Severe Decline of Estimated Glomerular Filtration Rate Associates with Progressive Cognitive Deterioration in the Elderly: A Community-Based Cohort Study

Chen, Yi Chi; Weng, Shuo-Chun; Liu, Jia Sin; Chuang, Han Lin; Hsu, Chih Cheng; Tarng, Der Cherng

doi:10.1038/srep42690

Cited by 25 publications

(33 citation statements)

References 55 publications

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“…A few aspects of the methodology require comment. The use of a threshold 20% decline in renal function as an end‐point reflects increasing calls to adopt such a strategy and is in keeping with previous studies . Percentage change based on single sample assays at each time point is less precise than multiple measures, while lack of urinary albumin data limits interpretation of CKD states.…”

Section: Discussionmentioning

confidence: 68%

Renal impairment after ileostomy formation: a frequent event with long‐term consequences

et al. 2019

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Aim High stoma output and dehydration is common following ileostomy formation. However, the impact of this on renal function, both in the short term and after ileostomy reversal, remains poorly defined. We aimed to assess the independent impact on kidney function of an ileostomy after rectal cancer surgery and subsequent reversibility after ileostomy closure. Methods This retrospective single‐site cohort study identified patients undergoing rectal cancer resection from 2003 to 2017, with or without a diverting ileostomy. Renal function was calculated preoperatively, before ileostomy closure, and 6 months after ileostomy reversal (or matched times for patients without ileostomy). Demographics, oncological treatments and nephrotoxic drug prescriptions were assessed. Outcome measures were deterioration from baseline renal function and development of moderate/severe chronic kidney disease (CKD ≥ 3). Multivariate analysis was performed to assess independent risk factors for postoperative renal impairment. Results Five hundred and eighty‐three of 1213 patients had an ileostomy. Postoperative renal impairment occurred more frequently in ileostomates (9.5% absolute increase in rate of CKD ≥ 3; P < 0.0001) vs no change in patients without an ileostomy (P = 0.757). Multivariate analysis identified ileostomy formation, age, anastomotic leak and renin–angiotensin system inhibitors as independently associated with postoperative renal decline. Despite stoma closure, ileostomates remained at increased risk of progression to new or worse CKD [74/438 (16.9%)] compared to patients without an ileostomy [36/437 (8.2%), P = 0.0001, OR 2.264 (1.49–3.46)]. Conclusions Ileostomy formation is independently associated with kidney injury, with an increased risk persisting after stoma closure. Strategies to protect against kidney injury may be important in higher risk patients (elderly, receiving renin–angiotensin system antihypertensives, or following anastomotic leakage).

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Section: Discussionmentioning

confidence: 68%

Renal impairment after ileostomy formation: a frequent event with long‐term consequences

et al. 2019

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“…From the literature, we established that a decline of greater than 20% in eGFR was a conservative cutoff point indicating clinically significant kidney function decline. 30 , 31 We defined mildly reduced kidney function as an eGFR between 60 and 89 mL/min/1.73 m 2 and moderately reduced kidney function as an eGFR less than 60 mL/min/1.73 m 2 .…”

Section: Methodsmentioning

confidence: 99%

“…We grouped former smokers with never smokers due to similarities observed in the bivariate analysis and to evaluate the effect of current smoking. 30 SAS version 9.4 (Cary, NC) was used for all analyses.…”

Section: Methodsmentioning

confidence: 99%

Risk Factors for Declines in Kidney Function in Sugarcane Workers in Guatemala

Butler-Dawson

Krisher

Asensio

et al. 2018

Journal of Occupational &Amp; Environmental Medicine

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Objectives:To characterize kidney function of sugarcane workers in Guatemala over the 6-month harvest and identify risk factors associated with changes in kidney function.Methods:Demographic and biological data were collected for 330 sugarcane cutters at the beginning and end of the harvest. Multivariable regression analyses were used to assess factors related to kidney function.Results:A decline in kidney function across the harvest was observed in 36% of the participants. Risk factors associated with this decline included working at a particular plantation mill, local area workers compared with highland workers, and current smokers.Conclusion:Results showed both occupational and behavioral factors play significant roles in declines in kidney function. These results underline the need for a comprehensive approach to the epidemic as well as further investigation of risk factors to guide research and interventions.

