scholarly journals Proteinuria-Lowering Effects of Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors in Chronic Kidney Disease Patients: A Real-World Multicentric Study

Metabolites ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 760
Author(s):  
Patricia Muñoz Ramos ◽  
Yohana Gil Giraldo ◽  
Vicente Álvarez-Chiva ◽  
David Arroyo ◽  
Cristina Sango Merino ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Lipid Profile ◽  
Total Cholesterol ◽  
Ldl Cholesterol ◽  
Proprotein Convertase ◽  
Multicentric Study ◽  
The Mean

Control of dyslipidemia in chronic kidney disease (CKD) is not always guaranteed with statins and/or ezetimibe. Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) have opened up a new era in lipid control, but their effect on renal function and proteinuria in real life have not yet been evaluated. The aim of the present study was to analyze the evolution of renal function and proteinuria in a cohort of CKD patients treated with PCSK9i. This retrospective multicentric cohort study included CKD patients treated with PCSK9i. Baseline epidemiological data, comorbidities and laboratory findings (including estimated glomerular filtration rate [eGFR], proteinuria and lipid profile) were collected. The evolution of renal function, proteinuria and lipid profile was analyzed during the 1-year follow-up. The cohort included 76 patients (68% male, mean age 66 ± 10 years). The mean baseline creatinine was 1.55 ± 0.77 mg/dL, and the mean eGFR was 52 ± 22 mL/min/1.73 m2. Reductions in LDL-cholesterol, total cholesterol and triglycerides during the first month were 51 ± 25%, 32 ± 25% and 11 ± 40%, respectively, levels that remained stable throughout the first year (p < 0.001 for LDL-cholesterol and total cholesterol trends and p = 0.002 for triglyceride trend). During follow-up, proteinuria improved from 57 (9–481) to 30 (7–520) mg/g (p = 0.021). In addition, eGFR remained stable, and no adverse events were reported. In our cohort, dyslipidemia treatment with PCSK9i was associated with decreased proteinuria in CKD patients, an effect that might be due to reduced lipid nephrotoxicity. Clinical trials are needed to further investigate whether this impact on proteinuria can significantly slow CKD progression in the long term.

scholarly journals P0183THE USE OF PCSK9 INHIBITORS COULD REDUCE PROTEINURIA IN CHRONIC KIDNEY DISEASE PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Patricia Muñoz Ramos ◽  
Leydy Yohana Gil Giraldo ◽  
Javier Reque ◽  
Borja Quiroga ◽  
Vicente Alvarez Chiva
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Adverse Events ◽  
Lipid Profile ◽  
Cardiovascular Events ◽  
Ldl Cholesterol ◽  
Density Lipoprotein ◽  
History Of

