Various Stages Of Chronic Kidney Disease Research Articles

#2955 Incidental findings in a renal magnetic resonance imaging study for evaluation of chronic kidney disease in type 2 diabetes population

Abstract Background and Aims Novel Magnetic Resonance Imaging (MRI) techniques are potential methods to non-invasively assess and quantify functional, structural and pathophysiological changes in chronic kidney disease (CKD) that may improve diagnosis, prognosis and treatment of these patients. Advances in imaging techniques are also likely to result in the detection of unexpected and asymptomatic incidental findings. We retrospectively analyzed the overall prevalence of incidental findings in the participants of our previously reported study utilizing a non-contrast multiparametric MRI protocol in patients with type 2 DM (T2DM) as compared to healthy controls. Method The subjects of this sub-study were participants of our original prospective, single-center, observational study, in which several MRI biomarkers were evaluated to differentiate diabetic versus healthy kidneys, and various stages of CKD. A complete medical history and physical examination were performed. The inclusion criteria for the T2DM cohort were: Age 18-70 years, type II DM with CKD staged 3-4 (estimated glomerular filtration rate [eGFR] 15-60 ml/min/1.73 m2, body mass index (BMI) 18-35 and provision of written informed consent. The control group comprised of healthy volunteers who were age- and sex-matched and had the following inclusion criteria: Age 18-70 years, eGFR >80 ml/min/1.73 m2, UACR <30 mmol/g, BMI 18-35 and provision of written informed consent. Exclusion criteria for the diabetic group were any apparent cause/s of CKD other than diabetes, previous kidney transplantation, pregnancy, contraindication for MRI examination, heart failure (NYHA class III or IV), allergies to iodine-based contrast agents. Factors that excluded healthy participants were pregnancy, contraindication for MRI examination, allergy to iodine-based contrast agents and any active or chronic disease/diagnosis. Measured GFR (mGFR) was assessed in all participants using iohexol clearance. An MRI scan using a wide range of non-contrast techniques was performed at baseline. Total scan time for patients did not exceed 45 min per session and no gadolinium-based contrast agents were used in any of the MRI examinations. All patients with incidental findings on MRI were further evaluated and referred to appropriate specialists for management. Results A total of 38 T2DM patients with CKD and 20 age- and gender-matched healthy volunteers who completed the study were included in the analysis. Of the T2DM patients, 2 were found to have CKD stage 2 by mGFR and 36 CKD stages 3–4. Clinically significant incidental findings (excluding 4 cases of renal cysts requiring only follow-up without further intervention) were found in 13 of the 38 (34%) T2DM patients. The most frequent findings were intraductal papillary mucinous neoplasm (IPMN) in 7 patients, followed by 3 cancers (1 case of kidney cancer, 1 bladder cancer and 1 lymphoma) and 3 cases of adrenal gland mass later diagnosed to be benign adenoma on further investigation. In contrast, of the 20 healthy volunteers, 2 (10%) were found to have significant incidental findings, which were IPMN in both. The follow-up duration varied between 2-6 years. The patient with bladder cancer had metastatic disease and died shortly after the diagnosis, the one with kidney cancer is under observation and the one with lymphoma underwent adequate treatment and is under remission. The cases of IPMN are being followed up regularly at our surgical department. Conclusion Clinically important incidental findings on renal MRI appear to be more common in T2DM patients than in healthy volunteers, which would have been missed without MRI examination. Mechanisms for reporting and strategies for dealing with incidental findings need to be taken into account in such investigational imaging studies. The detection of incidental findings also poses various practical and ethical issues. Further larger studies with long-term follow-up are needed to delineate the clinical relevance, natural course and management of such incidental findings.

#1244 Rates of eGFR and UACR testing in patients with chronic kidney disease in England: Clinical Practice Research Datalink 2010-2019

