (rhEPO) resistance by inhibiting iron absorption from gut and iron recycling from macrophages. Hence, elevated hepcidin can predict need for parenteral iron to overcome hepcidin-mediated iron-restricted erythropoiesis and need for relatively higher rhEPO doses to suppress hepcidin.

MO440KLOTHO AS A BIOMARKER OF SUBCLINICAL CARDIOVASCULAR DISEASE IN CHRONIC KIDNEY DISEASE: A PROOF-OF-CONCEPT STUDY*

Abstract Background and Aims Cardiovascular disease (CVD) is the major cause of mortality among chronic kidney disease (CKD) patients. Reductions in serum Klotho levels are related to the prevalence of CVD in CKD patients. However, it is unclear whether circulating Klotho, and its expression in peripheral blood cells (PBCs), are associated with subclinical atherosclerotic cardiovascular disease (sCVD) in these subjects. In this proof-of-concept study, we analyzed in a group of CKD patients the relationship between Klotho and two markers of sCVD: ankle-brachial index (ABI) and carotid intima-media thickness (CIMT). Method Gene expression in PBCs and serum levels of Klotho and inflammatory cytokines (TNF, IL6 and IL10) were measured in 103 CKD patients (stages 3-4), older than 18 years of age, and without known atherosclerotic cardiovascular disease. Biochemical data were obtained following standardized clinical methods. The presence of sCVD was defined as ABI &amp;lt; 0.9 and/or CIMT ≥ 0.9 mm. Patients with ABI values ≥ 1.3 were excluded. Results Patients with sCVD presented lower serum and PBCs expression levels of Klotho (P&amp;lt;0.001 for both). Stratified analysis showed that upper tertiles of both serum and PBCs expression levels of Klotho presented significantly higher ABI (P&amp;lt;0.001 for both Klotho determinations) and lower CIMT (P&amp;lt;0.001 for serum levels and P&amp;lt;0.01 for KL expression in PBCs), which resulted in a lower prevalence of sCVD (P&amp;lt;0.001 for both determinations of Klotho). Correlation analysis showed that both serum and PBCs mRNA Klotho levels were positively correlated with ABI (r=0.556, P&amp;lt;0.0001; and r=0.373, P&amp;lt;0.0001, respectively) and inversely correlated with CIMT (r=-0.541, P&amp;lt;0.0001; and r=-0.437, P&amp;lt;0.0001, respectively). Among inflammatory markers, only serum IL6 levels presented significant associations with sCVD, being inversely related with ABI (r=-0.568, P&amp;lt;0.0001) and positively associated with CIMT (r=0.558, P&amp;lt;0.0001). Multiple regression analysis with ABI and CIMT as dependent variables demonstrated that both Klotho variables, together with serum IL6, were positively and significantly associated with ABI (adjusted R2=0.511, P&amp;lt;0,0001) and CIMT (adjusted R2=0.445, P&amp;lt;0,0001) values, independently of traditional and emergent cardiovascular risk factors. Multivariate logistic regression, using the presence/absence of sCVD as the dependent variable, showed that circulating Klotho, and its expression in PBCs constituted independent protective factors for sCVD [OR (95% CI): 0.993 (P=0.002) and 0.231 (P=0.025), respectively]. Receiver operating curve (ROC) analysis pointed to the prognostic ability for sCVD of serum Klotho (area under the curve [AUC]: 0.817, 95% CI: 0.736–0.898, P&amp;lt;0.001) and its gene expression in PBCs (AUC: 0.742, 95% CI: 0.647–0.836, P&amp;lt;0.001). Conclusion The reductions in serum soluble and PBCs expression levels of Klotho in CKD patients are independently associated with the presence of sCVD. Further research exploring whether therapeutic approaches to maintain or elevate the Klotho level could reduce the impact of CVD in CKD patients is warranted.

