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1.
Artigo em Inglês | MEDLINE | ID: mdl-32967082

RESUMO

Prevalence studies on Chronic Kidney Disease of unknown etiology (CKDu) need stringent reporting on outcomes following existing guidelines. Only by doing so, the much-needed comparisons between occupations, regions and climates for the elucidation of the etiology/etiologies of CKDu, and subsequently for its prevention, are possible. We, here, comment on methodological issues in a recently published study on rice farmers from West Java, Indonesia.


Assuntos
Oryza , Insuficiência Renal Crônica , Estudos Transversais , Fazendeiros , Humanos , Indonésia/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/etiologia , Fatores de Risco
2.
Nat Rev Endocrinol ; 16(10): 556-577, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32855502

RESUMO

The management of type 2 diabetes mellitus (T2DM) is becoming increasingly complex. Sodium-glucose cotransporter type 2 inhibitors (SGLT2is) are the newest antidiabetic agents for T2DM. By targeting the kidney, they have a unique mechanism of action, which results in enhanced glucosuria, osmotic diuresis and natriuresis, thereby improving glucose control with a limited risk of hypoglycaemia and exerting additional positive effects such as weight loss and the lowering of blood pressure. Several outcome studies with canagliflozin, dapagliflozin or empagliflozin reported a statistically significant reduction in major cardiovascular events, hospitalization for heart failure and progression to advanced renal disease in patients with T2DM who have established atherosclerotic cardiovascular disease, several cardiovascular risk factors, albuminuric mild to moderate chronic kidney disease or heart failure. Current guidelines proposed a new paradigm in the management of T2DM, with a preferential place for SGLT2is, after metformin, in patients with atherosclerotic cardiovascular disease, heart failure and progressive kidney disease. Ongoing trials might extend the therapeutic potential of SGLT2is in patients with, but also without, T2DM. This Review provides an update of the current knowledge on SGLT2is, moving from their use as glucose-lowering medications to their new positioning as cardiovascular and renal protective agents.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Insuficiência Renal Crônica/prevenção & controle , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Cardiotônicos/farmacologia , Cardiotônicos/uso terapêutico , Doenças Cardiovasculares/etiologia , Ensaios Clínicos como Assunto , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/metabolismo , Humanos , Hipoglicemiantes/farmacologia , Insuficiência Renal Crônica/etiologia , Inibidores do Transportador 2 de Sódio-Glicose/farmacologia , Resultado do Tratamento
3.
Am J Cardiol ; 132: 72-78, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32773222

RESUMO

Atrial fibrillation (AF) is strongly linked to chronic kidney disease (CKD) and both of these conditions contribute to poor cardiovascular outcomes. We evaluated the impact of renal failure on major adverse cardiovascular events (MACE) in AF, and predictive value of the 2MACE score in this post-hoc analysis of the AMADEUS trial. The primary endpoint was MACE (composite of myocardial infarction, cardiac revascularisation and cardiovascular mortality). Secondary endpoints included the composite of stroke, major bleeding and non-cardiovascular mortality, and each of the specific outcomes separately. Of the 4,554 patients, 1,526 (33.5%) were females and the median age was 71 (IQR 64 to 77) years. There were 3,838 (84.3%) non-CKD and 716 (15.7%) CKD patients. The incidence of cardiovascular and non-cardiovascular mortality were 1.41% and 2.44% per 100 patient-years, respectively. There was no significant difference in crude study endpoints between the groups. Multivariable regression analysis found no association between CKD and MACE (HR 1.03 [95% CI, 0.45 to 2.34]). The c-index of the 2MACE score for MACE was 0.65 (95% CI, 0.59 to 0.71, p <0.001). In the presence of CKD, each additional point of the 2MACE score contributed to a greater risk of MACE (HR 3.17 [95% CI, 1.28 to 7.85] vs 1.48 [95% CI, 1.17 to 1.87] in the non-CKD group). In conclusion, the 2MACE score may be a useful tool for clinical risk stratification of high-risk AF patients with CKD and those at high MACE risk could be targeted for more intensive cardiovascular prevention strategies. The presence of CKD was not found to be independently associated with MACE in AF patients.


Assuntos
Fibrilação Atrial/complicações , Insuficiência Renal Crônica/epidemiologia , Medição de Risco/métodos , Idoso , Europa (Continente)/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/etiologia , Fatores de Risco , Taxa de Sobrevida/tendências
4.
PLoS One ; 15(8): e0238111, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32853266