Abstract Background and Aims Chronic kidney disease (CKD) is a cardiovascular risk factor per sé and enhances the risk of cardiovascular events. Dyslipidemia is one of the most studied risk factors and current guidelines recommend the universal treatment in CKD patients (not in dialysis) irrespective of low density lipoprotein (LDL) cholesterol level. However, the latest European Cardiology guidelines recommend monitoring LDL cholesterol to achieve levels lower than 70 mg/dl in CKD stage 3 and lower than 55 mg/dl in stages 4 and 5. Proprotein convertase subtilisin-kexin type 9 inhibitors (PCSK9i) have opened a new era leading greater reduction of LDL cholesterol and subsequently cardiovascular events but real-life data is not available in CKD patients. The aim of the present study is analysing the evolution of renal function and proteinuria in a cohort of patients with PCSK9i. Method This is a retrospective study that included all the patients treated with PCSK9i in our centre. Inclusion criteria were the presence of CKD and dyslipidemia with indication of the use of PCSK9i (not reaching LDL target with maximum tolerated statin dose or intolerance for the use of statins). At baseline, epidemiological data and comorbidities were collected, as well as renal function using glomerular filtration rate (GFR) estimation with CKD-EPI equation, proteinuria (mg/g of creatinine) and lipid profile. During a one-year follow up, renal function, proteinuria, lipid profile and adverse events were collected and analysed. Results: . Forty-one patients were included with a mean age of 70±10 years and 26 men (62%). Thirty-four patients (83%) had hypertension, 11 (27%) were diabetic, 19 (44%) had coronary disease, 8 (20%) history of heart failure, 3 (7%) peripheral vascular disease and 6 (15%) history of stroke. Regarding renal function, at baseline mean of creatinine was 1.3±0.5 mg/dl, GFR 54±19 ml/min/1.73m2 and proteinuria 456±215 mg/g. Lipid profile at baseline demonstrated an LDL cholesterol value of 163±58 mg/dl, triglycerides of 255±389 mg/dl and high density lipoprotein (HDL) of 53±14mg/dl. During follow up, total cholesterol, LDL-cholesterol and triglycerides improved significantly (p&lt;0.001 for all in comparison to baseline values). GFR remained stable during the first year of follow up (CKD-EPI at 1 year 52±20 ml/min/1.73m2). Proteinuria improved at first month (235±71 mg/g), achieving stability at 3 months (124±44 mg/g), 6 months (176±94 mg/g) and 1 year (163±83 mg/g) (p for trend 0.02) (figure 1). No adverse events were registered during follow up, and two patients required hospitalization due to cardiovascular events. Conclusion The treatment of dyslipidemia with PCSK9i could decrease proteinuria in CKD patients via controlling lipoid nephrotoxicity. Clinical trials are needed to further investigate this effect.

scholarly journals Sex modulates the association of radial artery augmentation index with renal function decline in individuals without chronic kidney disease

2021 ◽  
Author(s):  
Qiao Qin ◽  
Fangfang Fan ◽  
Jia Jia ◽  
Yan Zhang ◽  
Bo Zheng
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Arterial Stiffness ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Augmentation Index ◽  
Renal Function Decline

Abstract Purpose An increase in arterial stiffness is associated with rapid renal function decline (RFD) in patients with chronic kidney disease (CKD). The aim of this study was to investigate whether the radial augmentation index (rAI), a surrogate marker of arterial stiffness, affects RFD in individuals without CKD. Methods A total of 3165 Chinese participants from an atherosclerosis cohort with estimated glomerular filtration rates (eGFR) of ≥ 60 mL/min/1.73 m2 were included in this study. The baseline rAI normalized to a heart rate of 75 beats/min (rAIp75) was obtained using an arterial applanation tonometry probe. The eGFRs at both baseline and follow-up were calculated using the equation derived from the Chronic Kidney Disease Epidemiology Collaboration. The association of the rAIp75 with RFD (defined as a drop in the eGFR category accompanied by a ≥ 25% drop in eGFR from baseline or a sustained decline in eGFR of > 5 mL/min/1.73 m2/year) was evaluated using the multivariate regression model. Results During the 2.35-year follow-up, the incidence of RFD was 7.30%. The rAIp75 had no statistically independent association with RFD after adjustment for possible confounders (adjusted odds ratio = 1.12, 95% confidence interval: 0.99–1.27, p = 0.074). When stratified according to sex, the rAIp75 was significantly associated with RFD in women, but not in men (adjusted odds ratio and 95% confidence interval: 1.23[1.06–1.43], p = 0.007 for women, 0.94[0.76–1.16], p = 0.542 for men; p for interaction = 0.038). Conclusion The rAI might help screen for those at high risk of early rapid RFD in women without CKD.

scholarly journals Plasma natriuretic peptide level is an independent determinant of major clinical outcomes in atrial fibrillation patients without heart failure: the Fushimi AF Registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Hamatani ◽  
M Iguchi ◽  
Y Aono ◽  
K Ishigami ◽  
S Ikeda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Clinical Outcomes ◽  
Prognostic Marker ◽  
Oral Anticoagulants ◽  
Systemic Embolism ◽  
The Mean

