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Yu Y, Zhang M, Tang Y, Zhai C, Hu W, Yu G, Sun H, Xu Y, Zong Q, Liu Y, Gong X, Wang F, Zou Y. Global disease burden attributable to kidney dysfunction, 1990-2019: A health inequality and trend analysis based on the global burden of disease study. Diabetes Res Clin Pract 2024; 215:111801. [PMID: 39094741 DOI: 10.1016/j.diabres.2024.111801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 07/16/2024] [Accepted: 07/29/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE This study aimed to evaluate the burden of kidney dysfunction (KD), assess socioeconomic inequalities, and project trends in the future. METHODS Data on deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) were from Global Burden of Disease Study 2019. The Joinpoint regression model was utilized to analyze the temporal trend by the annual percentage change (APC). The slope index and concentration index were employed to evaluate cross-country disparities. The future trend was predicted using an age-period-cohort analysis. RESULTS In the past three decades, the death numbers of KD increased from 1,571,720 to 3,161,552, DALYs from 42,090,331 to 76,486,945, YLDs from 5,003,267 to 11,282,484, and YLLs from 37,087,065 to 65,204,461, respectively. The age-standardized rate (ASR) of deaths, DALYs, and YLLs exhibited a declining trend. The ASR of YLDs increased until 2017, then decreased. The slope index and concentration index for DALYs increased from 248.1 to 351.9 and from 40.70 to 57.8. In the future, the ASR of deaths, DALYs, YLDs, and YLLs will remain stable, while their numbers will continue to rise, except for YLLs. CONCLUSIONS The disease burden of KD remained serious. Tailored interventions should be developed based on national contexts.
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Affiliation(s)
- Yingying Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Mingyi Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yuqin Tang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Chunxia Zhai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Wanqin Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Guanghui Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Hongyu Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Ying Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Qiqun Zong
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yuqi Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Xingyu Gong
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Fang Wang
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yanfeng Zou
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
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Dorie JR, McIntyre CW, Lemoine S. Calcium Repletion and Regional Citrate Anticoagulation in Hemodialysis and Hemodiafiltration: Using Dialysate Calcium to Modify Hypocalcemia. Kidney Med 2021; 3:1100-1101. [PMID: 34939022 PMCID: PMC8664693 DOI: 10.1016/j.xkme.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Justin R. Dorie
- Lilibeth Caberto Kidney Clinical Research Unit, University of Western Ontario, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Christopher W. McIntyre
- Lilibeth Caberto Kidney Clinical Research Unit, University of Western Ontario, London, Ontario, Canada
- Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Division of Nephrology, London Health Sciences Centre, London, Ontario, Canada
- Address for Correspondence: Christopher W. McIntyre, MD, PhD, The Lilibeth Caberto Kidney Clinical Research Unit (KCRU), Kidney Clinical Research Unit Rm ELL-101, London Health Sciences Centre, 800 Commissioners Rd E, London, Ontario, Canada N6A 5W9.
| | - Sandrine Lemoine
- Lilibeth Caberto Kidney Clinical Research Unit, University of Western Ontario, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
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Wu J, Shi Z, Zhang Y, Yan J, Shang F, Wang Y, Lu H, Gu H, Dou W, Wang X, Yuan L. Native T1 Mapping in Assessing Kidney Fibrosis for Patients With Chronic Glomerulonephritis. Front Med (Lausanne) 2021; 8:772326. [PMID: 34733870 PMCID: PMC8558353 DOI: 10.3389/fmed.2021.772326] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/23/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To assess the utility of non-contrast enhanced native T1 mapping of the renal cortex in assessing renal fibrosis for patients with chronic glomerulonephritis (CGN). Methods: A total of 119 patients with CGN and 19 healthy volunteers (HVs) were recruited for this study. Among these patients, 43 had undergone kidney biopsy measurements. Clinical information and biopsy pathological scores were collected. According to the results of the renal biopsy, the patients were classified into the high (25-50%), low (<25%) and no renal interstitial fibrosis (IF) (0%) groups. The correlations between the T1 value in the renal cortex and each of the clinical parameters were separately analyzed. The relationships between each fibrosis group and the T1 value were also evaluated and compared between groups. Binary logistic regression analysis was further used to determine the relationship between the T1 value and renal fibrosis. Receiver operating characteristic (ROC) curves were plotted to analyze the diagnostic value of the T1 value for renal fibrosis. Results: Compared with those of the HVs, the T1 values were significantly higher in patients at all stages of chronic kidney disease (CKD) (all p < 0.05). Significant T1 differences were also revealed between patients with different stages of CKD (p < 0.05). Additionally, the T1 value correlated well with CKD stage (p < 0.05), except between CKD 2 and 3. In addition, the T1 value was positively correlated with cystatin C, neutrophil gelatinase-associated lipocalin, and serum creatinine and negatively correlated with hemoglobin, kidney length, estimated glomerular filtration rate and hematocrit (all p < 0.05). Compared with those of the no IF group, the T1 values were increased in the low- and high-IF groups (both p < 0.05). Logistic regression analysis showed that an elevated T1 value was an independent risk factor for renal fibrosis. ROC analysis suggested that the optimal critical value of T1 for predicting renal fibrosis was 1,695 ms, with a specificity of 0.778 and a sensitivity of 0.625. Conclusion: Native T1 mapping demonstrated good diagnostic performance in evaluating renal function and was an effective noninvasive method for detecting renal fibrosis in CGN patients.
