scholarly journals Serum Erythroferrone Levels Associate with Mortality and Cardiovascular Events in Hemodialysis and in CKD Patients: A Two Cohorts Study

2019 ◽  
Vol 8 (4) ◽  
pp. 523 ◽  
Author(s):  
Spoto ◽  
Kakkar ◽  
Lo ◽  
Devalaraja ◽  
Pizzini ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Iron Absorption ◽  
Linear Increase ◽  
Enzyme Linked Immunosorbent Assay ◽  
End Stage Kidney Disease ◽  
End Point ◽  
Traditional Risk Factors ◽  
End Stage ◽  
Stage 1 ◽  
The Relationship

Erythroferrone (ERFE) is a hepcidin inhibitor whose synthesis is stimulated by erythropoietin, which increases iron absorption and mobilization. We studied the association between serum ERFE and mortality and non-fatal cardiovascular (CV) events in a cohort of 1123 hemodialysis patients and in a cohort of 745 stage 1–5 chronic kidney disease (CKD) patients. Erythroferrone was measured by a validated enzyme-linked immunosorbent assay (ELISA). In the hemodialysis cohort, serum ERFE associated directly with erythropoiesis stimulating agents (ESA) dose (p < 0.001) and inversely with serum iron and ferritin (p < 0.001). Erythroferrone associated with the combined outcome in an analysis adjusting for traditional risk factors, factors peculiar to end-stage kidney disease, serum ferritin, inflammation, and nutritional status (HR, hazard ratio, (5 ng/mL increase: 1.04, 95% confidence interval, CI: 1.01–1.08, p = 0.005). Furthermore, treatment with ESA modified the relationship between ERFE and the combined end-point in adjusted analyses (p for the effect modification = 0.018). Similarly, in CKD patients there was a linear increase in the risk for the same outcome in adjusted analyses (HR (2 ng/mL increase): 1.04, 95% CI: 1.0–1.07, p = 0.015). Serum ERFE is associated with mortality and CV events in CKD and in HD patients, and treatment by ESA amplifies the risk for this combined end-point in HD patients.

scholarly journals Biochemical Parameters of Diabetes Ketoacidosis in patients with End-Stage Kidney Disease and Preserved Renal Function

2021 ◽  
Author(s):  
Rodolfo J Galindo ◽  
Francisco J Pasquel ◽  
Priyathama Vellanki ◽  
Cesar Zambrano ◽  
Bonnie Albury ◽  
...  
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Kidney Disease ◽  
Biochemical Parameters ◽  
University Hospitals ◽  
End Stage Kidney Disease ◽  
Emory University ◽  
End Stage ◽  
The Relationship ◽  
Moderate Renal Failure

Abstract Introduction Differences in biochemical parameters of diabetic ketoacidosis in patients with end-stage kidney disease (ESKD) has not been established. Accordingly, we assessed the relationship between degree of metabolic acidosis and ß -hydroxybutyrate in patients ESKD (eGFR &lt;15 mL/min/1.73 m 2), moderate renal failure (eGFR 15-60) or preserved renal function (eGFR &gt;60). Methods This observational study included adults (18-80 years) with DKA, admitted to Emory University Hospitals between 01/01/2006 to 12/31/2016. DKA and renal stages were confirmed on admission laboratory values. Results Admission bicarbonate levels (13.9±5 vs 13.4±5.3 vs 13.8±4.2 mmol/L, p=0.7), and pH levels (7.2±0.3 vs 7.2±0.2 vs 7.2±0.2, p=0.8) were similar among groups. Patients with ESKD had lower mean ß -hydroxybutyrate (4.3±3.3 vs 5.6±2.9 vs 5.9±2.5 mmol/L, p=0.01), but higher admission glucose (852±340.4 vs 714.6±253.3 mg/dL vs 518±185.7 mg/dL, p &lt;0.01), anion gap (23.4±7.6 vs 23±6.9 vs 19.5±4.7 mmol/L, p &lt;0.01), and osmolality (306±20.6 vs 303.5± vs 293.1±3.1mOsm/kg, p&lt;0.01), compared to patients with moderate renal failure and preserved renal function. The sensitivity of ß-hydroxybutyrate &gt;3 mmol/L for diagnosing DKA by bicarbonate level &lt;15 and &lt;18 mmol/L was 86.9% and 72% in ESKD, 89.3% and 83.7% in moderate renal failure and 96.2% and 88.3% in preserved renal function. In patients with ESKD, the corresponding ß-hydroxybutyrate with bicarbonate levels &lt;10, 10-15, &lt;18 mmol/L were 5.5, 3.9, 3.0 mmol/L, respectively. Conclusions Significant metabolic differences were found among DKA patients with different levels of renal function. In patients with ESKD, a ß-hydroxybutyrate level &gt; 3 mmol/L may assist with confirmation of DKA diagnosis.

