Journal articles on the topic 'Non-Dialysis Dependent Chronic kidney disease (NDD-CKD)'
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Toft, Gunnar, Uffe Heide-Jørgensen, Heleen van Haalen, Glen James, Katarina Hedman, Henrik Birn, Christian F. Christiansen, and Reimar W. Thomsen. "Anemia and clinical outcomes in patients with non-dialysis dependent or dialysis dependent severe chronic kidney disease: a Danish population-based study." Journal of Nephrology 33, no. 1 (October 5, 2019): 147–56. http://dx.doi.org/10.1007/s40620-019-00652-9.
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Abstract Background Routine clinical evidence is limited on clinical outcomes associated with anemia in patients with severe chronic kidney disease (CKD). Methods We linked population-based medical databases to identify individuals with severe CKD (eGFR < 30 mL/min/1.73 m2) in Northern Denmark from 2000 to 2016, including prevalent patients as of 1 January 2009 or incident patients hereafter into the study. We classified patients as non-anemic (≥ 12/≥ 13 g/dl hemoglobin (Hgb) in women/men), anemia grade 1 (10–12/13 g/dl Hgb in women/men), 2 (8–10 g/dl Hgb), and 3+ (< 8 g/dl Hgb), allowing persons to contribute with patient profiles and risk time in consecutively more severe anemia grade cohorts. Patients were stratified by dialysis status and followed for clinical outcomes. Results We identified 16,972 CKD patients contributing with a total of 28,510 anemia patient profiles, of which 3594 had dialysis dependent (DD) and 24,916 had non-dialysis dependent (NDD) severe CKD. Overall, 14% had no anemia, 35% grade 1 anemia, 44% grade 2 anemia and 17% grade 3+ anemia. Compared to patients with no anemia, adjusted hazard ratios (HRs) for NDD patients with grade 3+ anemia were elevated for incident dialysis (1.91, 95% CI 1.61–2.26), any acute hospitalization (1.74, 95% CI 1.57–1.93), all-cause death (1.82, 95% CI 1.70–1.94), and MACE (1.14, 95% CI 1.02–1.26). Similar HRs were observed among DD patients. Conclusions Among NDD or DD patients with severe CKD, presence and severity of anemia were associated with increased risks of incident dialysis for NDD patients and with acute hospitalizations, death and MACE for all patients.
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You, Amy S., Kamyar Kalantar-Zadeh, Elani Streja, Christina Park, John J. Sim, Ekamol Tantisattamo, Jui-Ting Hsiung, et al. "Mortality Risk in Chronic Kidney Disease Patients Transitioning to Dialysis: Impact of Opiate and Non-Opiate Use." American Journal of Nephrology 51, no. 9 (2020): 715–25. http://dx.doi.org/10.1159/000509451.
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Background: Population-based studies show there is a high prevalence of chronic kidney disease (CKD) patients suffering from chronic pain. While opiates are frequently prescribed in non-dialysis-dependent CKD (NDD-CKD) patients, there may be toxic accumulation of metabolites, particularly among those progressing to end-stage renal disease (ESRD). We examined the association of opiate versus other analgesic use during the pre-ESRD period with post-ESRD mortality among NDD-CKD patients transitioning to dialysis. Methods: We examined a national cohort of US Veterans with NDD-CKD who transitioned to dialysis over 2007–14. Among patients who received ≥1 prescription(s) in the Veterans Affairs (VA) Healthcare System within 1 year of transitioning to dialysis, we examined associations of pre-ESRD analgesic status, defined as opiate, gabapentin/pregabalin, other non-opiate analgesic, versus no analgesic use, with post-ESRD mortality using multivariable Cox models. Results: Among 57,764 patients who met eligibility criteria, pre-ESRD opiate and gabapentin/pregabalin use were each associated with higher post-ESRD mortality (ref: no analgesic use), whereas non-opiate analgesic use was not associated with higher mortality in expanded case-mix analyses: HRs (95% CIs) 1.07 (1.05–1.10), 1.07 (1.01–1.13), and 1.00 (0.94–1.06), respectively. In secondary analyses, increasing frequency of opiate prescriptions exceeding 1 opiate prescription in the 1-year pre-ESRD period was associated with incrementally higher post-ESRD mortality (ref: no analgesic use). Conclusions: In NDD-CKD patients transitioning to dialysis, pre-ESRD opiate and gabapentin/pregabalin use were associated with higher post-ESRD mortality, whereas non-opiate analgesic use was not associated with death. There was a graded association between increasing frequency of pre-ESRD opiate use and incrementally higher mortality.
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Montenegro, Julia, Márcia Klein, Carla Prado, and Maria Inês Barreto Silva. "Bone Mineral Metabolism and Muscle Alterations in Non-dialysis Dependent Patients With Chronic Kidney Disease." Current Developments in Nutrition 5, Supplement_2 (June 2021): 38. http://dx.doi.org/10.1093/cdn/nzab033_038.
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Abstract Objectives Abnormal bone mineral density (BMD) is common in chronic kidney disease (CKD) and related with higher risk of disease progression, cardiovascular disease, and mortality. The aim of this study was to assess BMD, its change overtime and association with body composition and biochemical parameters of mineraly metabolism. Methods This was a longitudinal study of patients with NDD-CKD (stages 3–5) undergoing interdisciplinary treatment at an outpatient Nephrology Clinic and instructed to follow a low protein diet. Dual energy X-ray absorptiometry (DXA) was performed to estimate body composition and BMD (T-score). Mineral metabolism parameters included parathormone (PTH), calcium, phosphorus and vitamin D. Glomerular filtration rate was estimated (eGFR) by the CKD-EPI equation. Osteopenia was defined as T-score < -1.0. Baseline and follow-up comparisons between groups with and without osteopenia were performed by two-way ANOVA. Correlations were adjusted by sex, age and eGFR. Results Forty-five patients (56% males) aged 64.4 ± 9.9 y and eGFR 31.4 ± 10.9 ml/min completed a follow-up of ∼3 years (2.7 ± 1.3). As expected, a reduction in renal function was observed (median = −1.10 ml/min; 95% CI: −8.8 to 0.64, P < 0.05). BMD and appendicular skeletal muscle (ASM) decreased: 1.06 ± 0.15 vs. 1.05 ± 0.03g/cm2 (P = 0.03) and 20.3 ± 4.6 vs. 18.9 ± 0.8kg (P = 0.01), respectively. Prevalence of osteopenia was 42.2% with no significant change overtime. Patients with osteopenia presented with higher (P < 0.0001) change in ASM (median: −1.58kg; 95% CI: −3.8 to 0.66 vs. −0.83; −4.0 to 2.4) and in LST (−1.08 kg; −5.0 to 2.8 vs. 0.88; −4.6 to 6.3), compared with patients without osteopenia. Changes in eGFR and mineral metabolism parameters were similar between groups. T-score change was negatively correlated with change in LST (r = 0.66; P = 0.04) and PTH (r = −0.70; P = 0,03), and with baseline LST (r = −0.35; P = 0.04) independent of age, sex and eGFR. Body fat increased (22.7 kg ± 8.1 vs. 23.8 kg ± 8.7; P = 0.04) during follow up, but it was not significantly correlated with T-score. Conclusions Prevalence of osteopenia was high in patients with NDD-CKD, and BMD decreased after 3 years, which was associated with a reduction in LST and increase in PTH, independent of eGFR, age, and sex. LST should be monitored in NDD-CKD to prevent risk for abnormal BMD. Funding Sources FAPERJ
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Wittbrodt, Eric T., Glen James, Supriya Kumar, Heleen van Haalen, Hungta Chen, James A. Sloand, and Kamyar Kalantar-Zadeh. "Contemporary outcomes of anemia in US patients with chronic kidney disease." Clinical Kidney Journal 15, no. 2 (October 6, 2021): 244–52. http://dx.doi.org/10.1093/ckj/sfab195.
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ABSTRACT Background Long-term clinical outcome data from patients with non-dialysis-dependent (NDD) chronic kidney disease (CKD) are lacking. We characterized patients with NDD-CKD and anemia using real-world data from the USA. Methods This retrospective longitudinal observational study evaluated integrated Limited Claims and Electronic Health Record Data (IBM Health, Armonk, NY), including patients ≥18 years with two or more estimated glomerular filtration rate (eGFR) measures <60 mL/min/1.73 m2 ≥90 days apart. Anemia was defined as the first observed hemoglobin <10 g/dL within 6-month pre- and post-CKD index date. Data were analyzed from January 2012 to June 2018. Patients with documented iron-deficiency anemia at baseline were excluded. Results Comprising 22 720 patients (57.4% female, 63.9% CKD stage 3, median hemoglobin 12.5 g/dL), median (interquartile range) follow-up for patients with and without anemia were 2.9 (1.5–4.4) and 3.8 (2.2–4.8) years, respectively. The most prevalent comorbidities were dyslipidemia (57.6%), type 2 diabetes mellitus (38.8%) and uncontrolled hypertension (20.0%). Overall, 23.3% of patients had anemia, of whom 1.9% and <0.1% received erythropoiesis-stimulating agents (ESAs) or intravenous iron, respectively. Anemia prevalence increased with CKD stage from 18.2% (stage 3a) to 72.8% (stage 5). Patients with anemia had a higher incidence rate of hospitalizations for heart failure (1.6 versus 0.8 per 100 patient-years), CKD stage advancement (43.5 versus 27.5 per 100 patient-years), and a 40% eGFR decrease (18.1 versus 7.3 per 100 patient-years) versus those without anemia. Conclusions Anemia, frequently observed in NDD-CKD and associated with adverse clinical outcomes, is rarely treated with ESAs and intravenous iron. These data suggest that opportunities exist for improved anemia management in patients with NDD-CKD.
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Sumida, Keiichi, Charles Dyer Diskin, Miklos Z. Molnar, Praveen K. Potukuchi, Fridtjof Thomas, Jun Ling Lu, Connie M. Rhee, et al. "Pre-End-Stage Renal Disease Hemoglobin Variability Predicts Post-End-Stage Renal Disease Mortality in Patients Transitioning to Dialysis." American Journal of Nephrology 46, no. 5 (2017): 397–407. http://dx.doi.org/10.1159/000484356.
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Background: Hemoglobin variability (Hb-var) has been associated with increased mortality both in non-dialysis dependent chronic kidney disease (NDD-CKD) and end-stage renal disease (ESRD) patients. However, the impact of Hb-var in advanced NDD-CKD on outcomes after dialysis initiation remains unknown. Methods: Among 11,872 US veterans with advanced NDD-CKD transitioning to dialysis between October 2007 through September 2011, we assessed Hb-var calculated from the residual SD of at least 3 Hb values during the last 6 months before dialysis initiation (prelude period) using within-subject linear regression models, and stratified into quartiles. Outcomes included post-transition all-cause, cardiovascular, and infection-related mortality, assessed in Cox proportional hazards models and adjusted for demographics, comorbidities, length of hospitalization, medications, estimated glomerular filtration rate (eGFR), type of vascular access, Hb parameters (baseline Hb [i.e., intercept] and change in Hb [i.e., slope]), and number of Hb measurements. Results: Higher prelude Hb-var was associated with use of iron and antiplatelet agents, tunneled dialysis catheter use, higher levels of baseline Hb, change in Hb, eGFR, and serum ferritin. After multivariable adjustment, higher prelude Hb-var was associated with higher post-ESRD all-cause and infection-related mortality, but not cardiovascular mortality (adjusted hazard ratios [95% CI] for the highest [vs. lowest] quartile of Hb-var, 1.10 [1.02–1.19], 1.28 [0.93–1.75], and 0.93 [0.79–1.10], respectively). Conclusions: High pre-ESRD Hb-var is associated with higher mortality, particularly from infectious causes rather than cardiovascular causes. Further research is required to clarify the underlying mechanisms and true causal nature of the observed association.
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Tomás-Simó, Patricia, Luis D’Marco, María Romero-Parra, Mari Carmen Tormos-Muñoz, Guillermo Sáez, Isidro Torregrosa, Nuria Estañ-Capell, Alfonso Miguel, José Luis Gorriz, and María Jesús Puchades. "Oxidative Stress in Non-Dialysis-Dependent Chronic Kidney Disease Patients." International Journal of Environmental Research and Public Health 18, no. 15 (July 23, 2021): 7806. http://dx.doi.org/10.3390/ijerph18157806.
