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Reviews in Cardiovascular Medicine Feb 2022Coronary artery disease (CAD) and chronic kidney disease (CKD) may reciprocally influence each other. Patients with CAD and CKD have an increased risk of both ischemic...
BACKGROUND
Coronary artery disease (CAD) and chronic kidney disease (CKD) may reciprocally influence each other. Patients with CAD and CKD have an increased risk of both ischemic and hemorrhagic events.
METHODS
In the present review, we summarize the existing literature focusing on the relationship between kidney dysfunction and acute coronary syndromes (ACS) in terms of risk factors, complications, and prognosis. We discuss also about the best evidence-based strategies to prevent deterioration of renal function in patients with CAD.
RESULTS
Patients with CKD less frequently receive an invasive management (percutaneous or surgical revascularization) and potent antithrombotic drugs. Nevertheless, recent evidence suggests they would benefit from a selective invasive management, especially in case of ACS.
CONCLUSION
Patients with CKD and CAD represent a challenging population, more randomized controlled trials and meta-analyses are needed to better define the best therapeutic strategy during an ACS episode.
Topics: Acute Coronary Syndrome; Coronary Artery Disease; Hemorrhage; Humans; Percutaneous Coronary Intervention; Renal Insufficiency, Chronic; Risk Factors
PubMed: 35229540
DOI: 10.31083/j.rcm2302049 -
Inappropriate Medication in Non-Hospitalized Patients With Renal Insufficiency: A Systematic Review.Journal of the American Geriatrics... Apr 2017Renal insufficiency is common among older patients and, accordingly, renally excreted drugs may require an adjustment in dosage for them. Rates of non-adherence to renal... (Review)
Review
OBJECTIVES
Renal insufficiency is common among older patients and, accordingly, renally excreted drugs may require an adjustment in dosage for them. Rates of non-adherence to renal dosing guidelines range from 19% to 70% across all settings, with the highest rate occurring in outpatient care. However, there is a paucity of research in this field. The main objective of this systematic review is to assess how often drugs are inappropriately prescribed in non-hospitalized patients with renal insufficiency.
DESIGN
A systematic literature search was performed. Data were identified from three electronic databases: PubMed, CINAHL, and Scopus. Studies were included if they reported quantitative data on inappropriate drug use with respect to renal function in non-hospitalized patients.
RESULTS
Our search strategy resulted in 2,403 hits, of which 18 articles satisfied the criteria for inclusion. Mean estimated glomerular filtration rate ranged from 36.0 to 60.4 mL/min. Prevalence of renally inappropriate drug use ranged from 1% to 37% in outpatient settings other than nursing homes, and from 6% to 43% in nursing homes. Eight of the studies we included identified predictors for use of drugs inappropriate for kidney function. Most frequently determined risk factors were increasing age and a high number of prescribed drugs.
CONCLUSION
Lack of dose adjustment for renal impairment seems to be a common problem, even in outpatients. However, the differences in methodologies used in these studies hampered any direct comparison. Accepted and comparable standards regarding the drugs included in the studies as well as estimation of renal function would be beneficial.
Topics: Aged; Glomerular Filtration Rate; Humans; Inappropriate Prescribing; Prescription Drugs; Renal Insufficiency; Risk Factors
PubMed: 28240771
DOI: 10.1111/jgs.14809 -
Scientific Reports Oct 2016The effect of pre-operative renal insufficiency on urothelial carcinoma (UC) prognosis has been investigated by numerous studies. While the majority report worse UC... (Meta-Analysis)
Meta-Analysis
The effect of pre-operative renal insufficiency on urothelial carcinoma (UC) prognosis has been investigated by numerous studies. While the majority report worse UC outcomes in patients with renal insufficiency, the results between the studies differed wildly. To enable us to better estimate the prognostic value of renal insufficiency on UC, we performed a systematic review and meta-analysis based on the published literature. A total of 16 studies which involved 5,232 patients with UC, investigated the relationship between pre-operative renal insufficiency and disease prognosis. Estimates of combined hazard ratio (HR) for bladder urothelial carcinoma recurrence, cancer-specific survival (CSS) and overall survival (OS) were 1.65 (95% CI, 1.11-2.19), 1.59 (95% CI, 1.14-2.05) and 1.45 (95% CI, 1.19-1.71), respectively; and for upper urinary tract urothelial carcinoma recurrence, CSS and OS were 2.27 (95% CI, 1.42-3.12), 1.02 (95% CI, 0.47-1.57) and 1.52 (95% CI, 1.05-1.99), respectively. Our results indicate that UC patients with pre-operative renal insufficiency tend to have higher recurrence rates and poorer survival compared to those with clinically normal renal function, thus renal function should be closely monitored in these patients. The impact of intervention for renal insufficiency on the prognosis of UC needs to be further studied.
