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Latest & greatest articles for chronic kidney disease
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Acute effects of intradialytic aerobic exercise on solute removal, blood gases and oxidative stress in patients with chronickidneydisease. Hemodialysis contributes to increased oxidative stress and induces transitory hypoxemia. Compartmentalization decreases the supply of solutes to the dialyzer during treatment. The aim of this study was to investigate the acute effects of intradialytic aerobic exercise on solute removal, blood gases and oxidative stress in patients with chronickidney (...) disease during a single hemodialysis session.Thirty patients were randomized to perform aerobic exercise with cycle ergometer for lower limbs during 30 minutes with intensity between 60-70% of maximal heart rate, or control group (CG). Blood samples were collected prior to and immediately after exercise or the equivalent time in CG. Analysis of blood and dialysate biochemistry as well as blood gases were performed. Mass removal and solute clearance were calculated. Oxidative stress was determined
Metabolic syndrome and its components are associated with increased chronickidneydisease risk: Evidence from a meta-analysis on 11 109 003 participants from 66 studies Observational studies examining the relationship between metabolic syndrome and the risk of chronickidneydisease (CKD) have reported inconclusive results. This meta-analysis was performed to resolve these controversies.The MEDLINE, EMBASE, and PubMed databases were systematically searched from their inception until March 2016
Inhibition of Interleukin-1beta by Canakinumab and Cardiovascular Outcomes in Patients With ChronicKidneyDisease Inflammation contributes to chronickidneydisease (CKD), in part mediated through activation of interleukin (IL)-1β by the NLRP3 inflammasome within the kidney. This process also likely contributes to the accelerated atherosclerosis associated with nephropathy.The authors hypothesized that canakinumab, a human monoclonal antibody targeting IL-1β, might reduce cardiovascular event
Effect of Coaching to Increase Water Intake on Kidney Function Decline in Adults With ChronicKidneyDisease: The CKD WIT Randomized Clinical Trial. In observational studies, increased water intake is associated with better kidney function.To determine the effect of coaching to increase water intake on kidney function in adults with chronickidney disease.The CKD WIT (ChronicKidneyDisease Water Intake Trial) randomized clinical trial was conducted in 9 centers in Ontario, Canada, from 2013 (...) until 2017 (last day of follow-up, May 25, 2017). Patients had stage 3 chronickidneydisease (estimated glomerular filtration rate [eGFR] 30-60 mL/min/1.73 m2 and microalbuminuria or macroalbuminuria) and a 24-hour urine volume of less than 3.0 L.Patients in the hydration group (n = 316) were coached to drink more water, and those in the control group (n = 315) were coached to maintain usual intake.The primary outcome was change in kidney function (eGFR from baseline to 12 months). Secondary
Gout medication may slow progression of chronickidneydisease Gout medication may slow progression of chronickidneydisease Discover Portal Discover Portal Gout medication may slow progression of chronickidneydisease Published on 20 February 2018 doi: In people with existing kidneydisease, one in four will have worse disease within six to 12 months. Uric acid-lowering drugs such as allopurinol halve the risk of disease progression over this period. They also reduce heart attack or stroke (...) by 60%. Uric acid, the cause of gout, is produced when proteins are broken down by the body. It is excreted by the kidneys and often builds up in people with chronickidneydisease. It is not certain whether increased uric acid causes progression of kidneydisease or is simply a marker of its severity. This review included 16 small trials of 1,211 people with moderate chronickidneydisease from a variety of causes which were allocated to take a uric acid lowering medication or usual care. Although
Uncertainty persists over choice of phosphate binders for chronickidneydisease Uncertainty persists over choice of phosphate binders for chronickidneydisease Discover Portal Discover Portal Uncertainty persists over choice of phosphate binders for chronickidneydisease Published on 30 August 2016 doi: NICE recommend calcium-based phosphate binding medicines for people with chronickidneydisease, however, new research suggests non-calcium based alternatives might lead to a lower risk (...) of death. The review is best viewed alongside other reviews which look at different aspects of chronickidneydisease. The totality of research and cost effectiveness will need to be considered if practice recommendations are to change. In this review, calcium-based phosphate binders were associated with increased risk of death compared with non-calcium alternatives, but there was no difference in the risk of cardiovascular death or hospitalisation. Effects of these agents on mortality need
