scholarly journals Visceral to subcutaneous fat ratio as an indicator of a ≥30% eGFR decline in chronic kidney disease

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241626
Author(s):  
Hiroshi Kataoka ◽  
Toshio Mochizuki ◽  
Kazuhiro Iwadoh ◽  
Yusuke Ushio ◽  
Keiko Kawachi ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Visceral Fat ◽  
Cox Regression ◽  
Strong Association ◽  
Subcutaneous Fat ◽  
Absolute Amount ◽  
Cox Regression Analysis ◽  
Renal Outcomes ◽  
Renal Prognosis

Whether the visceral-to-subcutaneous fat ratio (V/S ratio) is associated with renal prognosis in patients with chronic kidney disease (CKD) remains unclear. Furthermore, little is known about the effect of sex and the absolute amount of visceral fat accumulation such as visceral fat area (VFA) ≥100 cm2 on the V/S ratio in relation to renal prognosis. In this study, 200 patients with CKD were evaluated for renal prognosis. Survival analyses and logistic regression analyses were conducted, generating time-series pseudo-R2 values. The mean and percent change of the pseudo-R2 values from the 6th year to the 10th year (6Y–10Y Mean and 6Y–10Y Change, respectively) were calculated for determining the cut-off points for the medium-term renal prognosis. Multivariate Cox regression analysis revealed that the V/S ratio was significantly associated with renal outcomes and that the VFA category (VFA ≥ 100 cm2) had significant interactions with the V/S ratio regarding renal prognosis. The hazard ratio (HR) of the V/S ratio was higher in the sub-cohort of VFA < 100 cm2 than in the sub-cohort of VFA ≥ 100 cm2 (HR: 6.42 vs. 1.00). Regarding sex differences, a strong association was noted between the V/S ratio and renal prognosis in women but not in men (HR: 2.40 vs. 1.10). On the other hand, 6Y–10Y Mean of the pseudo-R2 values indicated differences in the cut-off points of the V/S ratio between men and women (V/S ratio: 0.75 vs. 0.5). Our findings indicate that it may be clinically meaningful to consider the differences in sex and the amount of VFA ≥100 cm2 for the V/S ratio in relation to renal outcomes in patients with CKD. The 6Y–10Y Mean of the pseudo-R2 values contributed to determining the cut-off points of the V/S ratio according to the sex difference.

Relationship between renal biopsy and renal survival in elderly patients with chronic kidney disease: A propensity score matching approach

2020 ◽  
Author(s):  
Xiaowei Lou ◽  
Shizhu Yuan ◽  
Wei Shen ◽  
Yueming Liu ◽  
Juan Jin ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Elderly Patients ◽  
Renal Biopsy ◽  
Cox Regression ◽  
Renal Survival ◽  
Aged Patients ◽  
Renal Outcomes ◽  
Propensity Matching

Abstract Background The effect of renal biopsy on the prognosis of elderly patients with chronic kidney disease remains unclear. Thus, in this study, we aimed to evaluate the relationship between renal biopsy and renal survival in this population.Methods In this multi-centre retrospective study, the baseline characteristics among three groups were balanced by propensity matching. All patients were divided into three groups according to age and renal biopsy. The clinicopathological features at biopsy and renal outcomes during the follow-up were collected and analysed. Renal outcomes were defined as estimated glomerular filtration rate < 15 mL/min/1.73 m2, dialysis, renal transplantation, or death. The prognostic effects of renal biopsy were evaluated using Cox regression models. Results A total of 1313 patients were identified. After propensity matching, 390 patients were selected and divided into three groups. After a total follow-up period of 55 months, 20 (13.3%) patients (47.6% group 1 vs 7.41% group 2 vs 39.1% group 3) reached renal outcomes. No significant differences were found in renal outcomes among aged patients whether they underwent renal biopsy or not. Cox regression analysis revealed risk factors in aged patients including low albumin and high levels of proteinuria and serum creatinine (P < 0.05). Platelet count was significant only in aged patients who underwent renal biopsy (hazard ratio: 0.642, P < 0.05). Conclusion In conclusion, renal biopsy in the elderly has not shown benefits in terms of renal survival, conservative treatment appears to be a viable therapeutic option in the management of those people.

