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Arabi Z, El Sarrag MIM, Arabi T, Alqudsi M, Shafqat A. Association of Coronary Calcium Score on Cardiac PET During Pre-Kidney Transplant Assessment with Persistent Hyperparathyroidism: A Retrospective Study. Ann Transplant 2024; 29:e943532. [PMID: 38561931 PMCID: PMC10998472 DOI: 10.12659/aot.943532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/12/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Secondary hyperparathyroidism and coronary calcifications are common complications in chronic kidney disease. However, the relation between coronary calcium score (CCS) and persistent hyperparathyroidism (pHPT) after kidney transplantation (KT) remains unknown. MATERIAL AND METHODS This was a single-center retrospective study of KT candidates from January 2017 to May 2020. We collected patients' demographics, cardiovascular (CV) risk factors, and the findings of pre-KT CV imaging. We also collected parathyroid hormone (PTH) values before KT, at 1-6 months, 6-12 months, and 12-24 months after KT. We defined pHPT as PTH ≥25.5 pmol/L after 12 months post-KT. RESULTS A total of 111 KT recipients (KTRs) with a mean age of 50.4 years were included, of which 62.2% were men and 77.5% were living-donor KTRs. Dialysis modality used before KT was peritoneal dialysis in 9.9% and hemodialysis in 82.9%. Dialysis vintage was 3±2.9 years. The prevalence of pHPT was 24.3% (n=27), and the prevalence of severe coronary calcifications (CCS >400 Agatston units) was 19.8% (n=22). PTH values at baseline, 1-6 months, 6-12 months, and 12-24 months were not different among between CCS >400 or CCS <400 groups. However, pHPT after KT was significantly more prevalent in KTRs with severe CCS (37% vs 14.3%, p=0.014). Severe CCS was associated with less improvement of PTH values after KT (r=0.288, p=0.020). Otherwise, the findings of cardiac PET and coronary angiogram were not significantly different between pHPT and non-pHPT patients. CCS >400 was independently associated with pHPT after transplant (aOR=18.8, P=0.012). CONCLUSIONS Severe CCS on pre-KT cardiac assessment is associated with pHPT after KT.
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Affiliation(s)
- Ziad Arabi
- Division of Nephrology, Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard – Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Tarek Arabi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Muhannad Alqudsi
- Division of Nephrology, Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard – Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Areez Shafqat
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Tijani A, Coons EM, Mizuki B, Dermady M, Stanilova K, Casey AL, Alqudsi M, Gastanaduy M, Elmayan A, Bamnolker A, Velez JCQ. Direct Oral Anticoagulants Versus Warfarin for Venous Thromboembolism Prophylaxis in Patients With Nephrotic Syndrome: A Retrospective Cohort Study. Ann Pharmacother 2022:10600280221129348. [DOI: 10.1177/10600280221129348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Evidence supporting venous thromboembolism (VTE) prophylaxis with direct oral anticoagulants (DOACs) in patients with nephrotic syndrome (NS) is limited to case reports. Objective: The purpose of this study was to compare bleeding and thromboembolic events in this population. Methods: A retrospective cohort study was conducted in adults with NS initiated on a DOAC or warfarin for VTE prophylaxis between January 2013 and July 2021 within the Ochsner Health System. Patients with study drug exposure within the preceding 7 days, acute VTE within the preceding 6 months, or ≤7 days of study drug exposure were excluded. The primary outcome was the composite rate of major bleeding and clinically relevant nonmajor bleeding. Secondary outcomes included time to major bleeding and rate of new thromboembolic events. This study was approved by the Ochsner Health System Institutional Review Board. Results: Twenty-five DOAC and 19 warfarin patients were included. The primary outcome occurred in 8% vs 26.3% ( P = 0.21) of patients treated with a DOAC or warfarin, respectively, and was driven by major bleeding (4% vs 21%, P = 0.25). Other secondary outcomes were similar between cohorts. The study was limited by a small sample size. Conclusion and Relevance: Use of DOACs for VTE prophylaxis resulted in a nonstatistically significant, but clinically relevant lower rate of major bleeding compared to warfarin. This study provides comparative data showing safe and effective use of DOACs in patients with NS. Prospective, randomized studies are needed to confirm results.
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Affiliation(s)
- Aminat Tijani
- Department of Pharmacy, Ochsner Health, New Orleans, LA, USA
| | - Eric M. Coons
- Department of Pharmacy, Ochsner Health, New Orleans, LA, USA
| | - Britta Mizuki
- Department of Pharmacy, Ochsner Health, New Orleans, LA, USA
| | - Miranda Dermady
- Department of Pharmacy, Ochsner Health, New Orleans, LA, USA
| | | | - Ashley L. Casey
- Department of Pharmacy, Ochsner Health, New Orleans, LA, USA
| | | | | | - Ardem Elmayan
- Ochsner Center for Outcomes Research, Ochsner Health, New Orleans, LA, USA
| | - Adi Bamnolker
- Department of Hospital Medicine, Ochsner Health, New Orleans, LA, USA
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Abstract
Kratom (Mitragyna speciosa), a tree found abundantly in Southeast Asia, has been used for centuries because of its opioid-like properties. In the last 20 years, it has gained popularity in the United States of America due to its easy availability and effects on pain control. However, different types of toxicity from kratom use have been reported in the literature. Here, we present a case of kratom-induced hyperkalemia in a 61-year-old patient with no significant past medical history. His laboratory work-up excluded other etiologies, and his potassium level eventually normalized after the discontinuation of kratom. Although reasonable data exist on kratom effects on the nervous and cardiovascular systems, the magnitude of its effect on potassium homeostasis and whether it is kidney mediated or not is not well recognized.