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Background: Cardiovascular complications are the leading cause of morbidity and mortality at any stage of chronic kidney disease (CKD). Moreover, the high rate of cardiovascular mortality observed in these patients is associated with an accelerated atherosclerosis process that likely starts at the early stages of CKD. Thus, traditional and non-traditional or uremic-related factors represent a link between CKD and cardiovascular risk. Among non-conventional risk factors, particular focus has been placed on anaemia, mineral and bone disorders, inflammation, malnutrition and oxidative stress and, in this regard, connections have been reported between oxidative stress and cardiovascular disease in dialysis patients. Methods: We evaluated the oxidation process in different molecular lines (proteins, lipids and genetic material) in 155 non-dialysis patients at different stages of CKD and 45 healthy controls. To assess oxidative stress status, we analyzed oxidized glutathione (GSSG), reduced glutathione (GSH) and the oxidized/reduced glutathione ratio (GSSG/GSH) and other oxidation indicators, including malondialdehyde (MDA) and 8-oxo-2’-deoxyguanosine (8-oxo-dG). Results: An active grade of oxidative stress was found from the early stages of CKD onwards, which affected all of the molecular lines studied. We observed a heightened oxidative state (indicated by a higher level of oxidized molecules together with decreased levels of antioxidant molecules) as kidney function declined. Furthermore, oxidative stress-related alterations were significantly greater in CKD patients than in the control group. Conclusions: CKD patients exhibit significantly higher oxidative stress than healthy individuals, and these alterations intensify as eGFR declines, showing significant differences between CKD stages. Thus, future research is warranted to provide clearer results in this area.
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Vida, Carmen, Carlos Oliva, Claudia Yuste, Noemí Ceprián, Paula Jara Caro, Gemma Valera, Ignacio González de Pablos, Enrique Morales, and Julia Carracedo. "Oxidative Stress in Patients with Advanced CKD and Renal Replacement Therapy: The Key Role of Peripheral Blood Leukocytes." Antioxidants 10, no. 7 (July 20, 2021): 1155. http://dx.doi.org/10.3390/antiox10071155.
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Oxidative stress plays a key role in the pathophysiology of chronic kidney disease (CKD). Most studies have investigated peripheral redox state focus on plasma, but not in different immune cells. Our study analyzed several redox state markers in plasma and isolated peripheral polymorphonuclear (PMNs) and mononuclear (MNs) leukocytes from advanced-CKD patients, also evaluating differences of hemodialysis (HD) and peritoneal dialysis (PD) procedures. Antioxidant (superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), reduced glutathione (GSH)) and oxidant parameters (xanthine oxidase (XO), oxidized glutathione (GSSG), malondialdehyde (MDA)) were assessed in plasma, PMNs and MNs from non-dialysis-dependent-CKD (NDD-CKD), HD and PD patients and healthy controls. Increased oxidative stress and damage were observed in plasma, PMNs and MNs from NDD-CKD, HD and PD patients (increased XO, GSSG and MDA; decreased SOD, CAT, GPX and GSH; altered GSSG/GSH balance). Several oxidative alterations were more exacerbated in PMNs, whereas others were only observed in MNs. Dialysis procedures had a positive effect on preserving the GSSG/GSH balance in PMNs. Interestingly, PD patients showed greater oxidative stress than HD patients, especially in MNs. The assessment of redox state parameters in PMNs and MNs could have potential use as biomarkers of the CKD progression.
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Islam, Md Tanvir, and Nurun Nahar Mukta. "Comparative study on nutritional status, food intake pattern and lifestyle between dialyzed and non-dialyzed kidney patients in Dhaka, Khulna and Rajshahi divisions of Bangladesh." Asian-Australasian Journal of Food Safety and Security 1, no. 1 (November 21, 2017): 25–34. http://dx.doi.org/10.3329/aajfss.v1i1.55758.
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Chronic kidney disease (CKD) is a worldwide public health problem. As per nephrologists' estimation, the CKD population grows at approximately 5% annually and in 2022, over 29 million people will be afflicted with CKD in Bangladesh. The objective of this study was to compare nutritional status, food intake pattern, and lifestyle between dialyzed and non-dialyzed kidney patients in Bangladesh. It was a cross-sectional comparative study of patients aged 18 to 85 year old to compare nutritional status, food intake pattern, and lifestyle between dialyzed and non-dialyzed kidney patients. Sample was conducted in three divisions Dhaka, Khulna and Rajshahi in Bangladesh. Data on food intake pattern, height, weight, GFR, other diseases along with kidney disease, physical activity, smoking and socioeconomic status etc. were collected from fifteen clinical centers and sometimes from household via in-person interviews. A total of 244 patients aged were selected among them 152 people were dialyzed patients and 92 people were Non-dialyzed patients. We found a relationship among dietary food habit, lifestyle factors and health outcomes such as chronic kidney disease progression, heart disease and death. Patients had a mean monthly family income of 23683.46, a mean monthly expenditure on food of 3815.2 and a mean monthly expenditure on treatment of 13317.69. According to our findings, highest dialysis patients were sedentary than non-dialysis patients were active at their active life (20-40 Years). From this study it was investigated that, 41.0% patients have not changed their addiction habit after diagnosis, where 20.1% dialysis patients and 20.9% non-dialysis patients have not changed their addiction habit totally. Another significant finding of this study was that dialysis patients had poor consumption from 16 groups. It can be highlighted that, the prevalence of the diseases were higher in urban people than rural people. This study suggests that additional research is needed to investigate the optimal dietary recommendations and body mass index levels to prevent disease progression and poor outcomes among individuals with CKD. The prevalence of HD-CKD and NDD-CKD can be said to be SES dependent. Chronic kidney disease and its complications, which involve most organ systems, can be prevented, but awareness and use of accurate methods are needed to enable timely diagnosis.
Asian Australas. J. Food Saf. Secur. 2017, 1 (1), 25-34
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Abdelazeem, Basel, Joseph Shehata, Kirellos Said Abbas, Nahla Ahmed El-Shahat, Bilal Malik, Pramod Savarapu, Mostafa Eltobgy, and Arvind Kunadi. "The efficacy and safety of roxadustat for the treatment of anemia in non-dialysis dependent chronic kidney disease patients: An updated systematic review and meta-analysis of randomized clinical trials." PLOS ONE 17, no. 4 (April 1, 2022): e0266243. http://dx.doi.org/10.1371/journal.pone.0266243.
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Background Roxadustat (ROX) is a new medication for anemia as a complication of chronic kidney disease (CKD). Our meta-analysis aims to evaluate the efficacy and safety of ROX, especially on the cardiovascular risks, for anemia in NDD-CKD patients. Methods Electronic databases were searched systematically from inception to July 2021 to look for randomized control trials (RCTs) that evaluated ROX NDD-CKD patients. Hemoglobin level and iron utilization parameters, including ferritin, serum iron, transferrin saturation (TSAT), total iron-binding capacity (TIBC), transferrin, and hepcidin were analyzed for efficacy. Pooled risk ratios (RRs) and standardized mean differences (SMDs) were calculated and presented with their 95% confidential intervals (CIs). Results Nine RCTs included a total of 3,175 patients in the ROX group and 2,446 patients in the control group. When compared the control group, ROX increased Hb level significantly (SMD: 1.65; 95% CI: 1.08, 2.22; P< 0.00001) and improved iron utilization parameters by decreasing ferritin (SMD: -0.32; 95% CI: -0.51, -0.14; P = 0.0006), TSAT (SMD: -0.19; 95% CI: -0.32, -0.07; P = 0.003), and hepcidin (SMD: -0.74; 95% CI: -1.09, -0.39; P< 0.0001) and increasing TIBC (SMD: 0.99; 95% CI: 0.76, 1.22; P< 0.00001) and transferrin (SMD: 1.20; 95% CI: 0.70, 1.71; P< 0.00001). As for safety, ROX was associated with higher serious adverse effects (RR: 1.07; 95% CI: 1.01, 1.13; P = 0.01), deep venous thrombosis (DVT) (RR: 3.80; 95% CI: 1.5, 9.64; P = 0.08), and hypertension (HTN) (RR: 1.37; 95% CI: 1.13, 1.65; P = 0.001). Conclusion We concluded that ROX increased Hb level and improved iron utilization parameters in NDD-CKD patients, but ROX was associated with higher serious adverse effects, especially DVT and HTN. Our results support the use of ROX for NDD-CKD patients with anemia. However, higher-quality RCTs are still needed to ensure its safety and risk of thrombosis.
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Karangizi, A. H. K., D. Chanouzas, A. Fenton, P. Moss, P. Cockwell, C. J. Ferro, and L. Harper. "Cytomegalovirus seropositivity is independently associated with cardiovascular disease in non-dialysis dependent chronic kidney disease." QJM: An International Journal of Medicine 113, no. 4 (October 15, 2019): 253–57. http://dx.doi.org/10.1093/qjmed/hcz258.
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Abstract Background Cardiovascular disease (CVD) is the leading cause of early death in patients with chronic kidney disease (CKD). Previous work has described an association between Cytomegalovirus (CMV) seropositivity and CVD amongst patients with dialysis dependent end stage renal disease. Whether CMV seropositivity is associated with CVD in non-dialysis dependent CKD has not been established. Aim Investigate whether past CMV infection is associated with prevalent CVD in patients with non-dialysis dependent CKD. Design A retrospective observational study using the Renal Impairment in Secondary Care cohort, a study evaluating bio-clinical determinants of outcomes in patients with progressive CKD. Methods We assayed cryopreserved serum samples collected at inception for anti-CMV IgG antibodies from 764 patients with stages 2 to 5 CKD (pre-dialysis) and investigated its relationship with prevalent CVD. Results Median estimated glomerular filtration was 24 ml/min/1.73 m2 (IQR 19–32). Sixty-eight percent of patients were CMV seropositive. CMV seropositivity was associated with older age, non-Caucasian ethnicity, diabetes and higher social deprivation index score. On univariable analysis, CMV seropositivity correlated with higher systolic blood pressure (P = 0.044), prevalent CVD (P < 0.001), ischaemic heart disease (P < 0.001) and cerebrovascular disease (P = 0.022). On multivariable analysis, CMV seropositive patients nearly twice as likely to have CVD compared to seronegative patients [Odds Ratio (OR) = 1.998, CI 1.231–3.242, P = 0.005]. Conclusions In patients with non-dialysis CKD, CMV seropositivity is independently associated with a higher prevalence of CVD.
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Ramos, Christiane Ishikawa, Rachel Gatti Armani, Maria Eugenia Fernandes Canziani, Maria Aparecida Dalboni, Carla Juliana Ribeiro Dolenga, Lia Sumie Nakao, Katrina Louise Campbell, and Lilian Cuppari. "Effect of prebiotic (fructooligosaccharide) on uremic toxins of chronic kidney disease patients: a randomized controlled trial." Nephrology Dialysis Transplantation 34, no. 11 (June 22, 2018): 1876–84. http://dx.doi.org/10.1093/ndt/gfy171.
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Abstract Background Microbial-derived uremic toxins, p-cresyl sulfate (PCS), indoxyl sulfate (IS) and indole 3-acetic acid (IAA), have been associated with the burden of chronic kidney disease (CKD). Prebiotics have emerged as an alternative to modulate the gut environment and to attenuate toxin production. This trial aims to investigate the effect of a prebiotic fructooligosaccharide (FOS) on uremic toxins of non-dialysis-dependent CKD (NDD-CKD) patients. Methods A double-blind, placebo-controlled, randomized trial was conducted for 3 months. In all, 50 nondiabetic NDD-CKD patients [estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m2], aged 18–80 years, were allocated to prebiotic (FOS, 12 g/day) or placebo (maltodextrin, 12 g/day) groups. Primary outcomes were changes in serum (total and free) and urinary (total) PCS. Secondary outcomes included changes in IS, IAA, serum markers of intestinal permeability (zonulin), gut-trophic factors (epidermal growth factor and glucagon-like peptide-2), eGFR, inflammation (high sensitive c-reactive protein and interleukin-6), homeostatic model assessment-insulin resistance, lipid profile and gastrointestinal symptoms. Results From 50 participants (54% men, 57.3 ± 14.6 years and eGFR 21.4 ± 7.6 mL/min/1.73 m2), 46 completed the follow-up. No changes in dietary intake or gastrointestinal symptoms were observed. There was a trend in the difference of serum total ΔPCS (treatment effect adjusted for baseline levels: −12.4 mg/L; 95% confidence interval (−5.6 to 0.9 mg/L; P = 0.07) and serum-free Δ%PCS [intervention −8.6 (−41.5 to 13.9%) versus placebo 3.5 (−28.8 to 85.5%); P = 0.07] between the groups. The trend in the difference of serum total ΔPCS was independent of eGFR and dietary protein:fiber ratio intake. No difference was found in urinary PCS. Aside from the decreased high-density lipoprotein cholesterol in the intervention, no differences were observed in the change of IS, IAA or other secondary outcome between the groups. Conclusions Our result suggests the potential of FOS in reducing serum total and free PCS in nondiabetic NDD-CKD patients.