Bypass Grafting vs Endovascular Therapy in Patients With Non-Dialysis-Dependent Chronic Kidney Disease and Chronic Limb-Threatening Ischemia (CRITISCH Registry)

2020 ◽  
Vol 27 (4) ◽  
pp. 599-607
Author(s):  
Konstantinos Stavroulakis ◽  
Asimakis Gkremoutis ◽  
Matthias Borowski ◽  
Giovanni Torsello ◽  
Dittmar Böckler ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Chronic Kidney Disease ◽  
Overall Survival ◽  
Kidney Disease ◽  
Endovascular Therapy ◽  
Proportional Hazards ◽  
Cox Regression ◽  
Cox Proportional Hazards ◽  
Bypass Grafting ◽  
Cox Regression Analysis

Purpose: To report the outcomes of bypass grafting (BG) vs endovascular therapy (EVT) in patients with non-dialysis-dependent chronic kidney disease (CKD) and chronic limb-threatening ischemia (CLTI). Materials and Methods: The CRITISCH Registry is a prospective, national, interdisciplinary, multicenter registry evaluating the current practice of all available treatment options in 1200 consecutive CLTI patients. For the purposes of this analysis, only the 337 patients with non-dialysis-dependent CKD treated by either BG (n=86; median 78 years, 48 men) or EVT (n=251; median age 80 years, 135 men) were analyzed. The primary composite outcome was amputation-free survival (AFS); secondary outcomes were overall survival (OS) and amputation-free time (AFT). All outcomes were evaluated in Cox proportional hazards models; the results are reported as the hazard ratio (HR) and 95% confidence interval (CI). Results: The Cox regression analysis revealed a significantly greater hazard of amputation or death after BG (HR 1.78, 95% CI 1.05 to 3.03, p=0.028). The models for AFT and overall survival also suggested a higher hazard for BG, but the differences were not significant (AFT: HR 1.66, 95% CI 0.78 to 3.53, p=0.188; OS: HR 1.41, 95% CI 0.80 to 2.47, p=0.348). The absence of runoff vessels (HR 1.73, 95% CI 1.15 to 2.60, p=0.008) was associated with a decreased AFS. The likelihood of amputation was higher in male patients (HR 2.21, 95% CI 1.10 to 4.45, p=0.027) and was associated with a lack of runoff vessels (HR 1.95, 95% CI 0.96 to 3.95, p=0.065) and myocardial infarction (HR 3.74, 95% CI 1.23 to 11.35, p=0.020). Death was more likely in patients without runoff vessels (HR 1.76, 95% CI 1.11 to 2.80, p=0.016) and those with a higher risk score (HR 1.73, 95% CI 1.03 to 2.91, p=0.038). Conclusion: This analysis suggested that BG was associated with poorer AFS than EVT in patients with non-dialysis-dependent CKD and CLTI. Male sex, previous myocardial infarction, and the absence of runoff vessels were additionally identified as predictors of poorer outcomes.

scholarly journals MO159CHA2DS2-VASC SCORE AS A PREDICTOR OF CARDIOVASCULAR MORTALITY IN CHRONIC KIDNEY DISEASE PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Nina Vodošek Hojs ◽  
Robert Ekart ◽  
Sebastjan Bevc ◽  
Nejc Piko ◽  
Radovan Hojs
Keyword(s):  
Chronic Kidney Disease ◽  
Regression Analysis ◽  
Cardiovascular Risk ◽  
Kidney Disease ◽  
Cardiovascular Mortality ◽  
Cox Regression ◽  
High Sensitivity ◽  
Cardiovascular Death ◽  
Cox Regression Analysis

