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Tang R, Liu Y, Chen J, Deng J, Liu Y, Xu Q. Association of a low ankle brachial index with progression to end-stage kidney disease in patients with advanced-stage diabetic kidney disease. Ren Fail 2023; 45:2160347. [PMID: 36632822 PMCID: PMC9848234 DOI: 10.1080/0886022x.2022.2160347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTIONS The effect of a low ankle-brachial index (ABI) in patients with advanced-stage diabetic kidney disease is not fully understood. This study investigates the prevalence of a low ABI in patients with advanced-stage diabetic kidney disease, which was defined as a urinary albumin-to-creatinine ratio (UACR) ≥300 mg/g and an estimated glomerular filtration rate (eGFR) between 15-60 mL/min/1.73 m2. Furthermore, the association between a low ABI and end-stage kidney disease (ESKD) was determined. METHODS This single-center, retrospective, cohort study included 529 patients with advanced-stage diabetic kidney disease who were stratified into groups according to the ABI: high (>1.3), normal (0.9-1.3), and low (<0.9). The Kaplan-Meier method and Cox proportional analysis were used to examine the association between the ABI and ESKD. RESULTS A total of 42.5% of patients with a low ABI progressed to ESKD. A low ABI was associated with a greater risk of ESKD (hazard ratio (HR): 1.073). After adjusting for traditional chronic kidney disease risk factors, a low ABI remained associated with a greater risk of ESKD (HR: 1.758; 95% confidence interval: 1.243-2.487; p = 0.001). CONCLUSIONS These results indicate that patients with a low ABI should be monitored carefully. Furthermore, preventive therapy should be considered to improve the long-term kidney survival of patients with residual kidney function.
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Affiliation(s)
- Ruiying Tang
- Department of Nephrology, Jiangmen Central Hospital, Jiangmen City, China
| | - Yun Liu
- Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou City, China
| | - Jiexin Chen
- Department of Nephrology, Jiangmen Central Hospital, Jiangmen City, China
| | - Jihong Deng
- Department of Nephrology, Jiangmen Central Hospital, Jiangmen City, China
| | - Yan Liu
- Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou City, China
| | - Qingdong Xu
- Department of Nephrology, Jiangmen Central Hospital, Jiangmen City, China,CONTACT Qingdong Xu Department of Nephrology, Jiangmen Central Hospital, Jiangmen City, China
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Incidence of impaired kidney function among people with HIV: a systematic review and meta-analysis. BMC Nephrol 2022; 23:107. [PMID: 35300612 PMCID: PMC8932163 DOI: 10.1186/s12882-022-02721-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/02/2022] [Indexed: 01/01/2023] Open
Abstract
Background In the era of combination antiretroviral therapy (ART), the incidence, manifestations and severity of kidney diseases have dramatically changed in people living with HIV (PLWH). Little is known about the incidence of impaired kidney function (IKF) measured by serum creatine-based estimated glomerular filtration rate (eGFR) in PLWH. Methods In this systematic review and meta-analysis, we searched PubMed, Ovid, Medline, Embase and Web of Science for studies published before May 7th, 2021, with estimates of incidence of IKF among PLWH. We independently reviewed each study for quality by using the Newcastle-Ottawa scale. The incidence and 95% confidence intervals (CIs) were calculated using random-effects model. Results Sixty out of 3797 identifiable studies were eligible for the meta-analysis. A total of 19 definitions of IKF were described and categorized into three types: the threshold of eGFR, an absolute or percent decrease in eGFR, and certain eGFR threshold combined with decrement in eGFR. The eGFR< 60 ml/min/1.73m2 was the most widely used definition or criterion for IKF, by which the pooled incidence rate of IKF was 12.50 (95%CI: 9.00–17.36) per 1000 person years (PYs). The second most-studied outcome was a > 25% decrease in eGFR, followed by eGFR< 90 ml/min/1.73m2, eGFR< 30 ml/min/1.73m2 and a combination of eGFR threshold plus decreased eGFR. The reported incidence rates of IKF differ widely by different definitions of IKF. The highest pooled incidence was observed for those with > 25% decrease in eGFR, while the lowest was observed in those with eGFR < 30 ml/min/1.73m2. Substantial heterogeneity was identified across most estimates. Conclusion Our study provides a comprehensive summary of eGFR-based definitions and incidence rates of IKF in PLWH, not only promoting our understanding of IKF, but also underscoring needs for a concerted action to unify definitions and outcomes of IKF and their applications in AIDS care. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02721-x.