RESUMO

BACKGROUND: Chronic kidney disease (CKD) is a public health problem, and an unfavorable lifestyle has been suggested as a modifiable risk factor for CKD. Cigarette smoking is closely associated with cardiovascular disease and cancers; however, there is a lack of evidence to prove that smoking is harmful for kidney health. Therefore, we aimed to determine the relationship between cigarette smoking and CKD among healthy middle-aged adults. METHODS: Using the database from the Korean Genome and Epidemiology Study, we analyzed 8,661 participants after excluding those with baseline estimated glomerular filtration rate (eGFR)<60 ml/min/1.72 m2 or proteinuria. Exposure of interest was smoking status: never-, former-, and current-smokers. Primary outcome was incident CKD defined as eGFR <60 ml/min/1.73 m2 or newly developed proteinuria. RESULTS: The mean age of the subjects was 52 years, and 47.6% of them were males. There were 551 (6.4%) and 1,255 (14.5%) subjects with diabetes and hypertension, respectively. The mean eGFR was 93.0 ml/min/1.73 m2. Among the participants, 5,140 (59.3%), 1,336 (15.4%), and 2,185 (25.2%) were never-smokers, former-smokers, and current-smokers, respectively. During a median follow-up of 11.6 years, incident CKD developed in 1,941 (22.4%) subjects with a crude incidence rate of 25.1 (24.0-26.2) per 1,000 person-years. The multivariable Cox regression analysis after adjustment of confounding factors showed hazard ratios (95% confidence interval) of 1.13 (0.95-1.35) and 1.26 (1.07-1.48) for CKD development in the former- and current-smokers, compared with never-smokers. CONCLUSION: This study showed that smoking was associated with a higher risk of incident CKD among healthy middle-aged adults.


Assuntos
Insuficiência Renal Crônica/etiologia , Fumar Tabaco/efeitos adversos , Estudos de Coortes , Feminino , Taxa de Filtração Glomerular/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco
5.
Intern Med ; 59(14): 1705-1710, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32669515

RESUMO

Objective Lipoprotein (a), or Lp (a), has been shown to be associated with the development of chronic kidney disease (CKD) in populations of various ethnicities. This study aimed to investigate the association between serum Lp (a) and CKD in Japanese patients. Methods A total of 6,130 subjects who underwent a serum Lp (a) level assessment for any reason (e.g. any type of surgery requiring prolonged bed rest or risk factors for atherosclerosis, such as hypertension or diabetes) were retrospectively investigated at Kanazawa University Hospital from April 2004 to March 2014. Of these, 1,895 subjects were excluded because of the lack of clinical data. Subjects were assessed for Lp (a), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, hypertension, diabetes, smoking, body mass index (BMI), coronary artery disease (CAD), and CKD (stage ≥3). Results When the study subjects were divided into quartiles of Lp (a) levels, significant trends were observed with regard to the presence of CKD (p = 2.7×10-13). A multiple regression analysis showed that Lp (a) was significantly associated with CKD [odds ratio (OR), 1.12; 95% confidence interval (CI), 1.08-1.17; p = 1.3×10-7, per 10 mg/dL], independent of other classical risk factors, including age, gender, BMI, hypertension, diabetes, smoking, LDL cholesterol, and triglycerides. Under these conditions, Lp (a) was significantly associated with CAD (OR = 1.11, 95% CI = 1.06-1.16; p = 1.7×10-6, per 10 mg/dL), independent of other risk factors. Conclusion Serum Lp (a) was associated with CKD, independent of other classical risk factors in a Japanese population.


Assuntos
Hiperlipidemias/complicações , Lipoproteína(a)/sangue , Insuficiência Renal Crônica/etiologia , Adulto , Idoso , Doenças Cardiovasculares/complicações , LDL-Colesterol/sangue , Doença da Artéria Coronariana/sangue , Feminino , Hospitalização , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Razão de Chances , Curva ROC , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Triglicerídeos/sangue
6.
Artigo em Inglês | MEDLINE | ID: mdl-32517110

RESUMO

Symptom burden and health-related quality of life (HRQOL) are important predictors of how a disease affects patients' lives, especially for endemic health problems such as chronic kidney disease of uncertain etiology (CKDu). Our study describes symptom burden, HRQOL, and associated demographic and clinical variables in CKDu patients in the Girandurukotte area, Sri Lanka. A cross-sectional study included 120 CKDu patients attending the renal clinic in the endemic area. The instruments applied were the Kidney Disease Quality of Life-Short Form (KDQOL-SFTM) version 1.3 and CKD Symptom Index-Sri Lanka. Socio-demographic, disease-related, and anthropometric variables were also investigated. The mean age of patients was 61.87 (SD 11.31), while 69.2% were male. The mean glomerular filtration rate was 28.17 (SD 14.03) mL/min/1.73 min2, and 70.8% were anemic. Bone/joint pain was the most experienced symptom while the median number of symptoms reported by patients was 5 (IQR 3-7). The mean symptom burden, physical component summary, mental component summary, and kidney-disease-specific component scores were 12.71 (SD 10.45), 68.63 (SD 19.58), 78.53 (SD 18.78), and 81.57 (SD 5.86), respectively. Age was found to be a significant predictor of HRQOL, while hemoglobin level and being a farmer were significant predictors of symptom burden. Our data indicate that CKDu patients in all stages experience at least one symptom affecting all aspects of HRQOL.


