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1.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 52(2): 334-339, 2021 Mar.
Artículo en Chino | MEDLINE | ID: mdl-33829711

RESUMEN

Objective: To investigate the status of osteoporosis and cardiovascular calcification in patients with chronic kidney disease (CKD) with different stages, and analyze the correlation between the stages and markers of bone metabolism To correlation. Methods: A total of 368 CKD patients at stage 3-5 who were treated in First Affiliated Hospital Affiliate to Chongqing Medical University and Chongqing Fuling Central Hospital from July 2017 to January 2018 were enrolled. A total of 60 healthy people who underwent physical examination in the hospital during the same period were enrolled as control group. Age, gender and body mass index (BMI) of all study objects at enrollment time were collected. The levels of estimate glomerular filtration rate (eGFR), serum calcium (Ca), phosphorus (P), albumin (ALB), intact parathyroid hormone (iPTH), bone alkaline phosphatase (BALP), procollagen Ⅰ N-terminal peptide (PINP) and ß-crosslaps (ß-CTX) were detected. The occurrence of osteoporosis, vascular calcification and heart valve calcification was detected. Pearson correlation analysis was applied to analyze correlation between eGFR, serum bone metabolism markers and osteoporosis, cardiovascular calcification. Results: Compared with control group, levels of serum P, iPTH, BALP, PINP and ß-CTX were significantly increased in CKD stage 3-5 group ( P<0.05), while levels of eGFR and serum Ca were decreased ( P<0.05). With the increase of CKD staging, changes of their levels were more significant ( P<0.05). The incidence of vascular calcification and heart valve calcification in CKD stage 5 hemodialysis group was higher than that in CKD stage 3-4 group and CKD stage 5 without dialysis group ( P<0.05). eGFR was positively correlated with serum Ca in CKD patients at stage 3-5 ( P<0.05), while negatively correlated with serum P, iPTH, BALP, PINP and ß-CTX ( P<0.05). The occurrence of osteoporosis, vascular calcification and heart valve calcification was negatively correlated with increase of eGFR and serum Ca levels in CKD patients at stage 3-5 ( P<0.05), while positively correlated with increase of levels of serum P, iPTH, BALP, PINP and ß-CTX ( P<0.05). Conclusion: The levels of serum bone metabolism markers and eGFR are closely related to occurrence of osteoporosis and cardiovascular calcification in CKD patients at stage 3-5.


Asunto(s)
Osteoporosis , Insuficiencia Renal Crónica , Biomarcadores , Estudios Transversales , Tasa de Filtración Glomerular , Humanos , Osteoporosis/etiología , Hormona Paratiroidea , Insuficiencia Renal Crónica/complicaciones
2.
Ann Afr Med ; 20(1): 59-63, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33727514

RESUMEN

Background: Rapid and accurate assessment of kidney function in patients after transplantation is of utmost importance. The aim of this study was to compare the relationships of serum creatinine and serum cystatin C with an estimated glomerular filtration rate (eGFR) in kidney transplants Saudi patients after a certain period of transplantation. Materials and Methods: In this prospective study, 127 patients were categorized into three groups based on their length of survival after kidney transplantation; <1 year, from 1 to 5 years, and above 5 years after transplantation. Results of cystatin C and creatinine levels were compared by eGFR derived from estimation equation chronic kidney disease epidemiology collaboration. Results: In the three assessed periods, the mean (standard deviation) cystatin C level was 1.72 (0.57), 1.59 (0.64), and 1.82 (0.82), respectively, being highest after 5 years of transplantation, normal in 9.40%, and elevated in 90.60% of the participants, while creatinine level, decreased from 1.57 (0.53) to 1.52 (0.64) in 1-5 years, then it became the highest at 1.75 (0.69) in more than 5 years. The mean was normal in 21.30% and elevated in 78.70% of the patients. Both serum creatinine and cystatin C levels were negatively correlated with posttransplantation time in kidney transplant patients. Conclusion: The cystatin C level was statistically significantly higher after 5 years of transplantation. It is a better parameter to rule out renal dysfunction after transplantation.


Asunto(s)
Creatinina/sangre , Cistatina C/sangre , Trasplante de Riñón/efectos adversos , Riñón/fisiología , Insuficiencia Renal Crónica/cirugía , Adulto , Femenino , Tasa de Filtración Glomerular , Humanos , Pruebas de Función Renal , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Insuficiencia Renal Crónica/mortalidad , Insuficiencia Renal Crónica/patología , Arabia Saudita , Tasa de Supervivencia
3.
Methods Mol Biol ; 2292: 193-200, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33651363

RESUMEN

Chronic kidney disease (CKD) is a type of kidney disease in which there is gradual loss of kidney function over a period of months to years. The clinical protocol of CKD forecasts that markers such as serum creatinine, the estimate of the glomerular filtration rate value, microalbuminuria, cystatin c are evaluated as routine markers. In recent years, new studies have identified new markers to diagnose and assess the level of kidney damage.The prevalence of CKD increases in subjects suffering from cardiovascular and metabolic diseases. The highest risk of cardiovascular risk in the CKD patient compared to the general population is related to risk factors such as hypertension, obesity, and specific renal disease factors such as albuminuria.Physical exercise, especially aerobic, has been seen through the analysis of urinary markers, able to mitigate the adverse effect of sedentary, hypertension and interstitial damage in patients with CKD and decrease the urinary levels liver-type fatty acid binding protein (L-FABP) and lower urinary albumin excretion.


