Oxalate nephropathy after Jejuno-Ileal bypass surgery

Taheri, Diana; Sarmadi, Tannaz; Shahidi, Shahrzad; Taheri, Shahram; Mortazavi, Mojgan; Atapour, Abdolamir; Dolatkhah, Shahaboddin; Moayednia, Reza

doi:10.4103/1319-2442.164599

Cited by 4 publications

(12 citation statements)

References 1 publication

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“…Of the included trials, 13 compared the mean change in pretreatment and post-treatment serum potassium levels between the MRAs and control groups (11 –15,17 –20,25 –28). Among them, eight trials (11 –13,18,25 –28) concluded that the changes in serum potassium levels were comparable in the two groups, and four trials (14,17,19,20) reported a significant increase in serum potassium levels compared with the control group. The last study reported mixed data (15); a significant increase in potassium levels could be observed only in patients treated with 50 mg eplerenone daily but not in those treated with lower doses.…”

Section: Resultsmentioning

confidence: 99%

“…All of the articles were RCTs published in English from 2005 to 2020, and a total of 1309 patients were included. Among them, 12 adopted a parallel design (11 –20,25,26), whereas the other two used a crossover design (27,28). The chosen MRA was spironolactone in 13 trials (11 –14,16 –20,25 –28), and eplerenone was used in one trial (15).…”

Section: Resultsmentioning

confidence: 99%

“…The incidence of hyperkalemia was reported in 11 of the 14 trials (12)(13)(14)(15)(16)(17)(18)(19)(20)26,28), whereas the other three trials (11,25,27) only reported the changes in serum potassium level. Among the 11 studies, only seven (12,13,15,(17)(18)(19)28) were included in the final meta-analysis of the risk of hyperkalemia; three of the studies (16,20,26) were excluded for lack of a clear cut point of hyperkalemia, and one ( 14) was excluded for only reporting the incidence of hyperkalemia in the MRA-treated group but not in the control group. The definitions of hyperkalemia varied across studies; it was defined as potassium level of .5.5 in three (18,19,28), .6.0 in another four (12,13,15,17), and .6.5 in three (12,13,15).…”

Section: Hyperkalemia and Serum Potassium Levelmentioning

confidence: 99%

“…However, in patients with kidney failure, despite the potential effect of mitigating the adverse effect of both cardiac remodeling and hyperaldosteronism, MRAs are not frequently applied because of the fear of hyperkalemia. We found several prospective studies (11 –20) and a medium-sized meta-analysis (21) that focused on the efficacy of MRAs in the past decade. Many of these studies have reported clinical benefits of MRAs despite higher risk of hyperkalemia.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and Safety of Mineralocorticoid Receptor Antagonists in Kidney Failure Patients Treated with Dialysis: A Systematic Review and Meta-Analysis

Chen

Kang

Lin

et al. 2021

CJASN

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Background and objectivesPatients with kidney failure have a high risk of cardiovascular disease due to cardiac remodeling, left ventricular fibrosis, and hyperaldosteronism, all of which can be potentially mitigated by mineralocorticoid receptor antagonists. However, because of the fear of hyperkalemia, the use of mineralocorticoid receptor antagonists in patients with kidney failure is limited in current clinical practice, and few studies have investigated the efficacy and safety. Thus, we aimed to determine the benefits and side effects of mineralocorticoid receptor antagonists in patients with kidney failure treated with dialysis.Design, setting, participants, & measurementsThis is a systematic review and meta-analysis of randomized controlled trials published from 2005 to 2020 that compared the effect of mineralocorticoid receptor antagonists with either placebo or no treatment in patients with kidney failure. Two reviewers independently searched the PubMed, EMBASE, and Cochrane databases for all published studies, extracted data, assessed the risk of bias, and rated the quality of evidence. A meta-analysis was conducted on 14 eligible randomized controlled trials, and a total of 1309 patients were included.ResultsHigh-quality evidence suggested that mineralocorticoid receptor antagonists are associated with lower cardiovascular mortality (relative risk, 0.41; 95% confidence interval, 0.24 to 0.70; P=0.001) and all-cause mortality (relative risk, 0.44; 95% confidence interval, 0.30 to 0.66; P<0.001), and the risk of hyperkalemia was comparable with that of control group (relative risk, 1.12; 95% confidence interval, 0.91 to 1.36; P=0.29). However, no significant decrease in nonfatal cardiovascular events and stroke was observed, and there was no significant improvement in BP or cardiac performance parameters, including left ventricular ejection fraction and left ventricular mass index.ConclusionsOur meta-analysis suggests that mineralocorticoid receptor antagonists might improve clinical outcomes of patients with kidney failure without significant increase in the risk of hyperkalemia.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Hyperkalemia and Serum Potassium Levelmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Efficacy and Safety of Mineralocorticoid Receptor Antagonists in Kidney Failure Patients Treated with Dialysis: A Systematic Review and Meta-Analysis