Assuntos
Qualidade de Vida , Insuficiência Renal Crônica , Adulto , Idoso , Estudos Transversais , Feminino , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/etiologia , Sri Lanka/epidemiologia
7.
Adv Gerontol ; 33(2): 360-366, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32593253

RESUMO

The aim of the work was to assess the dynamics of ultrasound parameters of renal blood flow in patients with chronic obstructive pulmonary disease (COPD)and initial stages of chronic kidney disease (CKD) during treatment with inactive vitamin D. The study included 264 patients with COPD of 2-4 degrees of severity in combination with CKD of 1-2 stages: 135 patients of the main group and 129 patients of the control group. Each group was divided into 4 subgroups according to the value of FEV1 and vitamin D level. In the main group, the native vitamin D was prescribed according to the scheme providing maintenance of vitamin D level >34,3 ng/ml during the year, in the control group - according to the recommendations of the Russian Association of Endocrinologists. An ultrasound of the kidneys with the calculation of the resistance index (RI) and albuminuria level were carried out in all patients at inclusion into the study and after its completion. A decrease in the severity of albuminuria from A3 to A2 was revealed in 24,1% (16), and an increase in GFR - in 42,9% (58) patients of all patients in the main group. A statistically significant decrease in the renal artery resistance index was recorded in the group of patients with moderate COPD (GOLD 2) and vitamin D deficiency in the main group (p<0,05). The maintaining of vitamin D levels more than 34,3 ng/ml over 12 months in patients with COPD in combination with CKD stage 1-2 was associated with a decrease in the severity of albuminuria, with an increase in GFR, and statistically significant decrease of resistance index in renal arteries of patients with moderate clinical course of COPD (GOLD 2) and lack of vitamin D.


Assuntos
Rim/irrigação sanguínea , Rim/efeitos dos fármacos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Fluxo Sanguíneo Regional/efeitos dos fármacos , Vitamina D/farmacologia , Vitamina D/uso terapêutico , Humanos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Insuficiência Renal Crônica/tratamento farmacológico , Insuficiência Renal Crônica/etiologia , Federação Russa , Índice de Gravidade de Doença , Deficiência de Vitamina D/fisiopatologia
8.
Ann Rheum Dis ; 79(8): 1077-1083, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32503858

RESUMO

OBJECTIVES: Short-term predictive endpoints of chronic kidney disease (CKD) are needed in lupus nephritis (LN). We tested response to therapy at 1 year. METHODS: We considered patients with LN who underwent renal biopsy followed by induction therapy between January 1970 and December 2016. LN was assessed using the International Society of Nephrology/Renal Pathology Society (2003) criteria and the National Institute of Health (NIH) activity and chronicity index. The renal outcome was CKD. Response was defined according to EULAR/European League Against Rheumatism/European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations: complete: proteinuria <0.5 g/24 hours, (near) normal estimated glomerular filtration rate (eGFR); partial: ≥50% proteinuria reduction to subnephrotic levels, (near) normal eGFR; and no response: all the other cases. Logistic regression analysis was employed for 12-month response and Cox regression for CKD prediction. RESULTS: We studied 381 patients (90.5% Caucasians). After 12-month therapy, 58%, 26% and 16% of patients achieved complete, partial and no response, respectively, according to EULAR/ERA-EDTA. During a median follow-up of 10.7 (IQR: 4.97-18.80) years, 53 patients developed CKD. At 15 years, CKD-free survival rate was 95.2%, 87.6% and 55.4% in patients with complete, partial and no response at 12 months, respectively (p<0.0001). CKD-free survival rates did not differ between complete and partial responders (p=0.067). Serum creatinine (HR: 1.485, 95% CI 1.276 to 1.625), eGFR (HR 0.967, 95% CI 0.957 to 0.977) and proteinuria at 12 months (HR 1.234, 95% CI 1.111 to 1.379) were associated with CKD, yet no reliable cut-offs were identified on the receiver operating characteristic curve. In multivariable analysis, no EULAR/ERA-EDTA response at 12 months (HR 5.165, 95% CI 2.770 to 7.628), low C4 (HR 1.053, 95% CI 1.019 to 1.089) and persistent arterial hypertension (HR 3.154, 95% CI 1.500 to 4.547) independently predicted CKD. CONCLUSIONS: Lack of EULAR/ERA-EDTA response at 12 months predicts CKD.


Assuntos
Nefrite Lúpica/complicações , Nefrite Lúpica/tratamento farmacológico , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/etiologia , Adulto , Feminino , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Prognóstico , Resultado do Tratamento
9.
Artigo em Inglês | MEDLINE | ID: mdl-32586019