Abstract Background and Aims The NICE chronic kidney disease (CKD) treatment guidelines recommend regular laboratory measurements of both kidney function (eGFR) and damage (proteinuria) to appropriately inform efforts to prevent and treat progression of CKD. Recommendations also indicate frequency of such testing should increase with CKD progression. There are few data on rates of testing in patients with confirmed CKD with particularly paucity in patients with various stages of CKD. Method This non-interventional, observational study utilised data from primary care electronic health records from Clinical Practice Research Datalink (CPRD) AURUM. Patients aged ≥18 years with CKD registered in CPRD with at least one year of follow-up (FU) between January 1, 2010 and December 31, 2019 were identified. CKD was defined by an eGFR <60 ml/min/1.73 m2 and/or presence of a uACR measurement ≥3 mg/mmol, both confirmed by a second measurement 90-365 days later (index). Patients with eGFR <9 ml/min/1.73 m2 at index were excluded. Frequency of renal testing (eGFR and UACR) for each complete year of FU was quantified starting the day after index and patients were censored the last day of the final complete calendar year of FU after index. Frequency of renal testing per FU year was calculated overall and by CKD stage and level of albuminuria at index. Results In the 650 565 patients with CKD identified, mean age (SD) was 76.1 (11.3) years, 55.4% were female, and 88.5% White. Most (62.0%) patients had stage 3a CKD (eGFR 45-<59 ml/min/1.73 m2) at index. Among patients with UACR measurements within 1 year prior to index (54.1%), 49.3% were A1 (<3 mg/mmol), 43.4% A2 (3-30 mg/mmol) and 7.3% A3 (>30 mg/mmol) at index. During the first year of FU, 81.45% of patients had 1+ eGFR test whereas 39.2% had 1+ UACR test. Patients more frequently received 1+ eGFR per year over subsequent years of FU but the low proportion with 1+ UACR test per year remained stable for UACR. The mean (SD) number of eGFR and UACR tests performed per patient in the first year of FU was 2.09 (2.39) and 0.49 (0.70), respectively. More frequent eGFR testing was observed with lower eGFR at index and across subsequent years of FU. Frequency of UACR testing was lower at more advanced stages of CKD at index in all FU years, however, no trends in UACR testing frequency were observed by level of albuminuria at index. Conclusion This evidence from a population-based sample of patients with confirmed CKD in England, indicates that eGFR is being monitored in the majority of patients, yet UACR testing is suboptimal according to NICE guidelines regardless of level of kidney function or level of albuminuria. Although eGFR testing is more frequent at more advanced stages of CKD, UACR testing seems to become less frequent with more advanced stages of CKD. With emergence of new therapies to prevent progression of CKD, efforts to increase frequency of UACR testing are needed (particularly in earlier CKD stages) to ensure that patients who are at risk of worsening CKD and albuminuria receive appropriate management.

Functional magnetic resonance imaging for staging chronic kidney disease: a systematic review and meta-analysis.

The commonly used clinical indicators are not sensitive and comprehensive enough to evaluate the early staging of chronic kidney disease (CKD). This study aimed to evaluate the differences in arterial spin labeling (ASL) and blood oxygenation level-dependent functional magnetic resonance imaging (BOLD-MRI) parameter values among patients at various stages of chronic kidney disease and healthy individuals. Electronic databases PubMed, Web of Science, Cochrane, and Embase were searched from inception to March 29, 2024, to identify relevant studies on ASL and BOLD in CKD. The renal blood flow (RBF) and apparent relaxation rate (R2*) values were obtained from healthy individuals and patients with various stages of CKD. The meta-analysis was conducted using STATA version 12.0. The random-effects model was used to obtain estimates of the effects, and the results were expressed as 95% confidence intervals (CIs) and mean differences (MDs) of continuous variables. A total of 18 published studies were included in this meta-analysis. The cortical RBF and R2* values and medulla RBF values were considerably distinct between patients with various stages of CKD and healthy controls (MD, - 78.162; 95% CI, - 85.103 to - 71.221; MD, 2.440; 95% CI, 1.843 to 3.037; and MD, - 36.787; 95% CI, - 47.107 to - 26.468, respectively). No obvious difference in medulla R2* values was noted between patients with various stages of CKD and healthy controls (MD, - 1.475; 95% CI, - 4.646 to 1.696). ASL and BOLD may provide complementary and distinct information regarding renal function and could potentially be used together to gain a more comprehensive understanding of renal physiology.

Chronic Kidney Disease and SGLT2 Inhibitors

Sodium glucose cotransporter 2 (SGLT2) inhibitors were initially developed to enhance glycemic control in diabetic patients, but they have emerged as a promising treatment for individuals with chronic kidney disease (CKD) regardless of diabetic status. A collaborative meta-analysis of large-scale SGLT2 inhibitor trials has provided compelling evidence supporting recommendations for the use of these agents in CKD patients, regardless of their primary kidney disease diagnosis or whether they have diabetes. Notably, the kidney-protective benefits of SGLT2 inhibitors have been observed across various stages of CKD, including advanced stage 4 CKD, and across all levels of albuminuria. Given the robust evidence highlighting the benefits of SGLT2 inhibitors across a broad spectrum of CKD patients, these agents should be considered foundational therapy for CKD, in order to mitigate the progression to kidney failure and its associated complications. Although the beneficial effects of SGLT2 inhibitors may not be immediately apparent, they are expected to grow over time, potentially altering the prognosis for numerous CKD patients.

