scholarly journals Effect of New-Onset Diabetes Mellitus on Renal Outcomes and Mortality in Patients with Chronic Kidney Disease

2018 ◽  
Vol 7 (12) ◽  
pp. 550 ◽  
Author(s):  
Po-Ke Hsu ◽  
Chew-Teng Kor ◽  
Yao-Peng Hsieh
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Clinical Outcomes ◽  
Cox Regression ◽  
Negative Impact ◽  
Incidence Rates ◽  
Research Database ◽  
Composite Outcome ◽  
Stage Renal Disease

Background: The incidence rates of diabetes mellitus (DM) and chronic kidney disease (CKD) are increasing worldwide and their coexistence can have a large negative impact on clinical outcomes. However, it is unclear how incident DM affects CKD patients. Methods: Incident CKD patients between 2000 and 2013 were identified from the National Health Insurance Research Database of Taiwan; they were classified as non-DM (n = 10,356), pre-existing DM (n = 6982), and incident DM (n = 1103). Non-DM cases were patients who did not develop DM before the end of the observation period. The outcomes of interest were end-stage renal disease (ESRD), mortality, and composite outcome (ESRD or death). The association between the DM groups and clinical outcomes was estimated using the inverse probability of group-weighted (IPW) multivariate-adjusted time-dependent Cox regression models. Results: During the study period of 14 years, 1735 (16.6%) patients in the non-DM group reached ESRD compared with 2168 (31.05%) in the pre-existing DM group and 111 (11.03%) in the incident DM group (p < 0.001). Moreover, 2219 (21.43%) patients in the non-DM group died compared with 1895 (27.14%) in the pre-existing DM group and 303 (27.47%) in the incident DM group (p < 0.001). Compared with the non-DM group, the pre-existing DM group was associated with a higher risk of ESRD [hazard ratio (HR) 2.54; 95% confidence interval (CI 2.43–2.65), death (HR 2.23; 95% CI 2.14–2.33), and a composite outcome (HR 2.29; 95% CI 2.21–2.36). Similarly, incident DM was also associated with a higher risk of ESRD (HR 1.12; 95% CI 1.06–1.19), death (HR 2.48; 95% CI 2.37–2.60), and a composite outcome (HR 1.77; 95% CI 1.70–1.84) compared with the non-DM group. Factors contributing to incident DM included old age, low monthly income, and having hypertension, hyperlipidemia, and ischemic heart disease, while pentoxifylline reduced the risk of incident DM. Conclusion: Similarly to pre-existing DM, CKD patients with incident DM carried a higher risk of ESRD, mortality, and a composite outcome compared with those with non-DM. For those at risk of incident DM, strict monitoring and intervention strategies must be adopted to help improve their clinical outcomes.

scholarly journals Increased chronic kidney disease development and progression in diabetic patients after appendectomy: a population-based cohort study

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e5019 ◽  
Author(s):  
Chin-Hua Chang ◽  
Chew-Teng Kor ◽  
Chia-Lin Wu ◽  
Ping-Fang Chiu ◽  
Jhao-Rong Li ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Propensity Score ◽  
Population Based ◽  
Incidence Rates ◽  
Control Group ◽  
Diabetic Patients ◽  
Research Database