MO472A PRELIMINARY STUDY OF POTENTIAL BIOMARKERS FOR EARLY DIAGNOSIS IN CHRONIC KIDNEY DISEASE

Abstract Background and Aims The conventionally used biomarkers for chronic kidney disease (CKD) diagnosis are not very sensitive for early diagnosis. Their values become clinically significant only when kidney damage is advanced, and a substantial filtration capacity has been lost. The reliance on these biomarkers may result in a long-time lapse in diagnosis, compromising the earlier use of successful therapeutic interventions to prevent CKD progression and reduce the risk of other common comorbidities. The study of earlier and more sensitive biomarkers for CKD diagnosis is an important medical need. Potentially new biomarkers reflecting different pathophysiological processes underlying CKD, such as changes in renal function, tubulointerstitial injury, inflammation and fibrosis, have been proposed. The use of a panel of biomarkers is likely to be synergetic in detecting CKD, since there are several different mechanisms by which CKD can initiate. Our aim was to identify markers of renal damage/dysfunction and evaluate their sensitivity for CKD detection, in patients at the earlier stages of the disease, stages 1 and 2. Method This study included 32 healthy controls and 29 CKD patients at stages 1 and 2, categorized according to the KDIGO guidelines, using the CKD-EPI equation based on serum creatinine to estimate the glomerular filtration rate (GFR). Causes of CKD in the studied patients were diabetes mellitus (n = 19), polycystic kidney disease (n = 1) and of unknown cause (n = 7) or other (n = 2). Circulating levels of creatinine and β-trace protein (BTP), as markers of renal function; interleukin 6 (IL-6), as a marker of inflammation; tissue inhibitor metalloproteinase 1 (TIMP 1), as a marker of tubulointerstitial injury; pro B-type natriuretic peptide (proBNP), as a marker of cardio-renal dysfunction; and cell-free DNA (cfDNA), as a marker of cellular damage, were evaluated. Results Compared to controls, we found significantly higher values of all studied markers in CKD patients (stage 1 and stage 2): BTP, TIMP-1, IL-6, pro-BNP, and cfDNA. In CKD patients, GFR was negatively correlated with circulating levels of pro-BNP (r = -0.610, P = 0.004, n = 20) and cfDNA (r = -0.408, P = 0.028, n = 29); and, microalbuminuria was positively correlated with circulating levels of BTP (r = 0.465, P = 0.013, n = 28). The biomarker cfDNA was positively correlated with TIMP-1 (r = 0.445, P = 0.16, n = 29) , a marker of tubulointerstitial injury, and with IL-6 (r = 0.670, P &amp;lt; 0.001, n = 29), a marker of inflammation. All patients presented at least two of the studied biomarkers with higher values than the median value presented by controls. Of all studied biomarkers, BTP was the one that was most altered in patients (86.2% presented higher values than the highest value presented by controls). Conclusion Our results suggest that the studied biomarkers are sensitive to the primary response to renal injury, being significantly elevated in the earlier stages of CKD, particularly BTP. Pro-BNP and cfDNA correlate well with disease severity assessed by GFR. The use of a panel comprising several biomarkers, related with different pathophysiological mechanisms underlying CKD initiation and progression, may increase the potential to detect patients at risk, when compared with the evaluation of each biomarker alone. Further validation for the use of these new potential biomarkers requires larger studies with standardized analytical methodologies. Acknowledgments: This work was supported by Applied Molecular Biosciences Unit (UCIBIO) and financed by FEDER COMPETE2020 funds UIDB/04378/2020 and UIDP/04539/2020 (CIBB); by POCI-01-0145-FEDER-007440; by FCT doctoral grant SFRH/BD/145939/2019; by funds from Portugal Regional Coordination and Development Commissions (Norte-01-0145-FEDER-000024).

