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1.
Trials ; 22(1): 612, 2021 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-34503563

RESUMO

BACKGROUND: Globally, over 1.2 million people die from chronic kidney disease (CKD) every year. Patients with CKD are up to 10 times more likely to die prematurely than progress to kidney failure requiring kidney replacement therapy. The burden of symptoms and impaired quality of life in CKD may be compounded by comorbidities and treatment side effects. However, patient-important outcomes remain inconsistently and infrequently reported in trials in patients with CKD, which can limit evidence-informed decision-making. The Standardised Outcomes in Nephrology - Chronic Kidney Disease (SONG-CKD) aims to establish a consensus-based core outcome set for trials in patients with CKD not yet requiring kidney replacement therapy to ensure outcomes of relevance to patients, caregivers and health professionals are consistently reported in trials. METHODS: SONG-CKD involves four phases: a systematic review to identify outcomes (domains and measures) that have been reported in randomised controlled trials involving adults with CKD who do not require kidney replacement therapy; stakeholder key informant interviews with health professionals involved in the care of adults with CKD to ascertain their views on establishing core outcomes in CKD; an international two-round online Delphi survey with patients, caregivers, clinicians, researchers, policy makers and industry representatives to obtain consensus on critically important outcome domains; and stakeholder consensus workshops to review and finalise the set of core outcome domains for trials in CKD. DISCUSSION: Establishing a core outcome set to be reported in trials in patients with CKD will enhance the relevance, transparency and impact of research to improve the lives of people with CKD. TRIAL REGISTRATION: Not applicable. This study is registered with the Core Outcome Measures in Effectiveness Trials (COMET) database: http://www.comet-initiative.org/Studies/Details/1653 .


Assuntos
Nefrologia , Insuficiência Renal Crônica , Adulto , Técnica Delfos , Humanos , Avaliação de Resultados em Cuidados de Saúde , Qualidade de Vida , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/terapia , Terapia de Substituição Renal , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento
2.
Intern Med ; 60(17): 2807-2809, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34470986

RESUMO

Sacubitril/valsartan has demonstrated its prognostic advantageousness over enalapril in patients with heart failure with a reduced ejection fraction. However, the optimal therapeutic strategy using sacubitril/valsartan in real-world practice, particularly among a Japanee cohort, remains uncertain. A 75-year-old man with systolic heart failure and chronic kidney disease was administered sacubitril/valsartan. Plasma B-type natriuretic peptide transiently increased, accompanied by an increase in the urine volume, which allowed us to terminate loop diuretics. The estimated glomerular filtration rate as well as heart failure symptom improved at the one-month follow-up. Sacubitril/valsartan might be a promising option to preserve the renal function and improve clinical outcomes when the dose of concomitant diuretics can be decreased, although further large-scale studies are warranted to validate our hypothesis.


Assuntos
Insuficiência Cardíaca Sistólica , Insuficiência Cardíaca , Insuficiência Renal Crônica , Idoso , Aminobutiratos/uso terapêutico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Compostos de Bifenilo , Combinação de Medicamentos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca Sistólica/tratamento farmacológico , Humanos , Japão , Masculino , Neprilisina , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/tratamento farmacológico , Volume Sistólico , Tetrazóis/uso terapêutico , Resultado do Tratamento , Valsartana/uso terapêutico
3.
Rinsho Ketsueki ; 62(8): 938-943, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34497234

RESUMO

Oxygen biology is currently a focus of intensive scientific research. Three scientists received the Nobel prize in physiology or medicine for their outstanding scientific efforts in revealing the mechanisms of oxygen sensing and defense against hypoxia. Hypoxia is a final common pathway to end-stage kidney disease and plays a crucial role in the pathogenesis of cardiovascular complications. Hypoxia-inducible factors (HIFs) are master regulators of defensive mechanisms against hypoxia. Erythropoietin is one of the main targets of HIFs that enhances oxygen delivery by increasing the production of red blood cells. HIF levels are regulated by HIF-prolyl hydroxylase (HIF-PH) inhibitors, which are now available as a new therapeutic modality against anemia in chronic kidney disease. HIF-PH inhibitors raise some theoretical concerns, but should be noted for their potential organ-protective effects.


