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Martínez-Hernández SL, Muñoz-Ortega MH, Ávila-Blanco ME, Medina-Pizaño MY, Ventura-Juárez J. Novel Approaches in Chronic Renal Failure without Renal Replacement Therapy: A Review. Biomedicines 2023; 11:2828. [PMID: 37893201 PMCID: PMC10604533 DOI: 10.3390/biomedicines11102828] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/28/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Chronic kidney disease (CKD) is characterized by renal parenchymal damage leading to a reduction in the glomerular filtration rate. The inflammatory response plays a pivotal role in the tissue damage contributing to renal failure. Current therapeutic options encompass dietary control, mineral salt regulation, and management of blood pressure, blood glucose, and fatty acid levels. However, they do not effectively halt the progression of renal damage. This review critically examines novel therapeutic avenues aimed at ameliorating inflammation, mitigating extracellular matrix accumulation, and fostering renal tissue regeneration in the context of CKD. Understanding the mechanisms sustaining a proinflammatory and profibrotic state may offer the potential for targeted pharmacological interventions. This, in turn, could pave the way for combination therapies capable of reversing renal damage in CKD. The non-replacement phase of CKD currently faces a dearth of efficacious therapeutic options. Future directions encompass exploring vaptans as diuretics to inhibit water absorption, investigating antifibrotic agents, antioxidants, and exploring regenerative treatment modalities, such as stem cell therapy and novel probiotics. Moreover, this review identifies pharmaceutical agents capable of mitigating renal parenchymal damage attributed to CKD, targeting molecular-level signaling pathways (TGF-β, Smad, and Nrf2) that predominate in the inflammatory processes of renal fibrogenic cells.
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Affiliation(s)
- Sandra Luz Martínez-Hernández
- Departamento de Microbiología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes 20100, Ags, Mexico
| | - Martín Humberto Muñoz-Ortega
- Departamento de Química, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes 20100, Ags, Mexico
| | - Manuel Enrique Ávila-Blanco
- Departamento de Morfología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes 20100, Ags, Mexico
| | - Mariana Yazmin Medina-Pizaño
- Departamento de Morfología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes 20100, Ags, Mexico
| | - Javier Ventura-Juárez
- Departamento de Morfología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes 20100, Ags, Mexico
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Onuigbo MA, Samuel E, Agbasi N. Hospital-acquired nephrotoxic exposures in the precipitation of acute kidney injury – A case series analysis and a call for more preventative nephrology practices. J Nephropharmacol 2017. [DOI: 10.15171/npj.2017.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Onuigbo MAC. The STOP-ACEi Trial - Apt timing for this long awaited randomised controlled trial - Validation of the syndrome of late-onset renal failure from angiotensin blockade (LORFFAB)? Int J Clin Pract 2017; 71. [PMID: 27933685 DOI: 10.1111/ijcp.12916] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 11/05/2016] [Indexed: 11/28/2022] Open
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Alabdan N, Gosmanova EO, Tran NQT, Oliphant CS, Pan H, Broyles JE, Hudson JQ. Acute Kidney Injury in Patients Continued on Renin-Angiotensin System Blockers During Hospitalization. Am J Med Sci 2016; 353:172-177. [PMID: 28183419 DOI: 10.1016/j.amjms.2016.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/19/2016] [Accepted: 09/27/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is common in hospitalized patients and is associated with adverse outcomes. This study aimed to evaluate patient characteristics and interventions during hospitalization associated with the development of AKI in patients continued on renin-angiotensin system (RAS) blockers during hospitalization. METHODS A retrospective study of 184 adult patients admitted between January 2012 and September 2014 and continued on RAS blockers was conducted. Risk factors for AKI were compared between AKI (n = 92) and non-AKI (n = 92) groups. RESULTS Patients who developed hospital-acquired AKI had a higher baseline serum creatinine (1.2 ± 0.4 versus 1 ± 0.3mg/dL, P < 0.001) and lower estimated glomerular filtration rate (54 ± 10 versus 57 ± 7mL/minute/1.73m2, P = 0.03) compared with patients who did not develop AKI. Patients who developed AKI were also more likely to be admitted to the intensive care unit, have surgical procedures, have hypotension and be prescribed loop diuretics. The presence of chronic kidney disease and hypotension were risk factors associated with AKI development. In addition, the AKI group had a significantly longer length of stay (14 days versus 8 days, P < 0.0001) and had a higher rate of all-cause hospital mortality (9% versus 1%, P = 0.03). CONCLUSIONS Patients with chronic kidney disease, hypotension and those undergoing surgeries were more likely to develop AKI while receiving RAS blockers. During hospitalization, temporary discontinuation of these medications may be warranted in patients with these characteristics.
