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Revista Da Associacao Medica Brasileira... Jan 2020Chronic kidney disease is highly prevalent (10-13% of the population), irreversible, progressive, and associated with higher cardiovascular risk. Patients with this... (Review)
Review
Chronic kidney disease is highly prevalent (10-13% of the population), irreversible, progressive, and associated with higher cardiovascular risk. Patients with this pathology remain asymptomatic most of the time, presenting the complications typical of renal dysfunction only in more advanced stages. Its treatment can be conservative (patients without indication for dialysis, usually those with glomerular filtration rate above 15 ml/minute) or replacement therapy (hemodialysis, peritoneal dialysis, and kidney transplantation). The objectives of the conservative treatment for chronic kidney disease are to slow down the progression of kidney dysfunction, treat complications (anemia, bone diseases, cardiovascular diseases), vaccination for hepatitis B, and preparation for kidney replacement therapy.
Topics: Humans; Kidney Failure, Chronic; Prevalence; Renal Dialysis; Renal Insufficiency; Renal Insufficiency, Chronic; Risk Factors
PubMed: 31939529
DOI: 10.1590/1806-9282.66.S1.3 -
Annals of Internal Medicine Jun 2013The Kidney Disease: Improving Global Outcomes (KDIGO) organization developed clinical practice guidelines in 2012 to provide guidance on the evaluation, management, and...
DESCRIPTION
The Kidney Disease: Improving Global Outcomes (KDIGO) organization developed clinical practice guidelines in 2012 to provide guidance on the evaluation, management, and treatment of chronic kidney disease (CKD) in adults and children who are not receiving renal replacement therapy.
METHODS
The KDIGO CKD Guideline Development Work Group defined the scope of the guideline, gathered evidence, determined topics for systematic review, and graded the quality of evidence that had been summarized by an evidence review team. Searches of the English-language literature were conducted through November 2012. Final modification of the guidelines was informed by the KDIGO Board of Directors and a public review process involving registered stakeholders.
RECOMMENDATIONS
The full guideline included 110 recommendations. This synopsis focuses on 10 key recommendations pertinent to definition, classification, monitoring, and management of CKD in adults.
Topics: Acute Kidney Injury; Adult; Albuminuria; Child; Disease Progression; Glomerular Filtration Rate; Humans; Monitoring, Physiologic; Practice Guidelines as Topic; Renal Insufficiency, Chronic
PubMed: 23732715
DOI: 10.7326/0003-4819-158-11-201306040-00007 -
Advances in Therapy Jan 2022Chronic kidney disease (CKD) is a complex disease which affects approximately 13% of the world's population. Over time, CKD can cause renal dysfunction and progression... (Review)
Review
Chronic kidney disease (CKD) is a complex disease which affects approximately 13% of the world's population. Over time, CKD can cause renal dysfunction and progression to end-stage kidney disease and cardiovascular disease. Complications associated with CKD may contribute to the acceleration of disease progression and the risk of cardiovascular-related morbidities. Early CKD is asymptomatic, and symptoms only present at later stages when complications of the disease arise, such as a decline in kidney function and the presence of other comorbidities associated with the disease. In advanced stages of the disease, when kidney function is significantly impaired, patients can only be treated with dialysis or a transplant. With limited treatment options available, an increasing prevalence of both the elderly population and comorbidities associated with the disease, the prevalence of CKD is set to rise. This review discusses the current challenges and the unmet patient need in CKD.
Topics: Aged; Cardiovascular Diseases; Disease Progression; Humans; Kidney Failure, Chronic; Renal Dialysis; Renal Insufficiency, Chronic
PubMed: 34739697
DOI: 10.1007/s12325-021-01927-z -
International Journal of Molecular... Aug 2021Uric acid (UA) is synthesized mainly in the liver, intestines, and vascular endothelium as the end product of an exogenous purine from food and endogenously from... (Review)
Review
Molecular Biological and Clinical Understanding of the Pathophysiology and Treatments of Hyperuricemia and Its Association with Metabolic Syndrome, Cardiovascular Diseases and Chronic Kidney Disease.
Uric acid (UA) is synthesized mainly in the liver, intestines, and vascular endothelium as the end product of an exogenous purine from food and endogenously from damaged, dying, and dead cells. The kidney plays a dominant role in UA excretion, and the kidney excretes approximately 70% of daily produced UA; the remaining 30% of UA is excreted from the intestine. When UA production exceeds UA excretion, hyperuricemia occurs. Hyperuricemia is significantly associated with the development and severity of the metabolic syndrome. The increased urate transporter 1 (URAT1) and glucose transporter 9 (GLUT9) expression, and glycolytic disturbances due to insulin resistance may be associated with the development of hyperuricemia in metabolic syndrome. Hyperuricemia was previously thought to be simply the cause of gout and gouty arthritis. Further, the hyperuricemia observed in patients with renal diseases was considered to be caused by UA underexcretion due to renal failure, and was not considered as an aggressive treatment target. The evidences obtained by basic science suggests a pathogenic role of hyperuricemia in the development of chronic kidney disease (CKD) and cardiovascular diseases (CVD), by inducing inflammation, endothelial dysfunction, proliferation of vascular smooth muscle cells, and activation of the renin-angiotensin system. Further, clinical evidences suggest that hyperuricemia is associated with the development of CVD and CKD. Further, accumulated data suggested that the UA-lowering treatments slower the progression of such diseases.
