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Latest & greatest articles for chronic kidney disease
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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.
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
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.].
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
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
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
was a prospective cohort study of 850 patients with advanced chronickidneydisease (CKD). Risk factors associated with death were calculated using a Cox's proportional hazards model. We used the statistical package SPSS version 22.0 for data analysis.The mean age of patients was 44.8 ± 17.2 years old. At the time of hospital admission, 87.6% of the population did not have a social security program to cover the cost of renal replacement treatment, and 91.3% of families had an income below US$300 per month (...) Mortality in Patients With ChronicRenalDisease Without Health Insurance in Mexico: Opportunities for a National Renal Health Policy Despite a systematic increase in the coverage of patients with end-stage renaldisease (ESRD) who have received dialytic therapies and transplantation over the past 2 decades, the Mexican health system currently still does not have a program to provide full coverage of ESRD. Our aim was to analyze mortality in patients with ESRD without health insurance.This
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 (...) rates and improve renal function among post-myocardial infarction patients with CKD.Stable post-myocardial infarction patients with high-sensitivity C-reactive protein (hsCRP) ≥ 2mg/l were randomly allocated to placebo or to 1 of 3 doses of canakinumab (50, 150, or 300 mg) given subcutaneously once every 3 months. Participants were followed for incident myocardial infarction, stroke, hospitalization for unstable angina requiring urgent revascularization, cardiovascular death, or death from any cause
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
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. (...) 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
Diagnostic Accuracy of Aspartate Aminotransferase to Platelet Ratio Index and Fibrosis 4 Scores in Predicting Advanced Liver Fibrosis in Patients with End-stage RenalDisease and Chronic Viral Hepatitis: Experience from Pakistan The aim was to assess the diagnostic accuracy of APRI and FIB-4 in assessing the stage of liver fibrosis in end stage renaldisease (ESRD) patients with chronic viral hepatitis and to compare the two tests with standard tru-cut liver biopsy.The study was conducted (...) at Sindh Institute of Urology and Transplantation Karachi (SIUT) from May 2010 to May 2014. All ESRD patients, being considered as candidates for renal transplantation and in whom liver biopsy was performed were included. Fibrosis stage was assessed on liver biopsy using Ishak scoring system. The serum transaminases and platelet counts were used to calculate APRI and FIB-4 scores.Out of 109 patients, hepatitis C and B virus infections were present in 104 (95.4%) and 3(2.8%), respectively, while 2 (1.8
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.
kidney injury (AKI). A small, but significant, number of cases progress to end-stage renaldisease (ESRD) requiring dialysis or kidney transplant, which carries a major personal, social, and economic burden. Historically, CKD was considered to be a condition to be managed primarily by specialists. However, the introduction of laboratory reporting of the estimated glomerular filtration rate (eGFR) alongside serum creatinine values has improved the identification of people with CKD in primary care (...) to be considered when dosing patients with renal impairment? Medicines Q&A 167.6. February 2016. https://www.sps.nhs.uk/articles/what-factors-need-to-be-considered-when- dosing-patients-with-renal-impairment-2/. Accessed 2 May 2017. 9. Webster AC et al. ChronicKidneyDisease. Lancet 2016; 389(10075): 1238-1252. 10. Anonymous. Sick day rules in kidneydisease. Drug and Therapeutics Bulletin April 2015; 53(4) 11. National Institute for Health and Care Excellence. Acute kidney injury: prevention, detection
Use of the Kidney Failure Risk Equation to Determine the Risk of Progression to End-stage RenalDisease 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 renaldisease (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
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
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.