Abstract Background Atrial fibrillation (AF) increases the risk of death, stroke/systemic embolism and heart failure (HF). Plasma natriuretic peptide (NP) level is an important prognostic marker in HF patients. However, little is known regarding the prognostic significance of plasma NP level in AF patients without HF. Purpose The aim of this study is to investigate the relationship between plasma NP level and clinical outcomes such as all-cause death, stroke/systemic embolism and HF hospitalization during follow-up period in AF patients without HF. Methods The Fushimi AF Registry is a community-based prospective survey of AF patients in our city. The inclusion criterion of the registry is the documentation of AF at 12-lead electrocardiogram or Holter monitoring at any time, and there are no exclusion criteria. We started to enroll patients from March 2011, and follow-up data were available for 4,466 patients by the end of November 2019. From the registry, we excluded 1,220 patients without a pre-existing HF (defined as having one of the following; prior hospitalization for HF, New York Heart Association class ≥2, or left ventricular ejection fraction &lt;40%). Among 3,246 AF patients without HF, we investigated 1,189 patients with the data of plasma BNP (n=401) or N-terminal pro-BNP (n=788) level at the enrollment. We divided the patients according to the quartile of each plasma BNP or NT-pro BNP level and compared the backgrounds and outcomes between these 4 groups stratified by plasma NP level. Results Of 1,189 patients, the mean age was 72.1±10.2 years, 454 (38%) were female and 684 (58%) were paroxysmal AF. The mean CHADS2 and CHA2DS2-VASc score were 1.6±1.1 and 2.9±1.5, respectively. Oral anticoagulants were prescribed in 671 (56%) at baseline. The median (interquartile range) BNP and N-terminal pro-BNP level were 84 (38, 176) and 500 (155, 984) pg/ml, respectively. Patients with high plasma NP level were older, and demonstrated lower prevalence of paroxysmal AF, higher CHADS2 and CHA2DS2-VASc scores and higher prevalence of chronic kidney disease and oral anticoagulants prescription (all P&lt;0.01). A total of 165 all-cause death, 114 stroke/systemic embolism and 103 HF hospitalization occurred during the median follow-up period of 5.0 years. Kaplan-Meier curves demonstrated that higher plasma NP level was significantly associated with the incidences of all-cause death, stroke/systemic embolism and HF hospitalization in AF patients without HF (Figure 1A). Multivariable Cox regression analysis revealed that plasma NP level could stratify the risk of clinical outcomes even after adjustment by type of AF, CHA2DS2-VASc score, chronic kidney disease and oral anticoagulant prescription (Figure 1B). Conclusion Plasma NP level is a significant prognostic marker for all-cause death, stroke/systemic embolism and HF hospitalization in AF patients without HF, suggesting the importance of measuring plasma NP level in AF patients even without HF. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals P0949EFFECT OF DIETARY PHOSPHORUS RESTRICTION ON FIBROBLAST GROWTH FACTOR,KLOTHO AND BODY COMPOSITION IN CHRONIC KIDNEY DISEASE PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Trisha Sachan ◽  
Anita Saxena ◽  
Amit Gupta
Keyword(s):  
Chronic Kidney Disease ◽  
Body Composition ◽  
Renal Function ◽  
Kidney Disease ◽  
Urinary Protein ◽  
Dietary Phosphorus ◽  
Ckd Stage ◽  
Significant Difference ◽  
The Mean ◽  
Fgf 23