Proteinuria in HIV-infected Indian children

2016 ◽  
Vol 47 (3) ◽  
pp. 230-233 ◽  
Author(s):  
Gopila Gupta ◽  
Alok Hemal ◽  
Abhijeet Saha ◽  
Kanika Kapoor ◽  
Parul Goyal ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Creatinine Ratio ◽  
End Stage Kidney Disease ◽  
Urine Protein ◽  
Indian Children ◽  
Spot Urine ◽  
Advanced Stages ◽  
Study Population ◽  
End Stage ◽  
Stage 1

Chronic kidney disease (CKD) is a major cause of morbidity and mortality among individuals with HIV infection. Screening for proteinuria in HIV-infected children will help in early detection and treatment, and thus prevention and progression to CKD to end-stage kidney disease (ESRD). We screened 139 HIV-infected children aged 18 months to 18 years for proteinuria by urinary dipstick and confirmed by spot urine protein-to-creatinine ratio. If proteinuria was absent by the above methods, patients were screened for microalbuminuria by urinary albumin to creatinine ratio. We found proteinuria in 11.5% and microalbuminuria in 10.6% of our study population. The prevalence of proteinuria was higher in the advanced stages; 8.05% in stage 1, 12.12% in stage 2 and 26.32% in stages 3 + 4.

scholarly journals Association of Kidney Disease With Outcomes in COVID‐19: Results From the American Heart Association COVID‐19 Cardiovascular Disease Registry

2021 ◽  
Author(s):  
Anjali Rao ◽  
Sagar Ranka ◽  
Colby Ayers ◽  
Nicholas Hendren ◽  
Anna Rosenblatt ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Kidney Disease ◽  
Major Adverse Cardiac Events ◽  
Secondary Outcome ◽  
Cardiac Events ◽  
End Stage Kidney Disease ◽  
Adverse Cardiac Events ◽  
All Cause Mortality ◽  
End Stage ◽  
Stage 1

Background Emerging evidence links acute kidney injury (AKI) in patients with COVID‐19 with higher mortality and respiratory morbidity, but the relationship of AKI with cardiovascular disease outcomes has not been reported in this population. We sought to evaluate associations between chronic kidney disease (CKD), AKI, and mortality and cardiovascular outcomes in patients hospitalized with COVID‐19. Methods and Results In a large multicenter registry including 8574 patients with COVID‐19 from 88 US hospitals, data were collected on baseline characteristics and serial laboratory data during index hospitalization. Primary exposure variables were CKD (categorized as no CKD, CKD, and end‐stage kidney disease) and AKI (classified into no AKI or stages 1, 2, or 3 using a modification of the Kidney Disease Improving Global Outcomes guideline definition). The primary outcome was all‐cause mortality. The key secondary outcome was major adverse cardiac events, defined as cardiovascular death, nonfatal stroke, nonfatal myocardial infarction, new‐onset nonfatal heart failure, and nonfatal cardiogenic shock. CKD and end‐stage kidney disease were not associated with mortality or major adverse cardiac events after multivariate adjustment. In contrast, AKI was significantly associated with mortality (stage 1 hazard ratio [HR], 1.72 [95% CI, 1.46–2.03]; stage 2 HR, 1.83 [95% CI, 1.52–2.20]; stage 3 HR, 1.69 [95% CI, 1.44–1.98]; versus no AKI) and major adverse cardiac events (stage 1 HR, 2.17 [95% CI, 1.74–2.71]; stage 2 HR, 2.70 [95% CI, 2.07–3.51]; stage 3 HR, 3.06 [95% CI, 2.52–3.72]; versus no AKI). Conclusions This large study demonstrates a significant association between AKI and all‐cause mortality and, for the first time, major adverse cardiovascular events in patients hospitalized with COVID‐19.

Association of novel biomarkers with major clinical outcomes in a cohort of patients with atherosclerotic renovascular disease

2019 ◽  
Vol 56 (4) ◽  
pp. 488-501
Author(s):  
Diana Vassallo ◽  
Helen Alderson ◽  
Nicolas Vuilleumier ◽  
James Ritchie ◽  
Darren Green ◽  
...  
Keyword(s):  
Risk Factors ◽  
Kidney Disease ◽  
Patient Selection ◽  
End Stage Kidney Disease ◽  
Renovascular Disease ◽  
Novel Biomarkers ◽  
Selection For ◽  
Traditional Risk Factors ◽  
End Stage ◽  
Atherosclerotic Renovascular Disease

Introduction In this study, we investigate whether the addition of biomarkers to a model based on traditional risk factors improves risk prediction and patient selection for revascularization in atherosclerotic renovascular disease. Methods Patients in the Salford Renovascular Study who had the following biomarkers analysed on a baseline sample were included in this study: FGF-23, Cystatin C, kidney injury molecule-1, myeloperoxidase, neutrophil gelatinase-associated lipocalin, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), high-sensitivity Troponin T and anti-apolipoprotein A1 IgG. Cox proportional hazards models and net reclassification index were used to study the effects of either individual or a panel of biomarkers on predicting death, end-stage kidney disease and cardiovascular events. Results A total of 112 patients were followed up for a median 59.9 months (IQR 33.6–86.9). In total, 75 patients died, 21 reached end-stage kidney disease and 36 suffered a cardiovascular event. Only NT-proBNP maintained a statistically significant association with all end-points (death: HR 1.62 [95% CI 1.26–2.10], P < 0.0005; end-stage kidney disease: HR 1.51 [95% 1.19–1.91], P = 0.001; cardiovascular event: HR 1.56 [95% CI 1.23–1.97], P < 0.0005). Risk reclassification improved with addition of all biomarkers as a panel to the base model. Only patients with NT-proBNP concentrations above 300 ng/L gained benefit from revascularization with regard to all adverse end-points compared with medically managed patients. Conclusions NT-proBNP is independently associated with increased risk for all adverse events in atherosclerotic renovascular disease. Novel biomarkers may have an incremental risk predictive value when used in combination with traditional risk factors, and NT-proBNP may have value in patient selection for revascularization. Given the small size of this study, larger multicentre studies are required to validate these findings.

