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1.
Dis Markers ; 2022: 4428484, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35756496

RESUMO

Objective: To assess the prognostic value of serum interleukin-6 (IL-6), nuclear factor-κB (NF-κB), and monocyte chemoattractant protein 1(MCP-1) assay in patients with diabetic nephropathy. Methods: From May 2019 to March 2020, 104 patients with diabetic nephropathy treated in our institution assessed for eligibility were recruited and assigned at a ratio of 1 : 1 to either the observation group ([urinary albumin excretion rate (UAER)] of 30 mg-300 mg/24 h) or the research group ([UAER] >300 mg/24 h). IL-6, MCP-1, renal function indices, and NF-κB levels were determined, and their correlation with DN was analyzed. Logistic regression was used to analyze the influencing factors of end-stage renal disease in patients with diabetic nephropathy. The receiver operating characteristic (ROC) curve was drawn, and the area under the curve (AUC) was calculated to analyze the predictive value of combined detection of IL-6, MCP-1, and NF-κB in the prognosis of patients with diabetic nephropathy. Results: The eligible patients with UAER of 30 mg-300 mg/24 h were associated with significantly higher levels of IL-6, MCP-1, NF-κB, blood urea nitrogen (BUN), and serum creatinine (Scr) versus those with UAER >300 mg/24 h (P < 0.05). During the follow-up, a total of 38 patients progressed to end-stage renal diseases. Eligible patients with end-stage renal diseases showed significantly higher serum IL-6, MCP-1, and NF-κB levels versus those without end-stage renal diseases (P < 0.05). Serum IL-6, MCP-1, and NF-κB are independent risk factors for the occurrence of end-stage renal disease in patients with diabetic nephropathy. The AUCs of IL-6, MCP-1, and NF-κB for predicting the prognosis of patients with diabetic nephropathy were 0.562, 0.634, and 0.647, respectively, and the AUC of the three combined detection for predicting the prognosis of patients with diabetic nephropathy was 0.889. Conclusion: Serum IL-6, NF-κB, and MCP-1 levels are closely related to renal injury and poor prognosis in patients with diabetic nephropathy, and the combined assay is valuable for assessing patients' condition and prognosis.


Assuntos
Quimiocina CCL2 , Diabetes Mellitus , Nefropatias Diabéticas , Interleucina-6 , NF-kappa B , Quimiocina CCL2/sangue , Diabetes Mellitus/sangue , Nefropatias Diabéticas/sangue , Humanos , Interleucina-6/sangue , Falência Renal Crônica/sangue , NF-kappa B/sangue , Prognóstico
2.
Physiol Rep ; 10(11): e15307, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35656701

RESUMO

Ferric citrate (FC) is an approved therapy for chronic kidney disease (CKD) patients as a phosphate (Pi) binder for dialysis-dependent CKD, and for iron deficiency anemia (IDA) in non-dialysis CKD. Elevated Pi and IDA both lead to increased FGF23, however, the roles of iron and FGF23 during CKD remain unclear. To this end, iron and Pi metabolism were tested in a mouse model of CKD (0.2% adenine) ± 0.5% FC for 6 weeks, with and without osteocyte deletion of Fgf23 (flox-Fgf23/Dmp1-Cre). Intact FGF23 (iFGF23) increased in all CKD mice but was lower in Cre+ mice with or without FC, thus the Dmp1-Cre effectively reduced FGF23. Cre+ mice fed AD-only had higher serum Pi than Cre- pre- and post-diet, and the Cre+ mice had higher BUN regardless of FC treatment. Total serum iron was higher in all mice receiving FC, and liver Tfrc, Bmp6, and hepcidin mRNAs were increased regardless of genotype; liver IL-6 showed decreased mRNA in FC-fed mice. The renal 1,25-dihydroxyvitamin D (1,25D) anabolic enzyme Cyp27b1 had higher mRNA and the catabolic Cyp24a1 showed lower mRNA in FC-fed mice. Finally, mice with loss of FGF23 had higher bone cortical porosity, whereas Raman spectroscopy showed no changes in matrix mineral parameters. Thus, FC- and FGF23-dependent and -independent actions were identified in CKD; loss of FGF23 was associated with higher serum Pi and BUN, demonstrating that FGF23 was protective of mineral metabolism. In contrast, FC maintained serum iron and corrected inflammation mediators, potentially providing ancillary benefit.