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“…The observation that patients with CKD are prone to cognitive impairment is not surprising because CKD shares many of the same risk factors, such as age, hypertension, diabetes, vascular endothelial dysfunction, anaemia and lowered albumin [23]. In addition, cerebrovascular risk factors may lead to cognitive impairment in patients with Alzheimer’s disease or other neurodegenerative diseases, and they may play a critical role in cognitive impairment in patients with CRF [24].…”

Section: Discussionmentioning

confidence: 99%

Change of Peripheral Blood Treg/Thl7 in Cognitive Impairment with Chronic Renal Failure Patients

Wang

Huang

et al. 2018

Cell Physiol Biochem

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Background/Aims: To investigate the changes in peripheral blood Treg/Th17 cell balance and its significance in patients with chronic renal failure (CRF) and cognitive impairment. Methods: A total of 71 patients with CRF were enrolled as a study group. The patients were divided into a cognitive impairment group and a normal cognitive function group according to the Mini-Mental State Examination (MMSE). Peripheral blood Treg and Th17 cells were analyzed by flow cytometry and their relevant cytokines (IL-17, IL-10 and TGF-β) and other biochemical indicators, including C-reactive protein (CRP) and IL-6, were determined by ELISA. Results: Thepatients with both CRF and cognitive impairment were older than the cognitive normal groups. Peripheral blood Treg cells by Flow cytometry (the CRF cognitive impairment group 5.57±1.3%, CRF group with normal cognitive function 7.5 ± 0.9% and normal control group 9.7 ± 1.7%,P<0.05) and its related cytokines (IL-10 and TGF-β) by ELISA detection were lower in the group with cognitive impairment than in the group without cognitive impairment ( IL-10, 7.4±4.2 pg/mL, 13.8±3.9 pg/mL, 18.3±3.2 pg/mL; TGF-β 335.6±175.3 pg/mL, 512.7 ± 114.6 pg/mL, 953.8±373.4 pg/mL P < 0.05, respectively).However, Th17 cell numbers (the CRF cognitive impairment group 3.3 ± 0.7%, CRF group with normal cognitive function2.2 ± 0.5% and normal control group 1.5 ± 0.3%),and cytokine levels (IL-17, IL-6 and CRP) were higher in the group with cognitive impairment IL-6 (21.3 ± 5.1 pg/mL), IL-17 (18.5 ± 4.2 pg/mL) and CRP (20.3 ± 5.9 mg/L) in the CRF group with cognitive impairment when compared with the CRF group and normal cognitive function (12.2 ± 4.5 pg/mL, 12.1 ± 3.7 pg/mL and 13.5 ± 4.6 mg/L, respectively) or the normal control group (9.2 ± 5.8 pg/mL, 7.4 ± 2.6 pg/mL and 3.2 ± 1.3 mg/L, respectively, P<0.05). The frequencies of Treg in patients with CRF were positively correlated with the MMSE scores ((r = 0.518, P < 0.05), but the Th17 numbers were negatively correlated (r = -0.435, P < 0.05). Conclusion: An imbalance of peripheral blood Treg/Th17 cells is associated with cognitive impairment in patients with CRF.

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Severe Decline of Estimated Glomerular Filtration Rate Associates with Progressive Cognitive Deterioration in the Elderly: A Community-Based Cohort Study

Cited by 25 publications

References 55 publications

Renal impairment after ileostomy formation: a frequent event with long‐term consequences

Renal impairment after ileostomy formation: a frequent event with long‐term consequences

Risk Factors for Declines in Kidney Function in Sugarcane Workers in Guatemala

Change of Peripheral Blood Treg/Thl7 in Cognitive Impairment with Chronic Renal Failure Patients

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