BackgroundThe vermiform appendix serves as a “safe house” for maintaining normal gut bacteria and appendectomy may impair the intestinal microbiota. Appendectomy is expected to profoundly alter the immune system and modulate the pathogenic inflammatory immune responses of the gut. Recent studies have shown that a dysbiotic gut increases the risk of cardiovascular disease and chronic kidney disease (CKD). Therefore, we hypothesized that appendectomy would increase the risk of CKD.MethodsThis nationwide, population-based, propensity-score-matched cohort study included 10,383 patients who underwent appendectomy and 41,532 propensity-score-matched controls. Data were collected by the National Health Insurance Research Database of Taiwan from 2000 to 2013. We examined the associations between appendectomy and CKD and end-stage renal disease (ESRD). The major outcome was a new diagnosis of CKD based on an outpatient diagnosis made at least three times or hospital discharge diagnosis made once during the follow-up period. ESRD was defined as undergoing dialysis therapy for at least 90 days, as in previous studies.ResultsThe incidence rates of CKD and ESRD were higher in the appendectomy group than in the control cohort (CKD: 6.52 vs. 5.93 per 1,000 person-years, respectively; ESRD: 0.49 vs. 0.31 per 1,000 person-years, respectively). Appendectomy patients also had a higher risk of developing CKD (adjusted hazard ratio [aHR] 1.13; 95% CI [1.01–1.26];P = 0.037) and ESRD (aHR 1.59; 95% CI [1.06–2.37];P = 0.024) than control group patients. Subgroup analysis showed that appendectomy patients with concomitant diabetes mellitus (aHR 2.08;P = 0.004) were at higher risk of incident ESRD than those without diabetes mellitus. The interaction effects of appendectomy and diabetes mellitus were significant for ESRD risk (P = 0.022); no interaction effect was found for CKD risk (P = 0.555).ConclusionsAppendectomy increases the risk of developing CKD and ESRD, especially in diabetic patients. Physicians should pay close attention to renal function prognosis in appendectomy patients.

scholarly journals Comparing the Effect of Folic Acid and Pentoxifylline on Delaying Dialysis Initiation in Patients with Advanced Chronic Kidney Disease

Nutrients ◽  
2019 ◽  
Vol 11 (9) ◽  
pp. 2192
Author(s):  
Hsun Yang ◽  
Shiun-Yang Juang ◽  
Kuan-Fu Liao ◽  
Yi-Hsin Chen
Keyword(s):  
Chronic Kidney Disease ◽  
Folic Acid ◽  
Kidney Disease ◽  
Index Date ◽  
Dialysis Initiation ◽  
Nutrient Loss ◽  
Research Database ◽  
Advanced Chronic Kidney Disease ◽  
Stage Renal Disease ◽  
End Stage

Background: We hypothesized that the nutrient loss and chronic inflammation status may stimulate progression in advanced chronic kidney disease. Therefore, we aimed to generate a study to state the influence of combined nutritional and anti-inflammatory interventions. Methods: The registry from the National Health Insurance Research Database in Taiwan was searched for 20–90 years individuals who had certified end-stage renal disease. From January 2005 through December 2010, the diagnosis code ICD-9 585 (chronic kidney disease, CKD) plus erythropoiesis-stimulating agent (ESA) use was defined as entering advanced chronic kidney disease. The ESA starting date was defined as the first index date, whereas the initiation day of maintenance dialysis was defined as the second index date. The duration between the index dates was analyzed in different medical treatments. Results: There were 10,954 patients analyzed. The combination therapy resulted in the longest duration (n = 2184, median 145 days, p < 0.001) before the dialysis initiation compared with folic acid (n = 5073, median 111 days), pentoxifylline (n = 1119, median 102 days, p = 0.654), and no drug group (control, n = 2578, median 89 days, p < 0.001). Lacking eGFR data and the retrospective nature are important limitations. Conclusions: In patients with advanced CKD on the ESA treatment, the combination of folic acid and pentoxifylline was associated with delayed initiation of hemodialysis.

scholarly journals Prescribing Trend of Antirheumatic Drugs in Taiwan and Risk of Cardiovascular Disease in Patients with Rheumatoid Arthritis: A Nationwide Cohort Study

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Chien-Ying Lee ◽  
Chih-Jaan Tai ◽  
Ya-Fang Tsai ◽  
Yu-Hsiang Kuan ◽  
Chiu-Hsiang Lee ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Diabetes Mellitus ◽  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Control Group ◽  
Research Database ◽  
Antirheumatic Drugs ◽  
Prescribing Trend

