The Relationship Between Nontraditional Risk Factors and Outcomes in Individuals With Stage 3 to 4 CKD

Weiner, Daniel E.; Tighiouart, Hocine; Elsayed, Essam F.; Griffith, John L.; Salem, Deeb N.; Levey, Andrew S.; Sarnak, Mark J.

doi:10.1053/j.ajkd.2007.10.035

Cited by 137 publications

(123 citation statements)

References 30 publications

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“…In accordance with the findings in the hemodialysis population, Evans et al 101 and Kovesdy et al 102 reported that a high BMI was protective in CKD stages 3-5 patients. However, Madero et al 103 and Weiner et al 104 reported that high BMI had no protective effect in CKD stages 3 and 4 patients. In a cohort also including patients with CKD stages 1 and 2, Hsu et al 50 reported that high BMI, similar to the general population, predicts poor outcome.…”

Section: Should Nephrologists Promote Weight Gain In Dialysis Patients?mentioning

confidence: 99%

Obesity in CKD—What Should Nephrologists Know?

Stenvinkel

Zoccali

İkizler

2013

Journal of the American Society of Nephrology

193

171

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Obesity, the epidemic of the 21st century, carries a markedly increased risk for comorbid complications, such as type 2 diabetes, cancer, hypertension, dyslipidemia, cardiovascular disease, and sleep apnea. In addition, obesity increases the risk for CKD and its progression to ESRD. Paradoxically, even morbid obesity associates with better outcomes in studies of ESRD patients on maintenance dialysis. Because the number of obese CKD and maintenance dialysis patients is projected to increase markedly in developed as well as low-and middle-income countries, obesity is a rapidly emerging problem for the international renal community. Targeting the obesity epidemic represents an unprecedented opportunity for health officials to ameliorate the current worldwide increase in CKD prevalence. Nephrologists need more information about assessing and managing obesity in the setting of CKD. Specifically, more precise estimation of regional fat distribution and the amount of muscle mass should be introduced into regular clinical practice to complement more commonly used practical markers, such as body mass index. Studies examining the effects of obesity on kidney disease progression and other clinical outcomes along with weight management strategies are much needed in this orphan area of research. 24: 172724: -173624: , 201324: . doi: 10.1681 Obesity has emerged as the largest pandemic in near history, with important implications of not only cardiovascular disease (CVD) but also CKD. Recent data from the United States indicate that the incidence and prevalence rates of obesity in maintenance dialysis patients largely exceed the corresponding figures in the general population. 1 A large European population survey documented that a high body mass index (BMI) ranks as one of the strongest risk factors for new-onset CKD. 2 The dimension of the obesity epidemic and the impact of the same epidemic on the kidney demand efforts for understanding the epidemiology and the mechanisms of CKD associated with excess adiposity. It also sets as an absolute public health priority for the development of treatment policies integrated across specialties and general practice to halt this much concerning problem. In this scenario, it is fundamental that nephrologists are updated on current knowledge about obesity in the setting of CKD. However, little attention is still paid to this issue in major nephrology journals. The suboptimal attention to the problem by major sources of dissemination of specialty information suggests that nephrologists may have scarce knowledge of how obesity should be assessed, its epidemiology, mechanisms whereby excess fat mass is conducive to CKD, and management of obesity in the catabolic uremic milieu. 3 J Am Soc Nephrol DEFINITION AND ASSESSMENT OF OBESITYThe most common method for defining obesity is based on BMI (i.e., a person's weight as obese. It should be emphasized that population norms of BMI could be different based on ethnic and racial background (i.e., the proportion of Asian people with a high ...

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Section: Should Nephrologists Promote Weight Gain In Dialysis Patients?mentioning

confidence: 99%

Obesity in CKD—What Should Nephrologists Know?

Stenvinkel

Zoccali

İkizler

2013

Journal of the American Society of Nephrology

193

171

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“…Increased serum Hcy level in adult CKD patients is an independent risk factor for cardiovascular system mortality. Elevated ADMA and hyperhomocysteinemia may be due to decreased renal excretion (18)(19)(20)(21)(22). It is reported that ADMA formation may be related with Hcy metabolism (18,19).…”

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confidence: 99%

“…It appears that the increase in endogenic NO inhibitors like ADMA plays a major role in this process (11,(15)(16)(17). It has been shown that Hcy stimulates ADMA formation and plasma ADMA levels elevate in humans and animals by hyperhomocysteinemia (18)(19)(20). Increased serum Hcy level in adult CKD patients is an independent risk factor for cardiovascular system mortality.…”

mentioning

confidence: 99%

“…Chronic Kidney Disease 206 hyperhomocysteinemia may involve ADMA-related cardiovascular effect in CKD (18)(19)(20). Hyperhomocysteinemia, elevated plasma ADMA concentrations have first been described in patients with renal failure (18).…”

mentioning

confidence: 99%

“…ADMA in methylation of homocystein plays an important role. Elevated homocysteine level is strongly related to renal function and probably due to decreased metabolic clearance (18)(19)(20). Homocysteine and ADMA are aminoacids which are biochemically linked by a common synthetic pathway.…”

