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PubMed2006

Limitations of estimating glomerular filtration rate from serum creatinine in the general population.

OBJECTIVE: To compare estimated glomerular filtration rate (GFR) in the general population on the basis of equations derived from different subsets of the general population. PARTICIPANTS AND METHODS: Adults (ages _45 years) were randomly selected from 1997 to 2000 from the Olmsted County, Minnesota, population and had their serum creatinine levels measured. The GFR was estimated using previously reported equations derived from a sample of patients with chronic kidney disease (CKD), a sample of healthy persons, and the combined samples. Serum creatinine was measured with the same assay used to derive these equations. RESULTS: Of 4203 subjects, 2042 (47% participation rate) were enrolled and studied. Serum samples from 1982 subjects were used to measure creatinine levels. The prevalence of a reduced estimated GFR (<60 mL/min per 1.73 m2) was 12% (95% confidence interval [CI], 10%-13%) based on an equation derived with all CKD patients, and this finding was similar to prior reports. However, the prevalence of a reduced estimated GFR was 5.7% (95% CI, 4.8%-6.8%) based on an equation derived with both CKD patients and healthy persons and 0.2% (95% CI, 0.1%-0.5%) based on an equation derived with all healthy persons. Women had a higher risk of reduced estimated GFR according to an equation derived with all CKD patients, but men had a higher risk with an equation derived with both CKD patients and healthy persons.

Aged↗
PubMedDate not supplied

Prevalence and treatment of anemia with once-weekly epoetin alfa in patients with diabetes and chronic kidney disease.

OBJECTIVE: To describe the characteristics and prevalence of anemia in patients with diabetes and chronic kidney disease (CKD) not receiving dialysis and to evaluate the efficacy and safety of once-weekly (QW) epoetin alfa for the treatment of anemia in these patients. METHODS: Post hoc subset analyses were conducted for 2 studies: a prospective, multicenter survey evaluating the prevalence of anemia in patients with CKD (the Prevalence of Anemia in Early Renal Insufficiency [PAERI] study) and a prospective, multicenter, open-label trial evaluating the efficacy and safety of QW epoetin alfa for the treatment of anemia associated with CKD (the Clinical Evaluation of Procrit Dosed Once Weekly in Patients With Anemia Due to Early Renal Insufficiency [POWER] study). Patients in the POWER study received epoetin alfa, 10,000 U subcutaneously QW for up to 16 weeks. Each study subset consisted of patients with type 1 or type 2 diabetes. RESULTS: More than 60% of patients in both studies had diabetes. In the PAERI study, 52.4% of the patients with diabetes (N = 3,361) had a hemoglobin (Hb) level < or = 12 g/dL, and 10.5% had Hb < or = 10 g/dL. Female sex, African American race, reduced kidney function, reduced transferrin saturation, and diabetes as the cause of CKD were strongly associated with anemia. In the POWER study, the mean Hb level in the patients with diabetes (N = 816) increased from 9.1 g/dL (baseline) to 11.6 g/dL (final); the mean increase in Hb from baseline was 2.4 g/dL (P<0.0001). Epoetin alfa therapy was associated with significant quality of life improvements and was well tolerated. CONCLUSION: Diabetes is prevalent in patients with CKD not receiving dialysis, and anemia is prevalent among these patients. Epoetin alfa QW is safe and effective in treating anemia in these patients.

Aged↗
PubMed2006

The burden of chronic kidney disease in Australian patients with type 2 diabetes (the NEFRON study).