Chen

Kang

Lin

et al. 2021

CJASN

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“…Furthermore, patient and graft survival post-transplant with RYGB are comparable to patients without bariatric surgery [16,17]. However, despite the benefit of RYGB in facilitating kidney transplant and co-morbidity management, RYGB has been reported to correlate with the risk for oxalate nephropathy and graft failure in several case reports [10,11,13,[18][19][20][21]. This likely influenced the most recent guideline on management of obesity in kidney transplant candidates recommending laparoscopic sleeve gastrectomy over other forms of bariatric surgery [22].…”

Section: Discussionmentioning

confidence: 99%

Characteristics and Graft Outcomes of Kidney Transplant Candidates with Enteric Risk Factors and Elevated Plasma Oxalate Levels

Khan¹,

Zhang²,

Jawdeh³

et al. 2023

Am J Nephrol

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Introduction: This study describes patient characteristics and examines graft function of kidney transplant recipients (without primary hyperoxaluria) with elevated plasma oxalate (POx) and enteric risk factors prior to transplant at our institution. Methods: Kidney transplant recipients between 2012 to 2020 with elevated POx at the time of kidney transplant evaluation were included. A matched control cohort was gathered using patient/donor age, living/deceased donor type, panel reactive antibody (PRA), kidney donor profile index (KDPI), and human leukocyte antigen (HLA) mismatch as matching variables. Graft function at 1 year and at last follow-up was reported. Results: A total of 106 patients with elevated POx were identified. A third of the patients had Roux-en-Y gastric bypass, a third had other enteric risks, and a third did not have an identifiable enteric risk. Median eGFR (estimated glomerular filtration rate) at 1-year and at last follow-up were similar between cases and controls except for subgroup of patients with pre-transplant POx >30mcmol/L where 1-year eGFR was lower compared to controls. Across eGFR categories, more cases were in eGFR category <30ml/min/1.73m2 compared to controls. Discussion/Conclusion: Roux-en-Y gastric bypass is the most common identifiable risk for elevated POx in kidney transplant candidates. 1-year graft function was not inferior in cases compared to matched controls except for subgroup with POx>30mcmol/L pre-transplant.

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The effects of mineralocorticoid receptor antagonists on cardiovascular outcomes in patients with end‐stage renal disease and heart failure

Lin

et al. 2022

European J of Heart Fail

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Aims Mineralocorticoid receptor antagonists (MRAs) have been shown to provide survival benefits in patients with heart failure; however, MRA use in patients with chronic kidney disease has been limited by safety concerns. The effects of MRAs on outcomes in patients with end‐stage renal disease (ESRD) and heart failure remain unknown. The aim of this study was to evaluate the effects of MRAs on cardiovascular outcomes in patients with heart failure under maintenance dialysis in a real‐world setting. Methods and results A retrospective cohort study was conducted by collecting data from the Taiwan National Health Insurance Research Database (NHIRD). Patients diagnosed with heart failure and ESRD and who started maintenance dialysis between 1 January 2001 and 31 December 2013 were identified. Patients were grouped according to MRA prescription. The outcomes of interest included cardiovascular (CV) death, hospitalization for heart failure (HHF), all‐cause mortality, acute myocardial infarction (AMI), ischaemic stroke, any coronary revascularization procedures, and new‐onset hyperkalaemia. Propensity score matching was performed at a 1:3 ratio between MRA users and non‐users to minimize selection bias. A total of 50 872 patients who satisfied our inclusion and exclusion criteria were identified. After 1:3 matching, 2176 patients were included in the MRA group, and 6528 patients were included in the non‐MRA group. The risk of CV death was significantly lower among patients who received MRAs than those who did not (hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.80–0.95), as was the risk of all‐cause mortality (HR 0.88, 95% CI 0.83–0.94). Reductions in the risks of CV death and all‐cause mortality were more prominent among patients undergoing haemodialysis and those with coronary artery disease. Conclusions In patients undergoing regular dialysis who are diagnosed with heart failure, the use of MRAs is associated with lower risks of all‐cause mortality and CV death. The benefits of MRA treatment in heart failure may persist in patients with ESRD. Further investigations through randomized controlled trials are needed to assess the efficacy and safety of MRAs in this high‐risk population.

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Oxalate nephropathy after Jejuno-Ileal bypass surgery

Cited by 4 publications

References 1 publication

Efficacy and Safety of Mineralocorticoid Receptor Antagonists in Kidney Failure Patients Treated with Dialysis: A Systematic Review and Meta-Analysis

Efficacy and Safety of Mineralocorticoid Receptor Antagonists in Kidney Failure Patients Treated with Dialysis: A Systematic Review and Meta-Analysis

Characteristics and Graft Outcomes of Kidney Transplant Candidates with Enteric Risk Factors and Elevated Plasma Oxalate Levels

The effects of mineralocorticoid receptor antagonists on cardiovascular outcomes in patients with end‐stage renal disease and heart failure

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