Muscle ultrasound to diagnose sarcopenia in chronic kidney disease: a systematic review and bayesian bivariate meta-analysis

ObjectiveThe aim of this systematic review was to assess the diagnostic test accuracy of muscle ultrasound for sarcopenia among chronic kidney disease (CKD) populations.BackgroundSarcopenia has become a worldwide health issue, especially for CKD patients. Conventional techniques of muscle mass assessment often prove limited, thus prompts increasing interest in ultrasound suitability.MethodsWe searched the Cochrane Library, PubMed and Embase for literature published up to June 2023. Ultrasound diagnosis of sarcopenia in CKD patients was included. Two independent investigators used the Quality Assessment Tool for Diagnosis Accuracy Studies (QUADAS-2) to assess the quality. We extracted valuable information from eligible studies. Using a Bayesian bivariate model, we pooled sensitivity and specificity values and summary receiver operating characteristic (SROC) curves.ResultsFive articles, involving 428 participants at various stages of CKD were included. Three studies diagnosed by the cross-sectional area (CSA) of the rectus femoris, while two others by muscle thickness (MT) and shear wave elastography (SWE) from the same muscle, separately. Overall, CSA or SWE had a pooled sensitivity of 0.95 (95% CrI, 0.80, 1.00), and the specificity was 0.73 (95% CrI, 0.55, 0.88) for diagnosing sarcopenia in CKD patients.ConclusionsUltrasound measurements of CSA and SWE were more sensitive for diagnosing sarcopenia in the CKD population than in the general population. Ultrasound assessment from a single peripheral skeletal muscle site may serve as a rapid screening tool for identifying sarcopenic individuals within the CKD population, if a specific cut-off value could be determined.

Renal stiffness measured by shear wave elastography and its relationship with perirenal fat in patients with chronic kidney disease.

This study aimed to utilize shear wave elastography (SWE) to assess changes in renal stiffness and its influencing factors in patients with chronic kidney disease (CKD) across different estimated glomerular filtration rate (eGFR) categories. It also sought to determine the correlation between perirenal fat (PF) and renal stiffness at various stages of CKD. A total of 190 CKD patients and 50 healthy controls were evaluated. Clinical parameters, conventional renal ultrasound measurements, PF, and renal stiffness trends were assessed separately. Factors independently associated with renal stiffness and PF were further analyzed. Renal parenchymal stiffness was significantly higher in the Albumin-CKD G1-2 (ALB-CKD G1-2) and CKD G3 groups than in the control group (p < 0.05). The parenchymal stiffness of the CKD G3 group was higher than that of the ALB-CKD G1-2 group (p < 0.05). The independent factors of renal parenchymal stiffness varied at different stages of disease development, with eGFR and PF being significant factors in the CKD G3 group. PF was elevated in the ALB-CKD G1-2 and CKD G3 groups compared to the control group, and the independent factors of PF varied across different stages, although waist circumference remained a common factor. Using SWE to detect renal elastic moduli can effectively assess changes in renal stiffness in patients with CKD with varying eGFRs. PF is an independent factor of renal stiffness in patients with CKD G3, providing a foundation for early diagnosis and clinical treatment.

Investigating household catastrophic health expenditure and coping mechanisms in patients with Chronic Kidney Disease in Enugu, Nigeria: a single center experience

The methods of financing healthcare expenditure for any country are vital in determining the health status of the country. To meet the rising costs of seeking health care, many poor households in managing chronic disease conditions like Chronic Kidney Disease (CKD) often resort to coping strategies that are further detrimental to their well-being. CKD is the 12th highest cause of death and 17th highest cause of disability worldwide. This study assessed the incidence of household catastrophic health expenditure and payment coping mechanism of patients with CKD. It was a descriptive cross-sectional study involving 100 patients with various stages of CKD attending the Nephrology clinics of University of Nigeria Teaching Hospital Enugu, South eastern Nigeria. They were recruited using a systematic sampling technique. A questionnaire was used to collect data. Data were collected using pre-tested semi-structured questionnaires and analyzed using descriptive statistics of frequencies, percentages, mean, standard deviation and interquartile range. Chi-square was used to test for association between payment coping mechanisms used by patients across socioeconomic groups. The study demonstrated uniformly high incidence of catastrophic expenditure for all the respondents both at 10% and 40% threshold (100% and 97%) respectively, with cost of treatment uniformly distributed among the various socioeconomic classes. Most of the patients assessed their treatment by paying out of pocket without reimbursement (88%), with money from personal bank savings being the commonest coping mechanism especially among the poorest Socioeconomic Status (SES) class, and borrowing among the least poor SES class. The study concluded that the prevalence of catastrophic expenditure was very high across all the socioeconomic status. It is recommended that the Nigerian Health Insurance program should be expanded to cover at least dialysis treatment of CKD, if not all aspects of CKD management in order to protect these patients and their household from ill-health mediated catastrophic expenditure.