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Pollock, C., S. Roger, R. Manllo-Karim, M. Pola, S. Tham, L. Szczech, P. Yu, and M. EL-SHAHAWY. "POS-256 ROXADUSTAT INCREASES HEMOGLOBIN IN ANEMIC NON-DIALYSIS-DEPENDENT (NDD) AND DIALYSIS-DEPENDENT (DD) CHRONIC KIDNEY DISEASE (CKD) PATIENTS INDEPENDENT OF INFLAMMATION." Kidney International Reports 6, no. 4 (April 2021): S108. http://dx.doi.org/10.1016/j.ekir.2021.03.271.
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Stopic, Bojan, Sandra Dragicevic, Branislava Medic-Brkic, Aleksandra Nikolic, Marko Stojanovic, Sreten Budisavljevic, and Nada Dimkovic. "Biomarkers of Uremic Cardiotoxicity." Toxins 13, no. 9 (September 10, 2021): 639. http://dx.doi.org/10.3390/toxins13090639.
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Cardiovascular (CV) morbidity and mortality increase along with the progression of chronic kidney disease (CKD). The potential novel biomarkers of cardiotoxicity have been tested with the aim of the early detection of patients at high CV risk, and among them are markers of inflammation, oxidative stress, acute renal injury, and microRNAs. The study analyzed biomarkers in non-dialysis-dependent (NDD; stage 3a–4 CKD) and dialysis-dependent (DD) CKD patients. The prospective cohort study included 87 patients who were followed for 18 months, during which period newly occurred CV events were recorded. Cox regression analysis confirmed serum albumin, urea, interventricular septum thickness diameter (IVST), the use of calcium antagonist, and erythropoiesis-stimulating agent to be significant predictors of CV outcome. No significant difference was observed in biomarkers of inflammation, oxidative stress, acute kidney injury (IL-18, CRP, ferritin, IMA, SOD, NGAL, and KIM-1), and miR-133a, in regards to the presence/absence of CV event, CV death, and left ventricular hypertrophy. Serum albumin, urea, IVST, and the use of calcium antagonist and erythropoiesis-stimulating agents were confirmed to be factors associated with CV events in CKD patients. Apart from traditional risk factors, new research is needed to define novel and reliable biomarkers of cardiotoxicity in CKD patients.
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Ibarra-Hernandez, Margarita, Maria de la Luz Alcantar-Vallin, Angela Soto-Cruz, Patricia Maria Jimenez-Alvarado, Francisco Villa-Villagran, Jose de Jesus Diaz-Avila, Fernando Tamez-Hernandez, et al. "Challenges in Managing Pregnancy in Underserved Women with Chronic Kidney Disease." American Journal of Nephrology 49, no. 5 (2019): 386–96. http://dx.doi.org/10.1159/000499964.
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Background: Chronic kidney disease (CKD) is a global public health problem and is linked to adverse outcomes during pregnancy; the high prevalence of CKD (3–6%) in women of childbearing age is of particular relevance in emerging countries where CKD prevalence is higher and resources are limited. Although CKD is a public health problem in Mexico, there is scant information on outcomes in pregnant CKD women in this country. We report maternal–fetal outcomes in a prospective cohort of poor, CKD pregnant women, and compare results with those of pregnant women without CKD. Methods: A prospective study of pregnant CKD women referred to a public obstetrics/nephrology clinic from July 2013 to December 2017; sociodemographic and clinical data, including complications and perinatal outcomes, were recorded. CKD was defined at referral as per KDIGO guidelines; preeclampsia and superimposed preeclampsia were defined as appearance or worsening of hypertension and proteinuria. Findings were compared to official data for Mexico and to a historic control of pregnant women without CKD who delivered at our hospital. Results: Sixty-two pregnancies in CKD patients, age 23.4 ± 5.8 years were observed; 46.8% of patients were primiparous. At referral, serum creatinine was 1.8 (1.1–3.0) mg/dL with an estimate glomerular filtration rate (eGFR) of 38.1 (21.9–68.0) mL/min/1.73 m2. In half of the cases, CKD was diagnosed during pregnancy. Forty-eight pregnant women without CKD, age 27 (22–34) years, who delivered during the study period were selected as controls: 33% were primiparous, serum creatinine was 0.50 (0.4–0.6) mg/dL, and estimate glomerular filtration rate was 135 (112–174) mL/min/1.73 m2. Twenty patients needed dialysis (HD-CKD): 2 were already on dialysis, and 18 began treatment during pregnancy; 42 CKD patients did not require dialysis (non-HD CKD). After delivery, 15 patients remained dialysis dependent while 5 did not. Preeclampsia was more frequent in CKD patients in comparison to controls. In total, 93% of CKD patients and 98% of controls delivered a live baby. Prematurity was more frequent in CKD patients than controls and was higher in HD-CKD than in non-HD CKD. Birth weight was lower in CKD when compared to controls. Logistic regression showed a higher risk of preeclampsia in CKD pregnancies than in controls, but it was not affected by age, parity, CKD stage, or need for dialysis during pregnancy. Conclusions: Underserved CKD Mexican women have a high rate of adverse maternal-fetal outcomes during pregnancy. The risk may be higher in patients needing dialysis during pregnancy, many of whom remained dialysis dependent after delivery.
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Castro-Alonso, Cristina, Luis D’Marco, Jaume Pomes, Monserrat Del Amo Conill, Ana Isabel García-Diez, Pablo Molina, María Jesús Puchades, et al. "Prevalence of Vertebral Fractures and Their Prognostic Significance in the Survival in Patients with Chronic Kidney Disease Stages 3‒5 Not on Dialysis." Journal of Clinical Medicine 9, no. 5 (May 25, 2020): 1604. http://dx.doi.org/10.3390/jcm9051604.
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Background: The prevalence of vertebral fractures (VF) and their association with clinical risk factors and outcomes are poorly documented in chronic kidney disease (CKD) cohorts. The aim of the study was to evaluate the prevalence of VF in patients with non-dialysis dependent CKD (NDD-CKD), their value in predicting mortality and its correlation with parameters of bone mineral metabolism and vascular calcification. Materials and Methods: 612 NDD 3‒5 stage CKD patients participating in the OSERCE-2 study, a prospective, multicenter, cohort study, were prospectively evaluated and categorized into two groups according to presence or absence of VF at enrollment. VF were assessed with lateral radiographs and Genant semi-quantitative method was applied. Three radiologists specialized in musculoskeletal radiology performed consensual reading of individual images obtained using a Raim DICOM Viewer and a Canon EOS 350 camera to measure with Java Image software in those who had traditional acetate X-ray. Factors related to VF were assessed by logistic regression analysis. Association between VF and death over a 3-year follow-up was assessed by Kaplan-Meier survival curves and Cox-proportional hazard models. Results: VF were detected in 110 patients (18%). Serum phosphate levels (OR 0.719, 95% CI 0.532 to 0.972, p = 0.032), ankle-brachial index < 0.9 (OR 1.694, 95% CI 1.056‒2.717, p = 0.029) and treatment with bisphosphonates (OR 5.636, 95% CI 1.876‒16.930, p = 0.002) were independently related to the presence of VF. After a median follow-up of 35 months (IQR: 17‒37 months), 62 patients (10%) died. The causes of death were cardiovascular (n = 21, 34%) and infectious (n = 11, 18%). In the crude analysis, fractured patients group had poorer survival (log-rank test, p = 0.02). After multivariate adjustment for age, MDRD, albumin, diabetes mellitus, comorbidity, Adragao Score > 3 and serum phosphate, the presence of VF (HR 1.983, 95% CI 1.009‒3.898, p = 0.047) were an independent predictor of all-cause mortality. Conclusions: In our study 18% of patients with NDD-CKD have VF. Factors associated with VF were age, low serum phosphate levels and peripheral vascular disease. The presence of VF was an independent risk factor for mortality in stages 3‒5 NDD-CKD patients. Clinical trials are needed to confirm whether this relationship is causal and reversible with treatment for osteoporosis.
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Kumar, S. Senthil, S. Vithiavathi, and T. Doraickannu. "Comparative study of ambulatory blood pressure monitoring in hemodialysis and non-dialysis CKD patients and their prognostic value." International Journal of Advances in Medicine 6, no. 4 (July 24, 2019): 1058. http://dx.doi.org/10.18203/2349-3933.ijam20192620.
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Background: Hypertension and chronic kidney disease are inextricably intertwined. Most patients with hypertension associated CKD die of heart attack and stroke before renal function. Ambulatory BP monitoring provides automated measurements of BP during a 24hrs period while patients engaged in their usual activities including sleep. Recommended normal value include an average daytime BP <135/85mmHg/night time BP <120/70mmHg and 24 hr BP <130/89mmHg. In patients with chronic kidney disease the control of hypertension slows the progression of end stage renal disease. This study was undertaken to define the prognostic role of ABPM in dialysis dependent and non-dialysis CKD patients so that better treatment strategies could be initiated to prevent adverse outcomes.Methods: This prospective cross sectional study was conducted at Aarupadai Veedu Medical College and hospital, Puducherry in both dialysis dependent and non-dialysis CKD patients admitted in both ICU and medical wards. APBM was performed by using the properly validated ambulatory blood pressure monitor. The monitor records BP on the non-dominant arm every 20 minutes while awake and hourly while sleep for a total duration 24hrs in both hemodialysis dependent and non-hemodialysis patients. In hemodialysis dependent patients ABPM was recorded on the second day of hemodialysis.Results: The mean maximum systolic blood pressure in dialysis dependent and non-dialysis CKD patients recorded was 146.23 and 166.12 mmHg respectively. The mean minimum systolic blood pressure in dialysis dependent and non-dialysis CKD patients recorded was 122.11 and 122.45 mmHg respectively. The mean maximum diastolic blood pressure in dialysis dependent and non-dialysis CKD patients recorded was 100.24 and 110.65mmHg respectively. The mean minimum diastolic blood pressure in dialysis dependent and non-dialysis CKD patients recorded was 78.65 and 80.67 mmHg respectively. In our study the prevalence of non-dipping in dialysis and non-dialysis CKD patients were 28% and 16% respectively.Conclusions: Ambulatory blood pressure monitoring is considered the gold standard for the diagnosis of hypertension. Tight BP control is needed to limit the progression of renal disease and lessen cardiovascular morbidity and mortality. To achieve this goal ABPM should be widely adopted in patients with CKD.
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Daneschvar, H., Ali Seddighzadeh, Gregory Piazza, and Samuel Goldhaber. "Deep vein thrombosis in patients with chronic kidney disease." Thrombosis and Haemostasis 99, no. 06 (2008): 1035–39. http://dx.doi.org/10.1160/th08-02-0107.
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SummaryDeep vein thrombosis (DVT) is a poorly understood complication of chronic kidney disease (CKD). The objective of our analysis was to profile DVT patients with and without CKD. We defined CKD as patients requiring dialysis or patients having nephrotic syndrome.We compared 268 patients with CKD (184 patients with dialysis-dependent renal disease and 84 with nephrotic syndrome) to 4,307 patients with preserved renal function from a prospective United States multicenter deep venous thrombosis (DVT) registry. Compared with non-CKD patients, CKD patients with DVT were younger (median age 62 vs. 69 years, p<0.0001), more often African- American (p<0.0001), and more often Hispanic (p=0.0003). CKD patients underwent surgery more frequently in the three months prior to developing DVT (48.9% vs. 39.0%, p=0.001) and more often had concomitant congestive heart failure (20.9% vs. 14.6%, p=0.005). CKD patients suffered upper extremity DVT more frequently (30.0% vs. 10.8%, p<0.0001). Patients with CKD presented less often with typical DVT symptoms of extremity discomfort (42.9% vs. 52.4%, p=0.003) and difficulty ambulating (5.4% vs. 10.1%, p=0.01). Prophylaxis rates prior to DVT were similarly low in CKD and non-CKD patients (44.2% vs. 38.0%, p=0.06). Future studies of DVT in CKD patients should explore novel strategies for improving prophylaxis utilization and the detection of DVT in this special population.
