Glomerular Filtration Rate Values Research Articles

A Report of 61 Cases of Retroperitoneal Laparoscopic Nephron-Sparing Surgery and Factors Affecting Postoperative Renal Function.

Objective To explore the situation of 61 patients with renal tumors who underwent retroperitoneal laparoscopic nephron-sparing surgery (RLNSS) and the factors affecting postoperative renal function. Methods A total of 61 patients with renal tumors who underwent RLNSS in our hospital from January 2018 to January 2021 were included in this study. All patients were treated with RLNSS. The clinical data of patients were recorded. Before operation and 3 months after operation, the change value of glomerular filtration rate (ΔGFR) was measured by the Gates method. Multivariate linear regression was used to analyze the related factors affecting postoperative renal function. Results All 61 patients successfully completed the operation. The mean operative time was 60–150 min‚ average (98.75 ± 14.38) min. The estimated intraoperative blood loss was 20–310 ml‚ average (107.93 ± 68.55) ml. Intraoperative warm ischemia time (WIT) was 0–39 min, with an average of (21.16 ± 6.47) min. All patients' pathological margins were negative after operation. In all patients, there were 5 postoperative complications, including 2 cases of renal wound bleeding (3.28%), 1 case of hematuria (1.64%), 1 case of urinary fistula (1.64%), and 1 case of subcutaneous emphysema (1.64%). There were significant differences in tumor diameter, preoperative GFR, operation time and WIT (P < 0.05). Multivariate analysis showed that tumor diameter, preoperative GFR, and WIT were all factors affecting the postoperative renal function of patients with RLNSS (P < 0.05). Conclusion RLNSS has a good curative effect on patients with renal tumor, and tumor diameter, preoperative GFR, and WIT were all factors affecting the postoperative renal function of patients with RLNSS.

Dose-dependent dynamics of glomerular filtration rate in patients with reduced renal function in the postinfarction period

Abstract Objective To evaluate the effect of 48-week therapy with atorvastatin at various doses on the glomerular filtration rate (GFR) in patients after acute ST-segment elevation myocardial infarction (STEMI). Methods 103 STEMI patients aged 52 (45.5; 59) years (92 men and 11 women) were examined. The patients were randomized into three groups: group 1 – 39 patients taking atorvastatin 80 mg; group 2 – 26 patients who received atorvastatin 40 mg; group 3 – 38 people who took atorvastatin 20 mg. The compared subjects were matched by age, sex, height, BMI, and office BP. All patients were receiving STEMI treatment prior to study entry. Initially and after 24, 48 weeks of follow-up, the creatinine level was determined on an Olympus AU400 analyzer (Olympus Corporation, Japan), followed by the calculation of GFR using the CKD-EPI formula. Results In group 1, GFR was 86.3 at baseline [95% CI 80.3; 92.3], after 24 weeks – 85.1 [95% CI 80.4; 89.7], after 48 weeks – 85.9 [95% CI 80.4; 91.4] ml/min. In group 2, the following GFR values were found: on days 7–9 – 78.4 [95% CI 73; 83.8], after 24 weeks – 82.2 [95% CI 75.5; 89], and 48 weeks – 78.9 [95% CI 74.1; 83.6] ml/min. In group 3, GFR was 88.2 at baseline [95% CI 80.9; 95.5], at the 24th week – 84.9 [95% CI 80.4; 89.4], after 48 weeks of therapy – 81.1 [95% CI 75.5; 86.7] ml/min. Individuals with a baseline decreased GFR &amp;lt;90 ml/min were identified in each group in accordance with the clinical practice guidelines of KDIGO (2012). At the same time, against the background of therapy with atorvastatin 80 mg, a significant increase in GFR from 71.8 [95% CI 67.9; 75.7] to 79.9 [95% CI 74.2; 85.6] after 24 weeks (p=0.02) and the subsequent increase in GFR to 81.0 [95% CI 74.9; 87.2] ml/min after 48 weeks (p=0.02). Against the background lower doses of atorvastatin, GFR dynamics were not observed: in group 2 – 74.0 [95% CI 69.1; 78.9], 79.3 [95% CI 71.5; 87.1], 77.2 [95% CI 71.7; 82.7] ml/min; in group 3 – 70.9 [95% CI 67.6; 74.1], 79.2 [95% CI 73.1; 85.4], 74.9 [95% CI 65.9; 83.9] ml/min. Conclusions In STEMI patients with an initially reduced GFR level, only atorvastatin therapy at a dose of 80 mg for 48 weeks of treatment was accompanied by a significant improvement in renal function. Funding Acknowledgement Type of funding sources: None.

Assessment of glomerular filtration rate measurement in dogs using dynamic contrast CT compared to serum iohexol clearance.

