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Wang D, Hu X, Jin H, Liu J, Chen X, Qin Y, Zhang Y, Xiang Q. Impaired kidney function and the risk of all-cause mortality and cardiovascular disease among Chinese hypertensive adults: Using three different equations to estimate the glomerular filtration rate. Prev Med 2024; 180:107869. [PMID: 38266581 DOI: 10.1016/j.ypmed.2024.107869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVES We aimed to seek accurate assessments of the glomerular filtration rate (GFR) in a Chinese hypertensive population to identify individuals at high risk for chronic kidney disease (CKD) progression. Then, the risk of cardiovascular disease (CVD) and all-cause death due to kidney injury were further investigated under appropriate GFR-estimation equations. METHODS In this prospective follow-up cohort study of 10,171 hypertensive patients, we compared the discrimination power of a trio of GFR-estimation equations using Harrell's C-index, measuring the model fit by calculating the Akaike information criterion. Univariate and multivariable logistic regression analyses were respectively used to calculate the hazard ratio (HR) and 95% confidence interval [CI] values for CKD progression. In addition, we also assessed the risk of CVD and all-cause death with impaired renal function using multivariable-adjusted Cox regression models. RESULTS The Modification of Diet in Renal Disease (MDRD) equation showed the highest C-index range for the predicted probability of CKD progression in the fully adjusted model. During MDRD analysis, a low eGFR (60-89 mL/min/1.73m2 or < 60 mL/min/1.73m2) was an independent risk factor for CVD, especially stroke (1.28 [95% CI, 1.05-1.55] and 1.89 [95% CI, 1.08-3.31]), as well as all-cause mortality (1.28 [95% CI, 1.09-1.50] and 1.68 [95% CI, 1.01-2.78]). CONCLUSIONS The MDRD equation seems to be more suitable for screening CKD progression in Chinese hypertensive populations, targeting potential risk factors for effective prevention to reduce renal impairment so as to further limit CVD morbidity and mortality.
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Affiliation(s)
- Dan Wang
- School of Public Health, Southeast University, Nanjing, China; Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiangju Hu
- Department of Chronic Non-communicable Disease Control and Prevention, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Hang Jin
- School of Public Health, Southeast University, Nanjing, China
| | - Jiali Liu
- School of Public Health, Southeast University, Nanjing, China
| | - Xin Chen
- School of Public Health, Southeast University, Nanjing, China
| | - Yu Qin
- Department of Chronic Non-communicable Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Yongqing Zhang
- Department of Chronic Non-communicable Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Quanyong Xiang
- School of Public Health, Southeast University, Nanjing, China; Department of Chronic Non-communicable Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China.
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Debourdeau E, Medard R, Chamard C, Nguyen V, Gabrielle PH, Creuzot-Garcher C, Allieu S, Gillies MC, Barthelmes D, Daien V. Does HbA1c Level or Glomerular Filtration Rate Affect the Clinical Response to Endothelial Growth Factor Therapy (Ranibizumab or Aflibercept) in Diabetic Macular Edema? A Real-Life Experience. Ophthalmol Ther 2023; 12:2657-2670. [PMID: 37505396 PMCID: PMC10441844 DOI: 10.1007/s40123-023-00758-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/14/2023] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION Anti-vascular endothelial growth factor (VEGF) therapy is the first-line treatment for diabetic macular edema (DME). We investigated the effect of initial glycosylated hemoglobin (HbA1c) level and glomerular filtration rate (GFR) on treatment outcomes in patients with DME receiving anti-VEGF injections in routine clinical practice. METHODS A retrospective analysis of data from the prospective, multi-center, observational Fight Retinal Blindness! registry was performed. A total of 178 eyes with DME treated with anti-VEGF agents (ranibizumab or aflibercept) from 1 January 2010 to 31 March 2019 were enrolled in the analysis, with the long study period to allow for up to 24 months of follow-up. Data for eyes were tracked in the Fight Retinal Blindness! registry, and clinical parameters were collected by using local software. Changes in visual (best-corrected visual acuity [BCVA], in letters) and anatomic outcomes (central subfield thickness [CST], in microns) between subgroups of patients according to baseline HbA1c level (≤ 7% vs. > 7%) and GFR (> vs. ≤ 60 ml/min/m2 at 24 months were assessed. RESULTS The multivariate adjusted mean improvement in BCVA at 24 months of treatment was + 5.2 and + 6.8 letters in subgroups with baseline HbA1c level ≤ 7% and > 7%, respectively (p = 0.541), and + 6.9 and + 6.4 letters in subgroups with GFR > 60 and < 60 ml/min/1.73 m2, respectively (p = 0.852). The multivariate adjusted mean CST reduction was - 89.9 and - 76.4 µm in subgroups with baseline HbA1c level ≤ 7% and > 7%, respectively (p = 0.505), and - 85 and - 115 µm in subgroups with baseline GFR > 60 and ≤ 60 ml/min/1.73 m2, respectively (p = 0.130). CONCLUSION These results seem to indicate that visual and anatomical improvement in patients receiving intravitreal VEGF inhibitors for DME are independent of baseline HbA1c level and GFR, leading to the conclusion that high HbA1c levels or low GFR should not dictate injection timing in routine clinical practice. This study offers valuable insights for ophthalmologists, enabling a personalized treatment approach and optimizing DME patient outcomes.
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Affiliation(s)
- Eloi Debourdeau
- Department of Ophthalmology, Gui de Chauliac Hospital, 80 Avenue Augustin Fliche, 34000, Montpellier, France.