Asunto(s)
Ejercicio Físico , Insuficiencia Renal Crónica/orina , Albuminuria/orina , Animales , Biomarcadores/orina , Proteínas de Unión a Ácidos Grasos/orina , Tasa de Filtración Glomerular , Humanos , Insuficiencia Renal Crónica/diagnóstico
4.
Medicine (Baltimore) ; 100(10): e24603, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33725824

RESUMEN

OBJECTIVES: This systematic review and meta-analysis assesses the utility of trimetazidine (TMZ) to prevent contrast induced nephropathy (CIN) in patients with renal insufficiency undergoing coronary angiography and angioplasty. MATERIALS AND METHODS: This meta-analysis was formulated and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of databases was conducted by 2 researchers independently for clinical trials, comparing hydration plus TMZ vs conventional hydration alone for prevention of CIN through January 2020. All patients had renal insufficiency (defined as GFR < 89 ml/minute/1.73 m2) and the outcome of interest was the incidence of contrast induced acute kidney injury. The odds ratio (OR) was estimated with 95% confidence interval (CI). Heterogeneity was reported with the I2 statistic, using a fixed-effects model, and >50% of I2 was considered to be statistically significant. RESULTS: Eleven studies, 1611 patients, met the inclusion/exclusion criteria: 797 patients comprised the TMZ plus hydration group and the remaining 814 patients comprised the control (hydration only) group. Heterogeneity was low I2 = 0%, P = .84, and the heterogeneity of each study was also low. The incidence of CIN in the TMZ plus hydration group was 6.6% (53/797), while the incidence of CIN in the control (hydration only) group was 20% (165/814). Pooled analysis of all studies showed TMZ reduced incidence of CIN compared to saline hydration alone (OR risk 0.30, 95% CI 0.21, 0.42, P < .0001). CONCLUSION: TMZ added to hydration reduces CIN in renal insufficiency patients undergoing coronary angiography.


Asunto(s)
Lesión Renal Aguda/prevención & control , Angioplastia/efectos adversos , Medios de Contraste/efectos adversos , Angiografía Coronaria/efectos adversos , Insuficiencia Renal Crónica/complicaciones , Trimetazidina/uso terapéutico , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , Medios de Contraste/farmacocinética , Angiografía Coronaria/métodos , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/diagnóstico , Enfermedad Coronaria/cirugía , Tasa de Filtración Glomerular/fisiología , Humanos , Incidencia , Ensayos Clínicos Controlados Aleatorios como Asunto , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/fisiopatología , Resultado del Tratamiento
5.
Medicine (Baltimore) ; 100(10): e24853, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33725841

RESUMEN

BACKGROUND: Rituximab is an induction immunosuppressant essential for ABO-incompatible kidney transplantation (ABOi KT). However, studies on its dosing, which differs among countries and transplant centers, are lacking. Therefore, we retrospectively investigated the effectiveness of the induction dose of rituximab against patient mortality, graft failure, and adverse events. METHODS: We included the studies referring to at least 2 of eligible induction doses (200 mg, 200-500 mg, or 500 mg) of rituximab during ABOi KT and relevant outcomes such as patient survival, graft failure, and bacterial and viral infections. We performed direct and indirect network meta-analyses using Bayesian models and ranked different rituximab doses using generation mixed treatment comparison. Publications were retrieved using CENTRAL, MEDLINE, EMBASE, and Science Citation Index Expanded databases from 1970 to February 2020 and analyzed. The GRADE of network meta-analysis approach specified 4 levels of certainty for a given result: high, moderate, low, and very low. RESULTS: Among the 4256 patients from 21 trials, glomerular filtration rate, graft loss, antibody-mediated rejection, T-cell mediated rejection, fungal infection, bacterial infection, and CMV infection did not differ among ABOi groups treated with different rituximab doses. The effect on mortality was significantly higher in rituximab 200 to 500 mg, and rituximab 500 mg groups (odds ratios [OR] 3.5, 95% CrI: 1.3-9.8, and OR 3.0, 95% CrI 1.1-9.8), but not in rituximab 20 mg group (OR 0.45, 95% CrI 0.036-2.5). The incidence of BK virus was significantly lower in the rituximab 200-mg group than in the other groups. DISCUSSION: In ABO-incompatible kidney transplantation, low-dose rituximab is more efficacious than higher doses and reduces serious infection risks. Additional randomized controlled trials might be needed to confirm these findings due to small sample size.


