1
|
Yuan W, Yu M, Zhang Z, Miao Q, Liu J, Zhang H, Zhou Q, Chen J, Zhai Y, Fang X, Xu H, Shen Q. The value of bioimpedance analysis in the assessment of hydration and nutritional status in children on chronic peritoneal dialysis. Ren Fail 2024; 46:2301531. [PMID: 38189097 PMCID: PMC10776048 DOI: 10.1080/0886022x.2023.2301531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/29/2023] [Indexed: 01/09/2024] Open
Abstract
Bioimpedance analysis (BIA)-body composition monitoring (BCM) has been used to evaluate the hydration and nutritional status of adults and children on dialysis. However, its clinical application still has challenges, so further exploration is valuable. We used BIA-BCM to evaluate the hydration and nutritional status of children undergoing chronic peritoneal dialysis from 1 July 2021 to 31 December 2022 in the Children's Hospital of Fudan University to explore the clinical value of this method. A total of 84 children on chronic peritoneal dialysis (PD) were included. In the PD group, 16 (19.05%) and 31 (36.90%) had mild and severe overhydration (OH), respectively; 41.27% (26/63) had a low lean tissue index (LTI). In the PD group, patients with relative OH (Re-OH) > 5.6% had significantly higher systolic blood pressure (SBP) and SBP z score (SBPz). Patients with LTI > 12% had significantly higher body mass index (BMI) and BMI z score (BMIz). Canonical correlation analysis indicated a linear relationship (ρ = 0.708) between BIA-BCM hydration and the clinical hydration indicator and a linear relationship (ρ = 0.995) between the BIA-BCM nutritional indicator and the clinical nutritional indicator. A total of 56% of children on chronic peritoneal dialysis had OH, and 41% had a low LTI. In PD patients, SBP and SBPz were correlated with BIA-BCM Re-OH, and BMI and BMIz were correlated with BIA-BCM LTI. BIA-BCM indicators have good clinical value in evaluating hydration and nutrition.
Collapse
Affiliation(s)
- Wei Yuan
- Department of Nephrology, Children’s Hospital -of Fudan University, National Children’s Medical Center, Shanghai, China
- Shanghai Kidney Development & Pediatric Kidney Disease Research Center, Shanghai, China
| | - Minghui Yu
- Department of Nephrology, Children’s Hospital -of Fudan University, National Children’s Medical Center, Shanghai, China
- Shanghai Kidney Development & Pediatric Kidney Disease Research Center, Shanghai, China
| | - Zhiqing Zhang
- Department of Nephrology, Children’s Hospital -of Fudan University, National Children’s Medical Center, Shanghai, China
- Shanghai Kidney Development & Pediatric Kidney Disease Research Center, Shanghai, China
| | - Qianfan Miao
- Department of Nephrology, Children’s Hospital -of Fudan University, National Children’s Medical Center, Shanghai, China
- Shanghai Kidney Development & Pediatric Kidney Disease Research Center, Shanghai, China
| | - Jiaojiao Liu
- Department of Nephrology, Children’s Hospital -of Fudan University, National Children’s Medical Center, Shanghai, China
- Shanghai Kidney Development & Pediatric Kidney Disease Research Center, Shanghai, China
| | - Hui Zhang
- Department of Nephrology, Children’s Hospital -of Fudan University, National Children’s Medical Center, Shanghai, China
- Shanghai Kidney Development & Pediatric Kidney Disease Research Center, Shanghai, China
| | - Qing Zhou
- Department of Nephrology, Children’s Hospital -of Fudan University, National Children’s Medical Center, Shanghai, China
- Shanghai Kidney Development & Pediatric Kidney Disease Research Center, Shanghai, China
| | - Jing Chen
- Department of Nephrology, Children’s Hospital -of Fudan University, National Children’s Medical Center, Shanghai, China
- Shanghai Kidney Development & Pediatric Kidney Disease Research Center, Shanghai, China
| | - Yihui Zhai
- Department of Nephrology, Children’s Hospital -of Fudan University, National Children’s Medical Center, Shanghai, China
- Shanghai Kidney Development & Pediatric Kidney Disease Research Center, Shanghai, China
| | - Xiaoyan Fang
- Department of Nephrology, Children’s Hospital -of Fudan University, National Children’s Medical Center, Shanghai, China
- Shanghai Kidney Development & Pediatric Kidney Disease Research Center, Shanghai, China
| | - Hong Xu
- Department of Nephrology, Children’s Hospital -of Fudan University, National Children’s Medical Center, Shanghai, China
- Shanghai Kidney Development & Pediatric Kidney Disease Research Center, Shanghai, China
- National Key Laboratory of Kidney Diseases, Shanghai, China
| | - Qian Shen
- Department of Nephrology, Children’s Hospital -of Fudan University, National Children’s Medical Center, Shanghai, China
- Shanghai Kidney Development & Pediatric Kidney Disease Research Center, Shanghai, China
| |
Collapse
|
2
|
Sung LC, Chiu HW, Yu SMW, Tsou LLA, Hsu YH, Wu MS, Lin CL, Tsai FJ, Chou CL. Thiazide diuretics versus loop diuretics in stage 3-5 CKD: impact on cardiorenal outcomes. Postgrad Med 2024:1-11. [PMID: 39189768 DOI: 10.1080/00325481.2024.2396796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 08/22/2024] [Indexed: 08/28/2024]
Abstract
OBJECTIVES The association between diuretic use and cardiorenal outcomes remains limited in patients with stage 3-5 chronic kidney disease (CKD) and hypertension. To address this gap, we aim to investigate the long-term clinical impact of diuretic use with its pharmacological classification in Taiwanese patients with stage 3-5 CKD and hypertension who were concurrently received angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs). METHODS Using data from the National Health Insurance Research Database (January 2008 to December 2019), we focused on individuals with stage 3-5 CKD receiving ACEIs/ARBs between 2010 and 2018. We categorized the cohort into non-diuretic, loop diuretic (furosemide), thiazide diuretic, and combination diuretic groups. We used a Cox proportional hazards regression model with propensity score matching to analyze the influence of diuretics on all-cause mortality, cardiovascular (CV) death, and cardiorenal adverse outcomes. RESULTS The study included 59,719 patients, with 17,585 in the non-diuretic group and 42,134 in the diuretic group. Diuretics including furosemide use was significantly associated the risks of hospitalization for decompensated congestive heart failure (CHF), acute renal failure (ARF), end-stage renal disease (ESRD) requiring dialysis, CV mortality, and all-cause mortality (p-value <0.001). Thiazide diuretics showed no such adverse outcomes associations. The group receiving both thiazide and furosemide was more associated with all-cause mortality than the nondiuretic, thiazide, and furosemide monotherapy groups (all p-value <0.001). CONCLUSION Among stage 3-5 CKD patients on ACEIs/ARBs, loop diuretics exposure was associated with increased mortality and hospitalization for cardiorenal events, while thiazide diuretics exposure in isolation had no such associations. In the present data, we cannot evaluate the relationship between furosemide-associated adverse outcomes and worse renal function. These findings highlight the need for randomized controlled trials to assess the safety of loop diuretics in this population, urging caution in their prescription without a clear clinical indication.
Collapse
Affiliation(s)
- Li-Chin Sung
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of General Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
- Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
| | - Hui-Wen Chiu
- Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Samuel Mon-Wei Yu
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Liam Li-An Tsou
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Biochemistry, Department of Chemistry, Hofstra University, Hempstead, NY, USA
| | - Yung-Ho Hsu
- Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, Hsin Kuo Min Hospital, Taipei Medical University, Taoyuan, Taiwan
| | - Mai-Szu Wu
- Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Fuu-Jen Tsai
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Division of Medical Genetics, China Medical University Children's Hospital, Taichung, Taiwan
- Department of Biotechnology and Bioinformatics, Asia University, Taichung, Taiwan
| | - Chu-Lin Chou
- Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, Hsin Kuo Min Hospital, Taipei Medical University, Taoyuan, Taiwan
| |
Collapse
|
3
|
Zhang C, Duan ZY, Nie SS, Zhang Z, Guo XR, Zhang CY, Dong J, Cai GY. Renin-angiotensin system inhibitors prescriptions in Chinese hospitalized chronic kidney disease patients. World J Clin Cases 2024; 12:3061-3075. [PMID: 38898860 PMCID: PMC11185381 DOI: 10.12998/wjcc.v12.i17.3061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/23/2024] [Accepted: 04/29/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Many guidelines have recommended renin-angiotensin system inhibitors (RASI) as the first-line treatment for patients with chronic kidney disease (CKD). We studied RASI prescription trends from 2010 to 2019, and analyzed the characteristics associated with RASI prescription in Chinese hospitalized CKD patients. AIM To study the prescription of renin angiotensin system inhibitors in hospitalized patients with CKD in China. METHODS It was retrospectively, cross-sectional reviewed RASI prescriptions in hospitalized CKD patients in China from 2010 to 2019. RASI prescribing trends were analyzed from 2010 to 2019, and bivariate and multivariate logistic regression analyses were conducted to identify characteristics associated with RASI prescription. RESULTS A total of 35090 CKD patients were included, with 10043 (28.6%) RASI prescriptions. Among these patients, 18919 (53.9%) met the criteria for RASI treatments based on the 2012 kidney disease: Improving global outcomes guidelines. Of these, 7246 (38.3%) patients received RASI prescriptions. RASI prescriptions showed an initial rapid increase from 2011 to 2012, reached its peak around 2015 and 2016, and then exhibited a subsequent slight decreasing trend. Both bivariate and multivariate analyses showed that several characteristics, including the male gender, age less than 60-year-old, nephrology department admission, lower CKD stage, history of hypertension or diabetes, proteinuria, glomerulonephritis as the CKD etiology, and non-acute kidney injury were associated with RASI prescriptions. CONCLUSION The frequency of RASI prescriptions showed an initial increase but a slight decreasing trend in more recent years. CKD patients with certain characteristics such as elderly age, advanced disease stage, surgery department admission, or acute kidney injury were less likely to receive RASI prescriptions. In the application of RASI in hospitalized CKD patients is insufficient. The actual clinical practice needs to be improved. The development of related research is helpful to guide the correct choice of clinical treatment strategy.
Collapse
Affiliation(s)
- Chun Zhang
- Department of Nephrology, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Zhi-Yu Duan
- Department of Nephrology, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Sa-Sa Nie
- Department of Nephrology, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Zhou Zhang
- Department of Nephrology, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Xin-Ru Guo
- School of Medicine, Nankai University, Tianjin 300071, China
| | - Chao-Yang Zhang
- Department of Nephrology, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Jing Dong
- National Engineering Laboratory for Medical Big Data Application Technology, Chinese PLA General Hospital, Beijing 100853, China
| | - Guang-Yan Cai
- Department of Nephrology, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| |
Collapse
|
4
|
Riccio E, D'Ercole A, Sannino A, Hamzeh S, De Marco O, Capuano I, Buonanno P, Rizzo M, Pisani A. Real-world management of chronic and postprandial hyperkalemia in CKD patients treated with patiromer: a single-center retrospective study. J Nephrol 2024; 37:1077-1084. [PMID: 38319545 DOI: 10.1007/s40620-024-01897-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/07/2024] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Hyperkalemia, one of the most important electrolyte abnormalities of chronic kidney disease (CKD), often limits the use of renin-angiotensin-aldosterone system inhibitors and can increase in the postprandial period. In this study we report a real-world experience with the new non-adsorbed potassium binder patiromer in stage 3b-4 CKD patients. Moreover, we performed a cross-sectional analysis to evaluate, for the first time, the efficacy of patiromer in the control of postprandial potassium concentrations. METHODS We retrospectively collected data of 40 patients at the time of patiromer initiation (T0), and after 2 (T2), 6 (T6) and 12 (T12) months of treatment. For cross sectional analysis, a blood sample was collected 2 h after the main meal for the evaluation of postprandial potassium concentrations. RESULTS Eighty-two point five percent of patients (33/40) reached normal potassium concentrations at T2. Serum potassium significantly decreased at T2 compared to T0 (5.13 ± 0.48 vs 5.77 ± 0.41 mmol/L, respectively; p < 0.001) and the reduction remained significant during the follow-up (5.06 ± 0.36 at T6 and 5.77 ± 0.41 at T12; p < 0.001 vs T0). Renin-angiotensin-aldosterone system inhibitors were continued by 93% of patients (27/29). Adverse events were reported in 27.5% of patients and were all mild-to-moderate. Postprandial potassium concentrations did not significantly change compared to fasting state potassium measured at T12 (4.53 ± 0.33 vs 5.06 ± 0.36 mmol/L; p = 0.15). CONCLUSIONS In a real-world setting of advanced CKD patients, patiromer is a useful treatment for hyperkalemia, since it significantly reduces serum potassium levels over the long term and is able to maintain potassium concentrations in the normal range even in the post-prandial period.
Collapse
Affiliation(s)
- Eleonora Riccio
- Chair of Nephrology, Department of Public Health, Federico II University of Naples, Naples, Italy.
| | - Anna D'Ercole
- Chair of Nephrology, Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Anna Sannino
- Chair of Nephrology, Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Sarah Hamzeh
- Chair of Nephrology, Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Oriana De Marco
- Chair of Nephrology, Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Ivana Capuano
- Chair of Nephrology, Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Pasquale Buonanno
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Manuela Rizzo
- Chair of Nephrology, Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Antonio Pisani
- Chair of Nephrology, Department of Public Health, Federico II University of Naples, Naples, Italy
| |
Collapse
|
5
|
Liang S, Wang Y, Wang WL, Guo XR, Zhang C, Yang C, Wang C, Cai GY, Chen XM. Characteristics of hospitalized elderly patients with CKD: a comparison between elderly and non-elderly CKD based on a multicenter cross-sectional study. Int Urol Nephrol 2024; 56:625-633. [PMID: 37450242 PMCID: PMC10808144 DOI: 10.1007/s11255-023-03675-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 06/14/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE We undertook a multicenter epidemiological survey among hospitalized patients with chronic kidney disease (CKD), aiming to reveal the characteristics of elderly CKD by comparing it with non-elderly CKD. METHODS Medical records were obtained from 18 military hospitals across China from 1 January 2009 to 31 December 2011. The characteristics of chronic kidney disease in the elderly were analyzed through comparing with those in younger patients with chronic kidney disease. RESULTS A total of 380,461 hospitalized patients were included in the database, with 25,826 (6.8%) diagnosed with CKD. Unlike non-elderly, the top-three causes of chronic kidney disease among elderly patients were diabetic nephropathy (24.1%), hypertension-related renal impairment (20.9%), and primary glomerular disease (11.1%). 71.6% of the elderly patients with CKD had more than one comorbidities and the number of morbidities increased with age. In-hospital mortality of the elderly was significantly higher than those of younger patients (3.3% vs. 1.0%). Multiple logistic regression analysis showed that age, CKD 5 stage, acidosis, cardiovascular and cerebrovascular diseases, infection disease, neoplasm, and dementia were independent risk factors for death from CKD in the elderly. The median length of stay (LOS) was similar between elderly and younger CKD patients. The median cost was higher for elderly CKD patients than for younger CKD patients. Among elderly individuals with CKD, LOS, and hospitalization costs also increased with an increase in the number of coexisting diseases. CONCLUSIONS Diabetic nephropathy, and hypertension-related kidney injury were the leading causes of chronic kidney disease in elderly patients, which is different from the non-elderly. Elderly patients with chronic kidney disease were more likely to have a higher burden of comorbidities, which were associated with worse in-hospital outcomes.