Assuntos
Anemia , Eritropoetina , Inibidores de Prolil-Hidrolase , Insuficiência Renal Crônica , Anemia/tratamento farmacológico , Anemia/etiologia , Humanos , Hipóxia , Inibidores de Prolil-Hidrolase/uso terapêutico , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/tratamento farmacológico
4.
Rev Med Chil ; 149(2): 187-195, 2021 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-34479262

RESUMO

BACKGROUND: Glomerular filtration rate (GFR) estimation in older adults using a creatinine clearance/24-hour (CrCl) or an equation based on serum creatinine, are often considered equivalent by clinicians. AIM: To compare GFR estimated (eGFR) with the available equations and measured CrCl in patients ≥ 70 years. A secondary aim was to know the differences in chronic kidney disease (CKD) classification, when using the different eGFR formulas. PATIENTS AND METHODS: In 144 patients aged 77 ± 5 years (58% men), CrCl was measured and GFR was estimated using MDRD, CKD-EPI, BIS-1 and FAS formulas. The eGFR and the stage of CKD were compared according to the different equations used. RESULTS: GFR estimated by MDRD and CKD-EPI equations was 7.8 and 8.4 mL/min/1.73 m2 lower than 24-hour ClCr, respectively. This difference was even greater using the BIS-1 and FAS equations. Twenty-four-hour CrCl classified 47.2% of the patients in a category of renal function > 60 mL/min/1.73 m2, while MDRD and CKD-EPI equations classified just over a third, and BIS-1 and FAS formulas around 20% of the patients. CONCLUSIONS: The practice of considering equivalent the GFR estimation using the creatinine-based equations with measured creatinine clearance in older adults should be reconsidered, because their results differ markedly.


Assuntos
Insuficiência Renal Crônica , Idoso , Creatinina , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Insuficiência Renal Crônica/diagnóstico
5.
Rev Med Chil ; 149(3): 409-421, 2021 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-34479320

RESUMO

The evaluation of renal function in older adults is usually carried out with a creatinine clearance or an estimation of glomerular filtration rate using formulas such as Cockcroft-Gault, MDRD or CKD-EPI. The results obtained with these formulas are often regarded as equivalent. However, in adults older than 70 years, the Cockcroft-Gault formula frequently underestimates the glomerular filtration rate with respect to reference methods and the MDRD formula overestimates it. CKD-EPI has a more unpredictable behavior. This leads to erroneously classifying patients in the stages of chronic kidney disease (CKD), artificially increasing the prevalence of this condition, overloading health systems and generating emotional disorders in patients mistakenly classified as carriers of CKD. Also, when kidney function is overestimated, CKD patients are prevented from receiving the treatments appropriate for their condition. In recent years, new formulas have been proposed (FAS, BIS) with a greater accuracy to estimate glomerular filtration rate in older adults. This review describes the behavior of these formulas in a significant number of older adults, from various countries, and proposes using those equations with the best performance in older adults.


Assuntos
Insuficiência Renal Crônica , Idoso , Creatinina , Taxa de Filtração Glomerular , Humanos , Rim , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia
6.
Medicine (Baltimore) ; 100(35): e26544, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34477114

RESUMO

BACKGROUND: To lower albuminuria and to achieve blood pressure (BP) goals, dual renin-angiotensin-aldosterone system (RAAS) inhibitors are sometimes used in clinical practice for the treatment of CKD. However, the efficacy and safety of dual RAAS blockade therapy remains controversial. METHODS: PubMed, EMBASE, and Cochrane Library were searched, and random effects model was used to calculate the effect sizes of eligible studies. Potential sources of heterogeneity were detected by meta-regression and subgroup analysis. RESULTS: The present meta-analysis of 72 randomized controlled trials with 10,296 patients demonstrated that dual RAAS blockade therapy was superior to monotherapy in reducing the urine albumin excretion, urine protein excretion, and BP. These beneficial effects were related to the decrease of glomerular filtration rate, the increase of serum potassium level, and higher rates of hyperkalemia and hypotension. Meanwhile, these effects did not lead to improvements in short-term or long-term outcomes, including doubling of serum creatinine, acute kidney injury, end-stage renal disease, mortality, and hospitalization. Compared with the single therapy, angiotensin-converting enzyme inhibitor (ACEI) in combination with angiotensin-receptor blocker (ARB) was a better dual therapy than ACEI or ARB in combination with renin inhibitor or aldosterone receptor antagonist in decreasing urine albumin excretion, urine protein excretion and BP, and the combination was not associated with a lower glomerular filtration rate. CONCLUSION: Compared with the single therapy, ACEI in combination with ARB was a better dual therapy than ACEI or ARB in combination with renin inhibitor or aldosterone receptor antagonist. Although ACEI in combination with ARB was associated with higher incidences of hyperkalemia and hypotension, careful individualized management and potassium binders may further expand its application (PROSPERO number CRD42020179398).