Asunto(s)
Sistema del Grupo Sanguíneo ABO , Incompatibilidad de Grupos Sanguíneos , Inmunosupresores/administración & dosificación , Trasplante de Riñón , Complicaciones Posoperatorias/prevención & control , Rituximab/administración & dosificación , Infecciones Bacterianas/prevención & control , Teorema de Bayes , Esquema de Medicación , Tasa de Filtración Glomerular , Rechazo de Injerto/inmunología , Rechazo de Injerto/prevención & control , Supervivencia de Injerto/inmunología , Humanos , Quimioterapia de Inducción , Trasplante de Riñón/efectos adversos , Donadores Vivos , Micosis/prevención & control , Metaanálisis en Red , Virosis/prevención & control
6.
JAMA Netw Open ; 4(3): e211095, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33688965

RESUMEN

Importance: Acute kidney injury (AKI) occurs in up to half of patients hospitalized with coronavirus disease 2019 (COVID-19). The longitudinal effects of COVID-19-associated AKI on kidney function remain unknown. Objective: To compare the rate of change in estimated glomerular filtration rate (eGFR) after hospital discharge between patients with and without COVID-19 who experienced in-hospital AKI. Design, Setting, and Participants: A retrospective cohort study was conducted at 5 hospitals in Connecticut and Rhode Island from March 10 to August 31, 2020. Patients who were tested for COVID-19 and developed AKI were screened, and those who survived past discharge, did not require dialysis within 3 days of discharge, and had at least 1 outpatient creatinine level measurement following discharge were included. Exposures: Diagnosis of COVID-19. Main Outcomes and Measures: Mixed-effects models were used to assess the association between COVID-19-associated AKI and eGFR slope after discharge. The secondary outcome was the time to AKI recovery for the subgroup of patients whose kidney function had not returned to the baseline level by discharge. Results: A total of 182 patients with COVID-19-associated AKI and 1430 patients with AKI not associated with COVID-19 were included. The population included 813 women (50.4%); median age was 69.7 years (interquartile range, 58.9-78.9 years). Patients with COVID-19-associated AKI were more likely to be Black (73 [40.1%] vs 225 [15.7%]) or Hispanic (40 [22%] vs 126 [8.8%]) and had fewer comorbidities than those without COVID-19 but similar rates of preexisting chronic kidney disease and hypertension. Patients with COVID-19-associated AKI had a greater decrease in eGFR in the unadjusted model (-11.3; 95% CI, -22.1 to -0.4 mL/min/1.73 m2/y; P = .04) and after adjusting for baseline comorbidities (-12.4; 95% CI, -23.7 to -1.2 mL/min/1.73 m2/y; P = .03). In the fully adjusted model controlling for comorbidities, peak creatinine level, and in-hospital dialysis requirement, the eGFR slope difference persisted (-14.0; 95% CI, -25.1 to -2.9 mL/min/1.73 m2/y; P = .01). In the subgroup of patients who had not achieved AKI recovery by discharge (n = 319), COVID-19-associated AKI was associated with decreased kidney recovery during outpatient follow-up (adjusted hazard ratio, 0.57; 95% CI, 0.35-0.92). Conclusions and Relevance: In this cohort study of US patients who experienced in-hospital AKI, COVID-19-associated AKI was associated with a greater rate of eGFR decrease after discharge compared with AKI in patients without COVID-19, independent of underlying comorbidities or AKI severity. This eGFR trajectory may reinforce the importance of monitoring kidney function after AKI and studying interventions to limit kidney disease after COVID-19-associated AKI.


Asunto(s)
Lesión Renal Aguda/metabolismo , Creatinina/metabolismo , Lesión Renal Aguda/complicaciones , Lesión Renal Aguda/epidemiología , Afroamericanos , Anciano , Anciano de 80 o más Años , /epidemiología , Estudios de Cohortes , Comorbilidad , Femenino , Estudios de Seguimiento , Tasa de Filtración Glomerular , Hispanoamericanos , Humanos , Hipertensión/epidemiología , Pruebas de Función Renal , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Alta del Paciente , Modelos de Riesgos Proporcionales , Insuficiencia Renal Crónica/epidemiología , Estudios Retrospectivos , Estados Unidos/epidemiología
7.
Medicine (Baltimore) ; 100(10): e25121, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33725910