OBJECTIVE: To estimate the frequency of chronic kidney disease (CKD) in a clinic-based sample of patients with type 2 diabetes in the setting of Australian primary care. DESIGN, SETTING AND PARTICIPANTS: Expressions of interest were invited from all registered general practitioners in Australia: 500 GP investigators were randomly selected from each stratum (state and urban versus rural location), proportional to the census population, and asked to recruit and provide data for 10-15 consecutively presenting adults with type 2 diabetes between April and September 2005. MAIN OUTCOME MEASURES: Estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m(2) and evidence of kidney damage on urinalysis (eg, microalbuminuria). RESULTS: 348 GP investigators submitted data for 3893 individuals with type 2 diabetes (52% men; median age, 66 years). Almost one in every four patients consulting their GPs had an eGFR < 60 mL/min/1.73 m(2) (23.1%; 95% CI, 21.8%-24.5%). More than one in three had an elevated urinary albumin-creatinine ratio (ACR) (34.6%; 95% CI, 33.3%-35.9%). There was an overlap of 10.4% of patients with both an eGFR < 60 mL/min/1.73 m(2) and an elevated urinary ACR, meaning that almost one in two patients with type 2 diabetes consulting their GPs (47.1%; 95% CI, 45.8%-48.4%) had CKD. CKD was significantly more common in women, in older people, and in individuals with established macrovascular disease. CONCLUSION: CKD is a common complication of type 2 diabetes, found in about half of all patients with type 2 diabetes consulting their GPs. Efforts to increase the recognition of CKD will lead to improved care, and possibly survival, of patients with type 2 diabetes.

Aged↗
PubMedDate not supplied

Epidemiology of chronic kidney disease in Italy: possible therapeutical approaches.

Chronic kidney disease (CKD) affects a significant percentage of the Italian population, particularly among the elderly. It is estimated that more than 300 patients per million population (pmp) are diagnosed as having CKD each year, and about 0.8% of Italians are thought to have serum creatinine levels >=1.5 mg/dL. The number of patients being admitted to renal replacement therapies (RRT) has been growing up rapidly in the last decades, leading to 134 patients pmp starting RRT throughout 2000 and to 804 patients pmp on chronic RRT in the same year. As such therapies are very expensive, CKD must be therefore considered as a striking problem also by a socio-economical point of view. As a consequence, any medical intervention being able to halt or at least to slow down the progression of CKD and/or to prevent the development of related complications or comorbidities is of paramount importance. Several therapeutical interventions, including hypertension and proteinuria control, protein restriction, anemia, calcium-phosphate disorders and dyslipidemia correction and smoking cessation, showed to be actually effective in at least partially achieving these objectives. Other emerging therapeutical approaches, although well promising, need further evidence to be definitively included in the management of CKD patients. Particular efforts should be made in order to refer these patients to the nephrologist as early as possible, as it has been widely demonstrated that an early and regular nephrological care leads to decreased morbidity and mortality and also to decreased social costs.

Adult↗
PubMed2003

Intravenous iron therapy in chronic kidney disease and peritoneal dialysis patients.

Identical National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) hematologic and iron targets apply to chronic kidney disease (CKD), peritoneal dialysis (PD), and hemodialysis (HD) patients, yet intravenous (i.v.) nondextran iron therapy is FDA approved only in HD patients. This is because oral iron has been considered adequate in CKD and PD patients, and delivering a parenteral therapy on a frequent basis to an outpatient population with notoriously poor vascular access presents logistical complexities. However, recognition of the need for more aggressive treatment of anemia in the CKD and PD population is growing. This awareness, along with the improved safety profiles of the new, nondextran irons, is tipping the risk-benefit ratio toward more widespread use of i.v. iron in these patients. This article provides a summary of the literature and of our own experience using i.v. iron therapy in CKD and PD patients. Our protocol relies on early monitoring and intervention with i.v. ferric gluconate before severe iron deficiency develops. The proactive approach allows for relatively infrequent treatments at only moderately "high" doses (250 mg) of ferric gluconate. The convergence of convenience and safety may expedite more energetic anemia prevention and treatment in PD and CKD patients.

Anemia, Iron-Deficiency↗
PubMed2004

Hyperhomocysteinemia and the development of chronic kidney disease in a general population: the Hisayama study.

