Prevalence of pulmonary hypertension in peritoneal dialysis patients: a meta-analysis

Purpose

Recent epidemiological evidence indicates an association between peritoneal dialysis (PD) patients and pulmonary hypertension (PH). However, the true prevalence of PH associated with PD has not been well described. So we conducted a meta-analysis to summarize the point prevalence of PH in adults with PD.

Methods

PubMed, EMBASE, the Cochrane Collaboration, and the reference lists of relevant articles were searched to identify eligible studies. We used a random-effect meta-analysis model to estimate the prevalence of PH. We also performed sensitivity analyses and assessments of publishing bias.

Results

Fourteen observational studies (n?=?1483 participants) were included in this meta-analysis. The result of analysis in random-effect model showed that the pooled prevalence was 21% (95% CI 16–28), with significant heterogeneity between these studies (I²?=?84%, p?<?0.01). Sensitivity analysis further demonstrated the results to be robust. Besides, the Egger’s test (p?=?0.287) showed no significant publication bias.

Conclusions

PH is highly prevalent in patients with PD. Further studies are encouraged to definitively clarify the relationship between PH and PD.

     

Life expectancy of Chinese patients with chronic kidney disease without dialysis

Aim: Long term dialysis is life‐saving for patients with end stage renal disease (ESRD). However, in ESRD patients with multiple comorbid conditions, dialysis may actually be futile, and conservative management is advisable. We studied the life expectancy of Chinese ESRD patients treated conservatively. Methods: We reviewed 63 consecutive ESRD patients who were treated conservatively in our centre. Duration of survival was calculated from the date of initial assessment for dialysis, as well as the expected date of needing dialysis based on previous trend of renal function decline. Results: At the end of the observation period, 55 patients died. Twelve patients died before the expected date of needing dialysis because of unrelated reasons, while 36 deaths were directly attributed to uraemia. The median overall survival after initial assessment for dialysis was 41.3 months (95% confidence interval (CI), 33.2 to 49.4 months). The median overall survival was 6.58 months (inter‐quartile range, 0.92 to 9.33 months) from the theoretical date of needing dialysis. The survival from the theoretical date of needing dialysis did not correlate with patient age, sex, diabetic status, or baseline renal function. Conclusions: In Chinese ESRD patients treated conservatively, the median survival is around 6 months after the theoretical date of needing dialysis. Our result provides an important piece of information for the decision of dialysis and patient counselling.     

Prevalence of chronic kidney disease in Bangladesh: a systematic review and meta-analysis

International Urology and Nephrology - Worldwide, chronic kidney disease (CKD) is a major public health issue, with a leading cause of death and disability. The aim of our study to estimate the...     

Prognostic value of pulmonary hypertension in pre-dialysis chronic kidney disease patients

International Urology and Nephrology - Pulmonary hypertension is common in chronic kidney disease (CKD) patients. However, the prognostic value of pulmonary hypertension in Chinese predialytic CKD...     

Effect of daprodustat on anemia in patients with chronic kidney disease: a meta-analysis

Background

The efficacy of daprodustat for the treatment of anemic patients with chronic kidney disease (CKD) remains controversial. The aim of the study is to perform a meta-analysis of randomized controlled trials to evaluate the efficacy and safety of daprodustat for anemic patients with chronic kidney disease.

Methods

We searched Medline, Embase, Science Citation Index, Cochrane Central Register of Controlled Trials, and Clinical Trial Registries for randomized controlled trials comparing daprodustat with placebo for anemic patients with CKD.

Results

Four studies were included. Compared with placebo groups, daprodustat groups significantly increased hemoglobin (WMD 1.29 g/dL; 95% CI 0.96–1.62, p?<?0.00001), transferrin (WMD 0.67 g/dL; 95% CI 0.45–0.89, p?<?0.00001), and total iron binding capacity (WMD 9.97 g/dL; 95% CI 6.07–13.8, p?<?0.00001). Daprodustat groups significantly decreased hepcidin (WMD ??76.1 μg/L; 95% CI ??91.8 to ??60.3, p?<?0.00001) and ferritin (WMD ??63.6 μg/L; 95% CI ??96.6 to ??30.7, p?=?0.0002) compared with that of placebo groups. In addition, there was no significant difference in adverse events between the two groups.

