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Rao S, Zhang J, Lin J, Wan J, Chen Y. Association of Red Blood Cell Life Span with Abnormal Changes in Cardiac Structure and Function in Non-Dialysis Patients with Chronic Kidney Disease Stages 3-5. J Clin Med 2022; 11:jcm11247373. [PMID: 36555989 PMCID: PMC9782058 DOI: 10.3390/jcm11247373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction: With the invention and improvement of the carbon monoxide (CO) breath test, the role of shortened red blood cell life span (RBCLS) in renal anemia, an independent risk factor for cardiovascular events in patients with chronic kidney disease (CKD), is gradually attracting attention. Considering that heart failure is the leading cause of morbidity and mortality in patients with CKD, this study investigated the correlation between the RBCLS and the cardiac structure and function in non-dialysis patients with CKD stages 3−5, aiming to provide new ideas to improve the long-term prognosis of CKD patients. Methods: One hundred thirty-three non-dialysis patients with CKD stages 3−5 were tested for RBCLS. We compared the serological data, cardiac ultrasound results, and follow-up prognosis of patients with different RBCLS. Results: As the RBCLS shortened, the patients’ blood pressure, BNP, and CRP gradually increased, most significantly in patients with an RBCLS < 50 d. Patients with an RBCLS < 50 d had substantially lower hemoglobin (Hb), hematocrit, and albumin levels than those with an RBCLS ≥ 50 d. The cardiac ultrasound results show that patients with an RBCLS < 50 d had significantly larger atrial diameters than those with an RBCLS ≥ 50 d and were associated with more severe diastolic dysfunction. Patients with an RBCLS < 50 d had a 3.06 times greater risk of combined heart failure at baseline than those with an RBCLS ≥ 70 d and a higher risk of heart failure at follow-up. CKD stage 5 patients with an RBCLS < 50 d were more likely to develop heart failure and require renal replacement therapy earlier than patients with an RBCLS ≥ 50 d. Conclusions: In non-dialysis patients with CKD stages 3−5, there is a correlation between the red blood cell life span and cardiac structure and function. The RBCLS may also impact the renal prognosis of CKD patients.
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Affiliation(s)
- Siyi Rao
- Department of Nephrology, Blood Purification Research Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - Jing Zhang
- Department of Nephrology, Blood Purification Research Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - Jiaqun Lin
- Department of Nephrology, Blood Purification Research Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
| | - Jianxin Wan
- Department of Nephrology, Blood Purification Research Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
- Correspondence: (J.W.); (Y.C.)
| | - Yi Chen
- Department of Nephrology, Blood Purification Research Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Fujian Clinical Research Center for Metabolic Chronic Kidney Disease, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Department of Nephrology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
- Correspondence: (J.W.); (Y.C.)
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Sági B, Késői I, Vas T, Csiky B, Nagy J, Kovács TJ. Left ventricular myocardial mass index associated with cardiovascular and renal prognosis in IgA nephropathy. BMC Nephrol 2022; 23:285. [PMID: 35974314 PMCID: PMC9382800 DOI: 10.1186/s12882-022-02909-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/08/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction In chronic kidney disease (CKD), like in IgA nephropathy (IgAN), cardiovascular (CV) mortality and morbidity are many times higher than in the general population, and left ventricular hypertrophy (LVH) is an independent risk factor for CV disease. This follow-up study investigated the association between left ventricular mass index (LVMI) and renal or cardiovascular outcomes. Methods We examined 118 IgAN patients prospectively. LVMI and LV geometry was investigated using echocardiography. The primary combined endpoints were total mortality, major CV events, and end-stage renal disease. Secondary endpoints, i.e.—cardiovascular or renal endpoints,—were also examined separately. Results Sixty seven percent were males, mean age 53.5 ± 13.5. Mean follow-up time: 184 months. LVMI inversely correlated with eGFR (corr. coefficient: -0.365; p < 0.01). We divided the patients into two groups based on the LVMI cut-off suggested by the literature. The presence of LVH caused a worse prognosis in primary (p < 0.001), renal endpoints (p = 0.01), and also in CV endpoints (p = 0.001). The higher LVMI in men significantly worsened the prognosis in all endpoints. Concentric hypertrophy meant a worse prognosis. Independent predictors of LVMI were gender and eGFR in uni- and multivariate regression and hemoglobin levels only in logistic regression. Independent predictors of the primary endpoint were LVMI, eGFR, gender, obesity, HT, DM, and metabolic syndrome in Cox regression analysis. Conclusion Increased LVMI may predict the progression to end-stage renal disease and CV events in IgAN. Determining LVMI may be a useful parameter not only in CV risk but also in the stratification of renal risk in CKD.
