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The prevalence and assessment of chronic kidney disease with diabetes: single center study

The prevalence and assessment of chronic kidney disease with diabetes: single center study

27. Brosius FC 3rd, Hostetter TH, Kelepouris E, Mitsnefes MM, Moe SM, Moore MA, et al. Detection of chronic kidney disease in patients with or at increased risk of cardiovascular disease: a science advisory from the American Heart Association Kidney And Cardiovascular Disease Council; the Councils on High Blood Pressure Research, Cardiovascular Disease in the Young, and Epidemiology and Prevention; and the Quality of

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Cardiovascular profile of patients with chronic kidney disease

Cardiovascular profile of patients with chronic kidney disease

The present study included 100 patients who were diagnosed with chronic kidney disease according to the National Kidney Foundation Kidney Disease Outcome Quality initiative and were assessed for cardiovascular changes. Echocardiographic studies have been the mainstay to demonstrate structural heart abnormalities in CKD patients. Similar to the results of the present study, 44% of the patients with CKD were found to have concentric left ventricular hypertrophy and 30% had predominately eccentric hypertrophy. These pathological changes are in response to volume and pressure overload. Volume overload increases left ventricular pressure which stretches the ventricular wall, which in turn stretches the myocytes. This process eventually results in wall thickening to reduce wall stress. On the other hand, pressure overload increases wall stress during systole, resulting in myocyte proliferation and wall thickening with preservation or reduction of cavity volume. Many of these processes can be accelerated by the uremic environment of chronic renal disease. Volume overload can commonly be caused by anemia, excess salt and water and arteriovenous fistulae in patients on dialysis, while hypertension results in pressure overload. These modifications in the physiological system are probably the primary stimuli to ventricular remodeling in uremia and also promote arterial remodeling in the large and resistance arteries. Additionally, secondary hyperparathyroidism and raised calcium-phosphate product may be associated with aortic valve calcification. Hypertension, which is a consequence of kidney damage, predisposes to coronary artery disease, congestive heart failure and stroke. Author study population had hypertension as the most common etiology for CKD. The characteristic lipid abnormality in CKD is elevated triglycerides, low HDL and normal to low LDL (except proteinuric CKD having high LDL). We did not observe a difference in lipid profile values with increasing severity of CKD. It is also not clear whether dyslipidemia associated with CKD increases the risk of atherosclerotic disease in such patients. Though not measured in the present study, procoagulants like fibrinogen, factor VIII and von Willebrand factor concentration increase in CKD and studies have suggested their role in increasing the risk of coronary diseases, stroke and other cardiovascular events.
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Hyperuricemia and deterioration of renal function in autosomal dominant polycystic kidney disease

Hyperuricemia and deterioration of renal function in autosomal dominant polycystic kidney disease

ACR: Albumin to creatinine ratio; ADPKD: Autosomal dominant polycystic kidney disease; CKD: Chronic kidney disease; CKD-EPI: Chronic kidney disease epidemiology collaboration; CT: Computed tomography; ESRD: End-stage renal disease; GFR: Glomerular filtration rate; GWAS: Genome-wide association studies; IDMS: Isotope dilution Mass Spectrometry; KDIGO: Kidney disease improving global outcomes; RAS: Renin-angiotensin aldosterone system; sCr: Serum creatinine; sUA: Serum uric acid; TGF- β : Transforming growth factor beta; TKV: Total kidney volume; TNF- α : Tumor necrosis factor alpha.
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On the rationale of population screening for chronic kidney disease: a public health perspective

On the rationale of population screening for chronic kidney disease: a public health perspective