Conclusion

Daprodustat could improve hemoglobin without increasing adverse events in the short term. Daprodustat may be another valuable choice for anemic patients with chronic kidney disease in the future.

     

Off-pump versus on-pump coronary surgery in patients with chronic kidney disease: a meta-analysis

Background

Patients with chronic kidney disease (CKD) have worse adverse cardiovascular outcomes after coronary artery bypass grafting (CABG). However, the adverse cardiovascular outcomes between off-pump coronary artery bypass grafting (OPCAB) versus on-pump coronary artery bypass grafting (ONCAB) in these patients have been a subject of debate.

Methods

We undertook a comprehensive literature search of PubMed, Embase, and the Cochrane Library database to identify all relevant studies comparing techniques between OPCAB and ONCAB in CKD patients. We pooled the odds ratios (ORs) and hazard ratios (HRs) from individual studies and conducted heterogeneity, quality assessment, and publication bias analyses.

Results

This meta-analysis includes 17 studies with 201,889 patients. In CKD patients, OPCAB was associated with significantly lower early mortality as compared to ONCAB (OR 0.88; 95% CI 0.82–0.93; p < 0.0001). OPCAB was associated with decreased risk of atrial fibrillation (OR 0.57; 95% CI 0.34–0.97; p = 0.04), cerebrovascular accident (OR 0.46; 95% CI 0.22–0.95; p = 0.04), blood transfusion (OR 0.20; 95% CI 0.08–0.49; p = 0.0005), pneumonia, prolonged ventilation, and shorter hospital stays. No difference was found regarding long-term survival (HR 1.08; 95% CI 0.86–1.36; p = 0.51) or myocardial infarction (OR 0.65; 95% CI 0.30–1.38; p = 0.26).

Conclusions

Compared with ONCAB, OPCAB is associated with superior postoperative morbidity and the early mortality in CKD patients. Long-term survival is comparable between the two surgical revascularizations.

     

Acquired cystic disease of kidney in chronic dialysis patients

Eight cases of acquired cystic disease of the kidney (ACDK) associated with chronic renal failure and hemodialysis are described. No patient had a family history or clinical evidence of congenital adult polycystic kidney disease (CAPKD). Glomerulonephritis was the cause of renal failure in 6, and pyelonephritis in 2. Massive renal and perirenal hemorrhage necessitated 3 nephrectomies in 2 patients. Single kidney weights did not exceed 280 Gm., a major feature in the distinction of ACDK from CAPKD. Morphologically, in addition to the usual stigmata of end-stage kidneys, 40 to 80 per cent of the renal parenchyma was replaced by small cysts. Continuity of cysts with tubules was established by nephron dissection.     

Prevalence of depression in patients with chronic obstructive pulmonary disease: a systematic review

BACKGROUND—Patients with chronic obstructive pulmonary disease (COPD) have repeatedly been characterised as a population of chronically ill patients with a higher than normal prevalence of depression. Susceptibility for depression has been noted in patients with certain other chronic conditions. This systematic review was conducted to achieve a more definite answer to the question: do patients with COPD show a higher than normal prevalence of depression?METHODS—Studies in English language journals were retrieved by an electronic search over the period from 1966 to December 1997 and by an extended search of reference lists, and were included or excluded according to a system of diagnostic and methodological criteria.RESULTS—Ten studies were included, of which only four had a case-control design. Three of the case-control studies reported an increased prevalence of depression among patients with COPD which was statistically significant in only one. The fourth controlled study found a significantly increased depression score among COPD patients. Of the remaining six uncontrolled studies three found a high baseline prevalence of depression among their study group.CONCLUSIONS—An association between COPD and depression was found in the four controlled studies. The two methodologically best conducted studies that did not detect a statistically significant higher prevalence lacked power. The two studies that did find a significant association used a questionable depression measure. The prevalence of depression was high compared with general population figures in three of six non-controlled studies. The empirical evidence for a significant risk of depression in patients with COPD remains inconclusive, due to the poor methodological quality of most of the published studies, the lack of studies with an adequate sample size, and variability in instruments and cut off scores used to measure depression.     