- Institute for Neurosciences of Montpellier (INM), Univ. Montpellier, INSERM, 34091, Montpellier, France.
| | - Robin Medard
- Department of Ophthalmology, Gui de Chauliac Hospital, 80 Avenue Augustin Fliche, 34000, Montpellier, France
| | - Chloe Chamard
- Department of Ophthalmology, Gui de Chauliac Hospital, 80 Avenue Augustin Fliche, 34000, Montpellier, France
- Institute for Neurosciences of Montpellier (INM), Univ. Montpellier, INSERM, 34091, Montpellier, France
| | - Vuong Nguyen
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | | | | | - Sandrine Allieu
- Department of Ophthalmology, Not-for-Profit Private Clinic Beau Soleil, 34000, Montpellier, France
| | - Mark C Gillies
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Daniel Barthelmes
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Vincent Daien
- Department of Ophthalmology, Gui de Chauliac Hospital, 80 Avenue Augustin Fliche, 34000, Montpellier, France.
- Institute for Neurosciences of Montpellier (INM), Univ. Montpellier, INSERM, 34091, Montpellier, France.
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
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Cristea AM, Zaharia DC, Leu S, Bogdan MA. Complications During Hospitalization in Patients With SARS-CoV-2 Pneumonia in a Romanian Pulmonary Center. Cureus 2023; 15:e33882. [PMID: 36819389 PMCID: PMC9934938 DOI: 10.7759/cureus.33882] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 01/19/2023] Open
Abstract
Introduction The coronavirus disease (COVID-19) was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. Facing a new and unknown virus, the entire medical community made considerable efforts to find a specific treatment, develop guidelines, and even create a vaccine. Besides all the measures taken, a wide range of complications associated with the disease increased the mortality and morbidity rates, adding more difficulty to the management of the patients. Study design We performed a retrospective study, including the patients with SARS-CoV-2 pneumonia who were admitted to our hospital between March 2020 and August 2021. We analyzed complications that developed during the hospitalization, such as respiratory failure or acute injury to other organs (the heart, pancreas, kidneys, and liver), and whether they were treatment- and hospitalization-related. Results One thousand eight hundred and forty-four cases were evaluated, and we analyzed the complications that developed during the hospitalization. Out of this, 1392 (75.48%) cases developed at least one complication during hospitalization, most frequently respiratory failure (71.14%), hyperglycemia (43.54%), renal injury (42.67%), or cardiovascular events (7.10%). Conclusion SARS-CoV-2 infection in hospitalized patients with pneumonia can cause injuries to any organ, making the management of those patients even more difficult.
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Affiliation(s)
- Alexandra M Cristea
- Pneumology, Marius Nasta Institute of Pneumology/ Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Dragos C Zaharia
- Pneumology, Marius Nasta Institute of Pneumology/ Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Stefan Leu
- Pneumology, Marius Nasta Institute of Pneumology, Bucharest, ROU
| | - Miron A Bogdan
- Pneumology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
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Collister D, Krakowsky Y, Potter E, Millar AC. Chronic Kidney Disease in the Transgender, Nonbinary, or Gender Diverse Person. Semin Nephrol 2022; 42:129-141. [PMID: 35718361 DOI: 10.1016/j.semnephrol.2022.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Nephrologists are increasingly providing care to transgender, nonbinary, and gender diverse (TNBGD) individuals with chronic kidney disease. This narrative review discusses the care of TNBGD individuals from a nephrology perspective. TNBGD individuals are under-represented in the nephrology literature. TNBGD individuals are at an increased risk of adverse outcomes compared with the cisgender population including mental health, cardiovascular disease, malignancy, sexually transmitted infections, and mortality. Gender-affirming hormone therapy (GAHT) with estradiol in transfeminine individuals potentially increases the risk of venous thromboembolism and cardiovascular disease. GAHT with testosterone in transmasculine individuals potentially increases the risk of erythrocytosis and requires careful monitoring. GAHT modifies body composition and lean muscle mass, which in turn influence creatinine generation and excretion, which may impact the performance of estimated glomerular filtration rate (GFR) equations and the estimation of 24-hour urine values from spot urine albumin/protein to creatinine ratios. There are limited studies regarding TNBGD individuals with chronic kidney disease. Additional research is needed to evaluate the effects of GAHT on GFR and biomarkers of kidney function and the performance of the estimated GFR equation in TNBGD populations.
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Affiliation(s)
- David Collister
- Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada; Population Health Research Institute, Hamilton, Ontario, Canada.