Albumin determined by bromocresol green leads to erroneous results in routine evaluation of patients with chronic kidney disease.

Measurement of plasma albumin is pivotal for clinical decision-making in patients with chronic kidney disease (CKD). Routinely used methods as bromocresol green (BCG) and bromocresol purple (BCP) can suffer from aselectivity, but the impact of aselectivity on the accuracy of plasma albumin results of CKD-patients is still unknown. Therefore, we evaluated the performance of BCG-, BCP- and JCTLM-endorsed immunological methods in patients with various stages of CKD. We evaluated the performance of commonly used albumin methods in patients with CKD stages G1 through G5, the latter divided in two groups based on whether they received hemodialysis treatment. In total, 163 patient plasma samples were measured at 14 laboratories, on six different BCG and BCP-platforms, and four different immunological platforms. The results were compared with an ERM-DA-470k-corrected nephelometric assay. The implications on outcome is evaluated by the proportion of patient results <38 g/L for the diagnosis of protein energy wasting. Albumin results determined with BCP- and immunological methods showed the best agreement with the target value (92.7 and 86.2 %, respectively vs. 66.7 % for BCG, namely due to overestimation). The relative agreement of each method with the target value was platform-dependent, with larger variability in agreement between platforms noted for BCG and immunological methods (3.2-4.6 and 2.6-5.3 %) as opposed to BCP (0.7-1.5 %). The stage of CKD had similar effects on the variability in agreement for the three method-groups (0.6-1.8 % vs. 0.7-1.5 % vs. 0.4-1.6 %). The differences between methods cause discrepancies in clinical decision-making, as structurally fewer patients were diagnosed with protein energy wasting upon using BCG-based albumin results. Our study shows that BCP is fit for the intended use to measure plasma albumin levels in CKD patients from all stages, including patients on hemodialysis. In contrast, most BCG-based platforms falsely overestimate the plasma albumin concentration.

ЗНАЧЕНИЕ МЕТОДА РЕНТГЕНОВСКОЙ ДЕНСИТОМЕТРИИ ПРИ ПЛАНИРОВАНИИ ДЕНТАЛЬНОЙ ИМПЛАНТАЦИИ У ЛИЦ СРЕДНЕГО ВОЗРАСТА ПРИ РАЗЛИЧНЫХ ФОРМАХ ПОЧЕЧНОГО ОСТЕОПОРОЗА

The subject of the study is the prospects of implementing the method of X-ray densitometry in preparation for dental implantation (DI) in patients with chronic kidney disease (CKD). &#x0D; The aim of the study was to determine the diagnostic significance of densitometry results (frequency and severity of BMD) in middle-aged patients with various stages of CKD and healthy controls when choosing a method of dental implantation.&#x0D; Methodology. We selected 203 ambulatory charts of middle-aged patients which underwent dual-energy X-ray absorptiometry (DXA) with DTX 200 densitometer (Denmark) on the basis of Saratov Regional Center of Osteoporosis Prevention and Treatment and osteoporosis centers. &#x0D; Results and discussion. The somatic pathology of the examined persons was represented by: diseases of cardiovascular system, kidney diseases, rheumatologic diseases, combination of cardiovascular diseases and kidney diseases and cardiovascular and rheumatologic diseases. Data on the periodontal status of those examined were unknown. Twelve groups of examinees were distinguished according to gender, glomerular filtration rate (GFR). Two other gender groups were patients on outpatient hemodialysis. &#x0D; BMD in CHD depends on patient's sex, somatic pathology and the nature of treatment, stage of the disease. As the disease severity increases, the number of patients with normal BMD decreases, the number of patients with low BMD increases, with osteopenia diagnosed in every third of both genders, and osteoporosis (OD) in every third man and every second woman. The pathology itself, regardless of the patient's gender, is of decisive importance in the development of a decreased BMD in patients with somatic pathology. It is important for MDI to distinguish forms of renal osteodystrophy (ROD), but X-ray densitometry cannot distinguish OP from several forms of ROD. &#x0D; Conclusions. In middle-aged individuals, X-ray densitometry should be performed as a mandatory examination for the timely detection of OP. For outpatient dental patients with CKD, we suggest not to test for MPCT by this method prior to MDI.

