A Patient with Heart Failure and Worsening Kidney Function

Sarnak, Mark J.

doi:10.2215/cjn.11601113

Cited by 28 publications

(19 citation statements)

References 73 publications

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“…In addition, more patients with stage 3 CKD were also included in this study compared with our study. It is well known that certain clinical factors, such as diabetes, proteinuria, heart failure, and baseline eGFR, could exacerbate the eGFR decline rate in patients with CKD [28][29][30][31]. In our study, although pharmacologic urate-lowering therapy was not related to kidney survival, univariate Cox regression analysis revealed that the above-mentioned clinical factors were also the significant prognostic factors for kidney survival.…”

Section: Discussionmentioning

confidence: 45%

Urate-lowering agents for asymptomatic hyperuricemia in stage 3 – 4 chronic kidney disease: Controversial role of kidney function

Jeon

Shin

2019

PLoS ONE

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Because the serum uric acid level increases as the glomerular filtration rate (GFR) decreases, hyperuricemia is associated with chronic kidney disease (CKD). Although hyperuricemia is a risk factor for CKD progression, the causal role of uric acid remains controversial in patients with CKD and asymptomatic hyperuricemia. This study included 588 patients with stage 3-4 CKD and asymptomatic hyperuricemia. Using propensity score matching, 165 pairs treated and untreated with pharmacologic urate-lowering therapy were matched. Kaplan-Meier curves were constructed to determine the effect of urate-lowering agents on kidney survival. The prognostic value for kidney survival was ascertained using Cox regression analysis. The GFR changes over time between the patients treated and untreated with urate-lowering agents were assessed using a linear mixed model analysis. The mean age of the matched patients was 63.2 ± 12.7 years, and 52 (15.8%) patients had diabetic nephropathy. The mean estimated GFR (eGFR) and serum uric acid level were 36.7 mL/min/1.73 m 2 and 7.8 mg/dL, respectively. During a mean follow-up period of 41.9 months, 87 developed end-stage kidney disease (ESKD). The incidence rates of ESKD were comparable between the patients treated and untreated with urate-lowering agents. The Kaplan-Meier analysis indicated that kidney survival was also comparable between them. In the multivariate analysis, heart failure and low eGFR were the significant prognostic factors for kidney survival. However, pharmacologic urate-lowering therapy was not predictive of kidney survival. The overall GFR decline rate was also comparable between the groups (P = 0.13). The efficacy of pharmacologic urate-lowering therapy in delaying CKD progression remains controversial. Therefore, further randomized controlled trials are needed to confirm its efficacy in attenuating kidney function deterioration in patients with stage 3-4 CKD.

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Section: Discussionmentioning

confidence: 45%

Urate-lowering agents for asymptomatic hyperuricemia in stage 3 – 4 chronic kidney disease: Controversial role of kidney function

Jeon

Shin

2019

PLoS ONE

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“…Kidney and cardiac dysfunction frequently coexist, reflecting common factors in their aetiology including diabetes, hypertension, atherosclerosis and left ventricular hypertrophy [14]. The cardio-renal syndrome describes the bidirectional relationship between the heart and kidneys whereby dysfunction in either may cause deterioration in the function of the other [14][15][16].…”