Collapse
Affiliation(s)
- Shuang Liang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Yong Wang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Wen-Ling Wang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
- Department of General Internal Medicine, The Fifth Medical Center of Chinese, PLA General Hospital, Beijing, China
| | - Xin-Ru Guo
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Chun Zhang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Chen Yang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Che Wang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Guang-Yan Cai
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China.
| | - Xiang-Mei Chen
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| |
Collapse
|
6
|
Bhandari S, Mehta S, Khawaja A, Cleland JGF, Ives N, Cockwell P. Evaluation of the stopping angiotensin converting enzyme inhibitor compared to angiotensin receptor blocker (STOP ACEi trial) in advanced and progressive chronic kidney disease. Kidney Int 2024; 105:200-208. [PMID: 37783444 DOI: 10.1016/j.kint.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/06/2023] [Accepted: 09/15/2023] [Indexed: 10/04/2023]
Abstract
In the STOP-ACEi trial, the outcome was similar whether or not renin-angiotensin system inhibitors (RASi) were discontinued. We now investigate whether the effect of withdrawing angiotensin converting enzyme inhibitors (ACEi) or angiotensin-receptor blockers (ARBs) differed. In this open label trial patients with estimated glomerular filtration rates (eGFR) under 30ml/min per 1.73 m2 and progressive chronic kidney disease (CKD) were randomized to stop or continue RASi. The primary outcome was eGFR at three years. The composite of kidney failure, over 50% fall in eGFR, or kidney replacement therapy (KRT) was also assessed. Of patients randomized, 99 stopped and 123 patients continued ACEi while 104 stopped and 77 continued ARB at baseline. At three years, the eGFR was similar whether or not patients were withdrawn from ACEi or from ARB. Kidney failure or initiation of KRT occurred in 65% of those stopping and 54% continuing ACEi (hazard ratio if stopped, 1.52; 95% Confidence Interval, 1.07 to 2.16) and in 60% on an ARB regardless of randomized group (hazard ratio if stopped, 1.23; 0.83 to 1.81). Kidney failure/Initiation of KRT with over 50% decline in eGFR occurred in 71% of those stopping and 59% continuing ACEi (relative risk if stopped, 1.19; 95% CI, 1.00 to 1.41) and in 65% stopping and 69% continuing ARB (relative risk if stopped, 0.96; 0.79 to 1.16). Thus, neither discontinuing ACEi nor ARB slowed the rate of decline in eGFR. Although discontinuation of ACEi appeared to have more unfavorable effects on kidney outcomes than stopping ARB, the trial was neither designed nor powered to show differences between agents.
Collapse
Affiliation(s)
- Sunil Bhandari
- Department of Renal Medicine, Hull University Teaching Hospitals NHS Trust, and Hull York Medical School, East Yorkshire, UK.
| | - Samir Mehta
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Arif Khawaja
- Department of Nephrology, Sheffield Kidney Institute, Sheffield, UK
| | - John G F Cleland
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Natalie Ives
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Paul Cockwell
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, UK
| |
Collapse
|
7
|
Chouhan AS, Kaple M, Hingway S. A Brief Review of Diagnostic Techniques and Clinical Management in Chronic Kidney Disease. Cureus 2023; 15:e49030. [PMID: 38116359 PMCID: PMC10728575 DOI: 10.7759/cureus.49030] [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: 10/01/2023] [Accepted: 11/18/2023] [Indexed: 12/21/2023] Open
Abstract
Given its increasing incidence and detrimental effects on life expectancy and quality of life, chronic kidney disease (CKD) is a significant worldwide health concern. This review article provides a complete summary of current information on the diagnosis and management of CKD, focusing on recent advances and innovative approaches. The article discusses the most current findings on CKD risk assessment, emphasizing the need for early diagnosis utilizing better biomarkers and predictive models. A rigorous examination of diagnostic tools such as albumin-to-creatinine ratio (ACR) in urine and glomerular filtration rate (GFR) highlights their importance in determining CKD phases and etiologies. In terms of therapy, the study explores evidence-based techniques to reduce the development of CKD, such as enhanced blood pressure control, glycemic management in diabetic patients, dietary changes, and renin-angiotensin-aldosterone system (RAAS) blocking. Novel therapeutic approaches, including antifibrotic and precision medicine, are evaluated regarding their potential to revolutionize CKD treatment. The study also underlines the need for multidisciplinary therapy and patient education to achieve the best possible CKD patient outcomes. It also highlights the financial and social effects of CKD, highlighting the importance of early treatment to lower medical expenses and enhance the patient's standard of living. Finally, this review article provides a comprehensive update on CKD diagnosis and treatment, highlighting present successes alongside future potential. It is a valuable resource for healthcare professionals, academics, and policymakers who want to improve CKD treatment methods and patient outcomes.
Collapse
Affiliation(s)
- Anant Shourya Chouhan
- Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Meghali Kaple
- Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Snehlata Hingway
- Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
8
|
Wei X, Khan N, Durrani H, Muzaffar N, Haldane V, Walley JD, Thorpe K, Ge E, Ge S, Dodd W, Wallace J, Aslanyan G, Laporte A, Khan MA. Protocol for a pragmatic cluster randomised controlled trial to evaluate the effectiveness of digital health interventions in improving non-communicable disease management during the pandemic in rural Pakistan. PLoS One 2023; 18:e0282543. [PMID: 37816010 PMCID: PMC10564142 DOI: 10.1371/journal.pone.0282543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 09/07/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has revealed gaps in global health systems, especially in the low- and middle-income countries (LMICs). Evidence shows that patients with non-communicable diseases (NCDs) are at higher risk of contracting COVID-19 and suffering direct and indirect health consequences. Considering the future challenges such as environmental disasters and pandemics to the LMICs health systems, digital health interventions (DHI) are well poised to strengthen health care resilience. This study aims to implement and evaluate a comprehensive package of DHIs of integrated COVID-NCD care to manage NCDs in primary care facilities in rural Pakistan. METHODS The study is designed as a pragmatic, parallel two-arm, multi-centre, mix-methods cluster randomised controlled trial. We will randomise 30 primary care facilities in three districts of Punjab, where basic hypertension and diabetes diagnosis and treatment are provided, with a ratio of 1:1 between intervention and control. In each facility, we will recruit 50 patients who have uncontrolled hypertension. The intervention arm will receive training on an integrated COVID-NCD guideline, and will use a smartphone app-based telemedicine platform where patients can communicate with health providers and peer-supporters, along with a remote training and supervision system. Usual care will be provided in the control arm. Patients will be followed up for 10 months. Our primary indicator is systolic blood pressure measured at 10 months. A process evaluation guided by implementation science frameworks will be conducted to explore implementation questions. A cost-effectiveness evaluation will be conducted to inform future scale up in Pakistan and other LMICs. DISCUSSION Our study is one of the first randomised controlled trials to evaluate the effectiveness of DHIs to manage NCDs to strengthen health system resilience in LMICs. We will also evaluate the implementation process and cost-effectiveness to inform future scale-up in similar resource constrained settings. TRIAL REGISTRATION ClinicalTrials.gov Identifier-NCT05699369.
Collapse
Affiliation(s)
- Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Nida Khan
- Association for Social Development, Islamabad, Pakistan
| | - Hammad Durrani
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Victoria Haldane
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - John D. Walley
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Kevin Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Erjia Ge
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Shiliang Ge
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Warren Dodd
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - James Wallace
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Garry Aslanyan
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- The Special Programme for Research & Training in Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Audrey Laporte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | |
Collapse
|
9
|
Jeong E. Impact on health outcomes of hemodialysis patients based on the experience level of registered nurses in the hemodialysis department: a cross-sectional analysis. FRONTIERS IN HEALTH SERVICES 2023; 3:1154989. [PMID: 37720846 PMCID: PMC10499627 DOI: 10.3389/frhs.2023.1154989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/12/2023] [Indexed: 09/19/2023]
Abstract
Background The aim of the study is to improve the policy of health authorities regarding registered nurses (RNs) staffing by understanding how the health outcomes of hemodialysis (HD) patients vary depending on the level of HD nursing experience of at least 2 years. Methods The study included 21,839 patients who started maintenance HD for 3 months in early 2013 in the same medical institutions. Demographic variables such as sex, age, and causes of HD; institutional variables such as type of institution and number of RNs; and health outcomes such as HD adequacy, systolic and diastolic blood pressure (SBP, DBP), hemoglobin (Hb), and serum albumin were collected through web-based questionnaires. To determine the relationship between variables, t-test, chi-square test, and ANOVA were employed. Binary logistic regression was used to examine the odds ratio. Results Institutions with 100% of experienced RNs with at least 2 years of experience in HD units were found to have higher NKF K-DOQI criteria satisfaction rate than Institutions with <50% of experienced RNs with at least 2 years of experience in HD units for all health outcomes, except DBP (42.9% vs. 38.8%, p < .001) and Hb (27.8% vs. 24.4%, p < .001). Four of the six health-related variables-HD adequacy (Kt/v, urea reduction rate, URR), SBP, and serum albumin-were higher in institutions with 100% of experienced RNs than those with less than 50%. Conclusions In order to improve HD patients' health outcomes, HD institutions should prioritize recruiting RNs who are proficient in HD care. A higher proportion of skilled RNs results in a higher ability to prepare for emergencies and early detection of patient complications. RNs with extensive experience in HD nursing, therefore, promote quality management of HD patients.
Collapse
Affiliation(s)
- EunYoung Jeong
- Department of Nursing, Wonkwang University, Iksan, Republic of Korea
| |
Collapse
|
10
|
Theofilis P, Vordoni A, Kalaitzidis RG. Novel therapeutic approaches in the management of chronic kidney disease: a narrative review. Postgrad Med 2023; 135:543-550. [PMID: 37401536 DOI: 10.1080/00325481.2023.2233492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/27/2023] [Indexed: 07/05/2023]
Abstract
Chronic kidney disease (CKD) remains a pathologic entity with constantly rising incidence and high rates of morbidity and mortality, which are associated with serious cardiovascular complications. Moreover, the incidence of end-stage renal disease tends to increase. The epidemiological trends of CKD warrant the development of novel therapeutic approaches aiming to prevent its development or retard its progression through the control of major risk factors: type 2 diabetes mellitus, arterial hypertension, and dyslipidemia. Contemporary therapeutics such as sodium-glucose cotransporter-2 inhibitors and second-generation mineralocorticoid receptor antagonists are utilized in this direction. Additionally, experimental and clinical studies present novel drug categories that could be employed in managing CKD, such as aldosterone synthesis inhibitors or activators guanylate cyclase, while the role of melatonin should be further tested in the clinical setting. Finally, in this patient population, the use of hypolipidemic agents may provide incremental benefits.
Collapse
Affiliation(s)
- Panagiotis Theofilis
- Center for Nephrology, "G. Papadakis" General Hospital of Nikaia-Piraeus "Ag. Panteleimon", Athens, Greece
| | - Aikaterini Vordoni
- Center for Nephrology, "G. Papadakis" General Hospital of Nikaia-Piraeus "Ag. Panteleimon", Athens, Greece
| | - Rigas G Kalaitzidis
- Center for Nephrology, "G. Papadakis" General Hospital of Nikaia-Piraeus "Ag. Panteleimon", Athens, Greece
| |
Collapse
|
11
|
Arabi Z, Fawzy N, Arabi T, Sabbah B, Alhamzah H, Alhejaili F. Incidence and Factors Associated with Uncontrolled Hypertension at 12 months after Kidney Transplantation in Saudi Arabia. Kidney Blood Press Res 2023; 48:476-484. [PMID: 37356430 PMCID: PMC10389795 DOI: 10.1159/000531597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/13/2023] [Indexed: 06/27/2023] Open
Abstract
INTRODUCTION Uncontrolled blood pressure (uBP) after kidney transplantation (KTx) is very common and is associated with significant morbidity. However, studies that assess its incidence and risk factors are limited and outdated in the Middle East. METHODS This is a single-center retrospective study of KTx recipients (KTRs) in our center between January 2017 and May 2020 with a 12-month follow-up period. The target of hypertension treatment during the time of this study was <140/90 mm Hg, according to the published guidelines. We divided patients according to their blood pressure (BP) control at 1 year into two groups: controlled BP (cBP) (<140/90) and uBP (≥140/90). We studied the association between uBP and patients' demographics, baseline cardiovascular risk factors, and changes in their metabolic and cardiovascular profile during the first 12 months post-KTx. RESULTS A total of 254 KTRs were included. 79.2% developed post-KTx hypertension, 74% were ≥30 years, 58% were men, and 80% were living donor KTRs. The renal replacement modality among our patients pre-KTx was hemodialysis in 78.4%, peritoneal dialysis in 11.5%, and 10.1% underwent preemptive transplantation. At 1 year, 76 (29.9%) KTRs did not attain the target BP goal. Systolic BP (SBP) decreased from baseline to 12 months by 13 ± 24 mm Hg in the cBP group and increased by 8.7 ± 21 mm Hg in the uBP group (p < 0.001). Additionally, diastolic BP (DBP) decreased by 8.5 ± 16.9 mm Hg in the cBP group and increased by 2.3 ± 18.8 mm Hg in the uBP group (p < 0.001). Factors associated with uBP included age (47 vs. 41 years, p = 0.008) and diabetes mellitus (p = 0.012). Contrarily, gender, dialysis vintage, preemptive transplantation, type of dialysis (hemodialysis vs. peritoneal dialysis), type of transplant (living donor KTx vs. deceased donor KTx), and smoking were not different among the two groups. There were no significant differences between the two groups in regard to changes in creatinine, weight, A1c, low-density lipoprotein, and parathyroid hormone levels. Additionally, rate of rejection, new onset diabetes post-transplant, and persistent hyperthyroidism were not different between the groups. However, higher body mass index at 12 months was associated with a higher incidence of uBP (27.2 ± 5.9 vs. 29.2 ± 5.4, p = 0.013). Using multivariate analysis, we found that serum creatinine at 12 months was the only predictor of uBP (OR = 1.005 [1-1.011], p = 0.036). CONCLUSION At 1-year post-renal transplantation, about one-third of KTRs had uBP despite multiple antihypertensive medications. SBP and DBP significantly trended upward after transplantation in uBP patients, whereas SBP and DBP significantly trended downward after transplantation in cBP patients. Serum creatinine at 12 months was the only factor independently associated with uBP.