Assuntos
Antagonistas de Receptores de Angiotensina/uso terapêutico , Insuficiência Renal Crônica/tratamento farmacológico , Sistema Renina-Angiotensina/efeitos dos fármacos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Insuficiência Renal Crônica/fisiopatologia
7.
BMC Geriatr ; 21(1): 481, 2021 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-34481470

RESUMO

BACKGROUND: The accuracy of the estimated glomerular filter rate (eGFR) in elderly patients is debatable. In 2020, a new creatinine-based equation by European Kidney Function Consortium (EKFC) was applied to all age groups. The objective of this study was to assess the appropriateness of the new EKFC equation with Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Lund-Malmö Revised (LMR), Berlin Initiative Study 1 (BIS1), and full age spectrum (FAS) equations based on serum creatinine (SCR) for elderly Chinese patients. METHODS: A total of 612 elderly patients with a measured glomerular filtration rate (mGFR) by the dual plasma sample clearance method with Technetium-99 m-diethylenetriamine-pentaacetic acid (Tc-99 m-DTPA) were divided into four subgroups based on age, sex, mGFR, and whether combined with diabetes. The performance of GFR was assessed while considering bias, precision, accuracy, and root-mean-square error (RMSE). Bland-Altman plots, concordance correlation coefficients (CCCs), and correlation coefficients were applied to evaluate the validity of eGFR. RESULTS: The median age of the 612 participants was 73 years, and 386 (63.1%) were male. Referring to mGFR (42.1 ml/min/1.73 m2), the CKD-EPI, LMR, BIS1, FAS, and EKFC equations estimated GFR at 44.4, 41.1, 43.6, 41.8 and 41.9 ml/min/1.73 m2, respectively. Overall, the smallest bias was found for the BIS1 equation (- 0.050 vs. range - 3.015 to 0.795, P<0.05, vs. the CKD-EPI equation). Regarding P30, interquartile range (IQR), RMSE, and GFR category misclassification, the BIS1 equation generally performed more accurately than the other eqs. (73.9%, 12.7, 12.9, and 35.3%, respectively). Nevertheless, no equation achieved optimal performance for the mGFR≥60 ml/min/1.73 m2 subgroup. Bland-Altman analysis showed the smallest mean difference (- 0.3 ml/min/1.73 m2) for the BIS1 equation when compared to the other equations. CONCLUSIONS: This study suggested that the BIS1 equation was the most applicable for estimating GFR in Chinese elderly patients with moderate to severe renal impairment.


Assuntos
Diabetes Mellitus , Insuficiência Renal Crônica , Idoso , China/epidemiologia , Creatinina , Taxa de Filtração Glomerular , Humanos , Masculino , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia
9.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 43(4): 642-648, 2021 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-34494538

RESUMO

Arterial spin labeling is a noninvasive,quantitative method for perfusion imaging,which does not need any contrast media.This technique has been used in the renal perfusion analysis.In this article,we briefly introduced this technique and summarized its application in healthy volunteers,acute kidney injury,chronic kidney diseases,renovascular diseases,renal tumors,and renal transplantation.


