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Latest & greatest articles for chronic kidney disease
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Low protein diets for non-diabetic adults with chronickidneydisease. Chronickidneydisease (CKD) is defined as reduced function of the kidneys present for 3 months or longer with adverse implications for health and survival. For several decades low protein diets have been proposed for participants with CKD with the aim of slowing the progression to end-stage kidneydisease (ESKD) and delaying the onset of renal replacement therapy. However the relative benefits and harms of dietary protein (...) relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov.We included randomised controlled trials (RCTs) or quasi RCTs in which adults with non-diabetic chronickidneydisease (stages 3 to 5) not on dialysis were randomised to receive a very low protein intake (0.3 to 0.4 g/kg/d) compared with a low protein intake (0.5 to 0.6 g/kg/d
Association between MPO-463Gâ€‰>â€‰A polymorphism and chronickidneydisease: a meta-analysis Previous studies have shown that MPO -463G > A (rs2333227) might be associated with chronickidneydisease (CKD) susceptibility, but sample sizes of those studies are relatively small. Hence, we decided to perform a meta-analysis to evaluate the association. Methods/main results: Two investigators search databases systematically and independently. Odds ratios and 95% confidence intervals were used
combinations. 4. In most cases, combination therapy with other antihypertensive agents might be needed to reach target BP levels (Grade D). This recommendation is based on expert consensus. 5. The combination of an ACE inhibitor and ARB is not recommended for patients with nonproteinuric chronickidneydisease (Grade B). Dual renin-angiotensin system (RAS) inhibition has been shown to reduce significantly proteinuria , a surrogate endpoint for cardiovascular disease, and renal impairment in patients (...) to develop future recommendations for these patient populations. References Klahr S, Levey AS, Beck GJ, et al. The effects of dietary protein restriction and blood- pressure control on the progression of chronicrenaldisease. Modification of Diet in RenalDisease Study Group. N Engl J Med 1994;330:877-84. Sarnak MJ, Greene T, Wang X, et al. The effect of a lower target blood pressure on the progression of kidneydisease: long-term follow-up of the Modification of Diet in RenalDisease study. Ann Intern
Do thiazides work in patients with chronickidneydisease? Do Thiazides Work in Patients With ChronicKidneyDisease? – Clinical Correlations Search Do Thiazides Work in Patients With ChronicKidneyDisease? October 4, 2018 4 min read By Hannah Friedman Peer Reviewed It is a commonly seen scenario on the wards: a patient with a past medical history of heart failure and stage 4 chronickidneydisease presents with progressive shortness of breath and worsening lower extremity edema. The patient (...) (Stage 4-5). However, recent literature .  Recent reports estimate that 13.1% of the US population has chronickidneydisease (CKD), with 8% having at least stage 3 CKD.  These patients have a ,  and this risk worsens as the disease progresses. Thiazides and thiazide-like diuretics act on the distal convoluted tubule of the nephron, specifically on the .  This mechanism makes thiazides useful not just as antihypertensives, but also as diuretics in volume-overloaded patients. Thiazides
Effects of Sacubitril/Valsartan Versus Irbesartan in Patients with ChronicKidneyDisease: A Randomised Double-Blind Trial Sacubitril/valsartan reduces the risk of cardiovascular mortality among patients with heart failure with reduced ejection fraction, but its effects on kidney function and cardiac biomarkers in people with moderate to severe chronickidneydisease are unknown.The UK HARP-III trial (United Kingdom Heart and Renal Protection-III), a randomized double-blind trial, included 414 (...) (36.7% versus 28.0%; rate ratio, 1.35; 95% CI, 0.96-1.90), and potassium ≥5.5 mmol/L (32% versus 24%, P=0.10) was not significantly different between randomized groups.Over 12 months, sacubitril/valsartan has similar effects on kidney function and albuminuria to irbesartan, but it has the additional effect of lowering blood pressure and cardiac biomarkers in people with chronickidney disease.URL: http://www.isrctn.com . Unique identifier: ISRCTN11958993.
Treating endothelial dysfunction with vitamin D in chronickidneydisease: a meta-analysis. Vitamin D deficiency is common in patients with chronickidneydisease (CKD), and is associated with endothelial dysfunction and cardiovascular disease. We performed a meta-analysis to assess the effect of vitamin D treatment on flow mediated vasodilation (FMD) in CKD patients.PubMed/Medline, Web of Science, Embase and Cochrane trials and reviews were searched systematically for randomized controlled (...) of vitamin D on vascular disease in CKD. Limitations of this meta-analysis are the small number of studies performed, and the short duration of intervention.
