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Hall RK, Kazancıoğlu R, Thanachayanont T, Wong G, Sabanayagam D, Battistella M, Ahmed SB, Inker LA, Barreto EF, Fu EL, Clase CM, Carrero JJ. Drug stewardship in chronic kidney disease to achieve effective and safe medication use. Nat Rev Nephrol 2024; 20:386-401. [PMID: 38491222 DOI: 10.1038/s41581-024-00823-3] [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] [Accepted: 02/22/2024] [Indexed: 03/18/2024]
Abstract
People living with chronic kidney disease (CKD) often experience multimorbidity and require polypharmacy. Kidney dysfunction can also alter the pharmacokinetics and pharmacodynamics of medications, which can modify their risks and benefits; the extent of these changes is not well understood for all situations or medications. The principle of drug stewardship is aimed at maximizing medication safety and effectiveness in a population of patients through a variety of processes including medication reconciliation, medication selection, dose adjustment, monitoring for effectiveness and safety, and discontinuation (deprescribing) when no longer necessary. This Review is aimed at serving as a resource for achieving optimal drug stewardship for patients with CKD. We describe special considerations for medication use during pregnancy and lactation, during acute illness and in patients with cancer, as well as guidance for the responsible use of over-the-counter drugs, herbal remedies, supplements and sick-day rules. We also highlight inequities in medication access worldwide and suggest policies to improve access to quality and essential medications for all persons with CKD. Further strategies to promote drug stewardship include patient education and engagement, the use of digital health tools, shared decision-making and collaboration within interdisciplinary teams. Throughout, we position the person with CKD at the centre of all drug stewardship efforts.
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Affiliation(s)
- Rasheeda K Hall
- Division of Nephrology, Department of Medicine, and Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | | | | | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | | | | | - Sofia B Ahmed
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lesley A Inker
- Division of Nephrology, Department of Internal Medicine, Tufts Medical Center, Boston, MA, USA
| | | | - Edouard L Fu
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Catherine M Clase
- Department of Medicine and Health Research Methods, Evidence and Impact, McMaster University, Ontario, Canada
| | - Juan J Carrero
- Medical Epidemiology and Biostatistics, Karolinska Institutet, and Division of Nephrology, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden.
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Cho SMJ, Lee H, Yoo TH, Jhee JH, Park S, Kim HC. Association Between Nocturnal Blood Pressure Dipping and Chronic Kidney Disease Among Patients With Controlled Office Blood Pressure. Am J Hypertens 2021; 34:821-830. [PMID: 33558892 DOI: 10.1093/ajh/hpab031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 01/12/2021] [Accepted: 02/03/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Although abnormal blood pressure (BP) patterns are associated with adverse cardiorenal outcomes, their associations are yet unquantified by nocturnal dipping status. We examined the association of nocturnal BP dipping pattern with albuminuria and kidney function among participants with controlled hypertension without prior advanced kidney disease. METHODS Ambulatory BP (ABP) measurements were collected from 995 middle-aged, cardiology clinic patients with controlled office BP (OBP) (<140/90 mm Hg). The magnitude of dipping was calculated as the difference between daytime and nighttime systolic BP (SBP) divided by daytime SBP. Accordingly, the participants were categorized as extreme-dipper (≥20%), dipper (10% to <20%), non-dipper (0% to <10%), or reverse-dipper (<0%). We analyzed the cross-sectional associations of dipping with albuminuria (urine albumin-to-creatinine ratio ≥30 mg/g) and decreased estimated glomerular filtration rate (<60 ml/min/1.73 m2), adjusting for OBP/ABP, antihypertensive class, body mass index, total cholesterol, fasting glucose, socioeconomic status, and health behavior. RESULTS The participants (mean age 60.2 years; 52.9% male) consisted of 13.5% extreme-dippers, 43.1% dippers, 34.7% non-dippers, and 8.7% reverse-dippers. In reference to dippers, odds ratios [95% confidence interval] for albuminuria were 1.73 [1.04-2.60] in reverse-dippers, 1.67 [1.20-2.32] in non-dippers, and 0.62 [0.38-1.04] in extreme-dippers. Likewise, abnormal dipping profile was associated with decreased kidney function: reverse-dipping, 2.02 [1.06-3.84]; non-dipping, 1.98 [1.07-3.08]; extreme-dipping, 0.69 [0.20-1.17]. The associations persisted among participants with more conservatively controlled OBP (<130/80 mm Hg). CONCLUSIONS Monitoring diurnal and nocturnal BP may identify chronic kidney disease otherwise overlooked based on OBP.
