scholarly journals Management of chronic kidney disease- an update

2015 ◽  
Vol 9 (1) ◽  
pp. 46-52
Author(s):  
Faruk Ahammad
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Public Health Issue ◽  
Global Public Health ◽  
Kidney Structure ◽  
Disease Epidemiology ◽  
Urine Albumin ◽  
Referral Criteria ◽  
Previous Definition ◽  
One Year

Chronic kidney disease (CKD) is a global public health issue demanding continuous improvement in its management. Different international groups and organizations have now achieved a good progress in its definition, classification (staging), treatment and referral criteria to nephrologists. In definition of CKD, "CKD is defined as abnormalities of kidney structure or function, present for at least three months with implications for health", the phrase "with implications for health" has been added at the end of the previous definition, which reflects the concept that there may be certain abnormalities of kidney structure or function that do not have prognostic consequences (for example, a simple renal cyst). At staging of CKD, grade 3 has been subdivided into G3a and G3b, according to whether the glomerular filtration rate (GFR) is (59 - 45) or (44 - 30) ml/min/1.73m2, respectively. Furthermore, albuminuria has been classified in any GFR grade, in to A1, A2 or A3 according to the albumin-creatinine ratio (ACR) in an isolated urine sample for values <3, 3-30 or >30mg/mmol, respectively. The term "microalbuminuria" has now been replaced by the term "moderately increased albuminuria". For GFR measurement Chronic Kidney Disease Epidemiology Collaboration (CKD- EPI) equation has been preferred than the Modification of Diet in Renal Disease (MDRD) study equation and new 2012 KDIGO guidelines consider the use of alternative formulas to be acceptable if they have been shown to improve accuracy when compared with the CKD-EPI formula. For detection of albuminuria ACR is preferred rather than conventional 24 hours urine albumin. The recommended BP control target is ?140/90mmHg (both diabetic and non-diabetic) if ACR <3mg/mmol and a stricter target is suggested, with BP ?130/80mmHg, (both in diabetic and non-diabetic) if the ACR is ? 3mg/mmol. Use of erythropoisis-stimulating agent (ESA) in anemia of CKD should be rational; to avoid its adverse effects like stroke, thrombosis or hypertension acceleration and hemoglobin goals should not exceed 11 g per dl. Treating dyslipidaemia in CKD with statins for all adults >50 years of age, irrespective of low density lipoprotien (LDL) cholesterol levels is recommended. Referral to nephrologist should be rational according to guidelines and at least one year prior to the start of renal replacement therapy (RRT).Faridpur Med. Coll. J. 2014;9(1): 46-52

scholarly journals Antisense Oligonucleotide: A Potential Therapeutic Intervention for Chronic Kidney Disease

2022 ◽  
Vol 2 (1) ◽  
pp. 16-37
Author(s):  
Yalin Li ◽  
Yuqin Tan ◽  
Rui Zhang ◽  
Tao Wang ◽  
Ning Na ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Antisense Oligonucleotide ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Public Health Issue ◽  
Global Public Health ◽  
Converting Enzyme Inhibitors ◽  
Development Platform

Chronic kidney disease (CKD) is a global public health issue that places an increasing burden on the healthcare systems of both the developed and developing countries. CKD is a progressive and irreversible condition, affecting approximately 10% of the population worldwide. Patients that have progressed to end-stage renal disease (ESRD) require expensive renal replacement therapy, i.e., dialysis or kidney transplantation. Current CKD therapy largely relies on the use of angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs). However, these treatments by no means halt the progression of CKD to ESRD. Therefore, the development of new therapies is urgently needed. Antisense oligonucleotide (ASO) has recently attracted considerable interest as a drug development platform. Thus far, eight ASO-based drugs have been granted approval by the US Food and Drug Administration for the treatment of various diseases. Herein, we review the ASOs developed for the identification of CKD-relevant genes and/or the simultaneous development of the ASOs as potential therapeutics towards treating CKD.

Carnosine and Kidney Diseases: What We Currently Know?