Insulin and glucose-lowering agents for treating people with diabetes and chronickidneydisease. Diabetes is the commonest cause of chronickidneydisease (CKD). Both conditions commonly co-exist. Glucometabolic changes and concurrent dialysis in diabetes and CKD make glucose-lowering challenging, increasing the risk of hypoglycaemia. Glucose-lowering agents have been mainly studied in people with near-normal kidney function. It is important to characterise existing knowledge of glucose (...) = 28%) and albuminuria (MD -8.14 mg/mmol creatinine, -14.51 to -1.77; I2 = 11%; low certainty evidence). SGLT2 inhibitors may have little or no effect on the risk of cardiovascular death, hypoglycaemia, acute kidney injury (AKI), and urinary tract infection (low certainty evidence). It is uncertain whether SGLT2 inhibitors have any effect on death, end-stage kidneydisease (ESKD), hypovolaemia, fractures, diabetic ketoacidosis, or discontinuation due to adverse effects (very low certainty evidence
Association between fibre intake and indoxyl sulphate/P-cresyl sulphate in patients with chronickidneydisease: Meta-analysis and systematic review of experimental studies. Indoxyl sulphate (IS) and p-cresyl sulphate (PCS), which are difficult to excrete adequately out of the body, are closely related to the progression of chronickidneydisease (CKD) and various deuteropathy. Better than peritoneal dialysis (PD) and haemodialysis (HD), dietary fibre has been considered to reduce IS and PCS
retinopathy diabetes mellitus hypertension age >50 years childhood kidneydisease smoking obesity black or Hispanic ethnicity family history of chronickidneydisease autoimmune disorders male sex long-term use of NSAIDs Diagnostic investigations serum creatinine urinalysis urine microalbumin renal ultrasound estimation of GFR renal biopsy plain abdominal radiograph abdominal CT abdominal MRI Treatment algorithm ACUTE Contributors Authors Assistant Professor of Medicine University of Arkansas for Medical (...) is determined only by laboratory studies. Glycaemic control for diabetic nephropathy and optimisation of blood pressure are key in slowing the progression of disease. Increased risk for cardiovascular disease. Definition Chronickidneydisease (CKD), also known as chronicrenal failure, is defined by either a pathological abnormality of the kidney, such as haematuria and/or proteinuria, or a reduction in the glomerular filtration rate to <60 mL/minute/1.73 m² for ≥3 months' duration. KidneyDisease
The role of hypoxia-inducible factor stabilizers in the treatment of anemia in patients with chronickidneydisease The purpose of this study was to analyze the effects of hypoxia-inducible factor (HIF) stabilizers on anemia in non-dialysis-dependent (NDD) and dialysis-dependent (DD) chronickidneydisease (CKD) patients.Published studies were extracted from PubMed, China Biological Medicine Database (CBM), Wanfang database, and Cochrane Library on March 10, 2018, and relevant studies were
Work of being an adult patient with chronickidneydisease: a systematic review of qualitative studies. Chronickidneydisease (CKD) requires patients and caregivers to invest in self-care and self-management of their disease. We aimed to describe the work for adult patients that follows from these investments and develop an understanding of burden of treatment (BoT).Systematic review of qualitative primary studies that builds on EXPERTS1 Protocol, PROSPERO registration number: CRD42014014547 (...) to and from haemodialysis centre, with variable availability and cost, was a common problem, aggravated for patients in non-urban areas, or with young children, and low resources. Additional work for those uninsured or underinsured included fund-raising. Transplanted patients needed to manage finances and responsibilities in an uncertain context. Information on the disease, treatment options and immunosuppressants side effects was a widespread problem.Being a person with end-stage kidneydisease always
Left Main Revascularization With PCI or CABG in Patients With ChronicKidneyDisease: EXCEL Trial The optimal revascularization strategy for patients with left main coronary artery disease (LMCAD) and chronickidneydisease (CKD) remains unclear.This study investigated the comparative effectiveness of percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) surgery in patients with LMCAD and low or intermediate anatomical complexity according to baseline renal (...) function from the multicenter randomized EXCEL (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial.CKD was defined as an estimated glomerular filtration rate <60 ml/min/1.73 m2 using the CKD Epidemiology Collaboration equation. Acute renal failure (ARF) was defined as a serum creatinine increase ≥5.0 mg/dl from baseline or a new requirement for dialysis. The primary composite endpoint was the composite of death, myocardial infarction (MI
Evans M, Grams ME, Sang Y, etÂ al., for the ChronicKidneyDisease Prognosis Consortium. Risk factors for prognosis in patients with severely decreased GFR. Kidney Int Rep. 2018;3:625â€“637 [This corrects the article DOI: 10.1016/j.ekir.2018.01.002.].