When CKD-MBD is not just CKD-MBD, a case of humoral hypercalcemia of malignancy in a dialysis patient

2020 ◽  
Vol 4 (3) ◽  
pp. 128-131
Author(s):  
Pulkit Gandhi ◽  
Roopali Goyal Gandhi ◽  
Ankur D Shah
Keyword(s):  
Kidney Disease ◽  
Dialysis Patient ◽  
Maintenance Hemodialysis ◽  
Humoral Hypercalcemia Of Malignancy ◽  
End Stage Kidney Disease ◽  
Hypercalcemia Of Malignancy ◽  
Humoral Hypercalcemia ◽  
Increased Risk ◽  
End Stage ◽  
The Relationship

Patients on maintenance hemodialysis have dysregulations of calcium and phosphorus homeostasis which results in a plethora of mineral and bone pathologies. Management is typically focused on maintenance eucalcemia and limiting hyperphosphatemia while avoiding extremes of intact parathyroid hormone. Hypercalcemia in this setting is often iatrogenic. We present a case of humoral hypercalcemia of malignancy initially thought to be iatrogenic due to mineral bone management and discuss the overlap of management of hypercalcemia and management of mineral bone disease in end stage kidney disease. We highlight the relationship between malignancy and end stage kidney disease and the increased risk of hypercalcemia associated with malignancy.

scholarly journals Role of GDF-15, YKL-40 and MMP 9 in patients with end-stage kidney disease: focus on sex-specific associations with vascular outcomes and all-cause mortality

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Agne Laucyte-Cibulskiene ◽  
Liam J. Ward ◽  
Thomas Ebert ◽  
Giulia Tosti ◽  
Claudia Tucci ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Kidney Disease ◽  
Gut Microbiota ◽  
Vascular Calcification ◽  
Cardiovascular Complications ◽  
Enzyme Linked Immunosorbent Assay ◽  
End Stage Kidney Disease ◽  
All Cause Mortality ◽  
Novel Biomarkers ◽  
End Stage

Abstract Background Sex differences are underappreciated in the current understanding of cardiovascular disease (CVD) in association with chronic kidney disease (CKD). A hallmark of CKD is vascular aging that is characterised, amongst others, by; systemic inflammation, microbiota disbalance, oxidative stress, and vascular calcification—features linked to atherosclerosis/arteriosclerosis development. Thus, it is the necessary to introduce novel biomarkers related to athero-/arteriosclerotic damage for better assessment of vascular ageing in patients CKD. However, little is known about the relationship between uraemia and novel CVD biomarkers, such as growth differentiation factor-15 (GDF-15), cartilage glycoprotein-39 (YKL-40) and matrix metalloproteinase-9 (MMP-9). Therefore, we hypothesise that there are sex-specific relationships between GDF-15, YKL-40, MMP-9 levels in end-stage kidney disease (ESKD) patients in relation to gut microbiota, vascular calcification, inflammation, comorbidities, and all-cause mortality. Methods ESKD patients, males (n = 151) and females (n = 79), not receiving renal replacement therapy were selected from two ongoing prospective ESKD cohorts. GDF-15, YKL-40 and MMP9 were analysed using enzyme-linked immunosorbent assay kits. Biomarker levels were analysed in the context of gut microbiota-derived trimethylamine N-oxide (TMAO), vascular calcification, inflammatory response, oxidative stress, comorbidities, and all-cause mortality. Results Increased GDF-15 correlated with higher TMAO in females only, and with higher coronary artery calcification and IL-6. In females, diabetes was associated with elevated GDF-15 and MMP-9, whilst males with diabetes only had elevated GDF-15. No associations were found between biomarkers and CVD comorbidity. Deceased males and females had higher GDF-15 concentrations (p = 0.01 and p < 0.001, respectively), meanwhile only YKL-40 was increased in deceased males (p = 0.02). Conclusions In conclusion, in males GDF-15 and YKL-40 were related to vascular calcification, inflammation, and oxidative stress, whilst in females GDF-15 was related to TMAO. Increased levels of YKL-40 and GDF-15 in males, and only GDF-15 in females, were associated with all-cause mortality. Our findings suggest that sex-specific associations of novel CVD biomarkers have a potential to affect development of cardiovascular complications in patients with ESKD.

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