Assuntos
Fatores de Crescimento de Fibroblastos , Ferro , Insuficiência Renal Crônica , Animais , Ácido Cítrico , Modelos Animais de Doenças , Eletrólitos , Compostos Férricos , Fatores de Crescimento de Fibroblastos/metabolismo , Humanos , Ferro/metabolismo , Camundongos , Minerais , RNA Mensageiro/metabolismo , Insuficiência Renal Crônica/metabolismo
3.
Intern Med ; 61(12): 1823-1833, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35705311

RESUMO

Objective Evaluating the rate of decline in the estimated glomerular filtration rate (eGFR) may help identify patients with occult chronic kidney disease (CKD). We herein report that eGFR fluctuation complicates the assessment of the rate of decline and propose a long-term eGFR plot analysis as a solution. Methods In 142 patients with persistent eGFR decline in a single hospital, we evaluated the factors influencing the rate of eGFR decline, calculated over the long term (≥3 years) and short term (<3 years) using eGFR plots, taking into account eGFR fluctuation between visits. Results The difference between the rate of eGFR decline calculated using short- and long-term plots increased as the time period considered in the short-term plots became shorter. A regression analysis revealed that eGFR fluctuation was the only factor that explained the difference and that the fluctuation exceeded the annual eGFR decline in all participants. Furthermore, the larger the eGFR fluctuation, the more difficult it became to detect eGFR decline using a short-term eGFR analysis. Obesity, a high eGFR at baseline, and faster eGFR decline were associated with larger eGFR fluctuations. To circumvent the issue of eGFR fluctuation in the assessment of the rate of eGFR decline, we developed a system that generates a long-term eGFR plot using all eGFR values for a participant, which enabled the detection of occult CKD, facilitating early therapeutic intervention. Conclusion The construction of long-term eGFR plots is useful for identifying patients with progressive eGFR decline, as it minimizes the effect of eGFR fluctuation.


Assuntos
Insuficiência Renal Crônica , Taxa de Filtração Glomerular , Humanos , Rim/fisiologia , Obesidade , Análise de Regressão , Fatores de Risco
4.
BMC Nephrol ; 23(1): 229, 2022 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-35761193

RESUMO

BACKGROUND: Controversy surrounds which factors are important for predicting early mortality after dialysis initiation (DI). We investigated associations of predialysis course and circumstances affecting planning and execution of DI with mortality following DI. METHODS: Among 1580 patients participating in the Peridialysis study, a study of causes and timing of DI, we registered features of predialysis course, clinical and biochemical data at DI, incidence of unplanned suboptimal DI, contraindications to peritoneal dialysis (PD) or hemodialysis (HD), and modality preference, actual choice, and cause of modality choice. Patients were followed for 12 months or until transplantation. A flexible parametric model was used to identify independent factors associated with all-cause mortality. RESULTS: First-year mortality was 19.33%. Independent factors predicting death were high age, comorbidity, clinical contraindications to PD or HD, suboptimal DI, high eGFR, low serum albumin, hyperphosphatemia, high C-reactive protein, signs of overhydration and cerebral symptoms at DI. Among 1061 (67.2%) patients who could select dialysis modality based on personal choice, 654 (61.6%) chose PD, 368 (34.7%) center HD and 39 (3.7%) home HD. The 12-months survival did not differ significantly between patients receiving PD and in-center HD. CONCLUSIONS: First-year mortality in incident dialysis patients was in addition to high age and comorbidity, associated with clinical contraindications to PD or HD, clinical symptoms, hyperphosphatemia, inflammation, and suboptimal DI. In patients with a "free" choice of dialysis modality based on their personal preferences, PD and in-center HD led to broadly similar short-term outcomes.