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Affiliation(s)
- Jianhua Wu
- Department of Nephrology, Affiliated Hospital of Nantong University, Jiangsu, China
| | - Zhaoyu Shi
- Department of Nephrology, Affiliated Hospital of Nantong University, Jiangsu, China
| | - Yuan Zhang
- Department of Nephrology, Affiliated Hospital of Nantong University, Jiangsu, China
| | - Jiaxin Yan
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Nantong University, Jiangsu, China
| | - Fangfang Shang
- Department of Nephrology, Affiliated Hospital of Nantong University, Jiangsu, China
| | - Yao Wang
- Department of Nephrology, Affiliated Hospital of Nantong University, Jiangsu, China
| | - Huijian Lu
- Department of Medical Imaging, Affiliated Hospital of Nantong University, Jiangsu, China
| | - Hongmei Gu
- Department of Medical Imaging, Affiliated Hospital of Nantong University, Jiangsu, China
| | | | - Xinquan Wang
- Department of Medical Imaging, Affiliated Hospital of Nantong University, Jiangsu, China
| | - Li Yuan
- Department of Nephrology, Affiliated Hospital of Nantong University, Jiangsu, China
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Bacharaki D, Diamandopoulos A. Emperor's syndrome in the COVID-19 era: Time for patient-centered nephrology? World J Nephrol 2021; 10:1-7. [PMID: 33552939 PMCID: PMC7829681 DOI: 10.5527/wjn.v10.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/04/2020] [Accepted: 11/11/2020] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease-19 (COVID-19) pandemic has been a wake-up call in which has forced us to react worldwide. Health policies and practices have attracted particular attention in terms of human and financial cost. Before COVID-19, chronic kidney disease was already considered a risk multiplier in patients with diabetes and hypertension, the two now being the major risk factors for COVID-19 infection and adverse outcome. In contrast to the urgent need for action, the nephrology field is considered to be in a state of stagnation regarding the management of chronic kidney disease patients who still experience unacceptably high morbidity and mortality. Ironically and paradoxically in a field lacking robust clinical trials, clinical practice is driven by guidelines-based medicine on weak evidence. The Emperor's syndrome, referring to Hans Christian Andersen's fairy tale, has been described in medicine as voluntary blindness to an obvious truth, being a weak evidence-based therapeutic intervention or weak health care. A promising positive example of improving heart and kidney outcomes is the emerging treatment with sodium-glucose cotransporter 2 inhibitors. COVID-19 could boost actions for patient-centered care as a positive shift in nephrology care.
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Affiliation(s)
- Dimitra Bacharaki
- Department of Nephrology, Attikon University Hospital, Chaidari 12462, Greece
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Park SH, Kim TJ, Jeong HB, Ko SB. Lack of Association between Low Cumulative Dose of Hydroxyethyl Starch and Acute Kidney Injury in Patients with Acute Ischemic Stroke. J Korean Med Sci 2020; 35:e325. [PMID: 33075852 PMCID: PMC7572228 DOI: 10.3346/jkms.2020.35.e325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/04/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Hydroxyethyl starch (HES, 6% 130/0.4) has been used as a volume expander for the treatment of cerebral hypoperfusion in acute ischemic stroke. Although HES use was associated with renal failure in sepsis or critical illness, it still remains to be elucidated whether HES is linked to renal adverse events in patients with acute ischemic stroke. METHODS A total of 524 patients with acute ischemic stroke within 7 days of onset were included between January 2012 and May 2016. Renal function on admission and follow-up on day 7 ± 2 was assessed using serum creatinine (SCr) and estimated glomerular filtration rate (eGFR). Propensity score matching (PSM) was used to perform a 1:1 matched-pair analysis to minimize the group differences caused by covariates. The percentage of patients with new-onset acute renal injury (AKI) using the Kidney Disease: Improving Global Outcomes or good functional outcome (modified Rankin Scale 0-2) at 90 days were compared between HES cohort and controls. RESULTS Among the included patients (mean age, 68.6 years; male, 56.5%), 81 patients (15.5%) were HES cohort (median cumulative dose, 1,450 mL). Baseline renal function was better in HES cohort compared to that in the controls (SCr, 0.87 ± 0.43 mg/dL vs. 1.15 ± 1.15 mg/dL, P < 0.001; eGFR, 86.91 ± 24.27 mL/min vs. 74.55 ± 29.58 mL/min, P < 0.001), which became not significant in PSM cohort (72 pairs). The percentage of new-onset AKI did not differ between the HES cohort and controls (1.4% vs. 1.4%, P = 1.000). In addition, new-onset AKI was not related to HES (odds ratio, 1.422; 95% confidence interval, 0.072-28.068; P = 0.817) after adjusting for confounders. HES cohort tended to have higher percentage of good functional outcome at 90 days compared to controls, which failed to reach statistical significance (68.1% vs. 54.2%, P = 0.087). CONCLUSION A low cumulative dose of HES was not associated with renal adverse events in patients with acute ischemic stroke.