RESUMEN

BACKGROUND: It is unclear whether there are false positive or negative results in the effects of sodium-glucose transporter 2 (SGLT2) inhibitors on various cardiovascular and renal outcomes in patients with type 2 diabetes. We aimed to explore this issue by a meta-analysis with trial sequential analysis. METHODS: We included randomized trials evaluating the effects of SGLT2 inhibitors on cardiorenal endpoints in type 2 diabetic patients. Eight endpoints evaluated in the study were fatal or nonfatal myocardial infarction (MI), fatal or nonfatal stroke, major adverse cardiovascular events (MACE), cardiovascular death or hospitalization for heart failure (CVD or HHF), all-cause death (ACD), cardiovascular death (CVD), hospitalization for heart failure (HHF), and kidney function progression (KFP). Meta-analysis and trial sequential analysis was conducted for each endpoint. RESULTS: Seven randomized trials of SGLT2 inhibitors were included for pooled analysis. Compared with placebo, SGLT2 inhibitors significantly reduced the risk of MACE (HR 0.89, 95% confidence interval [CI] 0.84-0.94), MI (HR 0.91, 95% CI 0.84-0.99), CVD (HR 0.86, 95% CI 0.79-0.93), CVD or HHF (HR 0.77, 95% CI 0.73-0.82), HHF (HR 0.67, 95% CI 0.62-0.74), KFP (HR 0.63, 95% CI 0.56-0.70), and ACD (HR 0.88, 95% CI 0.83-0.94), whereas SGLT2 inhibitors did not have significant effects on stroke (HR 0.98, 95% CI 0.88-1.09). Trial sequential analyses for MI and stroke showed that cumulative Z curve did not cross trial sequential monitoring boundary and required information size, whereas those for the other 6 endpoints showed that cumulative Z curve crossed trial sequential monitoring boundary and/or required information size. CONCLUSIONS: Compared with placebo, SGLT2 inhibitors conclusively reduce the risk of MACE, CVD or HHF, ACD, CVD, HHF, and KFP in patients with type 2 diabetes, whereas the effects of SGLT2 inhibitors on MI and stroke are not conclusive and need to be further assessed in future studies with the adequate sample size to reject or accept the effect size.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Nefropatías Diabéticas/diagnóstico , Tasa de Filtración Glomerular/efectos de los fármacos , Insuficiencia Cardíaca/epidemiología , Infarto del Miocardio/epidemiología , Inhibidores del Cotransportador de Sodio-Glucosa 2/administración & dosificación , Accidente Cerebrovascular/epidemiología , Causas de Muerte , Diabetes Mellitus Tipo 2/complicaciones , Nefropatías Diabéticas/etiología , Nefropatías Diabéticas/fisiopatología , Nefropatías Diabéticas/prevención & control , Progresión de la Enfermedad , Tasa de Filtración Glomerular/fisiología , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/prevención & control , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Infarto del Miocardio/etiología , Infarto del Miocardio/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto , Medición de Riesgo , Índice de Severidad de la Enfermedad , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control , Resultado del Tratamiento
8.
Kidney Int ; 99(4): 805-808, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33745545

RESUMEN

Gorski et al. report a meta-GWAS of rapid kidney function decline in 42 longitudinal studies from the CKDGen Consortium and UK Biobank, amounting to more than 270'000 individuals with two eGFRcrea measurements. They identified genome-wide significant variants associated with two indexes of rapid kidney function decline, involving genes with a high potential for causality. These data increase our understanding of kidney function and risk of disease.


Asunto(s)
Estudio de Asociación del Genoma Completo , Riñón , Tasa de Filtración Glomerular , Humanos , Estudios Longitudinales
9.
Kidney Int ; 99(4): 808-811, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33745546

RESUMEN

For application to general populations, estimating equations for glomerular filtration rate should be developed and validated in diverse populations, including a wide range of age, race-ethnicity, and clinical conditions. This issue includes reports on the development of new equations by 2 research groups to improve glomerular filtration rate estimation in children and young adults. Both equations performed better than guideline-recommended equations, but both require further evaluation of generalizability, and neither fulfills the goal of development in a diverse population.


Asunto(s)
Insuficiencia Renal Crónica , Niño , Creatinina , Europa (Continente) , Tasa de Filtración Glomerular , Humanos , América del Norte , Adulto Joven
10.
Kidney Int ; 99(4): 814-816, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33745548

RESUMEN

The drop in glomerular filtration rate often observed in the first weeks of nephroprotective treatment, whether because of protein restriction or renin-angiotensin system blockade, can be interpreted as a marker of the relationship between the intensity of baseline glomerular anomalies and the potential treatment benefit. In this issue, Oshima et al. reported a post hoc analysis of the Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation (CREDENCE) study, the results of which confirm that such a relationship is also observed under sodium-glucose cotransporter 2 inhibition in diabetic patients with chronic kidney disease.


Asunto(s)
Diabetes Mellitus Tipo 2 , Insuficiencia Renal Crónica , Inhibidores del Cotransportador de Sodio-Glucosa 2 , Canagliflozina/efectos adversos , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Tasa de Filtración Glomerular , Humanos , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/tratamiento farmacológico , Inhibidores del Cotransportador de Sodio-Glucosa 2/efectos adversos
11.
Medicine (Baltimore) ; 100(12): e25017, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761657