Assuntos
Hiperfosfatemia , Falência Renal Crônica , Diálise Peritoneal , Humanos , Hiperfosfatemia/etiologia , Incidência , Diálise Peritoneal/efeitos adversos , Diálise Renal/métodos
5.
Trials ; 23(1): 532, 2022 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-35761367

RESUMO

BACKGROUND: More than a third of the 65,000 people living with kidney failure in the UK attend a dialysis unit 2-5 times a week to have their blood cleaned for 3-5 h. In haemodialysis (HD), toxins are removed by diffusion, which can be enhanced using a high-flux dialyser. This can be augmented with convection, as occurs in haemodiafiltration (HDF), and improved outcomes have been reported in people who are able to achieve high volumes of convection. This study compares the clinical- and cost-effectiveness of high-volume HDF compared with high-flux HD in the treatment of kidney failure. METHODS: This is a UK-based, multi-centre, non-blinded randomised controlled trial. Adult patients already receiving HD or HDF will be randomised 1:1 to high-volume HDF (aiming for 21+ L of substitution fluid adjusted for body surface area) or high-flux HD. Exclusion criteria include lack of capacity to consent, life expectancy less than 3 months, on HD/HDF for less than 4 weeks, planned living kidney donor transplant or home dialysis scheduled within 3 months, prior intolerance of HDF and not suitable for high-volume HDF for other clinical reasons. The primary outcome is a composite of non-cancer mortality or hospital admission with a cardiovascular event or infection during follow-up (minimum 32 months, maximum 91 months) determined from routine data. Secondary outcomes include all-cause mortality, cardiovascular- and infection-related morbidity and mortality, health-related quality of life, cost-effectiveness and environmental impact. Baseline data will be collected by research personnel on-site. Follow-up data will be collected by linkage to routine healthcare databases - Hospital Episode Statistics, Civil Registration, Public Health England and the UK Renal Registry (UKRR) in England, and equivalent databases in Scotland and Wales, as necessary - and centrally administered patient-completed questionnaires. In addition, research personnel on-site will monitor for adverse events and collect data on adherence to the protocol (monthly during recruitment and quarterly during follow-up). DISCUSSION: This study will provide evidence of the effectiveness and cost-effectiveness of HD as compared to HDF for adults with kidney failure in-centre HD or HDF. It will inform management for this patient group in the UK and internationally. TRIAL REGISTRATION: ISRCTN10997319 . Registered on 10 October 2017.


Assuntos
Hemodiafiltração , Falência Renal Crônica , Insuficiência Renal , Adulto , Análise Custo-Benefício , Atenção à Saúde , Hemodiafiltração/efeitos adversos , Hemodiafiltração/métodos , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/terapia , Qualidade de Vida , Sistema de Registros , Diálise Renal/efeitos adversos , Diálise Renal/métodos , Insuficiência Renal/etiologia
6.
PLoS One ; 17(6): e0270214, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35749444

RESUMO

BACKGROUND: We tested if fatigue in incident Peritoneal Dialysis associated with an increased risk for mortality, independently from main confounders. METHODS: We conducted a side-by-side study from two of incident PD patients in Brazil and the United States. We used the same code to independently analyze data in both countries during 2004 to 2011. We included data from adults who completed KDQOL-SF vitality subscale within 90 days after starting PD. Vitality score was categorized in four groups: >50 (high vitality), ≥40 to ≤50 (moderate vitality), >35 to <40 (moderate fatigue), ≤35 (high fatigue; reference group). In each country's cohort, we built four distinct models to estimate the associations between vitality (exposure) and all-cause mortality (outcome): (i) Cox regression model; (ii) competing risk model accounting for technique failure events; (iii) multilevel survival model of clinic-level clusters; (iv) multivariate regression model with smoothing splines treating vitality as a continuous measure. Analyses were adjusted for age, comorbidities, PD modality, hemoglobin, and albumin. A mixed-effects meta-analysis was used to pool hazard ratios (HRs) from both cohorts to model mortality risk for each 10-unit increase in vitality. RESULTS: We used data from 4,285 PD patients (Brazil n = 1,388 and United States n = 2,897). Model estimates showed lower vitality levels within 90 days of starting PD were associated with a higher risk of mortality, which was consistent in Brazil and the United States cohorts. In the multivariate survival model, each 10-unit increase in vitality score was associated with lower risk of all-cause mortality in both cohorts (Brazil HR = 0.79 [95%CI 0.70 to 0.90] and United States HR = 0.90 [95%CI 0.88 to 0.93], pooled HR = 0.86 [95%CI 0.75 to 0.98]). Results for all models provided consistent effect estimates. CONCLUSIONS: Among patients in Brazil and the United States, lower vitality score in the initial months of PD was independently associated with all-cause mortality.