Collapse
Affiliation(s)
- Ziad Arabi
- Division of Nephrology, Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saudi bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Nader Fawzy
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Tarek Arabi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia,
| | - Belal Sabbah
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Hamzah Alhamzah
- Division of Nephrology, Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saudi bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Fayez Alhejaili
- Division of Nephrology, Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saudi bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
12
|
Gregg LP, Richardson PA, Herrera MA, Akeroyd JM, Jafry SA, Gobbel GT, Wydermyer S, Arney J, Hung A, Matheny ME, Virani SS, Navaneethan SD. Documented Adverse Drug Reactions and Discontinuation of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Chronic Kidney Disease. Am J Nephrol 2023; 54:126-135. [PMID: 37231800 PMCID: PMC10424561 DOI: 10.1159/000530988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/03/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) are frequently discontinued in patients with chronic kidney disease (CKD). Documented adverse drug reactions (ADRs) in medical records may provide insight into the reasons for treatment discontinuation. METHODS In this retrospective cohort of US veterans from 2005 to 2019, we identified individuals with CKD and a current prescription for an ACEi or ARB (current user group) or a discontinued prescription within the preceding 5 years (discontinued group). Documented ADRs in structured datasets associated with an ACEi or ARB were categorized into 17 pre-specified groups. Logistic regression assessed associations of documented ADRs with treatment discontinuation. RESULTS There were 882,441 (73.0%) individuals in the current user group and 326,794 (27.0%) in the discontinued group. There were 26,434 documented ADRs, with at least one documented ADR in 7,520 (0.9%) current users and 9,569 (2.9%) of the discontinued group. ADR presence was associated with treatment discontinuation, aOR 4.16 (95% CI: 4.03, 4.29). The most common documented ADRs were cough (37.3%), angioedema (14.2%), and allergic reaction (10.4%). ADRs related to angioedema (aOR 3.81, 95% CI: 3.47, 4.17), hyperkalemia (aOR 2.03, 95% CI: 1.84, 2.24), peripheral edema (aOR 1.53, 95% CI: 1.33, 1.77), or acute kidney injury (aOR 1.32, 95% CI: 1.15, 1.51) were associated with treatment discontinuation. CONCLUSION ADRs leading to drug discontinuation were infrequently documented. ADR types were differentially associated with treatment discontinuation. An understanding of which ADRs lead to treatment discontinuation provides an opportunity to address them at a healthcare system level.
Collapse
Affiliation(s)
- L. Parker Gregg
- Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, TX
- Research Service Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness and Safety, Houston, TX
| | - Peter A. Richardson
- Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness and Safety, Houston, TX
| | - Michael A. Herrera
- Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness and Safety, Houston, TX
| | - Julia M. Akeroyd
- Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness and Safety, Houston, TX
| | - Shehrezade A. Jafry
- Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness and Safety, Houston, TX
| | - Glenn T Gobbel
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Sheena Wydermyer
- Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
| | - Jennifer Arney
- Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness and Safety, Houston, TX
- Department of Sociology, University of Houston-Clear Lake, Houston, TX
| | - Adriana Hung
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Center for Kidney Disease, Nashville, TN
- Division of Nephrology, Veterans Affairs Tennessee Valley Health Care System, Nashville, TN
| | - Michael E. Matheny
- Geriatrics Research Education and clinical Care Service, Tennessee Valley Healthcare System VA, Nashville, TN
- Departments of Biomedical Informatics, Biostatistics, and Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Salim S. Virani
- Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness and Safety, Houston, TX
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Sankar D. Navaneethan
- Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, TX
- Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness and Safety, Houston, TX
- Renal Section, Medical Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- Institute of Clinical and Translational Research, Baylor College of Medicine, Houston, TX
| |
Collapse
|
13
|
Cleveland KH, Schnellmann RG. Pharmacological Targeting of Mitochondria in Diabetic Kidney Disease. Pharmacol Rev 2023; 75:250-262. [PMID: 36781216 DOI: 10.1124/pharmrev.122.000560] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 10/03/2022] [Indexed: 12/14/2022] Open
Abstract
Diabetic kidney disease (DKD) is the leading cause of end-stage renal disease (ESRD) in the United States and many other countries. DKD occurs through a variety of pathogenic processes that are in part driven by hyperglycemia and glomerular hypertension, leading to gradual loss of kidney function and eventually progressing to ESRD. In type 2 diabetes, chronic hyperglycemia and glomerular hyperfiltration leads to glomerular and proximal tubular dysfunction. Simultaneously, mitochondrial dysfunction occurs in the early stages of hyperglycemia and has been identified as a key event in the development of DKD. Clinical management for DKD relies primarily on blood pressure and glycemic control through the use of numerous therapeutics that slow disease progression. Because mitochondrial function is key for renal health over time, therapeutics that improve mitochondrial function could be of value in different renal diseases. Increasing evidence supports the idea that targeting aspects of mitochondrial dysfunction, such as mitochondrial biogenesis and dynamics, restores mitochondrial function and improves renal function in DKD. We will review mitochondrial function in DKD and the effects of current and experimental therapeutics on mitochondrial biogenesis and homeostasis in DKD over time. SIGNIFICANCE STATEMENT: Diabetic kidney disease (DKD) affects 20% to 40% of patients with diabetes and has limited treatment options. Mitochondrial dysfunction has been identified as a key event in the progression of DKD, and pharmacologically restoring mitochondrial function in the early stages of DKD may be a potential therapeutic strategy in preventing disease progression.
Collapse
Affiliation(s)
- Kristan H Cleveland
- Pharmacology and Toxicology, University of Arizona, Tucson, Arizona (K.H.C., R.G.S.) and Southern VA Healthcare System, Tucson, Arizona (R.G.S.)
| | - Rick G Schnellmann
- Pharmacology and Toxicology, University of Arizona, Tucson, Arizona (K.H.C., R.G.S.) and Southern VA Healthcare System, Tucson, Arizona (R.G.S.)
| |
Collapse
|
14
|
Jian S, Yang K, Zhang L, Zhang L, Xin Z, Wen C, He S, Deng J, Deng B. The modulation effects of plant‐derived bioactive ingredients on chronic kidney disease: Focus on the gut–kidney axis. FOOD FRONTIERS 2023. [DOI: 10.1002/fft2.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Shiyan Jian
- Guangdong Laboratory for Lingnan Modern Agriculture, Guangdong Provincial Key Laboratory of Animal Nutrition Control, College of Animal Science South China Agricultural University Guangzhou China
| | - Kang Yang
- Guangdong Laboratory for Lingnan Modern Agriculture, Guangdong Provincial Key Laboratory of Animal Nutrition Control, College of Animal Science South China Agricultural University Guangzhou China
| | - Lingna Zhang
- Guangdong Laboratory for Lingnan Modern Agriculture, Guangdong Provincial Key Laboratory of Animal Nutrition Control, College of Animal Science South China Agricultural University Guangzhou China
| | - Limeng Zhang
- Guangdong Laboratory for Lingnan Modern Agriculture, Guangdong Provincial Key Laboratory of Animal Nutrition Control, College of Animal Science South China Agricultural University Guangzhou China
| | - Zhongquan Xin
- Faculty of Food Science and Engineering Kunming University of Science and Technology Kunming China
| | - Chaoyu Wen
- Guangdong Laboratory for Lingnan Modern Agriculture, Guangdong Provincial Key Laboratory of Animal Nutrition Control, College of Animal Science South China Agricultural University Guangzhou China
| | - Shansong He
- Guangdong Laboratory for Lingnan Modern Agriculture, Guangdong Provincial Key Laboratory of Animal Nutrition Control, College of Animal Science South China Agricultural University Guangzhou China
| | - Jinping Deng
- Guangdong Laboratory for Lingnan Modern Agriculture, Guangdong Provincial Key Laboratory of Animal Nutrition Control, College of Animal Science South China Agricultural University Guangzhou China
| | - Baichuan Deng
- Guangdong Laboratory for Lingnan Modern Agriculture, Guangdong Provincial Key Laboratory of Animal Nutrition Control, College of Animal Science South China Agricultural University Guangzhou China
| |
Collapse
|
15
|
Sourij H, Edlinger R, Prischl FC, Kaser S, Horn S, Antlanger M, Paulweber B, Aberer F, Brix J, Cejka D, Stingl H, Kautzky-Willer A, Schmaldienst S, Clodi M, Rosenkranz A, Mayer G, Oberbauer R, Säemann M. [Diabetic kidney disease (update 2023) : Position paper of the Austrian Diabetes Association and the Austrian Society for Nephrology]. Wien Klin Wochenschr 2023; 135:182-194. [PMID: 37101040 PMCID: PMC10133372 DOI: 10.1007/s00508-022-02147-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 04/28/2023]
Abstract
Epidemiological investigations have shown that approximately 2-3% of all Austrians have diabetes mellitus with renal involvement, leaving 250,000 people in Austria affected. The risk of occurrence and progression of this disease can be attenuated by lifestyle interventions as well as optimization of blood pressure, blood glucose control and special drug classes. The present article represents the joint recommendations of the Austrian Diabetes Association and the Austrian Society of Nephrology for the diagnostic and treatment strategies of diabetic kidney disease.
Collapse
Affiliation(s)
- Harald Sourij
- Klinische Abteilung für Endokrinologie und Diabetologie, Trials Unit für Interdisziplinäre Metabolische Medizin, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich.
| | - Roland Edlinger
- 3. Medizinische Abteilung mit Stoffwechselerkrankungen und Nephrologie, Klinik Hietzing, Wien, Österreich
| | - Friedrich C Prischl
- Abteilung für Innere Medizin IV, Klinikum Wels-Grieskirchen, Wels, Österreich
| | - Susanne Kaser
- Universitätsklinik für Innere Medizin I, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Sabine Horn
- Abteilung für Innere Medizin, LKH Villach, Villach, Österreich
| | - Marlies Antlanger
- Universitätsklinik für Innere Medizin 2, Kepler Universitätsklinikum Linz, Linz, Österreich
| | - Bernhard Paulweber
- Universitätsklinik für Innere Medizin I, Landeskrankenhaus Salzburg, Uniklinikum der PMU, Salzburg, Österreich
| | - Felix Aberer
- Klinische Abteilung für Endokrinologie und Diabetologie, Medizinische Universität Graz, Graz, Österreich
| | - Johanna Brix
- 1. Medizinischen Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Klinik Landstraße, Wien, Österreich
| | - Daniel Cejka
- Abteilung für Innere Medizin 3, Ordensklinikum Linz, Elisabethinen, Linz, Österreich
| | - Harald Stingl
- Abteilung für Innere Medizin, LKH Melk, Melk, Österreich
| | - Alexandra Kautzky-Willer
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | | | - Martin Clodi
- Abteilung für Innere Medizin, Krankenhaus Barmherzige Brüder Linz, Linz, Österreich
| | - Alexander Rosenkranz
- Klinische Abteilung für Nephrologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
| | - Gert Mayer
- Nephrologie und Hypertensiologie, Universitätsklinik für Innere Medizin IV, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Rainer Oberbauer
- Klinische Abteilung für Nephrologie und Dialyse, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Marcus Säemann
- 6. Medizinische Abteilung mit Nephrologie & Dialyse, Klinik Ottakring, Wien, Österreich
| |
Collapse
|
16
|
Moeinzadeh F, Mortazavi M, Shahidi S, Mansourian M, Yazdani A, Zamani Z, Seirafian S. Chronic Kidney Disease and COVID-19 Infection: A Case-Control Study. Adv Biomed Res 2022; 11:112. [PMID: 36798912 PMCID: PMC9926033 DOI: 10.4103/abr.abr_203_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/07/2021] [Accepted: 09/01/2021] [Indexed: 12/28/2022] Open
Abstract
Background To organize efforts to manage the coronavirus disease 2019 (COVID-19), it is necessary to understand which groups are at higher risk of infection. Kidney disease seems to be substantial in COVID-19 patients, but there are limited data on COVID-19 incidence and fatality among chronic kidney disease (CKD) patients. In this study, we intend to examine the association between CKD and susceptibility to COVID-19 infection. Materials and Methods Participants were selected from those recruited in a population-based cross-sectional survey of CKD prevalence and associated risk factors in Iranian people 18 years and older. A three-part questionnaire was used for COVID-19 infection clinical symptoms and epidemiologic and hospitalization data. Results A total of 962 individuals including 403 CKD patients and 559 healthy controls were recruited in this study. Healthy controls were suffering more from common cold signs, cough, fever, sore throat, headache, anosmia, dyspnea, and abdominal pain (all P < 0.05). Furthermore, the number of healthy individuals with myalgia was marginally higher compared to the CKD patients (P = 0.057). Data regarding the number of CKD patients with/without COVID-19 infection throughout different CKD stages revealed that there was no significant difference between the two groups in terms of COVID-19 infection in different stages of CKD (P = 0.956). Conclusion We found that some of the clinical presentations of COVID-19 including common cold symptoms, cough, fever, sore throat, headache, anosmia, dyspnea, and abdominal pain were higher among healthy individuals compared to the CKD group. On the other hand, the susceptibility to COVID-19 infection was not significantly different in various early stages of CKD.
Collapse
Affiliation(s)
- Firouzeh Moeinzadeh
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojgan Mortazavi
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahrzad Shahidi
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Mansourian
- Department of Epidemiology and Biostatics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Akram Yazdani
- Department of Biostatics and Public Health, Faculty of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Zahra Zamani
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Isfahan, Iran
| | - Shiva Seirafian
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
17
|
Yang JW. Blood Pressure Control in Elderly Chronic Kidney Disease Patients. Electrolyte Blood Press 2022; 20:57-63. [PMID: 36688210 PMCID: PMC9827045 DOI: 10.5049/ebp.2022.20.2.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/02/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023] Open
Abstract
In elderly chronic kidney disease (CKD) patients, isolated systolic hypertension is common, the rate of renal function decline is slow, and there is a high possibility of physical damage due to side effects such as drug use-related orthostatic hypotension. Therefore, there are still many questions about whether lowering blood pressure in elderly patients will actually improve prognosis. Since many blood pressure-related clinical studies exclude advanced CKD and the elderly, it is particularly difficult to define target blood pressure in these populations. A randomized controlled trial is needed to establish optimal blood pressure targets and treatment strategies in elderly patients with CKD. This review seeks to summarize the guidelines available at this time.