RESUMO

Chronic kidney disease of unknown etiology (CKDu) in agricultural population is an increasing issue. This study aims to obtain a prevalence estimate of CKDu in male rice farmers in West Java, Indonesia; and analyze the relationship between CKDu and environmental and occupational factors. The study design was cross-sectional. This study included 354 healthy male farmers in two rice agriculture areas in West Java with different altitudes (low altitude and high-altitude location). This research included blood and urine sampling from the farmers for serum creatinine (SCr) level and proteinuria; questionnaire on demographic information, occupational factors and other risk factors for CKDu. We measured ambient temperature and humidity in both study locations for environmental factors. From SCr level and proteinuria, we categorized the farmers into five stages of CKD; then we distinguished CKDu from CKD if the farmers had stage 1-4 of CKD but without diabetes, hypertension and other traditional causes. Data were analyzed with multivariate logistic regression to get prevalence odd ratios of CKDu and its relationship with environmental and occupational factors, adjusted with other risk factors of CKDu. The overall prevalence of CKD was 24.9% and CKDu was 18.6%. For the environmental factors, farm location (high altitude versus low altitude location) was associated with CKDu (Prevalence Odds Ratio (POR): 2.0; 95% CI: 1.2-3.5). For the occupational factors, although not significant, the risk of CKDu increased with the longer use of insecticide and with the more frequent of insecticide use. We suggested that there was a need to conduct future research to investigate more on the association of those environmental and occupational factors with CKDu.


Assuntos
Agricultura , Agroquímicos/efeitos adversos , Fazendeiros , Doenças Profissionais/epidemiologia , Exposição Ocupacional/efeitos adversos , Oryza , Insuficiência Renal Crônica/etiologia , Creatinina/sangue , Estudos Transversais , Humanos , Indonésia/epidemiologia , Masculino , Doenças Profissionais/etiologia , Prevalência , Proteinúria/sangue , Insuficiência Renal Crônica/epidemiologia , Fatores de Risco
10.
Am J Clin Nutr ; 112(1): 129-137, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32453418

RESUMO

BACKGROUND: Advanced glycation end products (AGEs) accumulate in tissues with age and in conditions such as diabetes mellitus and chronic kidney disease (CKD), and they may be involved in age-related diseases. Skin AGEs measured as skin autofluorescence (SAF) are a noninvasive reflection of long-term AGE accumulation in tissues. Whether AGEs present in the diet (dAGEs) contribute to tissue AGEs is unclear. OBJECTIVES: Our aim was to investigate the association between dietary and skin AGEs in the Rotterdam Study, a population-based cohort of mainly European ancestry. METHODS: In 2515 participants, intake of 3 dAGEs [carboxymethyl-lysine (CML), N-(5-hydro-5-methyl-4-imidazolon-2-yl)-ornithine (MGH1), and carboxyethyl-lysine (CEL)] was estimated using FFQs and the content of AGEs measured in commonly consumed foods. SAF was measured 5 y (median value) later using an AGE Reader. The association of dAGEs with SAF was analyzed in linear regression models and stratified for diabetes and chronic kidney disease (CKD, defined as estimated glomerular filtration rate ≤60 mL/min) status. RESULTS: Mean ± SD intake was 3.40 ±0.89 mg/d for CML, 28.98 ±7.87 mg/d for MGH1, and 3.11 ±0.89 mg/d for CEL. None of them was associated with SAF in the total study population. However, in stratified analyses, CML was positively associated with SAF after excluding both individuals with diabetes and individuals with CKD: 1 SD higher daily CML intake was associated with a 0.03 (95% CI: 0.009, 0.05) arbitrary units higher SAF. MGH1 and CEL intake were not significantly associated with SAF. Nevertheless, the associations were stronger when the time difference between dAGEs and SAF measurements was shorter. CONCLUSIONS: Higher dietary CML intake was associated with higher SAF only among participants with neither diabetes nor CKD, which may be explained by high AGE formation in diabetes and decreased excretion in CKD or by dietary modifications in these disease groups. The dAGE-SAF associations were also modified by the time difference between measurements. Our results suggest that dAGEs can influence tissue AGE accumulation and possibly thereby age-related diseases. This trial was registered at the Netherlands National Trial Register as NTR6831 (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6831) and at the WHO International Clinical Trials Registry Platform as NTR6831 (http://www.who.int/ictrp/network/primary/en/).


Assuntos
Produtos Finais de Glicação Avançada/metabolismo , Insuficiência Renal Crônica/metabolismo , Pele/metabolismo , Idoso , Estudos de Coortes , Feminino , Fluorescência , Produtos Finais de Glicação Avançada/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/etiologia , Pele/química
11.
Adv Gerontol ; 33(1): 113-120, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32362093