| | - Yonah Krakowsky
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Surgery, Women's College Hospital, Toronto, Ontario, Canada
| | - Emery Potter
- Department of Surgery, Women's College Hospital, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Adam C Millar
- Division of Endocrinology and Metabolism, Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Rasking L, Vanbrabant K, Bové H, Plusquin M, De Vusser K, Roels HA, Nawrot TS. Adverse Effects of fine particulate matter on human kidney functioning: a systematic review. Environ Health 2022; 21:24. [PMID: 35135544 PMCID: PMC8822715 DOI: 10.1186/s12940-021-00827-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 12/27/2021] [Indexed: 05/24/2023]
Abstract
BACKGROUND Ambient fine particulate matter (PM < 2.5 μm, PM2.5) is gaining increasing attention as an environmental risk factor for health. The kidneys are considered a particularly vulnerable target to the toxic effects that PM2.5 exerts. Alteration of kidney function may lead to a disrupted homeostasis, affecting disparate tissues in the body. This review intends to summarize all relevant knowledge published between January 2000 and December 2021 on the effects of ambient PM2.5 and the adverse effects on kidney function in adults (≥ 18 years). RESULTS AND DISCUSSION Studies published in peer-reviewed journals, written in English, regarding the effects of PM2.5 on kidney function and the development and/or exacerbation of kidney disease(s) were included. Of the 587 nonduplicate studies evaluated, 40 were included, comprising of studies on healthy or diagnosed with pre-existing disease (sub)populations. Most of the studies were cohort studies (n = 27), followed by 10 cross-sectional, 1 ecological and 2 time-series studies. One longitudinal study was considered intermediate risk of bias, the other included studies were considered low risk of bias. A large portion of the studies (n = 36) showed that PM2.5 exposure worsened kidney outcome(s) investigated; however, some studies show contradictory results. Measurement of the estimated glomerular filtration rate, for instance, was found to be positively associated (n = 8) as well as negatively associated (n = 4) with PM2.5. LIMITATIONS AND CONCLUSION The main limitations of the included studies include residual confounding (e.g., smoking) and lack of individual exposure levels. The majority of included studies focused on specific subpopulations, which may limit generalizability. Evidence of the detrimental effects that ambient PM2.5 may exert on kidney function is emerging. However, further investigations are required to determine how and to what extent air pollution, specifically PM2.5, exerts adverse effects on the kidney and alters its function. REGISTRATION The systematic review protocol was submitted and published by the International Prospective Register of Systematic Reviews (PROSPERO; CRD42020175615 ).
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Affiliation(s)
- Leen Rasking
- Centre for Environmental Sciences, Hasselt University, Agoralaan Gebouw D, B-3590, Diepenbeek, Belgium
| | - Kenneth Vanbrabant
- Centre for Environmental Sciences, Hasselt University, Agoralaan Gebouw D, B-3590, Diepenbeek, Belgium
| | - Hannelore Bové
- Centre for Environmental Sciences, Hasselt University, Agoralaan Gebouw D, B-3590, Diepenbeek, Belgium
| | - Michelle Plusquin
- Centre for Environmental Sciences, Hasselt University, Agoralaan Gebouw D, B-3590, Diepenbeek, Belgium
| | - Katrien De Vusser
- Nephrology and Kidney Transplantation, University Hospital Leuven, Leuven, Belgium
- Department of Microbiology, Immunology, and Transplantation, Leuven University, Leuven, Belgium
| | - Harry A Roels
- Centre for Environmental Sciences, Hasselt University, Agoralaan Gebouw D, B-3590, Diepenbeek, Belgium
- Louvain Centre for Toxicology and Applied Pharmacology, Université catholique de Louvain, Brussels, Belgium
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Agoralaan Gebouw D, B-3590, Diepenbeek, Belgium.
- Department of Public Health and Primary Care, Environment and Health Unit, Leuven University, Leuven, Belgium.
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Lim SY, Wang R, Tan DJH, Ng CH, Lim WH, Quek J, Syn N, Nah BKY, Wong ETY, Huang DQ, Vathsala A, Siddiqui MS, Fung J, Muthiah MD, Tan EXX. A meta-analysis of the cumulative incidence, risk factors, and clinical outcomes associated with chronic kidney disease after liver transplantation. Transpl Int 2021; 34:2524-2533. [PMID: 34714569 DOI: 10.1111/tri.14149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/19/2021] [Accepted: 09/29/2021] [Indexed: 12/15/2022]
Abstract
Chronic kidney disease (CKD) remains a relatively common complication after liver transplantation (LT), and significantly impacts overall survival. We sought to assess the cumulative incidence, risk factors and mortality associated with post-LT CKD. CKD was defined as eGFR <60 ml/min/1.73 m2 as estimated by the Modified Diet in Renal Disease (MDRD) formula. Single-arm meta-analysis was done to evaluate the cumulative incidence of CKD at 1-, 3-, and 5-year timepoints post-LT. Risk factors for CKD were evaluated using hazard ratios (HR). Twenty-one studies involving 44 383 patients were included. Cumulative incidence of stage 3-5 CKD was 31.44% (CI 0.182-0.447), 36.71% (CI 0.188-0.546), and 43.52% (CI 0.296-0.574) at 1, 3, and 5 years after LT, respectively. Stage 5 CKD cumulative incidence increased from 0.274% (CI 0.001-0.005) at 1 year to 2.06% (CI 0.009-0.045) at 5 years post-LT. Age, female sex, diabetes, and peri-operative acute kidney injury (AKI) were significant risk factors for CKD. Stage 4-5 CKD was associated with a decrease in overall survival (HR 3.23, 95% CI 1.74-5.98, P < 0.01). CKD after LT is relatively common, and is associated with significantly reduced overall survival. Identification of patients at high risk of developing CKD allows physicians to prophylactically use renal-sparing immunosuppression which may be crucial in achieving desirable clinical outcomes.
