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Incident #gout and chronic #kidney Disease: healthcare utilization and survival
https://bmcrheumatol.biomedcentral.com/articles/10.1186/s41927-019-0060-0
The current study explored if healthcare resource utilization (HRU) and survival differs between patients with incident gout in the presence or absence of chronic kidney disease (CKD).
Higher rates of HRU were observed for gout patients with CKD than without. Total annual hospital admissions for patients with gout and CKD were at least 3 times higher for adults < 55 (mean = 0.51 vs 0.13) and approximately 1.5 times higher for adults 55+ (mean = 0.46 vs 0.29) without CKD. Healthcare utilization rates from year 1 to year 5 remained similar for gout patients < 55 years irrespective of CKD status, however varied according to healthcare utilization by CKD status for gout patients 55+ years. The 5-year all-cause mortality was higher among those with CKD compared to those without CKD for both age groups (HR< 55 years = 1.65; 95% CI 1.01–2.71; HR55+ years = 1.50; 95% CI 1.37–1.65).
Conclusions
The current study suggests important differences exist in patient characteristics and outcomes among patients with gout and CKD. Healthcare utilization differed between sub-populations, age and comorbidities, over the study period and the 5-year mortality risk was higher for gout patients with CKD, regardless of age..
Incident #gout and chronic #kidney Disease: healthcare utilization and survival
https://bmcrheumatol.biomedcentral.com/articles/10.1186/s41927-019-0060-0
The current study explored if healthcare resource utilization (HRU) and survival differs between patients with incident gout in the presence or absence of chronic kidney disease (CKD).
Higher rates of HRU were observed for gout patients with CKD than without. Total annual hospital admissions for patients with gout and CKD were at least 3 times higher for adults < 55 (mean = 0.51 vs 0.13) and approximately 1.5 times higher for adults 55+ (mean = 0.46 vs 0.29) without CKD. Healthcare utilization rates from year 1 to year 5 remained similar for gout patients < 55 years irrespective of CKD status, however varied according to healthcare utilization by CKD status for gout patients 55+ years. The 5-year all-cause mortality was higher among those with CKD compared to those without CKD for both age groups (HR< 55 years = 1.65; 95% CI 1.01–2.71; HR55+ years = 1.50; 95% CI 1.37–1.65).
Conclusions
The current study suggests important differences exist in patient characteristics and outcomes among patients with gout and CKD. Healthcare utilization differed between sub-populations, age and comorbidities, over the study period and the 5-year mortality risk was higher for gout patients with CKD, regardless of age..
BMC Rheumatology
Incident gout and chronic Kidney Disease: healthcare utilization and survival
Uncontrolled gout can cause significant joint and organ damage and has been associated with impairments in quality of life and high economic cost. Gout has also been associated with other comorbid diseases, such as chronic kidney disease. The current study…
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#Plant-Based Diets and Incident #CKD and #kidney Function
https://cjasn.asnjournals.org/content/early/2019/04/24/CJN.12391018
During a median follow-up of 24 years, 4343 incident CKD cases occurred. Higher adherence to a healthy plant-based diet (HR comparing quintile 5 versus quintile 1 [HRQ5 versus Q1], 0.86; 95% confidence interval [95% CI], 0.78 to 0.96; P for trend =0.001) and a provegetarian diet (HRQ5 versus Q1, 0.90; 95% CI, 0.82 to 0.99; P for trend =0.03) were associated with a lower risk of CKD, whereas higher adherence to a less healthy plant-based diet (HRQ5 versus Q1, 1.11; 95% CI, 1.01 to 1.21; P for trend =0.04) was associated with an elevated risk. Higher adherence to an overall plant-based diet and a healthy plant-based diet was associated with slower eGFR decline. The proportion of CKD attributable to lower adherence to healthy plant-based diets was 4.1% (95% CI, 0.6% to 8.3%).
Conclusions Higher adherence to healthy plant-based diets and a vegetarian diet was associated with favorable kidney disease outcomes.
