Outcomes of stage 1–5 chronic kidney disease in Mainland China

Objective: This study aims to quantify and compare the risks of death and end stage renal disease (ESRD) in a prospective cohort of patients with chronic kidney disease (CKD) stages 1–5 under renal management clinic at Peking University Third Hospital and to evaluate the risk factors associated with these two outcomes. Method: This was a prospective cohort study. Finally, 1076 patients at CKD stage 1–5 short of dialysis were recruited from renal management clinic. Patients were monitored for up to Dec, 2011 or until ESRD and death. Glomerular filtration rate was estimated (eGFR) according to the using the CKD Epidemiology Collaboration (CKD-EPI) formula. Results: At the end of follow-up, 111 patients (10.1%) developed ESRD (initiated dialysis or kidney transplantation (ESRD)) and 24 patients (2.2%) had died. There were more ESRD occurrence rate in patients with baseline diabetic nephropathy, lower eGFR, hemoglobin <100?g/L and 24?h urinary protein excretion ≥3.0?g. By multivariate Cox regression model, having heavy proteinuria and CKD stage were the risk factors of ESRD. For all-cause mortality, the most common cause was cardiovascular disease, followed by infectious disease and cancer. But we failed to conclude any significant variable as risk factors for mortality in multivariate analysis. Conclusions: Our study indicated that baseline diabetic nephropathy, lower hemoglobin level, lower baseline GFR and heavy proteinuria were the risk factors of ESRD. In this CKD cohort, patients were more likely to develop ESRD than mortality, and cardiovascular mortality was the leading cause of death, and then followed by infectious diseases and cancer in this population.     

Left ventricular remodeling and arterial remodeling in patients with chronic kidney disease stage 1–3

Abstract

Introduction: Chronic kidney disease (CKD) is an independent factor for cardiovascular system complications, such as arterial hypertension, left ventricular hypertrophy (LVH), heart failure or accelerated atherosclerosis progression. The aim of the paper was to analyze left ventricular and arterial remodeling in patients with CKD stages 1–3 to identify the subclinical marker of cardiovascular system damage which changes first in the course of CKD. Methods: The examined group consisted of 90 patients with CKD stage 1–3 and 30 subjects constituting the control group. Left ventricular mass index (LVMI), left ventricular relative wall thickness (RWT) and ejection fraction (EF) were determined by echocardiographic examination. Pulse wave velocity (PWV) between the carotid and femoral arteries as well as common carotid artery intima–media thickness (IMT) was measured. 24-h ambulatory blood pressure monitoring was performed in all subjects. Results: No differences were found between blood pressure values in the examined groups of patients with CKD1, CKD2 and CKD3. Concentric remodeling was found in 20.0%, concentric hypertrophy in 22.2% and eccentric hypertrophy in 18.9% of patients. LVMI values in patients with CKD2 and 3 were higher than in the control group. IMT values in patients with CKD3 were higher than in patients with CKD2. PWV in patients with stage 3 CKD was significantly higher than in the control group (p?<?0.05). Conclusions: In the course of CKD, the left ventricle undergoes remodeling earlier than large arterial vessels. Echocardiographic assessment of LVH in early stages of CKD may identify patients at increased cardiovascular risk.     

Clinical characteristics and outcomes of children with stage 3–5 chronic kidney disease

The aim of this study was to report on the clinical characteristics and outcomes of Belgian children with chronic kidney disease (CKD). Between 2001 and 2005, we followed 143 new successive patients younger than 20 years of age with a glomerular filtration rate of <60 ml/min/1.73 m² prospectively in a Belgian department of pediatric nephrology. The incidence of diagnosed CKD was 11.9 per million child population (pmcp), and the incidence of renal replacement therapy was 6.2 pmcp. There were 67% patients in CKD stage 3, 19% in CKD stage 4 and 14% in CKD stage 5. Patients with congenital anomalies of the kidney and urinary tract (CAKUTs), hereditary diseases and glomerular diseases were diagnosed at a median age of 1, 2 and 10 years, respectively. CAKUTs were the main causes of CKD, accounting for 59% of all cases. After 3, 4 and 5 years of follow-up, 27, 31 and 38% of patients treated conservatively, respectively, reached end-stage renal failure (ESRF). The progression rate to ESRF was eightfold higher in patients with CKD stage 4 than in those with CKD stage 3. Among our patient group, hereditary diseases progressed more rapidly to ESRF than CAKUTs. Transplantation was performed preemptively in 22% of these children. Infections and cardiovascular diseases were the main causes of death.     

The relationship between sclerostin and carotid artery atherosclerosis in patients with stage 3–5 chronic kidney disease

International Urology and Nephrology - Sclerostin is an antagonist of the Wnt/β-catenin pathway. We previously reported that sclerostin is closely related to carotid artery atherosclerosis and...     

Short-term efficacy of sevelamer versus calcium acetate in patients with chronic kidney disease stage 3–4

Background  

The relative effectiveness and safety of sevelamer, a mineral-free phosphate binder, for treatment of hyperphosphatemia in children with chronic kidney disease is uncertain.     

Effectiveness and safety of anakinra in gout patients with stage 4–5 chronic kidney disease or kidney transplantation: A multicentre,retrospective study

Objectives

Interleukin (IL)-1β blocking is effective for the treatment of gout flares and is recommended in patients with contraindications to the standard of care, such as stage 4–5 chronic kidney disease (CKD) patients. However, efficacy and safety data regarding these agents are lacking in this population. We aimed to investigate the efficacy and safety of anakinra for the treatment of gout flares in patients with stage 4–5 CKD or renal transplantation.