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Affiliation(s)
- Sze Yinn Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Renaeta Wang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jingxuan Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Biostatistics & Modelling Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Benjamin Kai Yi Nah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Emmett Tsz-Yeung Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Center for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Daniel Q Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Center for Organ Transplantation, National University Health System, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Anantharaman Vathsala
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Center for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Mohammad Shadab Siddiqui
- Division of Gastroenterology and Hepatology, Virginia Commonwealth University, Richmond, VA, USA
| | - James Fung
- Division of Gastroenterology and Hepatology, Department of Medicine, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Mark D Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Center for Organ Transplantation, National University Health System, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Eunice Xiang-Xuan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Center for Organ Transplantation, National University Health System, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
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Abd El Hafez S, Hagag M, Azmy R, Kasem H. Serum mast cell tryptase in patients with renal failure and its relation to severity of pruritus. MENOUFIA MEDICAL JOURNAL 2021; 34:467. [DOI: 10.4103/mmj.mmj_320_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Temkar S, Karuppaiah N, Takkar B, Bhowmik D, Tripathi M, Ramakrishnan S, Sharma YR, Vohra R, Chawla R, Venkatesh P. Impact of estimated glomerular filtration rate on diabetic macular edema. Int Ophthalmol 2018; 38:1043-1050. [PMID: 28523527 DOI: 10.1007/s10792-017-0557-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 05/10/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE Diabetic macular edema (DME) is a major cause of visual impairment in patients with diabetes and is influenced by various systemic factors. This study evaluates the effect of renal status on DME using estimated glomerular filtration rate (eGFR) as a study marker. METHODS This was a prospective observational cross-sectional study. One hundred and ninety-five patients of diabetic retinopathy (DR) were included. Group 1 had patients of DR without DME (n = 100), and group 2 had patients of DR with DME (n = 95). All patients were evaluated for DR/DME-related risk factors. eGFR was calculated in all patients. Spectral domain optical coherence tomography (SDOCT) was done to identify the various patterns and severity of DME. RESULTS Group 2 patients had significantly higher comorbidities than those in group 1 (p < 0.001). Hba1c, total cholesterol, triglycerides, LDL/HDL ratio, systolic and diastolic blood pressures were significantly higher in group II (p < 0.001 in each). There was no significant difference between the groups in terms of blood urea, serum creatinine or eGFR. eGFR did not show a significant association with a specific SDOCT pattern or severity of DME. CONCLUSION Comorbidities are more common and more severe in patients with DME. However, eGFR as a marker was not useful in predicting either the severity or pattern of DME. eGFR, in its present form, may not be useful in the evaluation and management of patients with DME.
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Affiliation(s)
- Shreyas Temkar
- Retina and Uvea Services, Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Nishanthini Karuppaiah
- Retina and Uvea Services, Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Brijesh Takkar
- Retina and Uvea Services, Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Dipankar Bhowmik
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | | | - Yog Raj Sharma
- Retina and Uvea Services, Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Rajpal Vohra
- Retina and Uvea Services, Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Rohan Chawla
- Retina and Uvea Services, Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Pradeep Venkatesh
- Retina and Uvea Services, Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110029, India.
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9
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The prevalence and association of chronic kidney disease and diabetes in liver cirrhosis using different estimated glomerular filtration rate equation. Oncotarget 2017; 9:2236-2248. [PMID: 29416767 PMCID: PMC5788635 DOI: 10.18632/oncotarget.23368] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 08/29/2017] [Indexed: 12/13/2022] Open
Abstract
Background Chronic kidney disease (CKD) in cirrhosis is one of the dreaded complications associated with a steep rise in mortality and morbidity, including diabetes. There are limited data on the prevalence of CKD and the association with diabetes in outpatients with cirrhosis. Methodology This is a cross-sectional study of 7,440 adult liver cirrhosis patients enrolled from August 2001 to April 2010 in a medical center. Case control matching by age and sex with 1,967 pairs, and conditional logistic regression for odds of diabetes was analyzed using adjusted model. Results CKD was present in 46.0%, 45.7% and 45.6% of the study population using the MDRD-6, CKD-EPI and MDRD-4 estimated glomerular filtration rate (eGFR) equations, respectively. Using a conditional logistic regression model after adjusting for other risk factors, odds for diabetes increased significantly compared with non-CKD in CKD stage 3 to 5 (stage 3~5) based on MDRD-6–adjusted model, ORs were: stage 3~5, 2.34 (95% CI, 1.78-3.01); MDRD-4–adjusted model, ORs were: stage 3~5, 8.51 (95% CI, 5.63-11.4); CKD-EPI–adjusted model, ORs were: stage 3~5, 8.61 (95% CI, 5.13-13.9). Conclusion In cirrhosis patients, prevalence of diabetes was higher in patients with advanced stage of CKD. For patients with cirrhosis, patients with CKD stages 3~5 defined by MDRD-4, MDRD-6, and CKD-EPI eGFR equations had increased risk for diabetes. More severe cirrhosis, indicated by the Child-Turcott-Pugh classification was also accompanied by an increased risk for diabetes.