We aimed to investigate the prescribing trend of antirheumatic drugs and assess the risk of cardiovascular disease in patients with rheumatoid arthritis in Taiwan. This study was a retrospective cohort study, conducted based on the Taiwan National Health Insurance Research Database. The study subjects were 15,366 new rheumatoid arthritis patients from 2003 to 2010. To avoid selection bias, we applied propensity score matching to obtain general patients, as the control group. Cox proportional hazard model was used to evaluate the risk of cardiovascular disease in rheumatoid arthritis patients. The most common prescriptions of rheumatoid arthritis were nonsteroidal anti-inflammatory drugs. After controlling for related variables, rheumatoid arthritis patients had a higher risk of cardiovascular disease than general patients (adjusted hazard ratio [aHR] = 1.31; 95% confidence interval [CI]: 1.23-1.39). Age was the most significantly associated risk factor with the cardiovascular disease. Other observed risk factors for cardiovascular disease included hypertension (aHR = 1.57, 95% CI: 1.48-1.65), diabetes mellitus (aHR = 1.47, 95% CI: 1.38-1.57), and chronic kidney disease (aHR = 1.48, 95% CI: 1.31-1.66). Patients with rheumatoid arthritis indeed had a higher risk of incident cardiovascular diseases. Besides, age, hypertension, diabetes mellitus, and chronic kidney disease were also associated with a higher risk of cardiovascular disease.

scholarly journals Services aimed at achieving desirable clinical outcomes in patients with chronic kidney disease and diabetes mellitus: A narrative review

2017 ◽  
Vol 5 ◽  
pp. 205031211774098
Author(s):  
Fergus William Gardiner ◽  
Ezekiel Uba Nwose ◽  
Phillip Taderera Bwititi ◽  
Judith Crockett ◽  
Lexin Wang
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Clinical Outcomes ◽  
Narrative Review

scholarly journals Asymptomatic Ventricular Arrhythmia and Clinical Outcomes in Chronic Kidney Disease: A Pilot Study

2016 ◽  
Vol 7 (1) ◽  
pp. 66-73 ◽  
Author(s):  
Fabiana Oliveira Bastos Bonato ◽  
Renato Watanabe ◽  
Marcelo Montebello Lemos ◽  
José Luiz Cassiolato ◽  
Myles Wolf ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Pilot Study ◽  
Kidney Disease ◽  
Ventricular Arrhythmia ◽  
Clinical Outcomes ◽  
Cardiovascular Events ◽  
Composite Outcome ◽  
Ventricular Extrasystoles ◽  
Increased Risk

Background/Aims: Ventricular arrhythmia is associated with increased risk of cardiovascular events and death in the general population. Sudden death is a leading cause of death in end-stage renal disease. We aimed at evaluating the effects of ventricular arrhythmia on clinical outcomes in patients with earlier stages of chronic kidney disease (CKD). Methods: In a prospective study of 109 nondialyzed CKD patients (estimated glomerular filtration rate 34.8 ± 16.1 ml/min/1.73 m2, 57 ± 11.4 years, 61% male, 24% diabetics), we tested the hypothesis that the presence of subclinical complex ventricular arrhythmia, assessed by 24-hour electrocardiogram, is associated with increased risks of cardiovascular events, hospitalization, and death and with their composite outcome during 24 months of follow-up. Complex ventricular arrhythmia was defined as the presence of multifocal ventricular extrasystoles, paired ventricular extrasystoles, nonsustained ventricular tachycardia, or R wave over T wave. Results: We identified complex ventricular arrhythmia in 14% of participants at baseline. During follow-up, 11 cardiovascular events, 15 hospitalizations, and 4 deaths occurred. The presence of complex ventricular arrhythmia was associated with cardiovascular events (p < 0.001), hospitalization (p = 0.018), mortality (p < 0.001), and the composite outcome (p < 0.001). In multivariate Cox regression analysis, adjusting for demographic characteristics, complex ventricular arrhythmia was associated with increased risk of the composite outcome (HR 4.40; 95% CI 1.60-12.12; p = 0.004). Conclusion: In this pilot study, the presence of asymptomatic complex ventricular arrhythmia was associated with poor clinical outcomes in nondialyzed CKD patients.