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Ankle-brachial index predicts renal outcomes and all-cause mortality in high cardiovascular risk population: a nationwide prospective cohort study in CORE project. Int Urol Nephrol 2021; 54:1641-1652. [PMID: 34724144 DOI: 10.1007/s11255-021-03049-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/24/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Low ankle-brachial index (ABI) related ischemic events are common among individuals with chronic kidney disease (CKD). It is also associated with an increased risk of rapid renal function decline. The presence of peripheral artery disease (PAD) with low ABI among patients with high cardiovascular (CV) risk increases limb loss and mortality. AIMS To estimate the association between abnormal ABI and renal endpoints and all-cause mortality. METHODS A multicenter prospective cohort study was conducted among subjects with high CV risk or established CV diseases in Thailand. The subjects were divided into 3 groups based on ABI at baseline > 1.3, 0.91-1.3, and ≤ 0.9, respectively. Primary composite outcome consisted of estimated glomerular filtration rate (eGFR) decline over 40%, eGFR less than 15 mL/min/1.73 m2, doubling of serum creatinine and initiation of dialysis. The secondary outcome was all-cause mortality. Cox regression analysis and Kaplan-Meier curve were performed. RESULTS A total of 5543 subjects (3005 men and 2538 women) were included. Cox proportional hazards model showed a significant relationship of low ABI (ABI ≤ 0.9) and primary composite outcome and all-cause mortality. Compared with the normal ABI group (ABI 0.91-1.3), subjects with low ABI at baseline significantly had 1.42-fold (95% CI 1.02-1.97) and 2.03-fold (95% CI 1.32-3.13) risk for the primary composite outcome and all-cause mortality, respectively, after adjusting for variable factors. CONCLUSION Our study suggested that PAD independently predicts the incidence of renal progression and all-cause mortality among Thai patients with high CV risk.
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Voicehovska JG, Bormane E, Grigane A, Moisejevs G, Moreino E, Trumpika D, Voicehovskis VV. Association of Arterial Stiffness With Chronic Kidney Disease Progression and Mortality. Heart Lung Circ 2021; 30:1694-1701. [PMID: 34503918 DOI: 10.1016/j.hlc.2021.08.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/12/2021] [Accepted: 08/27/2021] [Indexed: 01/11/2023]
Abstract
Chronic kidney disease (CKD) is a major public health concern. Despite many potentially life-threatening conditions that can accompany kidney disease, cardiovascular disease (CVD) remains the leading cause of death in these patients. Adjusted-for-age mortality from CVD in patients with end-stage renal disease is 10-30 times higher than in the general population. A decrease in renal function accelerates the development of cardiac pathology. Simultaneous exposure of CVD and CKD plays an important role in the relationship between arterial stiffness (AS) and estimated glomerular filtration rate. But there is a controversy as to whether the AS causes deterioration in kidney function, if renal dysfunction leads to AS, or the relationship is reciprocal. Hence, several studies that recruited high-risk populations reached a conclusion that comorbidities might lead to both AS and decline in kidney function over time. A number of studies have shown that several markers of AS, such as pulse pressure, central and peripheral pressure are associated with the development of CKD. This review takes into account the theoretical background, current status, and future potential of the techniques that measure AS within context of CKD assessment and management.
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Affiliation(s)
- Julija G Voicehovska
- Department of Internal Diseases, Riga Stradins University, Riga, Latvia; Department of Kidney Diseases and Renal Replacement Therapy, Riga East Clinical University Hospital, Riga, Latvia.
