Chronic Kidney Disease

Source: www.nih.gov --- 3 days ago
A 30 percent increase in Chronic Kidney Disease over the past decade has prompted the U.S. Renal Data System (USRDS) to issue for the first time a separate report documenting the magnitude of the Disease, which affects an estimated 27 million Americans and accounts for more than 24 percent of Medicare costs. The USRDS is funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health (NIH). ...

Source: www.ncbi.nlm.nih.gov --- 4 days ago
Related Articles Decreased body mass index as an independent risk factor for developing Chronic Kidney Disease. Clin Exp Nephrol. 2008 Oct 7; Authors: Tokashiki K, Tozawa M, Iseki C, Kohagura K, Kinjo K, Takishita S, Iseki K BACKGROUND: Obesity and metabolic syndrome are risk factors for the development of Chronic Kidney Disease (CKD). Few studies have examined the effect of change in body mass index (DeltaBMI) on CKD incidence in a general screening setting. METHODS: Subjects of this study were screenees that participated in the screening program of the Okinawa General Health Maintenance Association in 1993 and 2003 in Okinawa, Japan. Using identification number, birth date, sex, and other recorded identifiers, we identified 33,389 subjects among the 1993 screening participants (N = 143,948) who also participated in the 2003 screening. CKD was defined as estimated glomerular filtration rate <60 ml/min/1.73 m(2), according to the modification of diet in renal Disease study equation. Obesity was defined as BMI >/= 25 kg/m(2). RESULTS: CKD prevalence was 13.8% in 1993 and 22.4% in 2003. The incidence of developing CKD in 10 years was 15.5%. The effect of DeltaBMI on CKD incidence was evaluated after considering other confounding factors such as age, sex, blood pressure, BMI, fasting plasma glucose, and proteinuria. Median DeltaBMI was 1.0%. The adjusted odds ratio (95% CI) for the effect of DeltaBMI on CKD incidence was 1.111 (1.026-1.2 ...

Source: www.moreover.com --- 26 days ago
David Roth, MDTreating hepatitis C virus (HCV) can be risky, but treating patients who contract HCV and already have Chronic Kidney Disease (CKD) can be even trickier. ...

Source: www.ncbi.nlm.nih.gov --- 9 days ago
Related Articles The impact of sodium chloride and volume depletion in the Chronic Kidney Disease of congenital chloride diarrhea. Kidney Int. 2008 Oct;74(8):1085-93 Authors: Wedenoja S, Ormälä T, Berg UB, Halling SF, Jalanko H, Karikoski R, Kere J, Holmberg C, Höglund P Congenital chloride diarrhea is due to mutations in the intestinal Cl(-)/HCO(3)(-) exchange (SLC26A3) which results in sodium chloride and fluid depletion leading to hypochloremic and hypokalemic metabolic alkalosis. Although treatment with sodium and potassium chloride offers protection from renal involvement in childhood, the long-term renal outcome remains unclear. Here we describe two cases of congenital chloride diarrhea-associated end-stage renal Disease with transplantation. Further, we show that there is a high incidence of mild Chronic Kidney Disease in 35 other patients with congenital chloride diarrhea. The main feature of the renal injury was nephrocalcinosis, without hypercalciuria or nephrolithiasis with small sized kidneys and commensurately reduced glomerular filtration rates. This suggests that diarrhea-related sodium chloride and volume depletion, the first signs of non-optimal salt substitution, promote urine supersaturation and crystal precipitation. The poor compliance with salt substitution along with long-lasting hypochloremic and hypokalemic metabolic alkalosis is likely to induce progressive calcification and renal failure. Both our patients d ...

Source: www.ncbi.nlm.nih.gov --- 17 hours ago
Related Articles Introduction to the Canadian Society of Nephrology clinical practice guidelines for the management of anemia associated with Chronic Kidney Disease. Kidney Int Suppl. 2008 Aug;(110):S1-3 Authors: Manns BJ, White CT, Madore F, Moist LM, Klarenbach SW, Barrett BJ, Foley RN, Culleton BF, Tonelli M PMID: 18668115 [PubMed - indexed for MEDLINE] ...