Collapse
Affiliation(s)
- Jae Won Yang
- Division of Nephrology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.,The Korean Society of Geriatric Nephrology, Seoul, Republic of Korea
| |
Collapse
|
18
|
Capuano I, Buonanno P, Riccio E, Bianco A, Pisani A. Randomized Controlled Trials on Renin Angiotensin Aldosterone System Inhibitors in Chronic Kidney Disease Stages 3-5: Are They Robust? A Fragility Index Analysis. J Clin Med 2022; 11:6184. [PMID: 36294504 PMCID: PMC9605379 DOI: 10.3390/jcm11206184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 11/17/2022] Open
Abstract
Inhibition of the renin-angiotensin-aldosterone system (RAAS) is broadly recommended in many nephrological guidelines to prevent chronic kidney disease (CKD) progression. This work aimed to analyze the robustness of randomized controlled trials (RCTs) investigating the renal and cardiovascular outcomes in CKD stages 3-5 patients treated with RAAS inhibitors (RAASi). We searched for RCTs in MEDLINE (PubMed), EMBASE databases, and the Cochrane register. Fragility indexes (FIs) for every primary and secondary outcome were calculated according to Walsh et al., who first described this novel metric, suggesting 8 as the cut-off to consider a study robust. Spearman coefficient was calculated to correlate FI to p value and sample size of statistically significant primary and secondary outcomes. Twenty-two studies met the inclusion criteria, including 80,455 patients. Sample size considerably varied among the studies (median: 1693.5, range: 73-17,276). The median follow-up was 38 months (range 24-58). The overall median of both primary and secondary outcomes was 0 (range 0-117 and range 0-55, respectively). The median of FI for primary and secondary outcomes with a p value lower than 0.05 was 6 (range: 1-117) and 7.5 (range: 1-55), respectively. The medians of the FI for primary outcomes with a p value lower than 0.05 in CKD and no CKD patients were 5.5 (range 1-117) and 22 (range 1-80), respectively. Only a few RCTs have been shown to be robust. Our analysis underlined the need for further research with appropriate sample sizes and study design to explore the real potentialities of RAASi in the progression of CKD.
Collapse
Affiliation(s)
- Ivana Capuano
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy
| | - Pasquale Buonanno
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | - Eleonora Riccio
- Institute for Biomedical Research and Innovation, National Research Council of Italy, 80125 Palermo, Italy
| | - Antonio Bianco
- Interdepartmental Research Center for Arterial Hypertension and Associated Pathologies (CIRIAPA)-Hypertension Research Center, University of Naples “Federico II”, 80131 Naples, Italy
| | - Antonio Pisani
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy
| |
Collapse
|
19
|
Huang W, Chen YY, Li ZQ, He FF, Zhang C. Recent Advances in the Emerging Therapeutic Strategies for Diabetic Kidney Diseases. Int J Mol Sci 2022; 23:ijms231810882. [PMID: 36142794 PMCID: PMC9506036 DOI: 10.3390/ijms231810882] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/10/2022] [Accepted: 09/15/2022] [Indexed: 12/06/2022] Open
Abstract
Diabetic kidney disease (DKD) is one of the most common causes of end-stage renal disease worldwide. The treatment of DKD is strongly associated with clinical outcomes in patients with diabetes mellitus. Traditional therapeutic strategies focus on the control of major risk factors, such as blood glucose, blood lipids, and blood pressure. Renin–angiotensin–aldosterone system inhibitors have been the main therapeutic measures in the past, but the emergence of sodium–glucose cotransporter 2 inhibitors, incretin mimetics, and endothelin-1 receptor antagonists has provided more options for the management of DKD. Simultaneously, with advances in research on the pathogenesis of DKD, some new therapies targeting renal inflammation, fibrosis, and oxidative stress have gradually entered clinical application. In addition, some recently discovered therapeutic targets and signaling pathways, mainly in preclinical and early clinical trial stages, are expected to provide benefits for patients with DKD in the future. This review summarizes the traditional treatments and emerging management options for DKD, demonstrating recent advances in the therapeutic strategies for DKD.
Collapse
|
20
|
Yang K, Zhang P, Lv T, Wu J, Liu Q. Acupuncture at Taichong and Zusanli points exerts hypotensive effect in spontaneously hypertensive rats by metabolomic analysis. J Chromatogr B Analyt Technol Biomed Life Sci 2022; 1207:123352. [PMID: 35841734 DOI: 10.1016/j.jchromb.2022.123352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/30/2022] [Accepted: 06/24/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The development of hypertension affects several target organs, the kidneys being one of them. Acupuncture has been used to treat hypertension for a long time. Several mechanisms of acupuncture on hypotensive effect have been reveled, while the effects of acupuncture on the alterations in renal cortex from a metabolomic perspective are still unclear. METHODS Twelve male Wistar rats served as the control group (Wistar Group). Twenty-four male spontaneously hypertensive rats (SHR) were randomly divided into two groups: the model group (SHR Group) and the acupuncture group (AC Group). In the AC Group, milli-needle acupuncture was used to puncture the bilateral Taichong (LR3) and Zusanli (ST36) points. Blood pressure values were measured weekly and the rats were euthanized after three weeks. Renal cortical tissues were collected for non-targeted and targeted metabolomic analyses. RESULTS Acupuncture reduced blood pressure values in rats (Compared with the SHR Group, P < 0.001). Thirteen metabolites with significant differences and three metabolic pathways were screened by untargeted metabolomics. The SHR Group was compared with the Wistar Group and AC Group both involving metabolites and pathways related to bile acid metabolism. Furthermore, targeted metabolomics quantification of four bile acids, Cholic acid (CA), Allocholic acid (ACA), Deoxycholic acid (DCA) and Chenodeoxycholic acid (CDCA), revealed that all bile acid concentrations were relatively high in the SHR Group, except for ACA. CONCLUSION This study indicate that abnormal bile acid metabolism may be an independent risk factor the development of hypertension. Acupuncture at Taichong and at Zusanli points effectively modulated bile acids metabolism in SHR renal cortex tissues to exert a hypotensive effect, and CA may be able to be a new target for the treatment of hypertension.
Collapse
Affiliation(s)
- Kezhen Yang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 102488, China
| | - Pingna Zhang
- Renal Research Institution of Beijing University of Chinese Medicine, and Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China
| | - Taotao Lv
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 102488, China
| | - Jiaojuan Wu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 102488, China
| | - Qingguo Liu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 102488, China.
| |
Collapse
|
21
|
Zhang X, Wong GLH, Yip TCF, Tse YK, Liang LY, Hui VWK, Lin H, Li GL, Lai JCT, Chan HLY, Wong VWS. Angiotensin-converting enzyme inhibitors prevent liver-related events in nonalcoholic fatty liver disease. Hepatology 2022; 76:469-482. [PMID: 34939204 DOI: 10.1002/hep.32294] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/29/2021] [Accepted: 12/19/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) can inhibit liver fibrogenesis in animal models. We aimed to evaluate the impact of ACEI/ARB use on the risk of liver cancer and cirrhosis complications in patients with NAFLD. APPROACH AND RESULTS We conducted a retrospective, territory-wide cohort study of adult patients with NAFLD diagnosed between January 2000 and December 2014 to allow for at least 5 years of follow-up. ACEI or ARB users were defined as patients who had received ACEI or ARB treatment for at least 6 months. The primary endpoint was liver-related events (LREs), defined as a composite endpoint of liver cancer and cirrhosis complications. We analyzed data from 12,327 NAFLD patients (mean age, 54.2 ± 14.7 years; 6163 men [50.0%]); 6805 received ACEIs, and 2877 received ARBs. After propensity score weighting, ACEI treatment was associated with a lower risk of LREs (weighted subdistribution hazard ratio [SHR], 0.48; 95% CI, 0.35-0.66; p < 0.001), liver cancer (weighted SHR, 0.46; 95% CI, 0.28-0.75; p = 0.002), and cirrhosis complications (weighted SHR, 0.42; 95% CI, 0.27-0.66; p < 0.001), but ARB was not. In subgroup analysis, ACEI treatment was associated with greater reduction in LREs in patients with chronic kidney diseases (CKDs) than those without (CKD-weighted SHR, 0.74; 95% CI, 0.52-0.96; p = 0.036; non-CKD-weighted SHR, 0.15; 95% CI, 0.07-0.33; p < 0.001). CONCLUSIONS ACEI, rather than ARB, treatment is associated with a lower risk of LREs in NAFLD patients, especially among those with CKD.
Collapse
Affiliation(s)
- Xinrong Zhang
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong.,Medical Data Analytic Centre (MDAC), The Chinese University of Hong Kong, Shatin, Hong Kong.,Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Grace Lai-Hung Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong.,Medical Data Analytic Centre (MDAC), The Chinese University of Hong Kong, Shatin, Hong Kong.,Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Terry Cheuk-Fung Yip
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong.,Medical Data Analytic Centre (MDAC), The Chinese University of Hong Kong, Shatin, Hong Kong.,Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yee-Kit Tse
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong.,Medical Data Analytic Centre (MDAC), The Chinese University of Hong Kong, Shatin, Hong Kong.,Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Lilian Yan Liang
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong.,Medical Data Analytic Centre (MDAC), The Chinese University of Hong Kong, Shatin, Hong Kong.,Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Vicki Wing-Ki Hui
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong.,Medical Data Analytic Centre (MDAC), The Chinese University of Hong Kong, Shatin, Hong Kong.,Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Huapeng Lin
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong.,Medical Data Analytic Centre (MDAC), The Chinese University of Hong Kong, Shatin, Hong Kong.,Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Guan-Lin Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong.,Medical Data Analytic Centre (MDAC), The Chinese University of Hong Kong, Shatin, Hong Kong.,Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jimmy Che-To Lai
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong.,Medical Data Analytic Centre (MDAC), The Chinese University of Hong Kong, Shatin, Hong Kong.,Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Henry Lik-Yuen Chan
- Medical Data Analytic Centre (MDAC), The Chinese University of Hong Kong, Shatin, Hong Kong.,Union Hospital, Hong Kong SAR, China
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong.,Medical Data Analytic Centre (MDAC), The Chinese University of Hong Kong, Shatin, Hong Kong.,Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| |
Collapse
|
22
|
Aziz F, Jorgenson M, Garg N, Parajuli S, Mohamed M, Raza F, Mandelbrot D, Djamali A, Dhingra R. New Approaches to Cardiovascular Disease and Its Management in Kidney Transplant Recipients. Transplantation 2022; 106:1143-1158. [PMID: 34856598 DOI: 10.1097/tp.0000000000003990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cardiovascular events, including ischemic heart disease, heart failure, and arrhythmia, are common complications after kidney transplantation and continue to be leading causes of graft loss. Kidney transplant recipients have both traditional and transplant-specific risk factors for cardiovascular disease. In the general population, modification of cardiovascular risk factors is the best strategy to reduce cardiovascular events; however, studies evaluating the impact of risk modification strategies on cardiovascular outcomes among kidney transplant recipients are limited. Furthermore, there is only minimal guidance on appropriate cardiovascular screening and monitoring in this unique patient population. This review focuses on the limited scientific evidence that addresses cardiovascular events in kidney transplant recipients. Additionally, we focus on clinical management of specific cardiovascular entities that are more prevalent among kidney transplant recipients (ie, pulmonary hypertension, valvular diseases, diastolic dysfunction) and the use of newer evolving drug classes for treatment of heart failure within this cohort of patients. We note that there are no consensus documents describing optimal diagnostic, monitoring, or management strategies to reduce cardiovascular events after kidney transplantation; however, we outline quality initiatives and research recommendations for the assessment and management of cardiovascular-specific risk factors that could improve outcomes.
Collapse
Affiliation(s)
- Fahad Aziz
- Division of Nephrology, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Margaret Jorgenson
- Department of Pharmacology, University of Wisconsin-Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Neetika Garg
- Division of Nephrology, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Sandesh Parajuli
- Division of Nephrology, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Maha Mohamed
- Division of Nephrology, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Farhan Raza
- Cardiovascular Division, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Didier Mandelbrot
- Division of Nephrology, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Arjang Djamali
- Division of Nephrology, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI
- Division of Transplantation, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Ravi Dhingra
- Cardiovascular Division, Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI
| |
Collapse
|
23
|
Gentile G, Mckinney K, Reboldi G. Tight Blood Pressure Control in Chronic Kidney Disease. J Cardiovasc Dev Dis 2022; 9:jcdd9050139. [PMID: 35621850 PMCID: PMC9144041 DOI: 10.3390/jcdd9050139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 12/12/2022] Open
Abstract
Hypertension affects over a billion people worldwide and is the leading cause of cardiovascular disease and premature death worldwide, as well as one of the key determinants of chronic kidney disease worldwide. People with chronic kidney disease and hypertension are at very high risk of renal outcomes, including progression to end-stage renal disease, and, even more importantly, cardiovascular outcomes. Hence, blood pressure control is crucial in reducing the human and socio-economic burden of renal and cardiovascular outcomes in those patients. However, current guidelines from hypertension and renal societies have issued different and sometimes conflicting recommendations, which risk confusing clinicians and potentially contributing to a less effective prevention of renal and cardiovascular outcomes. In this review, we critically appraise existing evidence and key international guidelines, and we finally formulate our own opinion that clinicians should aim for a blood pressure target lower than 130/80 in all patients with chronic kidney disease and hypertension, unless they are frail or with multiple comorbidities. We also advocate for an even more ambitious systolic blood pressure target lower than 120 mmHg in younger patients with a lower burden of comorbidities, to minimise their risk of renal and cardiovascular events during their lifetime.