Assuntos
Rim , Insuficiência Renal Crônica , Humanos , Rim/diagnóstico por imagem , Imageamento por Ressonância Magnética , Perfusão , Imagem de Perfusão , Marcadores de Spin
10.
Nutrients ; 13(7)2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-34371980

RESUMO

Food manufacturers are increasingly substituting potassium chloride (KCl) in food products so as to reduce the sodium chloride content. Bread and bread products are common staple foods in many Western households and are a target for recipe reformulation using KCl. Given that chronic kidney disease (CKD) is a medical condition of global importance that requires dietary potassium restriction in the later stages, we sought to evaluate the impact and safety of varying levels of KCl substitution in bread products. We undertook a secondary analysis of dietary data from the National Nutrition and Physical Activity Survey 2011-2012 for 12,152 participants (154 participants with CKD). The sodium chloride content in bread and bread-based products was substituted with 20%, 30%, and 40% of KCl. The contribution of these alterations in the dietary potassium intake to the total daily potassium intake were then examined. The replacement of sodium in bread with varying amounts of KCl (20%, 30%, and 40%) resulted in one third of people with CKD exceeding the safe limits for dietary potassium consumption (31.8%, 32.6%, and 33%, respectively). KCl substitution in staple foods such as bread and bread products have serious and potentially fatal consequences for people who need to restrict dietary potassium. Improved food labelling is required for consumers to avoid excessive consumption.


Assuntos
Pão/análise , Estado Nutricional/efeitos dos fármacos , Cloreto de Potássio/análise , Potássio na Dieta/análise , Insuficiência Renal Crônica/fisiopatologia , Adulto , Austrália , Dieta/efeitos adversos , Dieta/métodos , Ingestão de Alimentos , Feminino , Humanos , Masculino , Inquéritos Nutricionais , Cloreto de Sódio na Dieta/análise
11.
Comput Methods Programs Biomed ; 209: 106329, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34418814

RESUMO

BACKGROUND AND OBJECTIVE: Chronic Kidney Disease (CKD) is a condition characterized by a progressive loss of kidney function over time caused by many diseases. The most effective weapons against CKD are early diagnosis and treatment, which in most of the cases can only postpone the onset of complete kidney failure. The CKD grading system is classified based on the estimated Glomerular Filtration Rate (eGFR), and it helps to stratify patients for risk, follow up and management planning. This study aims to effectively predict how soon a CKD patient will need to be dialyzed, thus allowing personalized care and strategic planning of treatment. METHODS: To accurately predict the time frame within which a CKD patient will necessarily have to be dialyzed, a computational model based on a supervised machine learning approach is developed. Many techniques, regarding both information extraction and model training phases, are compared in order to understand which approaches are most effective. The different models compared are trained on the data extracted from the Electronic Medical Records of the Vimercate Hospital. RESULTS: As final model, we propose a set of Extremely Randomized Trees classifiers considering 27 features, including creatinine level, urea, red blood cells count, eGFR trend (which is not even the most important), age and associated comorbidities. In predicting the occurrence of complete renal failure within the next year rather than later, it obtains a test accuracy of 94%, specificity of 91% and sensitivity of 96%. More and shorter time-frame intervals, up to 6 months of granularity, can be specified without relevantly worsening the model performance. CONCLUSIONS: The developed computational model provides nephrologists with a great support in predicting the patient's clinical pathway. The model promising results, coupled with the knowledge and experience of the clinicians, can effectively lead to better personalized care and strategic planning of both patient's needs and hospital resources.


Assuntos
Insuficiência Renal Crônica , Taxa de Filtração Glomerular , Humanos , Insuficiência Renal Crônica/diagnóstico , Aprendizado de Máquina Supervisionado
12.
BMJ Open ; 11(8): e045754, 2021 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-34462278