Kidney function is usually measured by estimating glomerular filtration rate (GFR), which is currently considered to be the best index. A direct measurement of GFR is possible, such as by assessing urinary iothalamate or inulin clearance, but this is cum- bersome and not suitable for route clinical or population screening. Several equations have been proposed to estimate GFR (eGFR) from serum creatinine and the currently recommended equation for adults is the Chronic Kidney Disease-Epidemiology Collab- oration (CKD-EPI) equation [6]. The CKD-EPI equation also takes age, sex and race into account, because of their association with muscle mass, which influences the gen- eration of creatinine. It is particularly challenging to accurately estimate eGFR in older adults, because the increase in serum creatinine reflecting reduced kidney function is paralleled by an age-related decrease in muscle mass [7]. Another issue is the need to calibrate serum creatinine assays across laboratories to use them to estimate GFR [8, 9]. Because creatinine depends on muscle mass and other factors, such as diet, that influence creatinine generation, there have been efforts to identify a marker of glomerular filtration that does not suffer from these limitations. Cystatin C, an endogenous protein produced by nearly all human cells that is freely filtered by the glomeruli, has recently been pro- posed as a new marker. Cystatin C-based equations to estimate GFR are now available [10–14]. Compared to creatinine, cystatin C-based equations better predicted all-cause mortality and cardiovascular events in people older than 65 years [15] as well as all-cause mortality and end-stage renal disease (ESRD) in general adult populations [11]. Cystatin C may be combined with creatinine to estimate GFR [11], as demonstrated by some recently published equations cited above [13, 14]. Markers of glomerular filtration (e.g. serum cre- atinine and cystatin C) and markers of kidney damage (e.g. albuminuria, renal biopsy find- ings) are also part of the tests used to define CKD-staging.
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Tenofovir-associated kidney disease in Africans: a systematic review

Tenofovir-associated kidney disease in Africans: a systematic review

While TDF has been shown to be effective and rela- tively safe, several studies indicate that it has nephro- toxic potential, characterised by proximal tubular cell injury which may result in acute kidney injury (AKI), chronic kidney disease (CKD) or partial or complete Fanconi syndrome [5, 8–11]. This may compound HIV associated nephropathy (HIVAN), a condition which is a leading cause of chronic kidney disease and end-stage renal disease (ESRD) and is caused by direct injury to the kidneys by the Human Immunodeficiency Virus (HIV) [12]. HIVAN is documented as being more common in African Americans that their white counterparts but has wide variability in different Sub-Saharan populations [13, 14]. AKI usually results in discontinuation of the drug while chronic manifestations may be managed by closer monitoring of the patient and treating symptomatically. Regardless of the underlying aetiology of kidney dis- ease, if left untreated, it may lead to death [15]. Initiat- ing patients with reduced estimated glomerular filtration rates (eGFR) of < 50 ml/min/1.73 m 2 on TDF containing
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A Study of Serum Fetuin-A Level in Patients with Chronic Kidney Disease.

A Study of Serum Fetuin-A Level in Patients with Chronic Kidney Disease.

It has been predicted that about two-thirds of normal adults, above the age of 40 years will experience a decrease in GFR, even though they might not have had any obvious kidney disease in the past, whereas in the remaining one-third of adults, GFR has been shown to remain stable. However, this decrease of GFR with age differs from the progressive deterioration of renal function that follows kidney damage and rarely requires therapy 23 .

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Assessment of Health Related Quality of Life among Patients with Chronic Kidney Disease on Maintenance Dialysis

Assessment of Health Related Quality of Life among Patients with Chronic Kidney Disease on Maintenance Dialysis

Van, Duangpaeng, Deenan & Bonner (2012) sought to examine the association between monthly income, comorbidity, length of time on dialysis, social support and Health Related Quality Of Life (HRQOL) among Vietnamese ESKD patients, using a descriptive design. Ninety Five patients, who were receiving hemodialysis (HD) and peritoneal dialysis (PD) from a hospital in Hanoi, were conveniently smpled. The research revealed that End Stage Kidney Disease (ESKD) patients reported having a moderate level of HRQOL. Factors associated with QOL were social support (r= 0.268, p <0.05), comorbid health conditions (r=-0.185, p <0.05), and length of time on dialysis (r = -0.182, p< 0.05).However, monthly sincome was not significantly related to HRQOL (p>0.05). The result seemed to indicate that End Stage Kidney Disease (ESKD) patients in Vietnam have a high level of support from family members, friends and significant others. There was also a negative impact of comorbid conditions on the QOL of these patients.
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Influence of antioxidant genotype and antioxidant status on progression of chronic kidney disease

Influence of antioxidant genotype and antioxidant status on progression of chronic kidney disease

List of Tables Table 1-1: Stages of Chronic Kidney Disease 2 Table 1-2: Causes of Chronic Kidney Disease 4 Table 1-3: Clinical Features of Chronic Kidney Disease 6 Table 1-4: Common Biom[r]