Abstract Background and Aims Changes in dietary phosphorus regulate serum FGF-23, parathyroid hormone, 1,25(OH)(2)D and Klotho concentrations . Cardiovascular disease (CVD) is the principal killer of patients with chronic kidney disease and hyperphosphetemia is a potent risk factor it. Of many causative factors for CVD in CKD, dietary interventions involving restriction of dietary phosphorous intake can help reduce onset of CVD at early stages of CKD with other corrective measures. Muscle wasting is a consequence of uremic syndrome which alters body composition. The aim of the study was to study effect of dietary phosphorous restriction on FGF-23, iPTH, Klotho, 1,25(OH)(2)D and body composition in chronic kidney disease patients. Method This is a longitudinal study with 12 months intervention, approved by Ethics Committee of the institute. A total 132 subjects were recruited (66 healthy controls, 66 CKD patient. of 66 patients 33 were in CKD stage 1 and 33 in stage 2. GFR was calculated with the help of MDRD formula. Biochemical parameters of subjects were evaluated at baseline, 6 and 12 months along with the anthropometric measurements (body weight, height, mid upper arm circumference (MUAC), and skin folds). Three days dietary recall was taken to evaluate energy, protein and phosphorous intake. CKD patients whose dietary phosphorous intake was more than 1000 mg/day, were given intense dietary counseling and prescribed dietary modifications by restricting dietary phosphorous between 800-1000 mg/day. Results The mean age of controls and patients was 37.01±9.62 and 38.27±12.06 and eGFR of 136.94±11.77 and 83.69±17.37 respectively. One way ANOVA showed significant difference among controls and the study groups in hemoglobin (p&lt;0.001), s albumin (p&lt;0.001), FGF-23 (p&lt;0.001), klotho (p&lt;0.001), urinary protein (p&lt;0.001) and Nephron Index (p&lt;0.001).The mean energy intake (p = 0.001) and dietary phosphorous intake (p&lt;0.001) of the CKD patients decreased significantly with the decline in the renal function along with the anthropometric measures i.e. BMI (p = 0.041),WHR (p = 0.015) and all four skin folds (p&lt;0.001). On applying Pearson’s correlation, eGFR correlated negatively with urinary protein (-0.739, 0.000), FGF-23 (-0.679, 0.000) and serum phosphorous (-0.697, 0.000) and positively with klotho (0.872, 0.000). FGF-23 correlated negatively with klotho (-0.742, 0.000). Dietary phosphorous was found to be positively correlated with urinary protein (0.496, 0.000), serum phosphorous (0.680, 0.000) and FGF-23 (0.573, 0.000) and negatively with Klotho (-0.602, 0.000). Nephron index revealed a positive correlation with eGFR (0.529, 0.000). Urinary protein correlated negatively with klotho (-0.810, 0.000). A multiple linear regression was run to predict eGFR from anthropometric variables such as BMI, WHR, MUAC, skin folds thickness and handgrip strength. All anthropometric variables predicted decline in eGFR (p&lt;0.05, R2 =0.223). At 6 and 12 months; repeated ANOVAs analysis showed a statistically significant difference in serum creatinine (p=0.000), serum phosphorous (p=0.000), FGF-23(p=0.000) and klotho (p=0.000). Conclusion Elevated levels of FGF-23 and decreased Klotho levels, with the moderate decline in renal function improved with the restricted phosphorous diet at 6 and 12 months emphasizing the importance of phosphorus restriction at an early stage.

MO403ACUTE KIDNEY INJURY IN ELDERLY: EPIDEMIOLOGICAL, CLINICAL AND ETIOLOGICAL FEATURES

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Mouna Malki abidi ◽  
Rajaa Aoudia ◽  
Soumaya Chargui ◽  
Imen Gorsane ◽  
Mouna Jerbi ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Injury ◽  
The Elderly ◽  
Major Interest ◽  
The Mean ◽  
Renal Aging ◽  
End Stage ◽  
Iatrogenic Origin