RESUMO

INTRODUCTION: Chronic kidney disease (CKD) causes severe disturbances in phosphate metabolism. New Nordic Renal Diet (NNRD) is a new dietary concept designed by the present research group that aims to offer patients with moderate CKD a whole food approach with a markedly reduction in dietary phosphorus intake, corresponding to 850 mg/day. The present protocol describes a randomised controlled trial aiming to test the long-term effects of dietary intervention with NNRD versus a non-restricted habitual diet on important parameters of phosphorus and lipid homeostasis. METHODS AND ANALYSIS: This trial will be executed at the Department of Nephrology, Rigshospitalet, University of Copenhagen, Denmark. Sixty patients aged >18 years with CKD stages 3 and 4 (estimated glomerular filtration rate between 15 and 45 mL/min) will be recruited and randomly assigned to the intervention or control group. The other inclusion criterion includes a medically stable condition for at least 2 months prior to the start of the study. Exclusion criteria are treatment with phosphate binders, metabolic disorders that require specific dietary regulation, pregnancy and breast feeding, any types of food allergies or those who are vegans. The observation period is 26 weeks including seven study visits at the outpatient clinic combined with a weekly telephone consultation in both groups. A follow-up visit 3 months after study completion finalises the intervention. The primary outcome is the difference in the change in 24-hour urine phosphorus excretion from baseline to week 26 between the two study groups. Secondary outcomes include changes in phosphate-related and lipid metabolism-related blood and urine biochemistry, blood pressure and body composition. Moreover, we wish to explore adherence to the diet as well as quality of life. ETHICS AND DISSEMINATION: The study has been approved by the Scientific Ethical Committee of the Capital Region of Denmark and the Danish Data Protection Agency. The results of the studies will be presented at national and international scientific meetings, and publications will be submitted to peer-reviewed journals. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (wwwclinicaltrialsgov) Registry (NCT04579315). PROTOCOL VERSION: The protocol, version 2, has been approved by the Ethical Committee Denmark on 18 September 2020. The protocol has also been approved by Data Protection Regulation and Data Protection Law on 15 September 2020. This study protocol is in accordance with the Standard Protocol Items: Recommendations for International Trials.


Assuntos
COVID-19 , Insuficiência Renal Crônica , Dieta , Feminino , Homeostase , Humanos , Fósforo , Gravidez , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Encaminhamento e Consulta , SARS-CoV-2 , Telefone , Resultado do Tratamento
13.
Curr Cardiol Rep ; 23(9): 132, 2021 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-34398316

RESUMO

PURPOSE OF REVIEW: To summarize and explain the new guideline on blood pressure (BP) management in chronic kidney disease (CKD) published by Kidney Disease: Improving Global Outcomes (KDIGO), an independent global nonprofit organization which develops and implements evidence-based clinical practice guidelines in kidney disease. KDIGO issued its first clinical practice guideline for the Management of Blood Pressure (BP) in Chronic Kidney Disease (CKD) for patients not receiving dialysis in 2012 and now updated the guideline in 2021. RECENT FINDINGS: Recommendations in this update were developed based on systematic literature reviews and appraisal of the quality of the evidence and strength of recommendation following the "Grading of Recommendations Assessment, Development and Evaluation" (GRADE) approach. The updated guideline includes five chapters covering BP measurement techniques, lifestyle interventions for lowering BP, and management of BP in three target populations, namely adults (with and without diabetes), kidney transplant recipients, and children. A dedicated chapter on BP measurement emphasizing standardized preparation and measurement protocols for office BP measurement is a new addition, following protocols used in large randomized trials of BP targets with pivotal clinical outcomes. Based on the available evidence, and in particular in the CKD subgroup of the SPRINT trial, the 2021 guideline suggests a systolic BP target of <120 mm Hg, based on standardized measurements, for most individuals with CKD not receiving dialysis, with the exception of kidney transplant recipients and children. This recommendation is strictly contingent on the measurement of BP using standardized office readings and not routine office readings.


Assuntos
Hipertensão , Insuficiência Renal Crônica , Adulto , Pressão Sanguínea , Criança , Humanos , Hipertensão/terapia , Estilo de Vida , Diálise Renal , Insuficiência Renal Crônica/terapia
14.
BMC Nephrol ; 22(1): 278, 2021 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-34376184