Assuntos
Falência Renal Crônica , Diálise Peritoneal , Adulto , Brasil/epidemiologia , Fadiga/etiologia , Humanos , Falência Renal Crônica/terapia , Diálise Peritoneal/efeitos adversos , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
7.
PLoS One ; 17(6): e0269849, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35749459

RESUMO

BACKGROUND: A higher body mass index (BMI) has been associated with better survival among chronic kidney disease patients in some reports. However, more research is required to determine the associations between BMI and mortality in incident hemodialysis patients. Therefore, this study aimed to investigate the association between mortality and BMI measured at the first hemodialysis session and 2 weeks after hemodialysis initiation in Japanese patients with incident hemodialysis. METHODS: We retrospectively enrolled 266 adult patients with incident hemodialysis who were treated at our hospital between May 2013 and June 2019. The data on BMI was obtained at the first hemodialysis session and 2 weeks after hemodialysis initiation. Patients were divided into tertiles based on BMI [<18.5 (low), 18.5-23.9 (normal), and ≥24 (high) kg/m2]. The normal group was used as the reference group. The primary outcome was all-cause mortality. RESULTS: The mean age of patient was 68.9 ± 12.0 years, and the BMI was 23.3 ± 4.24 kg/m2 at the first hemodialysis session. The body mass index was 22.0 ± 3.80 kg/m2 at 2 weeks after hemodialysis initiation. During a mean follow-up of 3.89 ± 2.12 years, 80 (30.1%) deaths occurred. In multivariate analyses, low BMI at the first hemodialysis session was significantly associated with worse all-cause mortality (hazard ratio, 2.39; 95% confidence interval, 1.13-5.03). At 2 weeks after hemodialysis initiation, high BMI was significantly associated with better all-cause mortality (hazard ratio, 0.38; 95% confidence interval, 0.18-0.81). CONCLUSION: At 2 weeks after HD initiation, high BMI was associated with lower mortality in Japanese patients with incident hemodialysis.


Assuntos
Falência Renal Crônica , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Humanos , Japão/epidemiologia , Falência Renal Crônica/complicações , Pessoa de Meia-Idade , Obesidade/complicações , Diálise Renal , Estudos Retrospectivos
8.
PLoS One ; 17(6): e0270062, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35749537

RESUMO

Risk factors for in-hospital mortality of COVID-19 patients in Saudi Arabia have not been well studied. Previous reports from other countries have highlighted the effect of age, gender, clinical presentation and health conditions on the outcome of COVID-19 patients. Saudi Arabia has a different epidemiological structure with a predominance of young population, which calls for separate study. The objective of this study is to assess the predictors of mortality among hospitalized patients with COVID-19 in Saudi Arabia. This is a retrospective observational cohort study of hospitalized adult COVID-19 patients at two tertiary hospitals in Saudi Arabia between May to July 2020. Electronic charts were retrospectively reviewed comparing survivors and non-survivors in terms of demographic and clinical variables and comorbid conditions. A total of 564 hospitalized patients with COVID-19 were included in the study. The overall in-hospital mortality rate was 20%. The non-survivors were significantly older than survivors (59.4 ± 13.7 years and 50.5 ± 13.9 years respectively P< 0.001). Diabetes mellitus, hypertension, heart failure and ischemic heart disease were more prevalent among non-survivors (P< 0.001). The mean values of glycosylated hemoglobin HgA1C, D-dimer, ferritin, lactate dehydrogenase LDH, Alanin aminotransferase ALT and creatinine were significantly higher among non-survivors (P < 0.05). Multivariate logistic regression analysis revealed that age (aOR = 1.04; 95% CI 1.02-1.08; P < 0.01), chronic kidney disease (aOR = 4.04; 95% CI 1.11-14.77; P < 0.05), acute respiratory distress syndrome ARDS (aOR = 14.53; 95% CI 5.42-38.69; P < 0.01), Mechanical Ventilation (aOR = 10.57; 95% CI 5.74-23.59; P < 0.01), Shock (aOR = 3.85; 95% CI 1.02-14.57; P < 0.05), admission to intensive care unit (ICU) (aOR = 0.12; 95% CI 0.04-0.33; P < 0.01) and length of stay (aOR = 0.96; 95% CI 0.93-0.99; P < 0.05) were significant contributors towards mortality. The in-hospital mortality rate of COVID-19 patients admitted to tertiary hospitals in Saudi Arabia is high. Older age, chronic kidney disease and ARDS were the most important predictors of mortality.