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Prevalence of chronic kidney disease and associated factors among the Chinese population in Taian, China

Prevalence of chronic kidney disease and associated factors among the Chinese population in Taian, China

CKD: Chronic kidney disease; eGFR: estimated glomerular filtration rate; K/DOQI: Kidney Disease Outcomes Quality Initiative; NFK: National Kidney Foundation; ESRD: End-stage renal disease; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; BMI: Body mass index; FBG: Fasting blood glucose; TCH: Total cholesterol; TG: Triglyceride; HDL-C: High density lipoprotein-cholesterol; LDL-C: Low density lipoprotein-cholesterol; UA: Uric acid; Scr: Serum creatinine; HLP: Hyperlipidemia; SD: Standard deviation; ORs: Odds ratios; CIs: Confidence intervals; T2DM: type 2 diabetes; WHO: World Health Organization.
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Physiological complications in chronic kidney disease

Physiological complications in chronic kidney disease

Kidney disease is a worldwide public health problem, with becoming increasingly incidence and prevalence, high cost, and poor outcome. Chronic kidney disease (CKD) involves an irreversible loss of renal function. CKD is becoming one of the major leading global health concerns that is projected to grow worldwide at a rate of 8% annually, and incidentally is doubled in last fifteen years; but it is under diagnosed and under treated. Patient with hypertension, diabetes, obesity, nephritic syndrome and stone diseases are at high risk for CKD. As number of CKD patient increases, primary care practitioners will be confronted with management of complex medical problems unique to patients with chronic renal impairment. The aim of the present study is to provide an overview and detailing the current knowledge of physiological complications associated with CKD.
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Predictors of Left Ventricular Mass in Chronic Kidney Disease - eGFR and protienuria

Predictors of Left Ventricular Mass in Chronic Kidney Disease - eGFR and protienuria

This is to certify that the dissertation entitled "eGFR AND PROTEINURIA – PREDICTORS OF LEFT VENTRICULAR MASS IN CHRONIC KIDNEY DISEASE" is a bonafide work done by Dr. M. JENIFER SINEKALATHA, Post Graduate student, Department of General Medicine, Kilpauk Medical College, Chennai-10, under our able guidance and supervision in partial fulfilment of the Rules and Regulations of The Tamilnadu Dr.M.G.R.Medical University for the award of M.D. Degree Branch I, (General Medicine) during the Academic period from May 2011to April 2014.
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Exploring sleep disorders in patients with chronic kidney disease

Exploring sleep disorders in patients with chronic kidney disease

OSA is a sleep disorder in which apneas (complete or near complete cessation of airflow), hypopneas (partial airway obstruction), or respiratory effort-related arousals (RERAs— limited airway obstruction with an associated arousal) are seen. Kidney disease has been found to have an association with OSA. It has been demonstrated that in critically ill patients, the subset of patients with OSA had a higher risk of incidence of acute kidney injury compared to those who were critically ill but did not have a diagnosis of OSA (57% vs. 41%). 32 OSA is estimated to be present in approximately
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Incidence and survival of end-stage kidney disease due to polycystic kidney disease in Australia and New Zealand (1963–2014)

Incidence and survival of end-stage kidney disease due to polycystic kidney disease in Australia and New Zealand (1963–2014)

function by eGFR was incrementally introduced 2005 onwards [31] but it is too premature to determine the impact (if any) this could have on the incidence of ESKD. In this regard, one caveat to these conclusions is that the rate of renal disease progression in PKD occurs slowly over many decades [32]. For example, a recent analysis suggested that the time taken to transition from the early stage chronic kidney disease to final phase of ESKD, is up to seven times slower in PKD than in that due to other causes (e.g., 17.1 years in PKD vs. 2.5 years in non-PKD diseases) [33]. Thus, there may be a signifi- cant lag-time for subtle improvements in pre-dialysis medical management to be discerned, even with long- term registry data. Additionally, in this study it is not possible to model potential factors that may influence the changes in incidence using registry data because relevant risk factors (such as the use of ACE inhibitors) are not part of routine ANZDATA data collection. In- stead, in the present study we have analyzed temporal changes in the incidence of the EKSD due to PKD and
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Frailty is Independently Associated with Worse Health Related Quality of Life in Chronic Kidney Disease:A Secondary Analysis of the ‘Frailty Assessment in Chronic Kidney Disease’ Study

