Detrimental effect of renin-angiotensin blockade on progression of chronic kidney disease at later stages: A matter of dosage adjustment?
This study aims to investigate if the rate of renal function decline in advanced CKD patients is associated to the doses of RAS blockers, and if dual RAS blockade worsens renal function independently of major confounding factors. MATERIAL AND METHODS: Retrospective, observational study in an incident cohort of adult patients with CKD stage 4 or 5 not on dialysis, treated with RAS blockers for at least 3 months prior to the study inclusion. Inclusion criteria were: having at least three consecutive measurements of estimated glomerular filtration rate (eGFR) in a follow-up period>3 months. Decline in renal function was estimated as the slope of the individual linear regression line of eGFR over follow-up time. Equipotent doses of RAS blockers were normalised for a body weight of 70kg or a body surface area of 1.73m2 (END-RASI). Associations of END-RASI or dual RAS blockade with the rate of renal function decline were analysed by uni- or multivariate linear regression models, accounting for major confounding variables. RESULTS: The study group consisted of 813 patients (mean age 64±14 years, 430 males) with a mean eGFR 14.9±4.2ml/min/1.73m2; 729 patients were on RAS blockade monotherapy and 84 on dual RAS blockade. Median END-RASI in the whole group was 0.91 (I.Q. ranges: 0.69-1.20). Patients on dual RAS blockade had significantly higher END-RASI than the rest of study patients (1.52±0.49 vs. 0.93±0.44; p
Sanchis et al.1 reported interesting data on the association between vascular calcification and arterial inflammaging in children with advanced chronic kidney disease. We agree that uremic children are a potentially ideal model for studying accelerated cellular senescence, but the authors do not differentiat e between those on hemodialysis and those on peritoneal dialysis therapy. Peritoneal dialysis is known to be characterized by a generally superior biocompatibility compared with hemodialysis.
The study by Wang et al.1 revealed a comprehensive description of the burden of chronic kidney disease and end-stage kidney disease in China. The study estimated that there were approximately 553,000 hemodialysis patients and 55,000 peritoneal dialysis patients in China in 2015. The median annual overall cost for each peritoneal dialysis and hemodialysis patient was 73,266 and 87,125 renminbi, respectively.1 According to these data, the total medical expenditure for dialysis patients would have been 40–50 billion renminbi in 2015, but it was reported as 429 million renminbi.
ConclusionsOur prospective study performed in a real-world setting showed a high immunogenicity and safety of HBV-AS04 vaccine in patients with CKD not yet on maintenance dialysis. Studies provided with longer follow-ups are under way to assess the durability of seroprotection in responders.
Authors: Jha VK, Sharda V, Mirza SA, Shashibhushan, Bhol KK Abstract Hemorrhagic stroke is leading cause of death in Chronic Kidney Disease (CKD) population. Uremic patients are susceptible to hemorrhagic complications due to multiple reasons i.e platelet dysfunction, low platelet number, use of heparin during hemodialysis, use of anticoagulants for thromboembolic risk etc. Prevention and treatment of hemorrhagic stroke is complicated in CKD setting and if not managed properly can lead to several fold increased mortality and morbidity rate. In this brief review we will discuss about the magnitude of hemorrhagic str...
Conclusion: Statin can be used as an adjuvant to erythropoietin in management of anemia in patients of chronic kidney disease, who show hyporesponsiveness to increased doses of erythropoietin, by its anti-inflammatory properties. PMID: 31313547 [PubMed - in process]
Authors: Saxena G, Khera P, Jain D Abstract Introduction: Disorders of mineral and bone metabolism in chronic kidney disease (CKD) are associated with increased risk for cardiovascular calcification and osteoporosis. Anemia has been associated with progressive loss of kidney function and increased mortality. Ferric citrate was recently developed, primarily as a novel oral, non-calcium phosphate binder, which has also shown to replenish the iron deficient state of the CKD patients. Material and methods: This prospective study was done on 40 pre-dialysis adult patients of CKD (stage 3-5) from a tertiary care cent...
Authors: Nand N, Giri K, Jain D Abstract Introduction: Disorders of mineral and bone metabolism in chronic kidney disease (CKD) are associated with increased risk for cardiovascular calcification and osteoporosis. Anemia has been associated with progressive loss of kidney function and increased mortality. Ferric citrate was recently developed, primarily as a novel oral, non-calcium phosphate binder, which has also shown to replenish the iron deficient state of the CKD patients. Material and methods: This prospective study was done on 40 pre-dialysis adult patients of CKD (stage 3-5) from a tertiary care centre ...
Conclusion In patients with advanced CKD and previous CABG, ULCA may be performed with high procedural success and without complications, minimizing the risk of CIN in these high-risk patients.
Conclusion: In early-stage CKD, NOACs had a benefit-risk profile superior to that of VKAs. For advanced CKD or ESKD, there was insufficient evidence to establish benefits or harms of VKAs or NOACs. Primary Funding Source: None. (PROSPERO: CRD42017079709). PMID: 31307056 [PubMed - as supplied by publisher]
Volume overload has been shown to be an independent risk factor for mortality in patients receiving chronic dialysis, but data in non-dialysis patients are scarce. Therefore we evaluated the prognostic value of extracellular fluid (ECF) volume for chronic kidney disease (CKD) progression and mortality in a prospective hospital-based cohort with CKD stage 1-4 (NephroTest Study). ECF (scaled to body surface area) and the measured glomerular filtration rate (mGFR) were determined using the distribution volume and clearance of 51Cr-EDTA, respectively.