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Affiliation(s)
- Balázs Sági
- Medical School, Clinical Center, 2Nd. Dep. of Internal Medicine and Nephrology, Diabetes Center, University of Pécs, 1 Pacsirta street, 7624, Pécs, Hungary.,Fresenius Medical Care Dialysis Center Pécs, Pecs, Hungary
| | - István Késői
- Department of Internal Medicine Cardiology, Mohács Hospital, Mohács, Hungary
| | - Tibor Vas
- Medical School, Clinical Center, 2Nd. Dep. of Internal Medicine and Nephrology, Diabetes Center, University of Pécs, 1 Pacsirta street, 7624, Pécs, Hungary
| | - Botond Csiky
- Medical School, Clinical Center, 2Nd. Dep. of Internal Medicine and Nephrology, Diabetes Center, University of Pécs, 1 Pacsirta street, 7624, Pécs, Hungary.,Fresenius Medical Care Dialysis Center Pécs, Pecs, Hungary
| | - Judit Nagy
- Medical School, Clinical Center, 2Nd. Dep. of Internal Medicine and Nephrology, Diabetes Center, University of Pécs, 1 Pacsirta street, 7624, Pécs, Hungary
| | - Tibor József Kovács
- Medical School, Clinical Center, 2Nd. Dep. of Internal Medicine and Nephrology, Diabetes Center, University of Pécs, 1 Pacsirta street, 7624, Pécs, Hungary.
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Pramod S, Goldfarb DS. Challenging patient phenotypes in the management of anaemia of chronic kidney disease. Int J Clin Pract 2021; 75:e14681. [PMID: 34331826 PMCID: PMC9285529 DOI: 10.1111/ijcp.14681] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/12/2021] [Accepted: 07/25/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is often complicated by anaemia, which is associated with disease progression and increased hospital visits, decreased quality of life, and increased mortality. METHODS A comprehensive literature search of English language peer-reviewed articles in PubMed/MedLine published between 1998 and 2020 related to the treatment of anaemia of CKD was conducted. The United States Renal Database System and Dialysis Outcomes and Practice Patterns Study (DOPPS) data reports, the Centers for Disease Control and Prevention and the US Food and Drug Administration websites, and published congress abstracts in 2020 were surveyed for relevant information. RESULTS Subgroups of patients with anaemia of CKD present a clinical challenge throughout the disease spectrum, including those with end-stage kidney disease, advanced age or resistance to or ineligibility for current standards of care (ie, oral or intravenous iron supplementation, erythropoietin-stimulating agents and red blood cell transfusions). In addition, those with an increased risk of adverse events because of comorbid conditions, such as cardiovascular diseases or diabetes, comprise special populations of patients with an unmet need for interventions to improve clinical outcomes. These comorbidities must be managed in parallel and may have a synergistic effect on overall disease severity. CONCLUSIONS Several therapies provide promising opportunities to address gaps with a standard of care, including hypoxia-inducible factor prolyl hydroxylase inhibitors, which stimulate haematopoiesis through promoting modest increases in serum erythropoietin and improved iron homeostasis. The critical issues in the management of anaemia of CKD in these challenging phenotypes and the clinical utility of new therapeutic agents in development for the treatment of anaemia of CKD should be assessed and the information should be made available to healthcare providers.