Abstract Background and Aims Acute kidney injury (AKI) is common in the elderly due to physiologic renal aging and underlying pathologies. Few studies focused on AKI in Tunisian elderly. The aim of our study was to highlight the epidemiological, clinical, etiological, therapeutic, and progressive characteristics of AKI in elderly. Method We conducted a descriptive retrospective study of AKI in patients admitted to our department over a period of 04 years from 01/01/2014 to 31/12/2017. Results We collected 40 patients including 25 women and 15 men with a sex ratio of 1.66. The mean age was 74 [65-87] years. We noted the presence of pre-existing chronic kidney disease in 58% of cases, diabetes in 50% of cases and hypertension in 73% of cases. Polypharmacy was found in 40% of cases. AKI was symptomatic in 80% of cases and found on a routine check-up in 20% of cases. Mean creatinine was 612+/-334 µmol/l. AKI was pre-renal in 37% and parenchymal in 63% of cases. Iatrogenic origin was found in 33% of cases. Renal biopsy was performed for diagnostic purposes in 6 cases. Haemodialysis was necessary in 50% of cases. Etiopathogenic treatment was initiated in 73% of cases. Intra-hospital mortality was 10%, recovery of renal function (RF) was partial in 40 % of cases and total in 20 % of cases. Follow-up time was 16 +/- 23.2 months. And at the last news, recovery of renal function (RF) was partial in 7 cases and total in 10 cases, 6 patients kept a chronic renal failure (CRF), among them 3 cases had and end-stage of CRF. Conclusion AKI is a frequent pathology in the elderly and its severity is linked to mortality and the transition to chronicity. Iatrogenic causes are frequent and preventable in this population, hence the major interest of prevention.

scholarly journals MP31-19 LONG-TERM FOLLOW-UP OF RENAL FUNCTION AND DEVELOPMENT OF CHRONIC KIDNEY DISEASE AFTER PARTIAL NEPHRECTOMY

2019 ◽  
Vol 201 (Supplement 4) ◽  
Author(s):  
Takashi Ikeda* ◽  
Toshio Takagi ◽  
Hiroki Ishihara ◽  
Hironori Fukuda ◽  
Kazuhiko Yoshida ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Partial Nephrectomy ◽  
Long Term Follow Up

THE CHANGES OF RENAL FUNCTION STATUS BASED ON PROTEINURIA AND GLOMERULUS FILTRATION RATE IN PATIENTS WITH HISTORY OF PREECLAMPSIA WITH SEVERE FEATURES

2021 ◽  
pp. 279-282
Author(s):  
Chairul Adilla Ardy ◽  
Muara Panusunan Lubis ◽  
Cut Adeya Adella ◽  
Hotma Partogi Pasaribu ◽  
Muhammad Rusda ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Late Onset ◽  
Case Series ◽  
Sampling Technique ◽  
Time Interval ◽  
History Of ◽  
The Mean

Background: Preeclampsia with severe features is an endothelial disease that causes renal system disorders during pregnancy. Preeclampsia is an important cause of acute kidney injury and risk for chronic kidney disease. Methods: This study was a case series conducted at the Department of Obstetrics and Gynecology, H. Adam Malik General Hospital Medan, Indonesia starting from December 2019 until January 2020. Total sampling technique was employed obtaining 31 subjects with a history of preeclampsia with severe features for at least 3 months to 2 years postpartum, without a history of chronic disease, diabetes mellitus, and congenital kidney disorders. Proteinuria, serum creatinine, and GFR calculations were performed. Results: There were 31 patients who met the inclusion and exclusion criteria. At a time interval of 4 - ≤13 months postpartum, 2 levels of proteinuria +1 (0-2), serum creatinine 0.81 ± 0.21 mg/dl, and levels of GFR 109.57 ± 25.13 (ml/min/1.73 m ). Whereas at the time interval of >13 - 24 months postpartum, levels of proteinuria +1 (0-3), serum creatinine 0.85 ± 0.23 mg/dl, and GFR 2 levels of 104. 41 ± 28.45 (ml/min/1.73 m ). The mean of serum creatinine before delivery was 0.69 ± 0.15 mg/dl and after delivery was 0.83 ± 0.22 mg/dl. The mean of GFR postpartum at group of history of early onset preeclampsia was 103.07 ± 25.23 2 2 (ml/min/1.73 m ) and group of history of late onset preeclampsia was 113.40 ± 28.24 (ml/min/1.73 m ). Conclusion: There was a tendency for a decrease in renal function among women with a history of preeclampsia with severe features with ndings of persistent proteinuria from more than 3 to 24 months postpartum, an increase in mean of serum creatinine levels from before and after delivery and a decrease in GFR, but it was not signicant. This was related to the slow course of chronic kidney disease, so it had to be followed up periodically.