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Triozzi, Jefferson Lorenzo, Jingbo Niu, Carl P. Walther, Wolfgang C. Winkelmayer, and Sankar D. Navaneethan. "Hospitalization and Critical Illness in Chronic Kidney Disease." Cardiorenal Medicine 10, no. 5 (2020): 302–12. http://dx.doi.org/10.1159/000507047.
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Background: Patients with chronic kidney disease (CKD) who are hospitalized with a critical illness are at increased risk for adverse outcomes. We studied the predictors of hospitalization with critical illness among patients with non-dialysis-dependent CKD stages 3 and 4 in a safety-net healthcare setting. Methods: A retrospective cohort study was conducted among patients ≥18 years of age with CKD stages 3 and 4 using a CKD registry from a safety-net healthcare system. Hospitalizations with critical illness were identified among patients requiring nonelective admission or transfer to the intermediate or intensive care unit during a 3-year period after the diagnosis of CKD. Poisson regression was used to determine associations between baseline characteristics and hospitalization requiring intermediate or intensive care among all CKD patients and in those with different stages of CKD. Outcomes of these hospitalizations were also tabulated. Results: Among 8,302 patients with CKD stages 3 and 4, 1,298 were hospitalized and 495 required intermediate or intensive care during a 3-year follow-up period. In the adjusted analysis, advanced CKD, Hispanics (incident rate ratio [IRR]: 1.88), non-Hispanic Blacks (IRR: 1.48), presence of congestive heart failure (IRR: 2.09), cardiovascular disease (IRR: 1.57), chronic pulmonary disease (IRR: 1.60), liver disease, malignancy, and anemia were associated with higher risk of hospitalization requiring intermediate or intensive care. The association of age, gender, race/ethnicity, congestive heart failure, anemia, and body mass index with hospitalization requiring intermediate or intensive care differed significantly by CKD stage (p value for interaction term <0.05). Congestive heart failure and severity of anemia were associated with a higher risk of hospitalization requiring intermediate or intensive care among patients with mild CKD, and the magnitude of association attenuated among patients with advanced CKD. Conclusions: The burden of hospitalization with critical illness among patients with non-dialysis-dependent CKD stages 3 and 4 remains high and was associated with demographic factors and comorbid medical conditions, especially among those with congestive heart failure and cardiovascular disease. Targeted, effective interventions to reduce the burden of hospitalization and critical illness in CKD patients within safety-net healthcare systems are needed.
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Silva, Maria Inês Barreto, Jenneffer Rayane Braga Tibaes, Márcia Klein, and Caroline Richard. "Sex Differences in Patients With Non-dialysis Dependent Chronic Kidney Disease on Serum Cytokines." Current Developments in Nutrition 5, Supplement_2 (June 2021): 1120. http://dx.doi.org/10.1093/cdn/nzab061_004.
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Abstract Objectives Cardiovascular (CV) mortality is higher in male compared to female patients with chronic kidney disease (CKD), but biological mechanisms for sex-specific differences are not established. Inflammation and high body fat are both associated with the development of CKD and CV diseases. Yet, little is known about the relationship between sex, body composition, and inflammation in CKD patients. The purpose of this study was to examine cytokines differences between male and female patients with CKD according to body composition. Methods This is a single center, cross-sectional study of patients with non-dialysis dependent CKD stages 3–5. Body composition was assessed by dual energy x-ray absorptiometry. Glomerular filtration rate (eGFR) was estimated by the CKD-EPI equation. Cytokines were measured using an ELISA multiplex assay kit for interleukin (IL) 4, IL6, IL8, IL10, IL12p70, IL17, monocyte chemoattractant protein-1, tumour necrosis factor alpha (TNFɑ), and interferon gamma (IFNγ). High fat mass and low appendicular muscle mass (ASM) was defined for females and males, respectively as ≥32%, ≥25%; and <20 kg, <15 kg. Results Patients with CKD (n = 167; 53.3%males) aged 60.4 ± 11.3 years, eGFR 30.9 ± 30.2 mL/min, and BMI 26.7 ± 5.0 kg/m2 were included. Age, eGFR, and BMI were similar in both sexes. IL4 was higher in males compared to females (6.5 ± 1.0 vs 3.8 ± 0.9 pg/mL, P = 0.04). After stratifying according to body composition, IL4 remained higher (P = 0.04) in lean males compared to lean females, both with adequate ASM, but this difference disappeared in patients with high fat mass (male versus female). Within sex comparison, females with high fat mass have higher concentrations of IL4, IL8, and IL17 compared with lean females, whereas IL6, IL8, IL17, TNFɑ, and INFγ were higher in males with high fat mass. Conclusions Male and female patients with CKD present a different cytokine profile according to body composition. The higher levels of IL4 observed in males in the present study is consistent with recent evidence that IL4 exerts pro-inflammatory effects on vascular endothelium and is associated with an increase of CV events in CKD. Thus, IL4 might be a cytokine of interest to explain sex differences of CV events and mortality in CKD. Funding Sources Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro.
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Barratt, Jonathan, Branislav Andric, Avtandil Tataradze, Michael Schömig, Michael Reusch, Udaya Valluri, and Christophe Mariat. "Roxadustat for the treatment of anaemia in chronic kidney disease patients not on dialysis: a Phase 3, randomized, open-label, active-controlled study (DOLOMITES)." Nephrology Dialysis Transplantation 36, no. 9 (June 2, 2021): 1616–28. http://dx.doi.org/10.1093/ndt/gfab191.
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Abstract Background Roxadustat, an orally administered hypoxia-inducible factor prolyl hydroxylase inhibitor, is being evaluated for treatment of anaemia of chronic kidney disease (CKD). Methods This randomized, open-label, active-controlled Phase 3 study compared roxadustat versus darbepoetin alfa (DA) in non-dialysis-dependent (NDD) CKD patients with anaemia for ≤104 weeks. Doses were titrated to correct and maintain haemoglobin (Hb) within 10.0–12.0 g/dL. The primary endpoint was Hb response in the full analysis set, defined as Hb ≥11.0 g/dL and Hb change from baseline (BL; CFB) ≥1.0 g/dL in patients with BL Hb >8.0 g/dL or CFB ≥2.0 g/dL in patients with BL Hb ≤8.0 g/dL during the first 24 weeks of treatment without rescue therapy (non-inferiority margin, −15%). Key secondary endpoints included change in low-density lipoprotein (LDL), time to first intravenous (IV) iron use, change in mean arterial pressure (MAP) and time to hypertension occurrence. Adverse events were assessed. Results Of 616 randomized patients (roxadustat, 323; DA, 293), 424 completed treatment (roxadustat, 215; DA, 209). Hb response with roxadustat was non-inferior to DA (roxadustat: 256/286, 89.5% versus DA: 213/273, 78.0%, difference 11.51%, 95% confidence interval 5.66–17.36%). Roxadustat maintained Hb for up to 2 years. Roxadustat was non-inferior to DA for change in MAP and time to occurrence of hypertension and superior for change in LDL and time to first IV iron use. Safety profiles were comparable between groups. Findings suggest that there was no difference between groups regarding the composite endpoints major adverse cardiovascular events (MACEs) and MACE+ [MACE: 0.81 (0.52–1.25), P = 0.339; MACE+: 0.90 (0.61–1.32), P = 0.583]. Conclusions Roxadustat is a viable option to treat anaemia in NDD CKD patients maintaining Hb levels for up to 104 weeks.
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Shurraw, Sabin, and Marcello Tonelli. "Statins for Treatment of Dyslipidemia in Chronic Kidney Disease." Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 26, no. 5 (September 2006): 523–39. http://dx.doi.org/10.1177/089686080602600503.
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Dyslipidemia is a potent cardiovascular (CV) risk factor in the general population. Elevated low-density lipoprotein cholesterol (LDL-C) and/or low high-density lipoprotein (HDL-C) are well-established CV risk factors, but more precise determinants of risk include increased apoprotein B (ApoB), lipoprotein(a) [Lp(a)], intermediate and very low-density lipoprotein (IDL-C, VLDL-C; “remnant particles”), and small dense LDL particles. Lipoprotein metabolism is altered in association with declining glomerular filtration rate such that patients with non dialysis-dependent chronic kidney disease (CKD) have lower levels of HDL-C, higher triglyceride, ApoB, remnant IDL-C, remnant VLDL-C, and Lp(a), and a greater proportion of oxidized LDL-C. Similar abnormalities are prevalent in hemodialysis (HD) patients, who often manifest proatherogenic changes in LDL-C in the absence of increased levels. Patients treated with peritoneal dialysis (PD) have a similar but more severe dyslipidemia compared to HD patients due to stimulation of hepatic lipoprotein synthesis by glucose absorption from dialysate, increased insulin levels, and selective protein loss in the dialysate analogous to the nephrotic syndrome. In the dialysis-dependent CKD population, total cholesterol is directly associated with increased mortality after controlling for the presence of malnutrition–inflammation. Treatment with statins reduces CV mortality in the general population by approximately one third, irrespective of baseline LDL-C or prior CV events. Statins have similar, if not greater, efficacy in altering the lipid profile in patients with dialysis-dependent CKD (HD and PD) compared to those with normal renal function, and are well tolerated in CKD patients at moderate doses (≤ 20 mg/day atorvastatin or simvastatin). Statins reduce C-reactive protein as well as lipid moieties such as ApoB, remnants IDL and VLDL-C, and oxidized and small dense LDL-C fraction. Large observational studies demonstrate that statin treatment is independently associated with a 30% – 50% mortality reduction in patients with dialysis-dependent CKD (similar between HD- and PD-treated patients). One recent randomized controlled trial evaluated the ability of statin treatment to reduce mortality in type II diabetics treated with HD (“4D”); the primary end point of death from cardiac cause, myocardial infarction, and stroke was not significantly reduced. However, results of this trial may not apply to other end-stage renal disease populations. Two ongoing randomized controlled trials (SHARP and AURORA) are underway evaluating the effect of statins on CV events and death in patients with CKD (including patients treated with HD and PD). Recruitment to future trials should be given a high priority by nephrologists and, until more data are available, consideration should be given to following published guidelines for the treatment of dyslipidemia in CKD. Additional consideration could be given to treating all dialysis patients felt to be at risk of CV disease (irrespective of cholesterol level), given the safety and potential efficacy of statins. This is especially relevant in patients treated with PD, given their more atherogenic lipid profile and the lack of randomized controlled trials in this population.
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Davies, Mark, Aamer Sandoo, and Jamie Macdonald. "The Role of Exercise Training in Delaying Kidney Function Decline in Non-Dialysis-Dependent Chronic Kidney Disease." Kidney and Dialysis 2, no. 2 (May 25, 2022): 262–86. http://dx.doi.org/10.3390/kidneydial2020026.
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Chronic Kidney Disease (CKD) is a progressive condition characterised by declining eGFR and associated, particularly in advanced stages, with increased morbidity and cardiovascular mortality. Current treatment options for delaying disease progression are limited to a small number of pharmacological agents. Considering that rates of kidney function decline are greater in patients with lower levels of habitual physical activity, there is interest in the potential benefits of structured exercise training in delaying CKD progression. This discursive review summarises the current state-of-play in this field of research by critically analysing the published systematic reviews of randomised controlled trials of structured exercise training in the non-dialysis CKD population. Several issues are highlighted that hamper definite conclusions as to the therapeutic effectiveness of exercise training for this purpose. However, following an overview of the pathophysiology and risk factors for kidney function decline, several potential mechanisms explaining how exercise training may benefit CKD progression are offered. Finally, suggestions for future research in this area are made. The review concludes that there is a need for further research on the effectiveness of exercise before it can be recommended as part of routine care for the purpose of delaying CKD progression. Exercise can be recommended, however, to individual patients because of a potential benefit to kidney function, and definite benefits to other outcomes such as quality of life, with no apparent evidence of harm.
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Kalra, Philip A., Sunil Bhandari, and Lars L. Thomsen. "FP392IRON ISOMALTOSIDE 1000 (MONOFER®) COMPARED TO ORAL IRON SULPHATE IN EUROPEAN PATIENTS WITH NON-DIALYSIS DEPENDENT CHRONIC KIDNEY DISEASE (NDD-CKD)." Nephrology Dialysis Transplantation 30, suppl_3 (May 2015): iii200. http://dx.doi.org/10.1093/ndt/gfv176.16.