#Plant-Based Diets and Incident #CKD and #kidney Function
https://cjasn.asnjournals.org/content/early/2019/04/24/CJN.12391018
During a median follow-up of 24 years, 4343 incident CKD cases occurred. Higher adherence to a healthy plant-based diet (HR comparing quintile 5 versus quintile 1 [HRQ5 versus Q1], 0.86; 95% confidence interval [95% CI], 0.78 to 0.96; P for trend =0.001) and a provegetarian diet (HRQ5 versus Q1, 0.90; 95% CI, 0.82 to 0.99; P for trend =0.03) were associated with a lower risk of CKD, whereas higher adherence to a less healthy plant-based diet (HRQ5 versus Q1, 1.11; 95% CI, 1.01 to 1.21; P for trend =0.04) was associated with an elevated risk. Higher adherence to an overall plant-based diet and a healthy plant-based diet was associated with slower eGFR decline. The proportion of CKD attributable to lower adherence to healthy plant-based diets was 4.1% (95% CI, 0.6% to 8.3%).
Conclusions Higher adherence to healthy plant-based diets and a vegetarian diet was associated with favorable kidney disease outcomes.
American Society of Nephrology
Plant-Based Diets and Incident CKD and Kidney Function
Background and objectives The association between plant-based diets, incident CKD, and kidney function decline has not been examined in the general population. We prospectively investigated this relationship in a population-based study, and evaluated if risk…
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Pre-#eclampsia and risk of later #kidney disease: nationwide cohort study
https://www.bmj.com/content/365/bmj.l1516
..In particular, strong associations were observed for chronic kidney disease, hypertensive kidney disease, and glomerular/proteinuric disease. Adjustment for cardiovascular disease and hypertension only partially attenuated the observed associations. Stratifying the analyses on time since pregnancy showed that associations between pre-eclampsia and chronic kidney disease and glomerular/proteinuric disease were much stronger within five years of the latest pregnancy (hazard ratio 6.11 (3.84 to 9.72) and 4.77 (3.88 to 5.86), respectively) than five years or longer after the latest pregnancy (2.06 (1.69 to 2.50) and 1.50 (1.19 to 1.88). By contrast, associations between pre-eclampsia and acute renal conditions were modest.
Conclusion s Pre-eclampsia, particularly early preterm pre-eclampsia, was strongly associated with several chronic renal disorders later in life. More research is needed to determine which women are most likely to develop kidney disease after pre-eclampsia, what mechanisms underlie the association, and what clinical follow-up and interventions (and in what timeframe post-pregnancy) would be most appropriate and effective.
Pre-#eclampsia and risk of later #kidney disease: nationwide cohort study
https://www.bmj.com/content/365/bmj.l1516
..In particular, strong associations were observed for chronic kidney disease, hypertensive kidney disease, and glomerular/proteinuric disease. Adjustment for cardiovascular disease and hypertension only partially attenuated the observed associations. Stratifying the analyses on time since pregnancy showed that associations between pre-eclampsia and chronic kidney disease and glomerular/proteinuric disease were much stronger within five years of the latest pregnancy (hazard ratio 6.11 (3.84 to 9.72) and 4.77 (3.88 to 5.86), respectively) than five years or longer after the latest pregnancy (2.06 (1.69 to 2.50) and 1.50 (1.19 to 1.88). By contrast, associations between pre-eclampsia and acute renal conditions were modest.
Conclusion s Pre-eclampsia, particularly early preterm pre-eclampsia, was strongly associated with several chronic renal disorders later in life. More research is needed to determine which women are most likely to develop kidney disease after pre-eclampsia, what mechanisms underlie the association, and what clinical follow-up and interventions (and in what timeframe post-pregnancy) would be most appropriate and effective.