BACKGROUND: Hyperhomocysteinemia has been linked with various atherosclerotic diseases, but has not been evaluated sufficiently as a risk factor for the development of chronic kidney disease (CKD) in the general population. METHODS: To clarify this issue, we followed up 1,477 community-dwelling individuals without CKD, aged 40 years or older, for 5 years and examined the effects of baseline serum total homocysteine (tHcy) levels on the development of CKD. RESULTS: During follow-up, 88 subjects experienced CKD. Baseline tHcy levels were greater in men than women (1.35 versus 1.04 mg/L [10.0 versus 7.7 micromol/L]; P < 0.01). Age-adjusted 5-year incidences were 2.2% in the low tertile, 5.4% in the middle tertile, and 8.6% in the high tertile of tHcy levels for men and 3.3%, 6.0%, and 6.9% for women, respectively. The difference between the low and high tertiles was statistically significant for both sexes ( P < 0.05). In multivariate analysis, these relationships remained substantially unchanged, even after adjustment for other confounding factors, such as systolic blood pressure, antihypertensive medication, hemoglobin A 1c level, total cholesterol level, high-density lipoprotein cholesterol level, habitual smoker status, regular alcohol intake, proteinuria, and baseline kidney function (odds ratio [OR] in the high tertile of tHcy levels, 2.09; 95% confidence interval [CI], 0.66 to 6.61 for men; OR, 2.86; 95% CI, 1.10 to 7.43 for women). Furthermore, baseline tHcy level showed a significantly inverse association with rate of change in kidney function during the 5 years after being adjusted for confounding factors, including baseline kidney function. CONCLUSION: Our findings suggest that elevated serum tHcy levels are a significant risk factor for the development of CKD in the general population.

Aged↗
PubMed2005

Retardation of kidney failure -- applying principles to practice.

Over the next decade, the number of patients with end-stage renal disease (ESRD) treated by dialysis may double, and even developed nations will have difficulty in coping with this alarming increase. This review will outline the proven and unproven strategies that have the potential to retard the progression of chronic kidney disease (CKD). Recently, a number of randomised clinical trials have demonstrated the efficacy of several strategies to slow the progression of CKD. Proven strategies include adequate blood pressure control (with angiotensin blockade), and for diabetic nephropathy good glycaemic control. Other potentially beneficial strategies include smoking cessation, lipid control and aldosterone blockade. The early institution of these strategies has the potential to regress established CKD as well as improve the long-term cardiovascular outcomes of these patients. Proof of the efficacy in humans of promising experimental approaches, such as the administration of growth factors (e.g., recombinant bone morphogenetic protein-7), anti-fibrotic agents (e.g., pirfenidone) and novel anti-proteinuric drugs (e.g., pentosan polysulphate), is awaited. Finally, the primary prevention of CKD, at least in part, by the eradication of type 2 diabetes and obesity (through improvement of lifestyle factors), and adequate treatment of hypertension, have the potential to eliminate up to half of the most common causes of CKD (or ESRD) in developed countries.

Angiotensin II Type 1 Receptor Blockers↗
PubMed2005

Cardiovascular disease in chronic kidney failure: is there a role for vitamin D analogs?

Vitamin D3 is modified by vitamin D3-25-hydroxylase in the liver, and 25-hydroxyvitamin D3-1alpha-hydroxylase in the kidney, to form the active metabolite, 1,25-dihydroxyvitamin D3. Chronic kidney disease (CKD) is characterized by reduced synthesis of 1,25-dibydroxyvitamin D3, inadequate renal phosphate clearance and calcium imbalance, secondary hyperparathyroidism (SHPT) and bone disease. CKD patients encounter a much higher risk of cardiovascular disease (CVD) than the general public. The cardiovascular risk factors for CKD patients include conventional factors such as age, gender, hypertension, diabetes, dyslipidemia and smoking, and non-conventional factors, such as anemia, uremia, reduced vascular compliance, inflammation and various hormonal factors. Several vitamin D analogs are currently available for the treatment of SHPT, and recent clinical data show that these analogs provide survival benefit for CKD patients in the order of paricalcitol > calcitriol > no vitamin D analog, independent of parathyroid hormone and calcium. Moreover, the survival benefit seems to be associated with cardiovascular causes. The observations made from these clinical studies raised intriguing questions about the involvement of the vitamin D receptor locus (VDR) in the cardiovascular system. This review discusses recent data regarding the role of vitamin D and its analogs in the CVD associated with CKD.

Calcitriol↗
PubMed2005

[Cardiovascular disease in Chinese chronic renal insufficiency patients-epidemiology survey].