Source: www.ncbi.nlm.nih.gov --- 2 days ago
Related Articles Variability of ferritin measurements in Chronic Kidney Disease; implications for iron management. Kidney Int. 2008 Oct 8; Authors: Ford BA, Coyne DW, Eby CS, Scott MG Serum ferritin levels are a proxy measure of iron stores; and existing guidelines for managing anemia in hemodialysis patients suggest that serum ferritin concentrations should be maintained at >200 ng/ml. The KDOQI recommendations further state there is insufficient evidence advocating routine intravenous iron when ferritin levels exceed 500 ng/ml. Here we determined the interassay differences and short-term intraindividual variability of serum ferritin measurements in patients on Chronic hemodialysis to illustrate how these variances may affect treatment decisions. Intermethod variations of up to 150 ng/ml were found comparing six commonly used ferritin assays that evaluated thirteen pools of serum from hemodialysis and nonhemodialysis patients. The intraindividual variability for ferritin in 60 stable hemodialysis patients ranged between 2-62% measured over an initial two-week period and from 3-52% when factored over a six-week period. Our results suggests that single serum ferritin values should not be used to guide clinical decisions regarding treatment of Chronic hemodialysis patients with intravenous iron due to significant analytical and intraindividual variability.Kidney International advance online publication, 8 October 2008; doi:10.1038/ki.2 ...

Source: www.ncbi.nlm.nih.gov --- 4 days ago
Related Articles Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with Chronic Kidney Disease: results of the study to evaluate early Kidney Disease. Kidney Int. 2008 Aug;74(3):389-90 Authors: Rouached M, El Kadiri Boutchich S, Al Rifai AM, Garabédian M, Fournier A PMID: 18626497 [PubMed - indexed for MEDLINE] ...

Source: www.ncbi.nlm.nih.gov --- 4 days ago
Related Articles Metabolic Syndrome Predicts New Onset Of Chronic Kidney Disease In 5829 Patients with Type 2 Diabetes - A 5-year Prospective Analysis of the Hong Kong Diabetes Registry. Diabetes Care. 2008 Oct 3; Authors: Luk AO, So WY, Ma RC, Kong AP, Ozaki R, Ng VS, Yu LW, Lau WW, Yang X, Chow FC, Chan JC, Tong PC Objective: Type 2 diabetes is the leading cause of end stage renal Disease worldwide. Aside from hyperglycemia and hypertension, other metabolic factors may determine renal outcome. We examined risk associations of metabolic syndrome (MetS) with new onset of Chronic Kidney Disease (CKD) in 5829 Chinese patients with type 2 diabetes enrolled between 1995 and 2005. Method: MetS was defined by National Cholesterol Education Program's Adult Treatment Panel III with Asian definition of obesity. Estimated glomerular filtration rate (eGFR) was calculated using abbreviated Modification of Diet in Renal Disease formula modified for Chinese population. New onset of CKD was defined as estimated eGFR < 60 ml/min/1.73m(2) at the time of censor. Subjects with CKD at baseline were excluded from the analysis. Results: After a median follow-up duration of 4.6 years [inter-quartile range: 1.9 - 7.3 years], 741 patients developed CKD. The multivariable-adjusted hazard ratio of CKD was 1.31, 95% confidence interval [CI] 1.12 - 1.54, p=0.001 for subjects with MetS compared to without. Relative to subjects with no other components of MetS exce ...

Source: www.ncbi.nlm.nih.gov --- 13 days ago
Related Articles Diagnosis and management of Chronic Kidney Disease. Mayo Clin Proc. 2008 Sep;83(9):1064-9 Authors: Graves JW As the US population has continued to age, the number of patients with Chronic Kidney Disease (CKD) has dramatically increased. Faced with this increase, clinicians need a better understanding of what an elevated serum creatinine level represents and a simple codified approach to evaluating renal failure. Creatinine, a muscle waste product, has an imperfect but predictable association with the glomerular filtration rate (GFR). Although other markers of GFR exist, including cystatin C, urea, inulin, and radioisotopic methods, their role in estimating GFR remains a matter for debate, especially that of cystatin C. Diagnosis and management of CKD are challenges for the nonspecialist. We describe a systematic approach that can be used by the nonspecialist to identify most but not all causes of renal insufficiency. Although this approach should allow for earlier recognition of treatable causes of CKD, it does not eliminate the involvement of a nephrologist in the care and management of the conditions causing the renal insufficiency. The nonspecialist should also be able to recognize the 9 therapies that are helpful in preservation of renal function in all patients with CKD. PMID: 18775206 [PubMed - indexed for MEDLINE] ...