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Affiliation(s)
- So Mi J Cho
- Department of Public Health, Yonsei University Graduate School, Seoul, Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hokyou Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Hyun Jhee
- Department of Internal Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Sungha Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
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Bowman C, Lunyera J, Alkon A, Boulware LE, St Clair Russell J, Riley J, Fink JC, Diamantidis C. A Patient Safety Educational Tool for Patients With Chronic Kidney Disease: Development and Usability Study. JMIR Form Res 2020; 4:e16137. [PMID: 32463366 PMCID: PMC7290458 DOI: 10.2196/16137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 02/04/2020] [Accepted: 03/23/2020] [Indexed: 12/22/2022] Open
Abstract
Background Chronic kidney disease (CKD) is a health condition that threatens patient safety; however, few interventions provide patient-centered education about kidney-specific safety hazards. Objective We sought to develop and test the usability of a mobile tablet–based educational tool designed to promote patient awareness of relevant safety topics in CKD. Methods We used plain language principles to develop content for the educational tool, targeting four patient-actionable safety objectives that are relevant for individuals with CKD. These four objectives included avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs); hypoglycemia awareness (among individuals with diabetes); temporary cessation of certain medications during acute volume depletion to prevent acute kidney injury (ie, “sick day protocol”); and contrast dye risk awareness. Our teaching strategies optimized human-computer interaction and content retention using audio, animation, and clinical vignettes to reinforce themes. For example, using a vignette of a patient with CKD with pain and pictures of common NSAIDs, participants were asked “Which of the following pain medicines are safe for Mr. Smith to take for his belly pain?” Assessment methods consisted of preknowledge and postknowledge surveys, with provision of correct responses and explanations. Usability testing of the tablet-based tool was performed among 12 patients with any stage of CKD, and program tasks were rated upon completion as no error, noncritical error (self-corrected), or critical error (needing assistance). Results The 12 participants in this usability study were predominantly 65 years of age or older (n=7, 58%) and female (n=7, 58%); all participants owned a mobile device and used it daily. Among the 725 total tasks that the participants completed, there were 31 noncritical errors (4.3%) and 15 critical errors (2.1%); 1 participant accounted for 30 of the total errors. Of the 12 participants, 10 (83%) easily completed 90% or more of their tasks. Most participants rated the use of the tablet as very easy (n=7, 58%), the activity length as “just right” (rather than too long or too short) (n=10, 83%), and the use of clinical vignettes as helpful (n=10, 83%); all participants stated that they would recommend this activity to others. The median rating of the activity was 8 on a scale of 1 to 10 (where 10 is best). We incorporated all participant recommendations into the final version of the educational tool. Conclusions A tablet-based patient safety educational tool is acceptable and usable by individuals with CKD. Future studies leveraging iterations of this educational tool will explore its impact on health outcomes in this high-risk population.
