scholarly journals Measures of Loop Diuretic Efficiency and Prognosis in Chronic Kidney Disease

2020 ◽  
Vol 10 (6) ◽  
pp. 402-414
Author(s):  
Frederik Hendrik Verbrugge ◽  
Pieter Martens ◽  
Jeffrey M. Testani ◽  
W.H. Wilson Tang ◽  
Dirk Kuypers ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Median Time ◽  
Urine Output ◽  
Loop Diuretic ◽  
Diuretic Therapy ◽  
Prognostic Impact ◽  
All Cause Mortality ◽  
Diuretic Efficiency ◽  
Class Iv

<b><i>Background:</i></b> The evolution and prognostic impact of loop diuretic efficiency according to chronic kidney disease (CKD) severity is unclear. <b><i>Methods:</i></b> This retrospective cohort study includes 783 CKD patients on oral loop diuretic therapy with a 24-h urine collection available. Acute kidney injury and history of renal replacement therapy were exclusion criteria. Patients were stratified according to Kidney Disease Improving Global Outcomes (KDIGO) glomerular filtration rate class. Loop diuretic efficiency was calculated as urine output, natriuresis, and chloruresis, each adjusted for loop diuretic dose, and compared among strata. Risk for onset of dialysis and all-cause mortality was evaluated. <b><i>Results:</i></b> Loop diuretic efficiency metrics decreased from KDIGO class IIIB to IV in furosemide users and from KDIGO class IV to V with all loop diuretics (<i>p</i> value &#x3c;0.05 for all comparisons). The correlation between loop diuretic efficiency and creatinine clearance was moderate at best (Spearman’s <i>ρ</i> 0.298–0.436; <i>p</i> value &#x3c;0.001 for all correlations). During median follow-up of 45 months, 457 patients died (58%) and 63 received kidney transplantation (8%), while dialysis was started before in 328 (42%). All loop diuretic efficiency metrics were significantly and independently associated with both the risk for dialysis and all-cause mortality. In KDIGO class IV/V patients, low loop diuretic efficiency (i.e., urine output adjusted for loop diuretic dose ≤1,000 mL) shortened median time to dialysis with 24 months and median time to all-cause mortality with 23 months. <b><i>Conclusion:</i></b> Low loop diuretic efficiency is independently associated with a shorter time to dialysis initiation and a higher risk for all-cause mortality in CKD.

scholarly journals Chronic kidney disease impairs prognosis in electrical storm

2021 ◽  
Author(s):  
Kathrin Weidner ◽  
Michael Behnes ◽  
Tobias Schupp ◽  
Jorge Hoppner ◽  
Uzair Ansari ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Heart Rhythm ◽  
Electrical Storm ◽  
Prognostic Impact ◽  
Cardiac Events ◽  
All Cause Mortality ◽  
Life Threatening ◽  
Long Term Mortality

Abstract Background The study sought to assess the prognostic impact of chronic kidney disease (CKD) in patients with electrical storm (ES). ES represents a life-threatening heart rhythm disorder. In particular, CKD patients are at risk of suffering from ES. However, data regarding the prognostic impact of CKD on long-term mortality in ES patients is limited. Methods All consecutive ES patients with an implantable cardioverter–defibrillator (ICD) were included retrospectively from 2002 to 2016. Patients with CKD (MDRD-GFR < 60 ml/min/1.73 m2) were compared to patients without CKD. The primary endpoint was all-cause mortality at 3 years. Secondary endpoints were in-hospital mortality, cardiac rehospitalization, recurrences of electrical storm (ES-R), and major adverse cardiac events (MACE) at 3 years. Results A total of 70 consecutive ES patients were included. CKD was present in 43% of ES patients with a median glomerular filtration rate (GFR) of 43.3 ml/min/1.73 m2. CKD was associated with increased all-cause mortality at 3 years (63% vs. 20%; p = 0.001; HR = 4.293; 95% CI 1.874–9.836; p = 0.001) and MACE (57% vs. 30%; p = 0.025; HR = 3.597; 95% CI 1.679–7.708; p = 0.001). In contrast, first cardiac rehospitalization (43% vs. 45%; log-rank p = 0.889) and ES-R (30% vs. 20%; log-rank p = 0.334) were not affected by CKD. Even after multivariable adjustment, CKD was still associated with increased long-term mortality (HR = 2.397; 95% CI 1.012–5.697; p = 0.047), as well as with the secondary endpoint MACE (HR = 2.520; 95% CI 1.109–5.727; p = 0.027). Conclusions In patients with ES, the presence of CKD was associated with increased long-term mortality and MACE.