Beta-blockers in elderly patients with left ventricular systolic dysfunction and chronic kidney disease: danger or benefit?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Martinez Milla ◽  
M Cortes ◽  
M Lopez-Castillo ◽  
A Devesa-Arbiol ◽  
A.L Rivero-Monteagudo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Propensity Score ◽  
Ejection Fraction ◽  
Beta Blockers ◽  
Hospital Records ◽  
Propensity Score Matching Analysis ◽  
The Mean

Abstract Introduction Beta-blockers (BB) have been shown to reduce mortality in patients with HFrEF. However, there is little data on the benefit of these therapies in patients with chronic kidney disease and even less in older patients. The aim of this work is to evaluate the role of beta-blockers in patients ≥75 years along the spectrum of kidney disease. Methods From January 2008 to July 2014, we consecutively enlisted 802 patients aged &gt;75 years that had ejection fraction ≤35%. From this group we included 380 patients that had CKD (defined as a glomerular filtration rate (GFR) ≤60 ml/min/1.73m2). Clinical, echocardiographic and electrocardiographic data were taken from hospital records. Follow-up was made via telephone and hospital records as well. Propensity score matching analysis was made to assess the relationship between treatment with BB and occurrence of major adverse cardiovascular event (MACE) composite of death for any cause or heart failure. hospitalization. Multivariate Cox regression analysis was also made in the different groups of CKD (45–60 ml/min/1.73m2, 30–45 ml/min/1.73m2, &lt;30 ml/min/1.73m2) in order to assess the effect of BB over mortality and CV events in each subgroup. Results 390 patients were included. Male represented 62.3% of all participants, and the mean age was 82.6±4.1 years. The mean ejection fraction was 27.9±6.5%. Ischemic etiology was found in 50.6% of cases. Glomerular filtrate (GF) was 60 to 45 ml/min/1.73 m2 in 50.3% of patients, 45–30 ml/min/1.73 m2 in 37.4% and &lt;30 ml/min/1.73 m2 in 12.3%. At the end of the follow-up, 67.4% of the patients were on beta-blocker treatment. The mean follow-up was 32±23 months. During the study period, 211 patients (54.1%) died and 257 patients (65.9%) had a major cardiovascular event (death or hospitalization for heart failure). After propensity score matching analysis, 178 were considered (89 each group) and they have no significant difference in baseline characteristics. BBs were found to significantly reduce mortality (HR 0.45 (95% CI, 0.27–0.75). When the effect of BB over the different subgroups of CKD was analyzed, it was seen also that BB reduced mortality in patients with eGFR 45–60 ml/min/1.73 m2 (HR 0.47 (95% CI, 0.26–0.86), in patients with eGFR 30–45 ml/min/1.73 m2 (HR 0.55 (95% CI, 0.26–1.06)and in eGFR &lt;30 ml/min/1.73 m2 (HR 0.29 (95% CI, 0.11–0.76) Conclusion The use of beta-blockers in elderly patients with HFrEF and kidney DISEASE was associated with increased survival, regardless of the degree of kidney failure. There is a need to raise awareness of the benefits of beta-blocker use in these patients to promote their use where possible. Funding Acknowledgement Type of funding source: None

scholarly journals Cardiovascular Outcomes in African Americans with Sickle Cell Trait and Chronic Kidney Disease

2019 ◽  
Vol 49 (2) ◽  
pp. 93-102 ◽  
Author(s):  
Kabir O. Olaniran ◽  
Nwamaka D. Eneanya ◽  
Andrew S. Allegretti ◽  
Sophia H. Zhao ◽  
Maureen M. Achebe ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
African American ◽  
Cardiovascular Risk ◽  
African Americans ◽  
Kidney Disease ◽  
Sickle Cell ◽  
Sickle Cell Trait ◽  
Increased Risk ◽  
The Mean

