Validated registry of pre-dialysis chronic kidney disease: description of a large cohort

Huaira, Rosália Maria Nunes Henriques; Paula, Rogério Baumgratz de; Bastos, Marcus Gomes; Colugnati, Fernando Antônio Basile; Fernandes, Natália

doi:10.1590/2175-8239-jbn-3841

Cited by 3 publications

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“…The sample consisted of patients with a lower mean age (56.3 ± 8.3 years) than that observed in the usual population of the pre-dialysis CKD outpatient clinic (66.2 ± 13.4 years) of the CHM-JF 27 In this study, the population presented, as a non-inclusion criterion, age > 65 years, considering that the increased incidence and prevalence of vascular and degenerative diseases occur from this age group onwards. This approach substantially reduced the age bias in the study sample.…”

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Cross-sectional assessment of mild cognitive impairment in pre-dialysis chronic kidney disease and its association with inflammation and changes seen on MRI: what the eyes cannot see

et al. 2022

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Introduction: Mild cognitive impairment (MCI) is a prevalent and underdiagnosed condition in chronic kidney disease (CKD), that shares common pathophysiological factors such as chronic inflammation. Objective: To evaluate the association of MCI in CKD stages 1-5 using inflammatory markers and changes by magnetic resonance imaging (MRI). Patients and Methods: Cross-sectional study in adult patients with pre-dialysis CKD. MCI was assessed by the Montreal Cognitive Assessment (MoCA) and the estimated glomerular filtration rate (eGFR) by the Chronic Kidney Disease Epidemiology Collaboration equation. Sociodemographic and clinical data were collected from medical records. The cytokines IL-4, IL-6, IL-17, TNF-α and hs-CRP were determined. Brain MRI was performed in a 1.5 Tesla device, without paramagnetic contrast. A descriptive analysis followed by a comparison of abnormal versus normal MoCA scores among all studied variables. A linear regression analysis was performed using MoCA as a dependent variable, adjusted for confounding factors. Results: Of 111 invited patients, eighty completed the neuropsychological assessment and 56 underwent MRI, and were included in the study. Mean age was 56.3 ± 8.3 years and 51.8% (n = 29) had altered MoCA. When compared to the group with normal MoCA, the group with altered MoCA had higher levels of IL-6 and IL-17. There was no correlation between altered MoCA with eGFR or with MRI abnormalities. Conclusão: MCI assessed by MoCA was prevalent in patients with pre-dialysis CKD, it was associated with inflammation and showed no correlation with MRI changes.

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Section: Discussionmentioning

confidence: 99%

Cross-sectional assessment of mild cognitive impairment in pre-dialysis chronic kidney disease and its association with inflammation and changes seen on MRI: what the eyes cannot see

et al. 2022

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“…По данным некоторых регистров больных с ХБП прослеживается аналогичная тенденция в назначении ИАПФ/БРА -в 69,0-76,1% случаев при различной рСКФ [32]. В другой выборке больных назначение АГТ было несколько иным -диуретическая терапия составляла порядка 82,9%, а ИАПФ -только 49,9% [33]. Уменьшение назначения ИАПФ, может быть связано с повышением уровня калия в крови при снижении Фп.…”

Section: результаты и обсуждениеunclassified

Analysis of lifestyle modifications and antihypertensive therapy in patients with arterial hypertension and chronic kidney disease (data from the national registry)

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et al. 2022

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The aim is to study the characteristics and quality of drug therapy and recommendations for lifestyle changes in patients with chronic kidney disease and arterial hypertension and, separately, chronic kidney disease and resistant arterial hypertension, observed in primary health care.Materials and methods. The study was carried out on the basis of the AH registry data (N = 43133; 2005-2019 years). Glomerular filtration rate (eGFR) was calculated using the CKD-EPI formula; renal structure and albuminuria were not evaluated. The analysis was performed using the SPSS software (version 22; SPSS Inc).Results. Less than half of all patients reached the target SBP values. ACE inhibitors/ARBs were not prescribed as first-line antihypertensive therapy in 18% of patients with stage 3 CKD. ACE inhibitors were more often prescribed to men than women (70,6% and 66,5%), and ARBs (11,9% and 15,6%). The frequency of prescribing ACE inhibitors, thiazide and thiazide-like diuretics remained practically unchanged at GFR ≥ 60 and 60 ≥ GFR < 30 ml/min/1,73m2, while the frequency of prescribing ARBs, CCBs, loop diuretics increased with a decrease in glomerular filtration rate. Approximately 60% of patients with hypertension were given advice on nutrition and normalization of body weight (among patients with obesity), about 50% — advice on physical activity and ~50% of smokers received advice on smoking cessation. In patients with hypertension and GFR below 60 ml/min/1,73m2, primary care physicians gave advice on lifestyle changes more often than patients with higher GFR. In men with hypertension and 3 stage CKD the incidence of coronary artery disease (2 times), CHF (1,5 times), the incidence of myocardial infarction in history (3,4 times), the incidence of stroke in history (1,9 times) higher than in women. The frequency of the presence of probable resistant hypertension increased up to 23,9% with a decrease of eGFR among patients with uncontrolled hypertension and up to 11% with controlled.Conclusion. For patients with hypertension and CKD, it is necessary to achieve target values of blood pressure, conduct drug therapy aimed at blocking the RAAS (ACE inhibitors /ARBs), select drugs from the CCB group and diuretics as second and third line therapy. In patients with resistant hypertension the addition mineralocorticoid receptor antagonists is necessary.

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A proposal to analyze the progression of non-dialytic chronic kidney disease by surrogate endpoints: introducing parametric survival models

2023

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IntroductionChronic kidney disease (CDK) progression studies increasingly use surrogate endpoints based on the estimated glomerular filtration rate. The clinical characteristics of these endpoints bring new challenges in comparing groups of patients, as traditional Cox models may lead to biased estimates mainly because they do not assume a hazard function.ObjectiveThis study proposes the use of parametric survival analysis models with the three most commonly used endpoints in nephrology based on a case study. Estimated glomerular filtration rate (eGFR) decay > 5 mL/year, eGFR decline > 30%, and change in CKD stage were evaluated.MethodThe case study is a 5-year retrospective cohort study that enrolled 778 patients in the predialysis stage. Exponential, Weibull, Gompertz, lognormal, and logistic models were compared, and proportional hazard and accelerated failure time (AFT) models were evaluated.ResultsThe endpoints had quite different hazard functions, demonstrating the importance of choosing appropriate models for each. AFT models were more suitable for the clinical interpretation of the effects of covariates on these endpoints.ConclusionSurrogate endpoints have different hazard distributions over time, which is already recognized by nephrologists. More flexible analysis techniques that capture these relevant clinical characteristics in decision-making should be encouraged and disseminated in nephrology research.

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Validated registry of pre-dialysis chronic kidney disease: description of a large cohort

Abstract: Validated data are of vital importance for health managers to monitor users. The population of this study is predominantly elderly, obese, requiring multi-professional care to slow the progression of the disease and decrease morbidity and mortality.

Cited by 3 publications

References 24 publications

Cross-sectional assessment of mild cognitive impairment in pre-dialysis chronic kidney disease and its association with inflammation and changes seen on MRI: what the eyes cannot see

Cross-sectional assessment of mild cognitive impairment in pre-dialysis chronic kidney disease and its association with inflammation and changes seen on MRI: what the eyes cannot see

Analysis of lifestyle modifications and antihypertensive therapy in patients with arterial hypertension and chronic kidney disease (data from the national registry)

A proposal to analyze the progression of non-dialytic chronic kidney disease by surrogate endpoints: introducing parametric survival models

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