RESUMEN

ABSTRACT: Overweight and obesity may be associated with poor clinical outcome, including chronic kidney disease (CKD). However, whether body mass index (BMI), waist-to-hip ratio (WHR), and waist circumference (WC) are related to CKD is yet to be elucidated.A total of 7593 adults were divided into 4 groups based on the estimated glomerular filtration rate (eGFR) quartile. The eGFR was calculated with the CKD Epidemiology Collaboration. Multiple linear regression analyzed the association between eGFR and WHR, BMI, and WC. Logistic regression analysis determined whether the CKD patients were associated with WHR, BMI, and WC after adjusting for other variables.The mean age of the cohort was 72.34 ±â€Š7.30 years. Multiple linear regression analysis showed that WC (P = .006) was associated with eGFR, although adjusted by lifestyle factor and biochemical indicators. The individuals in the underweight, overweight, and obese groups had significantly lower eGFR value than those in the healthy weight group in moderate CKD. The eGFR in the overweight group with WHR ≤0.894 was higher than in the healthy weight group with WHR >0.894 group (P = .036). Overweight with WHR ≤0.894 group had a longer WC with a pronounced increase in the hip circumference. Logistic regression analysis showed that the WC (OR = 1.362, P < .001) and BMI (OR = 1.227, P = .031) were independent risk factors for moderate CKD patients. Each standard deviation (SD) of high BMI and WC level was associated with 23.0% and 17.3% higher odds of moderate CKD (OR = 1.230, P = .017 and OR = 1.173, P = .021, respectively).WC is an independent risk factor for eGFR. Combined BMI and WC are important factors that would predict moderate CKD patients.


Asunto(s)
Índice de Masa Corporal , Insuficiencia Renal Crónica/diagnóstico , Circunferencia de la Cintura , Relación Cintura-Cadera , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Tasa de Filtración Glomerular , Humanos , Estilo de Vida , Modelos Logísticos , Persona de Mediana Edad , Obesidad/fisiopatología , Sobrepeso/fisiopatología , Insuficiencia Renal Crónica/etiología , Insuficiencia Renal Crónica/fisiopatología , Estudios Retrospectivos , Factores de Riesgo , Delgadez/fisiopatología , Adulto Joven
12.
Braz J Med Biol Res ; 54(4): e10022, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33656052

RESUMEN

Chronic kidney disease (CKD) is one of the main chronic diseases affecting the world population due to its high prevalence and increasing morbidity. Similarly, obesity gained the interest of the scientific community as it directly or indirectly increases mortality from cardiovascular causes, and its prevalence characterizes a pandemic. The objective of this study was to investigate obesity measured by body mass index as a predictor for end-stage renal disease in the general adult population. A systematic review and meta-analysis was carried out by searching 10 databases for prospective or retrospective cohort studies, with no restrictions on the language of publication, including adults with obesity without previous renal disease and who evolved to CKD (diagnosed by estimated glomerular filtration rate below 60 mL&mac_middot;min-1&mac_middot;(1.73 m2)-1 over the follow-up period. The R software and Meta package were used for data analysis. After removing duplicates, 5431 studies were submitted to the steps of the systematic review, and 21 articles were included in the data analysis. In total, 3,504,303 patients, 521,216 with obesity, and an average follow-up time of 9.86 years were included. The relative risk of obese people for developing CKD in the random effects model was 1.81 (95%CI: 1.52-2.16). The evidence found in this meta-analysis confirmed that obese people are at higher risk of developing CKD that the non-obese population (1.81 times higher), with obesity being a priority risk factor in preventive actions.


Asunto(s)
Insuficiencia Renal Crónica , Adulto , Tasa de Filtración Glomerular , Humanos , Obesidad/complicaciones , Obesidad/epidemiología , Estudios Prospectivos , Insuficiencia Renal Crónica/epidemiología , Insuficiencia Renal Crónica/etiología , Estudios Retrospectivos , Factores de Riesgo
13.
BMC Surg ; 21(1): 114, 2021 Mar 06.
Artículo en Inglés | MEDLINE | ID: mdl-33676462

RESUMEN

BACKGROUND: There is limited evidence to clarify the specific relationship between preoperative estimated glomerular filtration rate (preop-eGFR) and postoperative 30-day mortality in Asian patients undergoing non-cardiac and non-neuron surgery. We aimed to investigate details of this relationship. METHODS: We reanalyzed a retrospective analysis of the clinical records of 90,785 surgical patients at the Singapore General Hospital from January 1, 2012 to October 31, 2016. The main outcome was postoperative 30-day mortality. RESULTS: The average age of these recruited patients was 53.96 ± 16.88 years, of which approximately 51.64% were female. The mean of preop-eGFR distribution was 84.45 ± 38.56 mL/min/1.73 m2. Multivariate logistic regression analysis indicated that preop-eGFR was independently associated with 30-day mortality (adjusted odds ratio: 0.992; 95% confidence interval [CI] 0.990-0.995; P < 0.001). A U-shaped relationship was detected between preop-eGFR and 30-day mortality with an inflection point of 98.688 (P for log likelihood ratio test < 0.001). The effect sizes and confidence intervals on the right and left sides of the inflection point were 1.013 (1.007 to 1.019) [P < 0.0001] and 0.984 (0.981 to 0.987) [P < 0.0001], respectively. Preoperative comorbidities such as congestive heart failure (CHF), type 1 diabetes, ischemic heart disease (IHD), and anemia were associated with the odds ratio of preop-eGFR to 30-day mortality (interaction P < 0.05). DISCUSSION: The relationship between preop-eGFR and 30-day mortality is U-shaped. The recommended preop-eGFR at which the rate of the 30-day mortality was lowest was 98.688 mL/min/1.73 m2.