Background: Sickle cell trait (SCT) is common among African Americans and has been historically considered to be benign. Recently, SCT has been associated with an increased risk for chronic kidney disease (CKD) and cardiovascular disease in the general population. Our understanding of SCT has been extrapolated largely from data of patients with sickle cell disease (SCD). Notably, in SCD, the outcomes differ by sex. The effect of SCT on cardiovascular risk in the African American CKD population is unknown, and the interaction between SCT and sex on cardiovascular risk has not been investigated. Methods: We performed a 2-center retrospective cohort study of all African American patients with SCT using international classification of disease diagnosis codes and CKD (using the 2012 Kidney Disease Improving Global Outcomes criteria) with at least 1 year of follow-up between January 2005 and December 2017. A reference group of ­African American CKD patients without SCT was used as a comparator during the same period. SCT patients and the reference patients were matched at baseline for age, sex, comorbidities, and proteinuria. Primary outcomes were incident coronary artery disease (CAD), incident stroke, and all-cause mortality. Analysis of effect modification between sex and SCT on primary outcomes was performed. Results: We identified 621 African American CKD patients, 217 SCT patients, and 404 reference patients. The mean age was 56 ± 13 years and 66% were female. The mean estimated glomerular filtration rate was 69 ± 30 mL/min. The mean follow-up time was 8 ± 4 years. There were no significant differences in the primary outcomes comparing SCT patients to matched controls. The interaction term between SCT and sex, however, was significant in the CAD model (p < 0.01). Stratification by sex showed no increased risk in females but a significantly increased risk for CAD in male SCT patients (hazard ratio [HR] 2.14; 95% CI 1.18–3.86), which persisted after multivariable analysis (HR 2.13; 95% CI 1.17–3.86). Conclusion: SCT is associated with an increased risk for CAD in African American males with CKD. The excess risk in males with SCT appears to follow the same pattern as risk in males with SCD. Larger studies are needed to confirm these findings.

scholarly journals Efek ekstrak daun sirsak (Annona muricata Linn) terhadap profil lipid tikus putih jantan (Rattus Norvegicus)

2014 ◽  
Vol 3 (1) ◽  
pp. 7-12 ◽  
Author(s):  
Indrawati Wurdianing ◽  
SA Nugraheni ◽  
Zen Rahfiludin
Keyword(s):  
Treatment Group ◽  
Lipid Profile ◽  
Total Cholesterol ◽  
Cholesterol Level ◽  
Ldl Cholesterol ◽  
Total Cholesterol Level ◽  
Wilcoxon Test ◽  
Control Group ◽  
Annona Muricata ◽  
The Mean

Background: Lipid profile effects is a risk factor for Coronary Heart Disease. Soursop leaves (Annona muricata L) isa traditional medicine plant containing metabolic compounds that contribute to the improvement of the lipid profile.Objective: To determine the effects of soursop leaves extract on lipid profile (total cholesterol, LDL cholesterol, HDLcholesterol and triglyceride).Methods: An experimental study using randomized pre-posttest with control group design. Sample consisted of 28 maleWistar rats, were divided into four groups. The control group (K) was only given High Fat High Cholesterol (HFHC)diet and treatment groups (P1, P2, P3) were given a HFHC diet plus Annona muricata L extract with doses of 100, 200and 300 mg/kgBB per day for 28 days respectively. Data were analyzed by Wilcoxon test, Kruskal-Wallis and MannWhitney.Results: The mean total cholesterol level significantly decreased in the treatment group P1 (p = 0.028) from 60.7 mg/dl(47.6-75.3) to 45.5 mg/dl (38.4-62.4). Mean HDL cholesterol level significantly increased in the treatment group P2(p=0.043) from 26.0 mg/dl (19.7-35.3) to 27.9 mg/dl (18.8-38.0). The mean levels of LDL cholesterol and triglyceridedecreased but not significantly.Conclusion: The administration of Annona muricata L extract can decrease total cholesterol and increase HDLcholesterol significantly.

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