OBJECTIVE: Cardiovascular (CV) disease (CVD) is the single most important cause of death among Chinese dialysis patients, accounting for 51% of overall mortality. The study was performed to investigate the prevalence and the spectrum of CVD in Chinese chronic kidney disease (CKD) patients. METHODS: The multicenter Chinese cohort study examined 1239 CKD patients from 7 main medical centers (distributed in 5 regions of China) who were hospitalized between 2002 and 2003. RESULTS: (1) The most prevalent pathological form of CVD was left ventricular (LV) hypertrophy (LVH), accounting for 58.5% of total patients. The prevalence of coronary artery disease (CAD), congestive heart failure (CHF), and cerebrovascular accidents (CVA) was 16.5%, 27.7% and 5.6%, separately. (2) The cohort with minor renal dysfunction (stage 2-3) had higher prevalence of CAD (5.9%) and CVA (1.0%) compared with general population in the same regions. Up to 41.2% of minor CKD patients were complicated with LVH, and 13.8% of them had clinical evidence of CHF. The prevalence of CAD, LVH and CHF increased as glomerular filtration decline. (3) The prevalence of CAD (20.0%) was much lower and the prevalence of CVA (5.4%) was higher in Chinese dialysis patients than that in American dialysis population. There was significant geographical variations in CAD prevalence, but it was not different between genders. CONCLUSION: The CV risk is significantly increased in patients with CKD. Even minor CKD has a major impact on the CV risk. The prevalence of CAD in Chinese dialysis patients is markedly lower than that in American dialysis population.

Adult↗
PubMed2005

[Epidemiology of cardiovascular risk in Chinese chronic kidney disease patients].

OBJECTIVE: To identify the risk factors associated with cardiovascular disease (CVD) in Chinese chronic kidney disease (CKD) patients. METHODS: As part of a multicenter Chinese cohort study, the clinical data associated with CVD of 1239 patients with CKD (stage 2 - 5) hospitalized in 7 grade 3A hospitals distributed in 5 regions of China 2002 - 2003 were collected. Logistic regression model was used to analyze the association between CVD and the demographic variables, lifestyle, medical history, medication, physical examination, and laboratory variables. RESULTS: (1) Increase of serum C-reactive protein (CRP, cut off > 10 mg/L) was an independent risk factor for development of coronary artery disease (CAD) (OR 2.13; 95% confidence interval [CI], 1.32 - 3.43). 21.5% of the patients in this group showed a value of CRP > 10 mg/L. (2) Being female, anemia, and systolic hypertension were the major determinants of the development of left ventricular hypertrophy (OR 2.99, CI 2.09 - 4.26; OR 2.66, CI 1.19 - 3.57; and OR 1.02, CI 1.00 to -1.02). 54.2% of the patients in this group had their systolic pressure controlled under 140mmHg, and only 15% of the patients in this group had their hemoglobin remain at the level >or= 110 g/L. (3) There was a significant interaction between the calcium-phosphate product and congestive heart failure (CHF) (OR 1.023, CI 1.01 - 1.03). 25.9% of the patients in this cohort had their calcium-phosphate product >or= 55. (4) Hypoalbuminemia (OR 6.01, CI 1.25 - 28.96) and diastolic hypertension (OR 1.05, CI 1.00 - 1.09) played major role in determining cerebrovascular accidents (CVA). In these cohort the prevalence of hypoalbuminemia was 37.3%. (5) Diabetes was associated with CAD (OR 2.34), CHF (OR 1.97), and CVA (OR 4.40), although its prevalence was lower in Chinese CKD patients (20%). Age was the risk factors of CAD (OR 1.04) and CVA (OR 1.22). Hypertension was associated with LVH (OR 1.016), CHF (OR 1.02), and CVA (OR 1.04). CONCLUSION: CKD is associated with nontraditional risk factors for the development of CVD, including chronic inflammation, malnutrition and calcium-phosphate disorders. Particular care must be taken to give optimal treatment for the most important CVD risk factors active in Chinese CKD patients, e.g. anemia and hypertension.

Adult↗
PubMed2004

Diagnosis: Chronic kidney disease, now what!