A Deep Learning Approach for Kidney Disease Recognition and Prediction through Image Processing

Chronic kidney disease (CKD) is a gradual decline in renal function that can lead to kidney damage or failure. As the disease progresses, it becomes harder to diagnose. Using routine doctor consultation data to evaluate various stages of CKD could aid in early detection and prompt intervention. To this end, researchers propose a strategy for categorizing CKD using an optimization technique inspired by the learning process. Artificial intelligence has the potential to make many things in the world seem possible, even causing surprise with its capabilities. Some doctors are looking forward to advancements in technology that can scan a patient’s body and analyse their diseases. In this regard, advanced machine learning algorithms have been developed to detect the presence of kidney disease. This research presents a novel deep learning model, which combines a fuzzy deep neural network, for the recognition and prediction of kidney disease. The results show that the proposed model has an accuracy of 99.23%, which is better than existing methods. Furthermore, the accuracy of detecting chronic disease can be confirmed without doctor involvement as future work. Compared to existing information mining classifications, the proposed approach shows improved accuracy in classification, precision, F-measure, and sensitivity metrics.

Evaluation of Renal Impairment Influence on Metabolic Drug Clearance using a Modelling Approach.

Chronic kidney disease (CKD) may alter drug renal elimination but is also known for interacting with hepatic metabolism via multiple uremic components. However, few global models, considering the five major cytochromes, have been published, and none specifically address the decrease in cytochrome P450 (CYP450) activity. The aim of our study was to estimate the possibility of quantifying residual cytochrome activity as a function of filtration rate, according to the data available in the literature. For each drug in the DDI-predictor database, we collected available pharmacokinetic data comparing drug exposition in the healthy patient and in various stages of CKD, before building a model capable of predicting the variation of exposure according to the degree of renal damage. We followed an In vivo Mechanistic Static Model (IMSM) approach, previously validated for predicting change in liver clearance. We estimated the remaining fraction parameters at glomerular filtration rate (GFR) = 0 and the alpha value of GFR to 50% impairment for the 5 major cytochromes using a non-linear constrained regression using Matlab software. Thirty-one compounds had usable pharmacokinetic data, with 51 AUC ratios between healthy and renal impaired patients. The remaining CYP3A4 activity was estimated to be 0.4 when CYP2D6, 2C9, 2C19 and 1A2 activity was estimated to be 0.43; 1; 0.73 and 0.7, respectively. The alpha value was estimated to be at 6.62; 25; 9.8; 1.38 and 11.04 for each cytochrome. In comparison with published data, all estimates but one were correctly predicted in the range of 0.5-2. Our approach was able to describe the impact of CKD on metabolic elimination. Modelling this process makes it possible to anticipate changes in clearance and drug exposure in CKD patients, with the advantage of greater simplicity than approaches based on physiologically-based pharmacokinetic modelling. However, a precise estimation of the impact of renal failure is not possible with an IMSM approach due to the large variability of the published data, and thus should rely on specific pharmacokinetic modelling for narrow therapeutic margin drugs.

QUALITY OF LIFE AMONG PATIENTS AT VARIOUS STAGES OF CKD

The present study explored quality of life among patients of Chronic Kidney Disease (CKD) at various stage of the disease. CKD is a progressively degenerative disease in which kidney function deteriorates leading to End-Stage Renal Disease (ESRD) or renal failure. CKD, being among the leading health problem internationally, affects 1 in 7 American adults. Internationally CKD is estimated to have 13.4% prevalence. Sample of the current study comprises of 620 patients (males = 310, females = 310) of all five stages of CKD from CDK I to ESRD. A self constructed demographic form was used to take basic information from the patients. WHO Quality of Life-BREF (WHOQOL-BREF) was administered to assess the quality of life of the patients and Salma Siddiqui Depression Scale (SSDS) was used to assess depression level across various stages of CKD. Analysis of Variance (ANOVA) was applied to analyze the data. Results indicated that stages of CKD had significant impact on QOL F(4, 305) = 13.25, p &lt; .001, physical health domain F(4, 305) = 6.18, p &lt; .001, psychological health domain F(4, 305) = 13.21, p &lt; .001, social health domain F(4, 305) = 16.73, p &lt; .001, environment domain F(4, 305) = 15.63, p &lt; .001 of the patients. Moreover, it was found that QOL was better among patients with CKD I. Keywords: Chronic Kidney Disease, End Stage Renal Dysfunction, Quality of Life, Depression, Health-Related QOL, Glomerulus Filtration Rate.