MO515CONSTIPATION IN CHRONIC KIDNEY DISEASE: PREVALENCE AND RISK FACTORS

Abstract Background and Aims Among various gastrointestinal disorders, constipation is one of the most common symptom in chronic kidney disease (CKD). However it is often neglected by nephrologists as self-limiting condition. Constipation impacts quality of life in multiple ways and increases socio-psychological burden. Constipation and associated risk factors have been poorly studied and most studies are retrospective. Method We enrolled CKD stage 3 to 5 patients on regular follow-up with nephrologist from June 2018 to June 2020, at a tertiary care centre in North India. Constipation was defined using Rome IV criteria (Functional constipation) which is composed of six constipation related symptoms, and diagnosis of constipation is established by presence of two or more symptoms for at least 3 months. Patients were also asked to maintain a 7 day prospective stool diary. It consisted of seven day written prospective chart of stool form and frequency. Patients were instructed to record when each bowel movement happened and to mark stool form type for each movement as described in words and pictures on Bristol Stool Form Scale (BSFS). Opioid induced constipation was defined as per Rome IV criteria. The diagnostic criteria is similar to functional constipation, but with requisite that new or worsening symptoms occurred when initiating, changing or increasing opioid therapy. Results Two hundred twenty five patients were studied out of which 59 (26.2%) patients were in CKD stage3, eighty one (36%) patients were in CKD stage4 and 85 (37.8%) patients were in stage5. Out of 85 CKD stage5 patients, 23 (27%) were on dialysis. Mean age of patients was 49.1 years. Out of 225 patients, 135 (60%) were male. Constipation symptoms and diagnosis reported in each stage has been depicted in Table 1. Clinical correlates of constipation has been depicted in Table 2. Conclusion Constipation measured using Rome IV criteria affects around two-third of CKD stage 3-5 patients. Diabetes, hypertension and opioid use has been found to be significantly associated with constipation.

A longitudinal qualitative study to explore and optimize self-management in mild to end stage chronic kidney disease patients with limited health literacy: Perspectives of patients and health care professionals

ObjectivesLimited health literacy (LHL) is associated with faster kidney deterioration. Health care professionals (HCPs) promote self-management to maintain kidney function, which is difficult for patients with LHL. Evidence lacks on perceived barriers and best strategies to optimize their self-management. Our study aims to explore experiences with and barriers for self-management from the perspectives of LHL patients and HCPs to identify strategies to optimize self-management. MethodsWe performed a longitudinal qualitative study with semi-structured in-depth interviews and focus group discussions among CKD patients and LHL (n = 24) and HCPs (n = 37) from general practices and hospitals. ResultsFour themes arose among patients: (1) CKD elusiveness, (2) suboptimal intake of knowledge (3) not taking a front-seat role, and (4) maintaining change. Among HCPs, three themes emerged: (1) not recognizing HL problems, (2) lacking effective strategies, and (3) health care barriers. ConclusionWe suggest three routes to optimize self-management: providing earlier information, applying person-centered strategies to maintain changes, and improving competencies of HCPs. Practice implicationsHCPs need to explain CKD self-management better to prevent kidney deterioration. New interventions, based on behavioral approaches, are needed to optimize self-management. HCPs need training to improve recognition and support of LHL patients.