RESUMO

BACKGROUND: The recent COVID-19 pandemic has raised concerns about patient diagnosis and follow-up of chronically ill patients. Patients suffering from chronic illnesses, concomitantly infected by SARS-CoV-2, globally tend to have a worse prognosis and poor outcomes. Renal tropism and acute kidney injury following SARS-CoV-2 infection has recently been described in the literature, with elevated mortality rates. Furthermore, patients with pre-existing chronic kidney disease, infected by SARS-CoV-2, should be monitored carefully. Here, we report the case of a 69-year-old patient with splenic marginal zone lymphoma, suffering from longstanding chronic kidney disease following SARS-CoV-2 infection. CASE PRESENTATION: A 69-year-old male patient previously diagnosed with pulmonary embolism and splenic marginal zone lymphoma (Splenomegaly, Matutes 2/5, CD5 negative and CD23 positive), was admitted to the hospital with shortness of breath, fever and asthenia. A nasopharyngeal swab test was performed in addition to a CT-scan, which confirmed SARS-CoV-2 infection. Blood creatinine increased following SARS-CoV-2 infection at 130 µmol/l, with usual values at 95 µmol/l. The patient was discharged at home with rest and symptomatic medical treatment (paracetamol and hydration), then readmitted to the hospital in August 2020. A kidney biopsy was therefore conducted as blood creatinine levels were abnormally elevated. Immunodetection performed in a renal biopsy specimen confirmed co-localization of SARS-CoV2 nucleocapsid and protease 3C proteins with ACE2, Lewis x and sialyl-Lewis x antigens in proximal convoluted tubules and podocytes. Co-localization of structural and non-structural viral proteins clearly demonstrated viral replication in proximal convoluted tubules in this chronically ill patient. Additionally, we observed the co-localization of sialyl-Lewis x and ACE2 receptors in the same proximal convoluted tubules. Reverse Transcriptase-Polymerase Chain Reaction test performed on the kidney biopsy was negative, with very low Ct levels (above 40). The patient was finally readmitted to the haematology department for initiation of chemotherapy, including CHOP protocol and Rituximab. CONCLUSIONS: Our case emphasizes on the importance of monitoring kidney function in immunosuppressed patients and patients suffering from cancer following SARS-CoV-2 infection, through histological screening. Further studies will be required to decipher the mechanisms underlying chronic kidney disease and the putative role of sialyl-Lewis x and HBGA during SARS-CoV-2 infection.


Assuntos
COVID-19/complicações , Túbulos Renais/virologia , Insuficiência Renal Crônica/virologia , SARS-CoV-2/fisiologia , Replicação Viral , Idoso , Enzima de Conversão de Angiotensina 2/análise , Biópsia , COVID-19/sangue , COVID-19/diagnóstico , Proteínas do Nucleocapsídeo de Coronavírus/análise , Creatinina/sangue , Humanos , Rim/química , Rim/patologia , Rim/virologia , Túbulos Renais/química , Túbulos Renais/patologia , Antígenos CD15/análise , Linfoma de Zona Marginal Tipo Células B/complicações , Masculino , Insuficiência Renal Crônica/patologia , Antígeno Sialil Lewis X/análise , Neoplasias Esplênicas/complicações
15.
Sci Rep ; 11(1): 16843, 2021 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-34413390

RESUMO

Elevated angiotensin-converting enzyme 2 (ACE2) expression in organs that are potential targets of severe acute respiratory syndrome coronavirus 2 may increase the risk of coronavirus disease 2019 (COVID-19) infection. Previous reports show that ACE2 alter its tissue-specific expression patterns under various pathological conditions, including renal diseases. Here, we examined changes in pulmonary ACE2 expression in two mouse chronic kidney disease (CKD) models: adenine-induced (adenine mice) and aristolochic acid-induced (AA mice). We also investigated changes in pulmonary ACE2 expression due to renin-angiotensin system (RAS) blocker (olmesartan) treatment in these mice. Adenine mice showed significant renal functional decline and elevated blood pressure, compared with controls. AA mice also showed significant renal functional decline, compared with vehicles; blood pressure did not differ between groups. Renal ACE2 expression was significantly reduced in adenine mice and AA mice; pulmonary expression was unaffected. Olmesartan attenuated urinary albumin excretion in adenine mice, but did not affect renal or pulmonary ACE2 expression levels. The results suggest that the risk of COVID-19 infection may not be elevated in patients with CKD because of their stable pulmonary ACE2 expression. Moreover, RAS blockers can be used safely in treatment of COVID-19 patients with CKD.


