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International Journal of Cardiology Jan 2021We aimed to analyze the association of estimated glomerular filtration rate (eGFR) levels of hospitalized patients with treatment decisions and clinical outcomes in...
BACKGROUND
We aimed to analyze the association of estimated glomerular filtration rate (eGFR) levels of hospitalized patients with treatment decisions and clinical outcomes in Chinese patients with acute coronary syndrome (ACS).
METHODS
This was a secondary analysis study from CPACS-2 Program which was a trial of a quality improvement intervention in China and recruited 15,141 patients from 75 hospitals between October 2007 and August 2010. All patients were divided into three groups by the eGFR level on admission. The primary outcomes were several key performance indicators (KPIs) reflecting the management of ACS and the secondary outcomes were clinical outcomes.
RESULTS
A total of 14,437 ACS patients were enrolled in this analysis. Among patients with reduced eGFR levels, fewer patients received appropriate medical therapy (p for trend <0.001) and fewer high-risk patients received coronary angiography (p for trend <0.001) compared to patients with a normal eGFR. Furthermore, 436 cases of death, 357 cases of cardiac death, 686 cases of major adverse cardiovascular events, and 198 cases of major bleeding episodes were reported. Patients with a worse eGFR level had significantly higher rates of death (p for trend <0.001), cardiac death (p for trend <0.001), major adverse cardiovascular events (p for trend <0.001) and major bleeding episodes (p for trend <0.001).
CONCLUSION
Among Chinese ACS patients, those with renal insufficiency have a lower percentage of adherence to guideline-recommended treatments and worse clinical prognosis. Renal insufficiency is an important factor affecting guideline implementation in Chinese ACS patients.
CLINICAL TRIAL REGISTRATION
http://www.anzctr.org.au/default.aspx. Unique identifier: ACTRN12609000491268.
Topics: Acute Coronary Syndrome; China; Humans; Percutaneous Coronary Intervention; Renal Insufficiency; Treatment Outcome
PubMed: 32810549
DOI: 10.1016/j.ijcard.2020.08.022 -
Current Opinion in Nephrology and... Sep 2021Obesity is a risk factor for the development and progression of chronic kidney disease (CKD). In this review, we provide a comprehensive overview of various management... (Review)
Review
PURPOSE OF REVIEW
Obesity is a risk factor for the development and progression of chronic kidney disease (CKD). In this review, we provide a comprehensive overview of various management options (lifestyle intervention, medications, and bariatric surgery) to address obesity in those with CKD.
RECENT FINDINGS
Few clinical trials have examined the benefits of lifestyle modifications in those with preexisting CKD and suggest potential renal and cardiovascular benefits in this population. Yet, superiority of different dietary regimen to facilitate weight loss in CKD is unclear. Although medications could offer short-term benefits and assist weight loss, their safety and long-term benefits warrant further studies in this high-risk population. Observational studies report that bariatric procedures are associated with lower risk of end stage kidney disease. Clinicians should also recognize the higher risk of acute kidney injury, nephrolithiasis, and other complications noted with bariatric surgical procedures.
SUMMARY
Lifestyle modifications and some weight loss medications may be recommended for facilitating weight loss in CKD. Referral to bariatric centers should be considered among morbidly obese adults with CKD.
Topics: Bariatric Surgery; Humans; Kidney Failure, Chronic; Obesity, Morbid; Renal Insufficiency, Chronic; Weight Loss
PubMed: 34039849
DOI: 10.1097/MNH.0000000000000727 -
Current Diabetes Reports Aug 2018Chronic diabetic nephropathy and renal dysfunction from other causes are common in hospitalized patients with diabetes. Available diabetes management guidelines aim to... (Review)
Review
PURPOSE OF THIS REVIEW
Chronic diabetic nephropathy and renal dysfunction from other causes are common in hospitalized patients with diabetes. Available diabetes management guidelines aim to reduce hyperglycemia and hypoglycemia, both independent risk factors for hospital outcomes. Renal dysfunction, which increases the risk of hypoglycemia, adds a layer of complexity in diabetes management. Therefore, modified glucose goals and treatment regimens may be required.
RECENT FINDINGS
Recent prospective and retrospective studies provide direction on safe insulin therapy for diabetes inpatients with renal compromise. Studies of newer diabetes pharmacotherapy provide data on oral agent use in the inpatient setting. Diabetes therapy should be modified with changing renal function. Glucose management in patients on peritoneal or hemodialysis is challenging. Reducing weight-based doses of insulin and use of newer insulins can reduce hypoglycemia risk. Safety and efficacy of DPP-4 inhibitors has been evaluated in the hospital and nursing home setting. Metformin, SGLT-2 inhibitors, and GLP1 receptor agonists can be used in several stages of renal dysfunction prior to and at discharge.
Topics: Diabetes Mellitus; Humans; Hyperglycemia; Hypoglycemic Agents; Inpatients; Renal Dialysis; Renal Insufficiency
PubMed: 30112652
DOI: 10.1007/s11892-018-1044-y -
Zhonghua Yi Xue Za Zhi Nov 2023Acute kidney injury (AKI), a common and severe disease, is associated with a high risk of developing chronic kidney disease (CKD) and end-stage renal disease (ESRD),...
Acute kidney injury (AKI), a common and severe disease, is associated with a high risk of developing chronic kidney disease (CKD) and end-stage renal disease (ESRD), which is a global health burden with high morbidity and mortality. Although many foreign clinical practice guidelines have standardized the management and treatment of AKI, there is a lack of overall guidance for AKI which is suitable for our national conditions. Thus, an expert group in related fields were organized by the National Clinical Research Center for Kidney Diseases and Chinese Nephrologist Association to collaborate to complete the Chinese Clinical Practice Guideline for Acute Kidney Injury based on the latest existing evidence-based medical evidence both domestically and internationally. The guideline systematically introduces the definition and epidemiological feature, diagnosis and monitoring of AKI, pharmacological approaches to prevent or treat AKI, and management of renal replacement therapy, management of AKI on special populations, and the outcome and prognosis of AKI, aiming to provide reasonable recommendations for all level clinicians in China.