Topics: Carcinoma; Humans; Neoplasm Recurrence, Local; Prognosis; Proportional Hazards Models; Renal Insufficiency; Urologic Neoplasms; Urothelium
PubMed: 27725745
DOI: 10.1038/srep35214 -
Annals of Medicine Nov 2020Emerging data suggest that coronavirus disease 2019 (COVID-19) has extrapulmonary manifestations but its renal manifestations are not clearly defined. We aimed to... (Meta-Analysis)
Meta-Analysis
PURPOSE
Emerging data suggest that coronavirus disease 2019 (COVID-19) has extrapulmonary manifestations but its renal manifestations are not clearly defined. We aimed to evaluate renal complications of COVID-19 and their incidence using a systematic meta-analysis.
DESIGN
Observational studies reporting renal complications in COVID-19 patients were sought from MEDLINE, Embase and the Cochrane Library from 2019 to June 2020. The nine-star Newcastle-Ottawa Scale was used to evaluate methodological quality. Incidence with 95% confidence intervals (CIs) were pooled using random-effects models.
RESULTS
We included 22 observational cohort studies comprising of 17,391 COVID-19 patients. Quality scores of studies ranged from 4 to 6. The pooled prevalence of pre-existing chronic kidney disease (CKD) and end-stage kidney disease was 5.2% (2.8-8.1) and 2.3% (1.8-2.8), respectively. The pooled incidence over follow-up of 2-28 days was 12.5% (10.1-15.0) for electrolyte disturbance (e.g. hyperkalaemia), 11.0% (7.4-15.1) for acute kidney injury (AKI) and 6.8% (1.0-17.0) for renal replacement therapy (RRT). In subgroup analyses, there was a higher incidence of AKI in US populations and groups with higher prevalence of pre-existing CKD.
CONCLUSIONS
Frequent renal complications reported among hospitalized COVID-19 patients are electrolyte disturbance, AKI and RRT. Aggressive monitoring and management of these renal complications may help in the prediction of favourable outcomes. PROSPERO 2020: CRD42020186873 KEY MESSAGES COVID-19 affects multiple organs apart from the respiratory system; however, its renal manifestations are not clearly defined. In this systematic meta-analysis of 22 observational cohort studies, the prevalence of pre-existing chronic kidney disease (CKD) in COVID-19 patients was 5.2%. The most frequent renal complication was electrolyte disturbance (particularly hyperkalaemia) with an incidence of 12.5% followed by acute kidney injury (AKI) with an incidence of 11.0%; US populations and groups with higher prevalence of CKD had higher incidence of AKI.
Topics: Acute Kidney Injury; COVID-19; Coronavirus Infections; Humans; Incidence; Kidney Failure, Chronic; Pandemics; Pneumonia, Viral; Prevalence; Renal Insufficiency, Chronic; Water-Electrolyte Imbalance
PubMed: 32643418
DOI: 10.1080/07853890.2020.1790643 -
International Journal of Clinical... Jun 2019Background Clinical pharmacy services have potential to contribute significantly to the multidisciplinary team providing safe, effective and economic care for patients....