Association of D-dimer with estimated glomerular filtration rate in chronic kidney disease at different stages in Indian population

: Hyper-coagulability followed by cardiovascular disease is the most common cause of mortality in CKD (chronic kidney disease). Diagnostic usefulness of hypercoagulability marker at various stages of CKD needs to be assessed. : An observational cross-sectional study.: Dept of Biochemistry, Institute of Nephrourology, Bangalore, India from January 2022 to March 2022.Study population consists of CKD patients attending Nephrology outpatient for follow up. They were categorized into 5 stages using eGFR values. Laboratory test including D-Dimer was assayed in all the participants using Abbott Architect ci4100 analyzer. In our study, a peaked and statistically significant (P value = &amp;#60;0.0001) D-Dimer values were observed in stage 4&amp;5 (5.4 ±2.5) in comparison with stage 1, 2 &amp; 3 (0.9±0.2). D- Dimer had strong negative correlationR= - 0.79 with eGFR in stage 5 CKD. D-Dimer assay should be considered as a part of routine investigations in CKD patients especially in developing countries like India, where most of the patients reach hospital only at the later stages of the disease, in order to achieve a better follow-up and management of the disease.

Biochemical markers of bone metabolism in the diagnosis of mineral and bone disorders associated with chronic kidney disease

The diagnostic possibilities of using biochemical markers of bone metabolism in patients with secondary hyperparathyroidism (SHPT) and chronic kidney disease (CKD) have not yet been properly evaluated.We analyzed indicators of bone mineral density according to double X-ray absorptiometry, as well as biochemical markers of bone metabolism (OC, CTx, ALP), incl. using a neural network algorithm, in 452 patients with various stages of CKD and in 60 persons of the comparison group (control).It has been established that the levels of biochemical markers of bone metabolism in patients with CKD progressively increase with aggravation of renal failure, and are interrelated with PTH and the presence of SHPT, as well as with the presence of osteoporosis. Estimation of OC, CTx, ALP can be used as a source of additional information about the state of bone metabolism in patients with SHPT and CKD. It should be taken into account that in patients with CKD 4–5, the levels of OC, CTx significantly exceed those in a healthy population, due to both an increase in bone metabolism and a slowdown in the process of degradation and elimination of these markers.Using a neural network algorithm, we proposed reference intervals for these indicators depending on the stage of CKD. The data obtained are the basis for the development of recommendations for the diagnosis of osteopathy in SHPT and CKD, as well as multifactorial prevention and correction of this pathology. Only a comprehensive assessment of the state of the bone will make it possible to objectively assess its condition and choose an effective and safe way to correct the identified violations.

A Hybrid Analytic Model for the Effective Prediction of Different Stages in Chronic Kidney Ailments

Chronic kidney disease (CKD) is a gradual loss of kidney function over the period of time and it is irrevocable once functionality reaches the critical state. Detecting the various stages of CKD helps to reduce the progression of the disease. Accurate prediction of CKD stages is one of the urgent needs in the medical industry and it can be effectively done by adopting machine learning (ML) techniques. The primary objective of the present research is to develop an effective classification model for the accurate prediction of CKD stages based on the patient’s health profile as well as the clinical test reports. Here, a hybrid ML strategy is employed that integrates random forest (RF) and AdaBoost (AB) techniques through a voting classifier (VC). The standard CKD dataset with 400 tuples and 25 parameters is used for the proposed investigation. The modification of diet in renal disease (MDRD) equation is used to extract an additional feature known as “estimated Glomerular Filtration Rate (eGFR)” for the prediction of the CKD stage. Pre-processing is carried out on the CKD dataset to fill the missing values by considering the skewness of the parameters and the issue of data leakage is also well addressed. Medically important features are considered and Correlation analysis is carried out to select the appropriate features for the model building process. The proposed Hybrid Ensemble Model (HEM) aids in lowering the bias and variance. HEM model efficiency is assessed using the performance metrics such as cross validation score (CVS), accuracy, precision, recall, F1 measure, Mean Squared Error (MSE), bias and variance and it is compared with the state-of-the-art classification schemes. The outcomes of the analysis reveal that the proposed HEM ensures that the CKD stage prediction is more accurate with 99.16%, 100%, 100% in reduced feature set I, set II, set III and with cross validation score of 97.85%, 99.28%, and 99.64% with reduced features set I, set II and set III respectively.

Etiologic-sociodemographic assessment and comparison of dialysis modalities in pediatric Syrian migrants with chronic kidney disease.