The occupational health nurse can play an important role in supporting employees with CKD and ESRD by recognizing risk factors such as diabetes and hypertension associated with CKD. The occupational health nurse should encourage compliance with treatment regimens that retard or delay progression of kidney disease into the next stage, especially blood pressure and glucose control. When employees are in need of diagnostic testing, the occupational health nurse can describe the testing procedures such as laboratory values, ultrasounds, and biopsies, and explain the five stages of CKD. The occupational health nurse can assist employees in Stage 4 or 5 CKD in deciding on a treatment option modality that best suits their individual lifestyles, after they have seen a nephrologist and kidney patient educator. In addition, the occupational health nurse can guide employees with difficult lifestyle changes and provide support during the adjustment process. The occupational health nurse also can play a key role in facilitating and coordinating those changes with the renal social worker. Together they can explore available resources, such as the NKF, the American Association of Kidney Patients, and kidneydirections.com. See the Sidebar on pages 295 to 296 for other available resources. Kidney disease can be a devastating diagnosis. Support and education are key to a successful lifestyle transition. Employees who have CKD and work with an occupational health nurse who is informed about their disease and its stages of progression can benefit from educational processes that create informed choices to delay or retard the progression of their renal disease.

Chronic Disease↗
PubMed2005

[Increased levels of advanced oxidation protein products are associated with atherosclerosis in chronic kidney disease].

OBJECTIVE: Accumulation of advanced oxidation protein products (AOPP) has been found in patients with chronic kidney disease (CKD). The study was performed to investigate the association between serum levels of AOPP and atherosclerosis in CKD. METHODS: 109 CKD patients were involved in this cross-sectional cohort study. Carotid artery intima-medial thickness (IMT), cross-sectional calculated intima-media area (cIM area) and plaques were determined with non-invasive high-resolution B-mode ultrasonography. Serum levels of AOPP, malonyldialdehyde (MDA), glutathione peroxidase (GSHPx) and C-reactive protein (CRP) were also determined. RESULTS: Higher serum AOPP levels were found in patients with CKD [(64.72 +/- 19.69) micromol/L] as compared with those in healthy controls [(30.16 +/- 6.46) micromol/L, P < 0.01]. AOPP levels in dialysis patients [(70.02 +/- 16.51) micromol/L] were significantly higher than those in pre-dialysis patients [(51.71 +/- 15.53) micromol/L, P < 0.01]. AOPP levels increased with the progression of renal dysfunction and inversely correlated with creatinine clearance (Ccr) (r = -0.292, P < 0.05). Patients with carotid artery plaques showed significantly higher levels of AOPP [(73.87 +/- 19.40) micromol/L] as compared with patients without carotid artery plaques [(58.41 +/- 16.09) micromol/L, P < 0.01]. Serum levels of AOPP were strongly associated with carotid artery IMT (r = 0.332, P < 0.01) and cIM area (r = 0.288, P < 0.05). By stepwise multiple regression analysis and adjusting for age, gender, blood pressure, smoking, diabetes, body mass index (BMI), hemoglobin, lipid and albumin, strong association was still present between AOPP levels and carotid artery IMT (beta = 0.313, P < 0.001) and cIMarea (beta = 0.301, P < 0.01). Serum levels of AOPP were correlated positively with serum MDA (r = 0.300, P = 0.01) and CRP levels (r = 0.255, P < 0.05), while negatively with serum GSHPx (r = -0.647, P < 0.01). CONCLUSIONS: Serum levels of AOPP increased with the progression of renal failure and closely associated with occurrence of atherosclerosis. Strong association between serum AOPP and CRP suggests that AOPP might be involved in the pathogenesis of micro-inflammation which has been considered as a contributing factor for atherosclerosis in CKD.

Adult↗
PubMed2005

Phagocytic polymorphonuclear function in patients with progressive uremia and the effect of acute hemodialysis.

BACKGROUND: Susceptibility to infections is a major cause of high morbidity and mortality in patients with chronic kidney disease (CKD). Polymorphonuclear leukocytes (PMNs) play a major role in the host defense against various infections. Although the phagocytic function of PMNs in uremic patients has been subjected to repeated evaluation, results have been inconsistent. Also, the effects of progressive uremia and acute hemodialysis (HD) on polymorphonuclear function have been scarcely evaluated. METHODS: In this study, we assessed the phagocytic index (PI) of PMNs following their uptake of IgG-coated sheep erythrocytes in patients with varying severity of CKD and in healthy controls. In patients with advanced renal failure, the effects of acute HD on PI pre- and post-HD were also studied. RESULTS: A total of 30 patients with CKD and 15 healthy controls were studied. Patients with CKD were categorized into two groups: mild to moderate renal failure (S. Creatinine 2-6 mg/dL) and advanced renal failure (S. Creatinine >6 mg/dL) (n=15 for each). All three groups were age and sex matched. Patients with advanced renal failure had significantly impaired PI (4.03 +/- 1.15) as compared to patients with mild to moderate renal failure (7.17 +/- 2.62) and normal controls (8.13 +/- 3.31) (p < 0.001 for both). There was a statistically insignificant decline in the PI in patients with mild to moderate RF when compared to controls (7.17 +/- 2.62 versus 8.13 +/- 3.31). In patients with advanced renal failure, acute HD led to a significant improvement in PI (5.52 +/- 1.55 versus 4.03 +/- 1.15, p < 0.01). CONCLUSION: In patients with CKD, there is a progressive decline in the phagocytic index of the PMNs with increasing severity of uremia. Significant improvement in the phagocytic index following acute hemodialysis suggests the role of a circulating uremic toxin in this PMN dysfunction.