Prevalence of abdominal artery calcification in dialysis patients with end-stage renal disease: a systematic review and meta-analysis

International Urology and Nephrology - To systematically determine the prevalence of abdominal artery calcification (AAC) in dialysis patients with end-stage renal disease (ESRD) and identify...     

Mortality in chronic kidney disease patients with COVID-19: a systematic review and meta-analysis

International Urology and Nephrology - At the beginning of 2020, the outbreak of coronavirus disease 2019 (COVID-19) led to a worldwide pandemic and mass panic. The number of infected people has...     

慢性肾脏病患者高血压现状的横断面调查

目的 对慢性肾脏病（CKD）患者高血压的发病和治疗情况进行横断面调查。 方法 调查对象为2006年11月至2007年3月本院肾内科门诊就诊的900例CKD患者,男性480例,女性420例,其中维持性透析患者354例（血透228例,腹透126例）。 结果 （1）本组CKD患者高血压患病率为80.2%,其中男性患病率高于女性患者（83.5% 比76.4%,P < 0.01）;维持性透析患者显著高于非透析患者（90.1% 比73.8%,P < 0.01）;血液透析与腹膜透析患者的高血压患病率分别为91.7%和87.3%,差异无统计学意义。（2）高血压治疗率为92.4%,透析患者显著高于非透析患者（95.6% 比89.8%,P < 0.01）。（3）非透析患者高血压控制率（<130/80 mm Hg为标准）为20.4%,而尿蛋白量（24 h）>1 g的未透析患者,其血压控制在125/75 mm Hg以下者仅占8.4%。透析患者高血压控制率（<140/90 mm Hg）显著低于非透析患者（45.2% 比55.5%,P < 0.01）,其中血液透析组高血压控制率显著高于腹膜透析组（49.8% 比36.5%,P < 0.05)。（4）CKD患者高血压患病率随肾功能减退和年龄增长逐渐增高;糖尿病肾病患者的高血压患病率高于原发性肾小球疾病患者。高龄、糖尿病、肥胖、肾功能减退、高脂血症均为CKD高血压发病的危险因素。（5）CKD患者服用1、2、3和4种降压药物及以上者分别为37.2%、37.5%、19.3%和5.9%。单药用药以钙通道阻滞剂(CCB)最多（74.1%）,血管紧张素受体阻滞剂（ARB）和血管紧张素转换酶抑制剂（ACEI）分别为48.4%和25.6%,α、β受体阻滞剂为24.7%。联合用药以CCB联合ACEI或ARB最常用。 结论 CKD患者中高血压患病率很高。年龄、肾功能减退、糖尿病、肥胖是CKD高血压的危险因素。CKD患者高血压的治疗率较高,但控制率较低,透析患者和尿蛋白量较多患者的高血压控制情况更是有待提高。     

Acquired cystic kidney disease: occurrence in patients on chronic peritoneal dialysis

Acquired cystic kidney disease (ACKD) is a well-known complication of long-term hemodialysis. To the best of our knowledge, only six patients on continuous ambulatory peritoneal dialysis have been reported to develop this disease. We herein report two such cases, and concluded that the morphology of ACKD seems to be independent of the type of dialysis and that hemodialysis is not necessary for the development of ACKD.     

