Polypharmacy and Kidney Function in Community-Dwelling Adults Age 60 Years and Older: A Prospective Observational Study

ObjectivesInformation on the impact of polypharmacy on kidney function in older adults is limited. We prospectively investigated the association between intake of total number of drugs or nonsteroidal anti-inflammatory drugs (NSAIDs) and kidney function.DesignOur study is a prospective observational analysis of the 2-year Zurich Multiple Endpoint Vitamin D Trial in Knee Osteoarthritis Patients.Setting and participantsOf the 273 participants of the original trial, 270 participants (mean age 70.3 ± 6.4 years, 53% women) were included in this observational analysis.MethodsThe associations between (1) total number of drugs (or NSAIDs) at baseline or (2) cumulative number of drugs (or NASAIDs) repeatedly measured over 24 months and kidney function repeatedly measured over 24 months as estimated glomerular filtration rate (eGFR) were investigated using multivariable-adjusted repeated-measures analysis.ResultsPer drug at baseline, kidney function decreased by 0.64 mL/min/1.73 m² eGFR (Beta = −0.64; 95% CI −1.19 to −0.08; P = .024) over 24 months. With every additional drug taken cumulatively over 24 months, kidney function decreased by 0.39 mL/min/1.73 m² eGFR (Beta = −0.39; 95% CI −0.63 to −0.15; P = .002). In a high-risk subgroup, per NSAID taken cumulatively over 24 months, kidney function declined by 1.21 mL/min/1.73 m² eGFR (Beta = −1.21; 95% CI −2.35 to −0.07; P = .021).Conclusions and implicationsFor every additional drug prescribed among older adults, our study supports an independent and immediate harmful impact on kidney function. This negative impact seems to be about 3 times greater for NSAIDs compared with an additional average drug.     

Monitoring of patients with type 2 diabetes and nephropathy in a specialized diabetic nephropathy clinic seems to be beneficial

Background

The purpose of this study was to evaluate the outcome of DM2 patients with nephropathy when they are under surveillance of a joined clinic run by endocrinologists & nephrologists.

健康人群肾小球滤过率的增龄变化及其与营养、炎症和性激素的关联性研究

目的分析估算肾小球滤过率(eGFR)的增龄变化及其与营养、炎症和性激素的关联，为深入研究和临床防治增龄性eGFR减退提供线索。 方法多中心、横断面的大样本流行病学调查，共纳入健康研究对象520名(男224名，女296名)，依年龄分为成年组(年龄<65岁)和老年组(年龄≥65岁)，回顾性膳食调查计算热量和营养素摄入量，利用CKD-EPI公式计算eGFR；同时检测炎症、性激素及生化指标，多元线性回归分析总体人群、成人组和老年组的各项指标与eGFR的关联性。 结果①无论男性还是女性，eGFR均伴随增龄下降(P<0.05)，男女之间无明显差别(P>0.05)；②成人女性eGFR与睾酮、雌二醇、黄体酮均呈正相关(P<0.05)；③eGFR的独立影响因素，总体人群为体质量指数、平均动脉压、血清白蛋白、血清转铁蛋白、白细胞介素-6(IL-6)、雌二醇、黄体酮、纤维摄入量、硫胺素摄入量及尼克酸摄入量；成人组为平均动脉压、血清白蛋白、高敏C反应蛋白、雌二醇及镁摄入量；老年组仅为IL-6。 结论伴随增龄eGFR进行性降低，炎症状态是健康人群、特别是老年人eGFR的重要影响因素，成年女性eGFR与性激素明显相关。     

The impact of population-based identification of chronic kidney disease using estimated glomerular filtration rate (eGFR) reporting.