Asunto(s)
Tasa de Filtración Glomerular , Procedimientos Quirúrgicos Operativos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Singapur/epidemiología , Procedimientos Quirúrgicos Operativos/mortalidad
14.
Medicine (Baltimore) ; 100(8): e24541, 2021 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-33663060

RESUMEN

BACKGROUND: IgA nephropathy (IgAN) is one of the significant contributing factors of end-stage renal disease (ESRD). It is reported that over half of patients with IgAN accompany multiple high-risk factors, which increase the risk of ESRD progression. Studies have shown that immunosuppressive agents were beneficial in high-risk IgAN, but the efficacy and safety have not been fully demonstrated yet. The present study aims to elucidate the efficacy of commonly used immunosuppressants in high-risk IgAN and their relative safety profiles via a network meta-analysis strategy. METHODS: Randomized controlled trials (RCTs) eligible for this network meta-analysis were included to evaluate the efficacy and safety of different immunosuppressants for high-risk IgAN. Main outcomes and measures include incidence of renal composite end point, the rate of total remission, adverse events, and proteinuria. Besides, subgroup analysis and cluster analysis were carried out. RESULTS: This network meta-analysis of 37 RCTs involving 3012 participants found that Mycophenolate mofetil (MMF) combined with corticosteroids (CS) was superior to other interventions in end point events and proteinuria. Cyclosporine A (CsA) plus CS was the best option for clinical remission rate, and supportive care (SC) was the safest treatment. Cluster analysis showed that MMF+CS and Leflunomide (LEF)+CS were best protocols in efficacy and safety. Subgroup analysis indicated the best benefits of MMF were presented among the Asian population, and the benefits increased with the increase of follow-up duration. The effect of Cyclophosphamide (CTX) +CS on crescent IgAN was better than that of other risk factors. Moreover, the increasing follow-up duration was negatively associated with the effect. CONCLUSIONS: MMF+CS and LEF+CS appear to serve as the best choice for treating high-risk IgAN than other immunosuppressive therapies.


Asunto(s)
Glomerulonefritis por IGA/tratamiento farmacológico , Inmunosupresores/uso terapéutico , Corticoesteroides/uso terapéutico , Ciclofosfamida/uso terapéutico , Ciclosporina/uso terapéutico , Quimioterapia Combinada , Tasa de Filtración Glomerular , Humanos , Inmunosupresores/administración & dosificación , Inmunosupresores/efectos adversos , Ácido Micofenólico/uso terapéutico , Metaanálisis en Red , Ensayos Clínicos Controlados Aleatorios como Asunto
15.
Medicine (Baltimore) ; 100(8): e24655, 2021 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-33663074

RESUMEN

BACKGROUND: Many studies have shown the effects of SGLT2 inhibitors on type 2 diabetes, but the effects in patients with type 2 diabetes with chronic kidney disease remains unclear. This study aims to evaluate the effects of SGLT2 inhibitors on renal outcomes in patients with type 2 diabetes mellitus with chronic kidney disease. METHODS: We conducted systematic searches of PubMed, Embase, and Cochrane Central Register of Controlled Trials up to April 30, 2020 and included randomized controlled trials of SGLT2 inhibitors in adult type 2 diabetes mellitus (T2DM) patients with chronic kidney disease (CKD) reporting estimated glomerular filtration rate (eGFR) and/or urine albumin/creatinine ratio (UACR) changes and/or acute kidney injury or failure (AKI). Random effects models were adopted to measure the pooled outcomes. RESULTS: Nine studies with 8826 participants were included. SGLT2 inhibitors were not associated with a significant change in eGFR (mean difference (MD), -0.75 ml/minutes per 1.73 m2, 95% CI -1.61 to 0.10, P = .09) in type 2 diabetic patients with CKD. UACR reduction after SGLT2 inhibitors was significant in type 2 diabetic patients with CKD (MD -24.27 mg/g, 95% CI -44.46 to -4.09, P = .02). SGLT2 inhibitors associated with AKI in the patients were significant (OR 0.80, 95% CI [0.66 to 0.98], P = .03). CONCLUSION: SGLT2 inhibitors had no significant effect on kidney function (eGFR measured) in the pooled analysis. And SGLT2 inhibitors effectively reduced UACR in T2DM with CKD. Besides, SGLT2 inhibitors could reduce the incidence of AKI.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/epidemiología , Hipoglucemiantes/uso terapéutico , Insuficiencia Renal Crónica/epidemiología , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Albuminuria , Creatinina/sangre , Tasa de Filtración Glomerular , Humanos , Pruebas de Función Renal , Ensayos Clínicos Controlados Aleatorios como Asunto
16.
Zhonghua Yi Xue Za Zhi ; 101(10): 691-694, 2021 Mar 16.
Artículo en Chino | MEDLINE | ID: mdl-33721945