Asymptomatic atherosclerosis and hypertension in nondiabetic patients with chronic kidney disease

Abstract:  Atherosclerosis is accelerated in dialysis patients, but less is known about asymptomatic atherosclerosis and major risk factors in patients with different stages of chronic kidney disease (CKD). We compared intima media thickness (IMT) and plaque occurrence in the carotid arteries in 104 nondiabetic patients (stages 1–5 of CKD; mean age: 51.6 years) with those in 40 healthy control subjects. The IMT values (0.69 vs. 0.59 mm; P  < 0.002) were higher in patients. More patients had plaques (46.2 vs. 17.5%; P  < 0.002), and number of plaques was higher ( P  < 0.003). Negative correlation between IMT ( P  < 0.0001), presence of plaques ( P  < 0.0001), their number ( P  < 0.040), and chromium 51-labeled ethylenediaminetetraacetate (⁵¹Cr-EDTA) clearance were found in patients. With multiple regression analysis, relationship between IMT and ⁵¹Cr-EDTA clearance ( P  < 0.001) and presence of hypertension ( P  < 0.001) was found. Nondiabetic patients with CKD showed advanced atherosclerosis and IMT, plaque occurrence, and number increased directly with the level of renal dysfunction. Another important risk factor was hypertension.       

Prevalence of chronic kidney disease in hypertensive patients in Ghana

Chronic kidney disease (CKD) is common in tropical Africa although there are few data on the prevalence of this disorder. Therefore we initiated a multicenter screening study to identify the prevalence and staging of CKD in 712 patients with known hypertension in four polyclinics in Accra, Ghana. We measured estimated glomerular filtration rate by the six-variable modification of diet in renal disease equation and proteinuria by the protein/creatinine ratio. All the subjects studied were Ghanaian. Of the 712 patients studied, the median age was 59 years (range 19-90 years) and 560 (78.7%) of the patients were female. The mean duration of hypertension was 4 years (range 0.1-50). The overall prevalence of CKD was 46.9% (95% CI: 43.2-50.7%); 19.1% had CKD stages 1-2 and 27.8% had CKD stages 3-5. There was no difference in age between patients with or without CKD (p?=?0.12). The overall prevalence of proteinuria was 28.9% (95% CI: 25.6-32.4%); 14.7% of subjects had preexisting diabetes mellitus and their prevalence of CKD (55%; 95% CI: 42.4-62.2) did not differ from those without diabetes (46%; 95% CI: 41.9-50.0, p?=?0.133). CKD is common in hypertensive patients in Ghana, with a prevalence of 46.9%. This provides justification for the inclusion of this group in CKD screening programs in Ghana.     

Still a reasonable goal: Targeting cholesterol in dialysis and advanced chronic kidney disease patients

Chronic kidney disease (CKD) patients have a high burden of cardiovascular disease. In the general population, lipid metabolism disorders, which cause the initiation and progression of atherosclerotic vascular changes, are major targets for preventive and therapeutic strategies in cardiovascular medicine. However, data from large cohort studies and from clinical trials suggest that the treatment guidelines on cardiovascular disease prevention and therapy cannot uncritically be transferred from individuals with intact renal function to CKD patients. Thus, unlike in the general population, neither plasma levels of HDL‐cholesterol, nor the key parameter of HDL‐cholesterol function—that is, cholesterol efflux capacity—predicts future cardiovascular events. Therefore, HDL‐cholesterol should presently not be considered as therapeutic target in CKD patients. In contrast, lowering of LDL‐cholesterol has been shown to reduce cardiovascular events at least among nondialysis CKD patients. The cardiovascular benefit of targeting LDL‐cholesterol among dialysis CKD patients is less evident. We strongly believe that at least some subgroups of dialysis patients may profit from such treatment, particularly those with highest baseline LDL‐cholesterol. Finally, as CKD patients have been characterized to have rather high intestinal cholesterol absorption, and relatively low hepatic cholesterol synthesis, substituting combined statin/ezetimibe treatment for statin monotherapy may be of particular benefit for nephrologic patients.     

Prevalence of chronic kidney disease in Chinese HIV-infected patients.