Background:Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are among the important causes of mortality and morbidity in childhood. Early diagnosis and treatment of the underlying primary disease may prevent most of CKD patients from progressing to ESRD. There is no study examining chronic kidney diseases and dialysis modalities in Syrian immigrant children. We aimed to retrospectively research the etiologic, sociodemographic, and clinical factors in CKD among Syrian refugee children, and at the same time, to compare the clinical characteristics of patients with ESRD on peritoneal dialysis and hemodialysis.Methods:Our study included a total of 79 pediatric Syrian patients aged from 2-16 years monitored at Hatay State Hospital pediatric nephrology clinic with diagnosis of various stages of CKD and with ESRD. Physical-demographic features and clinical-laboratory information were retrospectively screened.Results:The most common cause of CKD was congenital anomalies of the kidneys and urinary tracts (CAKUT) (37.9%). Other causes were urolitiasis (15.1%), nephrotic syndrome (10.1%), spina bifida (8.8%), hemolytic uremic syndrome (7.5%), and glomerulonephritis (7.5%). Twenty-five patients used hemodialysis due to bad living conditions. Only 2 of the patients with peritoneal dialysis were using automatic peritoneal dialysis (APD), with 5 using continuous ambulatory peritoneal dialysis (CAPD). Long-term complications like left ventricle hypertrophy and retinopathy were significantly higher among hemodialysis patients. There was no difference identified between the groups in terms of hypertension and sex.Conclusion:Progression to ESRD due to preventable reasons is very frequent among CKD patients. For more effective use of peritoneal dialysis in pediatric patients, the responsibility of states must be improved.

Fibroblast growth factor 23 and Klotho protein: assessment of the role in the development of secondary hyperparathyroidism in patients with various stages of chronic kidney disease

Background. Secondary hyperparathyroidism (SHPT) is universal complication of chronic kidney disease (CKD), the likelihood of which increases as renal function decreases. Currently, SHPT is considered in the context of mineral and bone disorders associated with CKD. Mineral and bone disorders associated with CKD include, in addition to SHPT, disorders of calcium-phosphorus metabolism, bone pathology and metastatic calcification, which determine poor outcomes of the disease. The purpose of the study was to evaluate the serum concentrations of fibroblast growth factor (FGF) 23 and Klotho protein in patients with various stages of CKD and their relationship with SHPT, vitamin D levels, and calcium-phosphorus metabolism in patients with varying degrees of decreased renal function. Materials and methods. Serum concentrations of FGF 23, Klotho protein, parathyroid hormone (PTH), 25(OH)D, calcium and phosphorus were evaluated in 229 patients with various stages of chronic kidney disease and in 40 people without signs of CKD. Results. It has been shown that individuals with CKD are characterized by overproduction of humoral phosphatonin FGF 23 and Klotho deficiency, which increase as renal failure worsens. A significant relationship was established between FGF 23 and the levels of PTH and blood phosphorus; Klotho protein — with the patient’s age and serum vitamin D. An early marker of disorders in the FGF 23-Klotho system is a decrease in the Klotho protein concentration, which occurs in the early stages of CKD and is aggravated with the progression of renal failure. A statistically significant overproduction of FGF 23 associated with secondary hyperparathyroidism was registered in patients with glomerular filtration rate less than 35 ml/min/1.73 m2. Conclusions. An early marker of disorders in the FGF 23-Klotho system is a decrease in the concentration of the Klotho protein, which occurs in the early stages of CKD and is aggravated with the progression of renal fai-lure. The relationship between Klotho deficiency and the formation of SHPT has not been found. As kidney function decreases, excess production of PTH and FGF 23 appears and increases, hyperphosphatemia progresses. This proves the pathogenetic relationship between the formation of SHPT and the overproduction of humoral phosphatonin FGF 23, since it is this glomerular filtration rate that determines the growth of PTH above the upper limit of the general population reference interval.

Hepatocellular carcinoma in patients with renal dysfunction: Pathophysiology, prognosis, and treatment challenges.