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Affiliation(s)
- Soo Hyun Park
- Department of Neurology, Inha University Hospital, Incheon, Korea
- Department of Critical Care Medicine, Inha University Hospital, Incheon, Korea
- Department of Hospital Medicine, Inha University Hospital, Incheon, Korea
| | - Tae Jung Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hae Bong Jeong
- Department of Neurology, Chung-Ang University Hospital, Seoul, Korea
| | - Sang Bae Ko
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea.
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6
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Cui R, Li F, Shao J, Wang Y, Yue C, Zheng Y, Li X. Postoperative anemia is a risk factor for acute kidney injury after open aorta and vena cava surgeries. PLoS One 2020; 15:e0240243. [PMID: 33048948 PMCID: PMC7553320 DOI: 10.1371/journal.pone.0240243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 09/22/2020] [Indexed: 12/13/2022] Open
Abstract
Open aorta and vena cava surgeries are usually associated with substantial blood loss which may result in postoperative acute kidney injury (AKI). The present study is designed to investigate the prevalence, outcome and risk factors of postoperative AKI associated with open aorta and vena cava surgeries, with a focus on the role of anemia in these conditions. A retrospective review of medical records of Peking Union Medical College Hospital was conducted. Patients who underwent open aorta and vena cava surgeries during January 1, 2010 and June 30, 2014 were included in this study. The primary analysis was between patients underwent open aorta and vena cava surgeryies, with or without postoperative AKI. Multivariable logistic regression models were used to determine risk factors of postoperative AKI. The study included 79 patients (63.3% male) with a mean age of 52.5±17.3 years (range, 17–81 years). Postoperative AKI occurred in 23/79 (29.1%) of the patients. Anemia was present in 11/79 (16%) at baseline, and increased to 45/79 (52%) postoperatively. After adjustment for various risk factors, postoperative anemia (OR, 5.202; 95% CI 1.403–19.285) was independently associated with postoperative AKI. AKI is a common complication in patients who undergo open aorta and vena cava surgeries, and postoperative anemia was the most relevant predictive factor of AKI. Strategies to minimize bleeding and anemia for all patients may be advisable. Further studies are needed to assess the impact of AKI on long term outcome and to examine preventive strategies to address potentially modifiable risk factors.
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Affiliation(s)
- Rui Cui
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Department of Nephrology, Beijing Haidian Hospital and Beijing Haidian section of Peking University Third Hospital, Beijing, China
| | - Fangda Li
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jiang Shao
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuzhu Wang
- Department of Nephrology, Beijing Haidian Hospital and Beijing Haidian section of Peking University Third Hospital, Beijing, China
| | - Cai Yue
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- * E-mail: (CY); (YZ)
| | - Yuehong Zheng
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- * E-mail: (CY); (YZ)
| | - Xuemei Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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7
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Brassier A, Krug P, Lacaille F, Pontoizeau C, Krid S, Sissaoui S, Servais A, Arnoux JB, Legendre C, Charbit M, Scemla A, Francoz C, Benoist JF, Schiff M, Mochel F, Touati G, Broué P, Cano A, Tardieu M, Querciagrossa S, Grévent D, Boyer O, Dupic L, Oualha M, Girard M, Aigrain Y, Debray D, Capito C, Ottolenghi C, Salomon R, Chardot C, de Lonlay P. Long-term outcome of methylmalonic aciduria after kidney, liver, or combined liver-kidney transplantation: The French experience. J Inherit Metab Dis 2020; 43:234-243. [PMID: 31525265 DOI: 10.1002/jimd.12174] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/21/2019] [Accepted: 09/04/2019] [Indexed: 12/16/2022]
Abstract
Organ transplantation is discussed in methylmalonic aciduria (MMA) for renal failure, and poor quality of life and neurological outcome. We retrospectively evaluated 23 French MMA patients after kidney (KT), liver-kidney (LKT), and liver transplantation (LT). Two patients died, one after LKT, one of hepatoblastoma after KT. One graft was lost early after KT. Of 18 evaluable patients, 12 previously on dialysis, 8 underwent KT (mean 12.5 years), 8 LKT (mean 7 years), and 2 LT (7 and 2.5 years). At a median follow-up of 7.3 (KT), 2.3 (LKT), and 1.0 years (LT), no metabolic decompensation occurred except in 1 KT. Plasma and urine MMA levels dramatically decreased, more after LKT. Protein intake was increased more significantly after LKT than KT. Enteral nutrition was stopped in 7/8 LKT, 1/8 KT. Early complications were frequent after LKT. Neurological disorders occurred in four LKT, reversible in one. Five years after KT, four patients had renal failure. The metabolic outcomes were much better after LKT than KT. LKT in MMA is difficult but improves the quality of life. KT will be rarely indicated. We need more long-term data to indicate early LT, in the hope to delay renal failure and prevent neurodevelopmental complications.