Collapse
Affiliation(s)
- Giorgio Gentile
- College of Medicine and Health, University of Exeter, Exeter EX1 2LU, UK;
- Department of Nephrology, Royal Cornwall Hospitals NHS Trust, Truro TR1 3LQ, UK
| | - Kathryn Mckinney
- Faculty of Biology, College of Letters and Science, University of Wisconsin-Madison, Madison, WI 53706, USA;
| | - Gianpaolo Reboldi
- Centro di Ricerca Clinica e Traslazionale (CERICLET), Department of Medicine, University of Perugia, 06156 Perugia, Italy
- Correspondence:
| |
Collapse
|
24
|
Gong Z, Chen T. Nutritional potassium limitation impact on serum potassium change, and death in chronic kidney disease: A meta-analysis. Ther Apher Dial 2022; 26:1079-1085. [PMID: 35247229 DOI: 10.1111/1744-9987.13831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We performed a meta-analysis to evaluate the impact of nutritional potassium limitation on serum potassium change, and death in chronic kidney disease. METHODS A systematic literature search up to October 2021 was done and 8 studies included 92 558 subjects with chronic kidney disease at the start of the study; 41 474 of them were provided with nutritional potassium limitation and 510 084 were nonrestricted diet. RESULTS Nutritional potassium limitation had significantly lower serum potassium change (MD, -0.33; 95% CI, -0.58- -0.07, p = 0.01) compared to nonrestricted diet in subjects with chronic kidney disease. However, nutritional potassium limitation had no significant impact on the death (OR, 0.80; 95% CI, 0.58-1.10, p = 0.17) compared to nonrestricted diet in subjects with chronic kidney disease. CONCLUSIONS Nutritional potassium limitation had significantly lower serum potassium change compared to nonrestricted diet in subjects with chronic kidney disease. Further studies are required to validate these findings. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Zhumei Gong
- Department of Emergency, Yiwu Central Hospital, Zhejiang, China
| | - Taiai Chen
- Department of Nephrology, Qionghai People's Hospital, Hainan, China
| |
Collapse
|
25
|
Drawz PE, Beddhu S, Bignall ONR, Cohen JB, Flynn JT, Ku E, Rahman M, Thomas G, Weir MR, Whelton PK. KDOQI US Commentary on the 2021 KDIGO Clinical Practice Guideline for the Management of Blood Pressure in CKD. Am J Kidney Dis 2022; 79:311-327. [PMID: 35063302 DOI: 10.1053/j.ajkd.2021.09.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 09/26/2021] [Indexed: 12/13/2022]
Abstract
The Kidney Disease Outcomes Quality Initiative (KDOQI) convened a work group to review the 2021 KDIGO (Kidney Disease: Improving Global Outcomes) guideline for the management of blood pressure in chronic kidney disease (CKD). This commentary is the product of that work group and presents the recommendations and practice points from the KDIGO guideline in the context of US clinical practice. A critical addition to the KDIGO guideline is the recommendation for accurate assessment of blood pressure using standardized office blood pressure measurement. In the general adult population with CKD, KDIGO recommends a goal systolic blood pressure less than 120 mm Hg on the basis of results from the Systolic Blood Pressure Intervention Trial (SPRINT) and secondary analyses of the Action to Control Cardiovascular Risk in Diabetes-Blood Pressure (ACCORD-BP) trial. The KDOQI work group agreed with most of the recommendations while highlighting the weak evidence base especially for patients with diabetes and advanced CKD.
Collapse
Affiliation(s)
- Paul E Drawz
- Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, Minnesota.
| | | | - O N Ray Bignall
- Department of Pediatrics, The Ohio State University College of Medicine, Division of Nephrology and Hypertension, Nationwide Children's Hospital, Columbus, Ohio
| | - Jordana B Cohen
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Joseph T Flynn
- Department of Pediatrics, University of Washington School of Medicine, Division of Nephrology, Seattle Children's Hospital, Seattle, Washington
| | - Elaine Ku
- University of California-San Francisco, San Francisco, California
| | - Mahboob Rahman
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Louis Stokes Cleveland VA Medical Center Cleveland, Ohio
| | - George Thomas
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Matthew R Weir
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health & Tropical Medicine, New Orleans, Louisiana
| |
Collapse
|
26
|
Riccio E, Capuano I, Buonanno P, Andreucci M, Provenzano M, Amicone M, Rizzo M, Pisani A. RAAS Inhibitor Prescription and Hyperkalemia Event in Patients With Chronic Kidney Disease: A Single-Center Retrospective Study. Front Cardiovasc Med 2022; 9:824095. [PMID: 35224054 PMCID: PMC8874323 DOI: 10.3389/fcvm.2022.824095] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
Hyperkalemia is common in patients treated with renin-angiotensin-aldosterone system inhibitors (RAASis), and it represents the main cause of the large gap reported between guideline recommendations and real-world practice in chronic kidney disease (CKD). We conducted a CKD-population-based restrospective study to determine the prevalence of patients with CKD treated with RAASis, incidence of hyperkalemia in patients with CKD treated with RAASis, and proportion of patients with RAASi medication change after experiencing incident hyperkalemia. Among 809 patients with CKD analyzed, 556 (68.7%) were treated with RAASis, and RAASi prescription was greater in stages 2-4 of CKD. Hyperkalemia occurred in 9.2% of RAASi-treated patients, and the adjusted rate of hyperkalemia among patients with stage 4-5 CKD was 3-fold higher compared with patients with eGFR > 60 ml/min/1.73 m2. RAASi treatment was discontinued in 55.3% of the patients after hyperkalemia event (74.2% discontinued therapy, 3.2% received a reduced dose, and 22.6% reduced the number of RAASi drugs). This study shows that the incidence of hyperkalemia is frequently observed in patients with CKD patients with RAASis, and that rates increase with deteriorating levels of kidney function from stages 1 to 3. RAASi medication change following an episode of hyperkalemia occurred in almost half of the patients after experiencing hyperkalemia.
Collapse
Affiliation(s)
- Eleonora Riccio
- Institute for Biomedical Research and Innovation, National Research Council of Italy, Palermo, Italy
| | - Ivana Capuano
- Department of Public Health, Chair of Nephrology, University Federico II of Naples, Campania, Italy
| | - Pasquale Buonanno
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Michele Andreucci
- Department of Medical and Surgical Sciences-Renal Unit, “Magna Graecia” University, Catanzaro, Italy
| | - Michele Provenzano
- Department of Medical and Surgical Sciences-Renal Unit, “Magna Graecia” University, Catanzaro, Italy
| | - Maria Amicone
- Department of Public Health, Chair of Nephrology, University Federico II of Naples, Campania, Italy
| | - Manuela Rizzo
- Department of Public Health, Chair of Nephrology, University Federico II of Naples, Campania, Italy
| | - Antonio Pisani
- Department of Public Health, Chair of Nephrology, University Federico II of Naples, Campania, Italy
| |
Collapse
|
27
|
Yang K, Lv T, Wu J, Zhang X, Xue Y, Yu P, Liu Q. The Protective Effect of Electroacupuncture on the Renal Cortex of SHR: A Metabonomic Analysis. Biomed Chromatogr 2022; 36:e5338. [PMID: 35028961 DOI: 10.1002/bmc.5338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 11/07/2022]
Abstract
Hypertension will affect multiple organs in the body during the development of the disease. The antihypertensive effect of acupuncture on hypertension has been confirmed. The study of how the protective effect of electroacupuncture on the renal cortex of SHR is achieved has not yet been studied. The purpose of this study is to understand the impact of electroacupuncture on the blood pressure of spontaneously hypertensive rat (SHR) and the impact on metabolites in the renal cortex, looking for potential differential metabolites, and then proceeding to the next step of exploratory research. In the experiment, the experimental animals were divided into four groups: Control group, Model group, Electroacupuncture group, Losartan Potassium group, and electroacupuncture on bilateral Taichong (LR3) and Zusanli (ST36) lasted for 3 weeks, and the renal cortex was collected for metabonomics research. UHPLC-MS was used to analyze the changes in the metabolic spectrum of renal cortex tissue. The results showed that electroacupuncture can significantly reduce the blood pressure of SHR. A total of 12 metabolites have changed significantly in the comparison between each group and Model group. The possible mechanism is that the primary bile acid biosynthesis, bile secretion, tryptophan metabolism and other metabolic pathways affect the renal cortex.
Collapse
Affiliation(s)
- Kezhen Yang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Taotao Lv
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jiaojuan Wu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xudong Zhang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Yanjun Xue
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Pengcheng Yu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Qingguo Liu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| |
Collapse
|
28
|
Benmira AM, Moranne O, Prelipcean C, Pambrun E, Dauzat M, Demattei C, Pérez-Martin A. Direct Determination rather than Oscillometric Estimation of Systolic Blood Pressure in Patients with Severe Chronic Kidney Disease. Am J Nephrol 2022; 53:41-49. [PMID: 35021175 DOI: 10.1159/000520996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 11/16/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Although arterial hypertension is a major concern in patients with chronic kidney disease (CKD), obtaining accurate systolic blood pressure (SBP) measurement is challenging in this population for whom automatic oscillometric devices may yield erroneous results. METHODS This cross-sectional study was conducted in 89 patients with stages 4, 5, and 5D CKD, for whom we compared SBP values obtained by the recently described systolic foot-to-apex time interval (SFATI) technique which provides direct SBP determination, the standard technique (Korotkoff sounds), and oscillometry. We investigated the effects of age, sex, diabetes, CKD stage, and pulse pressure to explain measurement errors defined as biases or misclassification relative to the SBP thresholds of 110-130-mm Hg. RESULTS All 3 techniques showed satisfactory reproducibility for SBP measurement (CCC > 0.84 and >0.91, respectively, in dialyzed and nondialyzed patients). The mean ± SD from SBP as determined via Korotkoff sounds was 1.7 ± 4.6 mm Hg for SFATI (CCC = 0.98) and 5.9 ± 9.3 mm Hg for oscillometry (CCC = 0.88). Referring to the 110-130-mm Hg SBP range outside which treatment prescription or adaptation is recommended for CKD patients, SFATI underestimated SBP in 3 patients and overestimated it in 1, whereas oscillometry underestimated SBP in 12 patients and overestimated it in 3. Higher pulse pressure was the main explanatory factor for measurement and classification errors. DISCUSSION/CONCLUSION SFATI provides accurate SBP measurements in patients with severe CKD and paves the way for the standardization of automated noninvasive blood pressure measurement devices. Before prescribing or adjusting antihypertensive therapy, physicians should be aware of the risk of misclassification when using oscillometry.
Collapse
Affiliation(s)
- Amir M Benmira
- Vascular Medicine, Nimes University Hospital, Nimes, France
- IDESP, INSERM & Montpellier University, Montpellier, France
| | - Olivier Moranne
- IDESP, INSERM & Montpellier University, Montpellier, France,
- Nephology - Dialysis - Apheresis, Nimes University Hospital, Nimes, France,
| | - Camelia Prelipcean
- Nephology - Dialysis - Apheresis, Nimes University Hospital, Nimes, France
| | - Emilie Pambrun
- Nephology - Dialysis - Apheresis, Nimes University Hospital, Nimes, France
| | - Michel Dauzat
- Vascular Medicine, Nimes University Hospital, Nimes, France
- EA2992, Montpellier University, Montpellier, France
| | | | - Antonia Pérez-Martin
- Vascular Medicine, Nimes University Hospital, Nimes, France
- IDESP, INSERM & Montpellier University, Montpellier, France
| |
Collapse
|
29
|
Morris A, Krishnan N, Kimani PK, Lycett D. CORRECTED ARTICLE: Effect of Dietary Potassium Restriction on Serum Potassium, Disease Progression, and Mortality in Chronic Kidney Disease: A Systematic Review and Meta-Analysis. J Ren Nutr 2022; 32:e1-e10. [PMID: 34980365 DOI: 10.1053/j.jrn.2021.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Low-potassium diets are recommended to reduce serum potassium (Sk) and prevent complications of chronic kidney disease (CKD), but evidence underpinning this recommendation has not been systematically reviewed and synthesized. We conducted a systematic review comparing change in Sk, CKD progression, and mortality between those on a low-potassium versus unrestricted potassium diet. METHODS We searched Medline, AMED, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, and Clinicaltrials.org from inception to 3 April 2018. We included randomized and observational studies that compared these outcomes in adults with CKD who ate a restricted versus unrestricted amount of dietary potassium. We pooled mean change in Sk and adjusted hazard ratios of disease progression and mortality using random-effects meta-analyses. RESULTS We identified 5,563 articles, of which seven studies (3,489 participants) met our inclusion criteria. We found very low-quality evidence that restricted (1,295 mg/d) versus unrestricted (1,570 mg/d) dietary potassium lowered Sk by -0.22 mEq/L (95% confidence interval [CI]: -0.33, -0.10; I2 = 0%). Higher (4,558 mg/d) versus lower (1,725 mg/d) dietary potassium was not significantly associated with disease progression (hazard ratio [HR]: 1.14, 95% CI: [0.77, 1.70] I² = 57%). Higher (4,414 mg/d) compared with lower (1,670 mg/d) dietary potassium intake was not significantly associated with reduced mortality risk (HR: 0.80, 95% CI: [0.46, 1.41] I² = 78%). CONCLUSIONS Very-low-quality evidence supports consensus that dietary potassium restriction reduces Sk in normokalemia but whether this is associated with risk of death in those with CKD is uncertain. High-quality randomized controlled trials are needed.
Collapse
Affiliation(s)
- Andrew Morris
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK; Renal Department, University Hospital, Coventry, UK.
| | | | - Peter K Kimani
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Deborah Lycett
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| |
Collapse
|
30
|
Measurement of the Surface Area of the Renal Sinus Fat Using MDCT: Correlation with Presence and Severity of Essential Hypertension and Body Mass Index. J Belg Soc Radiol 2022; 106:91. [PMID: 36304908 PMCID: PMC9541188 DOI: 10.5334/jbsr.2776] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/27/2022] [Indexed: 11/07/2022] Open
Abstract
Objectives: Essential hypertension remains a major modifiable risk factor for cardiovascular disease. Excess visceral adipose tissue is associated with the presence of adverse metabolic risk factors. Our study aims to measure the surface area of the renal sinus fat using MDCT and correlate the renal sinus surface area with the presence and grading of essential hypertension as well as body mass index. Materials and Methods: This cross-sectional study included two groups; the patients’ group including 40 cases presented with a history of primary essential hypertension and the control group including 40 cases. The average of the surface area of the two kidneys as well as the average of the surface area of sinus fat was measured in the control and patient subgroups and was correlated with the presence and grading of essential hypertension as well as body mass index. Results: There was a significant correlation between the presence and grading of essential hypertension with prominent renal sinus fat. There was a significant correlation between the average surface area of kidneys and surface area of sinus fat in overweight and obese groups than in the control group (P < 0.01). Conclusion: Obesity is now recognized as a risk factor for the development of renal dysfunction. There was a significant correlation between the surface area of renal sinus fat measured using MDCT and the presence as well as grading of essential hypertension, suggesting that renal sinus fat may promote cardiovascular events.