RESUMEN

Diabetic kidney disease (DKD) is the most common chronic complication of diabetes mellitus and the major cause of end stage renal disease (ESRD). Prediction, early diagnosis and evaluation of disease progression are crucial to improve the prognosis of DKD. Estimated glomerular filtration rate (GFR) and urinary albumin excretion rate (AER) are the main diagnostic biomarkers of DKD. However, the sensitivity and specificity are insufficient. In recent years, more and more attention has been paid to the value of novel biomarkers of DKD. This article reviews the clinical studies of novel biomarkers of DKD, in order to provide reference for clinical diagnosis and prognosis evaluation of DKD.


Asunto(s)
Diabetes Mellitus Tipo 2 , Nefropatías Diabéticas , Fallo Renal Crónico , Biomarcadores , Nefropatías Diabéticas/diagnóstico , Progresión de la Enfermedad , Tasa de Filtración Glomerular , Humanos , Riñón
17.
Pol Merkur Lekarski ; 49(289): 13-18, 2021 Feb 24.
Artículo en Inglés | MEDLINE | ID: mdl-33713086

RESUMEN

Introduction of the definition and classification of chronic kidney disease (CKD) according to the KDOQI guidelines in 2002 served as a turning point in nephrology. On one hand, the new definition has allowed for the standardization of terminology, on the other hand, however, it has led to a rapid growth in CKD diagnoses. Another issue is the strengthening of the assumption, that diagnosis of CKD is associated with further progressive kidney dysfunction until reaching the end stage renal disease (ESRD). Clinical practice, however, provides evidence that not all patients diagnosed with CKD reach ESRD and eventually require renal replacement therapy (RRT), and in many cases CKD does not progress. AIM: The aim of the study was to assess practical information for a clinician provided by eGFR and its changes during the follow-up of a patient as regards the RRT prognosis and mortality risk. MATERIALS AND METHODS: The study group consisted of patients with CKD treated in the regional outpatient clinic. Progression was assessed by determining a linear trend line for eGFR results. Based on its course and the value of the coefficient of determination R2, four types of eGFR trajectories were identified: linear progression type (G2), nonlinear progression type (G1), improvement type (G3), undetermined eGFR change type (G4). RESULTS: The study group consisted of 65 patients 58.5% females, age mean 69 ± 12.8 years. The mean annual eGFR change in the entire group was -1.67±11.7 ml/min/1.73m2/year. During the study, 6.2% of patients began RRT (hemodialysis), and 9.2% died. Despite the evident tendency towards higher mortality in the group characterized by progression (G1+G2) as compared to the group without progression (G3+G4), the difference did not reach statistical significance (p=0.617). However, the comparison of groups with the baseline eGFR value above and below 45 ml/min/1.73 m2 differentiated the two groups that statistically differed in mortality (p=0.044). CONCLUSIONS: The baseline eGFR was not a significant predictor of future renal outcomes (ESRD, RRT). However, eGFR below 45 ml/min/ 1.73m2 was associated with a significantly higher mortality risk (p=0.036). Moreover, the groups with the fastest and with improved eGFR were characterized by the highest mortality.


Asunto(s)
Fallo Renal Crónico , Insuficiencia Renal Crónica , Anciano , Anciano de 80 o más Años , Progresión de la Enfermedad , Receptores ErbB , Femenino , Tasa de Filtración Glomerular , Humanos , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Pronóstico , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/terapia , Terapia de Reemplazo Renal
18.
High Blood Press Cardiovasc Prev ; 28(2): 177-184, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33625694