Outcomes of 7560 chronic total occlusion patients undergoing percutaneous coronary intervention: results from a Dutch nationwide registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Van Veelen ◽  
J Elias ◽  
I.M Van Dongen ◽  
J.P.S Henriques ◽  
P Knaapen
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
At Risk ◽  
Kidney Disease ◽  
Cardiogenic Shock ◽  
Clinical Outcomes ◽  
Female Gender ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Nationwide Registry

Abstract Background The presence of a chronic total coronary occlusion (CTO) is associated with worse clinical outcomes. We aimed to identify CTO patients that are at risk of these outcomes in a nationwide registry. Methods The Netherlands Heart Registration (NHR) is a nationwide registry that registers outcomes of cardiac interventions. For the purpose of this analysis, the data of all patients undergoing PCI from inception of the NHR to December 2019 were selected, that included PCI with at least one CTO in one of the treated coronary arteries. We used multivariate logistic regression of baseline characteristics for the outcome measures target vessel revascularization (TVR) &lt;1 year, 30-day myocardial infarction (MI) and 1-year mortality. The impact of the assessed risk factors on outcomes was described as odds ratio (OR) with corresponding 95% confidence intervals (CI). Results A total of 7560 patients underwent PCI with ≥1 CTO in one of the treated arteries between January 1, 2015 until December 31, 2018 (mean age 65±10 years, 77.4% male [n=5850]). Five percent of patients deceased within 1 year after PCI (n=375), TVR&lt;1 year occurred in 11% (n=525/4804) and 30-day MI occurred in 0.5% (25/4985). In multivariate regression, the only predictor for TVR&lt;1 year was the presence of diabetes mellitus (OR 1.29, 95% CI 1.06–1.56). Predictors for the outcome MI &lt;30 days were female gender (OR 2.24, 95% CI 1.05–4.79), chronic kidney disease (OR 3.94, 95% CI 1.15–13.50) and cardiogenic shock at presentation (OR 7.94, 95% CI 2.28–27.7). Strong predictors for 1 year mortality were the presence of cardiogenic shock at presentation (OR 17.86, 95% CI 2.90–109.92) and the presence of chronic kidney disease (OR 4.56, 95% CI 2.04–10.16), other predictors were age (OR 1.04, 95% CI 1.01–1.07), female gender (OR 1.83, 95% CI 1.08–3.10), diabetes (OR 1.66, 95% CI 1.01–2.73) and left ventricular ejection fraction (LVEF; OR 0.95, 95% CI 0.93–0.97). Conclusion In this nationwide registry of 7560 CTO patients undergoing PCI, cardiogenic shock and chronic kidney disease were strong predictors for 1 year mortality and 30 day MI. Diabetes mellitus was the only predictor for the occurrence of TVR &lt;1 year. Identification of patients at risk for poor clinical outcomes may help improve the outcomes of CTO patients in the future. Funding Acknowledgement Type of funding source: None

scholarly journals Metformin: From Immediate Release to Extended Release Formula, Effectiveness, And Safety in Patients With Chronic Kidney Disease

EMJ Diabetes ◽  
2020 ◽  
pp. 70-78
Author(s):  
Giuseppe Derosa ◽  
Rodolfo Rivera ◽  
Angela D'Angelo ◽  
Pamela Maffioli
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Type 2 Diabetes Mellitus ◽  
Kidney Disease ◽  
Immediate Release ◽  
The World ◽  
Stage Renal Disease ◽  
End Stage

Type 2 diabetes mellitus is currently the main cause of chronic kidney disease, leading to end-stage renal disease in most countries around the world. Metformin is the most commonly prescribed oral antihyperglycaemic in the world and after approval by the U.S. Food and Drug Administration (FDA) in 1994, it is currently recommended as the first-line pharmacological agent for newly diagnosed Type 2 diabetes mellitus by many professional diabetes associations. In this review, the authors analysed efficacy and safety of metformin in patients with chronic kidney disease.

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