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Kanwal, Shamsa, Muhammad Aamir, Khurram Mansoor, Naveed Asif, and Muhammad Tanveer. "ASSOCIATION BETWEEN ANEMIA AND BONE PROFILE IN NON-DIALYSIS DEPENDENT CHRONIC KIDNEY DISEASE ANEMIA AND BONE PROFILE IN CKD." PAFMJ 71, no. 4 (August 26, 2021): 1204–08. http://dx.doi.org/10.51253/pafmj.v71i4.4009.
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Objective: To determine association between iron deficiency anemia and bone profile in cases of chronic kidney disease not undergoing dialysis.
Study Design: Comparative cross sectional study.
Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology in collaboration with department of Nephrology, Armed Forces Institute of Urology, Rawalpindi, from Sep 2018 to Oct 2019.
Methodology: A total of 300 chronic kidney disease patients who were not dependent on any kind of dialysis were included in our study. Chronic kidney disease was confirmed according to National Kidney Foundation/Kidney Disease Outcome Quality Initiative criteria. Hemoglobin, Mean corpuscular volume and ferritin levels were used to diagnose iron deficiency anemia. Association of Calcium, inorganic Phosphorous, Magnesium, Alkaline phosphatase and Parathyroid Hormone (PTH) was determined with iron deficiency anemia.
Results: Out of 300 patients studied 201 (67%) were females while 99 (33%) were males. Mean age of participants was 43.51 ± 5.652 years. Mean duration of chronic kidney disease was 4.36 ± 3.712 years. One hundred and forty one (47%) patients had no anemia while 159 (53%) had presence of iron deficiency anemia. After applying binary logistic regression analysis hypocalcemia, hypophosphatemia and hypomagnesemia were noted to have a statistically significant association with iron deficiency anemia in the target sample size.
Conclusion: This study revealed a high frequency of iron deficiency anemia in non-dialysis chronic kidney disease patients. Hypocalcemia, hypophosphatemia and hypomagnesemia were found having strong association with presence of iron deficiency anemia in non-dialysis dependent chronic kidney disease patients.
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van de Wal-Visscher, Esther R., Jeroen P. Kooman, and Frank M. van der Sande. "Magnesium in Chronic Kidney Disease: Should We Care?" Blood Purification 45, no. 1-3 (2018): 173–78. http://dx.doi.org/10.1159/000485212.
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Background: Magnesium (Mg) is an essential cation for multiple processes in the body. The kidney plays a major role in regulating the Mg balance. In a healthy individual, total-body Mg content is kept constant by interactions among intestine, bones and the kidneys. Summary: In case of chronic kidney disease (CKD), renal regulatory mechanisms may be insufficient to balance intestinal Mg absorption. Usually Mg remains normal; however, when glomerular filtration rate declines, changes in serum Mg are observed. Patients with end-stage renal disease on dialysis are largely dependent on the dialysate Mg concentration for maintaining serum Mg and Mg homeostasis. A low Mg is associated with several complications such as hypertension, and vascular calcification, and also associated with an increased risk for both cardiovascular disease (CVD) and non-CVD mortality. Severe hypermagnesaemia is known to cause cardiac conduction defects, neuromuscular effects and muscle weakness; a slightly elevated Mg has been suggested to be beneficial in patients with end-stage renal disease. Key Messages: The role of both low and high Mg, in general, but especially in relation to CKD and dialysis patients is discussed.
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Nakagawa, Naoki, Keisuke Maruyama, and Naoyuki Hasebe. "Utility of Geriatric Nutritional Risk Index in Patients with Chronic Kidney Disease: A Mini-Review." Nutrients 13, no. 11 (October 20, 2021): 3688. http://dx.doi.org/10.3390/nu13113688.
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Chronic kidney disease (CKD) is one of the most significant risk factors for cardiovasculardisese. Malnutrition has been recognized as a significant risk factor for cardiovascular disease in patients with CKD, including those on chronic dialysis. Current studies showed higher all-cause and cardiovascular mortality rates in patients with CKD and malnutrition. Geriatric nutritional risk index (GNRI), a simple and validated nutritional screening measure for both elderly people and patients on dialysis, is based only on three objective parameters: body weight, height, and serum albumin level. Recently, we demonstrated that the cutoff GNRI for predicting all-cause and cardiovascular mortality was 96 in patients on hemodialysis. Moreover, together with left ventricular hypertrophy and low estimated glomerular filtration rate, the utility of GNRI as a significant determinant of cardiovascular events was demonstrated in non-dialysis-dependent patients with CKD. In the present review, we summarize available evidence regarding the relationship of GNRI with all-cause and cardiovascular mortality in patients with CKD including those on dialysis.
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Fatima, Razeen, Prakhar Kumar, and Mujahid Beg. "Electrophysiological study of peripheral neuropathies in chronic kidney disease patients and relation of severity of peripheral neuropathy with degree of renal failure." International Journal of Advances in Medicine 8, no. 10 (September 22, 2021): 1576. http://dx.doi.org/10.18203/2349-3933.ijam20213713.
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Background: Patients with chronic kidney disease (CKD) are frequently afflicted with neurological complications. Peripheral neuropathy occurs in 60-100% patients of CKD. Nerve conduction study is the gold standard method to diagnose uremic neuropathy. In this study we have examined the correlation of nerve conduction latency, amplitude and nerve conduction velocity with serum creatinine, blood urea, serum uric acid levels and compared these parameters among dialysis and non-dialysis dependent CKD patients.Methods: The present cross-sectional study was conducted on 100 adult patients diagnosed to have and treated for CKD. All cases were subjected to nerve conduction study (NCS) which was performed on median nerve, ulnar nerve, common peroneal nerve, tibial nerve and sural nerve.Results: The prevalence of neuropathy was 68% in both dialysis and non-dialysis dependent groups. The most involved nerve was sural nerve. On NCS, there was prolongation of nerve latency, decrease in nerve amplitude and nerve conduction velocity with rising blood urea and serum creatinine levels. All these abnormalities were more evident in dialysis dependent patients as compared to non-dialysis dependent patients. Depressed amplitude was the most common abnormality in all the tested nerves.Conclusions: The nerve latency, amplitude and nerve conduction velocity worsened with rise in blood urea, serum creatinine and decrease in eGFR suggesting that neuropathy progress with increased severity of renal failure. Nerve conduction abnormalities were more prominent in dialysis dependent patients and therefore was associated with more advanced stage of CKD.
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Tsai, Kai-Fan, Pai-Chin Hsu, Chien-Te Lee, Chia-Te Kung, Yi-Chin Chang, Lung-Ming Fu, Yu-Che Ou, Kuo-Chung Lan, Tzung-Hai Yen, and Wen-Chin Lee. "Association between Enzyme-Linked Immunosorbent Assay-Measured Kidney Injury Markers and Urinary Cadmium Levels in Chronic Kidney Disease." Journal of Clinical Medicine 11, no. 1 (December 29, 2021): 156. http://dx.doi.org/10.3390/jcm11010156.
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Cadmium exposure is associated with chronic kidney disease (CKD), but the optimal biomarker for early cadmium-associated nephrotoxicity in low-level exposure has not yet been established. We conducted a cross-sectional investigation involving 167 CKD patients stratified according to tertiles of urinary cadmium levels (UCd), in which enzyme-linked immunosorbent assay (ELISA)-measured novel renal biomarkers were utilized to assess the extent of renal injury associated with cadmium burden. In the analyses, urinary kidney injury molecule-1 (KIM-1) levels and age were the independent factors positively correlated with UCd after adjusting for covariates in non-dialysis-dependent CKD patients (high vs. low UCd, odds ratio (95% confidence interval), 1.0016 (1.0001–1.0032), p = 0.043, and 1.0534 (1.0091–1.0997), p = 0.018). Other conventional and novel renal biomarkers, such as serum creatinine, estimated glomerular filtration rate, CKD staging, urinary protein/creatinine ratio, urinary 8-hydroxy-2-deoxyguanosine (8-OHdG), and urinary epidermal growth factor (EGF) were not independently correlated with UCd in the analyses. In conclusion, our study found that the ELISA-measured urinary KIM-1 level could serve as an early renal injury marker in low-level cadmium exposure for non-dialysis-dependent CKD patients. In addition, age was an independent factor positively associated with UCd in this population.
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Tselios, Konstantinos, Dafna D. Gladman, Jiandong Su, and Murray B. Urowitz. "Advanced Chronic Kidney Disease in Lupus Nephritis: Is Dialysis Inevitable?" Journal of Rheumatology 47, no. 9 (April 1, 2020): 1366–73. http://dx.doi.org/10.3899/jrheum.191064.
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Objective.Advanced chronic kidney disease (CKD) carries an increased risk for progression to endstage renal disease (ESRD). We aimed to determine the rate of progression and the factors that drive the decline of renal function in lupus nephritis (LN).Methods.Patients with advanced LN-related CKD were identified from our longterm longitudinal cohort. Advanced CKD was defined as stage 3b [estimated glomerular filtration rate (eGFR) = 30–44 ml/min/1.73 m2] and stage 4 (eGFR = 15–29 ml/min/1.73 m2). All individuals were followed until progression to ESRD or the last visit and were divided into “progressors” and “non- progressors.” Demographic, clinical, immunological, and therapeutic variables were compared at baseline. Multivariable Cox regression analysis (both time-dependent and independent) was performed to identify predictors for progression.Results.One hundred eighteen patients (74 CKD 3b and 44 CKD 4) were included. Forty-five patients progressed (29 to ESRD and 16 from CKD 3b to CKD 4) after 6 years on average. No significant decline in the renal function was observed in 73 patients (“non-progressors”) after 10 years on average. Active serology (high anti-dsDNA titers and low complements C3/C4) at the time of CKD diagnosis and any increase of the daily prednisone dose after baseline were strongly associated with progression. Treatment with renin angiotensin system (RAS) blockers was associated with less risk for progression.Conclusion.Dialysis is not inevitable in LN-related advanced CKD because 62% of our patients did not progress over 10 years of followup on average. Certain predictors were identified to affect progression to ESRD.
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Sivakumar, Chaamanti, Vikki M. Jubb, Archie Lamplugh, and Sunil Bhandari. "Safety of Intravenous Iron – Cosmofer and Monofer Therapy in Peritoneal Dialysis and Non-Dialysis-Dependent Chronic Kidney Disease Patients." Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 39, no. 2 (March 2019): 192–95. http://dx.doi.org/10.3747/pdi.2018.00125.
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Safety of parenteral iron therapy is critical and has been demonstrated in several studies, but concerns persist on safety. We performed a retrospective single-center study investigating the safety and efficacy of parenteral iron administration using 2 iron preparations—Monofer and Cosmofer (Pharmacosmos A/S, Holbaek, Denmark)—in patients with chronic kidney disease (CKD), on peritoneal dialysis (PD) and non-dialysis. A database of CKD patients receiving intravenous (IV) iron was analyzed. Side effects were recorded during infusion, post-infusion, and after 48 hours. In a population of CKD patients (non-dialysis and PD), IV iron is safe with few major adverse effects for these 2 IV iron preparations studied with similar dosing schedules. These data provide reassurance on the relative short-term safety of IV iron preparations regarding acute infusion-related hypersensitivity reactions.
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Singh, Manisha, Deepa Raghavan, James S. Williams, Bradley C. Martin, Teresa J. Hudson, Richard R. Owen, and Nishank Jain. "Prevalence of Chronic Kidney Disease, Thrombotic Cardiovascular Events, and Use of Oral P2Y12 Inhibitors among Veterans." American Journal of Nephrology 47, no. 2 (2018): 67–71. http://dx.doi.org/10.1159/000486647.