RESUMO

The purpose of the work is to study the characteristics of the course of chronic kidney disease in elderly patients based on the analysis of the register of chronic kidney disease (CKD) for 2015-2018. in the Department of Nephrology, the Komi Republican Clinical Hospital. There are 484 patients in the register, of whom 231 are men (47,7%), 253 women (52,3%). The average age is 58,8±15,8 years old. The patients were divided into 3 groups: persons under the age of 59 years old - 218 people (group 1); from 60 to 74 years old - 207 people (group 2); and over 75 years old - 59 people (group 3). Most patients are between the ages of 60 and 69 years old. In the 1st group, the chronic glomerulonephritis is the leading cause of CKD - 27,1%; in the 2nd group - the chronic tubulo-interstitial nephritis (TIN) - 21,7%, the diabetic nephropathy (DN) - 20,8% and the hypertensive nephropathy - 15,9%; in the 3d group - TIN (27,1%), the chronic pyelonephritis (PN) (15,9%) and DN (13,6%). With increasing age, the incidence of TIN (p<0,1), MO (p<0,05), coronary kidney disease (IBP) (p<0,05), gouty nephropathy (p<0,1) were raised. The average reduction in GFR is 3,99 ml/min/1,73 m2 per year of observation. The rate of decline in GFR in the 1st group is 3,36±1,8 ml/min/1,73 m2 per year, in the 2nd - 2,43±1,2 (p<0,001 between group 1 and 2), in the 3rd group - 1,82±1,1; with aging the negative correlation was observed (p<0,05). 39 patients received hemodialysis, including: in the 1st group - 20 people (9%), in the 2nd group - 18 (8,7%), in the 3rd group - 1 patient (1,7%). Making the register of the patients with CKD allows us to know the number of patients and the causes of CKD among the patients of elderly and senile ages, to assess the clinical situation, the rate of decline in GFR and treatment tactics in these patients.


Assuntos
Insuficiência Renal Crônica/etiologia , Idoso , Nefropatias Diabéticas/complicações , Feminino , Taxa de Filtração Glomerular , Glomerulonefrite/complicações , Humanos , Hipertensão Renal/complicações , Masculino , Pessoa de Meia-Idade , Nefrite Intersticial/complicações , Pielonefrite/complicações , Sistema de Registros
12.
PLoS One ; 15(5): e0232522, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32365131

RESUMO

Chronic Kidney Disease of uncertain etiology (CKDu) is an endemic, disease that mostly affects young agricultural workers in the rural dry zone of Sri Lanka. This study was designed to identify specific biochemical manifestations of CKDu cases. All (119) non-dialysis definite CKDu patients in Girandurukotte and Wilgamuwa were selected. Blood and urine samples were collected and measured biochemical parameters. All analyses were performed in IBM SPSS statistics version 23 (IBM Corp, USA). The median blood pressure was normal though nearly half of the patients (45.4%) who were in the advanced stages (Stage 3b, 4 and 5) of CKDu. Patients without a history of hypertension before the diagnosis of CKDu (100%) and minimal proteinuria (26%) are similar to the previous findings. Patients without a history of diabetes before the CKDu diagnosis had high percentages of diabetes (15.7%) and pre-diabetes (59.8%) and hence indicated the possibility of uremia induced impaired glucose intolerance in the rural areas of the country. There were 62.2% patients who had low vitamin D and only a minority had evidence of bone mineral diseases. Out of liver disease markers serum glutamic pyruvic transaminases (SGPT), serum glutamic oxaloacetic transaminases (SGOT), gamma-glutamyl transferase (GGT), and Lactic acid degydrogenase (LDH) had an inverse correlation with the advancement of the disease indicating subclinical liver disease. Osmolality in serum and urine showed a discrepancy despite > 50% of CKDu patients had increased their serum osmolality. The current study supports most of the previously described manifestations of CKDu. Moreover, some specific patterns have been identified which need to be validated in a larger group.


Assuntos
Insuficiência Renal Crônica/metabolismo , Adulto , Idoso , Biomarcadores/sangue , Biomarcadores/urina , Creatinina/sangue , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Concentração Osmolar , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/etiologia , Sódio/sangue , Sri Lanka/epidemiologia , Adulto Jovem
13.
PLoS One ; 15(5): e0233233, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32469904

RESUMO

OBJECTIVE: Previous studies have shown that visit-to-visit blood pressure variability (BPV) is associated with chronic kidney disease (CKD). However, the results have not been consistent among studies. This systematic review and meta-analysis was conducted to comprehensively assess the association between visit-to-visit BPV and the risk of CKD. METHODS: Medline, Embase, and the Cochrane Library were searched from the date of inception through 1 August 2019 using the terms "blood pressure variability," "chronic kidney disease," "nephropathy," and other comparable terms. The primary outcome was the development of CKD. Two reviewers extracted the data independently. Meta-analysis was performed using a random effects model. RESULTS: Fourteen studies were included in the systematic review and meta-analysis. The risk of CKD was significantly greater in patients with high baseline systolic blood pressure variability (SBPV) than in patients with low baseline SBPV: the standard deviation (SD) showed relative risk (RR) of 1.69 and 95% CI of 1.38-2.08, the coefficient of variation (CV) showed RR of 1.23 and 95% CI of 1.12-1.36, and variance independent of mean (VIM) showed RR of 1.40 and 95% CI of 1.15-1.71. RRs for each unit increase in visit-to-visit SBPV and risk of CKD were 1.05 (95% CI: 1.03-1.07) for SD, 1.06 (95% CI: 1.03-1.09) for CV, and 1.1 (95% CI: 0.96-1.25) for VIM. Diastolic BPV was similarly predictive of CKD based on SD and CV. CONCLUSIONS: Increased visit-to-visit BPV might be an independent risk factor for CKD. However, significant heterogeneity was present; thus, future prospective studies are needed to confirm our findings. Our results indicate that treatment of hypertension should control blood pressure levels and prevent abnormal fluctuations in blood pressure to reduce the risk of CKD.