2020 ◽  
Vol 27 (11) ◽  
pp. 1764-1781 ◽  
Author(s):  
Katarzyna Kilis-Pstrusinska
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Enzyme Inhibitor ◽  
Kidney Diseases ◽  
Ischemia Reperfusion ◽  
Public Health Issue ◽  
Global Public Health ◽  
Drug Induced ◽  
Treatment And Prevention

: Carnosine (beta-alanyl-L-histidine) is an endogenously synthesised dipeptide which is present in different human tissues e.g. in the kidney. Carnosine is degraded by enzyme serum carnosinase, encoding by CNDP1 gene. Carnosine is engaged in different metabolic pathways in the kidney. It reduces the level of proinflammatory and profibrotic cytokines, inhibits advanced glycation end products’ formation, moreover, it also decreases the mesangial cell proliferation. Carnosine may also serve as a scavenger of peroxyl and hydroxyl radicals and a natural angiotensin-converting enzyme inhibitor. : This review summarizes the results of experimental and human studies concerning the role of carnosine in kidney diseases, particularly in chronic kidney disease, ischemia/reperfusion-induced acute renal failure, diabetic nephropathy and also drug-induced nephrotoxicity. The interplay between serum carnosine concentration and serum carnosinase activity and polymorphism in the CNDP1 gene is discussed. : Carnosine has renoprotective properties. It has a promising potential for the treatment and prevention of different kidney diseases, particularly chronic kidney disease which is a global public health issue. Further studies of the role of carnosine in the kidney may offer innovative and effective strategies for the management of kidney diseases.

KECEMASAN PASIEN PENYAKIT GINJAL KRONIS YANG MENJALANI HEMODIALISA

2019 ◽  
Vol 4 (1) ◽  
pp. 1
Author(s):  
Devi Novita Damanik
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Rating Scale ◽  
Femoral Vein ◽  
Univariate Analysis ◽  
Sampling Technique ◽  
Emotional Disturbances ◽  
Hamilton Anxiety Rating Scale ◽  
One Year ◽  
Severe Anxiety

Background: Anxiety is a condition of psychological and physiological disorders characterized by cognitive, somatic, emotional disturbances and components of behavioral sequences. Purpose: This study aims to describe the anxiety of chronic kidney disease patients undergoing hemodialysis. Methods: This study uses univariate analysis which will describe the anxiety level of chronic kidney disease patients undergoing hemodialysis. The anxiety variable was measured using the HARS (Hamilton Anxiety Rating Scale) anxiety instrument with a validity value of 0.68 dd 0.93 and a reliability value of 0.93. The population in this study were all chronic kidney disease patients who underwent hemodialysis and experienced anxiety. The sampling technique used in this study was purposive sampling technique. The sample in this study were patients with chronic kidney disease who met the requirements of the study patients, namely: Patients who underwent hemodialysis for less than one year, patients undergoing hemodialysis with femoral vein puncture, patients undergoing hemodialysis twice a week. Results: The results showed that the study respondents had a mild anxiety rate of 9 patients (56.25%), moderate anxiety as many as 8 patients (21.875%) and severe anxiety as many as 8 patients (21.875%). Conclusion: conclusions and implications for nursing practice. The results showed a high incidence of anxiety in patients undergoing hemodialysis and distributed evenly on mild, moderate and severe anxiety.

scholarly journals A Systematic Review and Meta-Analysis of Pharmacogenetic Studies in Patients with Chronic Kidney Disease

2021 ◽  
Vol 22 (9) ◽  
pp. 4480
Author(s):  
Maria Tziastoudi ◽  
Georgios Pissas ◽  
Georgios Raptis ◽  
Christos Cholevas ◽  
Theodoros Eleftheriadis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Meta Analysis ◽  
Public Health Problem ◽  
Response To Treatment ◽  
Genotype Distribution ◽  
Global Public Health ◽  
High Prevalence ◽  
Additive Inheritance

Chronic kidney disease (CKD) is an important global public health problem due to its high prevalence and morbidity. Although the treatment of nephrology patients has changed considerably, ineffectiveness and side effects of medications represent a major issue. In an effort to elucidate the contribution of genetic variants located in several genes in the response to treatment of patients with CKD, we performed a systematic review and meta-analysis of all available pharmacogenetics studies. The association between genotype distribution and response to medication was examined using the dominant, recessive, and additive inheritance models. Subgroup analysis based on ethnicity was also performed. In total, 29 studies were included in the meta-analysis, which examined the association of 11 genes (16 polymorphisms) with the response to treatment regarding CKD. Among the 29 studies, 18 studies included patients with renal transplantation, 8 involved patients with nephrotic syndrome, and 3 studies included patients with lupus nephritis. The present meta-analysis provides strong evidence for the contribution of variants harbored in the ABCB1, IL-10, ITPA, MIF, and TNF genes that creates some genetic predisposition that reduces effectiveness or is associated with adverse events of medications used in CKD.