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Background: Contemporary prevalence of chronic kidney disease (CKD) and thrombotic cardiovascular (CV) events remains unclear in Veterans enrolled in the Veterans Affairs Health Care System (VA) care. Although oral P2Y12 inhibitors (P2Y12i) are increasingly being prescribed to this patient population, the overall prescription trend for P2Y12i remains unclear. Methods: Using national VA corporate warehouse data, we used International Classification of Diseases-9 codes to identify Veterans with CKD, dialysis-dependent CKD, and CV events. VA pharmacy data were used to count P2Y12i prescriptions for the federal fiscal years (FY) 2011 through 2015. Results: The period prevalence of Veterans with CKD was 378,233 (6.1%). The point prevalence of CKD increased by 49% from 132,979 (2.30%) in FY11 to 213,444 (3.42%) in FY15. The period prevalence of Veterans with dialysis-dependent CKD was 150,298 (2.4%). In all, 128,703 (56.7%) CV events occurred in Veterans with CKD. Veterans with CKD were given 50.1% of prescriptions for clopidogrel, 49.3% for prasugrel, and 60.4% for ticagrelor. In this patient population, year-to-year increases in P2Y12i prescriptions were observed with a dramatic increase in ticagrelor prescriptions. Conclusion: CKD is common among Veterans and its true prevalence is likely being underestimated. The prevalence of dialysis-dependent CKD is higher among Veterans than the non-Veteran US population. CV events are widely co-prevalent and these patients are commonly prescribed P2Y12i. The recent increase in ticagrelor prescriptions in this patient population and large cost differences between the 3 P2Y12i underline the need for future studies to identify the preferred P2Y12i for these patients.
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Pergola, P., C. Charytan, D. Little, S. Tham, L. Szczech, R. Leong, and S. Fishbane. "POS-283 HEMOGLOBIN (HB) CORRECTION WITH ROXADUSTAT IS ASSOCIATED WITH IMPROVED IRON HOMEOSTASIS IN PATIENTS WITH NON-DIALYSIS-DEPENDENT (NDD) AND DIALYSIS-DEPENDENT (DD) CHRONIC KIDNEY DISEASE (CKD)." Kidney International Reports 6, no. 4 (April 2021): S120—S121. http://dx.doi.org/10.1016/j.ekir.2021.03.298.
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Michelassi, Stefano. "È possibile una gestione “ideale” della pandemia da malattia renale cronica?" Giornale di Clinica Nefrologica e Dialisi 34 (January 8, 2022): 1–9. http://dx.doi.org/10.33393/gcnd.2022.2352.
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Chronic Kidney Disease (CKD) is recognized as one of the major categories of noncommunicable epidemic diseases and in the last decades it has been largely growing in incidence and prevalence all over the world. Ideal management of CKD pandemic should be comprehensive of measures of tertiary, secondary, primary and primordial prevention. So, it should include prompt diagnosis and treatment of traditional and non-traditional risk factors for CKD, optimal conservative treatment for non-dialysis dependent CKD patients and appropriated dialysis therapy or renal transplantation for patients with end-stage renal disease. However, these goals are not easy to obtain on a global scale. It would be possible only by a broad and holistic approach, ranging from good governance to achievement of the sustainable development goals (SDGs).
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Runesson, Björn, Marco Trevisan, Ken Iseri, Abdul Rashid Qureshi, Bengt Lindholm, Peter Barany, Carl Gustaf Elinder, and Juan Jesus Carrero. "Fractures and their sequelae in non-dialysis-dependent chronic kidney disease: the Stockholm CREAtinine Measurement project." Nephrology Dialysis Transplantation 35, no. 11 (July 30, 2019): 1908–15. http://dx.doi.org/10.1093/ndt/gfz142.
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Abstract Introduction People undergoing maintenance dialysis are at high risk for fractures, but less is known about fracture incidence and associated outcomes in earlier stages of chronic kidney disease (CKD). Methods We conducted an observational analysis from the Stockholm Creatinine Measurement project, a Swedish health care utilization cohort during 2006–11. We identified all adults with confirmed CKD Stages 3–5 and no documented history of fractures and extracted information on comorbid history, ongoing medication, cardiovascular events and death. We studied incidence rates of fractures (overall and by location), with the estimated glomerular filtration rate (eGFR) as time-dependent exposure. We then studied hazard ratios [HRs and 95% confidence intervals (CIs)] for the events of death and major adverse cardiac events (MACE) using Cox regression with fracture as time-varying exposure. Results We identified 68 764 individuals with confirmed CKD (mean age 79 years, 56% women). During a median follow-up of 2.7 years, 9219 fractures occurred, of which 3105 were hip fractures. A more severe CKD stage was associated with a higher risk of fractures, particularly hip fractures: compared with CKD Stage 3a, the adjusted HR was 1.10 (95% CI 1.02–1.19), 1.32 (1.17–1.49) and 2.47 (1.94–3.15) for CKD Stage 3b, 4 and 5, respectively. Spline curves suggested a linear association with fracture risk with an eGFR <30 mL/min/1.73 m2. Compared with non-fracture periods, incident fracture was associated with a 4-fold increased mortality within 90 days [HR 4.21 (95% CI 3.95–4.49)]. The risk remained elevated beyond 90 days [HR 1.47 (95% CI 1.40–1.54)] and was stronger after hip fractures. Post-fracture MACE risk was also highest in the first 90 days [HR 4.02 (95% CI 3.73–4.33)], particularly after hip fractures, and persisted beyond 90 days [HR 1.20 (95% CI 1.10–1.30)]. Conclusion Our findings highlight the commonness of fractures and the increased risk for subsequent adverse outcomes in CKD patients. These results may inform clinical decisions regarding post-fracture clinical surveillance and fracture prevention strategies.
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Post, Adrian, Dimitrios Tsikas, and Stephan J. L. Bakker. "Creatine is a Conditionally Essential Nutrient in Chronic Kidney Disease: A Hypothesis and Narrative Literature Review." Nutrients 11, no. 5 (May 10, 2019): 1044. http://dx.doi.org/10.3390/nu11051044.
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To accommodate the loss of the plethora of functions of the kidneys, patients with chronic kidney disease require many dietary adjustments, including restrictions on the intake of protein, phosphorus, sodium and potassium. Plant-based foods are increasingly recommended as these foods contain smaller amounts of saturated fatty acids, protein and absorbable phosphorus than meat, generate less acid and are rich in fibers, polyunsaturated fatty acids, magnesium and potassium. Unfortunately, these dietary recommendations cannot prevent the occurrence of many symptoms, which typically include fatigue, impaired cognition, myalgia, muscle weakness, and muscle wasting. One threat coming with the recommendation of low-protein diets in patients with non-dialysis-dependent chronic kidney disease (CKD) and with high-protein diets in patients with dialysis-dependent CKD, particularly with current recommendations towards proteins coming from plant-based sources, is that of creatine deficiency. Creatine is an essential contributor in cellular energy homeostasis, yet on a daily basis 1.6–1.7% of the total creatine pool is degraded. As the average omnivorous diet cannot fully compensate for these losses, the endogenous synthesis of creatine is required for continuous replenishment. Endogenous creatine synthesis involves two enzymatic steps, of which the first step is a metabolic function of the kidney facilitated by the enzyme arginine:glycine amidinotransferase (AGAT). Recent findings strongly suggest that the capacity of renal AGAT, and thus endogenous creatine production, progressively decreases with the increasing degree of CKD, to become absent or virtually absent in dialysis patients. We hypothesize that with increasing degree of CKD, creatine coming from meat and dairy in food increasingly becomes an essential nutrient. This phenomenon will likely be present in patients with CKD stages 3, 4 and 5, but will likely be most pronouncedly present in patients with dialysis-dependent CKD, because of the combination of lowest endogenous production of creatine and unopposed losses of creatine into the dialysate. It is likely that these increased demands for dietary creatine are not sufficiently met. The result of which, may be a creatine deficiency with important contributions to the sarcopenia, fatigue, impaired quality of life, impaired cognition, and premature mortality seen in CKD.
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Provenzano, Robert, Lynda Szczech, Robert Leong, Khalil G. Saikali, Ming Zhong, Tyson T. Lee, Dustin J. Little, et al. "Efficacy and Cardiovascular Safety of Roxadustat for Treatment of Anemia in Patients with Non–Dialysis-Dependent CKD." Clinical Journal of the American Society of Nephrology 16, no. 8 (August 2021): 1190–200. http://dx.doi.org/10.2215/cjn.16191020.
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Background and objectivesWe evaluated the efficacy and cardiovascular safety of roxadustat versus placebo by analyzing data pooled from three phase 3 studies of roxadustat in patients with non–dialysis-dependent CKD and CKD-related anemia.Design, setting, participants, & measurementsIn the three phase 3, double-blind studies of roxadustat versus placebo evaluating the treatment of CKD-related anemia in patients not requiring dialysis, the primary efficacy end point was mean change from baseline in hemoglobin averaged over weeks 28–52, regardless of rescue therapy. The primary cardiovascular safety end point was a composite measure of major adverse cardiovascular events (MACE; all-cause mortality, myocardial infarction, stroke). MACE plus (MACE+; MACE plus unstable angina and heart failure requiring hospitalization) and all-cause mortality were key secondary safety end points. These safety end points were adjudicated.ResultsA total of 4277 patients with non–dialysis-dependent CKD were randomized (roxadustat, n=2391; placebo, n=1886). Baseline characteristics were comparable between groups; the mean (SD) hemoglobin was 9.1 (0.7) g/dl and mean eGFR was 20 (12) ml/min per 1.73 m2. Patients treated with roxadustat versus those treated with placebo showed a mean change from baseline in hemoglobin averaged over weeks 28–52, regardless of rescue therapy, of 1.9 versus 0.2 g/dl, a treatment difference of 1.7 (95% confidence interval [95% CI], 1.7 to 1.8). Roxadustat reduced the need for red blood cell transfusion in the first 52 weeks versus placebo (6.1 versus 20.4 per 100 patient-exposure years, respectively; hazard ratio [HR], 0.26; 95% CI, 0.21 to 0.32). There were no increased risks of MACE (HR, 1.10; 95% CI, 0.96 to 1.27), MACE+ (HR, 1.07; 95% CI, 0.94 to 1.21), all-cause mortality (HR, 1.08; 95% CI, 0.93 to 1.26), or individual MACE+ components in patients treated with roxadustat versus those treated with placebo.ConclusionsRoxadustat was more effective than placebo at increasing hemoglobin in patients with non–dialysis-dependent CKD and anemia, while decreasing transfusion rate and being noninferior to placebo with respect to risk of MACE.Clinical Trial registry name and registration number:A Study of FG-4592 for the Treatment of Anemia in Chronic Kidney Disease Patients Not Receiving Dialysis, NCT01750190; Roxadustat in the Treatment of Anemia in Chronic Kidney Disease Patients Not Requiring Dialysis (ALPS), NCT01887600; Safety and Efficacy Study of Roxadustat to Treat Anemia in Patients With Chronic Kidney Disease (CKD), Not on Dialysis, NCT02174627
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Huang, Tao-Min, Vin-Cent Wu, Yu-Feng Lin, Jian-Jhong Wang, Chih-Chung Shiao, Likwang Chen, Shih-Chieh Chueh, et al. "Effects of Statin Use in Advanced Chronic Kidney Disease Patients." Journal of Clinical Medicine 7, no. 9 (September 17, 2018): 285. http://dx.doi.org/10.3390/jcm7090285.
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Although statin treatment is recommended for patients with chronic kidney disease (CKD) stages I–IV, its potential benefits have not been reported in advanced CKD patients. Non-diabetic patients with advanced CKD (pre-dialysis patients, estimated glomerular filtration rate <15 mL/min/1.73 m2) were enrolled from a National Health Insurance Research Database with a population of 23 million. Statin users and non-users were matched using propensity scoring and analyzed using Cox proportional hazards models, taking mortality as a competing risk with subsequent end-stage renal disease (ESRD) and statin doses as time-dependent variables. A total of 2551 statin users and 7653 matched statin non-users were identified from a total 14,452 patients with advanced CKD. Taking mortality as a competing risk, statin use did not increase the risk of new-onset diabetes mellitus (NODM) or decrease the risk of de novo major adverse cardiovascular events (MACE), but reduced all-cause mortality (hazard ratio (HR) = 0.59 [95% CI 0.42–0.84], p = 0.004) and sepsis-related mortality (HR = 0.53 [95% CI 0.32–0.87], p = 0.012). For advanced CKD patients, statin was neither associated with increased risks of developing NODM, nor with decreased risk of de novo MACE occurrence, but with a reduced risk of all-cause mortality, mainly septic deaths.
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Lei, Juanjuan, Han Li, and Shixiang Wang. "Efficacy and Safety of Roxadustat in Patients with Chronic Kidney Disease: An Updated Meta-Analysis of Randomized Controlled Trials including 6,518 Patients." BioMed Research International 2022 (November 14, 2022): 1–12. http://dx.doi.org/10.1155/2022/2413176.