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Affiliation(s)
- Numan Alabdan
- Pharmaceutical Care Department, King Abdulaziz Medical City, Dammam, Saudi Arabia; Pharmacy Practice Department, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Elvira O Gosmanova
- Section of Nephrology, Stratton VA Medical Center, Albany, NY; Department of Medicine, Albany Medical College, Albany, NY
| | - Nhu Quynh T Tran
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN
| | - Carrie S Oliphant
- Department of Clinical Pharmacy, Methodist University Hospital, Memphis, TN; Department of Clinical Pharmacy, The University of Tennessee Health Science Center, Memphis, TN
| | - Hu Pan
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN
| | - Joyce E Broyles
- Department of Clinical Pharmacy, Methodist University Hospital, Memphis, TN; Department of Clinical Pharmacy, The University of Tennessee Health Science Center, Memphis, TN
| | - Joanna Q Hudson
- Department of Clinical Pharmacy, The University of Tennessee Health Science Center, Memphis, TN; Department of Medicine (Nephrology), The University of Tennessee Health Science Center, Memphis, TN.
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Onuigbo MAC, Agbasi N. Association of intraoperative hypotension with acute kidney injury after elective non-cardiac surgery—prevention is better than cure. Ren Fail 2016; 38:168-9. [DOI: 10.3109/0886022x.2015.1128448] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Onuigbo M, Agbasi N. Syndrome of rapid onset ESRD accounted for high hemodialysis catheter use--results of a 13-year Mayo Clinic incident hemodialysis study. Ren Fail 2015; 37:1486-91. [PMID: 26375630 DOI: 10.3109/0886022x.2015.1088336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The syndrome of rapid onset end-stage renal disease (SORO-ESRD) was first described in the journal Renal Failure in 2010. This is an acute precipitate unpredictable yet irreversible ESRD following acute kidney injury (AKI), as distinct from "classic" ESRD where chronic kidney disease (CKD)-ESRD progression was linear, time-dependent, and predictable. The overall impact of SORO-ESRD on ESRD outcomes in the adult US ESRD population remains speculative and called for larger studies. METHODS A retrospective investigation of an incident adult ESRD population, Mayo Clinic, Rochester, 2001-2013. RESULTS One hundred and forty-nine of 1461 (10%) incident patients with ESRD had SORO-ESRD - M:F = 76:73, age 62 (19-95) years, 139 (93%) native kidneys, and 10 (7%) renal transplant recipients (RTRs). The modal age group was 71-80 years. A total of 147 (99%) SORO-ESRD patients started first hemodialysis treatment via a dialysis catheter. Kidney biopsy in 10 RTRs and 34 native kidneys revealed acute tubular necrosis (ATN) as the commonest pathology. Cardiac arrest remained the leading cause of death among SORO-ESRD patients. CONCLUSIONS SORO-ESRD accounted for 149 (10%) of 1461 incident ESRD patients. There was no gender disparity. The older population was more susceptible. Ninety-nine percent (99%) of SORO-ESRD patients started their first hemodialysis treatment via a dialysis catheter, a major negative impact on AV fistula first programs. ATN was the leading pathologic diagnosis. We conclude that SORO-ESRD contributes significantly to incident ESRD here in the USA including renal allograft loss. Efforts to reduce AKI incidence or renoprevention demand more attention and priority.