Assuntos
Enzima de Conversão de Angiotensina 2/metabolismo , COVID-19/metabolismo , Rim/metabolismo , Insuficiência Renal Crônica/metabolismo , SARS-CoV-2/fisiologia , Adenina , Enzima de Conversão de Angiotensina 2/genética , Animais , Ácidos Aristolóquicos , Modelos Animais de Doenças , Regulação para Baixo , Humanos , Imidazóis/administração & dosagem , Rim/patologia , Camundongos , Camundongos Endogâmicos C57BL , Especificidade de Órgãos , Tetrazóis/administração & dosagem
16.
BMJ Case Rep ; 14(8)2021 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-34413038

RESUMO

A 75-year-old man presented with shortness of breath and somnolence and was found to have urosepsis. Blood and urine cultures subsequently grew multidrug-resistant (MDR) Klebsiella pneumoniae (Kp) with the New Delhi metallo-ß-lactamase gene. The patient was treated successfully with plazomicin and meropenem/vaborbactam combination therapy. The course was complicated by acute kidney injury temporarily requiring haemodialysis, gastrointestinal bleed requiring multiple transfusions and hospital readmission with blood cultures again positive with MDR Kp. Plazomicin drug levels were persistently high during treatment, suggesting that therapeutic drug monitoring may be needed to safely use this drug in patients with severe renal dysfunction. This case marks the first use of plazomicin for bacteraemia in the literature outside of a clinical trial and demonstrates its safe and effective use in a patient with advanced renal disease, and provides important insights about dosing and therapeutic drug monitoring considerations in this patient population.


Assuntos
Injúria Renal Aguda , Bacteriemia , Insuficiência Renal Crônica , Injúria Renal Aguda/tratamento farmacológico , Idoso , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Farmacorresistência Bacteriana Múltipla , Humanos , Klebsiella , Masculino , Insuficiência Renal Crônica/tratamento farmacológico , Terapia de Substituição Renal , Sisomicina/análogos & derivados
17.
BMJ Open ; 11(8): e049755, 2021 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-34413105

RESUMO

OBJECTIVE: To explore factors behind inpatient admissions by high-cost users (HCUs) in pre-end-stage chronic kidney disease (CKD). DESIGN: Retrospective analysis of CKD.QLD Registry and hospital admissions of the Queensland Government Department of Health recorded between 1 July 2011 and 30 June 2016. SETTING: Queensland public and private hospitals. PARTICIPANTS: 5096 individuals with CKD who consented to the CKD.QLD Registry via 1 of 11 participating sites. MAIN OUTCOMES: Associations of HCU status with patient characteristics, pathways and diagnoses behind hospital admissions at 12 months. RESULTS: Age, advanced CKD, primary renal diagnosis, cardiovascular disease and hypertension were predictors of the high-cost outcome. HCUs were more likely than non-HCUs to be admitted by means of episode change (relative risk: 5.21; 95% CI 5.02 to 5.39), 30-day readmission (2.19; 2.13 to 2.25), scheduled readmission (1.29; 1.11 to 1.46) and emergency (1.07; 1.02 to 1.13), for diagnoses of the nervous (1.94; 1.74 to 2.15), circulatory (1.24; 1.14 to 1.34) and respiratory (1.2; 1.03 to 1.37) systems and other factors influencing health status (1.92; 1.74 to 2.09). CONCLUSIONS: The high relevance of episode change and other factors influencing health status revealed that a substantial part of excess demand for inpatient care was associated with discordant conditions often linked to frailty, decline in psychological health and social vulnerability. This suggests that multidisciplinary models of care that aim to manage discordant comorbidities and address psychosocial determinants of health, such as renal supportive care, may play an important role in reducing inpatient admissions in this population.


Assuntos
Pacientes Internados , Insuficiência Renal Crônica , Hospitalização , Humanos , Sistema de Registros , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/terapia , Estudos Retrospectivos
18.
BMJ Glob Health ; 6(8)2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34348933

RESUMO

Chronic kidney disease (CKD) is a global public health problem, seemingly affecting individuals from low-income and-middle-income countries (LMICs) disproportionately, especially in sub-Saharan Africa. Despite the growing evidence pointing to an increasing prevalence of CKD across Africa, there has not been an Africa-wide concerted effort to provide reliable estimates that could adequately inform health services planning and policy development to address the consequences of CKD. Therefore, we established the CKD in Africa (CKD-Africa) Collaboration. To date, the network has curated data from 39 studies conducted in 12 African countries, totalling 35 747 participants, of which most are from sub-Saharan Africa. We are, however, continuously seeking further collaborations with other groups who have suitable data to grow the network. Although many successful research consortia exist, few papers have been published (with none from Africa) detailing the challenges faced and lessons learnt in setting up and managing a research consortium. Drawing on our experience, we describe the steps taken and the key factors required to establish a functional collaborative consortium among researchers in Africa. In addition, we present the challenges we encountered in building our network, how we managed those challenges and the benefit of such a collaboration for Africa. Although the CKD-Africa Collaboration is focused primarily on CKD research, many of the lessons learnt can be applied more widely in public health research in LMICs.