POS-484 COVID-19 RISK PERCEPTION IN PATIENTS WITH ADVANCED CHRONIC KIDNEY DISEASE

People with chronic kidney disease (CKD) are at increased risk of severe illness from COVID-19 (SARS-Cov2 infection). In the UK people with the greatest risk of severe illness were advised to shield from late March –August 2020. Until November this did not include patients with CKD stage 5 (CKD5). Our Low Clearance Clinic (LCC) cares for 500+ patients with GFR <20ml/min, most with CKD5. Our community has high levels of deprivation and an ethnically diverse population, and suffered high levels of COVID-19 mortality and morbidity during the first wave. As cases began to rise in the UK second wave we aimed to assess COVID-19 risk perception, factors affecting this, and impact on personal behaviour among our LCC cohort, with a view to improving our communication to patients. All suitable patients attending LCC appointments (face to face and telephone) at a single London hospital during a seven week period in Autumn 2020 were invited to participate. The study terminated at the start of the second England-wide lockdown. Participation comprised completion of an anonymous survey. After completion patients were provided with an information leaflet highlighting the vulnerability of CKD5 patients to COVID-19 and advice to reduce their chances of acquiring infection. • 89 participants (Table 1). • 5/89 (5.6%) had had COVID-19, and a further 29 (32.6%) knew people who had it. 22 (24.7%) knew someone who had either died of or been hospitalised with COVID-19.• Just over half (47, 52.8%) knew that their risk of severe illness should they catch COVID-19 was much higher than average for people of their age. The majority (67, 75.3%) thought that their risk was at least somewhat increased, 13 (14.6%) considered that they were at average risk, and 5 (5.6%) thought it was lower or much lower.• Patients were generally very worried about becoming seriously unwell from COVID-19 (median 7 on a scale from 0 to 10, IQR 5,10) and somewhat worried about the risks of coming to clinic (median 5, IQR 2,7); answers to both questions spanned the full range from 'not at all' to 'extremely' worried.• 38 (42.7%) said that they been advised to shield during the first lockdown. 9 (10.1%) weren’t sure if they were asked to shield or not. Self-reported adherence to shielding advice was high, including among those who did not think they had been advised to shield, but this was not universal (Figure 1).View Large Image Figure ViewerDownload Hi-res image Download (PPT)• Family, News and Government were popular sources of information. Information from specialist medical teams (predominantly Renal) was considered very useful but relatively scarce (Figure 2).View Large Image Figure ViewerDownload Hi-res image Download (PPT)• 14/87 (16.1%) said that they were definitely not or not very interested in a vaccine. Many LCC patients recognise their increased risk and are appropriately worried about COVID-19. However, a significant minority are not aware of their clinical vulnerability to severe COVID-19, and some have not adapted their behaviour to protect themselves. It is concerning that so many were unclear about their personal risk, including whether meant to be shielding or not. There is an opportunity for Renal teams to provide more information; it is likely to be considered useful. We acknowledge that during the pandemic clinicians focussed on delivering clinical care, with less attention to communication, which is made harder by constantly evolving information and the difficulty of conveying complex messages about risk.

Use of Three‐Dimensional Arterial Spin Labeling to Evaluate Renal Perfusion in Patients With Chronic Kidney Disease

A noninvasive method for evaluating renal blood flow (RBF) in patients with chronic kidney disease (CKD) may have clinical value in disease staging, management, and prognostication. To evaluate effectiveness of three-dimensional pseudocontinuous arterial spin labeling (pCASL) and pulsed arterial spin labeling (PASL) in assessment of cortex and outer medulla (cortex/OM) RBF in CKD patients and healthy volunteers (HVs). Prospective, in a single institution. A total of 48 CKD patients (stage 1, 2, 3, and 4-5: N=11, 12, 13, and 12, respectively) and 18 HVs FIELD STRENGTH/SEQUENCE: 3 T, pCASL, and PASL with a three-dimensional hybrid gradient echo/spin echo sequence. Quality of RBF images derived from pCASL and PASL were evaluated and RBF in cortex/OM measured. Clinical and laboratory data were recorded. Image quality differences between pCASL and PASL were evaluated with Wilcoxon signed-rank test. For both methods, analysis of variance, followed by Fisher's LSD-t test, was used to determine whether RBF differed between CKD stages and HVs. Pearson correlation coefficients were calculated to assess strength of relationships between cortex/OM RBF and data from clinical and laboratory tests. Image quality differences were significantly higher in pCASL than PASL in both patients and HVs (both P < 0.05). For pCASL, cortex/OM RBF of patients were significantly lower than those of HVs (P < 0.05). Cortex/OM RBF were higher in S1 and S2 patients than those in S3 and S4-5 (P < 0.05). For PASL, only RBF in cortex of S1 and S2 patients were significantly higher than those of S4-5 (P < 0.05). Good correlations between pCASL RBF and estimated glomerular filtration (eGFR) were found in cortex/OM of patients (rho=0.796 and 0.798, respectively, both P < 0.05), higher than those between PASL RBF and eGFR (rho =0.430 and 0.374, respectively, both P < 0.05). Three-dimensional pCASL may potentially be a noninvasive technique to assess renal perfusion in CKD patients in different stages. 1 TECHNICAL EFFICACY: Stage 2.