Renoprotective effects of angiotensin II receptor blocker,candesartan cilexetil,in patients with stage 4–5 chronic kidney disease

BACKGROUND: To investigate the renoprotective effects and safety of angiotensin II receptor blocker (ARB) for patients with stage 4-5 chronic kidney disease. METHODS: An ARB, candesartan cilexetil, was administered to 13 patients (ARB group, n = 7; control group, n = 6) with a serum creatinine level of 2.52-5.95 mg/dl whose blood pressure had been maintained below 140/90 mmHg by the use of drugs other than ARBs. Routine measurements were conducted for 48 weeks, and renal survival analysis was observed for up to 3 years with the endpoints being doubling of the serum creatinine level, entry to hemodialysis, or death. The results were compared with those of the control group that was not treated with ARB. RESULTS: No significant changes were observed in the blood pressure in either group. Proteinuria significantly decreased from 0.95 +/- 0.51 to 0.39 +/- 0.12 g/day (paired t test, P = 0.033) in the ARB group, but did not change in the control group. Creatinine clearance in the control group decreased significantly from 16.2 +/- 5.7 to 10.4 +/- 4.8 ml/min per 1.73 m2 (paired t test, P = 0.011), but did not change in the other group. Thus, the slopes of the reciprocal serum creatinine values became less steep in the ARB group as compared with the control (-0.002 +/- 0.015 vs. -0.025 +/- 0.015 dl/mg per month; unpaired t test, P = 0.019). Kaplan-Meier analysis revealed that ARB exhibited more favorable renal outcome at 3 years (log-rank, P = 0.025). No serious adverse events were noted in the study. CONCLUSION: These results show that ARB reduces proteinuria and protects renal function even in the advanced renal failure.     

The effects of depression and age on sleep disturbances in patients with non-dialysis stage 3–5 chronic kidney disease: a single-center study

International Urology and Nephrology - Sleep disturbances have a negative impact on the prognosis of chronic kidney disease (CKD). However, information on the prevalence and predictors is limited....     

Effects of HIF-1α, hepcidin and PTH on RankL in patients with chronic kidney disease in different stages

ObjectiveTo investigate the effects of hypoxia-inducible factor-1α (HIF-1α), hepcidin, and parathyroid hormone (PTH) on the serum nuclear factor κB and receptor activating factor ligand (RankL) in patients with chronic kidney disease (CKD) stages 3–5.MethodsA total of 90 patients admitted to our hospital's Department of Nephrology from March 2018 to December 2019 were randomly selected as the subjects (30 patients with CKD3, CKD4, and CKD5 each). A total of 30 healthy volunteers receiving a physical examination in our hospital during the same period were selected for the control group. Then, the participants' HIF-1α, hepcidin, and RankL levels were detected by double-antibody sandwiched enzyme-linked immunosorbent assay. The serum creatinine, serum iron, hemoglobin, and phosphorus (P³⁺) levels were determined by BeckMAN-c800 automatic biochemical analysis. The glomerular filtration rate (eGFR) was calculated by the CKD-EPI formula.Results(1) The levels of HIF-1α, RankL, hepcidin, and PTH were all elevated, and the serum ferritin and P³⁺ were elevated in each stage; (2) Linear correlation analysis: The HIF-1α and hepcidin showed a higher correlation with RankL in CKD3 and CKD4(CKD3: The correlation coefficient r = 0.558 between HIF-1α and RankL, and r = 0.604 between HEpcidin and RankL; CKD4: Correlation coefficient r = 0.840 between HIF-1α and RankL, and r = 0.753 between HEpcidin and RankL), while the PTH showed a higher correlation with RankL in CKD5 (correlation index r = 0.631). Multiple linear stepwise regression analysis: RankL was independently correlated with HIF-1α, hepcidin, and PTH. Regression coefficient B of HIF-1α was the highest in both CKD3 and CKD4. The coefficient B value of PTH in CKD5 was 3.971; HIF-1α and hepcidin were not included in the regression equation.ConclusionThe levels of RankL in both CKD3 and CKD4 were increased and mainly affected by HIF-1α, followed by hepcidin. Moreover, HIF-1α and PTH had a combined effect on the RankL level in CKD5, and PTH was the main influencing factor.     

Analysis of profibrogenic microRNAs (miRNAs) expression in urine and serum of chronic kidney disease (CKD) stage 1–4 patients and their relationship with proteinuria and kidney function

International Urology and Nephrology - Besides conventional kidney diseases diagnostics, micro RNAs (miRNAs) assessment in urine and serum is considered to be a promising non-invasive method of...     

Are biomarkers useful for assessing cardiovascular risk in patients with chronic kidney disease?

PURPOSE OF REVIEW: Chronic kidney disease is now recognized as an independent risk factor for cardiovascular events, and cardiovascular disease is the major cause of mortality in patients with the disease. Recent studies have attempted to evaluate the utility of biomarkers for assessing cardiovascular risk in patients with chronic kidney disease. This review will summarize these studies and critically assess the utility of cardiovascular risk biomarkers for clinical practice. RECENT FINDINGS: Traditional cardiovascular risk factors including dyslipidemia, hypertension, smoking and diabetes mellitus are highly prevalent in patients with chronic kidney disease. Although prediction models using traditional risk factors underestimate cardiovascular disease risk in these patients, nontraditional biomarkers (i.e. markers of inflammation, endothelial dysfunction, myocardial necrosis, and left ventricular remodeling) have been associated with increased cardiovascular event rates and mortality risk in populations with and without chronic kidney disease. Moreover, a high prevalence of biomarkers that are directly attributable to loss of kidney function is observed in patients with the disease. SUMMARY: Recent studies suggest only limited utility of either single or multiple biomarkers of cardiovascular risk as prognostic tools in patients with and without chronic kidney disease. Novel approaches for biomarker development capturing augmented information through a systems biology approach are urgently needed to improve the usefulness of cardiovascular risk biomarkers.