Abstract Background and Aims Cardiovascular mortality is high in chronic kidney disease (CKD) patients. Recognizing patients with higher cardiovascular risk might help in their treatment. CHA2DS2-VASc score was originally used to predict cerebral infarction in patients with atrial fibrillation (AF). However, it is also useful in predicting outcome in different cardiovascular conditions, independent of the presence of AF. Therefore, the aim of our research was to assess the role of CHA2DS2-VASc score in cardiovascular mortality in CKD patients. Method Eighty-seven non-dialysis CKD patients from our outpatient clinic were included. At the time of inclusion, medical history data and standard blood results were collected and CHA2DS2-VASc score was calculated. Patients were followed for assigned time or until their death. Mean follow-up time was 1696.45±564.60 days. Results Descriptive statistics of our patients are presented in table 1. During follow-up 11 patients suffered from cardiovascular death. Univariate Cox regression analysis showed that CHA2DS2-VASc score is a significant predictor of cardiovascular mortality (HR: 2.19, CI: 1.42-3.37, p=0.001). In multivariate Cox regression analysis in which CHA2DS2-VASc score, serum creatinine, urinary albumin/creatinine, haemoglobin, high sensitivity CRP and intact PTH were included, CHA2DS2-VASc score was an independent predictor of cardiovascular mortality (HR: 2.04, CI: 1.20-3.45, p=0.008) (table 2). Conclusion CHA2DS2-VASc score is a simple and quick way to identify cardiovascular risk in CKD patients.

scholarly journals Association of rs11780592 Polymorphism in the Human Soluble Epoxide Hydrolase Gene (EPHX2) with Oxidized LDL and Mortality in Patients with Diabetic Chronic Kidney Disease

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Stefanos Roumeliotis ◽  
Athanasios Roumeliotis ◽  
Aikaterini Stamou ◽  
Stylianos Panagoutsos ◽  
Vangelis G. Manolopoulos ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Epoxide Hydrolase ◽  
Cox Regression ◽  
Oxidized Ldl ◽  
Intima Media Thickness ◽  
Soluble Epoxide Hydrolase ◽  
Cox Regression Analysis ◽  
Functional Polymorphisms ◽  
All Cause Mortality

Soluble epoxide hydrolase 2 (EPHX2) is an enzyme promoting increased cellular apoptosis through induction of oxidative stress (OS) and inflammation. The EPHX2 gene which encodes soluble EPHX2 might be implicated in the pathogenesis and development of OS and atherosclerosis. We aimed to assess the possible association between two functional polymorphisms of the EPHX2 gene (rs2741335 and rs11780592) with oxidized LDL (ox-LDL), carotid atherosclerosis, mortality, and cardiovascular (CV) disease in 118 patients with diabetic chronic kidney disease (CKD). At baseline, ox-LDL and carotid intima-media thickness (cIMT) were evaluated and all patients were followed for seven years with outcomes all-cause mortality and CV events. rs11780592 EPHX2 polymorphism was associated with ox-LDL, cIMT, albuminuria, and hypertension. Compared to AG and GG, AA homozygotes had higher values of albuminuria, ox-LDL, and cIMT ( p = 0.046 , p = 0.003 , and p = 0.038 , respectively). These associations remained significant, even after grouping for the G allele. After the follow-up period, 42/118 patients died (30/60 with AA genotype, 11/42 with AG genotype, and 1/12 with GG genotype) and 49/118 experienced a new CV event (fatal or nonfatal). The Kaplan-Meier analysis revealed that patients with the AA genotype exhibited a significantly higher mortality risk, compared to patients with AG and GG genotypes ( p = 0.006 ). This association became even stronger, when AG and GG genotypes were grouped (AA vs. AG/GG, p = 0.002 ). AA homozygotes were strongly associated with all-cause mortality in both univariate (hazard ratio HR = 2.74 , confidence interval CI = 1.40 – 5.35 , p = 0.003 ) and multivariate Cox regression analysis ( HR = 2.61 , CI = 1.32 – 5.17 , p = 0.006 ). In conclusion, our study demonstrated that genetic variations of EPHX2 gene were associated with increased circulating ox-LDL, increased cIMT, and all-cause mortality in diabetic CKD. Since EPHX2 regulates the cholesterol efflux and the oxidation of LDL in foam cells and macrophages, our study suggests that a genetic basis to endothelial dysfunction and OS might be present in diabetic CKD.