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Affiliation(s)
- Aldo Torres-Ortiz
- Department of Internal Medicine, Ochsner Medical Center, New Orleans, USA
| | - Said Al Zein
- Department of Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Muhannad Alqudsi
- Department of Nephrology, The University of Queensland Ochsner Clinical School, New Orleans, USA
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Al Zein S, Shueib A, Alqudsi M. A Case of Immunoglobulin A (IgA)-Dominant Infection-Related Glomerulonephritis Treated With Plasmapheresis. Cureus 2022; 14:e22916. [PMID: 35399483 PMCID: PMC8986500 DOI: 10.7759/cureus.22916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 11/25/2022] Open
Abstract
Immunoglobulin A (IgA)-dominant infection-related glomerulonephritis (IRGN) is mostly associated with Staphylococcal or other bacterial infections like Streptococcus and Gram-negative bacilli. Antibiotics are the cornerstone of treatment in these cases. When the bacterial infection can’t be recognized or IRGN persists despite treating the underlying infection, controlling the kidney injury becomes cumbersome and lacks a strong evidence-based approach. In this report, we describe a 38-year-old male patient with a history of polysubstance abuse and chronic hepatitis B and hepatitis C infections who presented with acute kidney injury and nephrotic syndrome due to IgA-dominant IRGN without an active concurrent bacterial infection who responded well to plasmapheresis.
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Abstract
PURPOSE OF REVIEW Controlling hypertension to the desired target is commonly unsuccessful and requires multi-drug regimen, which can lead to undesirable side effects. Resistant hypertension (RH) is more cumbersome to deal with and has robust morbidity and mortality burden even with current multiple medical options. Herein, we review the literature for the potential role of sodium-glucose cotransporter 2 inhibitors (SGLT2i) as a treatment option for hypertension and RH. RECENT FINDINGS With more recent randomized controlled trials (RCTs), SGLT2i have gained more recognition for their renal and cardiovascular protection as well as mortality benefit that are believed to be medication class-related effects. Multiple RCTs have evaluated blood pressure (BP) lowering properties of SGLT2i, as a primary or secondary end point, in diabetic and nondiabetic patients, yet trials are scarce in studying SGLT2i as first-line antihypertensives, or as add-on agents for treating RH. SUMMARY Finding the right medical therapy in treating hypertension, especially RH, is commonly onerous when it comes to achieving BP targets, avoiding medication side effects, and aiming for the best outcomes. Utilizing existing drugs like SGLT2i or exploring other novel agents with more RCTs for these purposes will be beneficial. The addition of SGLT2i to the therapeutic armamentarium in patients with RH should be considered as a target for upcoming RCTs.
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Affiliation(s)
- Muhannad Alqudsi
- Department of Nephrology, Ochsner Health System, New Orleans, Louisiana, USA
- Ochsner Clinical School, The University of Queensland, St Lucia, Queensland, Australia
| | - Juan Carlos Q Velez
- Department of Nephrology, Ochsner Health System, New Orleans, Louisiana, USA
- Ochsner Clinical School, The University of Queensland, St Lucia, Queensland, Australia
| | - Jose Navarrete
- Emory University School of Medicine, Atlanta, Georgia, USA
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Mohamed MM, Lukitsch I, Torres-Ortiz AE, Walker JB, Varghese V, Hernandez-Arroyo CF, Alqudsi M, LeDoux JR, Velez JCQ. Acute Kidney Injury Associated with Coronavirus Disease 2019 in Urban New Orleans. ACTA ACUST UNITED AC 2020; 1:614-622. [DOI: 10.34067/kid.0002652020] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/13/2020] [Indexed: 01/01/2023]
Abstract
BackgroundAKI is a manifestation of COVID-19 (CoV-AKI). However, there is paucity of data from the United States, particularly from a predominantly black population. We report the phenotype and outcomes of AKI at an academic hospital in New Orleans.MethodsWe conducted an observational study in patients hospitalized at Ochsner Medical Center over a 1-month period with COVID-19 and diagnosis of AKI (KDIGO). We examined the rates of RRT and in-hospital mortality as outcome measures.ResultsAmong 575 admissions (70% black) with COVID-19 [173 (30%) to an intensive care unit (ICU)], we found 161 (28%) cases of AKI (61% ICU and 14% general ward admissions). Patients were predominantly men (62%) and hypertensive (83%). Median body mass index (BMI) was higher among those with AKI (34 versus 31 kg/m2, P<0.0001). AKI over preexisting CKD occurred in 35%. Median follow-up was 25 (1–45) days. The in-hospital mortality rate for the AKI cohort was 50%. Vasopressors and/or mechanical ventilation were required in 105 (65%) of those with AKI. RRT was required in 89 (55%) patients. Those with AKI requiring RRT (AKI-RRT) had higher median BMI (35 versus 33 kg/m2, P=0.05) and younger age (61 versus 68, P=0.0003). Initial values of ferritin, C-reactive protein, procalcitonin, and lactate dehydrogenase were higher among those with AKI; and among them, values were higher for those with AKI-RRT. Ischemic acute tubular injury (ATI) and rhabdomyolysis accounted for 66% and 7% of causes, respectively. In 13%, no obvious cause of AKI was identified aside from COVID-19 diagnosis.ConclusionsCoV-AKI is associated with high rates of RRT and death. Higher BMI and inflammatory marker levels are associated with AKI as well as with AKI-RRT. Hemodynamic instability leading to ischemic ATI is the predominant cause of AKI in this setting.
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