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Aiello FI, Bajo M, Marti F, Musso CG. How to evaluate renal function in stable cirrhotic patients. Postgrad Med 2017; 129:866-871. [DOI: 10.1080/00325481.2017.1365569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Florencia I. Aiello
- Human Physiology Department, Instituto Universitario del Hospital, Italiano de Buenos Aires, Argentina
| | - Magdalena Bajo
- Human Physiology Department, Instituto Universitario del Hospital, Italiano de Buenos Aires, Argentina
| | - Fernanda Marti
- Human Physiology Department, Instituto Universitario del Hospital, Italiano de Buenos Aires, Argentina
| | - Carlos G. Musso
- Human Physiology Department, Instituto Universitario del Hospital, Italiano de Buenos Aires, Argentina
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Abstract
BACKGROUND Acute kidney injury (AKI) is a common complication of advanced cirrhosis. Type 1 hepatorenal syndrome is the best-known and most severe form of AKI, and it has a precise definition and a set of specific diagnostic criteria. More recently, it has become recognized that milder degrees of renal dysfunction also have a negative impact on patient outcome in various patient populations. Key Messages: Several definitions and criteria for staging the severity of AKI have been proposed, including the RIFLE (Risk, Injury, Failure, Loss of Function and End-Stage Renal Disease) group, the Acute Kidney Injury Network (AKIN), and the Kidney Disease: Improving Global Outcome (KDIGO) group. All of them incorporate some changes of serum creatinine and urine output in the definition and staging of AKI. The hepatology community has mostly embraced the AKIN diagnostic and staging criteria and has applied them in the prognostication of patients with advanced cirrhosis. However, the AKIN criteria have not been strictly applied in all studies on cirrhosis. This is partly related to the fact that changes in urine output are difficult to assess in advanced cirrhosis, and partly related to the difficulty in defining the baseline serum creatinine from which the change in serum creatinine is calculated. This has led to some confusion in the interpretation of results of the various studies on AKI in cirrhosis. More recently, some investigators have suggested incorporating the AKIN criteria with setting a lower limit of serum creatinine of 1.5 mg/dl in determining the diagnosis and prognosis of AKI in cirrhosis. CONCLUSIONS This is an ongoing debate as to how best to define AKI in cirrhosis. In the near future there should be prospective clinical trials that will clarify which diagnostic and staging criteria of AKI will best serve the cirrhotic population.
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Affiliation(s)
- Florence Wong
- Division of Gastroenterology, Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Ont., Canada
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Weismüller TJ, Lerch C, Evangelidou E, Strassburg CP, Lehner F, Schrem H, Klempnauer J, Manns MP, Haller H, Schiffer M. A pocket guide to identify patients at risk for chronic kidney disease after liver transplantation. Transpl Int 2015; 28:519-28. [DOI: 10.1111/tri.12522] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 11/25/2014] [Accepted: 01/07/2015] [Indexed: 02/06/2023]
Affiliation(s)
- Tobias J. Weismüller
- Department of Gastroenterology, Hepatology and Endocrinology; Hannover Medical School; Carl-Neuberg-Str.1 30625 Hannover Germany
- Integrated Research and Treatment Centre Transplantation (IFB-TX); Hannover Medical School; Carl-Neuberg-Str.1 30625 Hannover Germany
| | - Christian Lerch
- Department of Nephrology and Hypertension; Hannover Medical School; Carl-Neuberg-Str.1 30625 Hannover Germany
- Integrated Research and Treatment Centre Transplantation (IFB-TX); Hannover Medical School; Carl-Neuberg-Str.1 30625 Hannover Germany
| | - Eleni Evangelidou
- Department of Nephrology and Hypertension; Hannover Medical School; Carl-Neuberg-Str.1 30625 Hannover Germany
| | - Christian P. Strassburg
- Department of Gastroenterology, Hepatology and Endocrinology; Hannover Medical School; Carl-Neuberg-Str.1 30625 Hannover Germany
- Integrated Research and Treatment Centre Transplantation (IFB-TX); Hannover Medical School; Carl-Neuberg-Str.1 30625 Hannover Germany
| | - Frank Lehner
- Department of Visceral and Transplant Surgery; Hannover Medical School; Carl-Neuberg-Str.1 30625 Hannover Germany
- Integrated Research and Treatment Centre Transplantation (IFB-TX); Hannover Medical School; Carl-Neuberg-Str.1 30625 Hannover Germany
| | - Harald Schrem
- Department of Visceral and Transplant Surgery; Hannover Medical School; Carl-Neuberg-Str.1 30625 Hannover Germany
- Integrated Research and Treatment Centre Transplantation (IFB-TX); Hannover Medical School; Carl-Neuberg-Str.1 30625 Hannover Germany
| | - Jürgen Klempnauer
- Department of Visceral and Transplant Surgery; Hannover Medical School; Carl-Neuberg-Str.1 30625 Hannover Germany
- Integrated Research and Treatment Centre Transplantation (IFB-TX); Hannover Medical School; Carl-Neuberg-Str.1 30625 Hannover Germany
| | - Michael P. Manns
- Department of Gastroenterology, Hepatology and Endocrinology; Hannover Medical School; Carl-Neuberg-Str.1 30625 Hannover Germany
- Integrated Research and Treatment Centre Transplantation (IFB-TX); Hannover Medical School; Carl-Neuberg-Str.1 30625 Hannover Germany
| | - Hermann Haller
- Department of Nephrology and Hypertension; Hannover Medical School; Carl-Neuberg-Str.1 30625 Hannover Germany