scholarly journals Dietary intakes of total polyphenol and its subclasses in relation to incidence of chronic kidney disease: a prospective population-based cohort study

2020 ◽  
Author(s):  
Parvin Mirmiran ◽  
Emad Yuzbashian ◽  
Pegah Rahbarinejad ◽  
Golaleh Asghari ◽  
Fereidoun Azizi
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Phenolic Acids ◽  
Cox Regression ◽  
Dietary Intakes ◽  
Total Polyphenols ◽  
Moderate Amount ◽  
Total Polyphenol ◽  
Cox Regression Analysis ◽  
Incidence Of Ckd

Abstract Background: Chronic kidney disease (CKD) is nowadays a public health challenge worldwide. Accordingly, this study is aiming to evaluate the association between long-term intake of total polyphenol and its subclasses, and the incidence of CKD. Methods: A sample of 3021 Iranian Adults (47% men) were selected from the Tehran Lipid and Glucose Study population. The participants aged 20-79 years and had no diagnosis of CKD at baseline. Total polyphenol intake and its major subclasses including flavonoids, phenolic acids, stilbenes, and lignans, was assessed by a validated and reliable food frequency questionnaire, and were categorized as flavonoids, phenolic acids, stilbenes, and lignans. CKD should be defined by either reduction in eGFR or by morphological abnormalities of the kidneys or by abnormalities in the urinalysis persistent for 3 months. Since GFR is generally accepted as the best overall index of kidney function, in current study CKD was exclusively defined as eGFR <60 mL/min/1.73m2. The Modification of Diet in Renal Disease Study equation was used to calculate the estimated glomerular filtration rate (eGFR).Hazard ratio and 95% confidence intervals of CKD by total polyphenols quartiles were assessed by Cox-regression analysis. Results: In this study, we documented 355 cases of diagnosed CKD over 11,058.464 person-years. The median [IQR] age of participants was 36 [27-46] years at baseline. After adjustment of the potential confounders, it was revealed that a moderate intake of lignans (≤6.8 mg) was negatively associated with the incidence of CKD, whereas there was no significant association between the higher amounts of lignan intake and CKD. No significant associations were observed between the consumption of total polyphenols and the incidence of CKD (HR: 0.97, 95% CI 0.67-1.40). Conclusions: Data of the current study suggest that in the case of lignan with protective properties, a moderate amount of lignan favorably reduced the incidence of CKD by approximately 32%, whereas higher amounts possessed a null effect.

scholarly journals Dietary intakes of total polyphenol and its subclasses in relation to incidence of chronic kidney disease: a prospective population-based cohort study

2020 ◽  
Author(s):  
Parvin Mirmiran ◽  
Emad Yuzbashian ◽  
Pegah Rahbarinejad ◽  
Golaleh Asghari ◽  
Fereidoun Azizi
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Phenolic Acids ◽  
Cox Regression ◽  
Dietary Intakes ◽  
Total Polyphenols ◽  
Moderate Amount ◽  
Total Polyphenol ◽  
Cox Regression Analysis ◽  
Incidence Of Ckd