| | - Eva Bormane
- Department of Kidney Diseases and Renal Replacement Therapy, Riga East Clinical University Hospital, Riga, Latvia
| | - Anda Grigane
- Department of Kidney Diseases and Renal Replacement Therapy, Riga East Clinical University Hospital, Riga, Latvia
| | - Georgijs Moisejevs
- Department of Internal Diseases, Riga Stradins University, Riga, Latvia; Department of Kidney Diseases and Renal Replacement Therapy, Riga East Clinical University Hospital, Riga, Latvia
| | - Eva Moreino
- Department of Internal Diseases, Riga Stradins University, Riga, Latvia
| | - Dace Trumpika
- Department of Kidney Diseases and Renal Replacement Therapy, Riga East Clinical University Hospital, Riga, Latvia
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Guo X, Li Y, Yang Y, Wang W, Liang S, Zheng Y, Chen X, Cai G. Noninvasive markers of arterial stiffness and renal outcomes in patients with chronic kidney disease. J Clin Hypertens (Greenwich) 2021; 23:823-830. [PMID: 33523570 PMCID: PMC8678811 DOI: 10.1111/jch.14185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/22/2020] [Accepted: 12/01/2020] [Indexed: 11/28/2022]
Abstract
Our study aimed to explore the intercorrelations of brachial‐ankle pulse wave velocity (baPWV), ankle‐brachial index (ABI), ambulatory arterial stiffness index (AASI), 24‐hour mean pulse pressure (24‐h PP), and augmentation index (AIx, AIx@75, the AIx standardized to a heart rate of 75) and compare the effectiveness of these markers for predicting renal outcomes. A total of 117 patients with chronic kidney disease (CKD) who received noninvasive arterial stiffness examinations were enrolled. We used correlation analysis and linear regression to explore the correlations between these five arterial stiffness markers and the Cox proportional hazards model and receiver operator characteristic (ROC) curve to assess the associations of markers with kidney disease outcomes. The median (interquartile range) of age and eGFR were 61 (49‐65) years and 50.5 (35.5‐84.1) ml/min/1.73 m2, respectively. In Pearson correlation analysis, baPWV was significantly associated with 24‐h PP (r = .531, p < .001), AIx@75 (r = .306, p < .001). Additionally, 24‐h PP was associated with AASI (r = .507, p < .001) and AIx@75 (r = .217, p = .019). During follow‐up for a median of 25 months, 26.5% (n = 31) of patients had a composite outcome; of these, 10 initiated dialysis, 17 had 40% eGFR loss, and 4 died. Increased AASI, 24‐h PP, and baPWV were associated with poor renal outcomes in a univariate Cox analysis. After adjusting for age, sex, MAP, eGFR, and 24 hours proteinuria, 1‐SD increase in AASI and 24‐h PP was associated with renal outcomes. The ROC analysis yielded the largest area under the curve (AUC) of 0.727 (95% CI: 0.624 to 0.831; p < .001) for 24 ‐h PP. When the Youden's index was at its maximum, the 24‐h PP value was 52 mmHg. In conclusion, 24‐h PP, baPWV, and AIx@75 were linked well to one another. Arterial stiffness is a target for delaying the decline in kidney function. The use of 24‐h PP as an arterial stiffness marker should be valued in CKD clinical practice.
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Affiliation(s)
- Xinru Guo
- Department of Nephrology, Medical School of Chinese PLA, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yisha Li
- Department of Nephrology, Medical School of Chinese PLA, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ying Yang
- Department of Nephrology, Medical School of Chinese PLA, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Wenling Wang
- Department of Nephrology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shuang Liang
- Department of Nephrology, Medical School of Chinese PLA, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ying Zheng
- Department of Nephrology, Medical School of Chinese PLA, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiangmei Chen
- Department of Nephrology, Medical School of Chinese PLA, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Guangyan Cai
- Department of Nephrology, Medical School of Chinese PLA, The First Medical Center, Chinese PLA General Hospital, Beijing, China
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Manabe S, Kataoka H, Mochizuki T, Iwadoh K, Ushio Y, Kawachi K, Watanabe K, Watanabe S, Akihisa T, Makabe S, Sato M, Iwasa N, Yoshida R, Sawara Y, Hanafusa N, Tsuchiya K, Nitta K. Maximum Carotid Intima-Media Thickness in Association with Renal Outcomes. J Atheroscler Thromb 2020; 28:491-505. [PMID: 32759541 PMCID: PMC8193787 DOI: 10.5551/jat.57752] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Aim:
We aimed to examine the association between the maximum intima-media thickness of the carotid artery (Max IMT) and renal prognosis, considering their potential interaction with age.
Methods:
Survival analyses were performed in 112 patients with chronic kidney disease (CKD), to assess renal prognosis, with the endpoint defined as a ≥ 30% decline in estimated glomerular filtration rate (eGFR) or end-stage renal disease.
Results:
During a median follow-up of 12.5 years, 44 participants reached the study endpoint. The major determinant of Max IMT was the maximum IMT of the internal carotid artery (Max ICA-IMT), which was the distribution ratio of 50.0% of Max IMT. Kaplan–Meier analyses showed that Max IMT ≥ 1.5 mm was significantly associated with renal prognosis when age and eGFR were matched. On multivariate Cox regression analysis, Max IMT was significantly associated with the renal outcomes and had a significant interaction with the age categories (≥ 65 years or <65 years) (
P
=0.0153 for interaction). A 1-mm increase in Max IMT was significantly associated with disease progression in the sub-cohort <65 years age-category, but not in the ≥ 65 years age-category; similarly the hazard ratio (HR) in the <65 years age-category was higher than in the ≥ 65 years age-category (HR: 2.52 vs. 0.95). Comparable results were obtained for Max ICA-IMT, Max bulb-IMT, but not for Max common carotid artery-IMT.