Insulin resistance in nondiabetic chronic kidney disease patients.

Chronic kidney disease (CKD) is accompanied by numerous metabolic derangements due to risk factors such as oxidative stress, chronic inflammation, and endothelial dysfunction. Insulin resistance (IR) has been reported as an independent risk factor for cardiovascular morbidity and mortality in patients with CKD. As reported from previous studies, it has been shown that IR is also seen in mild-to-moderate stages of CKD. Hence, the present study aimed to study IR in nondiabetic CKD patients and correlated with different stages of CKD. A two-year cross-sectional study was conducted in 175 patients among whom 25 healthy controls and 150 nondiabetic CKD patients in different stages are included. In the present study, fasting insulin and homeostatic model assessment for IR (HOMA-IR) levels were found to be higher in all nondiabetic CKD patients when compared to controls which was found to be statistically significant (P <0.05). In the present study, IR, as evidenced by HOMA-IR, is noted in patients on predialysis, continuous ambulatory peritoneal dialysis (CAPD), and postrenal transplant patients. Hence, periodic monitoring of IR by HOMA-IR might be prudent in CKD patients on predialysis, CAPD and in postrenal transplant patients. Interventions targeting IR in this patient population can also decrease cardiovascular morbidity and mortality.

Osteoprotegerin is a marker of cardiovascular\xa0mortality\xa0in patients with chronic kidney disease stages 3\u20135

Cardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD). Osteoprotegerin (OPG), known to regulate bone mass by inhibiting osteoclast differentiation and activation, might also play a role in vascular calcification. Increased circulating OPG levels in patients with CKD are associated with aortic calcification and increased mortality. We assessed the predictive role of OPG for all-cause and cardiovascular mortality in patients with CKD stages 3–5 over a 5-year follow-up period. We evaluated the relationship between OPG and all-cause and cardiovascular mortality in 145 CKD patients (stages 3–5) in a prospective observational follow-up study. Inflammation markers, including high-sensitivity C-reactive protein, standard echocardiography, and estimation of intima-media thickness in the common carotid artery, were assessed at baseline, and correlations with OPG levels were determined. The cutoff values for OPG were defined using ROC curves for cardiovascular mortality. Survival was assessed during follow up lasting for up to 5.5 years using Fine and Gray model. A total of 145 (89 men; age 58.9 ± 15.0 years) were followed up. The cutoff value for OPG determined using ROC was 10 pmol/L for general causes mortality and 10.08 pmol/L for CV causes mortality. Patients with higher serum OPG levels presented with higher mortality rates compared to patients with lower levels. Aalen–Johansen cumulative incidence curve analysis demonstrated significantly worse survival rates in individuals with higher baseline OPG levels for all-cause and cardiovascular mortality (p < 0.001). In multivariate analysis, OPG was a marker of general and cardiovascular mortality independent of sex, age, CVD, diabetes, and CRP levels. When CKD stages were included in the multivariate analysis, OPG was an independent marker of all-cause mortality but not cardiovascular mortality. Elevated serum OPG levels were associated with higher all-cause and cardiovascular mortality risk, independent of age, CVD, diabetes, and inflammatory markers, in patients with CKD.

Cystatin C, Vitamin D and Thyroid Function Test Profile in Chronic Kidney Disease Patients.