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Affiliation(s)
- Cassandra Bowman
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Joseph Lunyera
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Aviel Alkon
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, United States
| | - L Ebony Boulware
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Jennifer St Clair Russell
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, United States.,The National Kidney Foundation, Washington, DC, United States
| | - Jennie Riley
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Jeffrey C Fink
- Division of General Internal Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Clarissa Diamantidis
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, United States.,Division of Nephrology, Duke University School of Medicine, Durham, NC, United States.,Duke Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
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Elkhadragy N, Ifeachor AP, Diiulio JB, Arthur KJ, Weiner M, Militello LG, Glassman PA, Zillich AJ, Russ AL. Medication decision-making for patients with renal insufficiency in inpatient and outpatient care at a US Veterans Affairs Medical Centre: a qualitative, cognitive task analysis. BMJ Open 2019; 9:e027439. [PMID: 31129589 PMCID: PMC6537985 DOI: 10.1136/bmjopen-2018-027439] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Many studies identify factors that contribute to renal prescribing errors, but few examine how healthcare professionals (HCPs) detect and recover from an error or potential patient safety concern. Knowledge of this information could inform advanced error detection systems and decision support tools that help prevent prescribing errors. OBJECTIVE To examine the cognitive strategies that HCPs used to recognise and manage medication-related problems for patients with renal insufficiency. DESIGN HCPs submitted documentation about medication-related incidents. We then conducted cognitive task analysis interviews. Qualitative data were analysed inductively. SETTING Inpatient and outpatient facilities at a major US Veterans Affairs Medical Centre. PARTICIPANTS Physicians, nurses and pharmacists who took action to prevent or resolve a renal-drug problem in patients with renal insufficiency. OUTCOMES Emergent themes from interviews, as related to recognition of renal-drug problems and decision-making processes. RESULTS We interviewed 20 HCPs. Results yielded a descriptive model of the decision-making process, comprised of three main stages: detect, gather information and act. These stages often followed a cyclical path due largely to the gradual decline of patients' renal function. Most HCPs relied on being vigilant to detect patients' renal-drug problems rather than relying on systems to detect unanticipated cues. At each stage, HCPs relied on different cognitive cues depending on medication type: for renally eliminated medications, HCPs focused on gathering renal dosing guidelines, while for nephrotoxic medications, HCPs investigated the need for particular medication therapy, and if warranted, safer alternatives. CONCLUSIONS Our model is useful for trainees so they can gain familiarity with managing renal-drug problems. Based on findings, improvements are warranted for three aspects of healthcare systems: (1) supporting the cyclical nature of renal-drug problem management via longitudinal tracking mechanisms, (2) providing tools to alleviate HCPs' heavy reliance on vigilance and (3) supporting HCPs' different decision-making needs for renally eliminated versus nephrotoxic medications.
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Affiliation(s)
- Nervana Elkhadragy
- Centre for Health Information and Communication, Health Service Research and Development, Department of Veterans Affairs, Roudebush VA Medical Centre, Indianapolis, Indiana, USA
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, Indiana, USA
| | - Amanda P Ifeachor
- US Department of Veterans Affairs (VA), Veterans Health Administration, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | | | - Karen J Arthur
- US Department of Veterans Affairs (VA), Veterans Health Administration, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Michael Weiner
- Centre for Health Information and Communication, U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Centre; Regenstrief Institute, Inc;, Indiana University, Indianapolis, Indiana, USA
| | | | - Peter A Glassman
- Internal Medicine, Department of Veterans Affairs, Greater Los Angeles Healthcare System, and David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Alan J Zillich
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, Indiana, USA
| | - Alissa L Russ
- Centre for Health Information and Communication, Health Service Research and Development, Department of Veterans Affairs, Roudebush VA Medical Centre, Indianapolis, Indiana, USA
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, Indiana, USA
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The use of nephrotoxic drugs in patients with chronic kidney disease. Int J Clin Pharm 2019; 41:767-775. [DOI: 10.1007/s11096-019-00811-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 03/07/2019] [Indexed: 11/26/2022]