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Affiliation(s)
- Anaïs Brassier
- Reference Center of Inherited Metabolic Diseases, Hôpital Universitaire Necker-Enfants Malades, APHP, Imagine Institute, Filière G2M, MetabERN, INEM, University Paris Descartes, Paris, France
| | - Pauline Krug
- Reference Center of Pediatric Nephrology, Hôpital Universitaire Necker-Enfants Malades, APHP, Filière ORKID, ERKnet, University Paris Descartes, Paris, France
| | - Florence Lacaille
- Pediatric Hepatology Unit, Reference Center for rare pediatric liver diseases, Department of Gastroenterology-Hepatology-Nutrition, Hôpital Universitaire Necker-Enfants Malades, APHP, Filière Filfoie, ERN Transplantchild, Paris, France
| | - Clément Pontoizeau
- Reference Center of Inherited Metabolic Diseases, Hôpital Universitaire Necker-Enfants Malades, APHP, Imagine Institute, Filière G2M, MetabERN, INEM, University Paris Descartes, Paris, France
- Metabolic Biochemistry, Hôpital Universitaire Necker-Enfants Malades, APHP, Imagine Institute, Filière G2M, MetabERN, University Paris Descartes, Paris, France
| | - Saoussen Krid
- Reference Center of Pediatric Nephrology, Hôpital Universitaire Necker-Enfants Malades, APHP, Filière ORKID, ERKnet, University Paris Descartes, Paris, France
| | - Samira Sissaoui
- Pediatric Hepatology Unit, Reference Center for rare pediatric liver diseases, Department of Gastroenterology-Hepatology-Nutrition, Hôpital Universitaire Necker-Enfants Malades, APHP, Filière Filfoie, ERN Transplantchild, Paris, France
| | - Aude Servais
- Reference Center of Inherited Metabolic Diseases, Hôpital Universitaire Necker-Enfants Malades, APHP, Imagine Institute, Filière G2M, MetabERN, INEM, University Paris Descartes, Paris, France
- Unit of Adult Nephrology and Transplantation, Hôpital Universitaire Necker-Enfants Malades, APHP, Filière G2M, MetabERN, University Paris Descartes, Paris, France
| | - Jean-Baptiste Arnoux
- Reference Center of Inherited Metabolic Diseases, Hôpital Universitaire Necker-Enfants Malades, APHP, Imagine Institute, Filière G2M, MetabERN, INEM, University Paris Descartes, Paris, France
| | - Christophe Legendre
- Unit of Adult Nephrology and Transplantation, Hôpital Universitaire Necker-Enfants Malades, APHP, Filière G2M, MetabERN, University Paris Descartes, Paris, France
| | - Marina Charbit
- Reference Center of Pediatric Nephrology, Hôpital Universitaire Necker-Enfants Malades, APHP, Filière ORKID, ERKnet, University Paris Descartes, Paris, France
| | - Anne Scemla
- Reference Center of Inherited Metabolic Diseases, Hôpital Universitaire Necker-Enfants Malades, APHP, Imagine Institute, Filière G2M, MetabERN, INEM, University Paris Descartes, Paris, France
- Unit of Adult Nephrology and Transplantation, Hôpital Universitaire Necker-Enfants Malades, APHP, Filière G2M, MetabERN, University Paris Descartes, Paris, France
| | - Claire Francoz
- Unit of Adult Hepatology and Transplantation, Hôpital Beaujon, Paris, France
| | - Jean-François Benoist
- Metabolic Biochemistry, Hôpital Universitaire Robert-Debré, APHP, Filière G2M, MetabERN, University Paris Sud, Paris, France
| | - Manuel Schiff
- Reference Center of Inherited Metabolic Diseases, Hôpital Universitaire Robert-Debré, APHP, Filière G2M, MetabERN, Paris, France
| | - Fanny Mochel
- Reference Center of Inherited Metabolic Diseases, Hôpital La Pitié Salpêtrière, APHP, Filière G2M, Paris, France
| | - Guy Touati
- Reference Center of Inherited Metabolic Diseases, Hôpital Universitaire Necker-Enfants Malades, APHP, Imagine Institute, Filière G2M, MetabERN, INEM, University Paris Descartes, Paris, France
- Reference Center of Inherited Metabolic Diseases, Hôpital Purpan, Filière G2M, Toulouse, France
| | - Pierre Broué
- Reference Center of Inherited Metabolic Diseases, Hôpital Purpan, Filière G2M, Toulouse, France
| | - Aline Cano
- Reference Center of Inherited Metabolic Diseases, Hôpital La Timone, Filière G2M, MetabERN, Marseille, France
| | - Marine Tardieu
- Reference Center of Inherited Metabolic Diseases, CHRU, Filière G2M, Tours, France
| | - Stefania Querciagrossa
- Department of Anesthesia, Hôpital Universitaire Necker-Enfants Malades, APHP, University Paris Descartes, Paris, France
| | - David Grévent
- Department of Radiology, Hôpital Universitaire Necker-Enfants Malades, APHP, University Paris Descartes, Paris, France
| | - Olivia Boyer
- Reference Center of Pediatric Nephrology, Hôpital Universitaire Necker-Enfants Malades, APHP, Filière ORKID, ERKnet, University Paris Descartes, Paris, France
| | - Laurent Dupic
- Intensive Care Unit, Hôpital Universitaire Necker-Enfants Malades, APHP, University Paris Descartes, Paris, France
| | - Mehdi Oualha
- Intensive Care Unit, Hôpital Universitaire Necker-Enfants Malades, APHP, University Paris Descartes, Paris, France
| | - Muriel Girard
- Pediatric Hepatology Unit, Reference Center for rare pediatric liver diseases, Department of Gastroenterology-Hepatology-Nutrition, Hôpital Universitaire Necker-Enfants Malades, APHP, Filière Filfoie, ERN Transplantchild, Paris, France