Assuntos
COVID-19 , Insuficiência Renal Crônica , Síndrome do Desconforto Respiratório , Adulto , Estudos de Coortes , Mortalidade Hospitalar , Humanos , Estudos Retrospectivos , Fatores de Risco , Arábia Saudita/epidemiologia
9.
Adv Respir Med ; 90(3): 193-201, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35731112

RESUMO

INTRODUCTION: This retrospective observational study has been designed to identify clinical characteristics, treatment outcomes and factors associated with severe illness in 813 COVID-19 patients hospitalised in an Indian tertiary care hospital. MATERIAL AND METHODS: This was a retrospective analysis of patient admitted between 1st July to 15th Aug 2020 with COVID-19 infections. Logistic regression was performed to explore the association of clinical characteristics and laboratory parameters with the risk of severe disease and mortality. The statistical significance level was set at 0.05 (two-tailed). RESULTS: Out of 813 study patients, 630 (77.50%) patients were categorised with mild to moderate while 183 (22.50%) patients as severe Covid infection. Mortality was significantly higher in severe Covid patients as compared to mild moderate cases (66.21% vs. 10.31%. p<0.0001. Patients with severe infection were significantly more likely to have diabetes hypertension, chronic kidney disease (CKD) and had significantly higher Neutrophil count, serum creatinine, C-reactive protein (CRP), ferritin, D-Dimer and decreased haemoglobin, lymphocyte and serum calcium than patients with mild-moderate infection. In Multivariate analy-sis, age more than 60 years [AOR: 2.114, 95% CI (1.05-4.254), 0.036], NLR more than 3.3 [AOR: 1.082, 95% CI (1.030-1.137), 0.002] and D-Dimer >1 µg/mL [AOR: 2.999 (1.464- 6.146),0.003] were found significantly associated with severe disease (p < 0.05). Factors associated with mortality were age more than 60 years, presence of breathlessness, severe disease or presence of chronic kidney disease. CONCLUSIONS: Factors like elderly age (age > 60 years), elevated NRL, CRP, D-Dimer and serum ferritin were associated with sig-nificantly higher risk to develop severe COVID-19 infections. Elderly, and patients with CKD were associated with worse outcome.


Assuntos
COVID-19 , Insuficiência Renal Crônica , Idoso , Proteína C-Reativa , COVID-19/terapia , Ferritinas , Humanos , Índia/epidemiologia , Pessoa de Meia-Idade , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/terapia , Estudos Retrospectivos , SARS-CoV-2 , Centros de Atenção Terciária , Resultado do Tratamento
11.
PLoS One ; 17(6): e0268688, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35731726

RESUMO

Los Angeles, California became a warzone of COVID-19 infections with up to one death every 10 minutes at the end of 2020. As resources thinned, and ICU beds and ventilators became scarce, physicians began agonizing over potentially rationing medical care. In this study, we conducted a retrospective cohort analysis of 7,429 confirmed COVID-19 positive patients from two community hospitals in Los Angeles, California between March 16, 2020 and June 9, 2021. We applied the Cox proportional hazards regression model to determine the risk factors most strongly associated with in-hospital mortality. Using the multivariable Cox proportional hazards model, there was a higher hazard ratio (HR) for mortality in patients who were older (age ≥60 years) [HR 2.189, 95% CI 1.991-2.407, p<0.001], had low triage oxygenation < 90% [HR 1.439, 95% CI 1.339-1.546, p<0.001], had chronic kidney disease (CKD) [HR 1.348, 95% CI 1.234-1.496, p = 0.001)], and who were obese (BMI ≥ 30 kg/m^2) [HR 1.221, 95% CI 1.155-1.340, p = 0.003)]. Overall, our study concluded that age ≥ 60 years, low triage oxygenation less than 90%, chronic kidney disease, and obesity were the top patient characteristics associated with increased mortality for both the univariate and multivariate Cox proportional hazards model analyses. Furthermore, by separating our data set into a development and validation set, we created a novel prediction tool to forecast in-hospital mortality and achieved 86% accuracy.