Section: Recurrent Episodes Of Aki In Diabetic Kidney Disease Results mentioning

confidence: 99%

A Review of Diabetic Kidney Disease

Chan¹

2017

J Fam Med

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A 41-year-old obese male presented with rapid weight gain (7kg in one week) associated with bilateral oedema to the knees. He had nephrotic range proteinuria of 9 grams per day with impaired kidney function, serum creatinine 176umol/L. He was diagnosed with Type II Diabetes Mellitus (HbA1C 12.1%) and renal biopsy confirmed class III diabetic nephropathy with nodular glomeurlosclerosis.of developing renal failure, cardiovascular morbidity and mortality. Certain ethnic groups -especially Australian Aborigines andTorres Strait Islanders -are genetically predisposed to DKD.6. Patients with diabetic kidney disease are susceptible to acute kidney injury.7. Recurrent episodes of acute kidney injury in diabetic kidney disease result in progressive chronic kidney disease.8. Heart disease is common in diabetic kidney disease. Diabetic kidney disease worsens diabetic heart failure; heart failure worsens diabetic kidney disease.9. Glycaemic control and blood pressure control help reduce the development and progression of both diabetic kidney disease and heart disease.10. ACEI and angiotensin II receptor blockers are useful in diabetic nephropathy and diabetic heart disease. Preparation for End Stage Kidney Disease requires carefulplanning. IntroductionThe incidence and prevalence of diabetes mellitus have grown significantly throughout the world, primarily due to the increasing prevalence of Type II Diabetes Mellitus [1]. This increase in the number of people developing diabetes has had a major impact on the development of diabetic kidney disease (DKD). Although kidney disease attributable to diabetes is referred to as DKD, diabetes and various kidney diseases are common chronic conditions. Thus, people with diabetes may have other aetiologies of chronic kidney disease (CKD) in addition to diabetes. Notably, DKD remains one of the most frequent complications of both types of diabetes, and diabetes is the leading cause of end-stage kidney disease (ESKD), accounting for approximately 50% of cases in the developed world (Figure 1).The overall costs of care for people with DKD are extraordinarily high, due in large part of the strong relationship of DKD with cardiovascular disease (CVD) and development of ESKD [2]. For example, overall Medicare expenditures for diabetes and CKD in the mostly older (>65 years of age) Medicare population were approximately $25 billion in 2011. At the transition to ESKD, the per person per year costs were $20,000 for those covered by Medicare and $40,000 in the younger (<65 years of age) group. Increased albuminuria and decreased glomerular filtration rate (GFR) are each independently and additively associated with an increase in all-cause and CVD mortality, and, in fact, most of the excess CVD of diabetes is accounted for by the population with DKD.The following article discusses the epidemiology, clinical manifestations and treatments associated with diabetic kidney disease. It illustrates the spectrum of diabetic kidney disease which General Practitioners need to appreciate. Messages

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“…In addition, the same animal was associated with increased heart and kidney somatic index. Cardiorenal interaction in congestive heart failure has been increasingly recognized in medicine (SARNAK, 2014;DAMMAN & TESTANI, 2015).…”

Section: Discussionmentioning

confidence: 99%

Anisakis spp. IN TRAHIRAS (Hoplias lacerdae) FROM TELES PIRES RIVER AFFLUENT, MATO GROSSO STATE, BRAZIL

Silva

Bertipaglia

Lopes

et al. 2019

Ars Vet

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Anisakiasis is a parasitic disease caused by the consumption of raw or undercooked fish containing the third larval stage of anisakid nematodes. Safety in fish consumption from extractive fisheries is a challenge for public health authorities. This study presents the hematological analysis, necroscopic and histopathological examination of three Hoplias lacerdae parasitized by Anisakis spp. captured in an affluent of the Teles Pires River, in the municipality of Sinop, State of Mato Grosso, Brazil. At necropsy, intense parasitism was observed, characterized by free and adherent anisakid larvae in organs and mesentery. In the histopathological study, there were nephrotic alterations and hepatopathies, as well as the first report of the presence of Anisakis cyst adhered in the myocardium of Hoplias lacerdae. There was a correlation between the increase in the number of parasites and the circulating leukocytes, influenced by the number of neutrophils and eosinophils. However, other studies should be designed to elucidate the pathophysiological and epidemiological changes in Hoplias lacerdae by the parasitism of Anisakis spp., due to its socioeconomic importance, as well as the potential risk to public health.

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A Patient with Heart Failure and Worsening Kidney Function

Cited by 28 publications

References 73 publications

Urate-lowering agents for asymptomatic hyperuricemia in stage 3 – 4 chronic kidney disease: Controversial role of kidney function

Urate-lowering agents for asymptomatic hyperuricemia in stage 3 – 4 chronic kidney disease: Controversial role of kidney function

A Review of Diabetic Kidney Disease

Anisakis spp. IN TRAHIRAS (Hoplias lacerdae) FROM TELES PIRES RIVER AFFLUENT, MATO GROSSO STATE, BRAZIL

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