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Affiliation(s)
- Macaulay Onuigbo
- a Mayo Clinic College of Medicine , Rochester , MN , USA .,b Department of Nephrology , Mayo Clinic Health System , Eau Claire , WI , USA .,c MBA Executive, Mayo Clinic Health System, Eau Claire , WI , USA , and
| | - Nneoma Agbasi
- d Psychiatry Nursing, North East London NHS Foundation Trust , UK
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Diabetic Nephropathy and CKD-Analysis of Individual Patient Serum Creatinine Trajectories: A Forgotten Diagnostic Methodology for Diabetic CKD Prognostication and Prediction. J Clin Med 2015; 4:1348-68. [PMID: 26239680 PMCID: PMC4519794 DOI: 10.3390/jcm4071348] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 05/26/2015] [Accepted: 06/09/2015] [Indexed: 01/05/2023] Open
Abstract
Creatinine is produced in muscle metabolism as the end-product of creatine phosphate and is subsequently excreted principally by way of the kidneys, predominantly by glomerular filtration. Blood creatinine assays constitute the most common clinically relevant measure of renal function. The use of individual patient-level real-time serum creatinine trajectories provides a very attractive and tantalizing methodology in nephrology practice. Topics covered in this review include acute kidney injury (AKI) with its multifarious rainbow spectrum of renal outcomes; the stimulating vicissitudes of the diverse patterns of chronic kidney disease (CKD) to end-stage renal disease (ESRD) progression, including the syndrome of rapid onset end stage renal disease (SORO-ESRD); the syndrome of late onset renal failure from angiotensin blockade (LORFFAB); and post-operative AKI linked with the role of intra-operative hypotension in patients with diabetes mellitus and suspected diabetic nephropathy with CKD. We conclude that the study of individual patient-level serum creatinine trajectories, albeit a neglected and forgotten diagnostic methodology for diabetic CKD prognostication and prediction, is a most useful diagnostic tool, both in the short-term and in the long-term practice of nephrology. The analysis of serum creatinine trajectories, both in real time and retrospectively, indeed provides supplementary superior diagnostic and prognostic insights in the management of the nephrology patient.
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Musso CG, Vilas M, Onuigbo M. Nephroprevention in the oldest old with chronic kidney disease: Special considerations. World J Nephrol 2015; 4:1-5. [PMID: 25664242 PMCID: PMC4317619 DOI: 10.5527/wjn.v4.i1.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 11/07/2014] [Accepted: 11/19/2014] [Indexed: 02/06/2023] Open
Abstract
Nephroprevention strategies are crucial for handling chronic kidney disease (CKD) complications, and slowing its progression. However, these preventative measures should be guided by major geriatrics principles in order to help nephrologists to adequately handle the oldest old with CKD. These geriatric concepts consist of taking into account the relevance of choosing an individualized therapy, handling clinical frailty, and keeping a geriatric perspective which means that a good quality of life is sometimes a more important therapeutic objective in octogenarians than merely prolonging life. Even though nephroprevention strategies for treating the oldest old with CKD are basically similar to those applied to younger patients such as low sodium and protein diet, optimized hemoglobin levels, blood pressure and metabolic control, the treating physician or care provider must at all times be ready to make fundamental adjustments and tweak patient care paradigms and objectives if and when the initial therapeutic options applied have caused unintended clinical consequences and complications. Additionally, the sarcopenia status should also be evaluated and treated in very old CKD patients.