Assuntos
COVID-19 , Insuficiência Renal Crônica , Idoso , COVID-19/epidemiologia , COVID-19/terapia , Estudos de Coortes , Mortalidade Hospitalar , Hospitais , Humanos , Los Angeles/epidemiologia , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/terapia , Estudos Retrospectivos , Fatores de Risco , Triagem
12.
Nephrol Ther ; 18(3): 155-171, 2022 Jun.
Artigo em Francês | MEDLINE | ID: mdl-35732405

RESUMO

In French-speaking countries, the anglicism "traitement conservateur" is commonly used in clinical practice for CKD 5 patients, meaning comprehensive conservative care. In 2015, the publication of KDIGO controversies put forward this "new" therapeutic option at the same level as dialysis or transplantation. However, its detailed contents remain heterogeneous due to cultural and ethical considerations, varying with regional or national health systems. This is the reason why the French-speaking society of Nephrology, Dialysis, Transplantation (SFNDT) set up an international debate to publish clinical guidelines in French.


Assuntos
Nefrologia , Insuficiência Renal Crônica , Humanos , Diálise Renal , Insuficiência Renal Crônica/terapia
13.
Front Public Health ; 10: 895787, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35719641

RESUMO

Obesity and metabolic syndrome are strong risk factors for incident chronic kidney disease (CKD). However, the predictive accuracy of metabolic body composition status (MBCS), which combines the status of obesity and metabolic syndrome, for rapid kidney function decline (RKFD) is unclear. The aim of this study was to investigate the relationship between MBCS and RKFD in a healthy population in a prospective community-based cohort study. In the current study, we followed changes in renal function in 731 people residing in northern Taiwan for 5 years. The participants were divided into four groups according to their MBCS, including metabolically healthy normal weight (MHNW), metabolically healthy overweight (MHOW), metabolically unhealthy normal weight (MUNW), and metabolically unhealthy overweight (MUOW). We evaluated traditional risk factors for CKD and metabolic profiles. The primary outcome was RKFD, which was defined as a 15% decline in estimated glomerular filtration rate (eGFR) within the first 4 years, and a reduction in eGFR which did not improve in the 5th year. During the study period, a total of 731 participants were enrolled. The incidence of RKFD was 17.1% (125/731). Multiple Cox logistic regression hazard analysis revealed that age, cerebrovascular accident, eGFR, urine albumin-to-creatinine ratio, use of painkillers, depressive mood, MUNW and MUOW were independent predictors of RKFD. After adjusting for age, sex, eGFR and total cholesterol, the participants with MUNW and MUOW had higher hazard ratios (HRs) for RKFD [HR: 2.19, 95% confidence interval (CI): 1.22-3.95 for MUNW; HR: 1.86, 95% CI: 1.21-2.87 for MUOW] than those with MHNW. Similar results were also observed in subgroup analysis of those aged above 65 years. On the basis of the results of this study, we conclude that MBCS was independently associated with RKFD, especially in the older adults. On the basis of our results, we suggest that MUNW and MUOW should be considered as risk factors for RKFD.


Assuntos
Síndrome Metabólica , Insuficiência Renal Crônica , Idoso , Composição Corporal , Estudos de Coortes , Humanos , Rim , Síndrome Metabólica/epidemiologia , Obesidade/epidemiologia , Sobrepeso , Estudos Prospectivos , Insuficiência Renal Crônica/epidemiologia
15.
Acta Cir Bras ; 37(3): e370304, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35674582