- Integrated Research and Treatment Centre Transplantation (IFB-TX); Hannover Medical School; Carl-Neuberg-Str.1 30625 Hannover Germany
| | - Mario Schiffer
- Department of Nephrology and Hypertension; Hannover Medical School; Carl-Neuberg-Str.1 30625 Hannover Germany
- Integrated Research and Treatment Centre Transplantation (IFB-TX); Hannover Medical School; Carl-Neuberg-Str.1 30625 Hannover Germany
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Frequency, pattern and short-term outcome of chronic renal dysfunction in patients with cirrhosis: a prospective study using HRS and ADQI-IAC criteria. Eur J Gastroenterol Hepatol 2014; 26:1296-9. [PMID: 25171022 DOI: 10.1097/meg.0000000000000173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Diagnostic criteria of hepatorenal syndrome type 2 (HRS2) fail to detect milder degrees of chronic renal dysfunction (CRD) in cirrhosis and exclude patients with pre-existing kidney disease. Definitions addressing this have been proposed by Working Party of the Acute Dialysis Quality Initiative and International Ascites Club (ADQI-IAC). AIMS We studied the frequency, pattern and short-term outcome of CRD in patients with cirrhosis, using both HRS2 and ADQI-IAC criteria. PATIENTS AND METHODS Consecutive patients with cirrhosis and stable serum creatinine for 3 months or more attending outpatient clinics in Colombo North Teaching Hospital (Ragama, Sri Lanka) were prospectively recruited and followed up. RESULTS Of 277 patients with cirrhosis and stable serum creatinine, 23 (8.3%) fulfilled criteria for HRS2, and 65/277 (23.5%) had estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m [ADQI-IAC definition of chronic kidney disease (CKD)]. This included the 23 patients with HRS2 and an additional 42/65 (64.6%) who did not fulfil diagnostic criteria for HRS2 (non-HRS2 CKD). In all, 58/277 (20.9%) died during follow-up [mean 9.8 months (SD 4.5)]. This included 12/23 (52.2%) with HRS2 and 14/42 (33.3%) with non-HRS2 CKD. On the basis of multiple regression model, Child-Turcotte-Pugh class and CRD were significantly associated with death. After correcting for Child-Turcotte-Pugh class, both HRS2 (odds ratio 4.56, 95% confidence interval 1.79-11.53) and non-HRS2 CKD (odds ratio 2.19, 95% confidence interval 1.02-4.68) were independently associated with death. CONCLUSION Compared with HRS2 criteria, eGFR less than 60 ml/min/1.73 m detected almost twice the number of cirrhotics with CRD. Patients with eGFR less than 60 ml/min/1.73 m who did not fulfil criteria for HRS2 also had significant short-term mortality. ADQI-IAC criteria thus appear to be a more useful definition of CRD in cirrhotics.
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Vukobrat-Bijedic Z, Husic-Selimovic A, Mehinovic L, Junuzovic D, Bijedic N, Sofic A, Bjelogrlic I, Mehmedovic A. Estimated Glomerular Filtration Rate (eGFR) Values as Predictor of Renal Insufficiency in Advanced Stages of Liver Diseases with Different Etiology. Med Arch 2014; 68:159-62. [PMID: 25568524 PMCID: PMC4240337 DOI: 10.5455/medarh.2014.68.159-162] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 04/25/2014] [Indexed: 12/21/2022] Open
Abstract
Background: Various complications occur in patients with advanced stages of liver diseases. Renal dysfunction, a parameter included in the MELD score, is the most important prognostic factor. There is a strong need in clinical practice to estimate the GFR in this patients. Objectives: The aim of our study was to detect differences in renal function among patients with different stages of chronic liver diseases caused by HBV and HCV, also to determine the impact of viral etiology and gender on the values of eGFR and renal function. Patients and Methods: This was an observational cross-sectional study performed on patients with HBV and HCV chronic hepatitis, cirrhosis and HCC caused by these viruses hospitalized during period 2009–2014 in the Clinic of Gastroenterohepatology, Clinical Center University of Sarajevo. The estimated GFR (eGFR) was evaluated by the MDRD4 method. For the processing of data SPSS 21.0 statistical software was used. Statistical methods used in this study where: analysis of variance test (ANOVA test), Student’s t-test for independent samples and Pearson coefficient of correlation. The level of significance was p <0.05. Results: Among this three groups of patients there was a statistically significant difference in eGFR (F= 18.79, p<0.05), i.e. increase of degree of liver damage was related with increase of renal impairment, as reflected by a significant reduction in estimated glomerular filtration rate. Gender had no significant effect on eGFR and renal function (p>0.05), except in group of patients with HCC (p<0.05). Etiology had no significant effect on eGFR and renal (p>0.05). There was statistically significant inverse correlation between glomerular filtration rate and liver enzymes AST (-.184) and GGT (-.181). Conclusions: By calculation of GFR, we determined the existence of a significant reduction of kidney function through progression of liver damage from HBV and HCV chronic hepatitis, liver cirrhosis to HCC caused by these viruses, which drawing attention to the importance of the assessment of renal function in patients with this liver pathologies. Gender and etiology had no significant effect on eGFR and impairment of renal function. Given the statistically significant inverse correlation between eGFR and AST and GGT this liver enzymes may have important role as marker for both renal and hepatic injury.