Dynamic contrast CT with Patlak plot analysis can be used to determine the glomerular filtration rate (GFR). However, several studies have shown different GFR values and they are most likely less than the values by the standard techniques. The purpose of this prospective, experimental, and method comparison study was to evaluate the GFR using a CT technique (CT-GFR) in 12 healthy dogs compared to serum iohexol clearance (SIC-GFR). All dogs were anesthetized and placed in the right lateral recumbency position and the caudal part was lifted inside the CT gantry. A single-slice dynamic CT of the aorta and both kidneys was scanned sequentially every 2 s for 2 min after a bolus injection (3mL/s) of iohexol (300 mg/kg). Time attenuation curves (TAC) were constructed and the GFR per volume of kidney was calculated using the Patlak plot analysis method based on 30-120 s time intervals, and results were compared to global GFR from SIC that was determined with eight blood samples for up to 240 min. The CT-GFR value (1.85 ± 0.48 mL/min/kg) was significantly less than the SIC-GFR value (3.40 ± 0.80 mL/min/kg; P<.05). The CT-GFR was correlated with SIC-GFR by the coefficient of correlation (r) at 0.61 (P = .046). In conclusion, the CT-GFR underestimated SIC-GFR and should be used carefully. We suggest that the GFR should be calculated using the equation derived from linear regression between CT-GFR and the standard GFR method. With its own particular parameters, each institute should have its own prediction equation.

Effects of sacubitril/valsartan in patients with a systemic right ventricle: early evidence of exercise tolerance and systolic function improvement

Abstract Background Sacubitril/valsartan has been shown to reduce mortality and morbidity inpatients with heart failure and reduced systolic function. However, the effects of this novel association in patients with congenital heart disease and a systemic right ventricle (sRV) have not been investigated yet. Purpose We aimed to assess tolerability and efficacy of sacubitril/valsartan in patients with a sRV Methods From September 2020 to March 2021, 38 patients with congenitally corrected transposition of the great arteries or transposition of the great arteries after Senning or Mustard repair were prospectively enrolled. Inclusion criteria were: age ≥18 years, optimal medical therapy including ACEi/ARB for at least 6 months and EF of the sRV ≤40%. Patients with univentricular physiology, systolic blood pressure (SBP) &amp;lt;90mmHg, glomerular filtration rate (GFR) &amp;lt;30ml/min or K &amp;gt;5.5mEq/L were excluded. RV systolic function was assessed on echocardiography using a multiparametric evaluation. The study protocol contemplates serial assessments at 1, 3, 6 and 12 months after treatment initiation. Results Up to March 31th, 23 patients completed 1-month and 15 completed 3-month assessment after treatment initiation. Baseline patients' characteristics are summarized in table 1. The medication dose was up-titrated to the highest tolerated dose during follow-up. During early follow-up, no major adverse events were reported. Treatment did not impact significantly on the values of serum potassium (basal K+ 4.4 [4.2–4.6] mEq/L, K+ at 3 months 4.4 [4.3–4.6] mEq/L, p=0.7) and GFR (basal GFR 113.9±35ml/min, GFR at 3 months 107.8±21 ml/min, p=0.7). Although SBP did not change significantly (114±12 vs 113.9±19 mmHg at 1-month and 117.3±12 mmHg at 3 months; p=0.9 for both), 2 (5%) patients ceased the treatment due to symptomatic hypotension during the first month of treatment. There was no significant change in the NYHA class. However, the 6-minute walking distance increased significantly after 3 months (365±120 vs 498.3±71 min; p=0.01). Furthermore, while traditional echocardiographic parameters of RV systolic function (TAPSE, s wave and FAC) did not change significantly, RV global longitudinal strain (GLS) and RV free wall GLS demonstrated subclinical improvement in right ventricular systolic function (table 2). Conclusions Our short-term results from an ongoing prospective study showed that sacubitril/valsartan is well tolerated in patients with a sRV with early evidence of improvement in exercise tolerance and sRV systolic function. Longer follow-up is warranted to confirm these data. Funding Acknowledgement Type of funding sources: None. Table 1Table 2

Renal decline in patients with atrial fibrillation treated with rivaroxaban or warfarin: a population-based cohort study in the United Kingdom