Abstract Objective Chronic Kidney Disease (CKD) is nowadays a public health challenge worldwide. Accordingly, this study is aiming to evaluate the association between long-term intake of total polyphenol and its subclasses, and the incidence of CKD. Methods A sample of 3021 Iranian Adults (47% men) were selected from the the Tehran Lipid and Glucose Study population. The participants aged 20–79 years and had no diagnosis of CKD at baseline. Total polyphenol intake and its major subclasses including flavonoids, phenolic acids, stilbenes, and lignans, was assessed by a validated and reliable Food Frequency Questionnaire (FFQ). The of the were broadly categorized as flavonoids, phenolic acids, stilbenes, and lignans. The Modification of Diet in Renal Disease Study equation was used to calculate the Estimated Glomerular Filtration Rate (eGFR), and, CKD was defined as eGFR < 60 mL/min/1.73 m2. Hazard ratio and 95% confidence intervals of CKD by total polyphenols quartiles were assessed by Cox-regression analysis. Results In this study, we documented 355 cases of diagnosed CKD over 11,058.464 person-years. The mean ± SD age of participants was 37.3 ± 12.6 years at baseline. After adjustment of the potential confounders, it was revealed that a moderate intake of lignans (≤ 6.8 mg) was negatively associated with the incidence of CKD, whereas there was no significant association between the higher amounts of lignan intake and CKD. No significant associations were observed between the consumption of total polyphenols and the incidence of CKD (HR: 0.97, 95% CI 0.67–1.40). Conclusions Data of the current study suggest that in the case of lignan with protective properties, a moderate amount of lignan favorably reduced the incidence of CKD by approximately 32%, whereas higher amounts possessed a null effect.

scholarly journals Loss of the Normal Gradient in Arterial Compliance and Outcomes of Chronic Kidney Disease Patients

2019 ◽  
Vol 9 (5) ◽  
pp. 297-307
Author(s):  
Qiong Bai ◽  
Chun-Yan Su ◽  
Ai-Hua Zhang ◽  
Tao Wang ◽  
Wen Tang
Keyword(s):  
Patient Outcome ◽  
Chronic Kidney Disease ◽  
Regression Analysis ◽  
Kidney Disease ◽  
Cox Regression ◽  
Arterial Compliance ◽  
Prognostic Significance ◽  
Significant Interaction Effect ◽  
Cox Regression Analysis ◽  
Ckd Stage

Background: In dialysis patients, loss of the normal gradient in arterial compliance, assessed by the pulse wave velocity (PWV) ratio, predicts all-cause mortality better than does carotid-femoral PWV (CF-PWV) alone. However, the prognostic significance of the PWV ratio for outcome in chronic kidney disease (CKD) patients remains unclear. Methods: In this longitudinal cohort study, CKD patients who visited our CKD management clinic between April 27, 2006, and March 27, 2008, were included and followed up. To assess the gradient in arterial compliance, the PWV ratio was calculated using CF-PWV divided by carotid-radial PWV. Results: A total of 209 patients in CKD stages 1–4 with a median follow-up of 3.74 years were included. Patients with higher PWV ratio were relatively older (p < 0.001) and had worse renal function (p < 0.001), more hypertension (p < 0.001), diabetes mellitus (p < 0.001), and cardiovascular or cerebrovascular disease (p < 0.001). The median time to patient outcome (death, renal replacement therapy, or double increase in serum creatinine from baseline) in the group with a PWV ratio above the median (89.8 months, 95% CI 84.2–95.5) was shorter than that in the group with a PWV ratio below the median (105.3 months, 95% CI 101.3–109.3, p = 0.001). Univariate Cox regression analysis showed that both PWV ratio and CF-PWV were significantly associated with patient outcome. In multivariate Cox regression analysis, both PWV ratio and CF-PWV were associated with patient outcome. However, the HR for CF-PWV (2.177, 95% CI 1.064–4.453, p = 0.033) was slightly higher than that for PWV ratio (2.091, 95% CI 1.049–4.167, p = 0.036). There was a significant interaction effect between PWV ratio and CKD stage. It was shown that patients with advanced CKD stages and higher PWV ratios had a significantly higher risk of adverse CKD outcome (p = 0.006). Conclusions: The PWV ratio, as a measure of loss of the normal gradient in arterial compliance, was associated with CKD patient outcome. Patients with advanced CKD and a higher PWV ratio had a significantly higher risk of adverse CKD outcome.

