Chronic Kidney Disease

Abstract

Background Early and late readmissions may have different causal factors and thus require different strategies for prevention. Objective Determine whether predictors of readmission change within the 30-day window post-discharge. Design Retrospective cohort study Setting Academic medical center Participants Medicine discharges, 1/1/2009-12/31/2010 Exposures (1) Factors related to the index hospitalization: acute illness burden, inpatient care process factors, and clinical indicators of instability at discharge; (2) Unrelated factors: chronic illness burden, and social determinants of health. Outcomes (1) Early readmissions, 0-7d post-discharge; (2) Late readmissions, 8-30d post-discharge. Results 13,334 discharges, representing 8,078 patients were included in the analysis, 1,046 readmissions (7.8%) occurred in the early period and 1,586 readmissions (11.9%) occurred in the late period. Early readmissions were associated with markers of acute illness burden, including length of hospital stay (Odds Ratio(OR) 1.02, 95%CI 1.00-1.03), and whether a rapid response team assessment was called (OR1.48, 95%CI 1.15-1.89); some markers of chronic illness burden, including being on a medication that indicates organ failure (OR1.19 95%CI 1.02-1.40); and some social determinants of health, including barriers to learning (OR 1.18 95%CI 1.01-1.38); and were less likely if a patient was discharged from the hospital between 800AM-1259 PM (OR0.76, 95%CI 0.58-0.99). Late readmissions were associated with markers of chronic illness burden, including being on a medication that indicated organ failure (OR1.27, 95%CI 1.10-1.46) or hemodialysis (OR1.75, 95%CI 1.29-2.37); and social determinants of health, including barriers to learning (OR1.22, 95%CI 1.07-1.40), and having unsupplemented Medicare or Medicaid (OR1.20, 95%CI 1.04-1.38). Limitations Single center, only ascertains readmissions at our institution Conclusions The 30 days following hospital discharge may not be homogeneous. Causal factors and readmission prevention strategies may be different for the early vs. late periods. Primary Funding Source Health Resources and Services Administration training grant [T32 HP12706].

Retracted: Quercetin alleviates lipopolysaccharide‐induced inflammatory responses by up‐regulation miR‐124 in human renal tubular epithelial cell line HK‐2

“…In the present assay, we investigated an active extract, Quercetin, which hinted that Quercetin relieved LPS‐stimulated apoptosis and inflammatory reactions by mediating miR‐124 in HK‐2 cells. CKD is also identified as chronic renal insufficiency or chronic renal failure, which is a progressive and untenable renal structural and dysfunction with worldwide predominance of about 5–10% . With the growing predominance of hypertension and diabetes, CKD has been a main issue for social and researches around the world .…”

Salvianolic acid A attenuates kidney injury and inflammation by inhibiting NF-κB and p38 MAPK signaling pathways in 5/6 nephrectomized rats

“…Chronic kidney disease (CKD) is an increasing public health concern that harms the health and life of many individuals [1][2][3]. In a 2010 Global Burden of Disease study, CKD rose from the 27th greatest cause of the total number of global deaths in 1990 (agestandardized annual death rate of 15.7 per 100,000) to the alarming rank of 18th (with an annual death rate of 16.3 per 100,000 [4]).…”

Progression of chronic kidney disease after acute kidney injury

“…In particular, cardiology has become an integral and consistent stakeholder in this team, due to the high incidence of CKD in children with congenital heart disease, the high incidence of AKI due to cardiac dysfunction or cardiac surgery that may progress to CKD, and the significant long-term cardiovascular morbidity and mortality associated with CKD. 5–9 Children with both congenital heart disease and CKD are increasingly surviving to adulthood, with enormous and synergistically negative medical, financial, and quality of life impact. Given the potential to institute primary and secondary prevention strategies that minimize CKD progression, an improved understanding of the epidemiology, mechanisms, and early diagnosis is of importance to cardiologists, nephrologists, scientists, economists, and policy makers alike.…”