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Affiliation(s)
- Zora Vukobrat-Bijedic
- Gastroenterohepatology department, Clinical Center of Sarajevo, University Sarajevo, Bosnia and Herzegovina
| | - Azra Husic-Selimovic
- Gastroenterohepatology department, Clinical Center of Sarajevo, University Sarajevo, Bosnia and Herzegovina
| | - Lejla Mehinovic
- Pathology Department, Clinical Center of Sarajevo, University Sarajevo, Bosnia and Herzegovina
| | - Dzelaludin Junuzovic
- Urology department, Clinical center of Sarajevo University, Sarajev0, Bosnia and Herzegovina
| | - Nina Bijedic
- Faculty of Information Technologies, University "Dzemal Bijedic" Mostar, Bosnia and Herzegovina
| | - Amela Sofic
- Radiology Department, Clinical center of Sarajevo, University Sarajevo, Bosnia and Herzegovina
| | | | - Amila Mehmedovic
- Gastroenterohepatology department, Clinical Center of Sarajevo, University Sarajevo, Bosnia and Herzegovina
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Chen CY, Pan CF, Wu CJ, Chen HH, Chen YW. Bicarbonate can improve the prognostic value of the MELD score for critically ill patients with cirrhosis. Ren Fail 2014; 36:889-94. [PMID: 24601755 DOI: 10.3109/0886022x.2014.894765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The prognosis of critically ill patients with cirrhosis is poor. Our aim was to identify an objective variable that can improve the prognostic value of the Model of End-Stage Liver Disease (MELD) score in patients who have cirrhosis and are admitted to the intensive care unit (ICU). This retrospective cohort study included 177 patients who had liver cirrhosis and were admitted to the ICU. Data pertaining to arterial blood gas-related parameters and other variables were obtained on the day of ICU admission. The overall ICU mortality rate was 36.2%. The bicarbonate (HCO3) level was found to be an independent predictor of ICU mortality (odds ratio, 2.3; 95% confidence interval [CI], 1.0-4.8; p = 0.038). A new equation was constructed (MELD-Bicarbonate) by replacing total bilirubin by HCO3 in the original MELD score. The area under the receiver operating characteristic curve for predicting ICU mortality was 0.76 (95% CI, 0.69-0.84) for the MELD-Bicarbonate equation, 0.73 (95% CI, 0.65-0.81) for the MELD score, and 0.71 (95% CI, 0.63-0.80) for the Acute Physiology and Chronic Health Evaluation II score. Bicarbonate level assessment, as an objective and reproducible laboratory test, has significant predictive value in critically ill patients with cirrhosis. In contrast, the predictive value of total bilirubin is not as prominent in this setting. The MELD-Bicarbonate equation, which included three variables (international normalized ratio, creatinine level, and HCO3 level), showed better prognostic value than the original MELD score in critically ill patients with cirrhosis.
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Affiliation(s)
- Cheng-Yi Chen
- Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital , Taipei , Taiwan
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Acute kidney injury in patients with cirrhosis: perils and promise. Clin Gastroenterol Hepatol 2013; 11:1550-8. [PMID: 23583467 PMCID: PMC3840046 DOI: 10.1016/j.cgh.2013.03.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 03/19/2013] [Accepted: 03/20/2013] [Indexed: 02/07/2023]
Abstract
A 62-year-old man with cirrhosis secondary to hepatitis C and chronic alcohol abuse was admitted to the intensive care unit with hematemesis and mental status changes. Physical examination showed ascites and stigmata of chronic liver disease. Blood pressure was noted as 87/42 mm Hg and laboratory studies showed a serum creatinine level of 0.8 mg/dL, an estimated glomerular filtration rate of 84 mL/min/1.73 m(2) calculated using the Modification of Diet in Renal Disease Study equation, a serum sodium level of 123 mEq/L, a total serum bilirubin level of 4.3 mg/dL, and an international normalization ratio of 1.6. The patient was resuscitated with packed red blood cells and fresh-frozen plasma and bleeding was controlled. However, on the third day of admission, creatinine level increased to 1.5 mg/dL. Examination of urine sediment showed 1 to 5 bilirubin-stained granular casts per high-powered field and a few renal tubular epithelial cells. The urine sodium level was 21 mEq/L and the fractional excretion of sodium was 0.43%.
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Metabolic syndrome after liver transplantation: short-term prevalence and pre- and post-operative risk factors. Dig Liver Dis 2013; 45:833-9. [PMID: 23816695 DOI: 10.1016/j.dld.2013.03.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Revised: 01/07/2013] [Accepted: 03/17/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND The metabolic syndrome is a common condition among liver transplanted patients and contributes to morbidity and mortality by favouring the development of cardiovascular diseases. AIMS This prospective study assessed the prevalence of metabolic syndrome in the first year after orthotopic liver transplantation, the associated pre-operative and post-operative risk factors and the influence of nutritional factors. METHODS 84 cirrhotic patients (75% male, mean age 53.9±9.3 years) were evaluated at baseline and after liver transplantation. Metabolic syndrome was defined according to 2004 Adult Treatment Panel-III criteria. Nutritional habits were assessed using 3-day food records. RESULTS Prevalence of metabolic syndrome before orthotopic liver transplantation was 14/84 (16.6%); at 3, 6 and 12 months post-orthotopic liver transplantation it was 27/84 (32.1%), 30/84 (35.7%), and 32/81 (39.5%), respectively. Diabetes, family history of diabetes, and excess body weight at baseline independently correlated with incidence of metabolic syndrome. After orthotopic liver transplantation, patients with metabolic syndrome showed a higher increase in the intake of total energy and saturated fats and a higher prevalence of complications, especially cardiovascular events, than subjects without metabolic syndrome. CONCLUSION Occurrence of metabolic syndrome is an early phenomenon after liver transplantation. Pre-operative and post-operative factors predispose patients to metabolic syndrome, which may be reduced by controlling modifiable risk factors, such as body weight and dietary intake.