| | - Yves Aigrain
- Unit of Pediatric Surgery and Transplantation, Hôpital Universitaire Necker-Enfants Malades, APHP, Filière Filfoie, ERN Transplantchild, University Paris Descartes, Paris, France
| | - Dominique Debray
- Pediatric Hepatology Unit, Reference Center for rare pediatric liver diseases, Department of Gastroenterology-Hepatology-Nutrition, Hôpital Universitaire Necker-Enfants Malades, APHP, Filière Filfoie, ERN Transplantchild, Paris, France
| | - Carmen Capito
- Unit of Pediatric Surgery and Transplantation, Hôpital Universitaire Necker-Enfants Malades, APHP, Filière Filfoie, ERN Transplantchild, University Paris Descartes, Paris, France
| | - Chris Ottolenghi
- Reference Center of Inherited Metabolic Diseases, Hôpital Universitaire Necker-Enfants Malades, APHP, Imagine Institute, Filière G2M, MetabERN, INEM, University Paris Descartes, Paris, France
- Metabolic Biochemistry, Hôpital Universitaire Necker-Enfants Malades, APHP, Imagine Institute, Filière G2M, MetabERN, University Paris Descartes, Paris, France
| | - Rémi Salomon
- Reference Center of Pediatric Nephrology, Hôpital Universitaire Necker-Enfants Malades, APHP, Filière ORKID, ERKnet, University Paris Descartes, Paris, France
| | - Christophe Chardot
- Unit of Pediatric Surgery and Transplantation, Hôpital Universitaire Necker-Enfants Malades, APHP, Filière Filfoie, ERN Transplantchild, University Paris Descartes, Paris, France
| | - Pascale de Lonlay
- Reference Center of Inherited Metabolic Diseases, Hôpital Universitaire Necker-Enfants Malades, APHP, Imagine Institute, Filière G2M, MetabERN, INEM, University Paris Descartes, Paris, France
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8
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Silva RE, Baldim JL, Chagas-Paula DA, Soares MG, Lago JHG, Gonçalves RV, Novaes RD. Predictive metabolomic signatures of end-stage renal disease: A multivariate analysis of population-based data. Biochimie 2018; 152:14-30. [PMID: 29913183 DOI: 10.1016/j.biochi.2018.06.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/13/2018] [Indexed: 01/27/2023]
Abstract
The variability of molecular signatures and predictive low molecular weight markers of chronic kidney disease (CKD) in different populations are poorly understood. Thus, in a large sample with 4763 people we compare the molecular signatures and metabolites with diagnostic relevance in plasma and urine of CKD patients of different geographical origins. From an integrated model based on dynamic networks and multivariate statistics, metabolites with predictive value obtained from targeted and untargeted molecular analysis, interactions between metabolic pathways affected by CKD, and the methodological quality of metabolomic studies were analyzed. The metabolites 3-methylhistidine, citrulline, kynurenine, p-cresol sulfate, urea, and citrate presented consistent expression in all population groups. Only increased kynurenine and p-cresol sulfate in plasma samples obtained acceptable scores as CKD biomarkers, independent of geographic origin. Metabolites such as leucine, alanine, isoleucine, serine, histidine, and citrate were nodal points, indicating that protein metabolism pathways are similarly impaired in Asian, European and North American patients. Based on our integrated model, we show that the metabolome of CKD patients exhibits a strong geographic influence, leading to unique metabolic signatures. Contrary to the likelihood of molecular similarities between geographically distinct populations, metabolic convergences in protein metabolism pathways and the molecules kynurenine and p-cresol sulfate were relevant as general predictors of CKD. In general, the quality assessment indicated that the current evidence is based on research models with variable methodological quality, whose limitations described in this study should be considered in the refinement of molecular approaches.
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Affiliation(s)
- Robson E Silva
- School of Medicine, Federal University of Alfenas, Alfenas, 37130-001, Minas Gerais, Brazil
| | - João L Baldim
- Center of Human and Natural Sciences, Federal University of ABC, 09210-580, Santo André, SP, Brazil
| | - Daniela A Chagas-Paula
- Institute of Chemistry, Federal University of Alfenas, Alfenas, 37130-001, Minas Gerais, Brazil
| | - Marisi G Soares
- Institute of Chemistry, Federal University of Alfenas, Alfenas, 37130-001, Minas Gerais, Brazil
| | - João H G Lago
- Center of Human and Natural Sciences, Federal University of ABC, 09210-580, Santo André, SP, Brazil
| | - Reggiani V Gonçalves
- Department of Animal Biology, Federal University of Viçosa, Viçosa, 36570-000, Minas Gerais, Brazil
| | - Rômulo D Novaes
- Institute of Biomedical Sciences, Department of Structural Biology, Federal University of Alfenas, Alfenas, 37130-001, Minas Gerais, Brazil.