The population of patients with hepatocellular carcinoma (HCC) overlaps to a high degree with those for chronic kidney disease (CKD) and end-stage renal disease (ESRD). The degrees of renal dysfunction vary, from the various stages of CKD to dialysis-dependent ESRD, which often affects the prognosis and treatment choice of patients with HCC. In addition, renal dysfunction makes treatment more difficult and may negatively affect treatment outcomes. This study summarized the possible causes of the high comorbidity of HCC and renal dysfunction. The possible mechanisms of CKD causing HCC involve uremia itself, long-term dialysis status, immunosuppressive agents for postrenal transplant status, and miscellaneous factors such as hormone alterations and dysbiosis. The possible mechanisms of HCC affecting renal function include direct tumor invasion and hepatorenal syndrome. Finally, we categorized the risk factors that could lead to both HCC and CKD into four categories: Environmental toxins, viral hepatitis, metabolic syndrome, and vasoactive factors. Both CKD and ESRD have been reported to negatively affect HCC prognosis, but more research is warranted to confirm this. Furthermore, ESRD status itself ought not to prevent patients receiving aggressive treatments. This study then adopted the well-known Barcelona Clinic Liver Cancer guidelines as a framework to discuss the indicators for each stage of HCC treatment, treatment-related adverse renal effects, and concerns that are specific to patients with pre-existing renal dysfunction when undergoing aggressive treatments against CKD and ESRD. Such aggressive treatments include liver resection, simultaneous liver kidney transplantation, radiofrequency ablation, and transarterial chemoembolization. Finally, focusing on patients unable to receive active treatment, this study compiled information on the latest systemic pharmacological therapies, including targeted and immunotherapeutic drugs. Based on available clinical studies and Food and Drug Administration labels, this study details the drug indications, side effects, and dose adjustments for patients with renal dysfunction. It also provides a comprehensive review of information on HCC patients with renal dysfunction from disease onset to treatment.

English

BACKGROUND Multiple mechanisms have been identified contributing to pulmonary arterial hypertension (PAH) in chronic kidney disease (CKD) patients and it is one of the important sequelae of CKD and needs early detection. We wanted to study PAH in various stages of CKD and its association with renal and cardiovascular parameters. METHODS This was an observational study. PAH was diagnosed if mean pulmonary artery pressure (MPAP) was ≥ 25 mmHg using 2D - Doppler echocardiography in 96 CKD patients. Staging of CKD was done as per Kidney Disease Improving Global Outcomes (KDIGO) stages 1 - 5. Age, gender, diabetes, hypertension, stages of CKD, corticomedullary differentiation (CMD), estimated glomerular filtration rate (EGFR), urinary albumin creatinine ratio (UACR), left ventricular ejection fraction (LVEF) and left ventricular hypertrophy (LVH) were included as risk factors. Data was analysed by calculating percentage, mean, standard deviation, chi square and t test. P value &lt; 0.05 was taken as statistically significant. RESULTS PAH was detected in 37 (38.5 %) of CKD patients. Prevalence of PAH increased with stages of CKD being highest (59 %) in stage 5 and this was found to be statistically significant (P = 0.04). PAH was detected earliest in stage 2 (23.5 %). Lower mean eGFR ml / min / 1.733m2 (24.43 ± 17.8 vs 40.98 ± 25.7, P = 0.001) altered corticomedullary differentiation (50.9 % vs 20.5 % p = 0.003), reduced LVEF (81 % vs 26.7 % P = 0.000) and LVH (65 % vs 19.6 %, P = 0.000) were significantly associated with PAH in CKD patients. CONCLUSIONS PAH in CKD patients increases with CKD stages. Onset of PAH in CKD patients may be earlier and significantly associated with left ventricular dysfunction. KEYWORDS Pulmonary Arterial Hypertension, Chronic Kidney Disease, Left Ventricular Ejection Fraction, Left Ventricular Hypertrophy

Paricalcitol in management of chronic kidney disease–mineral and bone disorder

Mineral and bone disorders in chronic kidney disease (CKD) is a systemic disorder of mineral and bone metabolism due to CKD manifested by either one or a combination of the following: abnormalities of calcium, phosphorus, PTH, or vitamin D metabolism (secondary hyperparathyroidism); abnormalities in bone turnover, mineralization, volume, linear growth, or strength; or vascular or other soft tissue calcification. Decreasing 1,25(OH)2D (calcitriol) and rising parathyroid hormone (PTH) levels occur on early stages of CKD. Secondary hyperparathyroidism contributes to the high morbidity and mortality noted in this population. Long-term decompensation of secondary hyperparathyroidism in patients with impaired renal function leads to irreversible changes in multiple organ systems, resistance to conservative treatment and the requirement for surgical intervention. Suppress of renal CYP27B1 and the calcitriol deficiency play a major role in the development of mineral and bone disorders in CKD, thus VDR activators are widely used for management of secondary hyperparathyroidism. These medications are effective in suppression of PTH and demonstrate the positive effects on bone metabolism. There is evidence of pleiotropic effects of VDR activators that are crucial for the prevention of renal fibrosis and extraskeletal calcification. This review focuses on the involvement of vitamin D in the pathogenesis of mineral and bone disorders and the role of paricalcitol in their correction. The efficacy of paricalcitol in patients with various stages of CKD has been evaluated in a large number of observational and randomized clinical trials, the comparative effectiveness of paricalcitol therapy has been summarized in several metanalyses.