Therapeutic targets for the anemia of predialysis chronic kidney disease: a meta-analysis of randomized, controlled trials

2019 ◽  
Vol 67 (6) ◽  
pp. 1002-1008 ◽  
Author(s):  
Hongyong Liu ◽  
Yuqiu Ye ◽  
Yanbing Chen ◽  
Yunqiang Zhang ◽  
Shaomin Li ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Prognostic Impact ◽  
Stroke Treatment ◽  
Risk Of Death ◽  
Mesh Terms ◽  
Significant Difference ◽  
All Cause Mortality

Anemia is one of the major complications in predialysis patients with chronic kidney disease (CKD). A clearer cognition of the prognostic impact of hemoglobin (Hb) or hematocrit (Hct) target on the outcomes of predialysis patients with CKD is significant. This article aims to establish the suitable hemoglobin target to provide clinical guidance. MEDLINE, EmBase, the Cochrane Library and other databases were searched with both MeSH terms and keywords to gather researches that assessed all-cause mortality, stroke, treatment of renal replacement, and transfusion. The meta-analysis was accomplished via Revman 5.3 version. Totally, 13 eligible studies involving 7606 patients were included. There was a significantly lower risk of transfusion (risk ratio (RR) 0.59, 95% CI 0.52 to 0.67; p<0.00001) in the higher hemoglobin group than in the lower one. However, no significant difference was found in all-cause mortality (RR 1.10, 95% CI 0.98 to 1.23; p=0.11), stroke (RR 1.32, 95% CI 0.82 to 2.10; p=0.25) and treatment of renal replacement including hemodialysis, peritoneal dialysis and renal transplant (RR 1.08, 95% CI 0.95 to 1.22; p= 0.23) between the higher hemoglobin group and the lower one. The results favor the higher hemoglobin target. To target the higher hemoglobin when treating predialysis patients with CKD may decrease the risk of transfusion without increasing the risk of death, stoke, and treatment of renal replacement.

Acute coronary syndromes in chronic kidney disease patients: the good, the bad or the ugly?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Saleiro ◽  
D De Campos ◽  
J Lopes ◽  
R Teixeira ◽  
J.P Sousa ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Systolic Function ◽  
Lv Function ◽  
Angiotensin Ii Antagonist ◽  
All Cause Mortality ◽  
Group A ◽  
Lv Ejection Fraction ◽  
Group B ◽  
Lv Systolic Function

Abstract Background Patients with chronic kidney disease (CKD) are at increased risk of composite cardiovascular (CV) events and all-cause mortality. However, current aggressiveness of therapeutic strategies may minimize the course of the disease. Aim To assess the prognostic impact of optimized medical treatment in a CKD population with acute coronary syndrome (ACS). Methods 355 ACS patients admitted to a single coronary care with CKD who were discharged from hospital were included. Those with end-stage renal disease were excluded. Three groups were created based on the KDIGO classification: Group A (Stage 3A, eGFR [estimated glomerular filtration rate] 45–59mL/min/1.73 m2) N=190; Group B (Stage 3B, eGFR 30–44mL/min/1.73 m2) N=113; and Group C (Stage 3B, eGFR 15–29mL/min/1.73 m2) N=52. The primary endpoint was long-term all-cause mortality. Kaplan-Meyer survival curves and Cox regression were done. The median of follow-up was 32 (IQ 15–70) months. Results Groups were similar regarding demographics, CV risk factors, ACS type, heart failure diagnosis, left ventricular (LV) systolic function, peak troponin, multivessel disease, treatment option (PCI, CABG or OMT) and medical therapy at discharge. More advance renal failure patients had a higher prevalence of diabetes mellitus (DM), a lower haemoglobin, a higher NT-proBNP and were less likely to receive ACE inhibitors/angiotensin II antagonist at discharge. 170 patients met the primary outcome. Kaplan-Meyer curves showed decreased survival with worse renal function (Group A 68% vs Group B 57% vs Group C 37%, Log Rank P=0.006 – Figure 1). After adjustment for age, DM, haemoglobin, NT-proBNP, LV systolic function and ACE inhibitors/angiotensin II antagonist at discharge, eGFR was not associated with increased death (HR 1.00, 95% CI 0.98–1.01). In this model, only age (HR 1.04, 95% CI 1.01–1.07), haemoglobin (HR 0.86, 95% CI 0.979–0.94), Nt-proBNP (HR 1.00, 95% CI 1.00–1.00) and impaired LV function (LV ejection fraction 40–49%: HR 2.95, 95% CI 1.89–4.81; LV ejection fraction &lt;40%: HR 2.15, 95% CI 1.44–3.21) remained associated with the outcome. Conclusion The worse outcome attributed to CKD after an ACS seems to be related not the eGFR itself but to associated comorbidities such as age, anaemia, fluid overload and impaired LV function. The fact that some of these comorbidities may be altered by intensive therapy indicates that CKD patients should also be candidates to optimized medical treatment. Funding Acknowledgement Type of funding source: None

scholarly journals Prevalence and prognostic impact of chronic kidney disease in STEMI from a gender perspective: data from the SWEDEHEART register, a large Swedish prospective cohort

BMJ Open ◽  
2015 ◽  
Vol 5 (6) ◽  
pp. e008188 ◽  
Author(s):  
Sofia Sederholm Lawesson ◽  
Joakim Alfredsson ◽  
Karolina Szummer ◽  
Mats Fredrikson ◽  
Eva Swahn
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Prospective Cohort ◽  
Prognostic Impact ◽  
Gender Perspective

scholarly journals High dietary fiber intake is associated with decreased inflammation and all-cause mortality in patients with chronic kidney disease

2012 ◽  
Vol 81 (3) ◽  
pp. 300-306 ◽  
Author(s):  
Vidya M. Raj Krishnamurthy ◽  
Guo Wei ◽  
Bradley C. Baird ◽  
Maureen Murtaugh ◽  
Michel B. Chonchol ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Dietary Fiber ◽  
Fiber Intake ◽  
Dietary Fiber Intake ◽  
All Cause Mortality
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