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Loustau C, Rosine N, Forien M, Ottaviani S, Juge PA, Lioté F, Bardin T, Richette P, Dieudé P, Richez C, Bannwarth B, Schaeverbeke T, Ea HK, Truchetet ME. Effectiveness and safety of anakinra in gout patients with stage 4–5 chronic kidney disease or kidney transplantation: A multicentre, retrospective study. Joint Bone Spine 2018; 85:755-760. [DOI: 10.1016/j.jbspin.2018.03.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/04/2018] [Indexed: 10/17/2022]
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Hung PY, Lin CH, Lo YC, Liou DM. Building Chronic Kidney Disease Clinical Practice Guidelines Using the openEHR Guideline Definition Language. Methods Inf Med 2018; 55:495-505. [DOI: 10.3414/me16-01-0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 06/21/2016] [Indexed: 11/09/2022]
Abstract
SummaryBackground: As a result of the disease‘s high prevalence, chronic kidney disease (CKD) has become a global public health problem. A clinical decision support system that integrates with computer-interpretable guidelines (CIGs) should improve clinical outcomes and help to ensure patient safety.Objectives: The openEHR guideline definition language (GDL) is a formal language used to represent CIGs. This study explores the feasibility of using a GDL approach for CKD; it also attempts to identify any potential gaps between the ideal concept and reality.Methods: Using the Kidney Disease Improving Global Outcomes (KDIGO) anemia guideline as material, we designed a development workflow in order to establish a series of GDL guidelines. Focus group discussions were conducted in order to identify important issues related to GDL implementation.Results: Ten GDL guidelines and 37 archetypes were established using the KDIGO guideline document. For the focus group discussions, 16 clinicians and 22 IT experts were recruited and their perceptions, opinions and attitudes towards the GDL approach were explored. Both groups provided positive feedback regarding the GDL approach, but raised various concerns about GDL implementation.Conclusions: Based on the findings of this study, we identified some potential gaps that might exist during implementation between the GDL concept and reality. Three directions remain to be investigated in the future. Two of them are related to the openEHR GDL approach. Firstly, there is a need for the editing tool to be made more sophisticated. Secondly, there needs to be integration of the present approach into non openEHR-based hospital information systems. The last direction focuses on the applicability of guidelines and involves developing a method to resolve any conflicts that occur with insurance payment regulations.
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Abstract
Patients with chronic kidney disease (CKD) are at risk for complications both inherent to the disease and as a consequence of its treatment. The dangers that CKD patients face change across the spectrum of the disease. Providers who are well-versed in these safety threats are best poised to safeguard patients as their CKD progresses.
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Affiliation(s)
- Lee-Ann Wagner
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Jeffrey C Fink
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.
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Association of Renal Elasticity and Renal Function Progression in Patients with Chronic Kidney Disease Evaluated by Real-Time Ultrasound Elastography. Sci Rep 2017; 7:43303. [PMID: 28240304 PMCID: PMC5327389 DOI: 10.1038/srep43303] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 01/24/2017] [Indexed: 12/13/2022] Open
Abstract
Glomerulosclerosis and tubulointerstitial fibrosis are associated with lower renal parenchymal elasticity. This study was designed to evaluate the predictive ability of renal elasticity in patients with chronic kidney disease (CKD). 148 non-CKD patients and 227 patients with CKD were recruited. 145 (38.7%) were female, 166 (73.1%) had diabetes, the mean estimated glomerular filtration rate (eGFR) was 33.9 ± 15.8 ml/min/1.73 m2 and the median urinary protein-to-creatinine ratio (UPCR) 502 (122–1491) mg/g. Patients with later stages of CKD had lower renal elasticity values, indicating stiffer kidneys (p < 0.001), and smaller kidney (p < 0.001). Renal elasticity correlated with log-transformed UPCR (β = −7.544, P < 0.001). Renal length correlated with age (β = −0.231, P < 0.001), sex (β = −3.730, P < 0.001), serum albumin level (β = −3.024, P = 0.001), body mass index (β = 0.390, P = 0.009) and eGFR (β = 0.146, P < 0.001). In fully-adjusted logistic regression model, the odds ratio (OR) per 10 unit change in renal elasticity for rapid renal deterioration was 0.928 (95% CI, 0.864–0.997; P = 0.042). The OR per 1 mm change in renal length for rapid renal deterioration was 1.022 (95% CI, 0.994–1.050; P = 0.125). Renal elasticity is associated with proteinuria and rapid renal deterioration in patients with CKD.