Source: www.ncbi.nlm.nih.gov --- 23 days ago
Related Articles Effect of Exercise on Cardiac Tissue Oxidative and Inflammatory Mediators in Chronic Kidney Disease. Am J Nephrol. 2008 Sep 17;29(3):213-221 Authors: Bai Y, Sigala W, Adams GR, Vaziri ND Background: Chronic renal failure (CRF) results in diminished physical activity and increased risk of cardiovascular Disease (CVD). CVD risk factors are raised by sedentary life style and ameliorated by physical fitness in the general population. Accordingly, exercise improves hypertension, endothelial dysfunction, insulin resistance, dyslipidemia, inflammation and oxidative stress in high-risk populations. This study was designed to explore the effect of exercise on oxidative and inflammatory mediators in the left ventricle (LV) of CRF rats. Methods and Results: One week after 5/6 nephrectomy female rats were housed in either regular cages or cages equipped with running wheels for 4 weeks. Sham-operated rats housed in regular cages served as controls. Sedentary CRF rats exhibited azotemia, hypertension, anemia, oxidative stress, activation of NF-kappaB and upregulations of reactive oxygen species-generating enzyme, NAD(P)H oxidase, MCP-1, cyclooxygenase-2 (COX-2), and PAI-1 in LV. The CRF rats assigned to the exercise group ran 6.8 +/- 0.7 km/day and 72 +/- 8 min/day. Voluntary exercise reversed NF-kappaB activation and lowered NAD(P)H oxidase, PAI-1, MCP-1 and COX-2 abundance, increased LV mass by raising myofibrillar proteins and a ...

Source: www.ncbi.nlm.nih.gov --- 31 days ago
Related Articles Chronic Kidney Disease Adversely Influences Patient Safety. J Am Soc Nephrol. 2008 Sep 5; Authors: Seliger SL, Zhan M, Hsu VD, Walker LD, Fink JC Reducing medical errors and improving patient safety have become a national priority. Patients with Chronic Kidney Disease (CKD) may be at higher risk for adverse consequences of medical care, but few studies have evaluated this question. Here, data for patients hospitalized in the Veteran's Health Administration during 2004 to 2005 was analyzed to conduct a cross-sectional study of CKD and adverse safety events. Outcomes included 13 patient safety indicators (PSI) defined by the Agency for Healthcare Research and Quality and six experimental PSI relevant to CKD. The 71,666 (29%) hospitalized veterans with CKD had a higher risk for several PSI, even after case-mix adjustment. Among surgical hospitalizations, CKD was associated with increased risk for hip fracture, physiologic/metabolic derangements, and complications of anesthesia. Among all acute hospitalizations, the PSI with the highest risk in patients with CKD were infection as a result of medical care and death among those in diagnosis-related groups normally associated with low mortality. Furthermore, as preadmission estimated GFR decreased, a significant trend of increasing risk for all PSI was observed (P = 0.001). In conclusion, hospitalized patients with CKD are at increased risk for adverse safety events, measured ...

Source: www.ncbi.nlm.nih.gov --- 24 days ago
Related Articles Vitamin D: an old prohormone with an emergent role in Chronic Kidney Disease. J Nephrol. 2008 May-Jun;21(3):313-23 Authors: Coen G The term vitamin D is linked to the development of rickets and osteomalacia, and has been known about since at least the 17th century. Prevention of these diseases has challenged many researchers in the following centuries, which has resulted in important advances in prevention and treatment. However, it was only in 1900 that the vitamin structure was identified. In the following decades, many steps were made toward understanding the metabolism of the vitamin. Recent progress has revolutionized our view of vitamin D and suggested that it has much wider effects on the body than ever believed. In addition to its well-known effects on calcium-phosphate homeostasis, vitamin D, through its hormonal form calcitriol, has been found to be a cell-differentiating factor and antiproliferative agent with actions on a variety of tissues. By influencing gene expression, calcitriol affects many physiological processes, besides calcium-phosphate homeostasis, including muscle and keratinocyte differentiation, blood pressure regulation and the immune response. The widespread expression of 1a-hydroxylating enzyme in peripheral tissues supports the view that it exists to boost intracellular concentrations of calcitriol within some target tissues in order to modulate a unique set of genes. This new information ...

Source: www.ncbi.nlm.nih.gov --- 29 days ago
Related Articles Smoking cessation therapy considerations for patients with Chronic Kidney Disease. Nephrol Nurs J. 2008 Jul-Aug;35(4):357-63, 394; quiz 364 Authors: Manley HJ, Stack NM Cigarette smoking is a readily modifiable cardiovascular and Chronic Kidney Disease (CKD) risk factor. Smoking cessation aids include nicotine replacement therapy (NRT), bupropion, and varenicline. Several reports suggest that patients with CKD who use tobacco products be encouraged to stop; however, very little is offered to the healthcare provider as to how to successfully prescribe and monitor smoking cessation therapy for this patient population. This article reviews NRT, bupropion, and varenicline pharmacokinetics and dosing literature for patients with CKD. Evidence for the benefit of smoking cessation in patients with CKD is also reviewed. PMID: 18782998 [PubMed - in process] ...