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The Effects of Asymmetric Dimethylarginine (ADMA), Nitric Oxide (NO) and Homocysteine (Hcy) on Progression of Mild Chronic Kidney Disease (CKD): Relationship Between Clinical and Biochemical Parameters

Atamer¹,

Ecder²,

Atamer³

et al. 2012

Chronic Kidney Disease

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Chronic Kidney Disease 198 and plasma synthesized from endothelial cells (Figure 1). It is shown that high ADMA level increases the cardiovascular incident risk by 34% and mortality risk by 52% (4-8). Increased ADMA concentration has a high prevalence in hyperhomocysteinemia, coronary artery diseases, hypercholesterolemia, diabetes mellitus, hypertension, preeclampsia, peripheral arterial occlusive disease, impaired renal function and other diseases (7,9,10). Reduced nitric oxide (NO)-dependent vasodilation is regarded as an early indicator of atherosclerotic diseases (7,14). It is documented that adult patients with renal failure have 2-6 times higher ADMA than healthy subjects due to reduced renal excretion and reduced enzymatic degradation (15). NO is synthesized from L-arginine via NO synthase enzyme. NO inhibition decreases endothelial derived vasodilation and increases vascular resistance. Reduced NO availability can occur in patients with CKD. Moreover CKD can contribute to the accelaration of hypertension and cardiovascular complications. It appears that the increase in endogenic NO inhibitors like ADMA plays a major role in this process (11,(15)(16)(17). It has been shown that Hcy stimulates ADMA formation and plasma ADMA levels elevate in humans and animals by hyperhomocysteinemia (18)(19)(20). Increased serum Hcy level in adult CKD patients is an independent risk factor for cardiovascular system mortality. Elevated ADMA and hyperhomocysteinemia may be due to decreased renal excretion (18)(19)(20)(21)(22). It is reported that ADMA formation may be related with Hcy metabolism (18,19). It was found that there is a significant interaction of serum fibrinogen and CKD with respect to risk of both fatal/nonfatal coronary events and death (20-24).

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Outcomes after liver transplantation: Chronic kidney disease

Bahirwani

Reddy

2009

Liver Transpl

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Key Points 1. Chronic kidney disease is a common complication after liver transplantation and has a major impact on graft and patient survival. 2. Pretransplant renal dysfunction is the most important determinant of posttransplant chronic kidney disease; other factors include the presence of diabetes/hypertension, acute kidney injury pre‐transplant and post‐transplant, and the use of calcineurin inhibitor–based immunosuppression. 3. The most common cause of end‐stage renal disease post–orthotopic liver transplantation is calcineurin inhibitor toxicity, and this emphasizes the need for calcineurin inhibitor minimization protocols post‐transplant. 4. The presence of chronic kidney disease post–orthotopic liver transplantation not only is important with respect to the need for renal replacement therapy and kidney transplantation but also increases cardiovascular risk dramatically. 5. The Model for End‐Stage Liver Disease score is partly driven by creatinine, and it is not uncommon to have an elevated creatinine level in those who have a high Model for End‐Stage Liver Disease score and are close to having an organ allocated. Thus, evaluating patients with advanced liver disease and pretransplant acute kidney injury is challenging. It is important to identify pre–liver transplant patients at high risk for early evolution of chronic kidney disease post‐transplant in order to appropriately select patients for combined liver/kidney transplantation. Liver Transpl 15:S70–S74, 2009. © 2009 AASLD.

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The Relationship Between Nontraditional Risk Factors and Outcomes in Individuals With Stage 3 to 4 CKD

Abstract: Background-Chronic kidney disease is associated with an increased risk for cardiovascular disease and mortality. Both traditional and non-traditional cardiovascular disease risk factors may contribute.

Cited by 137 publications

References 30 publications

Obesity in CKD—What Should Nephrologists Know?

Obesity in CKD—What Should Nephrologists Know?

The Effects of Asymmetric Dimethylarginine (ADMA), Nitric Oxide (NO) and Homocysteine (Hcy) on Progression of Mild Chronic Kidney Disease (CKD): Relationship Between Clinical and Biochemical Parameters

Outcomes after liver transplantation: Chronic kidney disease

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