P0676CHOLESTEROL ABSORPTION JUGDED BY CAMPESTEROL / LATHOSTEROL RATIO AND OUTCOMES IN CHRONIC KIDNEY DISEASE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Insa Elena Emrich ◽  
Gunnar Henrik Heine ◽  
Schulze Christian ◽  
Kyrill S Rogacev ◽  
Danilo Fliser ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cardiovascular Events ◽  
Cholesterol Synthesis ◽  
Cox Regression ◽  
Composite Endpoint ◽  
Cholesterol Absorption ◽  
Statin Treatment ◽  
Cox Regression Analysis ◽  
Cholesterol Ratio

Abstract Background and Aims In dialysis patients, cholesterol-lowering therapy with statins is less effective than in other high-risk patients. This may partly be explained by a shift from cholesterol synthesis, which is inhibited by statin treatment, towards cholesterol absorption, which is inhibited by ezetimibe. In line, markers of cholesterol absorption – such as campesterol - better predict atherosclerotic cardiovascular events than markers of cholesterol synthesis – such as lathosterol - in dialysis patients. We now investigated in our CARE FOR HOMe study whether a similar shift towards cholesterol absorption occurs in non-dialysis chronic kidney disease (CKD), and whether the campesterol / lathosterol ratio predicts outcome in non-dialysis CKD patients. Method Since 2008, 599 participants suffering from chronic kidney disease have been included into the CARE FOR HOME study, an observational cohort study. 555 patients had baseline samples available for analyses of the lathosterol / cholesterol ratio as a marker for cholesterol synthesis, and the campesterol / cholesterol ratio as a marker for cholesterol absorption. We excluded those participants who were currently treated with statins or other lipid lowering drugs, leaving 251 patients for this analysis. Participants were followed annually for major atherosclerotic cardiovascular events (MACE), defined as non-fatal acute myocardial infarction, non-fatal ischemic stroke, cerebrovascular / peripheral arterial or coronary revascularization, major amputation above the ankle and cardiovascular death. Additionally, all-cause death and the composite endpoint MACE and all-cause death were explored. We performed univariate (Model 1) and multivariate Cox regression analysis, adjusting for age, gender (Model 2), estimated glomerular filtration rate (eGFR), log-transformed albuminuria (Model 3), prevalent cardiovascular disease, current smoking, diabetes mellitus, systolic blood pressure and body mass index (Model 4). The primary hypothesis was that patients with a high campesterol / lathosterol ratio had a higher event rate. Results Neither lathosterol / cholesterol ratio (r = 0.022, p = 0.730), nor campesterol / cholesterol ratio (r = 0.042; p = 0.519) nor the campesterol / lathosterol ratio (r = -0.103; p = 0.105) correlated significantly with eGFR. During follow-up of 5.1 ± 2.1 years, 47 participants suffered from MACE, 46 participants died and 61 participants reached the composite endpoint of MACE or all-cause death. In univariate Cox regression analysis, campesterol / lathosterol ratio did not significantly predict atherosclerotic cardiovascular events (HR 0.740; 0.368 – 1.487), all-cause death (HR 0.564; 0.277 – 1.145) or the composite endpoint (HR 0.652; 0.355 – 1.196). After full adjustment, results were not different: Campesterol / lathosterol ratio was not significantly associated with all three endpoints: MACE (HR 1.064; 0.507 – 2.231), all-cause death (HR 0.818; 0.420 – 1.594) and MACE and all-cause death (HR 0.956; 0.525 – 1.744). Conclusion We did not observe a shift from cholesterol synthesis to cholesterol absorption across the spectrum of non-dialysis CKD. Campesterol / lathosterol ratio did not predict future MACE or all-cause death in non-dialysis CKD. These findings do not support the concept that CKD patients may preferentially benefit from ezetimibe rather than from statin treatment.

scholarly journals Derived Subendocardial Viability Ratio and Cardiovascular Events in Patients with Chronic Kidney Disease

2018 ◽  
Vol 9 (1) ◽  
pp. 41-50 ◽  
Author(s):  
Robert Ekart ◽  
Sebastjan Bevc ◽  
Nina Hojs ◽  
Radovan Hojs
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cardiovascular Events ◽  
Cox Regression ◽  
Rank Test ◽  
Coronary Perfusion ◽  
Cox Regression Analysis ◽  
Non Invasive ◽  
Kaplan Meier ◽  
Subendocardial Viability Ratio