Source: www.ncbi.nlm.nih.gov --- 32 days ago
Related Articles Magnetic resonance detection of Kidney iron deposition in sickle cell Disease: A marker of Chronic hemolysis. J Magn Reson Imaging. 2008 Sep 5;28(3):698-704 Authors: Schein A, Enriquez C, Coates TD, Wood JC PURPOSE: To study the pattern, etiology, and significance of renal iron accumulation in chronically transfused sickle cell Disease (SCD) and thalassemia major (TM) patients using magnetic resonance imaging (MRI). MATERIALS AND METHODS: Magnetic resonance imaging (MRI) was performed in 75 SCD patients, 73 TM patients, and 16 healthy controls. Multiecho gradient echo protocols were used to measure T2* reciprocals (R2*) in the Kidney, liver, and heart. Kidney R2* was compared to tissue iron estimates, serum iron markers, and surrogates of intravascular hemolysis by univariate regression. RESULTS: Mean R2* in SCD patients was 55.3 +/- 45.3 Hz, compared with 22.1 +/- 11 Hz in TM patients and 21.3 +/- 5.8 Hz in control subjects (P < 0.001). Kidney R2* decreased with advancing age (R(2) = 0.09, P < 0.02). Kidney R2* correlated strongly with increased serum lactate dehydrogenase levels found in SCD (R(2) = 0.55, P < 0.001), but was independent of hepatic iron concentration and cardiac R2*. Kidney R2* did not correlate with blood pressure, creatinine, cardiac index, or right and left ejection fraction. CONCLUSION: Intravascular hemolysis, not Chronic transfusion, causes renal hemosiderosis in SCD. Prospective trials are nece ...

Source: www.ncbi.nlm.nih.gov --- 20 days ago
Related Articles Pharmacotherapeutic options for the treatment of depression in patients with Chronic Kidney Disease. Nephrol Nurs J. 2008 May-Jun;35(3):257-263; quiz 264 Authors: Raymond CB, Wazny LD, Honcharik PL Depressive disorders occur in up to one-third of patients with Chronic Kidney Disease CKD). First-line pharmacologic treatments include selective serotonin reuptake inhibitors and second generation agents, such as bupropion, mirtazapine, and venlafaxine. Although very little research has been conducted on the use of antidepressants in CKD, health care providers should be aware of renal dose adjustments for these agents, drug interactions, and potential adverse effects. This article reviews the epidemiology and significance of depression in patients with CKD and discusses drug therapy options for treatment of depression in this patient population. PMID: 18649586 [PubMed - indexed for MEDLINE] ...

Source: www.ncbi.nlm.nih.gov --- 17 days ago
Related Articles Outcomes of carotid revascularization in patients with Chronic Kidney Disease. Adv Chronic Kidney Dis. 2008 Oct;15(4):347-54 Authors: Govindarajan G, Saab G, Whaley-Connell A Chronic Kidney Disease (CKD) carries an increased risk for cardiovascular Disease (CVD) including cerebrovascular accidents (CVAs). There are multiple etiologies for CVA, and among them extracranial carotid artery Disease accounts for approximately 25% of ischemic strokes. It has been shown that carotid revascularization by carotid endarterectomy and carotid artery angioplasty and stenting can decrease the risk of CVA in appropriately selected population with carotid artery Disease. Both these techniques of carotid revascularization have been shown to be safe and clinically effective in many large multicentered randomized clinical trials. However, most of these large trials have predominately excluded the patients with Kidney failure. Most of the evidence for the management of carotid Disease in CKD is based on small clinical trials and expert opinions. There is an urgent need to conduct large clinical trials in patients with CKD to enable better understanding and to improve techniques of various carotid revascularization therapies in CKD patients. PMID: 18805380 [PubMed - in process] ...