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Background. Roxadustat is a newly listed oral hypoxia-inducible factor-proline enhancing enzyme inhibitor (HIF-PHI) in recent years. There have been some studies that have proved the efficacy of roxadustat on the treatment of renal anemia in patients with chronic kidney disease (CKD), but there are still different conclusions on its safety. Methods. PubMed, Embase, Cochrane, and ClinicalTrials were searched for randomized controlled trials (RCTs) that assess efficacy and safety of roxadustat treatment for anemia in CKD patients. The Cochrane Literature Quality Evaluation Scale was used to evaluate the quality of included literature. We choose fixed-effects model or random effects model for data processing based on heterogeneity. It was considered statistically significant when p value <0.05. Results. A total of 842 articles were retrieved, and 16 trials in the 15 articles were finally included. Roxadustat treatment significantly increased Hb levels. Iron (SMD 1.43, 95% CI 0.31 to 2.55), total iron-binding capacity (SMD 2.06, 95% CI 0.91 to 3.22), ferritin (WMD 21.33, 95% CI 3.04 to 39.62), transferrin saturation (SMD 4.17, 95% CI 3.90 to 4.45), and LDL-cholesterol (SMD -0.64, 95% CI -0.73 to -0.55) showed statistical significance in dialysis-dependent (DD) study. And hepcidin (SMD -1.56, 95% CI -2.63 to -0.50), transferrin (SMD 1.80, 95% CI 1.53 to 2.06), total iron-binding capacity (SMD 1.62, 95% CI 1.39 to 1.86), total cholesterol (SMD -0.88, 95% CI -1.68 to -0.09), ferritin (WMD -52.68, 95% CI -62.68 to -42.67), transferrin saturation (SMD -5.57, 95% CI -7.47 to -3.68), and LDL-cholesterol (SMD -0.85, 95% CI -1.37 to -0.34) showed statistical significance in not dialysis-dependent (NDD) study. In terms of safety, roxadustat treatment did not increase risk of total adverse events either in dialysis-dependent or not dialysis-dependent patients. Conclusion. Roxadustat can effectively improve anemia in patients with chronic kidney disease. There was no significant difference in total adverse events compared with the control group.
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Meyer, Alexander, Colin Griesbach, Nils Maudanz, Werner Lang, Veronika Almasi-Sperling, and Ulrich Rother. "Influence of end-stage renal disease on long-term survival after major amputation." Vasa 49, no. 4 (June 2020): 317–22. http://dx.doi.org/10.1024/0301-1526/a000856.
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Summary: Background: To analyze long-term outcomes and possible influencing factors in patients with endstage renal disease (ESRD) and critical limb ischemia (CLI) after major amputation compared to patients with normal renal function and non-dialysis-dependent chronic kidney disease. Patients and methods: Abstraction of single-center medical records of patients undergoing above knee (AKA) and below knee (BKA) amputation over a 10 years period (n = 436; 2009–2018). Excluded were amputations due to trauma or tumor. Patients were subdivided according to renal function in three categories: ESRD patients (n = 98), non-dialysis dependent chronic kidney disease (CKD, n = 98) and normal renal function (NF, n = 240). Predefined endpoints were survival and postoperative complications. Cox-regression models were built to analyze independent risk factors for outcome parameters. Results: In total, 298 AKA, 133 BKA and 5 knee joint exarticulations were performed. ESRD patients showed inferior in-hospital results as to death (ESRD 36.7 % vs. CKD 19.4 % and NF 20.0 %, P = .002). Similarly, long-term survival rates (6 months: ESRD 55.0 % vs. CKD 69.4 %, NF 67.9 % 1 year: ESRD 48.6 %, CKD 60.2 %, NF 60.8 % 5 years: ESRD 9.9 %, CKD 31.8 %, NF 37.1 %, P < .001) were significantly decreased for ESRD patients. Median postoperative survival was 10 months in ERSD, and 22 months in CKD and NF, respectively. Analysis of postoperative surgical complications revealed no differences between groups (ESRD 19.4 %, CKD 17.3 %, NF 17.0 %; P = 0.433). Cox regression analysis indicated that dialysis (HR 1.63; 95 % CI 1.22–2.16; P = .001), hypertension (HR 1.59; 95 % CI 0.99–2.54) and smoking (HR 1.22; 95 % CI 1.03–1.44; P = .022) was associated with increased risk of death during follow-up. Conclusions: Mortality after limb amputation in ERSD patients remains high. Survival of ERSD patients is lower in relation to chronic kidney disease and patients with normal renal function. Due to poor in hospital outcomes and absent long-term survival, benefit of primary amputation in ERSD seems scarce.
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Lacy, Peter, Susan J. Carr, David O'Brien, Barbara Fentum, Bryan Williams, Sanjoy K. Paul, and Thompson G. Robinson. "Reduced glomerular filtration rate in pre-dialysis non-diabetic chronic kidney disease patients is associated with impaired baroreceptor sensitivity and reduced vascular compliance." Clinical Science 110, no. 1 (December 12, 2005): 101–8. http://dx.doi.org/10.1042/cs20050192.
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Small uncontrolled studies of dialysis-dependent CKD (chronic kidney disease) patients have demonstrated abnormalities of cardiovascular autonomic control and vascular compliance, which may contribute to adverse cardiovascular morbidity in this population. However, there is little information utilizing newer non-invasive techniques in pre-dialysis patients with increasing degrees of uraemia. In the present study, 55 non-dialysis-dependent non-diabetic CKD patients with mean GFR (glomerular filtration rate) of 27 ml·min−1·m−2 were studied. All patients underwent a 10-min period of electrocardiographic and non-invasive blood pressure monitoring. Cardiac BRS (baroreceptor sensitivity) was calculated from the combined α-index. PWV (pulse wave velocity) measurement and determination of arterial wave reflexion by applanation tonometry was performed in all patients. Mean (S.D.) cardiac BRS was 10.8 (7.1) ms/mmHg and mean (S.D.) PWV was 8.6 (1.7) m/s. Reduced GFR was correlated with increased PWV and decreased cardiac BRS. On logistic regression analysis with adjustment for clinical significant risk factors, severely impaired renal function (assessed by GFR <15 ml·min−1·m−2) was associated with increased large artery stiffness [odds ratio for PWV=3.14 (95% confidence intervals, 1.03–9.53); P=0.04] and increased cardiovascular autonomic dysfunction [odds ratio for BRS=0.87 (95% confidence intervals, 0.75–1.80); P=0.06]. In conclusion, non-dialysis dependent non-diabetic CKD patients with decreasing GFR have reduced cardiac BRS and increased large artery stiffness. This may have important prognostic and therapeutic consequences for the management of vascular disease in a pre-dialysis population.
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Tsuruya, Kazuhiko, Masahiro Eriguchi, Shunsuke Yamada, Hideki Hirakata, and Takanari Kitazono. "Cardiorenal Syndrome in End-Stage Kidney Disease." Blood Purification 40, no. 4 (2015): 337–43. http://dx.doi.org/10.1159/000441583.
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Background: Cardiorenal syndrome (CRS) in patients with end-stage kidney disease (ESKD) represents mainly cardiovascular disease (CVD) due to various complications associated with renal dysfunction—defined as type 4 CRS by Ronco et al.—because the effect of cardiac dysfunction on the kidneys does not need to be taken into consideration, unlike in non-dialysis dependent chronic kidney disease (CKD). Summary: Patients with ESKD are often in a state of chronic inflammation due to the upregulation of proinflammatory cytokines. Chronic inflammation leads to malnutrition and consequently to vascular endothelial dysfunction and vascular calcification, which is referred to as malnutrition-inflammation-atherosclerosis (MIA) syndrome and acts as a major risk factor for CVD. Anemia also plays a crucial role in CVD, and individuals with erythropoietin-resistant anemia have a particularly high risk of CVD. However, caution is emphasized because not only anemia itself, but also the overtreatment of anemia with erythropoiesis-stimulating agents aimed at elevating hemoglobin to ≥13 g/dl can also increase the risk of CVD. In CKD-mineral and bone disorder (CKD-MBD), phosphate load triggers the interactions between various factors such as calcium, parathyroid hormone, vitamin D, and fibroblast growth factor 23, promoting vascular calcification and thus becoming a risk factor for CVD. Key Messages: In addition to traditional atherosclerosis risk factors such as hypertension, diabetes, and dyslipidemia, the involvement of MIA syndrome, anemia, and CKD-MBD accompanying CKD have also become a focus for investigation as major players in CRS in patients with ESKD.
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Doshida, Yuta, Mitsuyo Itabashi, Takashi Takei, Yuka Takino, Ayami Sato, Wako Yumura, Naoki Maruyama, and Akihito Ishigami. "Reduced Plasma Ascorbate and Increased Proportion of Dehydroascorbic Acid Levels in Patients Undergoing Hemodialysis." Life 11, no. 10 (September 28, 2021): 1023. http://dx.doi.org/10.3390/life11101023.
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Ascorbate functions as an electron donor and scavenges free radicals. Dehydroascorbic acid (DHA), the oxidized form of ascorbate, is generated as a result of these reactions. While low plasma ascorbate levels have been reported in hemodialysis patients worldwide, no studies have measured DHA because it is not generalized. In this study, we aimed to clarify whether plasma ascorbate levels are low in dialysis patients and whether plasma ascorbate levels fluctuate before and after dialysis. Moreover, we applied our previously established method to measure the plasma ascorbate and DHA levels in chronic kidney disease (CKD) stage G3–G5 non-hemodialysis-dependent patients, and pre- and post-dialysis plasma ascorbate and DHA levels in CKD stage G5D hemodialysis patients. The sample size was calculated using G-power software. The pre-dialysis plasma total ascorbate levels, including DHA, were significantly (56%) lower in hemodialysis patients than in non-hemodialysis-dependent CKD patients. After dialysis, there was a 40% reduction in the plasma total ascorbate levels. Hemodialysis increased the post-dialysis plasma proportions of DHA from 37% to 55%. The study results demonstrated lower plasma total ascorbate levels in hemodialysis patients compared with in non-hemodialysis-dependent CKD patients; these low levels in hemodialysis patients were further reduced by hemodialysis and increased DHA proportion.
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Lobov, G. I., A. N. Isachkina, and A. S. Gurkov. "Features of microvasculature regulation in patients with chronic kidney disease on peritoneal dialysis." Regional blood circulation and microcirculation 15, no. 1 (March 30, 2016): 65–72. http://dx.doi.org/10.24884/1682-6655-2016-15-1-65-72.
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Introduction and aim. Chronic kidney disease (CKD) is one of the most common non-infectious diseases, in which arterial hypertension (AH) is progressing. The mechanisms of AH in CKD are complex and understudied. This research was conducted with the objective to investigate the mechanisms of microvascular tonus increase in the group of patients with the 5th stage of CKD who were treated with peritoneal dialysis. Materials and methods. Patients from dialysis department were included in the study (76 people). Blood flow in microvessels was measured by laser Doppler flowmetry (LDF). Results of LDF used for the calculation of neurogenic (HT), myogenic (MT) and endothelium-dependent tonus (EDT) microvessels. Cardiotonic steroid concentration in plasma was measured by competitive immunofluorescence using antibodies to ouabain and marinobufagenin. The activity of Na/K-ATPase was measured by spectrophotometry. Results and discussion. HT microvessels in patients with CKD was increased by 21.4±3,88 %, MT - 33.4±5,62 %, EDT 17.1±3.14 % compared with the control group. Endogenous ouabain (EO) concentration in plasma of patients with CKD was on average 0.311±0.032 nM/L, in the control - 0.296±0.031 nM/L. Marinobufagenin (MBG) concentration in the plasma of patients with CKD was 2.10; 0.89; 3.07 nM/L (median, 25th and 75th percentile), and in control - 0.347; 0.103; 0.427 nM/L. The activity of Na/K-ATPase in patients with CKD was 1.54±0.18 μmol Pi/mL/hr, vs. 3.07±0.44 μmol Pi/mL/h in the control. The correlation between the value of MT of microvascular and MBG concentration in blood plasma of patients with CKD was found (rs = 0.736). Conclusions. Our results show that high NT of microvessels of patients with CKD and is connected with increased activity of the central structures of the sympathetic nervous system, while increase of EDT is connected with endothelial dysfunction and increase of MT is connected with increasing concentration of MBG (not EO) in blood plasma. We believe that the MBG causes contraction of smooth muscle cells of blood vessels by activating signaling function of Na/K-ATPase.
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Zsom, Lajos, Marianna Zsom, Sohail Abdul Salim, and Tibor Fülöp. "Estimated Glomerular Filtration Rate in Chronic Kidney Disease: A Critical Review of Estimate-Based Predictions of Individual Outcomes in Kidney Disease." Toxins 14, no. 2 (February 8, 2022): 127. http://dx.doi.org/10.3390/toxins14020127.