Abstract Background A recent observational study (1) has suggested that renal decline among patients with non-valvular atrial fibrillation (NVAF) could be faster in users of warfarin vs. rivaroxaban. Purpose To estimate renal decline in patients with NVAF and preserved renal function who started oral anticoagulant (OAC) therapy with rivaroxaban 20 mg or warfarin. Methods Using primary care electronic health records (EHRs) from the United Kingdom (UK), we identified patients with NVAF who initiated rivaroxaban (20 mg/day, N=5338) or warfarin (N=6314) from January 2014–March 2019. Patients were excluded if they had no estimated glomerular filtration rate (eGFR) or serum creatinine (sCr) values recorded in the year before OAC initiation, a history of end-stage renal disease (ESRD), or baseline eGFR &amp;lt;50 ml/min/1.73m2. We identified three renal decline outcomes during follow-up: a) doubling of sCr levels, b) ≥30% decline in eGFR (confirmed by a subsequent measurement), and c) ESRD (code for ESRD/stage 5 CKD/chronic dialysis, or eGFR &amp;lt;15 ml/min/1.73m2 confirmed by subsequent measurement). To identify incident cases of each outcome, we followed patients from OAC initiation to the earliest of a renal decline event, death, or the end of the study period (September 2019). Cox regression was used to calculate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for each outcome with rivaroxaban vs. warfarin use, overall and among heart failure and diabetes patient subgroups. We estimated the average eGFR slope using a mixed model regression among the subset of individuals with at least two eGFR measurements during follow-up, where the first was recorded within 120 days of the start of follow-up, and the last was recorded &amp;gt;180 days after the first eGFR measurement (rivaroxaban n=2054, warfarin n=2464). Results After a mean follow-up of 2.5 years, the number of incident cases was: doubling sCr (n=322), ≥30% decline in eGFR (n=1179), and ESRD (n=22). As shown in the Table, after adjusting for age, sex, baseline renal function and comorbidity, HRs for the renal outcomes with rivaroxaban vs. warfarin users were: doubling sCr, 0.63 (95% CI: 0.49–0.81); ≥30% decline in eGFR, 0.76 (95% CI: 0.67–0.86); ESRD, 0.77 (95% CI: 0.29–2.04). Similar results were observed among patients with diabetes or heart failure. Estimated mean loss in renal function during the study period was 2.03 ml/min/1.73 m2 per year among warfarin users and 1.65 ml/min/1.73 m2 among rivaroxaban initiators (p=0.03). Conclusion The risk of renal decline events and rate of decline in renal function among patients with baseline eGFR &amp;gt;50 ml/min/1.73m2 was lower in patients using rivaroxaban 20 mg vs. warfarin. As residual confounding could have been present, further research is needed to confirm/refute our findings. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Bayer AG

Contrast-induced nephropathy after staged balloon pulmonary angioplasty: lower risk compared with left-sided cardiac procedures

Abstract Introduction The risk of contrast-induced nephropathy (CIN) after left-sided cardiac procedures is reported as 10–15%. When the ratio of total contrast volume in ml to glomerular filtration rate (GFR) in mL/min (ratio V/GFR) exceeds 3.7, the risk increases significantly. However, there are few reports regarding the risk of CIN in patients (pts) with right-sided cardiac interventions such as balloon pulmonary angioplasty (BPA) and ratio V/GFR is not validated for use in this procedures. Purpose To assess the prevalence of CIN in pts with chronic thromboembolic pulmonary disease with or without hypertension (CTEPH/CTED) undergoing BPA. Methods Prospective single-centre study that included all BPA sessions performed from 2017 to 2020. Serum creatinine concentration (SC) was measured and the GFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) before and 48 hours after each BPA procedure and 6 months after BPA treatment completion. CIN was defined as an increase of ≥25% and/or ≥0.5 mg/dL in SC from the baseline value within 48h of contrast administration. Results 76 consecutive BPA sessions were performed in 15 CTEPH/CTED pts: mean age 63.2±14.0 years, 60% female, 86.7% CTEPH, mean of 5.3±1.9 sessions per patient with 4.3±1.9 vessels dilated per session. Mean value of GFR before BPA program was 73.5±26.3 mL/min. All the procedures were performed using low-osmolality contrast agent with a 1:1 dilution ratio with normal saline solution. Pts received 273.0±73.0 mL of contrast per session with a ratio V/GFR 3.7±1.7 mL. SC and GFR did not change significantly within 48h after BPA (+3.1%, p=0.07 and −3.0%, p=0.13, respectively). Ratio V/GFR &amp;gt;3.7 occurred in 44.3% of cases (n=31), but CIN occurred in only 5.3% (n=4) with an increase in SC &amp;lt;0.5 mg/dL but ≥25% in 3 cases (+33% in mean) and ≥0.5 mg/dL in 1 case. None of the pts required renal replacement therapy. Higher SC and lower GFR 48h after BPA were significantly correlated with greater rato V/GFR during procedure (r=0.75, p&amp;lt;0.01 and r=−0.74, p&amp;lt;0.01, respectively) – see figure. But neither higher values of ratio V/GFR (OR 1.43; CI95% 0.84–2.41; p=0.19) nor V/GFR &amp;gt;3.7 (OR 1.28; CI95% 0.17–9.6; p=0.81) were predictors of CIN. GFR before procedure did not influence the contrast volume administered (p=0.901), number of vessels (p=0.63) and segments treated by session (p=0.45). At 6 months follow-up, there was a trend for SC (1.3±0.2 mg/dL vs 1.1±0.2 mg/dL, −15%, p=0.43) and GFR (44.5±8.3 mg/dL vs 53.0±12.6 mg/dL, +16%, p=0.34) improvement in pts with impaired renal function at baseline (GFR&amp;lt;60 mL/min). Conclusions These findings suggested that the occurrence of CIN after BPA was low, raising the hypothesis that the influence of contrast agent on renal function could differ in right-sided cardiac interventions. Although the ratio V/GFR may be correlated with the risk of nephropathy, it is necessary to find a new cut-off to predict CIN in BPA pts. Funding Acknowledgement Type of funding sources: None.