Assuntos
Hipertensão/complicações , Insuficiência Renal Crônica/etiologia , Pressão Sanguínea , Humanos , Hipertensão/fisiopatologia , Insuficiência Renal Crônica/patologia , Fatores de Risco
14.
Am J Kidney Dis ; 76(2): 295-297, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32362418
15.
BMC Public Health ; 20(1): 406, 2020 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-32223743

RESUMO

BACKGROUND: Hypertension is highly prevalent and is the primary risk factor for cardiovascular disease (CVD) and chronic kidney disease (CKD). While declining in some developed countries, it is increasing rapidly in some developing countries. Sichuan province is the largest and underdeveloped region in southwest China, with 486 thousand square kilometers, more than 80 million residents, unbalanced economic development, and high prevalence, low awareness, low treatment and low control rate of hypertension. We forecasted the death burden due to high systolic blood pressure (SBP) in Sichuan from 1990 to 2030, to raise the awareness of public and government of the importance and benefits of hypertension control. METHODS: We conducted secondary analysis based on data of Global Burden of Disease (GBD) 1990-2015, and predicted the population SBP level, population attributable fraction, and death burden for people aged 30-69 under different scenarios in 2030. RESULTS: Comparing with natural trend, if the prevalence of high SBP can be reduced relatively by 25% by 2030, the deaths of non-communicable chronic diseases (NCDs), CVD and CKD would be reduced by 27.1 thousand, 26.2 thousand and 0.8 thousand for people aged 30-69; the mortality would be reduced by 10.8, 32.8 and 16.0%; and the premature mortality would be reduced by 9.9, 32.0 and 16.0%, respectively. CONCLUSIONS: Controlling or decreasing the prevalence of high SBP can significantly reduce the deaths, death rate and premature mortality of NCDs, CVD and CKD for the 30-69 years old population in Sichuan. There would be huge benefits for the governments to take cost-effective measures to control or reduce the prevalence of hypertension.


Assuntos
Doenças Cardiovasculares/mortalidade , Hipertensão/mortalidade , Mortalidade Prematura/tendências , Doenças não Transmissíveis/mortalidade , Insuficiência Renal Crônica/mortalidade , Adulto , Idoso , Doenças Cardiovasculares/etiologia , China/epidemiologia , Feminino , Previsões , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/etiologia , Fatores de Risco
16.
Am J Physiol Renal Physiol ; 318(5): F1229-F1236, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32249610

RESUMO

Metformin, an AMP-activated protein kinase (AMPK) activator, has been shown in previous studies to reduce kidney fibrosis in different models of experimental chronic kidney disease (CKD). However, in all of these studies, the administration of metformin was initiated before the establishment of renal disease, which is a condition that does not typically occur in clinical settings. The aim of the present study was to investigate whether the administration of metformin could arrest the progression of established renal disease in a well-recognized model of CKD, the subtotal kidney nephrectomy (Nx) model. Adult male Munich-Wistar rats underwent either Nx or sham operations. After the surgery (30 days), Nx rats that had systolic blood pressures of >170 mmHg and albuminuria levels of >40 mg/24 h were randomized to a no-treatment condition or to a treatment condition with metformin (300 mg·kg-1·day-1) for a period of either 60 or 120 days. After 60 days of treatment, we did not observe any differences in kidney disease parameters between Nx metformin-treated and untreated rats. However, after 120 days, Nx rats that had been treated with metformin displayed significant reductions in albuminuria levels and in markers of renal fibrosis. These effects were independent of any other effects on blood pressure or glycemia. In addition, treatment with metformin was also able to activate kidney AMPK and therefore improve mitochondrial biogenesis. It was concluded that metformin can arrest the progression of established kidney disease in the Nx model, likely via the activation of AMPK.


Assuntos
Proteínas Quinases Ativadas por AMP/metabolismo , Ativadores de Enzimas/farmacologia , Rim/efeitos dos fármacos , Metformina/farmacologia , Nefrectomia , Insuficiência Renal Crônica/prevenção & controle , Albuminúria/etiologia , Albuminúria/metabolismo , Albuminúria/prevenção & controle , Animais , Modelos Animais de Doenças , Progressão da Doença , Ativação Enzimática , Fibrose , Hipertensão/etiologia , Hipertensão/metabolismo , Hipertensão/prevenção & controle , Rim/enzimologia , Rim/patologia , Rim/cirurgia , Masculino , Mitocôndrias/efeitos dos fármacos , Mitocôndrias/metabolismo , Mitocôndrias/patologia , Biogênese de Organelas , Ratos Wistar , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/metabolismo , Insuficiência Renal Crônica/patologia , Fatores de Tempo
17.
Am J Obstet Gynecol ; 223(3): 427.e1-427.e14, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32112729

