Chronic renal diseases as a public health problem: Epidemiology, social, and economic implications

Schieppati, Arrigo; Remuzzi, Giuseppe

doi:10.1111/j.1523-1755.2005.09801.x

Cited by 356 publications

(284 citation statements)

References 12 publications

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“…Renal interstitial fibrosis is a progressive process that ultimately leads to end-stage renal failure, which requires dialysis or kidney transplantation. 1 Among various factors that regulate renal fibrosis, transforming growth factor-b (TGF-b) perhaps is the major cytokine that has a central function. TGF-b initiates the transition of renal tubular epithelial cells to myofibroblasts, the cellular source for ECM synthesis, which ultimately leads to irreversible renal failure.…”

mentioning

confidence: 99%

Low-dose paclitaxel ameliorates renal fibrosis in rat UUO model by inhibition of TGF-β/Smad activity

Zhang

Sun

Xian

et al. 2010

Laboratory Investigation

108

100

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Transforming growth factor-b (TGF-b) has a pivotal function in the progression of renal fibrosis in a wide variety of renal diseases. Smad proteins have been identified to have an important function in regulating the expression of extracellular matrix (ECM) proteins through TGF-b signaling pathway. Aberrant TGF-b/Smad signaling can be modulated by stabilization of microtubules with paclitaxel. In this study, we investigated if paclitaxel can attenuate tubulointerstitial fibrosis in a rat model of unilateral ureteral obstruction (UUO). Rats in groups of six were subjected to UUO and received low-dose intraperitoneal injection of paclitaxel (0.3 mg/kg) twice a week. They were killed at day 7 and 14 after UUO or Sham operation. TGF-b signaling cascade and status of various ECM proteins were evaluated by RT-PCR, western blotting and immunohistochemical or immunofluorescence staining. The paclitaxel treatment markedly suppressed Smad2 and Smad3 phosphorylation. This was associated with attenuated expression of integrin-linked kinase, collagens I and III, fibronectin (FN) and a-smooth muscle actin, and a substantial decrease in renal fibrosis in animals that underwent UUO and received paclitaxel. These data indicate that the low-dose paclitaxel ameliorates renal tubulointerstitial fibrosis by modulating TGF-b signaling, and thus, the paclitaxel may have some therapeutic value in humans.

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mentioning

confidence: 99%

Low-dose paclitaxel ameliorates renal fibrosis in rat UUO model by inhibition of TGF-β/Smad activity

Zhang

Sun

Xian

et al. 2010

Laboratory Investigation

108

100

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“…The number of patients requiring renal replacement therapy either by dialysis or kidney transplantation is estimated to be about 1.4 million worldwide, and that number is growing at 8% annually (4). A number of factors may account for the increase; the major factors are diabetes, aging populations, and hypertension.…”

Section: Incidence Of Kidney Failure In Guyanamentioning

confidence: 99%

Report of the First Peritoneal Dialysis Program in Guyana, South America

et al. 2013

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Introduction In 2008, we initiated the first Guyanese comprehensive kidney replacement program, comprising hemodialysis (HD), peritoneal dialysis (PD), vascular access procedures, and living-donor kidney transplantation. The government of Guyana, US-based philanthropists, US-based physicians, and Guyanese caregivers teamed up to form a public–private partnership. This pilot program was free of cost to the patients. Methods From July 2010 to the time of writing, we placed 17 patients with end-stage kidney disease on PD, which was used as a bridge to living-donor kidney transplantation. During the same period, we placed 12 primary arteriovenous fistulae. Results The 17 patients who received a PD catheter had a mean age of 43.6 years and a mean follow-up of 5.3 months. In that group, 2 deaths occurred (from multi-organ failure) within 2 weeks of catheter placement, and 2 patients were switched to HD because of inadequate clearance. Technical issues were noted in 2 patients, and 3 patients developed peritonitis (treated with intravenous antibiotics). An exit- site abscess in 1 patient was drained under local anesthesia. The peritonitis rate was 0.36 episodes per patient–year. Of the 17 patients who received PD, 4 underwent living-donor kidney transplantation. Conclusions In Guyana, PD is a safe and cost-effective option; it may be equally suitable for similar developing countries. In Guyana, PD was used as a bridge to living-donor kidney transplantation. We have been able to sustain this program since 2008 by making incremental gains and nurturing the ongoing public– private partnership.

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“…The prevalence of CKD is on the rise worldwide and this condition is rapidly becoming a major clinical and public health problem. 1 Early detection and treatment of risk factors associated with the presence of CKD may improve the outcome and quality of life in a considerable number of patients, and may also reduce the costs of end-stage renal disease. 2 Metabolic syndrome (MS) has been acknowledged as a forerunner of diabetes and subsequent cardiovascular events.…”

Section: Introductionmentioning

confidence: 99%

Metabolic syndrome and microalbuminuria predict renal outcome in non-diabetic patients with primary hypertension: the MAGIC study

et al. 2011

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Metabolic syndrome (MS) has recently been shown to be a forerunner of chronic kidney disease (CKD). Microalbuminuria (MA) is associated with both MS and CKD. This study aimed to prospectively investigate the relationship among MA, MS and renal outcome in nondiabetic patients with primary hypertension. A total of 790 hypertensive patients enrolled in the MAGIC study between 1993 and 1997 (mean age 49.3 ± 10.7 years) were included in the analysis. Renal outcome was defined as the first hospitalization with a diagnosis of CKD. At baseline, 146 (19%) and 60 (7.6%) patients met MS and MA criteria, respectively. A total of 20 patients (2.5%) concomitantly showed MS and MA. After a median follow-up of 11.6 years (interquartile range 3.2 years), renal end point was reached in 15.8% of patients with MS and in 8.9% of those without it (P ¼ 0.0087). The incidence of renal events increased progressively starting from patients with neither MS nor MA, to patients with only one of these abnormalities and then to those with both. Significant interaction was observed between MS and MA. Patients with concomitant occurrence of MS and MA at baseline showed a greater than fivefold risk of renal outcome, as compared with patients with neither of these two risk factors (hazard ratio 5.46; 95% confidence interval 2. 34-12.75). This risk became even higher when data were adjusted for potential confounders. MS and MA are independent and interactive predictors of renal outcome in non-diabetic patients with primary hypertension.

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Chronic renal diseases as a public health problem: Epidemiology, social, and economic implications

Cited by 356 publications

References 12 publications

Low-dose paclitaxel ameliorates renal fibrosis in rat UUO model by inhibition of TGF-β/Smad activity

Low-dose paclitaxel ameliorates renal fibrosis in rat UUO model by inhibition of TGF-β/Smad activity

Report of the First Peritoneal Dialysis Program in Guyana, South America

Metabolic syndrome and microalbuminuria predict renal outcome in non-diabetic patients with primary hypertension: the MAGIC study

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