New generation anticoagulants may be safer than warfarin for people with chronickidneydisease New generation anticoagulants may be safer than warfarin for people with chronickidneydisease Discover Portal Discover Portal New generation anticoagulants may be safer than warfarin for people with chronickidneydisease Published on 26 April 2016 doi: Newer generation anticoagulants appear to reduce the risk of bleeding compared with older anticoagulants like warfarin, when used to prevent clots (...) in people who also have mild to moderate chronickidneydisease. This group of drugs, called direct oral anticoagulants, have been well researched in healthy people with atrial fibrillation or at risk of thromboembolism but this was the first review to look at their safety, in terms of bleeding and risk of bleeding within the brain, in people with kidneydisease. As a group, these newer drugs appear safer than older anticoagulants such as warfarin. Evidence from the trials comparing individual new
Chronickidneydisease care models in low- and middle-income countries: a systematic review The number of persons with chronickidneydisease (CKD) living in low- and middle-income countries (LMIC) is increasing rapidly; yet systems built to care for them have received little attention. In order to inform the development of scalable CKD care models, we conducted a systematic review to characterise existing CKD care models in LMICs.We searched PubMed, Embase and WHO Global Health Library (...) databases for published reports of CKD care models from LMICs between January 2000 and 31 October 2017. We used a combination of database-specific medical subject headings and keywords for care models, CKD and LMICs as defined by the World Bank.Of 3367 retrieved articles, we reviewed the full text of 104 and identified 17 articles describing 16 programmes from 10 countries for inclusion. National efforts (n=4) focused on the prevention of end-stage renal disease through enhanced screening, public
Do Statins Induce or Protect from Acute Kidney Injury and ChronicKidneyDisease: An Update Review in 2018 Statins essentially are cholesterol-lowering drugs that are extensively prescribed for primary and secondary prevention of cardiovascular disease. Compelling evidence suggests that the beneficial effects of statins may not only be due to its ability to control cholesterol levels but also due to a pleiotropic cholesterol-independent anti-inflammatory, antioxidant, endothelial-protective (...) and plaque-stabilizing activity. Along this line, statins may also exert acute and long-term effects on renal function. We present a narrative literature review that summarizes arguments in favor of or against the preventive and/or therapeutic use of statins in kidney-related diseases or complications. We also highlight the ongoing controversy regarding statin therapy in chronic and end-stage kidneydisease.
Very low-protein diet to postpone renal failure: Pathophysiology andÂ clinical applications in chronickidneydisease The uremic syndrome is a metabolic disorder characterized by the impairment of renal handling of several solutes, the resulting accumulation of toxic products and the activation of some adaptive but detrimental mechanisms which all together contribute to the progression of renal damage. In moderate to advanced renal failure, the dietary manipulation of nutrients improves (...) metabolic abnormalities and may contribute to delay the time of dialysis initiation. This commentary focuses on the physiopathological rationale and the clinical application of the very low-protein diet supplemented with ketoanalogs for the management of chronickidneydisease.
Multiple-frequency bioimpedance devices for fluid management in people with chronickidneydisease receiving dialysis: a systematic review and economic evaluation Multiple-frequency bioimpedance devices for fluid management in people with chronickidneydisease receiving dialysis: a systematic review and economic evaluation Multiple-frequency bioimpedance devices for fluid management in people with chronickidneydisease receiving dialysis: a systematic review and economic evaluation Scotland G (...) , Cruickshank M, Jacobsen E, Cooper D, Fraser C, Shimonovich M, Marks A & Brazzelli M Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Scotland G, Cruickshank M, Jacobsen E, Cooper D, Fraser C, Shimonovich M, Marks A & Brazzelli M. Multiple-frequency bioimpedance devices for fluid management in people with chronickidneydisease receiving dialysis
Use of the Kidney Failure Risk Equation to Determine the Risk of Progression to End-stage Renal Disease in Children With ChronicKidneyDisease The kidney failure risk equation (KFRE) has been shown to accurately estimate progression to kidney failure in adults with chronickidneydisease (CKD). Use of the KFRE in children with CKD, if accurate, would help to optimize planning for end-stage renal disease (ESRD) care.To determine whether the KFRE adequately discriminates the risk of ESRD (...) in children with CKD.This retrospective cohort study included 603 children with an estimated glomerular filtration rate of less than 60 mL/min/1.73 m2 in the ChronicKidneyDisease in Children study, a national multicenter observational study. Data were collected from January 1, 2005, through July 31, 2013, and analyzed from September 30, 2016, through September 8, 2017.The primary predictive factors were the 4-variable (age, sex, bedside Schwartz estimated glomerular filtration rate, and ratio of albumin