Background: Chronic kidney disease (CKD) is a well-known mortality risk factor. The subendocardial viability ratio (SEVR) is one of the pulse wave analysis parameters that constitutes a non-invasive measure of coronary perfusion. We aimed to assess the prognostic value of the SEVR for cardiovascular outcome in non-dialysis CKD patients. Methods: A total of 98 CKD patients (mean age 60 years) were prospectively followed up from the date of the SEVR measurement until their death or the start of dialysis/transplantation, maximally up to 7.1 years (mean 5 years). According to the manufacturer’s instructions regarding normal SEVR values, the patients were divided into a low SEVR group (SEVR ≤130%, n = 26) and a normal SEVR group (SEVR > 130%, n = 72). Results: During the follow-up period, 13 patients (13.3%) suffered fatal and 23 patients (23.5%) suffered combined (non-fatal and fatal) cardiovascular events. In the patients who died of cardiovascular causes, the SEVR values were statistically significantly lower (130 vs. 154%; p = 0.017) than in those who survived. A Kaplan-Meier survival analysis showed that the cardiovascular survival rate in the low SEVR group of patients was statistically significantly lower (log-rank test: p < 0.001). Using an unadjusted Cox regression analysis, the patients in the low SEVR group had a 5.6-fold higher risk (95% CI: 1.8–17.3; p = 0.002) of fatal cardiovascular events and a 2.7-fold higher risk (95% CI: 1.1–6.3; p = 0.024) of combined fatal and non-fatal cardiovascular events. In the adjusted Cox regression model, the patients in the low SEVR group had a 16-fold higher risk (95% CI: 1.2–9.7; p = 0.004) of fatal cardiovascular events and a 7-fold higher risk (95% CI: 1–9.7; p = 0.009) of combined fatal and non-fatal cardiovascular events. Conclusions: An SEVR < 130% predicts fatal and non-fatal cardiovascular events in non-dialysis CKD patients.

scholarly journals Improving Prognostic and Fibrotic Evaluation of Chronic Kidney Disease with Contrast‐Enhanced Ultrasound Index Derived Peak Intensity: an observational study

2019 ◽  
Author(s):  
Yao Xu ◽  
Hongli Li ◽  
Chunlin Wang ◽  
Minfang Zhang ◽  
Qin Wang ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Proportional Hazards Model ◽  
Cox Regression ◽  
Cox Proportional Hazards Model ◽  
High Morbidity ◽  
Ckd Progression ◽  
Cox Regression Analysis ◽  
Peak Intensity ◽  
Contrast Enhanced

Abstract Background Chronic kidney disease (CKD) is a progressive disease with high morbidity and mortality. Contrast-enhanced ultrasonography (CEUS) has emerged as a cost-effective novel non-invasive imaging technique to improve the diagnosis and predict CKD progression. Methods Patients diagnosed with CKD who underwent CEUS with intravenous bolus contrast 1.5 ml SonoVue during 2014 to December 2014 at Ren Ji hospital, Shanghai, China, were enrolled in this study. Time-intensity curves and quantitative indexes were created using QLAB quantification software. Kidney biopsies were analyzed with α-SMA immunohistochemistry. The Cox proportional hazards model was used to investigate the risk factors for kidney survival. Results Out of 167 CKD patients followed for a median of 23.6±11.3 months, 29 (17.4%) exhibited CKD progression with decline in glomerular filtration rate of more than 25% or end-stage renal disease. Multivariate Cox regression analysis revealed lower derived peak intensity (DPI) was independently associated with progression of kidney disease. Patients with DPI≤11.98db had more severe renal fibrosis and less likely to recover from CKD progression. Conclusions This study demonstrated that the DPI is a reliable CEUS parameter for the evaluation of renal function and independent predictor for the prognosis of CKD patients.

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