Background: The progression of chronic kidney disease (CKD) is concomitant with complications, including thyroid dysfunction, dyslipidemia and cardiovascular diseases. The aim of this study is to determine serum cystatin C levels, and the prevalence of vitamin D deficiency and thyroid dysfunction in CKD patients. Methods: A cross-sectional study was conducted involving 140 CKD patients (stages 1–5) that were referred to a renal clinic. Demographic data was collected and thyroid function tests, serum 25-OH-vitamin D, cystatin C levels, and routine biochemistry tests were determined using cobas 6000 analyzer. Results: 129 (92.1%) of CKD patients had elevated serum cystatin C levels and there was a stepwise increase from stage 1–5. Overt hypothyroidism was present in one patient and nine had subclinical hypothyroidism. There was a stepwise reduction in serum 25-OH-vitamin D levels from stage 2–5, 31 (22.1%) had vitamin D insufficiency and 31 (22.1%) presented with deficiency. Conclusions: 25-OH-vitamin D deficiency and thyroid disorders are exhibited in chronic kidney disease patients and the severity of the former rises with disease progression, as indicated by elevated cystatin C levels. Routine screening and timely intervention is recommended so as to reduce the risk of cardiovascular diseases.

Determination of Serum Perfluorooctanoic Acid and Perfluorooctanesulfonic Acid Levels with Different Stages of Chronic Kidney Disease.

The aim of this study is to investigate the perfluorooctanoic acid (PFOA) and perfluorooctanesulfonic acid (PFOS) levels in patients with different stages of chronic kidney disease (CKD). Sixty-one CKD stage 1-4 patients who applied to the nephrology outpatient clinic were recruited. A control group consisting of 26 age- and sex-matched healthy controls were also included in the study. Concentrations of PFOA and PFOS were determined by comparing their peak areas with their standard curves. All samples were analyzed three times. The average values of blank samples were subtracted from the detected PFOA and PFOS values. PFOA and PFOS levels were significantly higher in CKD group than the controls (11.4 ± 7.47, 0.45 ± 0.55; 0.13 ± 0. 17, 0.19 ± 0.4 ng/mL, respectively) (P = 0.001). Hemoglobin, serum albumin, and estimated glomerular filtration rate (eGFR) levels were significantly lower and potassium and uric acid levels were higher in the CKD group than the controls. PFOA and PFOS levels were significantly higher in all stages of CKD patients than healthy controls. However, there was no correlation between eGFR, and PFOS and PFOA. We have demonstrated significantly increased PFOA and PFOS concentrations in different stages of CKD patients. We could not find an association between eGFR, age, and serum PFOS and PFOA concentrations.

Assessment of Ischemia Modified Albumin as a Marker of Oxidative Stress in Chronic Kidney Disease.

Increased oxidative stress (OS) in chronic kidney disease (CKD), and particularly in those undergoing hemodialysis (HD), is widely recognized. We aimed to evaluate ischemia modified albumin (IMA) as a marker of OS in CKD patients who are not yet on HD compared to chronic HD patients. A cross-sectional study was conducted in Hitit University, Corum, Turkey in 2015. In this study, 39 chronic HD and 36 CKD patients in stage 3-4 were included, as well as 34 healthy individuals as a control group. IMA levels in HD patients (before and after HD session), stage 3-4 CKD patients and control group were evaluated using the ELISA method. Pre-HD and post-HD albumin levels were measured and albumin-adjusted IMA (aIMA) levels were calculated. IMA and aIMA levels were higher in chronic HD and CKD patients who are not yet on HD, compared to healthy individuals (IMA, 179.76 ± 60.46, 209.67 ± 69.84, 67.41 ± 32.22, P <0.001, respectively, aIMA, 186.22 ± 64.84, 212.96 ± 72.84, 68.80 ± 34.42, P <0.001, respectively). Likewise, IMA and aIMA levels in post-HD patients were higher than pre-HD levels (IMA, 294.62 ± 66.64, 179.76 ± 60.46, P <0.001, respectively, aIMA, 298.31 ± 70.93, 186.22 ± 64.83, P <0.001). Linear regression analysis identified glomerular filtration rate as the most effective factor on IMA (P <0.001). CKD is associated with increased OS and the HD procedure itself also contributes to the increase in OS. IMA may serve as a feasible biomarker for determination of OS.