Healthy Kidney Segmentation in the Dce-Mr Images Using a Convolutional Neural Network and Temporal Signal Characteristics.

Quantification of renal perfusion based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) requires determination of signal intensity time courses in the region of renal parenchyma. Thus, selection of voxels representing the kidney must be accomplished with special care and constitutes one of the major technical limitations which hampers wider usage of this technique as a standard clinical routine. Manual segmentation of renal compartments—even if performed by experts—is a common source of decreased repeatability and reproducibility. In this paper, we present a processing framework for the automatic kidney segmentation in DCE-MR images. The framework consists of two stages. Firstly, kidney masks are generated using a convolutional neural network. Then, mask voxels are classified to one of three regions—cortex, medulla, and pelvis–based on DCE-MRI signal intensity time courses. The proposed approach was evaluated on a cohort of 10 healthy volunteers who underwent the DCE-MRI examination. MRI scanning was repeated on two time events within a 10-day interval. For semantic segmentation task we employed a classic U-Net architecture, whereas experiments on voxel classification were performed using three alternative algorithms—support vector machines, logistic regression and extreme gradient boosting trees, among which SVM produced the most accurate results. Both segmentation and classification steps were accomplished by a series of models, each trained separately for a given subject using the data from other participants only. The mean achieved accuracy of the whole kidney segmentation was 94% in terms of IoU coefficient. Cortex, medulla and pelvis were segmented with IoU ranging from 90 to 93% depending on the tissue and body side. The results were also validated by comparing image-derived perfusion parameters with ground truth measurements of glomerular filtration rate (GFR). The repeatability of GFR calculation, as assessed by the coefficient of variation was determined at the level of 14.5 and 17.5% for the left and right kidney, respectively and it improved relative to manual segmentation. Reproduciblity, in turn, was evaluated by measuring agreement between image-derived and iohexol-based GFR values. The estimated absolute mean differences were equal to 9.4 and 12.9 mL/min/1.73 m2 for scanning sessions 1 and 2 and the proposed automated segmentation method. The result for session 2 was comparable with manual segmentation, whereas for session 1 reproducibility in the automatic pipeline was weaker.

Chronic kidney disease in patients with recurrent nephrolithiasis and concomitant damage to the cardiovascular system

Introduction. Chronic kidney disease (CKD) is commonly diagnosed in patients with cardiovascular diseases (CVDs) and also manifests itself in most patients with urolithiasis. Numerous studies have shown that renal dysfunction is not only directly related to the high risk of developing various CVDs and chronic heart failure (CHF) as one of the most common complications but also the mortality rate in comorbid patients. CKD and CHF have similar pathogenetic mechanisms and common target organs; co-existing, both pathological conditions accelerate the progression of major diseases and significantly aggravate their course. In patients with recurrent nephrolithiasis combined with CVDs, all the causes leading to the formation of CKD (recurrent obstructive pyelonephritis, nephroangiosclerosis, etc.) are present to some extent.Purpose of the study. To evaluate the incidence and characteristics of CKD in patients suffering from recurrent urolithiasis associated with CVDs.Materials and methods. The prospective study included 406 patients who were treated for recurrent nephrolithiasis and concomitant CVDs from 2007 to 2020 (Urology Division, Burdenko Principal Military Clinical Hospital). From long-term follow-up respondents who lived at least 10 years after inclusion in the study (n = 52), three groups were formed: group I (n = 18) included patients with a combination of essential hypertension (EH) and ischemic heart disease (IHD), complicated by CHF; group II (n = 15) consisted of patients with uncomplicated CVDs (EH – 7 patients, IHD – 8 patients). The control group III (n = 19) included respondents suffering from nephrolithiasis without CVDs. The glomerular filtration rate (GFR) was determined by the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) following the Russian National Guidelines for «Chronic Kidney Disease». The analysis of the obtained data was carried out using Statistica 8.0; the Fisher and Wilcoxon criteria were calculated; the differences were considered significant at p &lt; 0.05.Results. All patients included in the study were repeatedly hospitalized urgently and as planned and underwent at least one non-invasive manipulation or surgery. The average age of the patients was 58.9 ± 2.95 years; men predominated (~ 75 – 78%). A GFR decrease was recorded in 41.1% of patients included in the study, in 40.5% of patients with a combination of nephrolithiasis and uncomplicated CVDs, Also, its decrease was found in 60 (58.8%) of patients with chronic heart failure (CHF) in 41.1% of cases from the general sample and 40.5% of patients without CHF. CKD stage II occurred in 44 (43.1%) cases of CHF; CKD stages III Ca and Cb were detected in 10 (9.8%) and 4 (1%) cases, respectively; CKD stage IV developed in 1 (0.25%) patient with one of the re-hospitalizations. Of the 52 patients included in the second study part, the ratio of men and women was 41/11 (78.8 and 21.2%, respectively). All three groups were also dominated by men. The initial values of GFR in group I patients significantly differed from those in the control group; in group II, statistically significant differences appeared 4 years after the s the study initiation, and in group I – after 2 years. A sharp (1.5-fold) significant decrease in renal filtration function was registered in group I by the 6th research year, in group II (1.3-fold) – by the 8th research year, and in group III (1.28-fold) – only by the 10th research year. The GFR level in group I and group II decreased during the 1st follow-up year by 2.36 and 1.65 times, respectively.Conclusion. CKD in patients suffering from recurrent nephrolithiasis in combination with IHD and EH is generally benign. The progression rate of filtration deficiency is relatively low and is (at least in the early stages) about 4.5 ml/min per year. The addition of CHF increases the rate of decline in renal filtration function by up to 25% (from 4 ml/min per year to 5 ml/min per year). The main negative effect of concomitant CVDs (especially complicated CHF) is not an ultrahigh decrease in GFR but a reduction in kidney functioning stable period up to complete cessation.