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#Preterm birth and risk of chronic #kidney disease from childhood into mid-adulthood: national cohort study
https://www.bmj.com/content/365/bmj.l1346
Preterm birth and extremely preterm birth (<28 weeks) were associated with nearly twofold and threefold risks of CKD, respectively, from birth into mid-adulthood (adjusted hazard ratio 1.94, 95% confidence interval 1.74 to 2.16; P<0.001; 3.01, 1.67 to 5.45; P<0.001). An increased risk was observed even among those born at early term (37-38 weeks) (1.30, 1.20 to 1.40; P<0.001). The association between preterm birth and CKD was strongest at ages 0-9 years (5.09, 4.11 to 6.31; P<0.001), then weakened but remained increased at ages 10-19 years (1.97, 1.57 to 2.49; P<0.001) and 20-43 years (1.34, 1.15 to 1.57; P<0.001). These associations affected both males and females and did not seem to be related to shared genetic or environmental factors in families.
Conclusions Preterm and early term birth are strong risk factors for the development of CKD from childhood into mid-adulthood. People born prematurely need long term follow-up for monitoring and preventive actions to preserve renal function across the life course.
#Preterm birth and risk of chronic #kidney disease from childhood into mid-adulthood: national cohort study
https://www.bmj.com/content/365/bmj.l1346
Preterm birth and extremely preterm birth (<28 weeks) were associated with nearly twofold and threefold risks of CKD, respectively, from birth into mid-adulthood (adjusted hazard ratio 1.94, 95% confidence interval 1.74 to 2.16; P<0.001; 3.01, 1.67 to 5.45; P<0.001). An increased risk was observed even among those born at early term (37-38 weeks) (1.30, 1.20 to 1.40; P<0.001). The association between preterm birth and CKD was strongest at ages 0-9 years (5.09, 4.11 to 6.31; P<0.001), then weakened but remained increased at ages 10-19 years (1.97, 1.57 to 2.49; P<0.001) and 20-43 years (1.34, 1.15 to 1.57; P<0.001). These associations affected both males and females and did not seem to be related to shared genetic or environmental factors in families.
Conclusions Preterm and early term birth are strong risk factors for the development of CKD from childhood into mid-adulthood. People born prematurely need long term follow-up for monitoring and preventive actions to preserve renal function across the life course.
Saving Veins, Saving Lives, for Patients With Chronic #Kidney Disease
https://annals.org/aim/article-abstract/2735183/saving-veins-saving-lives-patients-chronic-kidney-disease
Vascular access has long been recognized as the Achilles' heel of the management of patients receiving maintenance hemodialysis. Such patients require cannulation with 15-gauge needles 3 times weekly, blood flows of about 400 mL/min, and treatments of 4 to 5 hours per session. This requires creation of arteriovenous fistulae using native veins or arteriovenous grafts using synthetic vein material. Absent usable vessels or time to surgically create and allow maturation of internal access for dialysis, clinicians use large-bore, dual-lumen, tunneled, cuffed dialysis catheters placed in the internal jugular vein. Robust data show that mortality among patients receiving dialysis with #catheters is about 1.6 to 2.5 times higher than among those with internal access and no catheter. The higher rate of catheter use in U.S. hemodialysis patients likely explains the observed higher mortality compared with that in other countries (1, 2)..
https://annals.org/aim/article-abstract/2735183/saving-veins-saving-lives-patients-chronic-kidney-disease
Vascular access has long been recognized as the Achilles' heel of the management of patients receiving maintenance hemodialysis. Such patients require cannulation with 15-gauge needles 3 times weekly, blood flows of about 400 mL/min, and treatments of 4 to 5 hours per session. This requires creation of arteriovenous fistulae using native veins or arteriovenous grafts using synthetic vein material. Absent usable vessels or time to surgically create and allow maturation of internal access for dialysis, clinicians use large-bore, dual-lumen, tunneled, cuffed dialysis catheters placed in the internal jugular vein. Robust data show that mortality among patients receiving dialysis with #catheters is about 1.6 to 2.5 times higher than among those with internal access and no catheter. The higher rate of catheter use in U.S. hemodialysis patients likely explains the observed higher mortality compared with that in other countries (1, 2)..