RESUMO

BACKGROUND: Stillbirth is a devastating adverse pregnancy outcome that may occur without any obvious reason or may occur in the context of fetal growth restriction, preeclampsia, or other obstetric complications. There is increasing evidence that women who experience stillbirths are at greater risk of long-term cardiovascular disease, but little is known about their risk of chronic kidney disease and end-stage renal disease. We conducted the largest study to date to investigate the subsequent risk of maternal chronic kidney disease and end-stage renal disease following stillbirth. OBJECTIVE: To identify whether pregnancy complicated by stillbirth is associated with subsequent risk of maternal chronic kidney disease and end-stage renal disease, independent of underlying medical or obstetric comorbidities. STUDY DESIGN/METHODS: We conducted a population-based cohort study using nationwide data from the Swedish Medical Birth Register, National Patient Register, and Swedish Renal Register. We included all women who had live births and stillbirths from 1973 to 2012, with follow-up to 2013. Women with preexisting renal disease were excluded. Cox proportional hazard regression models were used to estimate adjusted hazard ratios and 95% confidence intervals for associations between stillbirth and maternal chronic kidney disease and end-stage renal disease respectively. We controlled for maternal age, year of delivery, country of origin, parity, body mass index, smoking, gestational diabetes, preeclampsia, and small for gestational age deliveries. Women who had a history of medical comorbidities, which may predispose to renal disease (prepregnancy cardiovascular disease, hypertension, diabetes, lupus, systemic sclerosis, hemoglobinopathy, or coagulopathy), were excluded from the main analysis and examined separately. RESULTS: There were 1,941,057 unique women who had 3,755,444 singleton pregnancies, followed up over 42,313,758 person-years. The median follow-up time was 20.7 years (interquartile range, 9.9-30.0 years). 13,032 women (0.7%) had at least 1 stillbirth. Women who had experienced at least 1 stillbirth had a greater risk of developing chronic kidney disease (adjusted hazard ratio, 1.26; 95% confidence interval, 1.09-1.45) and end-stage renal disease (adjusted hazard ratio, 2.25; 95% confidence interval, 1.55-3.25) compared with women who only had live births. These associations persisted after removing all stillbirths that occurred in the context of preeclampsia, and small for gestational age or congenital malformations (for chronic kidney disease, adjusted hazard ratio, 1.33; 95% confidence interval, 1.13-1.57; for end-stage renal disease, adjusted hazard ratio, 2.95; 95% confidence interval, CI 1.86-4.68). There was no significant association observed between stillbirth and either chronic kidney disease or end-stage renal disease in women who had preexisting medical comorbidities (chronic kidney disease, adjusted hazard ratio, 1.13; 95% confidence interval, 0.73-1.75 or end-stage renal disease, adjusted hazard ratio, 1.49; 95% confidence interval, 0.78-2.85). CONCLUSION: Women who have a history of stillbirth may be at increased risk of chronic kidney disease and end-stage renal disease compared with women who have only had live births. This association persists independently of preeclampsia, and small for gestational age, maternal smoking, obesity, and medical comorbidities. Further research is required to determine whether affected women would benefit from closer surveillance and follow-up for future renal disease.


Assuntos
Transtornos Puerperais/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Natimorto , Adulto , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Gravidez , Transtornos Puerperais/etiologia , Sistema de Registros , Insuficiência Renal Crônica/etiologia , Fatores de Risco , Suécia/epidemiologia
18.
Environ Res ; 184: 109312, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32151839

RESUMO

BACKGROUND AND OBJECTIVES: Famine exposure in human early life is proven to be associated with urinary protein concentration and renal function but has not been studied with chronic kidney disease. We aimed to explore the association between exposure to the Chinese famine (from 1959 to 1962) in early life and the risk of chronic kidney disease in adulthood. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: We selected 6267 participants from the baseline survey of China Health and Retirement Longitudinal Study (CHARLS) 2011-2012. Based on the birth year, they were divided into fetal exposed, preschool exposed, school-aged exposed, and non-exposed groups. The estimated glomerular filtration rate (eGFR) was calculated according to Japanese coefficient-modified Chronic Kidney Disease Epidemiology Collaboration equation. Chronic kidney disease (CKD) was defined as eGFR less than 60 mL/min per 1.73 m2. RESULTS: The prevalence of CKD in fetal exposed, preschool exposed, school-aged exposed and non-exposed groups was 4.27%, 5.41%, 9.65% and 2.42%, respectively. The risk of CKD in fetal exposed, preschool exposed and school-aged exposed groups was significantly higher than the non-exposed group. In addition, after stratification by gender and famine severity, we found that only fetal exposure to the severe famine was associated with the elevated risk of CKD among male adults (OR 4.44, 95%CI 1.10-17.92, P < 0.05), even after adjusting for age, marital status, household per capita income, history of kidney disease, hypertension, diabetes or abnormal glucose tolerance, smoking, drinking, rural/urban residence and highest educational attainment of parents. CONCLUSIONS: Severe famine exposure as a fetus might increase the risk of chronic kidney disease in male adults.