Placental Cryoextract and Renin-Angiotensin-Aldosterone System Blockade Mitigate Renal Failure in Rats

Here, we have studied the impact of administration of rat placental cryoextract (PCE), drug blockade of the renin-angiotensin-aldosterone system (RAAS) with enalapril and spironolactone and their combination on the rat kidney tissue structure and excretory function at different stages of chronic renal failure (CRF) development using the glycerol model. In 3 weeks after glycerol introduction, the animals from all the groups showed low values of glomerular filtration rate, impaired blood flow in renal cortex, tubular epithelial dystrophy, inflammation and edema of interstitium, indicating the onset of CRF development. Tubulo-interstitial nephritis and nephrosclerosis were dominated in untreated rats 16 weeks later. The use of RAAS drug blockade, as well as a comprehensive therapy with RAAS blockers and placental cryoextract stopped the inflammatory processes in renal tissue, restored blood circulation and normalized excretory function, which persisted for up to 16 weeks of observation.

Analysis of Glomerular Filtration Rate in Ischemic Cerebrovascular Diseases under the Magnetic Resonance Angiography Image Segmentation Algorithm

In order to discuss the segmentation effect of the magnetic resonance angiography (MRA) image segmentation algorithm based on the fuzzy clustering algorithm and DR-CV model and the prognostic value of glomerular filtration rate (GFR) in the ischemic cerebrovascular disease (ICVD), a total of 178 patients who were admitted to the hospital and received MRA due to ICVD were selected as the research objects of this study. Blood vessel segmentation was performed on the MRA image by fuzzy clustering algorithm and DR-CV model, and all patients were divided into a control group (group A), a single-vessel stenosis group (group B), a two-vessel stenosis group (group C), and a multiple-vessel stenosis group (group D). The GFR was estimated by using the dietary modification equation for kidney disease, and the correlation between GFR and the severity of arterial stenosis in patients with ICVD was analyzed. It was found that the results of the Dice similarity index (DSI) of the MRA image blood vessel segmentation algorithm based on the fuzzy clustering algorithm and the integrated model of boundary and regional information (DR-CV model) were all above 85%. The age and GFR values of the four groups of patients were significantly different ( P &lt; 0.05). The proportions of patients in groups C and D in the group with low DFR were significantly different from those in groups A and B ( P &lt; 0.01); the proportions of patients in groups A and B in the high-level GFR group had extremely significant differences compared with group D ( P &lt; 0.01). Age, GFR, total cholesterol (TC), and high-density lipoprotein-C (HDL-C) were correlated with the degree of arterial stenosis ( P &lt; 0.05). It showed that the segmentation effect of MRA image blood vessel segmentation algorithm based on the fuzzy clustering algorithm and DR-CV model was better, and the GFR level can be used as an independent risk factor for the ICVD.

Artificial neural network for the prediction model of glomerular filtration rate to estimate the normal or abnormal stages of kidney using gamma camera.