RESUMO

PURPOSE: To investigate the protective effects of Shenkang injection (SKI) on adenine-induced chronic renal failure (CRF) in rat. METHODS: Sprague Dawley rats were randomly divided into five groups: control, model, and SKI groups (5, 10, 20 mL/kg). Rats in model and SKI groups were treated with adenine i.g. at a dose of 150 mg/kg every day for 12 weeks to induce CRF. Twelve weeks later, SKI was administered to the rat i.p. for four weeks. The effects of SKI on kidney injury and fibrosis were detected. RESULTS: SKI inhibited the elevation of the urine level of N-acetyl-b-D-glucosaminidase, kidney injury molecule-1, beta-2-microglobulin, urea protein in CRF rats. The serum levels of uric acid and serum creatinine increased and albumin decreased in the model group, which was prevented by SKI. SKI inhibited the release of inflammatory cytokines and increasing the activities of antioxidant enzymes in serum. SKI inhibited the expression of transforming growth factor-ß1, vascular cell adhesion molecule 1, intercellular adhesion molecule 1, collagen I, collagen III, endothelin-1, laminin in kidney of CRF rats. CONCLUSIONS: SKI protected against adenine-induced kidney injury and fibrosis and exerted anti-inflammatory, and antioxidant effects in CRF rats.


Assuntos
Falência Renal Crônica , Insuficiência Renal Crônica , Adenina/metabolismo , Adenina/farmacologia , Adenina/uso terapêutico , Animais , Medicamentos de Ervas Chinesas , Fibrose , Rim , Falência Renal Crônica/induzido quimicamente , Falência Renal Crônica/tratamento farmacológico , Falência Renal Crônica/prevenção & controle , Ratos , Ratos Sprague-Dawley , Insuficiência Renal Crônica/tratamento farmacológico
16.
Methods Mol Biol ; 2472: 187-196, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35674901

RESUMO

The NOTCH signaling pathway is an evolutionarily conserved family of transmembrane receptors, ligands, and transcription factors. The NOTCH signaling is activated in many biological processes including nephrogenesis, tubulogenesis, and glomerulogenesis, as well as during pathological situations. Activation of Notch signaling is characterized by successive proteolytic cleavages triggered by the interaction between membrane-bound Notch receptors and ligands expressed on neighboring cells. In chronic kidney diseases, activation of the canonical NOTCH signaling pathway has been described. The following protocols will allow the direct assessment of Jagged-1/NOTCH signaling activation in biopsies of patients with chronic kidney diseases and in murine experimental models of renal damage.


Assuntos
Receptores Notch , Insuficiência Renal Crônica , Animais , Biópsia , Proteínas de Ligação ao Cálcio/metabolismo , Proteínas de Transporte/metabolismo , Humanos , Proteína Jagged-1/genética , Rim/metabolismo , Ligantes , Camundongos , Receptores Notch/metabolismo , Transdução de Sinais/fisiologia
17.
PLoS One ; 17(6): e0269632, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35675292

RESUMO

BACKGROUND AND OBJECTIVE: Chronic kidney disease (CKD) constitutes a major public health challenge, with a global prevalence of 15-74.7 cases /million children. Preventing CKD in children, slowing its progression and management of complications are essential, especially in challenged health systems in low middle income countries (LMIC). We conducted a retrospective review to assess the underlying cause and stage of CKD at presentation and clinical outcomes in children and adolescents at the Indus Hospital and Health Network (IHHN) in Karachi, Pakistan. METHODS: Children 0-16 years with CKD stage 1 and/or higher at presentation were included. Data including demographics, clinical status and lab results at presentation and during follow-up, surgical intervention if any, kidney function at last visit and outcome at last follow-up was recorded. RESULTS: A total of 229 children diagnosed with CKD are included in our study. The median age at diagnosis was 10 years with male: female ratio of 1.8:1. Only 5% children presented in stage 1 CKD. The rate of adverse outcomes is 4.5 times higher in children with CKD stage 3-5 compared to early CKD. Congenital anomaly of kidney and urinary tract (CAKUT) was the underlying cause in 49% children. Children with glomerular disease had comparatively worse outcome. Proteinuria, hypertension, anemia and bone disease were associated with high morbidity and mortality. CONCLUSION: The true epidemiology of childhood CKD is unknown in Pakistan. Our cohort showed better CKD outcomes in children diagnosed early with appropriate surgical and medical follow-up. Prompt diagnosis, treatment and prevention of progression can be life-saving in our setting. CKD registry data can inform policy changes that can prevent poor outcomes.