RESUMEN

INTRODUCTION: Patients with chronic kidney disease (CKD) are vulnerable to adverse-drug events from cardiovascular drugs. AIM: To evaluate awareness and knowledge for appropriate dose adjustment of cardiovascular drugs in CKD patients among Internal Medicine house-staff (IMHS). METHODS: Cross-sectional convenience sample survey in Fall 2015 among 341 IMHS from multiple academic institutions in the suburban New York City metropolitan area. Awareness was whether drug dose adjustment was needed. Knowledge was correct GFR level for drug dose adjustment. Multivariate logistic regression was conducted. RESULTS: We found overall high percentages and high odds for all cardiovascular drugs for incorrect awareness and knowledge. Postgraduate year (PGY)-1 had greater odds than PGY-3 for Carvedilol (OR: 5.56, 95% CI: 2.19-14.12, p < 0.001) and Digoxin (OR: 3.87, 95% CI: 1.37-10.95, p < 0.05), and lesser odds than PGY3 for Atenolol (OR: 0.31, 95% CI: 0.10-0.91, p < 0.05). Nephrology exposure during medical school rotation, renal clinic, or family history had lesser odds for Carvedilol (OR: 0.45, 95% CI: 0.21-0.97, p < 0.05), Simvastatin (OR: 0.40, 95% CI: 0.16-0.97, p < 0.05), and Hydralazine (OR: 0.31, 95% CI: 0.12-0.81, p < 0.05). Nephrology exposure during residency (OR: 1.96, 95% CI: 1.10-3.50, p < 0.05) and US osteopathic graduates (OR: 2.40, 95% CI: 1.04-5.50, p < 0.05) each had greater odds for Enalapril (OR: 2.40, 95% CI: 1.04-5.50, p < 0.05). International medical graduates had lesser odds than US graduates for Amlodipine (OR: 0.30, 95% CI: 0.11-0.82, p < 0.05). CONCLUSIONS: IMHS had overall poor awareness and knowledge for dose adjustment for common cardiovascular drugs in patients with CKD. As the majority of CKD patients are managed by their primary care providers, training programs should ensure that IMHS have adequate education in Nephrology during their residency training.


Asunto(s)
Fármacos Cardiovasculares/administración & dosificación , Enfermedades Cardiovasculares/tratamiento farmacológico , Tasa de Filtración Glomerular , Conocimientos, Actitudes y Práctica en Salud , Medicina Interna , Riñón/fisiopatología , Cuerpo Médico de Hospitales , Insuficiencia Renal Crónica/fisiopatología , Adulto , Fármacos Cardiovasculares/efectos adversos , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/fisiopatología , Estudios Transversales , Cálculo de Dosificación de Drogas , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/diagnóstico , Medición de Riesgo , Factores de Riesgo
19.
Medicine (Baltimore) ; 100(4): e23990, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530196

RESUMEN

ABSTRACT: The association between anemia and body mass index (BMI) in Koreans, considering kidney function, has not been clarified. Thus, we aimed to examine the association between anemia and BMI among Korean adults aged ≥19 years.This retrospective cross-sectional study evaluated male and female Korean adults aged ≥19 years who participated in the 5th, 6th, and 7th Korean National Health and Nutrition Examination Surveys (KNHANES) conducted between 2010 and 2017 were used. The participants were classified as underweight, normal weight, and overweight according to their BMI. Anemia was defined as hemoglobin levels of <13 g/dL for men and <12 g/dL for women according to the World Health Organization standards. Kidney function was evaluated according to the estimated glomerular filtration rate (eGFR), with abnormal kidney function in men defined as eGFR <60 mL/min/1.73 m2. Clinicodemographic variables were analyzed using logistic regression adjusted for weight. After propensity score matching (PSM), 6596 study participants were divided into 2 groups of 3298 participants each. Additionally, subgroup analysis by sex and kidney function was performed.On PSM, similar distribution patterns were obtained between the anemia and non-anemia groups; significant differences in BMI; kidney function; level of hemoglobin, hematocrit, and serum creatinine; iron intake; and eGFR were also observed between these groups. Anemia and BMI showed a significant association in both crude and adjusted logistic regression models. In model 2, which was adjusted for age, sex, education level, household income, alcohol consumption, smoking status, and exercise period, underweight men with abnormal kidney function showed a significantly higher risk of anemia than did normal weight men (odds ratio [OR]: 3.27; 95% confidence interval [CI]: 1.25-8.57; P = .016). Meanwhile, overweight men showed a significantly lower risk of anemia than did normal weight men (OR: 0.48; 95% CI: 0.33-0.70, P < .001).Anemia is associated with BMI according to sex. Compared with normal weight men, underweight men with abnormal kidney function had a significantly higher prevalence of anemia after adjusting for kidney function and sex, thus highlighting their need for careful management for anemia.


Asunto(s)
Anemia/epidemiología , Índice de Masa Corporal , Insuficiencia Renal/epidemiología , Adulto , Anciano , Peso Corporal , Creatinina/sangre , Estudios Transversales , Femenino , Tasa de Filtración Glomerular , Conductas Relacionadas con la Salud , Encuestas Epidemiológicas , Hemoglobinas/análisis , Humanos , Masculino , Persona de Mediana Edad , Puntaje de Propensión , República de Corea/epidemiología , Factores de Riesgo , Factores Socioeconómicos , Adulto Joven
20.
Ann Intern Med ; 174(2): JC20, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33524285

RESUMEN

SOURCE CITATION: Heerspink HJ, Stefánsson BV, Correa-Rotter R, et al. Dapagliflozin in patients with chronic kidney disease. N Engl J Med. 2020;383:1436-46. 32970396.


Asunto(s)
Fallo Renal Crónico , Insuficiencia Renal Crónica , Compuestos de Bencidrilo , Receptores ErbB , Tasa de Filtración Glomerular , Glucósidos/efectos adversos , Humanos , Fallo Renal Crónico/complicaciones , Insuficiencia Renal Crónica/complicaciones
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