Chronic kidney disease (CKD) is evaluated based on glomerular filtration rate (GFR) using a gamma camera in the nuclear medicine center or hospital in a routine procedure, but the gamma camera does not provide the accurate stages of the diseases. Therefore, this research aimed to find out the normal or abnormal stages of CKD based on the value of GFR using an artificial neural network (ANN). Two hundred fifty (Training 188, Testing 62) kidney patients who underwent the ultrasonography test to diagnose the renal test in our nuclear medical centre were scanned using gamma camera. The patients were injected with 99mTc-DTPA before the scanning procedure. After pushing the syringe into the patient's vein, the pre-syringe and post syringe radioactive counts were calculated using the gamma camera. The artificial neural network uses the softmax function with cross-entropy loss to diagnose CKD normal or abnormal labels depending on the value of GFR in the output layer. The results showed that the accuracy of the proposed ANN model was 99.20% for K-fold cross-validation. The sensitivity and specificity were 99.10% and 99.20%, respectively. The Area under the curve (AUC) was 0.9994. The proposed model using an artificial neural network can classify the normal or abnormal stages of CKD. After implementing the proposed model clinically, it may upgrade the gamma camera to diagnose the normal or abnormal stages of the CKD with an appropriate GFR value.

Effect of preoperative asymptomatic renal dysfunction on the clinical course after colectomy for colon cancer.

To evaluate the effect of mild renal dysfunction on the clinical course after colectomy in patients with colon cancer. The subjects of this retrospective study were 263 patients who underwent surgical resection for colon cancer at our hospital between 2011 and 2015. Renal function was assessed based on preoperative estimated glomerular filtration rate (eGFR) values. Patients were divided into groups based on their eGFR value of 55ml/min/1.73 m2. The Mann-Whitney U test, chi-square or Fisher exact test, and log-rank test were used in the data analysis. There were 59 patients (22.4%) in the low eGFR group and 204 patients in the normal eGFR group. There were differences between the groups in age, comorbidities, and the levels of hemoglobin, albumin, and serum creatinine. The overall postoperative complication rate, frequency of severe complications, and length of stay were significantly higher in the low eGFR group than in the normal eGFR group. Multivariate analysis revealed that low eGFR was the only independent risk factor for severe complications (Clavien-Dindo classification III/IV). There were no differences in survival between the groups. Preoperative asymptomatic renal dysfunction may be correlated with the development of postoperative complications and a possible significant risk factor for severe complications after colon cancer surgery.

A Spectrum of Biopsy - Proven Renal Disorders and Their Clinicopathological Correlation in Elderly Population From a Tertiary Care Center in South India.

IntroductionChronic kidney disease (CKD) has become a health concern with an extensive burden on incidence and prognosis. While the increasing lifespan contributes to a higher incidence of CKD among the elderly, the diagnostic picture in this age group is complicated by senescence-related changes. A better understanding of the etiology and progression of the disease warrants renal biopsy in such patients. This study aims to explore the histopathological spectrum of native renal biopsies leading to CKD in elderly patients in a tertiary care hospital.MethodsAmong the list of patients who had undergone renal biopsy at our institute from January 2015 to March 2020, elderly patients aged ≥ 60years were chosen for this study. Their demographic details, lab investigations and histopathological reports were collected. The sex distribution and prevalence of different renal diseases was calculated. The subjects were classified into four broad diagnostic groups - primary glomerular disease, diabetic nephropathy, hypertensive nephropathy, and tubulointerstitial disease. The estimated glomerular filtration rate (eGFR) values were calculated and used to stage chronic kidney disease in these patients. Statistical analysis was carried out to find a correlation between diagnostic groups and CKD presence and between serum C3 values and immunofluorescence for the same on biopsy.ResultsOne hundred thirty-two patients formed the study sample with a male to female ratio of 1.28:1, showing a slight male predominance. The most common diagnostic group was primary glomerular disease (46%), among which focal segmental glomerulosclerosis (FSGS) was the most common entity (12%). 47.7% and 66.6% of patients in the study sample showed elevated serum blood urea nitrogen (BUN) and creatinine values, respectively. 86% of our study sample had low eGFR values, and the majority (35%) of the patients were classified under CKD stage 3. CKD incidence was high among patients with primary glomerular diseases, but no significant statistical correlation was found. 43.5% of all IF positive cases showed low serum C3 values and established a positive correlation between IF and serum C3 values.ConclusionThere is no statistically significant correlation of the four diagnostic groups to the CKD. CKD in the elderly may be multifactorial, and a collaborative study across the nations may be needed to further evaluate the etiology.

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 New Clinical Utility for Tubular Markers to Identify Kidney Responders to Saxagliptin Treatment in Adults With Diabetic Nephropathy