Conclusions:
A higher Max IMT was a significant renal prognosis factor in patients with CKD aged <65 years. Our results may provide new insights into treating CKD.
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Affiliation(s)
- Shun Manabe
- Department of Nephrology, Tokyo Women's Medical University
| | - Hiroshi Kataoka
- Department of Nephrology, Tokyo Women's Medical University.,Department of Nephrology, Clinical Research Division for Polycystic Kidney Disease, Tokyo Women's Medical University
| | - Toshio Mochizuki
- Department of Nephrology, Tokyo Women's Medical University.,Department of Nephrology, Clinical Research Division for Polycystic Kidney Disease, Tokyo Women's Medical University
| | - Kazuhiro Iwadoh
- Department of Blood Purification, Tokyo Women's Medical University
| | - Yusuke Ushio
- Department of Nephrology, Tokyo Women's Medical University
| | - Keiko Kawachi
- Department of Nephrology, Tokyo Women's Medical University
| | | | - Saki Watanabe
- Department of Nephrology, Tokyo Women's Medical University
| | - Taro Akihisa
- Department of Nephrology, Tokyo Women's Medical University
| | - Shiho Makabe
- Department of Nephrology, Tokyo Women's Medical University
| | - Masayo Sato
- Department of Nephrology, Tokyo Women's Medical University
| | - Naomi Iwasa
- Department of Nephrology, Tokyo Women's Medical University.,Department of Nephrology, Clinical Research Division for Polycystic Kidney Disease, Tokyo Women's Medical University
| | - Rie Yoshida
- Department of Nephrology, Tokyo Women's Medical University.,Department of Nephrology, Clinical Research Division for Polycystic Kidney Disease, Tokyo Women's Medical University
| | - Yukako Sawara
- Department of Nephrology, Tokyo Women's Medical University
| | - Norio Hanafusa
- Department of Blood Purification, Tokyo Women's Medical University
| | - Ken Tsuchiya
- Department of Blood Purification, Tokyo Women's Medical University
| | - Kosaku Nitta
- Department of Nephrology, Tokyo Women's Medical University
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Tanaka S, Nakano T, Hiyamuta H, Taniguchi M, Tokumoto M, Masutani K, Ooboshi H, Tsuruya K, Kitazono T. Impact of Multivascular Disease on Cardiovascular Mortality and Morbidity in Patients Receiving Hemodialysis: Ten-Year Outcomes of the Q-Cohort Study. J Atheroscler Thromb 2020; 28:385-395. [PMID: 32684556 PMCID: PMC8147568 DOI: 10.5551/jat.54098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Multivascular disease, indicating concurrent arteriosclerotic lesions in a number of different vascular beds, is an independent risk factor for recurrent ischemic events in the general population. However, the impact of multivascular disease on the risk of developing cardiovascular disease has not been fully evaluated in patients receiving hemodialysis. METHODS A total of 3,504 hemodialysis patients were prospectively followed for 10 years. In this study, multivascular disease was defined as the coexistence of coronary artery disease and stroke. We examined the relationship between multivascular disease and the occurrence of composite cardiovascular endpoint, consisting of cardiovascular death, nonfatal coronary artery disease, nonfatal stroke, and peripheral artery disease. RESULTS The proportion of participants with multivascular disease was 5.7% (n=200) at baseline. During follow-up (median, 106.6 months; interquartile range, 50.1-121.8 months), 1,311 patients experienced the composite endpoint, which was defined as at least one of the following: cardiovascular death (n=620), nonfatal coronary artery disease (n=318), nonfatal stroke (n=340), and peripheral artery disease (n=257). Compared with the group with no history of cardiovascular disease, the risk of experiencing the composite endpoint increased significantly with higher numbers of injured vascular beds in patients with single vascular disease (hazard ratio, 1.68; 95% confidence interval, 1.49-1.89) and in those with multivascular disease (hazard ratio, 2.11; 95% confidence interval, 1.71-2.60). In a multivariable analysis, multivascular disease was an independent predictor of cardiovascular events, in addition to diabetes, aging, and hypertension. CONCLUSIONS This study clearly demonstrated that multivascular disease was a powerful predictor for cardiovascular mortality and morbidity in patients receiving hemodialysis.
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Affiliation(s)
- Shigeru Tanaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | - Hiroto Hiyamuta
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | | | | | - Kosuke Masutani
- Department of Nephrology and Rheumatology, Faculty of Medicine, Fukuoka University
| | | | | | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
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Nakano T. The Ankle-Brachial Index and Risk of Chronic Kidney Disease. J Atheroscler Thromb 2019; 26:1043-1044. [PMID: 31217397 PMCID: PMC6927810 DOI: 10.5551/jat.ed112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
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