Assessment of semen parameters and Anti-müllerian hormone level in patients with chronic kidney disease on hemodialysis: a case control study

Background and Objective: Chronic kidney disease (CKD) is a common health problem which is accompanied by considerable morbidity and mortality. Anti-müllerian hormone (AMH) is one of the hormones that are affected by CKD. The objective was to assess semen parameters and AMH level in CKD patients on hemodialysis. Material and methods: This study was a case control study of 20 patients with stage 4 and 5 CKD on hemodialysis, attending Nephrology Outpatient Clinic and Renal Dialysis Unit of Suez Canal University hospital and 20 healthy fertile controls. Full history, clinical examination, kidney function tests and semen analysis were performed. AMH level in serum and seminal plasma was measured using ELISA. Results: The mean AMH level in serum of case group was 3.35 ± 2.43 ng/mL versus 4.13 ± 3.17 ng/mL in the controls respectively (p &gt; 0.05) while mean AMH level in semen of the case group was 2.13 ± 2.64 ng/mL compared to 9.37 ± 3.79 ng/mL in controls respectively (p &lt; 0.05). There was a positive correlation between AMH in seminal plasma and sperm count, total sperm motility, progressive sperm motility and sperm viability, while the AMH level in serum was insignificantly related. Conclusion: Semen parameters in CKD patients on hemodialysis were significantly poorer than normal controls AMH in seminal plasma was significantly decreased in CKD patients (stage 4–5 on hemodialysis) and significantly correlated with the semen parameters.

Study of the Prevalence of Echocardiographic Abnormalities and their Relation to Disease Progression in Chronic Kidney Disease

Context: Study of the prevalence of echocardiographic abnormalities and there relation to disease progression in chronic kidney disease (CKD). Aims: Study correlation of echocardiographic changes and CKD progression. Settings and Design: A prospective, cross-sectional, observational, analytical study, where we performed complete echocardiographic evaluation of patients with CKD stage II–V. We compared various echocardiographic parameters to predict the progression of CKD. Subjects and Methods: Ninety CKD patients stage II–V presenting to our hospital from November 2016 to December 2017 were included in the study. A complete echocardiographic evaluation was done. Left ventricular hypertrophy (LVH), systolic and diastolic dysfunction using Doppler indices at mitral inflow, left atrial volume, speckle tracking, and global longitudinal strain (GLS) were studied. Results: Patients were age and sex matched in all the groups with a male preponderance. Forty-one patients (45.56%) were diabetic and 74 (82.22%) were hypertensive. The prevalence of hypertension increased from 66.67% to 89.29% as CKD stage progressed from stage II to stage V. There were significant echocardiographic abnormalities seen in CKD patients. The severity increased with worsening of the stages of CKD. LVH and early diastolic mitral inflow to annular velocity ratio progression was statistically significant when stage V was compared to stage II. Left atrial volume, mitral early diastolic to late diastolic velocity ratio, maximum tricuspid regurgitation (TRmax) velocity, and diastolic dysfunction prevalence were significantly raised in stage IV and stage V compared to stage II. Only GLS showed statistical significance between stage II to stage III, stage IV and stage V and thus predicting progression of CKD. Conclusions: LVH, dilated left atrium, abnormal GLS, TRmax, diastolic dysfunction, and related tissue Doppler imaging parameters correlate with worsening renal function. GLS was the only parameter showing significant difference between stage II and stage III. This can be used as a novel modality for detection of subclinical cardiac dysfunction in CKD.