Adolescent↗
PubMed2005

[Can angiotensin-converting enzyme inhibitor be used in chronic kidney disease patients with serum creatinine level greater than 266 micromol/L?].

OBJECTIVE: Angiotensin-converting enzyme inhibitor (ACEI) has been demonstrated to have protective effect for patients with mild to moderate chronic kidney disease (CKD). However, little evidence is available for the benefit or side-effects of ACEI in treating patients with more severe CKD. A prospective, randomized controlled trial was performed to evaluate the renal protective effect and safety of ACEI in patients whose serum creatinine (Scr) levels were higher than 265 micromol/L. METHODS: 168 CKD patients took benazepril for two months. 21 patients quitted the trial because of cough. The remaining 147 CKD patients were divided into two groups according to their Scr levels. Patients with Scr 133 - 265 micromol/L were included in group A (n = 55), and those with Scr 266-442 micromol/L were included in group B (n = 92). Furthermore, group B were divided randomly into two subgroups, B1 (n = 47) and B2 (n = 45). Benazepril was given (10 - 20 mg/d) as an intervention for group A and group B1. Additional calcium-channel antagonist and/or beta-blocker and/or vasodilator were used for blood pressure control in those two groups. Patients in group B2 served as controls who take calcium-channel antagonist and/or beta-blocker and/or vasodilator but not Benazepril. The target blood pressure is 125/75 mm Hg or less in all groups. All patients were followed for two years. Doubling of the baseline Scr level or end-stage renal disease with the need for dialysis was regarded as the major end point of the trial. RESULTS: (1) The magnitude of mean arterial pressure reduction was comparable in group A [(12.90 +/- 3.21) mm Hg], group B1 [(13.36 +/- 4.27) mm Hg] and group B2 [(10.38 +/- 3.85) mm Hg]. There was no significant change among them (P > 0.05 in all). (2) The magnitude of urinary protein reduction (Delta) in group A [(0.52 +/- 0.29) g/24 h], group B1 [(0.50 +/- 0.26) g/24 h] were much higher than that in group B2 [(0.19 +/- 0.13) g/24 h] (P < 0.05), but there was no significant difference between group A and B1 (P = 0.94). (3) By the end of two years, the percentages of cases reaching the major end point in group A, group B1 and group B2 were 19.23%, 40.90% and 51.35% respectively. There was significant difference among the three groups (chi(2) = 12.14, upsilon = 2, P = 0.002). (4) After two years of treatment, the left ventricular mass indexes and the percentages of left ventricular hypertrophy in group A, group B1 and group B2 were all decreased significantly. There were no statistical differences among the three groups. (5) The incidence of ACEI related adverse reactions, such as rapid increase of Scr more than 30%, dry cough or hyperkalemia were not different among the three groups. CONCLUSIONS: Benazepril slows the progression of CKD in patients with Scr higher than 266 micromol/L, it is safe in these patients.

Adolescent↗
PubMed2005

Piecing together the evidence on anemia: the link between chronic kidney disease and cardiovascular disease.