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9
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Determinants of Acute Kidney Injury and Renal Function Decline After Endovascular Abdominal Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2017; 54:712-720. [PMID: 29110930 DOI: 10.1016/j.ejvs.2017.09.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 09/17/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE/BACKGROUND Endovascular aneurysm repair (EVAR) may be associated with renal injury and more insight is needed into potential risk factors. The aim was to identify clinical, anatomical, and peri-procedural parameters as potential risk factors for the occurrence of acute kidney injury (AKI) and to evaluate chronic kidney disease (CKD) after EVAR. METHODS A cohort of 212 consecutive patients who underwent elective EVAR for abdominal aortic aneurysm from January 2009 to October 2016 was included. A subgroup of 149 patients with 2 years follow-up was compared with a set of 135 non-operated aneurysm patients with smaller aneurysms (similar cardiovascular risk profile) to assess CKD. Primary outcomes were AKI (Acute Kidney Injury Network criteria) and CKD measured by estimated glomerular filtration rate (Kidney Disease Improving Global Outcomes guidelines). For AKI, candidate risk factors were identified by univariate and multivariate logistic regression analysis; for chronic renal function decline, risk factors were identified using Cox regression analysis. RESULTS AKI occurred in 30 patients (15%). On multivariate analysis, the use of angiotensin II blocker (odds ratio [OR] 4.08, 95% confidence interval [CI] 1.38-12.07) and peri-operative complications (OR 3.12, 95% CI 1.20-8.10) were independent risk factors for AKI, whereas statin use was a protective factor (OR 0.19, 95% CI 0.07-0.52). EVAR resulted in a significant increase (23.5%) in the occurrence of CKD compared with the control group (6.7%; p <.001). On univariate and multivariate Cox regression the risk factors: aortic neck diameter (per mm increase) (hazard ratio [HR] 1.13, 95% CI 1.02-1.25), renal artery stenosis >50% (HR 2.24, 95% CI 1.05-4.79), and the occurrence of AKI (HR 2.19, 95% CI 0.99-4.85) were significant predictors of CKD. CONCLUSION This study identified use of angiotensin II blockers and peri-operative complications as risk factors for AKI. In addition, the problem of renal function decline after EVAR is highlighted, which indicates that prolonged protective measures (e.g., in those patients at high risk) over time are needed to improve patient outcomes.
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10
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Forcellini Pedrollo E, Bellincanta Nicoletto B, Salomoni Carpes L, de Melo Cardoso de Freitas J, Buboltz JR, Carra Forte C, Bauer AC, Ceratti Manfro R, Corrêa Souza G, Bauermann Leitão C. Effect of an intensive nutrition intervention of a high protein and low glycemic-index diet on weight of kidney transplant recipients: study protocol for a randomized clinical trial. Trials 2017; 18:413. [PMID: 28874181 PMCID: PMC5585938 DOI: 10.1186/s13063-017-2158-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 08/21/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Excessive weight gain is commonly observed within the first year after kidney transplantation and is associated with negative outcomes, such as graft loss and cardiovascular events. The purpose of this study is to evaluate the effect of a high protein and low glycemic-index diet on preventing weight gain after kidney transplantation. METHODS We designed a prospective, single-center, open-label, randomized controlled study to compare the efficacy of a high protein (1.3-1.4 g/kg/day) and low-glycemic index diet versus a conventional diet (0.8-1.0 g/kg/day of protein) on preventing weight gain after kidney transplantation. A total of 120 eligible patients 2 months after transplantation will be recruited. Patients with an estimated glomerular filtration rate through the modification of diet of renal disease (MDRD) formula < 30 mL/min/1.73 m2 or urinary albumin excretion > 300 mg/24 h will be excluded. Patients' diets will be allocated through simple sequential randomization. Patients will be followed-up for 12 months with nine clinic appointments with a dietitian and the evaluations will include nutritional assessment (anthropometrics, body composition, and resting metabolic rate) and laboratory tests. The primary outcome is weight maintenance or body weight gain under 5% after 12 months. Secondary outcomes include body composition, resting metabolic rate, satiety sensation, kidney function, and other metabolic parameters. DISCUSSION Diets with higher protein content and lower glycemic index may lead to weight loss because of higher satiety sensation. However, there is a concern about the association of high protein intake and kidney damage. Nevertheless, there is little evidence on the impact of high protein intake on long-term kidney function outcome. Therefore, we designed a study to test if a high protein diet with low-glycemic index will be an effective and safe nutritional intervention to prevent weight gain in kidney transplant patients. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT02883777 . Registered on 3 August 2016.