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Offurum A, Wagner LA, Gooden T. Adverse safety events in patients with Chronic Kidney Disease (CKD). Expert Opin Drug Saf 2016; 15:1597-1607. [PMID: 27648959 DOI: 10.1080/14740338.2016.1236909] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Chronic kidney disease (CKD) confers a higher risk of adverse safety events as a result of many factors including medication dosing errors and use of nephrotoxic drugs, which can cause kidney injury and renal function decline. CKD patients may also have comorbidities such as hypertension and diabetes for which they require more frequent care from different providers, and for which standard, but countervailing treatments, may put them at risk for adverse safety events. Areas covered: In addition to the well-known agents such as iodinated radiocontrast, antimicrobials, diuretics and angiotensin converting enzyme (ACE) inhibitors which can directly affect renal function, safety considerations in the treatment of common CKD complications such as anemia, diabetes, analgesia and thrombosis will also be discussed. Expert opinion: Better outcomes in CKD may be achieved by alerting care providers to the special care needs of kidney patients and encouraging patients to self-manage their disease with the decision support of multidisciplinary patient care teams.
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Affiliation(s)
- Ada Offurum
- a General Internal Medicine , University of Maryland Medical System Ringgold standard institution , Baltimore , MD , USA
| | - Lee-Ann Wagner
- a General Internal Medicine , University of Maryland Medical System Ringgold standard institution , Baltimore , MD , USA
| | - Tanisha Gooden
- a General Internal Medicine , University of Maryland Medical System Ringgold standard institution , Baltimore , MD , USA
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Heleniak Z, Cieplińska M, Szychliński T, Rychter D, Jagodzińska K, Kłos A, Kuźmiuk I, Tylicka MJ, Tylicki L, Rutkowski B, Dębska-Ślizień A. Nonsteroidal anti-inflammatory drug use in patients with chronic kidney disease. J Nephrol 2016; 30:781-786. [PMID: 27679400 PMCID: PMC5698389 DOI: 10.1007/s40620-016-0352-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 09/14/2016] [Indexed: 11/25/2022]
Abstract
Aims Nonsteroidal anti-inflammatory drugs (NSAIDs) are the cornerstone of pain management. There are no detailed data on NSAIDs use in Poland, especially in patients with chronic kidney disease (CKD). The aim of this study was to evaluate the frequency, circumstances, and causes of NSAIDs use as well as knowledge of their side-effects in patients with CKD. Method This cross-sectional study was conducted in 972 individuals with CKD, enrolled in a written survey originally developed by the authors. There were 574 patients with CKD stage I-IV, 414 patients after renal transplantation stage II-IV (CKDT) and 84 dialyzed patients (44 peritoneal, 40 hemodialysis). Results Among the entire study group, 16.9 % of patients used NSAIDs every day, or several times a week. The average number of tablets taken within a month was 21.8. Subgroup analysis revealed that NSAIDs were taken most often by patients on hemodialysis: 35 % of them used NSAIDs every day or several times a week (43.15 pills per month). The most common reason for using NSAIDs were bone-joint pain (29.3 %) and headache (26.2 %). Side effects of painkillers such as renal function deterioration and the possible promotion of stomach ulcers were experienced by 43.6 and 37.6 % of respondents, respectively. Conclusion Patients with CKD often take NSAIDs. This applies especially to the group of people undergoing hemodialysis, which is mainly associated with chronic osteo-articular pain. The results also show a low awareness of painkillers’ adverse effects.