BACKGROUND: The object of this study was to determine the impact of estimated glomerular filtration rate (eGFR) reporting, as part of a disease management programme (DMP), and clarify the prevalence of chronic kidney disease (CKD) and the level of un-met need in a UK Primary Care Trust. METHODS: Our approach was to prospectively identify patients with an eGFR <60 ml/min/1.73 m(2) using the four-variable MDRD equation in all patients from West Lincolnshire PCT (population 185 434 over the age of 15 years) having a routine estimation of serum creatinine. RESULTS: During the first 12 months of the programme 25.4% of the population had an eGFR reported. The likelihood of having an eGFR reported increased markedly with age. The prevalence of CKD stages 3-5 within primary care was 7.3%. Only 3.7% of patients with CKD stages 3-5 were under nephrology care compared to 13.7% in non-nephrology secondary care and 82.6% in primary care. There were marked differences in the male to female ratio between primary care and nephrology care, 1:1.9 versus 0.6:1, respectively (P < 0.001). The incidence of newly identified patients with CKD stages 4 and 5 was 0.16%. Initially there was a marked (up to 7-fold month on month) rise in nephrology referrals following institution of eGFR reporting which was reversed by the introduction of a referral management service as part of the DMP. Only 33% of patients with CKD stage 4 or 5, identified from within primary care, went on to have a nephrology referral in the subsequent 12 months compared with 44% and 78% respectively identified from non-nephrology secondary care (P < 0.001). CONCLUSIONS: The reporting of the eGFR in association with this DMP effectively identified patients with CKD. A referral assessment programme can effectively ensure appropriate nephrology referral and avoids exceeding the capacity of nephrology services. The vast majority of patients with CKD stages 3-5 are cared for within primary care. There are marked gender differences in the prevalence of CKD stages 3-5 that are not reflected by referral patterns to nephrology services. There are significant differences in referral practices between primary and secondary care. In a steady state the burden of incident patients with CKD stages 4-5 should not exceed the capacity of the local nephrology service.     

Imaging-Related Risk Factors for Bleeding Complications of US-Guided Native Renal Biopsy: A Propensity Score Matching Analysis

Purpose

To evaluate imaging-related hemorrhagic risk factors for ultrasound (US)-guided native kidney biopsy.

Impact of Polar Renal Artery Coverage on Early Renal Function after Chimney Endovascular Aortic Aneurysm Repair

Purpose

To evaluate impact of polar renal artery coverage on early renal function after chimney endovascular aneurysm repair (EVAR).

Increased mortality,morbidities, and costs after heart transplantation in heterotaxy syndrome and other complex situs arrangements

Objectives

Identify pediatric heart transplant (HT) recipients with heterotaxy and other complex arrangements of cardiac situs (heterotaxy/situs anomaly) and compare mortality, morbidities, length of stay (LOS), and costs to recipients with congenital heart disease without heterotaxy/situs anomaly.

The change in kidney function was associated with carotid artery plaque in a community-based population: A cohort study

Background and aimsWe performed the current study to evaluate the association between dynamic change in estimated glomerular filtration rate (eGFR) and the risk of carotid artery plaque (CAP) in a community-based population.Methods and resultsA total number of 37,093 Chinese adults (21,790 men and 15,303 women, aged 42.6 ± 11.6 years) free of chronic kidney diseases were enrolled. The change in eGFR was calculated based on two measurements in 2013 and 2014 (mean interval: 1.2 y). Participants were further classified into three groups based on the change in eGFR: fast-decrease (<-3.3%), stable (from ?3.3% to 3.3%), and fast-increase (≥3.3%). CAP was annually assessed by ultrasound B model throughout the study (2013–2018). We have identified 1,624 new cases of CAP (16.0 per 1000 person-year) during follow up. Compared to participants with stable eGFR, participants in both fast-decrease and fast-increase groups were associated with 1.99 folds (HR = 1.99, 95% CI: 1.54, 2.57) and 3.15 folds (HR = 3.15, 95% CI: 2.38, 4.16) higher likelihood of developing CAP. The association between continuous change in eGFR and the risk of CAP demonstrate a “U” shape. Sensitivity analysis generated similar results with main analysis.ConclusionsBoth fast decrease and increase in eGFR were associated with the risk of developing CAP in Chinese adults.