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Onuigbo MAC. Renoprevention revisited--The impact of preemptive withdrawal of RAAS blockade prior to iodinated contrast exposure in older CKD patients: results of a new meta-analysis. Cardiology 2014; 130:25-6. [PMID: 25471399 DOI: 10.1159/000369295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 10/23/2014] [Indexed: 11/19/2022]
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Onuigbo MAC, Agbasi N. Chronic kidney disease prediction is an inexact science: The concept of “progressors” and “nonprogressors”. World J Nephrol 2014; 3:31-49. [PMID: 25332895 PMCID: PMC4202491 DOI: 10.5527/wjn.v3.i3.31] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 06/13/2014] [Accepted: 07/29/2014] [Indexed: 02/06/2023] Open
Abstract
In 2002, the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) instituted new guidelines that established a novel chronic kidney disease (CKD) staging paradigm. This set of guidelines, since updated, is now very widely accepted around the world. Nevertheless, the authoritative United States Preventative Task Force had in August 2012 acknowledged that we know surprisingly little about whether screening adults with no signs or symptoms of CKD improve health outcomes and that we deserve better information on CKD. More recently, the American Society of Nephrology and the American College of Physicians, two very well respected United States professional physician organizations were strongly at odds coming out with exactly opposite recommendations regarding the need or otherwise for ”CKD screening” among the asymptomatic population. In this review, we revisit the various angles and perspectives of these conflicting arguments, raise unanswered questions regarding the validity and veracity of the NKF KDOQI CKD staging model, and raise even more questions about the soundness of its evidence-base. We show clinical evidence, from a Mayo Clinic Health System Renal Unit in Northwestern Wisconsin, United States, of the pitfalls of the current CKD staging model, show the inexactitude and unpredictable vagaries of current CKD prediction models and call for a more cautious and guarded application of CKD staging paradigms in clinical practice. The impacts of acute kidney injury on CKD initiation and CKD propagation and progression, the effects of such phenomenon as the syndrome of late onset renal failure from angiotensin blockade and the syndrome of rapid onset end stage renal disease on CKD initiation, CKD propagation and CKD progression to end stage renal disease all demand further study and analysis. Yet more research on CKD staging, CKD prognostication and CKD predictions is warranted. Finally and most importantly, cognizant of the very serious limitations and drawbacks of the NKF K/DOQI CKD staging model, the need to individualize CKD care, both in terms of patient care and prognostication, cannot be overemphasized.
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Onuigbo MAC, Onuigbo NT, Musso CG. Syndrome of rapid onset end stage renal disease in incident Mayo Clinic chronic hemodialysis patient. Indian J Nephrol 2014; 24:75-81. [PMID: 24701038 PMCID: PMC3968613 DOI: 10.4103/0971-4065.127886] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Despite decades of research, a full understanding of chronic kidney disease (CKD)-end stage renal disease (ESRD) progression remains elusive. The common consensus is a predictable, linear, progressive and time-dependent decline of CKD to ESRD. Acute kidney injury (AKI) on CKD is usually assumed to be transient, with recovery as the expected outcome. AKI-ESRD association in current nephrology literature is blamed on the so-called "residual confounding." We had previously described a relationship between AKI events and rapid onset yet irreversible ESRD happening in a continuum in a high-risk CKD cohort. However, the contribution of the syndrome of rapid onset-ESRD (SORO-ESRD) to incident United States ESRD population remained conjectural. In this retrospective analysis, we analyzed serum creatinine trajectories of the last 100 consecutive ESRD patients in 4 Mayo Clinic chronic hemodialysis units to determine the incidence of SORO-ESRD. Excluding 9 patients, 31 (34%) patients, including two renal transplant recipients, had SORO-ESRD: 18 males and 13 females age 72 (range 50-92) years. Precipitating AKI followed pneumonia (8), acutely decompensated heart failure (7), pyelonephritis (4), post-operative (5), sepsis (3), contrast-induced nephropathy (2), and others (2). Time to dialysis was shortest following surgical procedures. Concurrent renin angiotensin aldosterone system blockade was higher with SORO-ESRD - 23% versus 5%, P = 0.0113. In conclusion, SORO-ESRD is not uncommon among the incident general US ESRD population. The implications for ESRD care planning, AV-fistula-first programs, general CKD care and any associations with renal ageing/senescence warrant further study.
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Affiliation(s)
- M A C Onuigbo
- Department of Medicine, College of Medicine, Mayo Clinic, Rochester, MN, WI, USA ; Department of Nephrology, Mayo Clinic Health System, WI, USA ; Healthcare Executive, Eau Claire, WI, USA
| | - N T Onuigbo
- Information Technology, NTEC Solution LLC, Eau Claire, WI, USA
| | - C G Musso
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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