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Affiliation(s)
- Elis Forcellini Pedrollo
- Post Graduate Program in Health Sciences, Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 90035-003 Porto Alegre, RS Brazil
| | - Bruna Bellincanta Nicoletto
- Post Graduate Program in Health Sciences, Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 90035-003 Porto Alegre, RS Brazil
- Nutrition Course, Knowledge Area of Life Sciences, Universidade de Caxias do Sul, Caxias do Sul, RS Brazil
| | - Larissa Salomoni Carpes
- Nutrition Graduate Course, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil
| | | | - Julia Roberta Buboltz
- Nutrition Graduate Course, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil
| | - Cristina Carra Forte
- Post Graduate Program in Health Sciences, Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 90035-003 Porto Alegre, RS Brazil
| | - Andrea Carla Bauer
- Post Graduate Program in Health Sciences, Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 90035-003 Porto Alegre, RS Brazil
- Department of Internal Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 90035-003 Porto Alegre, RS Brazil
| | - Roberto Ceratti Manfro
- Department of Internal Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 90035-003 Porto Alegre, RS Brazil
- Post Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 90035-003 Porto Alegre, RS Brazil
| | - Gabriela Corrêa Souza
- Department of Nutrition, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS Brazil
- Food and Nutrition Research Center, Hospital de Clínicas de Porto Alegre (HCPA-UFRGS), Porto Alegre, RS Brazil
| | - Cristiane Bauermann Leitão
- Post Graduate Program in Health Sciences, Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 90035-003 Porto Alegre, RS Brazil
- Department of Internal Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 90035-003 Porto Alegre, RS Brazil
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11
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Pre-operative Functional Cardiovascular Reserve Is Associated with Acute Kidney Injury after Intervention. Eur J Vasc Endovasc Surg 2017; 53:717-724. [DOI: 10.1016/j.ejvs.2017.01.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 01/24/2017] [Indexed: 12/15/2022]
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12
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Abstract
Chronic kidney disease is prevalent among adults in the United States. To aid in diagnosis and treatment, the Kidney Disease: Improving Global Outcomes 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease provides an evidence-based approach. This article reviews the major recommendations of this guideline.
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Affiliation(s)
- Cynthia Ann Smith
- Cynthia Ann Smith is a nephrology and family NP at Renal Consultants, PLLC, South Charleston, W.Va
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13
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Hypoalbuminemia: a risk factor for acute kidney injury development and progression to chronic kidney disease in critically ill patients. Int Urol Nephrol 2016; 49:295-302. [DOI: 10.1007/s11255-016-1453-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
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14
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Romagnoli S, Ricci Z. Statins and acute kidney injury following cardiac surgery: has the last word been told? J Thorac Dis 2016; 8:E451-4. [PMID: 27294251 DOI: 10.21037/jtd.2016.04.34] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Stefano Romagnoli
- 1 Department of Health Science, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy ; 2 Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla, Florence, Italy ; 3 Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, Rome, Italy
| | - Zaccaria Ricci
- 1 Department of Health Science, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy ; 2 Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla, Florence, Italy ; 3 Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, Rome, Italy
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15
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Abstract
Social and spatial context are important determinants of morbidity and mortality. However, there is little clarity about the role of context for kidney disease specifically, particularly before the end stage. Meanwhile, research clarifying the clinical, cellular, molecular, and genetic causes of kidney disease is accelerating considerably. We postulate that without contextual information, even the most detailed biomedical information cannot fully capture the factors that ultimately drive the development and progression of kidney disease. The Nephrotic Syndrome Study Network is integrating detailed, state-of-the-art information on a social and spatial context to enable the exploration of the associations between the social environment and kidney disease. Here, we discuss the extant literature on social context and kidney disease, present information on sources of contextual information, and provide recommended further reading to facilitate future research on the contribution of the social context to kidney disease.
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Affiliation(s)
- Margaret T Hicken
- Survey Research Center, Institute for Social Research and Division of Nephrology, Department of Internal Medicine, University of Michigan School of Medicine, University of Michigan, Ann Arbor, MI
| | - Debbie S Gipson
- Department of Pediatrics, University of Michigan School of Medicine, University of Michigan, Ann Arbor, MI
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16
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Alseiari M, Meyer KB, Wong JB. Evidence Underlying KDIGO (Kidney Disease: Improving Global Outcomes) Guideline Recommendations: A Systematic Review. Am J Kidney Dis 2016; 67:417-22. [DOI: 10.1053/j.ajkd.2015.09.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 09/10/2015] [Indexed: 11/11/2022]
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17
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Saratzis A, Nduwayo S, Sarafidis P, Sayers RD, Bown MJ. Renal Function is the Main Predictor of Acute Kidney Injury after Endovascular Abdominal Aortic Aneurysm Repair. Ann Vasc Surg 2015; 31:52-9. [PMID: 26658089 DOI: 10.1016/j.avsg.2015.10.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/05/2015] [Accepted: 10/06/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Postoperative acute kidney injury (AKI) may occur in up to 18% of elective endovascular abdominal aortic aneurysm repair (EVAR) and has been associated with poor outcome; however, it is not clear which patients are at highest risk, to target renoprotection effectively. We sought to determine the predictive factors of AKI after elective EVAR. METHODS Overall, 947 patients undergoing elective EVAR between January 2004 and December 2014 were analyzed, using prospectively collected data. Postoperative AKI was defined by serum creatinine change within 48 hr, as per the Kidney Disease Improving Global Outcomes guidelines. Cardiovascular and kidney-disease risk factors were entered in univariate and multivariate analyses to assess influence on AKI development. RESULTS Overall, 167 (17.6%) patients developed AKI but only 2 patients required dialysis perioperatively. At multivariate analysis, adjusted for established AKI-risk factors and parameters that differed between groups at baseline, preoperative estimated glomerular filtration rate (eGFR; as per the chronic kidney disease epidemiology [CKD] formula); odds ratio (OR): 1.02 (per unit decrease); 95% confidence interval (CI): 1.003-1.041; P = 0.025; and chronic kidney disease (CKD) stage > 2 (OR: 1.28; 95% CI: 1.249-2.531, P = 0.001) were associated with development of AKI. CONCLUSIONS AKI was common after elective infrarenal EVAR and preoperative renal function appears to be the main factor associated with AKI. Patients with a low eGFR need to be targeted with more aggressive renal protection.