Chronic kidney disease (CKD) is now accepted as an independent cardiovascular disease (CVD)-risk state, regardless of its underlying cause. Anemia is a common feature of CKD, particularly in end-stage renal disease. Anemia is also independently associated with poorer outcomes in a wide variety of CVD states, including congestive heart failure and coronary artery disease. Anemia appears to act as an independent mortality multiplier when hemoglobin levels drop below 12 g/dL. With the independent and profound contribution of both CKD and anemia to cardiovascular mortality and morbidity, understanding the pathophysiologic links among these disease states is important. In addition, it is hoped that treatments currently under active investigation and geared specifically to attenuate the cardiovascular risk associated with anemia and CKD, such as erythropoietin therapy, will improve outcomes. This article reviews the evidence for an association among CKD, anemia, and CVD.

Anemia↗
PubMed2005

Pathogenesis of anemia in cardiorenal disease.

The link between chronic heart failure (CHF) and chronic kidney disease (CKD) is well known. Approximately 50% of patients with CHF have some renal dysfunction, and 25% of patients with CKD and serum creatinine levels ranging from 1.5 mg/dL to 6 mg/dL have CHF. The association of CHF with CKD is strong and may contribute to its long-term progression. Anemia is also common in patients with CKD and contributes to increased morbidity and mortality. More recently, anemia has been found to be frequently present in patients with CHF, and its presence is associated with worse long-term CHF outcomes. Thus, anemia, CHF, and CKD may be independently related to one another, and this relationship may have important implications for their management.

Anemia↗
PubMed2005

The correlation of insulin resistance and renal function in non diabetic chronic kidney disease patients.

INTRODUCTION: A greater degree of insulin resistance may predispose to renal injury by worsening renal hemodynamics through the elevation of glomerular filtration fraction. However, there are sparse data on the relationship between insulin resistance, glomerular filtration rate (GFR) and body composition in chronic kidney disease (CKD) without diabetes. OBJECTIVES: To evaluate the relationship between insulin resistance, total body fat and GFR in CKD without diabetes. MATERIAL AND METHOD: The authors screened 84 non-diabetic CKD patients according to the K/DOQI definitions and only 78 patients were enrolled into the study (CKD stages 2-4, GFR between 15 and 90 ml/min/ 1.73 m2). Insulin resistance was evaluated by homeostasis model assessment (HOMA-IR). Bioelectrical impedance analysis was performed to determine the percentage of total body fat. GFR was calculated by the average of creatinine and urea clearances. RESULTS: The correlation analysis showed that HOMA-IR was positively correlated with percent body fat (r = 0.32, P<0.05), BMI (r = 0.46, P<0.01), serum triglyceride (TG) (r =0.29, P<0.01), and mean arterial pressure (r =0.25, P<0.05), but not significantly correlated with GFR, age, cholesterol, HDL, uric acid and 24-hr urinary protein. CONCLUSION: In non-diabetic CKD patients, the independent factor for insulin resistance was the amount of total body fat. The insulin level and HOMA-IR were not dependent on the GFR in the present study.

Adult↗
PubMedDate not supplied

Chronic periodontitis in hemodialysis patients with chronic kidney disease is associated with elevated serum C-reactive protein concentration and greater intima-media thickness of the carotid artery.

BACKGROUND: An increasing number of papers have documented the contribution of chronic periodontitis (P) to the pathogenesis of cardiovascular disease. The aim of this study was to answer the question whether there is an association between periodontal inflammation and atherosclerotic processes in hemodialysis patients with chronic kidney disease (CKD). METHODS: Forty-four hemodialysis patients with CKD were considered. Advanced chronic periodontitis was found in 17, whereas 27 patients had no or moderate chronic periodontitis. In all patients examined, serum C-reactive protein (CRP), TNF-alfa and IL-6 concentrations, as well as intima-media thickness (IMT) of the carotid artery, were assessed. RESULTS: Patients with CKD and advanced periodontitis were characterized by a significantly higher serum CRP concentration (13.2 +/- 11.4 vs. 10.4 +/- 14.4; p<0.05) and IMT (0.742 +/- 0.028 vs. 0.656 +/- 0.019, p<0.05) than CKD patients without periodontitis. In the univariate analysis, a significant correlation between CRP and number of atherosclerotic plaques was revealed; however, it was not confirmed as an independent relationship in the multiple regression analysis. CONCLUSIONS: Inflammation of the periodontal tissue in patients with CKD is associated with increased serum CRP concentration and greater IMT. It is possible that periodontitis may induce a systemic process that may exacerbate atherosclerosis.

Adult↗