Assuntos
Hipertensão , Insuficiência Renal Crônica , Adolescente , Criança , Países em Desenvolvimento , Progressão da Doença , Feminino , Humanos , Hipertensão/epidemiologia , Rim , Masculino , Proteinúria/complicações , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/terapia , Fatores de Risco
18.
Saudi Med J ; 43(6): 633-636, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35675935

RESUMO

OBJECTIVES: To report the outcome of patients with end stage kidney disease (ESKD) who were diagnosed with COVID-19 at a large community hospital in Eastern Saudi Arabia. METHODS: A single center, prospective observational study at Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia. Patients with ESKD who were maintained on dialysis and developed COVID-19 between June 15, 2020 and October 31, 2021 were enrolled. RESULTS: In total, 30 patients with ESKD were diagnosed with severe acute respiratory syndrome coronavirus 2 infection. Twenty two (73%) patients developed the disease prior to COVID-19 vaccine rollout. The median age of the cohort was 63 (55-75) years. Most patients were diabetic (73%), hypertensive (97%) and had a median body mass index of 28 kg/m2. Twenty seven (90%) patients required admission, 16 (52%) patients developed pneumonia, and 5 (17%) patients required mechanical ventilation. Patients who developed pneumonia were older, and the majority had diabetes mellitus and coronary artery disease. Five patients died with a total mortality of 17%. CONCLUSION: Patients with ESKD who developed COVID-19 had a poor outcome with high mortality compared to the general population. Presence of diabetes mellitus, coronary artery disease and older age were associated with a higher risk of severe disease. There was a sharp decline in the number of positive cases following implementation of the vaccination program.


Assuntos
COVID-19 , Doença da Artéria Coronariana , Falência Renal Crônica , Idoso , COVID-19/epidemiologia , Vacinas contra COVID-19 , Hospitais Comunitários , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Arábia Saudita/epidemiologia
19.
Sci Rep ; 12(1): 9384, 2022 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-35672344

RESUMO

This study aimed to determine whether the patterns of diabetic complications differed when patients with type 2 diabetes mellitus (T2DM) were simply classified according to insulin sensitivity and beta-cell function. This observational study included 8861 patients with T2DM who underwent concurrent testing for fasting glucose, fasting insulin, and one or more diabetic complications. We categorized the patients into four groups according to insulin sensitivity and beta-cell function. Compared with the reference group (mild insulin resistance and beta-cell dysfunction), the "severe beta-cell dysfunction" group had lower odds of chronic kidney disease [adjusted odds ratios (aOR) 0.611]. The "severe insulin resistance" group had higher odds of carotid artery plaque presence (aOR 1.238). The "severe insulin resistance and beta-cell dysfunction" group had significantly higher odds of large fiber neuropathy (aOR 1.397, all p < 0.05). After a median of five years of follow-up, this group distinction did not lead to a difference in risk of new diabetic retinopathy or chronic kidney disease. In addition, there was no significant difference among the groups in plaque progression risk over 8-10 years in the longitudinal follow-up analysis. The patterns of complications differ when patients with T2DM are classified according to insulin resistance and beta-cell dysfunction. However, there were no differences in the risk of developing new complications.


Assuntos
Diabetes Mellitus Tipo 2 , Resistência à Insulina , Células Secretoras de Insulina , Insuficiência Renal Crônica , Glicemia , Diabetes Mellitus Tipo 2/complicações , Humanos , Insulina , Resistência à Insulina/fisiologia , Insuficiência Renal Crônica/complicações
20.
Stud Health Technol Inform ; 290: 304-308, 2022 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-35673023

RESUMO

We present an automated knowledge synthesis and discovery framework to analyze published literature to identify and represent underlying mechanistic associations that aggravate chronic conditions due to COVID-19. Our literature-based discovery approach integrates text mining, knowledge graphs and medical ontologies to discover hidden and previously unknown pathophysiologic relations, dispersed across multiple public literature databases, between COVID-19 and chronic disease mechanisms. We applied our approach to discover mechanistic associations between COVID-19 and chronic conditions-i.e. diabetes mellitus and chronic kidney disease-to understand the long-term impact of COVID-19 on patients with chronic diseases. We found several gene-disease associations that could help identify mechanisms driving poor outcomes for COVID-19 patients with underlying conditions.


Assuntos
COVID-19 , Diabetes Mellitus , Insuficiência Renal Crônica , Doença Crônica , Diabetes Mellitus/epidemiologia , Humanos , Reconhecimento Automatizado de Padrão , Insuficiência Renal Crônica/epidemiologia
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