ObjectivesIn recent clinical studies, saxagliptin exhibited nephroprotective potential by lowering albuminuria. In this study, we aimed to determine whether these kidney effects of saxagliptin were mediated by changes in markers of kidney tubular damage, including urinary neutrophil gelatinase-associated protein (uNGAL) and liver-type fatty acid–binding protein (uL-FABP). MethodsOur study included 80 patients with type 2 diabetes, hypertension and mild to moderate diabetic kidney disease (DKD) with prevalent albuminuria. Patients were either randomly assigned to saxagliptin as add-on therapy or remained unchanged on their stable antidiabetic therapy as a control arm. ResultsSaxagliptin significantly reduced uNGAL with a median change of −25.4% (interquartile range [IQR], −35.6% to −12.2%) compared with the control group (median change, −0.91%; IQR, −12% to 11.88%; p<0.001) after 3 months. Similarly, patients given saxagliptin had a highly significant reduction in uL-FABP (median change, −24.4%; IQR, −30.5% to −15.1%) compared with controls (median change, −3.8%; IQR −10% to 12.5%; p<0.001). Median estimated glomerular filtration rate (eGFR) values after 3 months in the saxagliptin arm were significantly higher (76.5 mL/min per 1.73 m2; IQR, 70 to 92.75 mL/min per 1.73 m2) in the low-risk uNGAL group compared with controls (59.8 mL/min per 1.73 m2; IQR, 51 to 76.2 mL/min per 1.73 m2; p=0.002). Also, higher—although not significantly—posttreatment eGFR levels were observed in patients with low risk of uL-FABP (73 mL/min per 1.73 m2; IQR, 58 to 91.3 mL/min per 1.73 m2) compared with controls (57.3 mL/min per 1.73 m2; IQR, 49.5 to 72.6 mL/min per 1.73 m2; p=0.06). No significant increase was observed in high-risk patients for either marker when compared with controls. ConclusionsThe albuminuria-lowering effect of saxagliptin may be due to inhibition of kidney tubular damage. Use of tubular markers may be a promising approach to identifying kidney responders to gliptins.

Insights Into the Results of Sotagliflozin Cardiovascular Outcome Trials: Is Dual Inhibition the Cherry on the Cake of Cardiorenal Protection?

Sotagliflozin is a dual sodium-glucose co-transporter (SGLT) 2 inhibitor, manifesting a 20-fold higher inhibitory activity for SGLT2 than for SGLT1. Differences in SGLT2 over SGLT1 selectivity of the available agents have been proposed to relate to variability in efficacy and safety characteristics. In contrast to other SGLT2 inhibitors, the cardiorenal effects of sotagliflozin in type 2 diabetes had not been explored until recently, when the results of SOLOIST-WHF (focusing on heart failure [HF] outcomes) and SCORED (focusing on renal outcomes) were published. In SOLOIST-WHF, sotagliflozin reduced the risk of the primary composite outcome of cardiovascular (CV) death and hospitalizations and urgent visits for HF. The findings showed that the risk reduction was consistent in people with reduced but also in those with preserved ejection fraction (EF). In SCORED, sotagliflozin significantly reduced the primary end point of CV deaths, hospitalizations for HF, and urgent visits for HF. A reduction in glycated hemoglobin was evident even in participants with estimated glomerular filtration rate values below 30 mL/min/1.73 m2. SCORED is also the first trial to illustrate the benefits of the class across the full range of albuminuria. Moreover, the endpoint of stroke was significantly reduced by 34% in the sotagliflozin compared with the placebo group. The findings of the two studies provide novel insights into the clinical utility of SGLT2 inhibitors, particularly with respect to the early initiation in stable HF, the benefits in HF with preserved EF, the glucose-lowering efficacy in people with severe renal impairment and their potential to improve atherosclerotic vascular disease, including stroke, outcomes.

The distribution of eGFR by age in a community-based healthy population: the Japan specific health checkups study (J-SHC study)

Renal function gradually declines with age. However, the association between changes in renal function and healthy aging has not been determined. This study examined the distribution of estimated glomerular filtration rate (eGFR) values in healthy subjects by age using large-scale cross-sectional data of health check-up participants in Japan. Among the 394,180 health check-up participants, 75,217 (19.1%) subjects without hypertension, diabetes, hyperlipidemia, obesity, proteinuria, smoking, past history of cardiovascular diseases, and renal failure/not undergoing dialysis were included in the healthy group. The distribution of eGFR values was determined at each age between 39 and 74years. in healthy subjects, the mean (± 2 SD range) values of eGFR (mL/min/1.73m2) at ages 40, 50, 60, and 70 were 88.0 (55.4-121.7), 82.3 (51.2-113.3), 77.8 (48.1-107.6), and 72.9 (44.7-101.1), respectively. The difference in the mean eGFR by age was almost constant across all ages. In the linear regression analysis adjusted for sex, the regression coefficient of mean eGFR for a one-year increase in age was -0.46mL/min/1.73m2 in healthy subjects (P < 0.001). By sex, the distribution of eGFR and the 1-year change in eGFR showed similar results in both men and women. Renal function slowly declined with age in a healthy population; however, it was relatively preserved until the mid 70s. This result suggests that a decline in renal function often observed in the elderly does not attribute to aging alone, and further examination might be required to clarify the cause of renal impairment.

A cross-sectional comparison of selected anthropometric, laboratory, and densitometric parameters in postmenopausal osteoporotic women with and without vertebral compression fractures.