Collapse
|
31
|
Kilgallon JL, Gannon M, Burns Z, McMahon G, Dykes P, Linder J, Bates DW, Waikar S, Lipsitz S, Baer HJ, Samal L. Multicomponent intervention to improve blood pressure management in chronic kidney disease: a protocol for a pragmatic clinical trial. BMJ Open 2021; 11:e054065. [PMID: 34937722 PMCID: PMC8705218 DOI: 10.1136/bmjopen-2021-054065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The purpose of this study is to incorporate behavioural economic principles and user-centred design principles into a multicomponent intervention for the management of uncontrolled hypertension (HTN) in chronic kidney disease (CKD) in primary care. METHODS AND ANALYSIS This is a multicentre, pragmatic, controlled trial cluster-randomised at the clinician level at The Brigham and Women's Practice -Based Research Network of 15 practices. Of 220 total clinicians, 184 were eligible to be enrolled, and the remainder were excluded (residents and clinicians who see urgent care or walk-in patients); no clinicians opted out. The intervention consists of a clinical decision support system based in behavioural economic and user-centred design principles that will: (1) synthesise existing laboratory tests, medication orders and vital sign data; (2) increase recognition of CKD, (3) increase recognition of uncontrolled HTN in CKD patients and (4) deliver evidence-based CKD and HTN management recommendations. The primary endpoint is the change in mean systolic blood pressure between baseline and 6 months compared across arms. We will use the Reach Effectiveness Adoption Implementation Maintenance framework. At the conclusion of this study, we will have: (1) validated an intervention that combines laboratory tests, medication records and clinical information collected by electronic health records to recognise uncontrolled HTN in CKD patients and recommend a course of care, (2) tested the effectiveness of said intervention and (3) collected information about the implementation of the intervention that will aid in dissemination of the intervention to other practice settings. ETHICS AND DISSEMINATION The Human Subjects Institutional Review Board at Brigham and Women's Hospital provided an expedited review and approval for this study protocol, and a Data Safety Monitoring Board will ensure the ongoing safety of the trial. TRIAL REGISTRATION NUMBER NCT03679247.
Collapse
Affiliation(s)
- John L Kilgallon
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael Gannon
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Zoe Burns
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Gearoid McMahon
- Division of Nephrology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Patricia Dykes
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey Linder
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - David Westfall Bates
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sushrut Waikar
- Nephrology, Department of Medicine, Boston University Medical Center, Boston, Massachusetts, USA
| | - Stuart Lipsitz
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Heather J Baer
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Lipika Samal
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
32
|
Suzuki N, Hitomi Y, Takata H, Ushiya S, Yamada M, Sakai Y, Konishi T, Takeda Y, Sumino Y, Mizo M, Tsuji Y, Nishimura M, Hashimoto T, Kobayashi H. Association between salt intake and long-term mortality in hemodialysis patients: A retrospective cohort study. PLoS One 2021; 16:e0260671. [PMID: 34914719 PMCID: PMC8675678 DOI: 10.1371/journal.pone.0260671] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/13/2021] [Indexed: 01/19/2023] Open
Abstract
Background The association between salt intake and clinical outcomes in hemodialysis patients has been controversial. This study aimed to clarify the association between salt intake and mortality in hemodialysis patients. Method The present study included patients who underwent hemodialysis from June 1st 2016 to May 31st 2020. Corrected salt intake by ideal body weight was the main predictor of outcomes. Ideal body weight was calculated assuming that the ideal body mass index is 22 kg/m2 for the Japanese population. The multivariate Cox proportional hazards model was used to determine the association between corrected salt intake and mortality, adjusting for potential confounders. The outcomes considered were all-cause mortality and cumulative incidence of cardiovascular events at year 4. Result A total of 492 adult patients were enrolled in the study. The mean daily salt intake and corrected salt intake at baseline were 9.5 g/day and 0.17 g/kg/day, respectively. The low corrected salt intake group (< 0.13 g/kg/day) demonstrated the highest 4-year all-cause mortality. No association was observed between corrected salt intake and the cumulative incidence of cardiovascular events. In multivariate Cox proportional hazards analysis, only the group with corrected salt intake of 0.16–0.20 g/kg/day was associated with a decreased hazard risk for all-cause death compared with the low corrected salt intake group. Conclusion The present study found that a low salt intake was associated with high all-cause mortality in hemodialysis patients. Reduced long-term survival may be attributed to malnutrition resulting from excessive salt restriction.
Collapse
Affiliation(s)
- Naoki Suzuki
- Division of Clinical Engineering, Tojinkai Hospital, Kyoto, Japan
- * E-mail:
| | - Yasumasa Hitomi
- Division of Clinical Engineering, Tojinkai Hospital, Kyoto, Japan
| | - Hiroya Takata
- Division of Clinical Engineering, Tojinkai Hospital, Kyoto, Japan
| | - Shinji Ushiya
- Division of Clinical Engineering, Tojinkai Hospital, Kyoto, Japan
| | - Masahiro Yamada
- Division of Clinical Engineering, Tojinkai Hospital, Kyoto, Japan
| | - Yusuke Sakai
- Division of Clinical Engineering, Tojinkai Hospital, Kyoto, Japan
| | - Takahiro Konishi
- Division of Clinical Engineering, Tojinkai Hospital, Kyoto, Japan
| | - Yuuki Takeda
- Division of Clinical Engineering, Tojinkai Hospital, Kyoto, Japan
| | - Yuuki Sumino
- Division of Clinical Engineering, Tojinkai Hospital, Kyoto, Japan
| | - Masaya Mizo
- Division of Clinical Engineering, Tojinkai Hospital, Kyoto, Japan
| | - Yoshihiro Tsuji
- Faculty of Health Science, Morinomiya University of Medical Sciences, Osaka, Japan
| | | | | | | |
Collapse
|
33
|
Yan MT, Chao CT, Lin SH. Chronic Kidney Disease: Strategies to Retard Progression. Int J Mol Sci 2021; 22:ijms221810084. [PMID: 34576247 PMCID: PMC8470895 DOI: 10.3390/ijms221810084] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 12/11/2022] Open
Abstract
Chronic kidney disease (CKD), defined as the presence of irreversible structural or functional kidney damages, increases the risk of poor outcomes due to its association with multiple complications, including altered mineral metabolism, anemia, metabolic acidosis, and increased cardiovascular events. The mainstay of treatments for CKD lies in the prevention of the development and progression of CKD as well as its complications. Due to the heterogeneous origins and the uncertainty in the pathogenesis of CKD, efficacious therapies for CKD remain challenging. In this review, we focus on the following four themes: first, a summary of the known factors that contribute to CKD development and progression, with an emphasis on avoiding acute kidney injury (AKI); second, an etiology-based treatment strategy for retarding CKD, including the approaches for the common and under-recognized ones; and third, the recommended approaches for ameliorating CKD complications, and the final section discusses the novel agents for counteracting CKD progression.
Collapse
Affiliation(s)
- Ming-Tso Yan
- Department of Medicine, Division of Nephrology, Cathay General Hospital, School of Medicine, Fu-Jen Catholic University, Taipei 106, Taiwan;
- National Defense Medical Center, Graduate Institute of Medical Sciences, Taipei 114, Taiwan
| | - Chia-Ter Chao
- Department of Internal Medicine, Nephrology Division, National Taiwan University Hospital, Taipei 104, Taiwan;
- Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei 104, Taiwan
- Department of Internal Medicine, Nephrology Division, National Taiwan University College of Medicine, Taipei 104, Taiwan
| | - Shih-Hua Lin
- National Defense Medical Center, Graduate Institute of Medical Sciences, Taipei 114, Taiwan
- Department of Internal Medicine, Nephrology Division, National Defense Medical Center, Taipei 104, Taiwan
- Correspondence: or
| |
Collapse
|
34
|
Chen TH, Liu CW, Ho YH, Huang CK, Hung CS, Smith BH, Lin JC. Gut Microbiota Composition and Its Metabolites in Different Stages of Chronic Kidney Disease. J Clin Med 2021; 10:jcm10173881. [PMID: 34501329 PMCID: PMC8432073 DOI: 10.3390/jcm10173881] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 12/12/2022] Open
Abstract
A growing body of study have documented the association of gut dysbiosis or fecal metabolites with chronic kidney disease (CKD). However, it is not clear whether the phenomenon simply reflects the microenvironment changes correlated with the CKD severity or contributes to the progression of CKD. In this study, we identified the gut microbiota and metabolite in feces samples correlated with CKD severity using the Nanopore long-read sequencing platform and UPLC-coupled MS/MS approach. A cross-sectional cohort study was performed from 1 June 2020 to 31 December 2020. One hundred and fifty-six clinical participants, including 60 healthy enrollees and 96 Stage 1–5 CKD patients, were enrolled in this study. The ROC curve generated with the relative abundance of Klebsiella pneumonia or S-Adenosylhomocysteine showed a gradual increase with the CKD severity. Our results further revealed the positive correlation of increased K. pneumonia and S-Adenosylhomocysteine in gut environment, which may be of etiological importance to the deterioration of a CKD patient. In that sense, the microbiota or metabolite changes constitute potential candidates for evaluating the progression of CKD.
Collapse
Affiliation(s)
- Tso-Hsiao Chen
- Division of Nephrology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan;
- Department of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Chao-Wei Liu
- Ph.D. Program in Medical Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan; (C.-W.L.); (C.-S.H.)
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Yi-Hsien Ho
- Department of Laboratory Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (Y.-H.H.); (C.-K.H.)
- School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan
| | - Chun-Kai Huang
- Department of Laboratory Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (Y.-H.H.); (C.-K.H.)
- School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan
| | - Ching-Sheng Hung
- Ph.D. Program in Medical Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan; (C.-W.L.); (C.-S.H.)
- Department of Laboratory Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (Y.-H.H.); (C.-K.H.)
- School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan
| | - Barry H. Smith
- Applied Medical Research Inc., Nashville, TN 37219, USA;
| | - Jung-Chun Lin
- Ph.D. Program in Medical Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan; (C.-W.L.); (C.-S.H.)
- School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan
- Pulmonary Research Center, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Correspondence: ; Tel.: +886-2-2736-1661 (ext. 3330)
| |
Collapse
|
35
|
Koike K, Yamagishi SI, Hamano T, Komukai S, Okuda S, Fukami K. New Estimation Formulas for Daily Sodium Intake in Hemodialysis Patients by a Duplicate Portion Method. J Ren Nutr 2021; 32:326-333. [PMID: 34294551 DOI: 10.1053/j.jrn.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/22/2021] [Accepted: 05/25/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Excess sodium intake is associated with volume overload and increased blood pressure. Therefore, to prevent future cardiovascular events, a sodium-restricted diet is strongly recommended for patients on maintenance hemodialysis (HD). However, only one formula for estimating dietary sodium intake in HD patients is available, and its validity has not been adequately evaluated. This study aimed to measure daily sodium intake using the duplicate portion method and provide a new formula for estimating dietary sodium intake. DESIGN AND METHODS Nineteen Japanese patients undergoing HD were enrolled in this cross-sectional multicenter study. The daily sodium intake of these patients was measured directly using the duplicate portion method. Two formulas for estimating sodium intake were developed by stepwise regression analysis. Their validities were compared with the validity of the previous formula. Furthermore, using these new formulas, we estimated the daily consumption of sodium in a large number of Japanese HD patients. RESULTS The previous formula underestimated true sodium intake using Bland-Altman diagrams. No significant correlation was noted between the measured sodium intake and the estimated intake (r = 0.30, P = .23, Fisher's Z-transformation). The new formulas 1 and 2, which included age, predialysis and postdialysis serum sodium levels, predialysis body weight, and interdialytic body weight gain, accurately estimated sodium consumption. The coefficients of correlation between the estimated values and the true sodium intake were r = 0.858 and r = 0.805, respectively. The simulation model using data from the Japanese Society for Dialysis Therapy showed that the distribution of the estimated sodium intake using the previous formula shifted left compared with that using the new formulas. CONCLUSIONS The new formulas accurately estimated the daily sodium consumption in HD patients. Further longitudinal studies are required to determine whether the estimated sodium intake level calculated using the new formulas would serve as a potential marker and/or therapeutic target to prevent cardiovascular events in HD patients.
Collapse
Affiliation(s)
- Kiyomi Koike
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan; Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, Kariya, Japan.
| | - Sho-Ichi Yamagishi
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Takayuki Hamano
- Department of Nephrology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shou Komukai
- Division of Biomedical Statistics, Department of Integrated Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Seiya Okuda
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Kei Fukami
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| |
Collapse
|
36
|
Diabetic Nephropathy: Challenges in Pathogenesis, Diagnosis, and Treatment. BIOMED RESEARCH INTERNATIONAL 2021; 2021:1497449. [PMID: 34307650 PMCID: PMC8285185 DOI: 10.1155/2021/1497449] [Citation(s) in RCA: 322] [Impact Index Per Article: 107.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/02/2021] [Indexed: 12/15/2022]
Abstract
Diabetic nephropathy (DN) is the leading cause of end-stage renal disease worldwide. Chronic hyperglycemia and high blood pressure are the main risk factors for the development of DN. In general, screening for microalbuminuria should be performed annually, starting 5 years after diagnosis in type 1 diabetes and at diagnosis and annually thereafter in type 2 diabetes. Standard therapy is blood glucose and blood pressure control using the renin-angiotensin system blockade, targeting A1c < 7%, and <130/80 mmHg. Regression of albuminuria remains an important therapeutic goal. However, there are problems in diagnosis and treatment of nonproteinuric DN (NP-DN), which does not follow the classic pattern of DN. In fact, the prevalence of DN continues to increase, and additional therapy is needed to prevent or ameliorate the condition. In addition to conventional therapies, vitamin D receptor activators, incretin-related drugs, and therapies that target inflammation may also be promising for the prevention of DN progression. This review focuses on the role of inflammation and oxidative stress in the pathogenesis of DN, approaches to diagnosis in classic and NP-DN, and current and emerging therapeutic interventions.
Collapse
|
37
|
Valtuille R. Potential Novel Benefits of Sodium Restriction in Chronic Kidney Disease. Curr Hypertens Rev 2021; 17:59-66. [PMID: 32538730 DOI: 10.2174/1573402116666200615152139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/20/2020] [Accepted: 04/30/2020] [Indexed: 11/22/2022]
Abstract
Chronic kidney disease is a global public health issue, and it has been considered as the epidemic of the 21st century. Therefore, all initiatives addressed to slow down the evolution and complications of this condition should be well received. While the effects of salt reduction on cardiovascular disease have some controversial issues, in chronic kidney disease, such a policy is beneficial in multiple aspects. In chronic kidney disease patients, dietary sodium restriction is regularly recommended to control extracellular fluid expansion, hypertension and cardiovascular risk. Instead, the effects of sodium reduction on chronic kidney disease progression are still controversial. In the last years, potentially beneficial effects of a low sodium diet on chronic kidney disease evolution have emerged. Firstly, recent magnetic resonance-based findings of increased Na depots in skin and muscle associated with renal function, ageing and sodium intake open a vast body of investigation as a potential tool for monitoring effects of sodium restriction. In this narrative review, we also discussed novel aspects of sodium restriction in chronic kidney disease to manage metabolic acidosis as well as renal effects on fibroblast growth factor 23 or gut microbiota. Beyond current evidence, these approaches showed that common findings of kidney failure environment such as sodium -sensitivity, micro-inflammation, arterial stiffness metabolic acidosis and sarcopenia could be delayed controlling dietary sodium. Additional studies are now needed in populations with chronic kidney disease to confirm these new findings, addressed to slow down the evolution and complications of this condition.