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Affiliation(s)
- Sheena Pramod
- Department of Internal MedicineDivision of NephrologyMarshall University School of MedicineHuntingtonWest VirginiaUSA
| | - David S. Goldfarb
- Department of MedicineDivision of NephrologyNYU School of MedicineNew YorkNew YorkUSA
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Io H, Nakata J, Inoshita H, Ishizaka M, Tomino Y, Suzuki Y. Relationship among Left Ventricular Hypertrophy, Cardiovascular Events, and Preferred Blood Pressure Measurement Timing in Hemodialysis Patients. J Clin Med 2020; 9:E3512. [PMID: 33143005 PMCID: PMC7694059 DOI: 10.3390/jcm9113512] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 12/12/2022] Open
Abstract
This study aimed to identify the ideal timing and setting for measuring blood pressure (BP) and determine whether the left ventricular mass index (LVMI) is an independent risk factor associated with increased cardiovascular events in hemodialysis (HD) patients. BP and LVMI were measured at baseline and at 6 and 12 months after HD initiation. BP was monitored and recorded at nine different time points, including before and after HD over a one-week period (HDBP). The mean BP measurement was calculated as the weekly averaged BP (WABP). LVMI was significantly correlated with home BP, in-office BP, HDBP, and WABP. Receiver operating characteristic analysis indicated that the cutoff LVMI value for cardiovascular events was 156 g/m2. LVMI and diabetes mellitus were significant influencing factors for cardiovascular events (hazards ratio (95% confidence interval): diabetes mellitus, 2.84 (1.17,7.45); LVMI > 156 g/m2, 2.86 (1.22,6.99)). Pre-HDBP, post-HDBP, and WABP were independently associated with higher LVMI in the follow-up periods. Hemoglobin and human atrial natriuretic peptide (hANP) levels were associated with LVMI beyond 12 months after HD initiation. Treatment of hypertension, overhydration based on hANP, and anemia may reduce the progression of LVMI and help identify HD patients at high risk for cardiovascular events.
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Affiliation(s)
- Hiroaki Io
- Department of Nephrology, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan; (H.I.); (M.I.)
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo 113-8412, Japan; (J.N.); (Y.T.); (Y.S.)
| | - Junichiro Nakata
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo 113-8412, Japan; (J.N.); (Y.T.); (Y.S.)
| | - Hiroyuki Inoshita
- Department of Nephrology, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan; (H.I.); (M.I.)
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo 113-8412, Japan; (J.N.); (Y.T.); (Y.S.)
| | - Masanori Ishizaka
- Department of Nephrology, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan; (H.I.); (M.I.)
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo 113-8412, Japan; (J.N.); (Y.T.); (Y.S.)
| | - Yasuhiko Tomino
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo 113-8412, Japan; (J.N.); (Y.T.); (Y.S.)
| | - Yusuke Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo 113-8412, Japan; (J.N.); (Y.T.); (Y.S.)
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Moriya H, Mochida Y, Ishioka K, Oka M, Maesato K, Hidaka S, Ohtake T, Kobayashi S. Plasma neutrophil gelatinase-associated lipocalin (NGAL) is an indicator of interstitial damage and a predictor of kidney function worsening of chronic kidney disease in the early stage: a pilot study. Clin Exp Nephrol 2017; 21:1053-1059. [PMID: 28397074 DOI: 10.1007/s10157-017-1402-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 03/11/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND The aim of this study was to examine whether plasma neutrophil gelatinase-associated lipocalin (NGAL) levels predict the outcome of kidney function and correlate with the severity of tubulointerstitial damages in patients with chronic kidney disease (CKD). METHODS In this prospective 18-month cohort study of 112 patients with CKD between 2010 and 2011, associations between plasma NGAL levels and estimated glomerular filtration ratio (eGFR), further worsening of kidney function and histological lesion on kidney biopsy were investigated. RESULTS Serum levels of creatinine and eGFR before the study were 1.48 ± 0.65 mg/dl and 42.6 ± 22.0 ml/min/1.73 m2. Median plasma NGAL level was 148.5 (83.75-248.25) ng/ml and showed no correlation with eGFR or age. 87 out of 112 patients were able to follow up for 18 months. Patients with higher levels of NGAL (>107.8 ng/ml) showed significantly more decrease in eGFR in CKD stage 1 or 2 than those with lower levels of NGAL (≦107.8 ng/ml), while there was no difference in change in eGFR in CKD stage 3-5 between patients with higher and lower levels of NGAL. In the kidney biopsy of 27 patients out of enrolled patients, plasma NGAL levels correlated significantly with the degree of interstitial cell infiltration and fibrosis, but did not correlate with that of glomerular sclerosis. In ROC analysis, plasma NGAL levels predicted tubulointerstitial cell infiltrations more accurately [AUC = 0.8300 than eGFR (AUC = 0.716)]. CONCLUSION Plasma NGAL is a useful marker of interstitial lesions in patients with CKD and a predictor of further kidney worsening in the early CKD stage.