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Benefits and Harms of Oral #Anticoagulant Therapy in Chronic #Kidney Disease: A Systematic Review and Meta-analysis
https://annals.org/aim/article-abstract/2738158/benefits-harms-oral-anticoagulant-therapy-chronic-kidney-disease-systematic-review
All but the 8 trials involving patients with ESKD excluded participants with creatinine clearance less than 20 mL/min or estimated glomerular filtration rate less than 15 mL/min/1.73 m2. In AF, compared with VKAs, NOACs reduced risks for stroke or systemic embolism (risk ratio RR, 0.79 95% CI, 0.66 to 0.93; high-certainty evidence) and hemorrhagic stroke (RR, 0.48 CI, 0.30 to 0.76; moderate-certainty evidence). Compared with VKAs, the effects of NOACs on recurrent VTE or VTE-related death were uncertain (RR, 0.72 CI, 0.44 to 1.17; low-certainty evidence). In all trials combined, NOACs seemingly reduced major bleeding risk compared with VKAs (RR, 0.75 CI, 0.56 to 1.01; low-certainty evidence).
Conclusion:
In early-stage CKD, NOACs had a benefit–risk profile superior to that of VKAs. For advanced CKD or ESKD, there was insufficient evidence to establish benefits or harms of VKAs or NOACs.
Benefits and Harms of Oral #Anticoagulant Therapy in Chronic #Kidney Disease: A Systematic Review and Meta-analysis
https://annals.org/aim/article-abstract/2738158/benefits-harms-oral-anticoagulant-therapy-chronic-kidney-disease-systematic-review
All but the 8 trials involving patients with ESKD excluded participants with creatinine clearance less than 20 mL/min or estimated glomerular filtration rate less than 15 mL/min/1.73 m2. In AF, compared with VKAs, NOACs reduced risks for stroke or systemic embolism (risk ratio RR, 0.79 95% CI, 0.66 to 0.93; high-certainty evidence) and hemorrhagic stroke (RR, 0.48 CI, 0.30 to 0.76; moderate-certainty evidence). Compared with VKAs, the effects of NOACs on recurrent VTE or VTE-related death were uncertain (RR, 0.72 CI, 0.44 to 1.17; low-certainty evidence). In all trials combined, NOACs seemingly reduced major bleeding risk compared with VKAs (RR, 0.75 CI, 0.56 to 1.01; low-certainty evidence).
Conclusion:
In early-stage CKD, NOACs had a benefit–risk profile superior to that of VKAs. For advanced CKD or ESKD, there was insufficient evidence to establish benefits or harms of VKAs or NOACs.
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Acute #Kidney Injury Among Older Patients Undergoing Coronary #Angiography for Acute Myocardial Infarction: The SILVER-AMI Study
..Comorbid diseases and aging-related conditions were both more common among individuals experiencing acute kidney injury. However, after multivariable adjustment, no aging-related conditions were retained. There were 11 risk factors in the final model; the strongest were heart failure on presentation (odds ratio [OR] 1.91; 95% confidence interval [CI], 1.41-2.59), body mass index [BMI] >30 (vs BMI 18-25: OR 1.75; 95% CI, 1.27-2.42), and nonwhite race (OR 1.65; 95% CI, 1.16-2.33). The final model achieved an area under the receiver operating characteristic curve of 0.72 and was well calibrated (Hosmer-Lemeshow P = .50). Acute kidney injury was independently associated with 6-month mortality (OR 1.98; 95% CI, 1.36-2.88) but not readmission (OR 1.26; 95% CI, 0.98-1.61).
Conclusions
Acute kidney injury is common among older adults with acute myocardial infarction undergoing coronary angiography. Predictors largely mirrored those in previous studies of younger individuals, which suggests that geriatric conditions mediate their influence through other risk factors
https://bit.ly/38zXjxL
Acute #Kidney Injury Among Older Patients Undergoing Coronary #Angiography for Acute Myocardial Infarction: The SILVER-AMI Study
..Comorbid diseases and aging-related conditions were both more common among individuals experiencing acute kidney injury. However, after multivariable adjustment, no aging-related conditions were retained. There were 11 risk factors in the final model; the strongest were heart failure on presentation (odds ratio [OR] 1.91; 95% confidence interval [CI], 1.41-2.59), body mass index [BMI] >30 (vs BMI 18-25: OR 1.75; 95% CI, 1.27-2.42), and nonwhite race (OR 1.65; 95% CI, 1.16-2.33). The final model achieved an area under the receiver operating characteristic curve of 0.72 and was well calibrated (Hosmer-Lemeshow P = .50). Acute kidney injury was independently associated with 6-month mortality (OR 1.98; 95% CI, 1.36-2.88) but not readmission (OR 1.26; 95% CI, 0.98-1.61).