Assuntos
Insuficiência Renal Crônica , África ao Sul do Saara/epidemiologia , Humanos , Pobreza , Saúde Pública , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/terapia
19.
BMJ Open ; 11(8): e047770, 2021 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-34362802

RESUMO

OBJECTIVE: To investigate the literature and determine if prematurity has an impact on long-term adverse kidney outcomes. DESIGN: Systematic review. DATA SOURCES: OVID Medline, PubMed, SCOPUS, CINAHL and EMBASE databases were searched for studies relating to the adverse outcomes of prematurity from 1990 to April 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: All articles published between January 1990 and April 2021 that investigated whether premature infants developed long-term adverse renal outcomes were included in this review. Articles must have been human studies and written in English. Case series with less than 20 participants and case studies were excluded. DATA EXTRACTION AND SYNTHESIS: One reviewer completed the database searches. Article selection was performed independently and in a non-blinded manner by both reviewers. Initial screening was by title and abstract. Full texts of remaining articles were reviewed. Articles for which inclusion was unclear were re-reviewed by both reviewers, and a unanimous decision was taken as to whether they should be included. The Newcastle-Ottawa Scale was used for quality assessment of the included articles. RESULTS: The literature search yielded 31 human studies, which investigated the short-term and long-term kidney outcomes of prematurity. These studies were conducted in 17 different countries. The most common outcomes measured were blood pressure (BP) and glomerular filtration rate. Other common outcomes measured included kidney size and mass, proteinuria, albuminuria, chronic kidney disease (CKD) and physical parameters such as height, weight and body mass index. CONCLUSION: Prematurity is likely linked to increased risk of kidney dysfunction and high BP in childhood and into early adulthood. Premature birth conferred a twofold increased risk of CKD and extremely premature birth conferred a threefold increased risk of CKD. However, further larger multicentre studies are needed to draw definitive conclusions on the long-term kidney outcomes of prematurity.


Assuntos
Nascimento Prematuro , Insuficiência Renal Crônica , Adulto , Feminino , Taxa de Filtração Glomerular , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Rim , Gravidez , Insuficiência Renal Crônica/epidemiologia
20.
Rev Assoc Med Bras (1992) ; 67(2): 313-317, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34406259

RESUMO

INTRODUCTION: Sickle cell anemia affects more than 30 million people worldwide. Chronic kidney disease develops in 40% of individuals. The death rate of patients with sickle nephropathy is still high, with little known predictors related to its development. To answer the question "What predictors are associated with the onset of chronic kidney disease in patients with sickle cell anemia?", this article seeks to contribute to a better understanding of sickle nephropathy, making possible a new look at the sickle cell anemia and its kidney complications. METHODS: A systematic review was developed, using the PRISMA recommendation, for cohort studies on predictors related to the outcome of sickle nephropathy in patients with sickle cell anemia. RESULTS: Initially 321 studies were identified in Pubmed, of which six were selected to compose this systematic review. Lower hemoglobin levels, increased ages and albuminuria were the most pointed predictors associated with chronic kidney disease. CONCLUSION: The main predictors associated with the development of chronic kidney disease in individuals with sickle cell anemia were lower hemoglobin levels, increased ages, and albuminuria. New studies evaluating predictors for the development of chronic kidney disease in sickle cell anemia are needed to better understand its installation and prevent its progression.


Assuntos
Anemia Falciforme , Nefropatias , Insuficiência Renal Crônica , Albuminúria/etiologia , Anemia Falciforme/complicações , Estudos de Coortes , Humanos , Rim , Insuficiência Renal Crônica/etiologia
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