Collapse
Affiliation(s)
- Rodolfo Valtuille
- Department of Clinical Research, Universidad Nacional Guillermo Brown, 2289 Espora Avenue, Burzaco, B1852FZD Buenos Aires, Argentina
| |
Collapse
|
38
|
Prischl FC, Rossing P, Bakris G, Mayer G, Wanner C. Major adverse renal events (MARE): a proposal to unify renal endpoints. Nephrol Dial Transplant 2021; 36:491-497. [PMID: 31711188 DOI: 10.1093/ndt/gfz212] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND In renal studies, various outcome endpoints are used with variable definitions, making it nearly impossible to perform meta-analyses and deduce meaningful conclusions. Increasing attention is directed towards standardization of renal outcome reporting. METHODS A working group was formed to produce a unifying definition of renal outcomes that can be used by all investigators. We propose major adverse renal events (MARE) as the term for a standardized composite of hard renal outcomes. We discuss the components for inclusion in MARE from existing evidence. RESULTS MARE could include three to five items, considered relevant to patients and regulators. New onset of kidney injury, that is persistent albuminuria/proteinuria and/or decreasing glomerular filtration rate (GFR) <60 ml/min/1.73 m2, persistent signs of worsening kidney disease, development of end-stage kidney disease with estimated GFR <15 ml/min/1.73 m2 without or with initiation of kidney replacement therapy, and death from renal cause are core items of MARE. Additionally, patient reported outcomes should be reported in parallel to MARE as a standard set of primary (or secondary) endpoints in studies on kidney disease of diabetic, hypertensive-vascular, or other origin. CONCLUSIONS MARE as a reporting standard will enhance the ability to compare studies and thus, facilitate meaningful meta-analyses. This will result in standardized endpoints that should result in guideline improvement to better individualize care of patients with kidney disease.
Collapse
Affiliation(s)
- Friedrich C Prischl
- Department of Nephrology, 4th Department of Internal Medicine, Klinikum WelsGrieskirchen, Wels, Austria
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - George Bakris
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, University of Chicago, Chicago, IL, USA
| | - Gert Mayer
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | | |
Collapse
|
39
|
Zhang Y, Li JJ, Wang AJ, Wang B, Hu SL, Zhang H, Li T, Tuo YH. Effects of intensive blood pressure control on mortality and cardiorenal function in chronic kidney disease patients. Ren Fail 2021; 43:811-820. [PMID: 33966601 PMCID: PMC8118417 DOI: 10.1080/0886022x.2021.1920427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Blood pressure (BP) variability is highly correlated with cardiovascular and kidney outcomes in patients with chronic kidney disease (CKD). However, appropriate BP targets in patients with CKD remain uncertain. METHODS We searched PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) of CKD patients who underwent intensive BP management. Kappa score was used to assess inter-rater agreement. A good agreement between the authors was observed to inter-rater reliability of RCTs selection (kappa = 0.77; P = 0.005). RESULTS Ten relevant studies involving 20 059 patients were included in the meta-analysis. Overall, intensive BP management may reduce the incidence of cardiovascular disease mortality (RR: 0.69, 95% CI: 0.53 to 0.90, P: 0.01), all-cause mortality (RR: 0.77, 95% CI: 0.67 to 0.88, P < 0.01) and composite cardiovascular events (RR: 0.84 95% CI: 0.75 to 0.95, P < 0.01) in patients with CKD. However, reducing BP has no significant effect on the incidence of doubling of serum creatinine level or 50% reduction in GFR (RR: 1.26, 95% CI: 0.66 to 2.40, P = 0.48), composite renal events (RR 1.07, 95% CI: 0.81 to 1.41, P = 0.64) or SAEs (RR: 0.97, 95% CI: 0.90 to 1.05, P = 0.48). CONCLUSION In patients with CKD, enhanced BP management is associated with reduced all-cause mortality, cardiovascular mortality, and incidence of composite cardiovascular events.
Collapse
Affiliation(s)
- Yong Zhang
- Department of Nephrology, Jianli People's Hospital, Jingzhou, China
| | - Jing-Jing Li
- Department of Ultrasonic Imaging, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - An-Jun Wang
- Department of Nephrology, Jianli People's Hospital, Jingzhou, China
| | - Bo Wang
- Department of Ultrasound, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Shou-Liang Hu
- Department of Nephrology, The First Affiliated Hospital of Yangtze University, Jingzhou, China
| | - Heng Zhang
- Department of Histology and Embryology, Xiang Ya School of Medicine, Central South University, Changsha, China
| | - Tian Li
- School of Basic Medicine, Fourth Military Medical University, Xi'an, China
| | - Yan-Hong Tuo
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
40
|
Bakris G, Pergola PE, Delgado B, Genov D, Doliashvili T, Vo N, Yang YF, McCabe J, Benn V, Pitt B. Effect of KBP-5074 on Blood Pressure in Advanced Chronic Kidney Disease: Results of the BLOCK-CKD Study. Hypertension 2021; 78:74-81. [PMID: 33966452 PMCID: PMC8189259 DOI: 10.1161/hypertensionaha.121.17073] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. In patients with resistant or poorly controlled hypertension and advanced chronic kidney disease, mineralocorticoid receptor antagonists are recommended; however, hyperkalemia limits their use. BLOCK-CKD was a phase 2b, multicenter, randomized, double-blind, placebo-controlled, parallel-group study that evaluated the safety, efficacy, and pharmacokinetics of KBP-5074, a nonsteroidal mineralocorticoid receptor antagonist, for uncontrolled hypertension in patients with stage 3b/4 chronic kidney disease. The study tested the hypothesis that addition of KBP-5074 to standard treatment lowers blood pressure without increased risk of hyperkalemia. Patients (N=162) were randomly assigned 1:1:1 to once-daily oral treatment with placebo, KBP-5074 0.25 mg, or KBP-5074 0.5 mg. The primary end point was systolic blood pressure change from baseline at day 84. Baseline mean (SD) systolic blood pressure was 155.3 (13.55) mm Hg. After 84 days, the placebo-subtracted treatment mean difference (SE) was −7.0 (3.37) mm Hg with KBP-5074 0.25 mg (P=0.0399) and −10.2 (3.32) mm Hg with KBP-5074 0.5 mg (P=0.0026). Hyperkalemia incidence, ≥5.6 <6 mmol/L, were similar among groups 5 (8.8%) placebo, 6 (11.8%) 0.25 mg, and 9 (16.7%) 0.5 mg patients. No hyperkalemia ≥6.0 mmol/L was observed. We conclude that KBP-5074 effectively lowers blood pressure with some risk of hyperkalemia in individuals with advanced chronic kidney disease and uncontrolled blood pressure.
Collapse
Affiliation(s)
- George Bakris
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, The University of Chicago Medicine, IL (G.B.)
| | | | | | - Diyan Genov
- MC Comac Medical LTD EOOD, Sofia, Bulgaria (D.G.)
| | | | - Nam Vo
- Mountain Kidney and Hypertension Associates, Asheville, NC (N.V.)
| | - Y Fred Yang
- KBP Biosciences, Princeton, NJ (Y.F.Y., J.M., V.B.)
| | - James McCabe
- KBP Biosciences, Princeton, NJ (Y.F.Y., J.M., V.B.)
| | - Vincent Benn
- KBP Biosciences, Princeton, NJ (Y.F.Y., J.M., V.B.)
| | - Bertram Pitt
- Department of Medicine, University of Michigan School of Medicine, Ann Arbor (B.P.)
| | | |
Collapse
|
41
|
Update on Treatment of Hypertension After Renal Transplantation. Curr Hypertens Rep 2021; 23:25. [PMID: 33961145 DOI: 10.1007/s11906-021-01151-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW To incorporate novel findings on pathophysiology and treatment of posttransplant hypertension. RECENT FINDINGS (1) The sodium retaining effects of CNIs are mediated by stimulation of the thiazide-sensitive sodium chloride co-transporter in the distal convoluted tubule and in this regard chlorthalidone was proven to be an effective antihypertensive drug in renal transplantation. (2) Local and not systemic activation of the renin-angiotensin-aldosterone system plays a crucial role in the pathogenesis of posttransplant hypertension. (3) Recent randomized controlled trials failed to prove the presumed superiority of renin-angiotensin blockers in kidney transplantation. (4) Steroid-free and mammalian target of rapamycin-based immunosuppressive drug combinations did not show favorable effects on blood pressure control. (5) In a recent report the risk of non-melanoma skin cancer was higher with thiazide diuretics. But the increased cancer risk in transplant recipients is mainly attributed to comorbidities, such as diabetes and hypertension and of course to the transplantation condition itself or the obligatory application of immunosuppression, and has little to do with the antihypertensive medication Actual recommendations about BP targets in adult renal transplant recipients are coming from a post hoc analysis of a large randomized trial with another primary endpoint. Unless convincing studies on treatment of hypertension after renal transplantation are available, the ESC/ESH Guidelines 2018 should apply for these patients.
Collapse
|
42
|
Ari E, Fici F, Robles NR. Hypertension in Kidney Transplant Recipients: Where Are We Today? Curr Hypertens Rep 2021; 23:21. [PMID: 33847830 DOI: 10.1007/s11906-021-01139-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW Cardiovascular disease is the leading cause of death and allograft loss among kidney transplant recipients, and hypertension is an independent risk factor for cardiovascular morbidity of this patient population. The etiology of hypertension is multifactorial, including pre-transplant volume overload, post-transplant recipient and donor-associated variables, and transplant-specific causes (immunosuppressive medications, allograft dysfunction and surgical complications such as transplant artery stenosis). RECENT FINDINGS No randomized controlled trials have assessed the optimal blood pressure targets and explored the best antihypertensive regimen for kidney transplant recipients. According to the large observational studies, it is reasonable to achieve a blood pressure goal of equal to or less than 130/80 mmHg in the long-term follow-up for minimizing the cardiovascular morbidity. The selection of antihypertensive agents should be based on the patient's co-morbidities; however, the initial choice could be calcium channel blockers especially in the first few months of transplantation. In patients with cardiovascular indications of renin-angiotensin-aldosterone system inhibition, given the well-described benefits in diabetic and proteinuric patients, it is reasonable to consider the use of renin-angiotensin-aldosterone system inhibitors. There is a need for future prospective trials in the transplant population to define optimal blood pressure goals and therapies.
Collapse
Affiliation(s)
- Elif Ari
- Department of Nephrology, Bahcesehir University, 34734, Istanbul, Turkey.
| | - Francesco Fici
- Cardiovascular Risk Chair, University of Salamanca School of Medicine, Salamanca, Spain
| | - Nicolas Roberto Robles
- Department of Nephrology, Hospital Universitario de Badajoz, and Cardiovascular Risk Chair, University of Salamanca School of Medicine, Salamanca, Spain
| |
Collapse
|
43
|
Song Y, Lobene AJ, Wang Y, Hill Gallant KM. The DASH Diet and Cardiometabolic Health and Chronic Kidney Disease: A Narrative Review of the Evidence in East Asian Countries. Nutrients 2021; 13:984. [PMID: 33803731 PMCID: PMC8003274 DOI: 10.3390/nu13030984] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/16/2021] [Accepted: 03/16/2021] [Indexed: 02/07/2023] Open
Abstract
The rising incidence of cardiometabolic diseases and chronic kidney disease (CKD) is a leading public health problem in East Asia. Diet is an important modifiable risk factor; thus, adopting a healthy diet such as the Dietary Approaches to Stop Hypertension (DASH) diet may help combat these chronic diseases. The DASH diet was originally developed in a U.S. population, and East Asia is demographically and culturally different from the U.S. Therefore, it is important to examine the evidence regarding the DASH diet and chronic disease in this unique population. This narrative review summarizes the evidence on the DASH diet and cardiometabolic health and CKD in East Asia. Culturally-modified DASH diets have been developed in some East Asian countries. Studies suggest the DASH diet is effective at lowering blood pressure in this population, though the long-term benefits remain unclear. Evidence also suggests the DASH diet may reduce the risk of type 2 diabetes and metabolic syndrome. Further research indicates the DASH diet and its components may reduce CKD risk. However, recommending the DASH diet in those who already have CKD is controversial, as it conflicts with current CKD dietary guidelines, especially in advanced CKD. Notably, current intakes in the general population differ from the DASH dietary pattern, suggesting public health efforts would be needed to encourage adoption of the DASH diet.
Collapse
Affiliation(s)
- Yazhen Song
- Peking University Clinical Research Institute, Beijing 100191, China; (Y.S.); (Y.W.)
| | - Andrea J. Lobene
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA;
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE 19713, USA
| | - Yanfang Wang
- Peking University Clinical Research Institute, Beijing 100191, China; (Y.S.); (Y.W.)
| | - Kathleen M. Hill Gallant
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA;
- Department of Food Science and Nutrition, University of Minnesota, St. Paul, MN 55108, USA
| |
Collapse
|
44
|
Frequency and Patterns of Prescribing Antihypertensive Agents in Outpatient Kidney Transplant Recipients Among Six Cities in China from 2011 to 2018. Clin Ther 2021; 43:602-612. [PMID: 33637331 DOI: 10.1016/j.clinthera.2021.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/27/2020] [Accepted: 01/11/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Antihypertensive agents are frequently prescribed in kidney transplant recipients (KTRs). However, the frequency and patterns of prescribing antihypertensive agents remain uncharacterized in KTRs in China. Therefore, this investigation was carried out. METHODS Retrospective prescription data dated 2011 to 2018 from KTRs in China were accessed using the Hospital Prescription Analysis Program database. Information about sex, birth date, and identification number of the patient; city, date, and department of the medical visit; major diagnoses; and the generic names, specifications, quantities, and usage of prescribed drugs were collected. Antihypertensive agents were grouped into 5 classes: angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers (BBs), calcium channel blockers (CCBs), and diuretics. The frequency and patterns of prescribing these antihypertensive agents were analyzed. FINDINGS Prescriptions from 174,749 KTRs (67.2% male; mean age, 42.5 [9.4] years) were obtained, and 58.2% of the patients were prescribed antihypertensive agents. The percentage of patients who received antihypertensive treatment increased from 52.9% in 2011 to 61.6% in 2018 and varied by city. Cyclosporine was associated with higher prescription frequency of antihypertensive agents than was tacrolimus (71.7% vs 63.4%; P < 0.0001). During the 8-year study period, CCBs were most frequently prescribed (39.0%), followed by ARBs (31.9%), BBs (14.3%), ACEIs (11.6%), and diuretics (3.2%). The mean (SD) number of antihypertensive drugs prescribed per KTR was 1.7 (0.8). Almost half of KTRs (51.2%) received just 1 antihypertensive drug. Co-administration of 2 or more antihypertensive drugs presented an obviously upward trend. The most commonly prescribed 2-drug combination was CCB + ARB (44.8%), followed by CCB + BB (20.1%) and CCB + ACEI (13.0%). In the patients who received 3 antihypertensive drugs, the 2 most frequently prescribed combinations were CCB + ARB + BB (37.5%) and CCB + ARB + ACEI (32.7%). Specific data varied by both year and city. IMPLICATIONS The prescribing patterns of antihypertensive agents in KTRs varied by city even within same country. Hence, more high-quality research studies on the use of antihypertensive agents in KTRs are needed.