Conclusions
Acute kidney injury is common among older adults with acute myocardial infarction undergoing coronary angiography. Predictors largely mirrored those in previous studies of younger individuals, which suggests that geriatric conditions mediate their influence through other risk factors
https://bit.ly/38zXjxL
Acute #kidney injury after primary total hip #arthroplasty: a risk multiplier for complication, mortality, and healthcare utilization
https://2medical.news/2020/03/17/acute-kidney-injury-after-primary-total-hip-arthroplasty-a-risk-multiplier-for-complication-mortality-and-healthcare-utilization/
To assess whether acute kidney injury (AKI) is associated with more complications and higher healthcare utilization in people undergoing primary total hip arthroplasty (THA).. ..Adjusted for age, gender, race, income, underlying diagnosis, medical comorbidity, and the insurance payer, AKI in people who underwent primary THA was associated with significantly higher OR (95% CI) of (1) implant infection, 2.34 (95% CI, 1.87, 2.93); (2) transfusion, 2.46 …
https://2medical.news/2020/03/17/acute-kidney-injury-after-primary-total-hip-arthroplasty-a-risk-multiplier-for-complication-mortality-and-healthcare-utilization/
To assess whether acute kidney injury (AKI) is associated with more complications and higher healthcare utilization in people undergoing primary total hip arthroplasty (THA).. ..Adjusted for age, gender, race, income, underlying diagnosis, medical comorbidity, and the insurance payer, AKI in people who underwent primary THA was associated with significantly higher OR (95% CI) of (1) implant infection, 2.34 (95% CI, 1.87, 2.93); (2) transfusion, 2.46 …
EMA advises continued use of medicines for #hypertension, heart or #kidney disease during COVID-19 pandemic
https://2medical.news/2020/04/02/ema-advises-continued-use-of-medicines-for-hypertension-heart-or-kidney-disease-during-covid-19-pandemic/
EMA is aware of recent media reports and publications which question whether some medicines, for instance angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs, or sartan medicines), could worsen coronavirus disease (COVID-19). ACE inhibitors and ARBs are most commonly used for treating patients with high blood pressure, heart failure or kidney disease. It is important that patients do not interrupt their treatment with …
https://2medical.news/2020/04/02/ema-advises-continued-use-of-medicines-for-hypertension-heart-or-kidney-disease-during-covid-19-pandemic/
EMA is aware of recent media reports and publications which question whether some medicines, for instance angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs, or sartan medicines), could worsen coronavirus disease (COVID-19). ACE inhibitors and ARBs are most commonly used for treating patients with high blood pressure, heart failure or kidney disease. It is important that patients do not interrupt their treatment with …
ACUTE #KIDNEY INJURY IN PATIENTS HOSPITALIZED WITH #COVID-19
https://2medical.news/2020/05/21/acute-kidney-injury-in-patients-hospitalized-with-covid-19/
The rate of acute kidney injury (AKI) associated with patients hospitalized with Covid-19, and associated outcomes are not well understood. This study describes the presentation, risk factors and outcomes of AKI in patients hospitalized with Covid-19. We reviewed the health records for all patients hospitalized with Covid-19 between March 1, and April 5, 2020, at 13 academic and community hospitals in metropolitan New York. Patients …
https://2medical.news/2020/05/21/acute-kidney-injury-in-patients-hospitalized-with-covid-19/
The rate of acute kidney injury (AKI) associated with patients hospitalized with Covid-19, and associated outcomes are not well understood. This study describes the presentation, risk factors and outcomes of AKI in patients hospitalized with Covid-19. We reviewed the health records for all patients hospitalized with Covid-19 between March 1, and April 5, 2020, at 13 academic and community hospitals in metropolitan New York. Patients …