BACKGROUND: To evaluate the prevalence of chronic kidney disease (CKD) in Chinese HIV-infected population. METHODS: This was a cross-sectional point prevalence study. All Chinese HIV-infected patients who were followed up in a tertiary referral center in Hong Kong were recruited. Spot urine was saved for each patient to calculate urine protein-to-creatinine ratio (urine P/Cr). Those with urine P/Cr > 0.3 would have 24-h urine collection to determine the exact amount of proteinuria. Glomerular filtration rate (GFR) was estimated using MDRD formula. CKD was defined as GFR <60 ml/min/1.73 m2 and/or urine P/Cr > 0.3. Baseline demographic and clinical data were extracted from patients' records. RESULTS: In total 322 patients were recruited. The mean age was 45.2 +/- 11.7 years. The duration of follow up was 6.0 +/- 4.0 years. There were 264 male and 58 female patients. The prevalence of hypertension, diabetes mellitus and CKD were 7.4%, 10.6% and 16.8%, respectively. Eighteen patients (5.6%) had GFR < 60 ml/min/1.73 m2 while 44 patients (13.7%) had spot urine P/Cr > 0.3. Among those with urine P/Cr > 0.3, 38 patients had 24-h urine collection. Using univariate analysis, CKD was found to be significantly (P < 0.05) associated with age, hypertension, diabetes, use of indinavir, lower CD4 count and peak viral load. Multivariate logistic regression revealed older age (P < 0.001), lower CD4 count (P = 0.02) and use of indinavir therapy (P = 0.04) were associated with development of CKD. CONCLUSION: CKD is prevalent in Chinese HIV-infected patients. Patients with CKD were more likely to be older, associated with use of indinavir and CD4 nadir less than 100 cells/mul.     

Prevalence of restless legs syndrome in chronic kidney disease: a systematic review and meta-analysis of observational studies

Introduction: Nowadays prevalence of restless legs syndrome (RLS) in chronic kidney disease (CKD) patients was reported in many studies, while the results varied. The aim of our study was to investigate the prevalence of RLS in this population, considering different data collecting measures and diagnostic criteria.

Methods: MEDLINE, Embase, PsycINFO, and Scopus databases were searched for relevant studies. We limited the analyses to studies using clinical interview or questionnaire for diagnosis. Univariate meta-regression analysis was preformed to assess the effects of the disease-related covariates on prevalence estimates. Comprehensive Meta-Analysis 2.0 was used to perform the meta-analysis.

Results: Fifty-one studies were included in the analysis. Prevalence of RLS was varied by renal function and diagnostic methods. Overall prevalence in CKD populations was 24.2% (95%CI, 20.1–28.7). Pooled prevalence of RLS was higher in patients diagnosed by questionnaire than by clinical interview [26.2% (95%CI, 17.9–36.5) vs. 23.6% (95%CI, 19.6–28.1)]. When grouped by CKD setting, the prevalence was 28.4% (95%CI, 24.6–32.6) in dialysis patients, followed by early stages patients [9.9% (95%CI, 5.4–17.5)], and kidney transplant recipients [6.7% (95%CI, 5.6–7.8)].

Conclusions: Our meta-analysis suggested that more than one-quarter of CKD sufferers, especially those who were on dialysis, were plagued by RLS. Higher sensitivity of diagnostic criteria in interview may be valuable for timely treatment.     

Prevalence and risk factors for pulmonary arterial hypertension in end-stage renal disease patients undergoing continuous ambulatory peritoneal dialysis

Background: Pulmonary arterial hypertension (PAH) is a major complication in renal failure patients, but very little information is available on the cardiovascular parameters in these patients. The prevalence and risk factors for PAH were systematically evaluated in patients with end-stage renal diseases (ESRD) undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods: Between January 2010 and January 2014, 177 ESRD patients (85 males and 92 females) undergoing CAPD therapy were recruited. General data, biochemical parameters and echocardiographic findings were collected and PAH risk factors studied. Results: Study participants consisted of 65 patients (36.52%) with PAH (PAH group) and 112 patients without PAH (non-PAH group). The interdialytic weight gain, systolic blood pressure and diastolic blood pressure (DBP), mean arterial pressure and hypertensive nephropathy incidence in the PAH group were significantly higher than the non-PAH group (all p?p?p?p?Conclusion: We observed a high incidence of PAH in ESRD patients undergoing CAPD. Logistic regression analysis revealed that DBP, NT-proBNP, LAD, RVID, RVOTD, LVEF, TAPSE and E/E’ are high-risk factors for PAH in ESRD patients undergoing CAPD.