Phosphate binders for preventing and treating chronickidneydisease-mineral and bone disorder (CKD-MBD). Phosphate binders are used to reduce positive phosphate balance and to lower serum phosphate levels for people with chronickidneydisease (CKD) with the aim to prevent progression of chronickidneydisease-mineral and bone disorder (CKD-MBD). This is an update of a review first published in 2011.The aim of this review was to assess the benefits and harms of phosphate binders for people (...) with CKD with particular reference to relevant biochemical end-points, musculoskeletal and cardiovascular morbidity, hospitalisation, and death.We searched the Cochrane Kidney and Transplant Register of Studies up to 12 July 2018 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal
Correlation between Soluble Î±-Klotho and Renal Function in Patients with ChronicKidneyDisease: A Review and Meta-Analysis Over decades, numerous inconsistent studies are reported on the relationship between soluble α-Klotho and renal function in patients with chronickidneydisease (CKD). This study aims to perform a meta-analysis to figure out the correlations between soluble α-Klotho and renal function in patients with CKD.We searched medical and scientific literature databases, PubMed (...) and EMBASE (from the inception to October 2017), for publications that reported studies on associations between soluble α-Klotho and renal function in patients with CKD. Only publications in English were extracted. Summary correlation coefficient (r) values were extracted from each study, and 95% confidence intervals (CIs) were calculated. Publication bias was tested, and sensitivity and subgroup analyses were performed to investigate potential heterogeneity.Of 611 studies, 9 publications with 1457
disease —mineral and bone disorder (CKD-MBD). KidneyDisease : Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronickidneydisease –mineral and bone disorder (CKD-MBD). Kidney Int Suppl. 2017 Jul;7 2017 10. Pharmacotherapy in ChronicKidneyDisease Patients Presenting With Acute Coronary Syndrome Pharmacotherapy in ChronicKidneyDisease Patients Presenting With Acute Coronary (...) on management of older patients with chronickidneydisease stage 3b or higher (eGFR chronickidneydisease stage 3b or higher (eGFR 2016 3. Chronickidneydisease - not diabetic Chronickidneydisease - not diabetic - NICE CKS Clinical Knowledge Summaries Share Chronickidneydisease - not diabetic - Summary Chronickidneydisease (CKD) is an abnormality of kidney function or structure that is present for more than 3 months, with implications for health. Complications of CKD include worsening renaldisease
Efficacy and safety of dapagliflozin in patients with type 2 diabetes and moderate renal impairment (chronickidneydisease stage 3A): The DERIVE Study Dapagliflozin is a selective inhibitor of sodium glucose co-transporter 2 (SGLT2). This study assessed the efficacy and safety of dapagliflozin 10 mg vs placebo in patients with type 2 diabetes (T2D) and moderate renal impairment (estimated glomerular filtration rate [eGFR], 45-59 mL/min/1.73 m2 ; chronickidneydisease [CKD] stage 3A
Meso-American nephropathy: what we have learned about the potential genetic influence on chronickidneydisease development Chronickidneydisease of unknown aetiology (CKDu) refers to the epidemic level of incidence of CKD in several low- and middle-income countries, usually near the equator, for which the aetiology has not been identified. CKDu represents a form of CKD hotspot, defined as a country, region, community or ethnicity with a higher than average incidence of CKD. In terms (...) of the number of persons affected, the so-called hypertensive nephropathy of African Americans probably represents the largest CKD hotspot, which is largely driven by variants of the APOL1 gene, questioning the very existence of hypertensive nephropathy and illustrating how kidneydisease driven by genetic predisposition may underlie some forms of hypertension. For CKDu, hard physical work leading to dehydration (the first global warming-related disease?) and local toxins are leading aetiological candidates
Probiotics, prebiotics and synbiotics for chronickidneydisease: protocol for a systematic review and meta-analysis. There is a growing interest in probiotic, prebiotic and synbiotic supplements for patients with chronickidneydisease (CKD). However, a systematic review and evaluation is lacking. The purpose of the present study is to assess the efficacy and safety of probiotics, prebiotics and synbiotics for non-dialysis or non-renal transplant patients with CKD.An extensive literature (...) outcome measures are uraemic toxins. Secondary outcomes include kidney function, adverse cardiovascular events, all-cause mortality, cause-specific death, progression to end-stage kidneydisease, quality of life, gastrointestinal function and adverse events. Data will be synthesised using appropriate statistical methods. The quality of evidence for each outcome will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.No ethical approval is required
ChronicKidneyDisease, Queensland (CKD.QLD) Registry: Management of CKD With Telenephrology Enabled by the ChronicKidneyDisease, Queensland (CKD.QLD) Registry, we aim to outline the structure, implementation, and outcomes of telenephrology clinics for the management of patients with chronickidneydisease (CKD) in rural, regional, and remote areas of the Darling Downs region in Queensland, Australia.This is an observational registry-based study involving adult patients with CKD, attending