Osteoporosis leads to an increased risk of vertebral compression fractures (VCFs). Most of them are spontaneous, which makes early diagnosis difficult. The aim of the study was to find parameters that distinguish osteoporotic women with and without vertebral compression fractures. A total of 437 women with postmenopausal osteoporosis were enrolled to the study. Based on the results of densitometric vertebral fracture assessment, patients were divided into 2 groups: with (n = 193) and without (n = 244) VCFs. Then selected anthropometric, laboratory, and densitometric parameters as well as questionnaire data were compared. The following distinguishing factors were found among patients with VCFs in comparison to patients without such fractures: older age- 73.93 years vs. 69.63 years [p(1) < 0.001, p(2) < 0.001], shorter height - 1.56 m vs. 1.58 m [p(4) < 0.001], lower value of glomerular filtration rate (GFR) according to Cockcroft-Gault formula - 58.22 mL/min. vs. 66.25 mL/min. [p(1) < 0.025, p(2) = 0.002], lower peripheral blood haemoglobin and serum albumin concentration (OR = 1.24, 95% CI: 1.02-1.51, p(5) = 0.03; OR = 2.29, 95% CI: 1.09-4.80, p(5) = 0.03, respectively), and higher 10-year risk of major osteoporotic fracture (FRAX MOF) -12.01% vs. 9.69% [p(1) < 0.01, p(2) < 0.001] and hip fracture (FRAX HIP) - 3.85% vs. 2.55% [p(1) < 0.01, p(2) < 0.001]. In addition, among patients with VCFs a greater severity of back pain was found in the 11-grade scale of pain intensity - 6.12 vs. 4.29 [p(1) < 0.001, p(2) < 0.001, p(3) < 0.001]. The bone mineral content (BMC) and bone mineral density (BMD) of the hip were lower in patients with VCFs - 25.25 vs. 26.2 g and 0.72 g/cm² vs. 0.75 g/cm², respectively [p(4) = 0.04 and p(4) < 0.001, respectively]. Patients with VCFs were characterised by greater back pain intensity, higher fracture risk according to the FRAX calculator, and lower values of the following: GFR according to Cockcroft-Gault formula, peripheral blood haemoglobin and serum albumin concentration, and BMD of the hip. Further studies are required to validate the FRAX calculator to assess not only the risk of future fractures but also unrecognised VCFs.

Chronic Kidney Disease in the U.S. Hemophilia Population: A Cohort Study

Chronic Kidney Disease in the U.S. Hemophilia Population: A Cohort Study

Longitudinal Evaluation of Renal Function in Multiple Myeloma

Background: Renal impairment (RI) is frequent in patients with Multiple Myeloma (MM), yet no substantial data exist on the long-term course of renal function throughout the disease. Further, it remains unknown whether factors determinable at diagnosis might predict the course of renal function in MM.Methods: Estimated glomerular filtration rate (eGFR) values (n=22,457) were used to create renal function trajectories in 243 newly diagnosed MM patients throughout a 5-year observation period. For each 90-day interval, the eGFR mean was calculated as the area under the eGRF curve. Baseline epidemiological and laboratory factors were used for stratified analysis.Results: The cohort exhibited a mean eGFR of 61.9±24.5 ml/min/1.73m2 at diagnosis; 40.2% had an eGFR below 60 ml/min/1.73m2. An initial overall increase of 2.81±8.97 ml/min/1.73m2 within the first 90-day period was observed (Figure 1). Thereafter, a steady overall eGFR decline (mean change -0.19±6.57 ml/min/1.73m2 per period) was observed, resulting in a net mean decrease of 3.58 ml/min/1.73m2 after 5 years. Patients with an eGFR below 45 ml/min/1.73m2 at diagnosis tended to improve most throughout the observation period (+15.15 ml/min/1.73m2; Figure 2). While a lower eGFR at diagnosis was associated with higher age and lower hemoglobin, these factors as well as the percentage of bone marrow plasma cell infiltration and total serum protein were not predictive of renal function. This also applied for the specific sub-type of paraprotein.Conclusions: Renal impairment is extraordinarily frequent in MM patients both at diagnosis and throughout the disease course. In the presented cohort, kidney function followed a non-linear course; after an initial amelioration in most patients, a continuous decline of eGFR was observed. Established surrogate parameters for negative outcome did not serve as predictive markers for the course of renal function in this cohort.However, patients with the lowest initial eGFR and highest MM disease burden exhibited a strong potential for renal improvement. [Display omitted] DisclosuresGisslinger:AOP Orphan Pharmaceuticals AG: Consultancy, Honoraria; Takeda: Honoraria; Novartis: Consultancy, Honoraria; PharmaEssentia: Consultancy, Honoraria; Shire: Honoraria; Janssen Cilag: Honoraria. Krauth:Janssen Cilag: Honoraria; Novartis: Honoraria; Celgene: Honoraria; BMS: Honoraria; Takeda: Honoraria; Amgen: Honoraria; AOP Orphan Pharmaceuticals AG: Honoraria.