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Affiliation(s)
- Zbigniew Heleniak
- Unit of Clinical Pharmacology in the Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 7 Dębinki Street, 80-952, Gdańsk, Poland.
| | - Magdalena Cieplińska
- Unit of Clinical Pharmacology in the Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 7 Dębinki Street, 80-952, Gdańsk, Poland
| | - Tomasz Szychliński
- Unit of Clinical Pharmacology in the Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 7 Dębinki Street, 80-952, Gdańsk, Poland
| | - Dymitr Rychter
- Unit of Clinical Pharmacology in the Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 7 Dębinki Street, 80-952, Gdańsk, Poland
| | - Kalina Jagodzińska
- Unit of Clinical Pharmacology in the Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 7 Dębinki Street, 80-952, Gdańsk, Poland
| | - Alicja Kłos
- Unit of Clinical Pharmacology in the Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 7 Dębinki Street, 80-952, Gdańsk, Poland
| | - Izabela Kuźmiuk
- Unit of Clinical Pharmacology in the Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 7 Dębinki Street, 80-952, Gdańsk, Poland
| | - Marzena Jakimowicz Tylicka
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Leszek Tylicki
- Unit of Clinical Pharmacology in the Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, 7 Dębinki Street, 80-952, Gdańsk, Poland
| | - Bolesław Rutkowski
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
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Li LP, Tan H, Thacker JM, Li W, Zhou Y, Kohn O, Sprague SM, Prasad PV. Evaluation of Renal Blood Flow in Chronic Kidney Disease Using Arterial Spin Labeling Perfusion Magnetic Resonance Imaging. Kidney Int Rep 2016; 2:36-43. [PMID: 28868513 PMCID: PMC5575771 DOI: 10.1016/j.ekir.2016.09.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction Chronic kidney disease (CKD) is known to be associated with reduced renal blood flow. However, data in humans are limited to date. Methods In this study, noninvasive arterial spin labeling magnetic resonance imaging data were acquired in 33 patients with diabetes and stage 3 CKD as well as in 30 healthy controls. Results A significantly lower renal blood flow in both the cortex (108.4 ± 36.4 vs. 207.3 ± 41.8; P < 0.001, d = 2.52) and medulla (23.2 ± 8.9 vs. 42.6 ± 15.8; P < 0.001, d = 1.5) was observed. Both cortical (ρ = 0.67, P < 0.001) and medullary (ρ = 0.62, P < 0.001) blood flow were correlated with estimated glomerular filtration rate, and cortical blood flow was found to be confounded by age and body mass index. However, in a subset of subjects who were matched for age and body mass index (n = 6), the differences between CKD patients and control subjects remained significant in both the cortex (107.4 ± 42.8 vs. 187.51 ± 20.44; P = 0.002) and medulla (15.43 ± 8.43 vs. 39.18 ± 11.13; P = 0.002). A threshold value to separate healthy controls and CKD patients was estimated to be a cortical blood flow of 142.9 and a medullary blood flow of 24.1. Discussion These results support the use of arterial spin labeling in the evaluation of renal blood flow in patients with a moderate level of CKD. Whether these measurements can identify patients at risk for progressive CKD requires further longitudinal follow-up.
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Affiliation(s)
- Lu-Ping Li
- Center for Advanced Imaging, NorthShore University HealthSystem, Evanston, IL
| | - Huan Tan
- Center for Advanced Imaging, NorthShore University HealthSystem, Evanston, IL
| | - Jon M Thacker
- Department of Biomedical Engineering, Northwestern University, Evanston, IL
| | - Wei Li
- Center for Advanced Imaging, NorthShore University HealthSystem, Evanston, IL
| | - Ying Zhou
- Center for Biomedical Research & Informatics, NorthShore University HealthSystem, Evanston, IL
| | - Orly Kohn
- Department of Nephrology, University of Chicago, Chicago, IL
| | - Stuart M Sprague
- Department of Nephrology, NorthShore University HealthSystem, Evanston, IL.,Department of Nephrology, University of Chicago, Chicago, IL
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Link DK. Management of the Chronic Kidney Disease Patient. PHYSICIAN ASSISTANT CLINICS 2016. [DOI: 10.1016/j.cpha.2015.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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