The Efficacy Evaluation of the Nephroprotective Therapy: Minireview and Saint Petersburg Registry Data

Земченков, А. Ю.; Румянцев, А. Ш.; Смирнов, А. В.

doi:10.24884/1561-6274-2018-22-1-58-68

Cited by 5 publications

(2 citation statements)

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“…The predicted time to achieve the need for RRT from 20 ml/ min/1.73 m 2 in the treatment group was 5 months longer. Thus, in real practice, the accuracy of previous simulation modeling has been confirmed: the predicted lengthening of the predialysis stage of treatment was 1.6 ± 1.7 years (p = 0.002) from the baseline GFR level of 20-40 ml/min/1.73 m 2 [56].…”

Section: Discussionmentioning

confidence: 60%

Renoprotective interventions efficacy in the late stages of CKD

Sergeevna Sadovskaya

2024

Chronic Kidney Disease - Novel Insights Into Pathophysiology and Treatment

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The efficacy of renoprotective interventions in the late stages of chronic kidney disease (CKD) varies significantly from that in the early stages, with approaches in advanced CKD being insufficiently developed and sometimes conflicting. In a small prospective study, we evaluated the effectiveness of intensive follow-up protocol aimed at reducing CKD progression rates, cardiovascular complications, and improving outcomes among 100 patients with CKD3B-5 stages at a single center. This evaluation was compared with the outcomes of standard nephrology care. Positive changes in modifiable parameters resulting from interventions (such as serum albumin, hemoglobin, and standard bicarbonate) or reductions in negative parameters (like serum phosphate, plasma calcium deviation from target range, uric acid, and systolic blood pressure) were independently associated with a comparable reduction in the decrease of glomerular filtration rate (GFR). For the treatment group, the predicted time to reach the need for renal replacement therapy (RRT) from a conditional GFR of 20 ml/min/1.73 m2 was 5 months longer than in the regular follow-up group. The distribution of average GFR at the start of dialysis suggested a late and possibly premature start in the control group, with less than 60% of cases being planned. In contrast, the treatment group always had a planned start.

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Section: Discussionmentioning

confidence: 60%

Renoprotective interventions efficacy in the late stages of CKD

Sergeevna Sadovskaya

2024

Chronic Kidney Disease - Novel Insights Into Pathophysiology and Treatment

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“…длиннее. Таким образом, в реальной практике подтверждена точность симуляционного моделирования с вводными данными из российской популяции: прогнозируемое удлинение преддиализного этапа лечения составило 1,6 ± 1,7 года (p = 0,002) от уровня исходной СКФ в 20-40 мл/мин/1,73 м 2 [52].…”

Section: Discussionunclassified

Evaluation of the nephroprotective strategy effectiveness in the late stages of chronic kidney disease

Sadovskaya

Vishnevskii

Konakova

et al. 2023

HERALD of North-Western State Medical University named after I.

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Background. Classical nephroprotection reduces its effectiveness at the late CKD stages; the search for effective algorithms is hampered by accelerating decline in GFR, therefore there are no generally accepted ways to evaluate the effectiveness. Aim: to build a model for predicting the GFR decline rate in order to assess the effectiveness of the intensive follow-up. Methods. A representative group of regular follow-up (N=540) was allocated from the city database (N=7696) to built-up the polynomial model that predicts GFR annual decline. We used the model to evaluate the intensive monitoring effectiveness (N=100) by the difference between predicted and actual rates of GFR decline. We also selected well matched subgroup of 200 patients for direct comparison of hard and surrogate outcomes. Results. During last year before need in dialysis, the rate of GFR decline in intensive group was 5.981.69 vs. the predicted 9.060.59ml/min/1.73 m/year. We used that assessment of the intervention effectiveness as dependent variable in regression and categorical analysis. The significant components of the nephroprotection: phosphatemia decrease (0.25 mmol/l), hemoglobin increase (1 g/dl), effective administration of RAAS blockers (to reduce proteinuria by 0.1 g/l), systolic blood pressure decrease (5 mmHg), calcemia deviations decrease from the target (0.1 mmol/l), acidosis correction (2 mmol/l), inflammation reduction and albumin increase (1.5 g/l) -were associated with the smaller GFR decrease rate by 15%. In intensive group, the dialysis risk was 2.2 times lower, the death risk was 4 times. The only planned dialysis start was ensured in intensive group, 67% chose peritoneal dialysis. Conclusions. The prediction of GFR decline rate calculated by nonlinear model in comparison with the actual one can evaluate the nephroprotection effectiveness; it differs significantly from the classical ones at the CKD late stages.

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Urine uromodulin and angiotensin converting enzyme inhibitors: is there a relationship?

Khasun¹,

Rumyantsev

Galkina³

2022

Nefrologiâ (St.-Peterbg.)

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BACKGROUND. Uromodulin (UMO) is a multifunctional glycoprotein expressed in epithelial cells of the thick ascending part of the loop of Henle. Currently, enough information has been accumulated about the participation of this glycoprotein in a number of important physiological and pathological processes. THE AIM: to evaluate the relationship between the level of urine uromodulin (Umo) and the intake of angiotensin converting enzyme (ACE) inhibitors in chronic kidney disease. PATIENTS AND METHODS. 96 patients aged 43.6±15.4 years were examined. (M:W = 46:50). The presence of kidney disease in all cases is confirmed morphologically. The main criterion for the inclusion of patients in the study was the presence of CKD C1-C3. The exclusion criteria were age over 70 years, the presence of diabetes mellitus, immunosuppressive therapy at the time of examination, taking diuretics. Umo concentrations in blood serum (SUmo) and urine (UUmo) were measured by enzyme immunoassay. Serum and urinary concentrations of creatinine, potassium, sodium, chlorine, calcium, and inorganic phosphorus, as well as protein levels in urine, were also determined. The glomerular filtration rate (eGFR) was calculated using the formula CKD-EPI. The values of daily excretion, clearance, and fractional excretion were calculated for all ions. RESULTS. The patients were divided into two groups: group 1 – 20 people who did not take ACE inhibitors; group 2 – 78 people who took ACE inhibitors. The content of Umo in urine correlated in the first group with the value of systolic and diastolic blood pressure and serum Umo. In the second group, associations of the concentration of Umo in urine with age, eGFR, the excreted fraction of sodium and chlorine, and serum Umo were noted. CONCLUSION. The data obtained suggest that the nephroprotective properties of ACE inhibitors are broader than is commonly thought. Our data allow us to talk about their protective effect at the level of the tubular apparatus. The authors believe that the information currently available is quite sufficient to discuss the need to introduce the definitions of SUmo and UUmo into real clinical practice.

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The Efficacy Evaluation of the Nephroprotective Therapy: Minireview and Saint Petersburg Registry Data

Cited by 5 publications

References 0 publications

Renoprotective interventions efficacy in the late stages of CKD

Renoprotective interventions efficacy in the late stages of CKD

Evaluation of the nephroprotective strategy effectiveness in the late stages of chronic kidney disease

Urine uromodulin and angiotensin converting enzyme inhibitors: is there a relationship?

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