Background Clinical pharmacy services have potential to contribute significantly to the multidisciplinary team providing safe, effective and economic care for patients. Given recent practice developments (e.g. polypharmacy reviews and pharmacist prescribing) there is a need to provide a current synthesis of the evidence base for characteristics and outcomes of clinical pharmacy practice in chronic kidney disease patients. Aim of the review To critically appraise, synthesise and present the available evidence of the characteristics (structures and processes) and outcomes of clinical pharmacy practice as part of the multidisciplinary care of patients with chronic kidney disease. Method PubMed, International Pharmaceutical Abstracts (IPA), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and Scopus were searched for peer reviewed papers using improved search strategy. Included studies were quality assessed using Downs and Black tool for controlled studies and the mixed methods appraisal tool for all controlled and non-controlled studies. Data were extracted and synthesised using a narrative approach. Screening, quality assessment and data extraction were performed by two independent researchers. Ethics approval was not required. Results Forty-seven studies were identified from a variety of countries, with 31 based in a hospital setting. Controlled study designs were employed in 20, with only ten of these using randomisation. Resources available for service provision were poorly reported in all papers. Positive impact on clinical outcomes included significant improvement in parathyroid hormone, blood pressure, haemoglobin and creatinine clearance. Pharmacists identified 5302 drug related problems in 2933 patients and made 3160 recommendations with acceptance rates up to 95%. Impact on humanistic outcomes was shown through improvement in health related quality of life and patient satisfaction. Economic benefits arose from significant cost savings through pharmaceutical care provision. Conclusion While there is some evidence of positive impact on clinical, humanistic and economic outcomes, this evidence is generally of low quality and insufficient volume. While the existing evidence is in favour of pharmacists' involvement in the multidisciplinary team providing care to patients with chronic kidney disease, more high-quality research is warranted.
Topics: Community Pharmacy Services; Humans; Pharmacists; Pharmacy Service, Hospital; Professional Role; Prospective Studies; Randomized Controlled Trials as Topic; Renal Insufficiency, Chronic; Retrospective Studies
PubMed: 30963447
DOI: 10.1007/s11096-019-00816-4 -
Transplantation Reviews (Orlando, Fla.) Jul 2023Effective workup and listing of end-stage renal disease (ESRD) patients for renal transplantation, often with multiple co-morbidities, poses a challenge for transplant... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Effective workup and listing of end-stage renal disease (ESRD) patients for renal transplantation, often with multiple co-morbidities, poses a challenge for transplant teams. Obesity is a common co-morbidity associated with adverse outcomes in ESRD and kidney transplant (KT) recipients. Bariatric and metabolic surgery (BMS) has long been established as a safe and effective treatment for morbid obesity. In this study, the authors aimed to evaluate the strength of evidence for both the efficacy and safety of bariatric surgery in patients with ESRD or kidney transplantation.
METHODS
A literature search was performed using key terms including "transplantation", "kidney", "renal", "obesity", and "bariatric". Databases searched include MEDLINE, EMBASE and Web of Science from inception to date (April 2021). Methodological quality was assessed using the Newcastle-Ottawa tool. Selected articles were then categorised into patients awaiting waiting list acceptance, patients awaiting transplantation, patients undergoing simultaneous BMS + KT and patients undergoing BMS following a previous renal transplant. Summary effects are presented with a level of statistical significance and 95% Confidence Intervals.
RESULTS
A total of 28 articles were selected following the literature search. Fourteen studies on patients awaiting listing (n = 1903), nine on patients on the KT waiting list (n = 196), a single study on simultaneous BMS and KT and ten studies on patients undergoing BMS following KT (n = 198). Mean change in BMI for patients awaiting listing was -11.3 kg/m (95%CI: -15.3 to -7.3, p < 0.001), mean change in BMI for patients listed for KT was -11.2 kg/m 2(95%CI: -12.9 to -9.5, p 0.001) and mean change for patients with prior KT was -11.0 kg/m (95%CI: -7.09 to -14.9, p < 0.001). The combined mortality rate for patients who had undergone both BMS and KT was 4% (n = 15).
DISCUSSION
This review demonstrates BMS is both safe and efficacious in patients with ESRD prior to KT and in those post KT. It would enable difficult-to-list obese recipients the possibility to undergo transplantation and should be considered as part of the work up process.
Topics: Humans; Kidney Transplantation; Bariatric Surgery; Obesity, Morbid; Kidney Failure, Chronic; Treatment Outcome; Renal Insufficiency
PubMed: 37459746
DOI: 10.1016/j.trre.2023.100777 -
Thrombosis and Haemostasis Jul 2020This article evaluates the association between renal insufficiency and short-term outcomes among patients with acute pulmonary embolism. (Meta-Analysis)
Meta-Analysis
BACKGROUND
This article evaluates the association between renal insufficiency and short-term outcomes among patients with acute pulmonary embolism.