scholarly journals An Update on Hepatocellular Carcinoma in Chronic Kidney Disease

Cancers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 3617
Author(s):  
Fabrizio Fabrizi ◽  
Roberta Cerutti ◽  
Carlo M. Alfieri ◽  
Ezequiel Ridruejo
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Early Stage ◽  
Survival Rates ◽  
International Study ◽  
Public Health Issue ◽  
Advanced Chronic Kidney Disease ◽  
Ablative Techniques ◽  
Risk Of Cancer

Chronic kidney disease is a major public health issue globally and the risk of cancer (including HCC) is greater in patients on long-term dialysis and kidney transplant compared with the general population. According to an international study on 831,804 patients on long-term dialysis, the standardized incidence ratio for liver cancer was 1.2 (95% CI, 1.0–1.4) and 1.5 (95% CI, 1.3–1.7) in European and USA cohorts, respectively. It appears that important predictors of HCC in dialysis population are hepatotropic viruses (HBV and HCV) and cirrhosis. 1-, 3-, and 5-year survival rates are lower in HCC patients on long-term dialysis than those with HCC and intact kidneys. NAFLD is a metabolic disease with increasing prevalence worldwide and recent evidence shows that it is an important cause of liver-related and extra liver-related diseases (including HCC and CKD, respectively). Some longitudinal studies have shown that patients with chronic hepatitis B are aging and the frequency of comorbidities (such as HCC and CKD) is increasing over time in these patients; it has been suggested to connect these patients to an appropriate care earlier. Antiviral therapy of HBV and HCV plays a pivotal role in the management of HCC in CKD and some combinations of DAAs (elbasvir/grazoprevir, glecaprevir/pibrentasvir, sofosbuvir-based regimens) are now available for HCV positive patients and advanced chronic kidney disease. The interventional management of HCC includes liver resection. Some ablative techniques have been suggested for HCC in CKD patients who are not appropriate candidates to surgery. Transcatheter arterial chemoembolization has been proposed for HCC in patients who are not candidates to liver surgery due to comorbidities. The gold standard for early-stage HCC in patients with chronic liver disease and/or cirrhosis is still liver transplant.

scholarly journals Everyday Discrimination and Kidney Function Among Older Adults: Evidence From the Health and Retirement Study

2019 ◽  
Vol 75 (3) ◽  
pp. 517-521
Author(s):  
Ryon J Cobb ◽  
Roland J Thorpe ◽  
Keith C Norris
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
The United States ◽  
Health And Retirement Study ◽  
Disease Epidemiology ◽  
Lower Egfr ◽  
Everyday Discrimination ◽  
Retirement Study

Abstract Background With advancing age, there is an increase in the time of and number of experiences with psychosocial stressors that may lead to the initiation and/or progression of chronic kidney disease (CKD). Our study tests whether one type of experience, everyday discrimination, predicts kidney function among middle and older adults. Methods The data were from 10 973 respondents (ages 52–100) in the 2006/2008 Health and Retirement Study, an ongoing biennial nationally representative survey of older adults in the United States. Estimated glomerular filtration rate (eGFR) derives from the Chronic Kidney Disease Epidemiology Collaboration equation. Our indicator of everyday discrimination is drawn from self-reports from respondents. Ordinary Least Squared regression (OLS) models with robust standard errors are applied to test hypotheses regarding the link between everyday discrimination and kidney function. Results Everyday discrimination was associated with poorer kidney function among respondents in our study. Respondents with higher everyday discrimination scores had lower eGFR after adjusting for demographic characteristics (B = −1.35, p &lt; .05), and while attenuated, remained significant (B = −0.79, p &lt; .05) after further adjustments for clinical, health behavior, and socioeconomic covariates. Conclusions Our study suggests everyday discrimination is independently associated with lower eGFR. These findings highlight the importance of psychosocial factors in predicting insufficiency in kidney function among middle-aged and older adults.

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