Assuntos
Fome Epidêmica , Efeitos Tardios da Exposição Pré-Natal , Insuficiência Renal Crônica , Adulto , Criança , Pré-Escolar , China/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Gravidez , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Prevalência , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/etiologia , Fatores de Risco
19.
Am J Physiol Renal Physiol ; 318(5): F1086-F1099, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32174143

RESUMO

Unilateral ischemia-reperfusion (UIR) injury leads to progressive renal atrophy and tubulointerstitial fibrosis (TIF) and is commonly used to investigate the pathogenesis of the acute kidney injury-chronic kidney disease transition. Although it is well known that contralateral nephrectomy (CNX), even 2 wk post-UIR injury, can improve recovery, the physiological mechanisms and tubular signaling pathways mediating such improved recovery remain poorly defined. Here, we examined the renal hemodynamic and tubular signaling pathways associated with UIR injury and its reversal by CNX. Male Sprague-Dawley rats underwent left UIR or sham UIR and 2 wk later CNX or sham CNX. Blood pressure, left renal blood flow (RBF), and total glomerular filtration rate were assessed in conscious rats for 3 days before and over 2 wk after CNX or sham CNX. In the presence of a contralateral uninjured kidney, left RBF was lower (P < 0.05) from 2 to 4 wk following UIR (3.6 ± 0.3 mL/min) versus sham UIR (9.6 ± 0.3 mL/min). Without CNX, extensive renal atrophy, TIF, and tubule dedifferentiation, but minimal pimonidazole and hypoxia-inducible factor-1α positivity in tubules, were present at 4 wk post-UIR injury. Conversely, CNX led (P < 0.05) to sustained increases in left RBF (6.2 ± 0.6 mL/min) that preceded the increases in glomerular filtration rate. The CNX-induced improvement in renal function was associated with renal hypertrophy, more redifferentiated tubules, less TIF, and robust pimonidazole and hypoxia-inducible factor-1α staining in UIR injured kidneys. Thus, contrary to expectations, indexes of hypoxia are not observed with the extensive TIF at 4 wk post-UIR injury in the absence of CNX but are rather associated with the improved recovery of renal function and structure following CNX.


Assuntos
Lesão Renal Aguda/fisiopatologia , Rim/irrigação sanguínea , Circulação Renal , Insuficiência Renal Crônica/etiologia , Traumatismo por Reperfusão/fisiopatologia , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/metabolismo , Animais , Atrofia , Hipóxia Celular , Modelos Animais de Doenças , Progressão da Doença , Fibrose , Hemodinâmica , Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Rim/metabolismo , Rim/patologia , Masculino , Nefrectomia , Ratos Sprague-Dawley , Recuperação de Função Fisiológica , Insuficiência Renal Crônica/metabolismo , Insuficiência Renal Crônica/fisiopatologia , Traumatismo por Reperfusão/etiologia , Traumatismo por Reperfusão/metabolismo , Fatores de Tempo , Fator A de Crescimento do Endotélio Vascular/metabolismo
20.
PLoS One ; 15(3): e0230189, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32187219

RESUMO

OBJECTIVE: Atrial fibrillation (AF) is associated with adverse outcomes in the general population, but its impact on patients with chronic kidney disease (CKD) remains unclear. In this study, we assessed the association between AF and risks of all-cause mortality and stroke in Chinese adults with CKD. METHODS: We enrolled adults aged 45 years or older with CKD (defined as an estimated glomerular filtration rate <60 mL/min per 1.73 m2 and/or proteinuria identified using the urine dipstick method) from the Kailuan study between 2008 and 2014. AF was identified by 12-lead electrocardiography or hospital discharge diagnostic codes. Mortality data were collected from the provincial vital statistics, and physician-diagnosed ischemic or hemorrhagic stroke was confirmed in the biennial interview. RESULTS: Among the 21587 CKD adults, 216 patients were identified with AF, the median follow-up duration was 5.21 years (5.69 ± 1.96 years); During follow-up, there were 70 cases of death, and 16 cases of ischemic stroke and 6 cases of hemorrhagic stroke in the participants with AF in comparison with 2572 cases of death and 656 cases of ischemic stroke and 184 cases of hemorrhagic stroke among the participants without AF. After adjustment for potential confounders, AF was associated with an 86% increase in the rate of death (hazard ratio [HR], 1.86; 95% confidence interval [CI], 1.33-2.59, P<0.001), a 104% (HR, 2.04; 95% CI, 1.09-3.83, P = 0.026) and 325% (HR, 4.25; 95% CI, 1.74-10.36, P = 0.001) increase in the rate of ischemic stroke and hemorrhagic stroke, respectively. These associations were still consistent and strong after propensity score-matched analysis. CONCLUSION: Our study shows that AF is independently associated with increased risk of all-cause mortality, ischemic and hemorrhagic stroke in Chinese CKD adults. Future studies are required to elucidate the physiological mechanisms underlying this association.


Assuntos
Fibrilação Atrial/complicações , Insuficiência Renal Crônica/etiologia , Idoso , Eletrocardiografia/métodos , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Modelos de Riscos Proporcionais , Estudos Prospectivos , Proteinúria/etiologia , Fatores de Risco , Acidente Vascular Cerebral/etiologia
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