Chronickidneydisease Bulletin “Independent prescribing information for NHS Wales” Chronickidneydisease (CKD) is a long-term irreversible deterioration in the function of the kidneys, often in patients with diabetes and/or hypertension. It affects approximately 5.5% of adults, with a higher prevalence in older people. 1 CKD can have huge health implications for individual patients, including significantly increased risk of cardiovascular disease (CVD) and an increased vulnerability to acute (...) that should be avoided, e.g. over-the-counter NSAIDs. 2,5,19 Healthcare professionals may not always inform people that they have CKD. This could be due to concerns over the validity of the diagnosis and a desire not to induce unnecessary anxiety or ‘medicalise’ the ageing process. 19 Older people, in whom reduced kidney function is common, may find the use of the words ‘chronic’ and ‘disease’ distressing unless a sensitive explanation is offered. 19 As well as enabling self-management, there is a patient
Antihypertensive Medications and Change in Stages of ChronicKidneyDisease The goal of this study is to estimate the change in the relationships between use of five classes of antihypertensive medications and stages of ChronicKidneyDisease (CKD) in American adults treated for hypertension.The US National Health and Nutrition Examination Survey (NHANES) data sets 1999-2012 were used with the final analytical sample of 3,045 participants. Population prevalence estimates were calculated using (...) and in users of ARB in patients with albuminuria (p = 0.0031).Aggressive pharmacological management of hypertension with ARB as add-on therapy may have accelerated kidney damage in American adults. However, prospective longitudinal studies are needed to establish proper temporal sequence in this relationship.
Determinant factors for chronickidneydisease after partial nephrectomy The objective of this review is to evaluate the factors that determine the development or deterioration of ChronicKidneyDisease (CKD) after partial nephrectomy (PN). When current literature is reviewed, it is found that factors that influence renal function after partial nephrectomy, are multifactorial. Those are divided into pre-surgical factors, such as hypertension, diabetes mellitus, urolithiasis, obesity, metabolic
Diagnosis, Evaluation, Prevention, and Treatment of ChronicKidneyDisease-Mineral and Bone Disorder: Synopsis of the KidneyDisease: Improving Global Outcomes 2017 Clinical Practice Guideline Update. The KidneyDisease: Improving Global Outcomes (KDIGO) 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of ChronicKidneyDisease-Mineral and Bone Disorder (CKD-MBD) is a selective update of the prior CKD-MBD guideline published in 2009. The guideline
Ischaemic stroke, haemorrhage, and mortality in older patients with chronickidneydisease newly started on anticoagulation for atrial fibrillation: a population based study from UK primary care. To assess the association between anticoagulation, ischaemic stroke, gastrointestinal and cerebral haemorrhage, and all cause mortality in older people with atrial fibrillation and chronickidney disease.Propensity matched, population based, retrospective cohort analysis from January 2006 through (...) December 2016.The Royal College of General Practitioners Research and Surveillance Centre database population of almost 2.73 million patients from 110 general practices across England and Wales.Patients aged 65 years and over with a new diagnosis of atrial fibrillation and estimated glomerular filtration rate (eGFR) of <50 mL/min/1.73m2, calculated using the chronickidneydisease epidemiology collaboration creatinine equation. Patients with a previous diagnosis of atrial fibrillation or receiving
Empagliflozin and Clinical Outcomes in Patients With Type 2 Diabetes Mellitus, Established Cardiovascular Disease, and ChronicKidneyDisease Empagliflozin, a sodium-glucose cotransporter 2 inhibitor, reduced cardiovascular morbidity and mortality in patients with type 2 diabetes mellitus and established cardiovascular disease in the EMPA-REG OUTCOME trial (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients). Urinary glucose excretion with empagliflozin (...) decreases with declining renal function, resulting in less potency for glucose lowering in patients with kidneydisease. We investigated the effects of empagliflozin on clinical outcomes in patients with type 2 diabetes mellitus, established cardiovascular disease, and chronickidney disease.Patients with type 2 diabetes mellitus, established cardiovascular disease, and estimated glomerular filtration rate (eGFR) ≥30 mL·min-1·1.73 m-2 at screening were randomized to receive empagliflozin 10 mg
Risk of stroke and bleeding in patients with heart failure and chronickidneydisease: a nationwide cohort study The aim of this study was to assess the prognostic value of chronickidneydisease (CKD) in relation to ischaemic stroke, intracranial haemorrhage, major bleeding, and all-cause death in heart failure patients without atrial fibrillation.In this observational cohort study, heart failure patients without atrial fibrillation were identified using Danish nationwide registries. Risk