METHODS
The literature search was completed on December 31, 2019 and data were contracted from 13 cohort studies. Diagnosis of renal insufficiency was based on estimated glomerular filtration rate (eGFR), serum creatinine level, or self-report. The primary outcome was all-cause mortality of 30 days or during hospitalization. The pooled risk ratios (RRs), pooled mortality rates, and between-study heterogeneity were estimated by random-effect models. All the statistical analyses were performed using STATA/SE software.
RESULTS
We included 13 studies ( = 35,662) in the meta-analysis, including two focused on acute kidney injury (AKI). Early all-cause mortality in patients with versus without renal insufficiency were 15% (95% confidence interval [CI] 9-22%) and 5% (95% CI 3-8%), respectively (RR 1.76, 95% CI 1.61-1.92). For patients with eGFR < 30 mL/min·1.73m, rates were 30% (95% CI 11-75%) versus 10% (95% CI 5-14%) (RR 3.32, 95% CI 1.53-6.70). For patients with AKI during hospitalization, rates were 32% (95% CI 11-75%) versus 13% (95% CI 4-29%) (RR 2.69, 95% CI 1.24-5.84). Pulmonary embolism (PE)-related death and fatal bleeding were significantly higher in patients with renal insufficiency.
CONCLUSION
Renal insufficiency, especially AKI and severe renal insufficiency, was associated with early mortality in acute PE patients. Our results may escalate vigilance in risk stratification and management of PE patients with renal insufficiency in clinical practice.
Topics: Acute Kidney Injury; Adult; Aged; Aged, 80 and over; Biomarkers; Creatinine; Female; Glomerular Filtration Rate; Humans; Kidney; Male; Middle Aged; Pulmonary Embolism; Renal Insufficiency; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome
PubMed: 32526792
DOI: 10.1055/s-0040-1712459 -
Medicine Dec 2014Renal dysfunction is a prevalent comorbidity in acute ischemic stroke patients requiring thrombolytic therapy. However, the effect of renal dysfunction on the clinical... (Meta-Analysis)
Meta-Analysis Review
Renal dysfunction is a prevalent comorbidity in acute ischemic stroke patients requiring thrombolytic therapy. However, the effect of renal dysfunction on the clinical outcome of this population remains controversial. This study aimed to evaluate the safety and effectiveness of thrombolytic therapy in acute stroke patients with renal dysfunction using a meta-analysis. We systematically searched PubMed and EMBASE for studies that evaluated the relationship between renal dysfunction and intravenous tissue plasminogen activator (tPA) in patients with acute ischemic stroke. Poor outcome (modified Rankin Scale≥2), mortality, and symptomatic intracranial hemorrhage (ICH) and any ICH were analyzed. Fourteen studies were included (N=53,553 patients). The mean age ranged from 66 to 75 years. The proportion of male participants was 49% to 74%. The proportion of renal dysfunction varied from 21.9% to 83% according to different definitions. Based on 9 studies with a total of 7796 patients, the meta-analysis did not identify a significant difference in the odds of poor outcome (odds ratio [OR]=1.06; 95% confidence interval [CI]: 0.96-1.16; I=44.5) between patients with renal dysfunction and those without renal dysfunction. Patients with renal dysfunction were more likely to die after intravenous thrombolysis (OR=1.13; 95% CI: 1.05-1.21; I=70.3). No association was observed between symptomatic ICH (OR=1.02; 95% CI: 0.94-1.10; I=0) and any ICH (OR=1.07; 95% CI: 0.96-1.18; I=25.8). Renal dysfunction does not increase the risk of poor outcome and ICH after stroke thrombolysis. Renal dysfunction should not be a contraindication for administration of intravenous thrombolysis to eligible patients.