Topics: Humans; Acute Kidney Injury; East Asian People; Kidney Failure, Chronic; Prognosis; Renal Insufficiency, Chronic; Practice Guidelines as Topic
PubMed: 37963734
DOI: 10.3760/cma.j.cn112137-20230802-00133 -
Japanese Journal of Clinical Oncology Jul 2015Onco-nephrology is a new and evolving subspecialized area in nephrology that deals with kidney diseases in cancer patients. As many newer cancer therapies emerge in the... (Review)
Review
Onco-nephrology is a new and evolving subspecialized area in nephrology that deals with kidney diseases in cancer patients. As many newer cancer therapies emerge in the field of oncology, cancer patients are surviving longer than ever before. However, the benefits of the remarkable advances in cancer management have not been fully appreciated. Not only is cancer often associated with abnormalities that affect the kidney, but cancer therapy often leads to both acute and chronic kidney diseases. The development of cancer-associated kidney complications is associated with poor prognosis, whereas prompt recognition and treatment initiation are associated with improved outcomes in this population. Therefore, both nephrologists and oncologists should be familiar with the diagnosis and management of cancer-associated kidney complications. Another unique aspect of onco-nephrology is that significant improvements in predialysis and dialysis care in recent years have led to prolonged survival and a higher incidence of patients with chronic kidney disease suffering from cancer. Therefore, research is urgently needed to establish treatment for patients with chronic kidney disease. This update addresses the pathophysiology and treatment of various cancer-associated kidney complications, and highlights cancer treatment for patients with chronic kidney disease.
Topics: Acute Kidney Injury; Antineoplastic Agents; Humans; Medical Oncology; Nephrology; Renal Dialysis; Renal Insufficiency, Chronic
PubMed: 25784734
DOI: 10.1093/jjco/hyv035 -
Disease-a-month : DM Sep 2015
Review
Topics: Humans; Prognosis; Renal Insufficiency, Chronic
PubMed: 26342715
DOI: 10.1016/j.disamonth.2015.08.001 -
Acta Physiologica (Oxford, England) Oct 2015
Review
Topics: Acute Kidney Injury; Animals; Humans; Ischemia; Kidney; Renal Insufficiency, Chronic; Reperfusion Injury; Risk Factors
PubMed: 26176499
DOI: 10.1111/apha.12555 -
Age and Ageing Sep 2019Extremes of temperature are likely to increase in frequency associated with climate change. Older patients are particularly vulnerable to the effects of heat with excess... (Review)
Review
Extremes of temperature are likely to increase in frequency associated with climate change. Older patients are particularly vulnerable to the effects of heat with excess mortality well documented in this population. Age-associated neurohormonal changes particularly affecting the renin angiotensin aldosterone system (RAAS), alterations in thermoregulatory mechanisms, changes in renal function and body composition render older persons vulnerable to dehydration, renal failure, heat stroke and increased mortality. Barriers to diagnosis and recognition of dehydration and renal failure include the absence of reliable clinical signs and cost-effective diagnostic tools. Regularly used medications also impact on physiological responses to excess heat as well as interfering with the recognition and management of dehydration during heat waves. In view of the above, anticipatory measures should be instituted ideally prior to the onset of heat waves to minimise morbidity and mortality for older people during periods of excess heat.
Topics: Age Factors; Aged; Body Temperature Regulation; Dehydration; Hot Temperature; Humans; Renal Insufficiency; Risk Factors
PubMed: 31268494
DOI: 10.1093/ageing/afz080 -
Annales D'endocrinologie Apr 2022
Topics: Adrenal Gland Neoplasms; Female; Humans; Male; Pheochromocytoma; Renal Insufficiency
PubMed: 35131288
DOI: 10.1016/j.ando.2022.01.005 -
Nature Reviews. Nephrology Dec 2015Patients with kidney disease often exhibit multiple organ dysfunction that is caused, in part, by marked connectivity between the kidney and other organs and tissues.... (Review)
Review
Patients with kidney disease often exhibit multiple organ dysfunction that is caused, in part, by marked connectivity between the kidney and other organs and tissues. Substantial crosstalk occurs between the kidney and the brain, as indicated by the frequent presentation of neurological disorders, such as cerebrovascular disease, cognitive impairment, and neuropathy during the natural history of chronic kidney disease. The underlying pathophysiology of such comorbid neurological disorders in kidney disease is governed by shared anatomic and vasoregulatory systems and humoral and non-humoral bidirectional pathways that affect both the kidney and the brain. During acute kidney injury, the brain and kidney might interact through the amplification of cytokine-induced damage, extravasation of leukocytes, oxidative stress, and dysregulation of sodium, potassium, and water channels. The advent of dialysis and renal transplantation programmes has led to a reduction in the rate of neurological complications associated with uraemia, but a new set of complications have arisen as a consequence of the effects of dialysis on the central nervous system over the short and long term. This Review discusses the clinical complications of acute and chronic renal failure from a neurologic perspective, and highlights current understanding of the underlying pathophysiologies.
Topics: Acute Kidney Injury; Brain; Brain Diseases; Cerebrovascular Disorders; Cognition Disorders; Humans; Kidney; Kidney Failure, Chronic; Renal Dialysis; Renal Insufficiency, Chronic
PubMed: 26281892
DOI: 10.1038/nrneph.2015.131