Topics: Animals; Biomarkers; Cardiovascular Diseases; Disease Management; Disease Susceptibility; Humans; Hyperuricemia; Metabolic Syndrome; Renal Insufficiency, Chronic; Severity of Illness Index
PubMed: 34502127
DOI: 10.3390/ijms22179221 -
American Journal of Physiology. Renal... Jun 2019The gut microbiome is composed of a diverse population of bacteria that have beneficial and adverse effects on human health. The microbiome has recently gained attention... (Review)
Review
The gut microbiome is composed of a diverse population of bacteria that have beneficial and adverse effects on human health. The microbiome has recently gained attention and is increasingly noted to play a significant role in health and a number of disease states. Increasing urea concentration during chronic kidney disease (CKD) leads to alterations in the intestinal flora that can increase production of gut-derived toxins and alter the intestinal epithelial barrier. These changes can lead to an acceleration of the process of kidney injury. A number of strategies have been proposed to interrupt this pathway of injury in CKD. The purpose of this review is to summarize the role of the gut microbiome in CKD, tools used to study this microbial population, and attempts to alter its composition for therapeutic purposes.
Topics: Animals; Bacteria; Dietary Supplements; Gastrointestinal Microbiome; Host-Pathogen Interactions; Humans; Intestinal Mucosa; Intestines; Kidney; Permeability; Renal Insufficiency, Chronic; Urea; Uremia
PubMed: 30864840
DOI: 10.1152/ajprenal.00298.2018 -
Kidney International Nov 2022
Topics: Humans; Renal Insufficiency, Chronic; Disease Management; Diabetes Mellitus
PubMed: 36272764
DOI: 10.1016/j.kint.2022.06.008 -
Nephron 2023There is a pandemic of obesity worldwide and in Europe up to 30% of the adult population is already obese. Obesity is strongly related to the risk of CKD, progression of... (Review)
Review
There is a pandemic of obesity worldwide and in Europe up to 30% of the adult population is already obese. Obesity is strongly related to the risk of CKD, progression of CKD, and end-stage renal disease (ESRD), also after adjustment for age, sex, race, smoking status, comorbidities, and laboratory tests. In the general population, obesity increases the risk of death. In nondialysis-dependent CKD patients, the association between body mass index and weight with mortality is controversial. In ESRD patients, obesity is paradoxically associated with better survival. There are only a few studies investigating changes in weight in these patients and in most weight loss was associated with higher mortality. However, it is not clear if weight change was intentional or unintentional and this is an important limitation of these studies. Management of obesity includes life-style interventions, bariatric surgery, and pharmacotherapy. In the last 2 years, a long-acting glucagon-like peptide-1 (GLP-1) receptor agonist and GLP-1 and glucose-dependent insulinotropic polypeptide receptor agonist were shown to be effective in managing weight loss in non-CKD patients, but we are awaiting results of more definitive studies in CKD patients.
Topics: Adult; Humans; Renal Insufficiency, Chronic; Obesity; Kidney Failure, Chronic; Weight Loss; Glucagon-Like Peptide 1
PubMed: 37271131
DOI: 10.1159/000531379 -
Pediatric Clinics of North America Feb 2019Chronic kidney disease is an ongoing deterioration of renal function that often progresses to end-stage renal disease. Management goals in children include slowing... (Review)
Review
Chronic kidney disease is an ongoing deterioration of renal function that often progresses to end-stage renal disease. Management goals in children include slowing disease progression, prevention and treatment of complications, and optimizing growth, development, and quality of life. Nutritional management is critically important to achieve these goals. Control of blood pressure, proteinuria, and metabolic acidosis with dietary and pharmacologic measures may slow progression of chronic kidney disease. Although significant progress in management has been made, further research is required to resolve many outstanding controversies. We review recent developments in pediatric chronic kidney disease, focusing on dietary measures to improve outcomes.
Topics: Child; Diagnosis, Differential; Disease Progression; Humans; Kidney Function Tests; Quality of Life; Renal Insufficiency, Chronic
PubMed: 30454747
DOI: 10.1016/j.pcl.2018.09.007 -
Soins; La Revue de Reference Infirmiere Jun 2018Today in France, more than 5% of the population suffers from chronic kidney disease and its prevalence is increasing. It is important to detect these pathologies early...
Today in France, more than 5% of the population suffers from chronic kidney disease and its prevalence is increasing. It is important to detect these pathologies early and to provide patients with a multidisciplinary care programme in which nephrologists, endocrinologists and cardiologists coordinate their approach.
Topics: Cardiovascular Diseases; Disease Progression; France; Humans; Renal Dialysis; Renal Insufficiency, Chronic; Risk Factors
PubMed: 29958574
DOI: 10.1016/j.soin.2018.04.004 -
Current Cardiology Reviews 2019Chronic Kidney Disease is a growing health burden world wide. Traditional and mutual risk factors between CVD and CKD are age, hypertension, diabetes mellitus,... (Review)
Review
INTRODUCTION
Chronic Kidney Disease is a growing health burden world wide. Traditional and mutual risk factors between CVD and CKD are age, hypertension, diabetes mellitus, dyslipidemia, tobacco use, family history and male gender. In this review, we will focus on whether or not early CKD is an important risk factor for the presence, severity and progression of CVD. Specifically, we will examine both traditional and novel risk factors of both CKD and CVD and how they relate to each other.
CONCLUSION
We will also assess if early treatment of CKD, intensive compared to standard, has an important effect on the halt of the development of CKD as well as CVD. Insights into the pathogenesis and early recognition of CKD as well as the importance of novel kidney biomarkers will be pointed out. Also, common pathogenetic mechanisms between CKD and CVD will be discussed.
Topics: Cardiovascular Diseases; Disease Progression; Early Diagnosis; Humans; Male; Renal Insufficiency, Chronic; Risk Factors
PubMed: 29992892
DOI: 10.2174/1573403X14666180711124825