Frailty is Independently Associated with Worse Health Related Quality of Life in Chronic Kidney Disease:A Secondary Analysis of the ‘Frailty Assessment in Chronic Kidney Disease’ Study

18 van de Luijtgaarden MWM, Caskey FJ, Wanner C, Chesnaye NC, Postorino M, Janmaat CJ, Rao A, Torino C, Klinger M, Drechsler C, Heimburger O, Szymczak M, Evans M, Dekker FW, Jager KJ, investigators Es: Uraemic symptom burden and clinical condition in women and men of >/=65 years of age with advanced chronic kidney disease: results from the EQUAL study. Nephrol Dial Transplant 2018

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Modelling the long-term benefits of tolvaptan therapy on renal function decline in autosomal dominant polycystic kidney disease: an exploratory analysis using the ADPKD outcomes model

Modelling the long-term benefits of tolvaptan therapy on renal function decline in autosomal dominant polycystic kidney disease: an exploratory analysis using the ADPKD outcomes model

ist, became the first pharmacological agent to receive regulatory approval for the management of ADPKD. Since its initial approval in Japan, tolvaptan has subsequently received marketing authorisation for the treatment of adult ADPKD patients in the EU, Canada, South Korea, Switzerland, Hong Kong, Australia, and most recently, the United States [3–7]. Regulatory ap- provals of tolvaptan in ADPKD were primarily informed by the phase 3 Tolvaptan Efficacy and Safety in Manage- ment of Autosomal Dominant Polycystic Kidney Disease and Its Outcomes trial (TEMPO 3:4; ClinicalTrials.gov identifier NCT00428948), which compared tolvaptan against placebo in patients with early ADPKD and evi- dence of rapidly progressing disease [8]. Over the course of 3 years, TEMPO 3:4 found that tolvaptan therapy
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Autosomal dominant tubulointerstitial kidney disease-UMOD is the most frequent non polycystic genetic kidney disease

Autosomal dominant tubulointerstitial kidney disease-UMOD is the most frequent non polycystic genetic kidney disease

Autosomal dominant tubulointerstitial kidney disease (ADTKD) is a rare genetic kidney disease. ADTKD caused by mutations in the UMOD gene (ADTKD-U- MOD) is the most common form of ADTKD [1, 2]. Other gene mutations causing ADTKD include mucin 1 (MUC1), hepatocyte nuclear factor 1 beta (HNF1b), renin (REN), and the alpha subunit of the endoplasmic re- ticular membrane translocon (SEC61A1) [3–7]. Previously known as familial juvenile hyperuricaemic nephropathy (FJHN) and uromodulin associated kidney disease (UAKD), ADTKD-UMOD is characterised by early onset hyperuricaemia and gout affecting both sexes, and the development of insidious renal failure with tubulointersti- tial disease [8]. These disorders characteristically do not feature haematuria or proteinuria. Patients usually develop end stage renal disease (ESRD) between the third and sixth decade of life. However, clinical features are variable and hyperuricaemia and gout may be absent [9]. Some patients are found to have medullary renal cysts [10]. It has been shown that pathogenic UMOD mutations cause protein misfolding, retention in the endoplasmic reticulum (ER) and mistargeting of uromodulin in the thick ascending limb of Henle, resulting in tubulointersti- tial damage through ER stress and reduced urinary uro- modulin excretion [11–13]. A recent knock-in mouse model harbouring a human mutation has given insight into the pathophysiology of ADTKD-UMOD [14].
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Quality of Life in Patients with Chronic Kidney Disease: A Cross-sectional Study Comparing Patients on Hemodialysis, Peritoneal Dialysis and with Kidney Transplantation

Quality of Life in Patients with Chronic Kidney Disease: A Cross-sectional Study Comparing Patients on Hemodialysis, Peritoneal Dialysis and with Kidney Transplantation