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Affiliation(s)
- Hidekazu Moriya
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, 247-8533, Japan. .,Department of Center of Clinical and Translational Science, Shonan Kamakura General Hospital, Kanagawa, Japan.
| | - Yasuhiro Mochida
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, 247-8533, Japan.,Department of Center of Clinical and Translational Science, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Kunihiko Ishioka
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, 247-8533, Japan.,Department of Center of Clinical and Translational Science, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Machiko Oka
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, 247-8533, Japan.,Department of Center of Clinical and Translational Science, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Kyoko Maesato
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, 247-8533, Japan.,Department of Center of Clinical and Translational Science, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Sumi Hidaka
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, 247-8533, Japan.,Department of Center of Clinical and Translational Science, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Takayasu Ohtake
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, 247-8533, Japan.,Department of Center of Clinical and Translational Science, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Shuzo Kobayashi
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, 247-8533, Japan.,Department of Center of Clinical and Translational Science, Shonan Kamakura General Hospital, Kanagawa, Japan
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6
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Vazzana N, Santilli F, Lattanzio S, Liani M, Giacci L, Del Rosso G, Salvati F, Boccatonda A, Ferroni P, Davì G. Determinants of thromboxane biosynthesis in patients with moderate to severe chronic kidney disease. Eur J Intern Med 2016; 33:74-80. [PMID: 27389698 DOI: 10.1016/j.ejim.2016.06.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 06/12/2016] [Accepted: 06/14/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Mechanisms of accelerated atherothrombosis in patients with chronic kidney disease (CKD) are only partly characterized. The aims of this study were to evaluate the extent of thromboxane (TX)-dependent platelet activation in patients with CKD, and to characterize the determinants of altered TX biosynthesis in this setting, with particular reference to enhanced lipid peroxidation, low grade inflammation and CKD-related anemia. PATIENTS AND METHODS A cross sectional comparison between urinary 8-iso-PGF2α and 11-dehydro-TXB2, in vivo markers of oxidative stress and platelet activation, respectively, was performed in 115 patients with stage 1-4 CKD. RESULTS Levels of both urinary 11-dehydro-TXB2 and 8-iso-PGF2α increased sequentially across the four CKD stages (P<0.0001, Kruskal-Wallis test). Both urinary prostanoids were inversely associated with either estimated glomerular filtration rate (eGFR, P<0.0001) or hemoglobin levels (P<0.0001). A significant direct correlation was also observed between urinary 11-dehydro-TXB2 and 8-iso-PGF2α (Rho=0.620, P<0.0001). On multivariate analysis, urinary 8-iso-PGF2α (β=0.459, P<0.0001), hemoglobin levels (β=- 0.261, P=0.002) and eGFR (β=-0.172, P=0.032) were independent predictors of urinary 11-dehydro-TXB2 (adjusted R(2)=0.488). CONCLUSIONS This study provides biochemical evidence of persistent platelet activation in patients with CKD. This condition occurs early in the natural history of the disease and is related to kidney function and oxidative stress. Moreover, we found an independent inverse relationship between hemoglobin levels and TX-dependent platelet activation. This finding may provide a mechanistic link between CKD-related anemia and increased cardiovascular risk.
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Affiliation(s)
- Natale Vazzana
- Internal Medicine and Center of Excellence on Aging, "G. d'Annunzio" University Foundation, Chieti, Italy
| | - Francesca Santilli
- Internal Medicine and Center of Excellence on Aging, "G. d'Annunzio" University Foundation, Chieti, Italy
| | - Stefano Lattanzio
- Internal Medicine and Center of Excellence on Aging, "G. d'Annunzio" University Foundation, Chieti, Italy
| | - Mario Liani
- Nephrology and Dialysis Unit, "S. Massimo" Hospital, Penne, Italy
| | | | | | | | - Andrea Boccatonda
- Internal Medicine and Center of Excellence on Aging, "G. d'Annunzio" University Foundation, Chieti, Italy
| | - Patrizia Ferroni
- San Raffaele Rome Open University, IRCCS San Raffaele Pisana, Rome, Italy
| | - Giovanni Davì
- Internal Medicine and Center of Excellence on Aging, "G. d'Annunzio" University Foundation, Chieti, Italy.
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