Source: www.ncbi.nlm.nih.gov --- 36 days ago
Related Articles Thyroid hormone action in Chronic Kidney Disease. Curr Opin Endocrinol Diabetes Obes. 2008 Oct;15(5):459-65 Authors: Amato AA, Santos GM, de Assis Rocha Neves F PURPOSE OF REVIEW: Chronic Kidney Disease is characterized by multiple abnormalities in the thyroid hormone physiology. In the present review, we will briefly discuss the effects of uremia on thyroid hormone synthesis, metabolism, transport, and action. RECENT FINDINGS: Uremic toxins have been shown to interfere at various levels of the thyroid hormone action, including thyroid hormone transport across plasma membrane and thyroid hormone receptor activity. These abnormalities could explain the resistance to thyroid hormone action in uremia, at least in some tissues. SUMMARY: The pathogenesis of thyroid axis abnormalities in uremia is incompletely understood, and its clinical significance remains unclear. The increasing prevalence of Chronic Kidney Disease underscores the need for further efforts to understand the metabolic consequences of uremia and address questions such as the impact of thyroid hormone therapy. PMID: 18769220 [PubMed - in process] ...

Source: www.ncbi.nlm.nih.gov --- 22 days ago
Related Articles Comparison of health-related quality of life measures for Chronic renal failure: quality of well-being scale, short-form-6D, and the Kidney Disease quality of life instrument. Qual Life Res. 2008 Sep 13; Authors: Saban KL, Stroupe KT, Bryant FB, Reda DJ, Browning MM, Hynes DM BACKGROUND: Studies have found that health-related quality of life (HRQOL) measurements with different conceptual bases yield widely varying results within the same study sample. Using data from a cohort of patients with Chronic Kidney failure, the purpose of this study was to compare the Quality of Well-Being Scale-Self-Administered (QWB-SA), the Short-Form-6D (SF-6D), and the Kidney Disease Component Summary (KDCS). METHODS: Baseline data from a multi-site prospective observational study of 322 veterans receiving hemodialysis were analyzed. Descriptive statistics were calculated. Confirmatory factor analysis was conducted to determine how closely the three HRQOL tools reflected the same underlying construct. RESULTS: Our confirmatory factor analysis offered strong evidence that the subscales of the QWB-SA, SF-6D, and 7-subscale KDCS measured more than one factor in this study sample. In the three-factor model, the SF-6D and 7-subscale KDCS correlated .911 (P < .05), indicating 83% of the variance in the 7-subscale KDCS was correlated with the SF-6D. However, a two-factor model, in which the highly correlated SF-6D and 7-subscale KDCS were combin ...

Source: www.ncbi.nlm.nih.gov --- 12 days ago
Related Articles Minimal Effect of Cold Ischemia Time on Progression to Late-Stage Chronic Kidney Disease Observed Long Term After Partial Nephrectomy. Urology. 2008 Sep 24; Authors: Iida S, Kondo T, Amano H, Nakazawa H, Ito F, Hashimoto Y, Tanabe K OBJECTIVES: To assess the influence of cold ischemia on postoperative renal function and the new onset of late-stage Chronic Kidney Disease during long-term follow-up after partial nephrectomy. METHODS: A total of 131 patients with renal tumors who underwent partial nephrectomy and were followed up for >/=12 months were included in the present study. Renal function was analyzed using the estimated glomerular filtration rate (e-GFR). RESULTS: We classified the subjects into 3 groups according to the length of cold ischemia time: group 1, 1-30 minutes; group 2, 31-60 minutes; and group 3, >60 minutes. Although the postoperative e-GFR was lower in group 3 than in groups 1 and 2, no significant difference was found among the 3 groups during long-term follow-up when preoperative CKD was absent. A cold ischemia time of >/=44 minutes significantly increased the probability of freedom from the new onset of an e-GFR of <45 mL/min/1.73 m(2), but this difference was minimal. Multivariate analysis showed that the preoperative e-GFR and the relative decrease of e-GFR at 1 year after surgery were the significant factors determining postoperative renal function. CONCLUSIONS: A cold ischemia time of >44 m ...

Source: www.ncbi.nlm.nih.gov --- 26 days ago
Related Articles Change in darbepoetin alfa administration schedule affects erythropoiesis-stimulating agent resistance in patients with Chronic Kidney Disease receiving hemodialysis. Ren Fail. 2008;30(8):778-83 Authors: Molina M, Navarro MJ, de Gracia C, Alvarez G, de Alarcon R, Garcia MA One hundred and four patients receiving hemodialysis and undergoing anaemia treatment with darbepoetin alfa intravenously once weekly were switched to a biweekly dosing schedule and followed for 24 weeks. The darbepoetin alfa dose was adjusted to maintain the target Hb concentration of 11-14 g/dL. A significant decline in the erythropoiesis-stimulating agent resistance index was observed over the 24-week follow-up, beginning with week 16, whereas the mean dose of darbepoetin alfa did not change significantly after switching to the biweekly dosing schedule. Other factors that might affect resistance to erythropoiesis remained unchanged. PMID: 18791951 [PubMed - in process] ...