For the comparison between males and females, Mann-Whitney U test was applied for all three patient-groups (Tables 6 and 7). Significant differences were found mainly in HD patients, revealing higher scores in males in almost all dimensions, i.e. in physical functioning, bodily pain, general health, vitality and mental health. Males rated significant higher scores in both the physical and the mental health component summary (44.7 vs 30.8, P=.003 and 52.2 vs 37, P=.01, respectively). With regard to the kidney- specific components, males had significant higher scores on symptoms and problems (75.1 vs 65.2, P=.004), effects of kidney disease (51.7 vs 40.2, P=.003) and work status (21.5 vs 10.3, P=.02). Higher scores in males are observed also in the PD group nearly in all components. However, significant differences are recorded only in the components bodily pain (85.5 vs 50, P=.01), mental health (77.4 vs 59.1, P=.03) and symptoms and problems (87.4 vs 69.9, P=.001). No statistical significant differences were observed between male and female kidney transplant recipients. For more details refer to Table 6 and Table 7.
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A Study of Lipid Profile in Chronic Kidney Disease Patients on Conservative Management, Haemodialysis and After Renal Transplantation

A Study of Lipid Profile in Chronic Kidney Disease Patients on Conservative Management, Haemodialysis and After Renal Transplantation

Chronic kidney disease [CKD] is associated with specific abnormalities in the lipoprotein metabolism both in the early and in the advanced stages of chronic renal failure. It has been suggested that the renal dyslipoproteinaemia of renal insufficiency contributes to the progression of glomerular and tubular lesions, with subsequent deterioration of renal function. Regardless of age, heart disease is a major cause of morbidity and mortality among patients with renal failure. Atherosclerotic heart disease is believed to account for approximately 55% of mortality and contributes to a 20-fold increase in ischemic heart disease and to a 10-fold increase in risk of stroke among patients with ESRD (chronic kidney disease stage 5)(8). Hypertension and diabetes mellitus, known risk factors for the development of cardiovascular disease (CVD) in the general population, are also the most common causes for the development of CVD in patients with CKD and ESRD. There are several other important risk factors, such as smoking, proteinuria, oxidative stress, inflammation and dyslipidemia that independently or in combination with elevated blood pressure, can cause deterioration in renal function.
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Markers of increased atherosclerotic risk in patients with chronic kidney disease: a preliminary study

Markers of increased atherosclerotic risk in patients with chronic kidney disease: a preliminary study

According to studies, in comparison to non-uremic serum, uremic serum increases the mineralization of vascular smooth muscle cells (VSMCs) and up-regulates the expression of Cbfa1/Runx2 and osteopontin (OPN), regardless of the serum P 2 concentration [29, 31]. Bone- associated proteins such as fetuin A, osteoprotegerin (OPG), osteopontin (OPN) and MGP have been demon- strated to be expressed in atherosclerotic plaques and to participate in its calcification, while exogenous osteocal- cin was shown to inhibit the process of calcification [32]. The level of osteocalcin (which is a non-collagenous, vitamin K-dependent protein produced by osteoblasts) is considered to be a non-invasive marker of osteoblast ac- tivity and bone formation [33]. In this study, no statisti- cally significant differences in osteocalcin concentration between the control group and patients with chronic kidney disease were observed. However, it was found that the concentration of osteocalcin was highest in pa- tients with stage I/II CKD and gradually decreased to reach its lowest value in patients with stage V/dialysis. Levels of osteocalcin in patients with CKD stage I-II and III were higher than in patients with higher CKD stages. Similar results were obtained in the study of Delmas et al. [34] who observed elevated levels of osteocalcin in patients with mild or moderate renal impairment. Ac- cording to them, such results reflect the enhanced bone metabolism rather than decreased renal filtration.
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<p>Prevalence Of Anemia And Its Associated Factors Among Chronic Kidney Disease Patients At University Of Gondar Hospital, Northwest Ethiopia: A Hospital-Based Cross Sectional Study</p>

<p>Prevalence Of Anemia And Its Associated Factors Among Chronic Kidney Disease Patients At University Of Gondar Hospital, Northwest Ethiopia: A Hospital-Based Cross Sectional Study</p>

Chronic kidney disease (CKD) is progressive, irreversible damage to the kidneys, which leads to inability of the kidneys to perform homeostatic, synthetic and excretory functions. Estimated epidemiological prevalence of CKD in global and sub-Saharan Africa was reported to be 15% and 10% respectively. 1 – 7 The evident reasons for escalating burden of kidney failure in Africa were due to growing urbanization, environmental pollutant exposure, high burden of infectious diseases

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