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Chen YW, Chang CW, Chang CW, Wang TE, Wu CJ, Chen HH. Is an estimated glomerular filtration rate better than creatinine to be incorporated into the end-stage liver disease score? World J Hepatol 2012; 4:291-8. [PMID: 23293714 PMCID: PMC3536835 DOI: 10.4254/wjh.v4.i11.291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 08/17/2012] [Accepted: 10/22/2012] [Indexed: 02/06/2023] Open
Abstract
AIM To incorporate estimated glomerular filtration rate (eGFR) into the model for end-stage liver disease (MELD) score to evaluate the predictive value. METHODS From January 2004 to October 2008, the records of 4127 admitted cirrhotic patients were reviewed. Patients who survived and were followed up as outpatients were defined as survivors and their most recent available laboratory data were collected. Patients whose records indicated death at any time during the hospital stay were defined as non-survivors (in-hospital mortality). Patients with incomplete data or with cirrhosis due to a congenital abnormality such as primary biliary cirrhosis were excluded; thus, a total of 3857 patients were enrolled in the present study. The eGFR, which was calculated by using either the modification of diet in renal disease (MDRD) equation or the chronic kidney disease epidemiology collaboration (CKD-EPI) equation, was incorporated into the MELD score after adjustment with the original MELD equation by logistic regression analysis [bilirubin and international normalized ratio (INR) were set at 1.0 for values less than 1.0]. RESULTS Patients defined as survivors were significantly younger, had a lower incidence of hepatoma, lower Child-Pugh and MELD scores, and better renal function. The underlying causes of cirrhosis were very different from those in Western countries. In Taiwan, most cirrhotic patients were associated with the hepatitis virus, especially hepatitis B. There were 16 parameters included in univariate logistic regression analysis to predict in-hospital mortality and those with significant predicting values were included in further multivariate analysis. Both 4-variable MDRD eGFR and 6-variable MDRD eGFR, rather than creatinine, were significant predictors of in-hospital mortality. Three new equations were constructed (MELD-MDRD-4, MELD-MDRD-6, MELD-CKD-EPI). As expected, original MELD score was a significant predictor of in-hospital mortality (odds ratio = 1.25, P < 0.001). MELD-MDRD-4 excluded serum creatinine, with the coefficients refit among the remaining 3 variables, i.e., total bilirubin, INR and 4-variable MDRD eGFR. This model represented an exacerbated outcome over MELD score, as suggested by a decrease in chi-square (2161.45 vs 2198.32) and an increase in -2 log (likelihood) (2810.77 vs 2773.90). MELD-MDRD-6 included 6-variable MDRD eGFR as one of the variables and showed an improvement over MELD score, as suggested by an increase in chi-square (2293.82 vs 2198.32) and a decrease in -2 log (likelihood) (2810.77 vs 2664.79). Finally, when serum creatinine was replaced by CKD-EPI eGFR, it showed a slight improvement compared to the original MELD score (chi-square: 2199.16, -2 log (likelihood): 2773.07). In the receiver-operating characteristic curve, the MELD-MDRD-6 score showed a marginal improvement in area under the curve (0.909 vs 0.902), sensitivity (0.854 vs 0.819) and specificity (0.818 vs 0.839) compared to the original MELD equation. In patients with a different eGFR, the MELD-MDRD-6 equation showed a better predictive value in patients with eGFR ≥ 90, 60-89, 30-59 and 15-29. CONCLUSION Incorporating eGFR obtained by the 6-variable MDRD equation into the MELD score showed an equal predictive performance in in-hospital mortality compared to a creatinine-based MELD score.
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Affiliation(s)
- Yu-Wei Chen
- Yu-Wei Chen, Chih-Jen Wu, Han-Hsiang Chen, Department of Nephrology, Mackay Memorial Hospital, Taipei 10449, Taiwan
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Filiopoulos V, Koutis I, Takouli L, Arvanitis D, Panagiotopoulos K, Vlassopoulos D. Chronic kidney disease epidemiology collaboration equation accuracy in predicting peritoneal dialysis-delivered creatinine clearance. Ren Fail 2012; 35:88-93. [PMID: 23151212 DOI: 10.3109/0886022x.2012.741649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Measuring total (residual kidney plus peritoneal) creatinine clearance (CrCl) with 24-h urine and dialysate collections is recommended for peritoneal dialysis (PD) adequacy evaluation. Prediction equations applied in this instance could simplify the approach. Cockcroft-Gault and modification of diet in renal disease (MDRD) four (MDRD-4) and six (MDRD-6) variables equations have been tested in this setting, and conflicting results have been reported. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is currently considered to be more sensitive than the established equations for kidney function estimation. However, its performance in PD adequacy evaluation has not been studied. Our aim was to assess CKD-EPI equation's performance in predicting total measured CrCl (MCC) in PD patients. MATERIAL AND METHODS A group of 23 consecutive PD patients, male/female: 5/18, median age: 66 (32-91) years, median time on PD 32 (2-126) months, were enrolled in the study. All were treated by automated PD (APD). Sixteen out of twenty-three had residual renal function (RRF). MCC was determined from 24-h dialysate and urine collections and also predicted by Cockcroft-Gault, MDRD (4 and 6), and CKD-EPI equations. RESULTS CKD-EPI and MDRD-6 estimation results were similar to MCC (9.01 ± 3.90 and 9.54 ± 2.98 vs. 8.64 ± 3.75 mL/min/1.73 m(2) p = 0.49 and 0.09, respectively). Neither the presence nor the volume of residual urine affected the accuracy of prediction. Cockcroft-Gault and MDRD-4 equations differed significantly from MCC and were not accurately predictive. CONCLUSION CKD-EPI equation could be used with accuracy for predicting MCC in PD patients. Only MDRD-6 showed similar accuracy, whereas MDRD-4 and Cockcroft-Gault equations were found to be inappropriate in this setting.
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