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Chronic kidney disease (CKD) is generally regarded as a final common pathway of several renal diseases, often leading to end-stage kidney disease (ESKD) and a need for renal replacement therapy. Estimated GFR (eGFR) has been used to predict this outcome recognizing its robust association with renal disease progression and the eventual need for dialysis in large, mainly cross-sectional epidemiological studies. However, GFR is implicitly limited as follows: (1) GFR reflects only one of the many physiological functions of the kidney; (2) it is dependent on several non-renal factors; (3) it has intrinsic variability that is a function of dietary intake, fluid and cardiovascular status, and blood pressure especially with impaired autoregulation or medication use; (4) it has been shown to change with age with a unique non-linear pattern; and (5) eGFR may not correlate with GFR in certain conditions and disease states. Yet, many clinicians, especially our non-nephrologist colleagues, tend to regard eGFR obtained from a simple laboratory test as both a valid reflection of renal function and a reliable diagnostic tool in establishing the diagnosis of CKD. What is the validity of these beliefs? This review will critically reassess the limitations of such single-focused attention, with a particular focus on inter-individual variability. What does science actually tell us about the usefulness of eGFR in diagnosing CKD?
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Fouque, Denis, Vincenzo Bellizzi, Antonio Bellasi, and Juan Jesus Carrera. "Retarding CKD Progression: Readily Available through Comprehensive Nutritional Management?" Nephrology @ Point of Care 2, no. 1 (January 2016): pocj.5000202. http://dx.doi.org/10.5301/pocj.5000202.
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This manuscript is aimed at summarising the evidences raised by the 2nd International conference of the European Renal Nutrition (ERN) working group at the ERA-EDTA “Retarding CKD progression: readily available through comprehensive nutritional management?” This project is focused on everyday nutritional issues related to non-dialysis-dependent chronic kidney disease (CKD) condition. A non-dialysis CKD clinical case of common presentation in the daily clinical practice will be reported and thereafter several key aspects of the comprehensive nutritional management which nephrologists face daily in clinics will be addressed; definitely, baseline nutritional assessment, basic nutritional concerns, major nutritional targets, nutritional strategies to improve renal outcomes, and modalities of nutritional follow-up will be discussed in relation to follow-up of the case report.
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Ahn, Jung-Won, Sun Mi Lee, and Yon Hee Seo. "Factors associated with self-care behavior in patients with pre-dialysis or dialysis-dependent chronic kidney disease." PLOS ONE 17, no. 10 (October 13, 2022): e0274454. http://dx.doi.org/10.1371/journal.pone.0274454.
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Self-care behavior plays a pivotal role in the management of chronic kidney disease. Improved self-care behavior in patients with chronic kidney disease is a key factor in health management and treatment adherence. This study aimed to evaluate the participants’ general and medical condition-related characteristics, physiological indices and the level of health literacy affecting self-care behavior in patients with chronic kidney disease in South Korea. The data of 278 participants were analyzed using t-test, analysis of variance, correlation coefficient, and linear multiple regression analysis. There were significant differences in self-care behavior scores depending on participants’ age and cohabitation status, employment, and smoking status as well as having dialysis due to end-stage kidney disease; number of comorbidities; levels of serum hemoglobin, calcium, and creatinine; and estimated glomerular filtration rate. The results of regression analysis revealed that not currently working, non-smoker, end-stage kidney disease, and positive response to the “actively managing my health” scale of the Health Literacy Questionnaire significantly affected self-care behavior in patients with chronic kidney disease, and the explanatory power of the model was 32.7%. Therefore, it is necessary to identify each patient’s barriers or needs according to individual characteristics, such as age, cohabitation and employment status, and daily life circumstances, including smoking habits, comorbidities, social support, and level of health literacy to develop efficient support strategies for promoting adequate self-care behavior with CKD.
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Pergola, Pablo E., Chaim Charytan, Dustin J. Little, Stefan Tham, Lynda Szczech, Robert Leong, and Steven Fishbane. "Changes in Iron Availability with Roxadustat in Non-Dialysis-Dependent and Dialysis-Dependent Patients with Anemia of CKD." Kidney360, June 29, 2022, 10.34067/KID.0001442022. http://dx.doi.org/10.34067/kid.0001442022.
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Background: Roxadustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor, increases hemoglobin by stimulating erythropoietin synthesis, and improving iron availability through facilitation of iron uptake and/or release from stores. In this exploratory analysis, we assessed the effect of roxadustat treatment on laboratory parameters related to iron metabolism in patients with anemia of chronic kidney disease (CKD). Methods: Data were pooled from pivotal, randomized, phase 3 roxadustat trials: three placebo-controlled, double-blind trials in non-dialysis-dependent (NDD)-CKD and three open-label, active-comparator (epoetin alfa) trials in dialysis-dependent (DD)-CKD. In this exploratory analysis, mean changes from baseline in hemoglobin, iron parameters, and hepcidin, and intravenous (IV) iron use were evaluated. Pooled results in NDD-CKD and DD-CKD patients are reported. Results: Overall, 4277 patients with NDD-CKD and 3890 patients with DD-CKD were evaluated. Hemoglobin increases with roxadustat treatment were accompanied by increases in serum iron and total iron-binding capacity (TIBC) and decreases in serum ferritin and hepcidin from baseline through Week 52. With epoetin alfa, the hemoglobin increase was accompanied by decreases in serum ferritin and hepcidin, but serum iron decreased and there was no change in TIBC. With placebo, there were no changes in hemoglobin, iron parameters, or hepcidin. During treatment, IV iron use was reduced with roxadustat versus placebo and epoetin alfa. Conclusions: In patients with NDD-CKD and DD-CKD, roxadustat treatment is associated with increases in serum iron and TIBC, accompanied by reduced hepcidin and indicative of improved iron kinetics. Patients treated with roxadustat achieved target hemoglobin levels with less IV iron use versus comparators. Practitioners treating patients with anemia of CKD with roxadustat should consider its unique effects when interpreting iron parameters.
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Tang, Mei, Changyu Zhu, Ting Yan, Yanglin Zhou, Qin Lv, and Junlan Chuan. "Safe and Effective Treatment for Anemic Patients With Chronic Kidney Disease: An Updated Systematic Review and Meta-Analysis on Roxadustat." Frontiers in Pharmacology 12 (July 2, 2021). http://dx.doi.org/10.3389/fphar.2021.658079.
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Background: Roxadustat is a new oral drug for anemia in chronic kidney disease (CKD). This study aimed to synthesize the evidence from randomized controlled trial (RCT)-based studies that estimated the efficacy and safety of roxadustat in anemia patients with non-dialysis-dependent (NDD) and dialysis-dependent (DD) CKD.Methods: We searched the PubMed, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) databases for related published studies. Moreover, we manually searched relevant pharmaceutical company websites and two international clinical trial registers to search for published and unpublished RCTs comparing roxadustat with erythropoietin-stimulating agents (ESAs) or placebo.Results: Fifteen RCTs (seven for DD-CKD patients, eight for NDD-CKD patients) were included in the meta-analysis, with 10,189 patients, 4,810 DD-CKD patients, and 5,379 NDD-CKD patients enrolled. Compared with ESAs (epoetin alfa or darbepoetin alfa) and placebo, roxadustat raised the hemoglobin level [weighted mean difference (WMD): 0.82 g/dL; 95% confidence interval (CI): 0.43–1.21], transferrin level (WMD: 0.5 g/L; 95% CI: 0.34–0.65), and TIBC level (WMD: 41.79 μg/dL; 95% CI: 38.67–44.92) and lowered the hepcidin level (WMD: −37.38 ng/ml; 95% CI: −46.63– −28.12) in both the DD-CKD and NDD-CKD patients with renal anemia. Roxadustat improved hemoglobin response and lowered the ferritin and TAST levels in the NDD-CKD patients but not in the DD-CKD patients. Furthermore, there was no difference between the treatment-emergent adverse events (TEAEs) of roxadustat and that of ESAs or placebo. But the incidence of serious TEAEs in the roxadustat group was significantly higher with NDD-CKD patients (OR: 1.15; 95% CI: 1.02–1.29).Conclusion: This study confirmed that roxadustat therapy could alleviate the anemia of DD-CKD and NDD-CKD patients by raising the hemoglobin level and regulating iron metabolism, but increased serious incidences of treatment-emergent adverse events (TEAEs) in NDD-CKD patients.
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Yu, Huan, Chaoyang Zhang, Yan Cai, Ning Wu, Kai Duan, Wenwei Bo, Ying Liu, and Zitong Xu. "Abnormal regional homogeneity and amplitude of low frequency fluctuation in chronic kidney patients with and without dialysis." Frontiers in Neuroscience 16 (November 22, 2022). http://dx.doi.org/10.3389/fnins.2022.1064813.
Full textAbstract:
PurposeThe study characterizes regional homogeneity (ReHo) and amplitude of low frequency fluctuations (ALFF) in abnormal regions of brain in patients of chronic kidney disease (CKD).Materials and methodsA total of 64 patients of CKD were divided into 26 cases of non-dialysis-dependent chronic kidney disease (NDD-CKD), and 38 cases of dialysis-dependent chronic kidney disease (DD-CKD). A total of 43 healthy controls (normal control, NC) were also included. All subjects underwent resting-state functional magnetic resonance imaging (rs-fMRI). ALFF and ReHo data was processed for monitoring the differences in spontaneous brain activity between the three groups. ALFF and ReHo values of extracted differential brain regions were correlated to the clinical data and cognitive scores of CKD patients.ResultsNon-dialysis-dependent group has increased ALFF levels in 13 brain regions while that of DD group in 28 brain regions as compared with NC group. ReHo values are altered in six brain regions of DD group. ALFF is correlated with urea nitrogen and ReHo with urea nitrogen and creatinine. DD group has altered ReHo in two brain regions compared with NDD group. The differences are located in basal ganglia, cerebellar, and hippocampus regions.ConclusionAbnormal activity in basal ganglia, cerebellar, and hippocampal regions may be involved in the cognitive decline of CKD patients. This link can provide theoretical basis for understanding the cognitive decline.
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Liu, Chao, Zhangning Fu, Jiawei Jiang, Kun Chi, Xiaodong Geng, Zhi Mao, Chengcheng Song, et al. "Safety and Efficacy of Roxadustat for Anemia in Patients With Chronic Kidney Disease: A Meta-Analysis and Trial Sequential Analysis." Frontiers in Medicine 8 (August 31, 2021). http://dx.doi.org/10.3389/fmed.2021.724456.
Full textAbstract:
Background: Roxadustat, a hypoxia-inducible factor prolyl-hydroxylase inhibitor (HIF-PHI), has been used to treat anemia in patients with chronic kidney disease (CKD). However, its safety and efficacy remain controversial.Methods: The PubMed, EMBASE, Science Citation Index, Cochrane Central Register of Controlled Trials, and Clinical Trial Registries databases were searched for relevant studies published up to April 2021. We identified randomized controlled trials (RCTs) comparing roxadustat with placebo or erythropoiesis-stimulating agents (ESAs) in anemia patients with CKD with or without dialysis.Results: Eleven studies including 6,631 patients met the inclusion criteria. In non-dialysis-dependent (NDD-) and dialysis-dependent (DD-) CKD patients, the total adverse events were not significantly different between the roxadustat and control (placebo for NDD-CKD patients and ESA for DD-CKD patients) groups [relative risk (RR) = 1.02, 95% confidence interval (CI) = 1.00, 1.04, P = 0.08, and RR = 1.22, 95% CI = 0.91, 1.64, P = 0.18, respectively], and the trial sequential analysis (TSA) confirmed the result in the NDD-CKD groups. No significant differences in hyperkalemia and infection incidences were found between roxadustat and placebo in the DD-CKD groups. The pooled results showed that roxadustat significantly increased the hemoglobin response rate compared with placebo in the NDD-CKD group and had an effect similar to that of ESA in the DD-CKD group. However, iron metabolism parameters did not seem to be obviously optimized by roxadustat.Conclusion: Roxadustat can be safely used in CKD patients. Oral roxadustat was more effective than placebo as a therapy for anemia in NDD-CKD patients and non-inferior to ESA in correcting anemia in DD-CKD patients. However, additional clinical trials are still needed to further prove whether roxadustat can optimize iron metabolism.