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Affiliation(s)
- Athanasios Saratzis
- Department of Cardiovascular Sciences and NIHR Leicester Cardiovascular Biomedical Research Unit, Leicester Royal Infirmary, University of Leicester, Leicester, UK.
| | - Sarah Nduwayo
- Department of Cardiovascular Sciences and NIHR Leicester Cardiovascular Biomedical Research Unit, Leicester Royal Infirmary, University of Leicester, Leicester, UK
| | - Pantelis Sarafidis
- Department of Cardiovascular Sciences and NIHR Leicester Cardiovascular Biomedical Research Unit, Leicester Royal Infirmary, University of Leicester, Leicester, UK
| | - Robert D Sayers
- Department of Cardiovascular Sciences and NIHR Leicester Cardiovascular Biomedical Research Unit, Leicester Royal Infirmary, University of Leicester, Leicester, UK
| | - Matthew J Bown
- Department of Cardiovascular Sciences and NIHR Leicester Cardiovascular Biomedical Research Unit, Leicester Royal Infirmary, University of Leicester, Leicester, UK
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18
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Down-regulation of Wt1 activates Wnt/β-catenin signaling through modulating endocytic route of LRP6 in podocyte dysfunction in vitro. Cell Signal 2015; 27:1772-80. [DOI: 10.1016/j.cellsig.2015.05.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 05/27/2015] [Indexed: 11/22/2022]
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19
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Saratzis A, Melas N, Mahmood A, Sarafidis P. Incidence of Acute Kidney Injury (AKI) after Endovascular Abdominal Aortic Aneurysm Repair (EVAR) and Impact on Outcome. Eur J Vasc Endovasc Surg 2015; 49:534-40. [PMID: 25736516 DOI: 10.1016/j.ejvs.2015.01.002] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 01/05/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is an important post-operative complication that may impact on mortality, morbidity, and cost. The incidence after endovascular aneurysm repair (EVAR) remains unknown, as the current literature has not employed consistent definitions. The aim of this study is to assess the incidence of AKI after elective EVAR and examine the impact of AKI on mortality and cardiovascular morbidity using the current universally accepted definitions. METHODS This was a cohort study using prospectively collected data, including consecutive patients undergoing elective EVAR for an infrarenal abdominal aortic aneurysm (AAA). Those with end stage renal failure were excluded. The primary endpoint was incidence of AKI as per the "Acute Kidney Injury Network" (AKIN), and "Kidney Disease Improving Global Outcomes" (KDIGO) criteria. Secondary endpoints included AKI stage, drop in estimated glomerular filtration rate (eGFR), and mortality and cardiovascular morbidity. RESULTS 149 patients were included (16 females, 11%; mean age: 69 ± 8 years; mean AAA diameter: 6.0 ± 1.1 cm), 28 (18.8%) of whom developed AKI (26 patients classified as stage 1 and 2 as stage 2). Within 48 hours, those with AKI dropped their eGFR from 61 ± 20 mL/kg/1.73 m(2) to 51 ± 20 units (p < .001), and those without from 75 ± 9 to 74 ± 10 units (p < .001). None required dialysis during a 33 ± 11 month follow up. Development of AKI was associated with mortality (HR 0.035, 95% CI: 0.005 to 0.240, p < .001) and cardiovascular morbidity (HR: 0.021, 95% CI: 0.004 to 0.11, p < .001) on adjusted regression analysis. CONCLUSIONS The incidence of AKI after EVAR is significant and is independently associated with medium-term mortality and morbidity.
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Affiliation(s)
- A Saratzis
- Department of Surgery, University Hospitals Coventry and Warwickshire, Coventry, UK; Department of General and Vascular Surgery, Papageorgiou General Hospital, Aristotle University, Thessaloniki, Greece.
| | - N Melas
- Department of General and Vascular Surgery, Papageorgiou General Hospital, Aristotle University, Thessaloniki, Greece
| | - A Mahmood
- Department of Surgery, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - P Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece
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