Collapse
|
45
|
Lee YB, Lee JS, Hong SH, Kim JA, Roh E, Yoo HJ, Baik SH, Choi KM. Optimal blood pressure for patients with chronic kidney disease: a nationwide population-based cohort study. Sci Rep 2021; 11:1538. [PMID: 33452422 PMCID: PMC7810974 DOI: 10.1038/s41598-021-81328-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 01/06/2021] [Indexed: 12/16/2022] Open
Abstract
The effect of blood pressure (BP) on the incident cardiovascular events, progression to end-stage renal disease (ESRD) and mortality were evaluated among chronic kidney disease (CKD) patients with and without antihypertensive treatment. This nationwide study used the Korean National Health Insurance Service-Health Screening Cohort data. The hazards of outcomes were analysed according to the systolic BP (SBP) or diastolic BP (DBP) among adults (aged ≥ 40 years) with CKD and without previous cardiovascular disease or ESRD (n = 22,278). The SBP and DBP were ≥ 130 mmHg and ≥ 80 mmHg in 10,809 (48.52%) and 11,583 (51.99%) participants, respectively. During a median 6.2 years, 1271 cardiovascular events, 201 ESRD incidents, and 1061 deaths were noted. Individuals with SBP ≥ 130 mmHg and DBP ≥ 80 mmHg had higher hazards of hypertension-related adverse outcomes compared to the references (SBP 120-129 mmHg and DBP 70-79 mmHg). SBP < 100 mmHg was associated with hazards of all-cause death, and composite of ESRD and all-cause death during follow-up only among the antihypertensive medication users suggesting that the BP should be < 130/80 mmHg and the SBP should not be < 100 mmHg with antihypertensive agents to prevent the adverse outcome risk of insufficient and excessive antihypertensive treatment in CKD patients.
Collapse
Affiliation(s)
- You-Bin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, College of Medicine, Ulsan University, Seoul, Republic of Korea
| | - So-Hyeon Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Jung A Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Eun Roh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Hye Jin Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Sei Hyun Baik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
| |
Collapse
|
46
|
Polychronopoulou E, Wuerzner G, Burnier M. How Do I Manage Hypertension in Patients with Advanced Chronic Kidney Disease Not on Dialysis? Perspectives from Clinical Practice. Vasc Health Risk Manag 2021; 17:1-11. [PMID: 33442257 PMCID: PMC7797323 DOI: 10.2147/vhrm.s292522] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/18/2020] [Indexed: 12/24/2022] Open
Abstract
In the general population, the prevalence of moderate and severe chronic kidney disease (CKD) is usually below 5% but this figure is often higher in specific groups of patients such as those with type 2 diabetes. Patients with advanced CKD (CKD stage 3b and 4) are at high or very high cardiovascular risk, and their risk of progressing towards end-stage kidney disease (CKD stage 5) and the need of renal replacement therapy are elevated. Hypertension is a major cause of poor cardiovascular and renal outcomes in severe CKD. Therefore, an adequate control of blood pressure (BP) is mandatory. However, normalizing BP is often challenging in these patients because the clinical management of hypertension in advanced CKD is not well defined and rarely supported by large randomized controlled trials. In the present review, we discuss the characteristics of hypertension in advanced CKD, excluding dialysis, and its management integrating data from recent clinical studies and a pragmatic approach enriched by a long-standing clinical experience.
Collapse
Affiliation(s)
| | - Gregoire Wuerzner
- Service of Nephrology and Hypertension, University Hospital, Lausanne, Switzerland.,Hypertension Research Foundation, Saint-Légier, Switzerland
| | - Michel Burnier
- Service of Nephrology and Hypertension, University Hospital, Lausanne, Switzerland.,Hypertension Research Foundation, Saint-Légier, Switzerland
| |
Collapse
|
47
|
ACE Inhibitor Benefit to Kidney and Cardiovascular Outcomes for Patients with Non-Dialysis Chronic Kidney Disease Stages 3-5: A Network Meta-Analysis of Randomised Clinical Trials. Drugs 2020; 80:797-811. [PMID: 32333236 PMCID: PMC7242277 DOI: 10.1007/s40265-020-01290-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background The advantages of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) in reducing risk of cardiovascular events (CVEs) and delaying end-stage kidney disease (ESKD) in patients with chronic kidney disease (CKD) is well-known. However, the efficacy and safety of these agents in non-dialysis CKD stages 3–5 patients are still a controversial issue. Methods Two investigators (Yaru Zhang and Dandan He) independently searched and identified relevant studies from MEDLINE (from 1950 to October 2018), EMBASE (from 1970 to October 2018), and the Cochrane Library database. Randomised clinical trials in non-dialysis CKD3–5 patients treated with renin-angiotensin system (RAS) inhibitors were included. We used standard criteria (Cochrane risk of bias tool) to assess the inherent risk of bias of trials. We calculated the odds ratio (OR) and 95% confidence interval (CI) for each outcome by random-effects model. A 2-sided p value < 0.05 was considered statistically significant, and all statistical analyses were performed using STATA, version 15.0. This network meta-analysis was undertaken by the frequency model. Results Forty-four randomised clinical trials with 42,319 patients were included in our network meta-analysis. ACEIs monotherapy significantly decreased the odds of kidney events (OR 0.54, 95% CI 0.41–0.73), cardiovascular events (OR 0.73, 95% CI 0.64–0.84), cardiovascular death (OR 0.73, 95% CI 0.63–0.86) and all-cause death (OR 0.77, 95% CI 0.66–0.91) when compared to placebo. According to the cumulative ranking area (SUCRA), ACEI monotherapy had the highest probabilities of their protective effects on outcomes of kidney events (SUCRA 93.3%), cardiovascular events (SUCRA 77.2%), cardiovascular death (SUCRA 86%), and all-cause death (SUCRA 94.1%), even if there were no significant differences between ACEIs and other antihypertensive drugs, including calcium channel blockers (CCBs), β-blockers and diuretics on above outcomes except for kidney events. ARB monotherapy and combination therapy of an ACEI plus an ARB showed no more advantage than CCBs, β-blockers and diuretics in all primary outcomes. In the subgroup of non-dialysis diabetic kidney disease patients, no drugs, including ACEIs or ARBs, significantly lowered the odds of cardiovascular events and all-cause death. However, ACEIs were still better than other antihypertensive drugs including ARBs in all-cause death but not ARBs in cardiovascular events according to the SUCRA. Only ARBs had significant differences in preventing the occurrence of kidney events compared with placebo (OR 0.82, 95% CI 0.72–0.95). Both ACEI/ARB monotherapy and combination therapy had higher odds of hyperkalaemia. ACEIs had 3.81 times higher odds than CCBs (95% CI 1.58–9.20), ARBs had 2.08–5.10 times higher odds than placebo and CCBs and combination therapy of an ACEI and an ARB had 4.80–24.5 times higher odds than all other treatments. Compared with placebo, CCBs and β blockers, ACEI therapy significantly increased the odds of cough (OR 2.90, 95% CI 1.76–4.77; OR 8.21, 95% CI 3.13–21.54 and OR 1.80, 95% CI 1.08–3.00). There were no statistical differences in hypotension among all comparisons except ACEIs versus placebo. Conclusions Although ACEIs increased the odds of hyperkalaemia, cough and hypotension, they were still superior to ARBs and other antihypertensive drugs and had the highest benefits for the prevention of kidney events, cardiovascular outcomes, cardiovascular death and all-cause mortality in non-dialysis CKD3–5 patients. In patients with advanced diabetic kidney disease, ACEIs were superior to ARBs in lowering risk of all-cause death but not in kidney events and cardiovascular events. Electronic supplementary material The online version of this article (10.1007/s40265-020-01290-3) contains supplementary material, which is available to authorized users.
Collapse
|
48
|
Jehn U, Schütte-Nütgen K, Strauss M, Kunert J, Pavenstädt H, Thölking G, Suwelack B, Reuter S. Antihypertensive Treatment in Kidney Transplant Recipients-A Current Single Center Experience. J Clin Med 2020; 9:jcm9123969. [PMID: 33297518 PMCID: PMC7762385 DOI: 10.3390/jcm9123969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/20/2020] [Accepted: 12/03/2020] [Indexed: 12/11/2022] Open
Abstract
Arterial hypertension affects the survival of the kidney graft and the cardiovascular morbidity and mortality of the recipient after kidney transplantation (KTx). Thus, antihypertensive treatment is necessary for a vast majority of these patients. Long-term data on antihypertensive drugs and their effects on allograft function after KTx is still limited, and further investigation is required. We retrospectively analyzed a cohort of 854 recipients who received a kidney transplant at our transplant center between 2007 and 2015 with regard to antihypertensive treatment and its influence on graft function and survival. 1-y after KTx, 95.3% patients were treated with antihypertensive therapy. Of these, 38.6% received mono- or dual-drug therapy, 38.0% received three to four drugs and 8.1% were on a regimen of ≥5 drugs. Beta-blockers were the most frequently used antihypertensive agents (68.1%). Neither the use of angiotensin-converting enzyme inhibitor/angiotensin receptor blockers (51.9%) and calcium channel blockers (51.5%), nor the use the use of loop diuretics (38.7%) affected allograft survival. Arterial hypertension and the number of antihypertensive agents were associated with unfavorable allograft outcomes (each p < 0.001). In addition to the well-known risk factors of cold ischemic time and acute rejection episodes, the number of antihypertensive drugs after one year, which reflects the severity of hypertension, is a strong predictor of unfavorable allograft survival.
Collapse
Affiliation(s)
- Ulrich Jehn
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, 48149 Münster, Germany; (U.J.); (K.S.-N.); (J.K.); (H.P.); (G.T.); (B.S.)
| | - Katharina Schütte-Nütgen
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, 48149 Münster, Germany; (U.J.); (K.S.-N.); (J.K.); (H.P.); (G.T.); (B.S.)
| | - Markus Strauss
- Department of Medicine C, Division of Cardiology and Angiology, University Hospital of Münster, 48149 Münster, Germany;
| | - Jan Kunert
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, 48149 Münster, Germany; (U.J.); (K.S.-N.); (J.K.); (H.P.); (G.T.); (B.S.)
| | - Hermann Pavenstädt
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, 48149 Münster, Germany; (U.J.); (K.S.-N.); (J.K.); (H.P.); (G.T.); (B.S.)
| | - Gerold Thölking
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, 48149 Münster, Germany; (U.J.); (K.S.-N.); (J.K.); (H.P.); (G.T.); (B.S.)
| | - Barbara Suwelack
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, 48149 Münster, Germany; (U.J.); (K.S.-N.); (J.K.); (H.P.); (G.T.); (B.S.)
| | - Stefan Reuter
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, 48149 Münster, Germany; (U.J.); (K.S.-N.); (J.K.); (H.P.); (G.T.); (B.S.)
- Correspondence: ; Tel.: +49-251-83-47540; Fax: +49-251-83-56973
| |
Collapse
|
49
|
Relationship between blood pressure and kidney diseases in large randomized controlled trials: secondary analyses using SPRINT and ACCORD-BP trials. J Hum Hypertens 2020; 35:859-869. [PMID: 33093616 DOI: 10.1038/s41371-020-00430-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/05/2020] [Accepted: 10/05/2020] [Indexed: 12/17/2022]
Abstract
Hypertension is a risk factor for acute kidney injury. In this study, we aimed to identify the optimal blood pressure (BP) targets for CKD and non-CKD patients. We analyzed the data of the Systolic Blood Pressure Intervention Trial (SPRINT) and the Action to Control Cardiovascular Risk in Diabetes Blood Pressure trial (ACCORD BP) to determine the nonlinear relationship between BP and renal disease development using the Generalized Additive Model (GAM). Optimal systolic BP/diastolic BP (SBP/DBP) with lowest renal risk were estimated using GAM. Logistic regression was employed to find odds ratios (ORs) of adverse renal outcomes by three BP groups (high/medium/low). Both study trials have demonstrated a "U"-shaped relationship between BP and renal outcomes. For non-CKD patients in SPRINT trial, risk of 30% reduction in eGFR among intensive group patients with DBP ≤ 70 mmHg was significantly higher than the group with DBP between 71 and 85 mmHg (OR = 2.31, 95% CI = 1.51-3.53). For non-CKD patients in ACCORD trial, risk of doubling of serum creatinine (SCr) or >20 mL/min decrease in eGFR among intensive group patients with DBP ≤ 70 mmHg was significantly higher than the group with DBP between 71 and 85 mmHg (OR = 1.49, 95% CI = 1.12-1.99). For CKD patients in SPRINT trial, there are no significant differences in renal outcomes by different SBP/DBP levels. Our analysis of both SPRINT and ACCORD datasets demonstrated that lower-than-optimal DBP may lead to poor renal outcomes in non-CKD patients. Healthcare providers should be cautious of too low DBP level in intensive BP management due to poor renal outcomes for non-CKD patients.
Collapse
|
50
|
Ali W, Bakris GL. How to Manage Hypertension in People With Diabetes. Am J Hypertens 2020; 33:935-943. [PMID: 32307510 DOI: 10.1093/ajh/hpaa067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/13/2020] [Accepted: 04/15/2020] [Indexed: 11/14/2022] Open
Abstract
Hypertension is a common condition that is often seen in patients with diabetes. Both diseases increase the risk of morbidity and mortality from CV events and kidney disease progression. Factors that influence blood pressure (BP) control in diabetes include the persons' genetic background for hypertension and kidney disease, level of obesity and insulin resistance, the magnitude of preexisting kidney disease, and lifestyle factors, such as level of sodium and potassium intake, sleep quality and exercise effort all of which can affect levels of sympathetic nerve activity and contribute to increased BP variability. Lifestyle intervention is a key component to the effective management of diabetes and hypertension and can markedly reduce event rates of both heart and kidney outcomes. The approach to pharmacologic treatment of BP in diabetes is crucial since certain classes of agents for both BP and diabetes confer significant benefits to reduce cardiorenal outcomes.
Collapse
Affiliation(s)
- Waleed Ali
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, The University of Chicago Medicine, Chicago, Illinois, USA
| | - George L Bakris
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, The University of Chicago Medicine, Chicago, Illinois, USA
| |
Collapse
|