Topics: Acute Disease; Brain Ischemia; Fibrinolytic Agents; Global Health; Glomerular Filtration Rate; Humans; Incidence; Renal Insufficiency; Thrombolytic Therapy
PubMed: 25526464
DOI: 10.1097/MD.0000000000000286 -
Journal of Nephrology Dec 2022As awareness around infertility is increasing among patients with chronic kidney disease (CKD), ever more of them are seeking Assisted Reproductive Technology (ART). Our... (Review)
Review
BACKGROUND
As awareness around infertility is increasing among patients with chronic kidney disease (CKD), ever more of them are seeking Assisted Reproductive Technology (ART). Our aim was to perform a systematic review to describe obstetric and renal outcomes in women with CKD following ART.
METHODS
The following databases were searched from 1946 to May 2021: (1) Cochrane Central Register of Controlled Trials (CENTRAL), (2) Cumulative Index to Nursing and Allied Health Literature (CINAHL), (3) Embase and (4) MEDLINE.
RESULTS
The database search identified 3520 records, of which 32 publications were suitable. A total of 84 fertility treatment cycles were analysed in 68 women. Median age at time of pregnancy was 32.5 years (IQR 30.0, 33.9 years). There were 60 clinical pregnancies resulting in 70 live births (including 16 multifetal births). Four women developed ovarian hyperstimulation syndrome which were associated with acute kidney injury. Hypertensive disorders complicated 26 pregnancies (38.3%), 24 (35.3%) pregnancies were preterm delivery, and low birth weight was present in 42.6% of pregnancies. Rates of live birth and miscarriage were similar for women with CKD requiring ART or having natural conception. However, more women with ART developed pre-eclampsia (p < 0.05) and had multifetal deliveries (p < 0.001), furthermore the babies were lower gestational ages (p < 0.001) and had lower birth weights (p < 0.001).
CONCLUSION
This systematic review represents the most comprehensive assessment of fertility outcomes in patients with CKD following ART. However, the high reported live birth rate is likely related to reporting bias. Patient selection remains crucial in order to maximise patient safety, screen for adverse events and optimise fertility outcomes.
Topics: Infant; Pregnancy; Infant, Newborn; Humans; Female; Renal Insufficiency, Chronic; Kidney; Reproductive Techniques, Assisted; Acute Kidney Injury; Live Birth
PubMed: 36396849
DOI: 10.1007/s40620-022-01510-x -
Renal Failure Nov 2015To identify benefit of N-acetylcysteine (NAC) on patients with pre-existing renal insufficiency or diabetes. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To identify benefit of N-acetylcysteine (NAC) on patients with pre-existing renal insufficiency or diabetes.
BACKGROUND
NAC administration is a common method for prevention of contrast-induced nephropathy (CIN). Nevertheless, its benefit on patients with pre-existing renal insufficiency or diabetes remains uncertain and controversial.
METHODS
Randomized controlled trials (RCTs) to evaluate the efficacy of NAC for the prevention of CIN in patients with pre-existing renal insufficiency or diabetes were searched from the databases of MEDLINE, EMBASE, and Cochrane library. Pooled odds ratio (OR) with 95% confidence interval (95% CI) were calculated using fixed-effects model by the Mantel-Haenszel test.
RESULTS
Twenty RCTs involving 3466 subjects (1756 assigned to NAC and 1710 assigned to the control) were included in the pre-existing renal dysfunction group. Pooled analysis suggested a significant reduction in CIN among this group (OR, 0.76; 95% CI, 0.61-0.93; p = 0.008). However, the nine trials comparing NAC versus control among patients with diabetes (NAC, 367 subjects; control, 358 subjects) showed no benefit of NAC for prevention of CIN (OR = 0.87; 95% CI, 0.58-1.30; p = 0.50). No significant heterogeneity was detected (p = 0.07; I2 = 34% for the group of pre-existing renal dysfunction; p = 0.40; I2 = 5% for the group of diabetes).
CONCLUSION
Our results suggest that NAC decreases the incidence of contrast-induced nephropathy among patients with pre-existing renal insufficiency. The benefit was not existed in patients with diabetes.
Topics: Acetylcysteine; Contrast Media; Diabetic Nephropathies; Humans; Kidney Diseases; Randomized Controlled Trials as Topic; Renal Insufficiency
PubMed: 26458505
DOI: 10.3109/0886022X.2015.1012985