Aim
The objective of this meta‐analysis was to compare the effects of off‐pump and on‐pump coronary artery bypass grafting (CABG) on acute kidney injury (AKI) and the need of dialysis after surgery.
...Methods
Comprehensive literature searches for randomized controlled trials (RCTs) of CABG with on‐pump and off‐pump was performed using MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials Systematic Reviews and clinicaltrials.gov from inception through September 2014. Primary outcomes were the incidence of AKI and the need of dialysis. Mortality was assessed among the studies that reported renal outcomes. Pooled risk ratios (RRs) and 95% confidence interval (CI) were calculated using a random‐effect, generic inverse variance method.
Results
Thirty‐three RCTs with 17 322 patients were enrolled in our study. Patients in the off‐pump CABG group had overall lower incidence of AKI (19.1%) compared with the on‐pump CABG group (22.2%). There was a protective effect of off‐pump CABG on the incidence of AKI compared with the on‐pump CABG group (RR: 0.87; 95% CI: 0.77–0.98). However, there was no significant difference in the need for dialysis in the off‐pump group compared with the on‐pump group (RR: 0.84; 95% CI 0.63–1.13). Within the selected trials, post hoc analysis assessing the mortality outcome demonstrated a pooled RR of 0.97 (95% CI, 0.77–1.23) in off‐pump versus on‐pump CABGs.
Conclusions
Our study demonstrates a beneficial effect of off‐pump CABG on the incidence of AKI. However, our meta‐analysis does not show benefits of the need of dialysis or survival among patients undergoing off‐pump CABG.
Summary at a Glance
The authors performed a meta‐analysis of RCTs studying the impact of off‐pump CABG on the incidence of AKI. The analysis favours the use of off‐pump on the outcome of AKI despite lacking an impact on the need for dialysis or mortality.
Aims
To investigate whether metabolic syndrome (MetS) could predict renal outcome in patients with established chronic kidney disease (CKD).
Materials and Methods
We enroled 2500 patients with CKD ...stage 1–4 from the Integrated CKD care programme, Kaohsiung for delaying Dialysis (ICKD) prospective observational study. 66.9% and 49.2% patients had MetS and diabetes (DM), respectively. We accessed three clinical outcomes, including all‐cause mortality, RRT, and 50% decline in estimated glomerular filtration rate events.
Results
The MetS score was positively associated with proteinuria, inflammation, and nutrition markers. In fully adjusted Cox regression, the hazard ratio (HR) (95% confidence interval) of MetS for composite renal outcome (renal replacement therapy, and 50% decline of renal function) in the DM and non‐DM subgroups was 1.56 (1.15–2.12) and 1.31 (1.02–1.70), respectively, while that for all‐cause mortality was 1.00 (0.71–1.40) and 1.27 (0.92–1.74). Blood pressure is the most important component of MetS for renal outcomes. In the 2 by 2 matrix, compared with the non‐DM/non‐MetS group, the DM/MetS group (HR: 1.62 (1.31–2.02)) and the non‐DM/MetS group (HR: 1.33 (1.05–1.69)) had higher risks for composite renal outcome, whereas the DM/MetS group had higher risk for all‐cause mortality (HR: 1.43 (1.09–1.88)).
Conclusions
MetS could predict renal outcome in patients with CKD stage 1–4 independent of DM.
Background
In patients with transthyretin cardiac amyloidosis (ATTR‐CA), renal dysfunction is a poor prognostic indicator. Limited data are available on variables that portend worsening renal ...function (wRF) among ATTR‐CA patients.
Objectives
This study assesses which characteristics place patients at higher risk for the development of wRF (defined as a drop of ≥10% in glomerular filtration rate GFR) within the first year following diagnosis of ATTR‐CA.
Methods
We included patients with ATTR‐CA (n = 134) evaluated between 2/2016 and 12/2022 and followed for up to 1 year at our amyloid clinic. Patients were stratified into two groups: a group with maintained renal function (mRF) and a group with wRF and compared using appropriate testing. Significant variables in the univariate analysis were included in the multivariable logistic regression model to determine characteristics associated with wRF.
Results
Within a follow‐up period of 326 ± 118 days, the median GFR% change measured −6% −18%, +8. About 41.8% (n = 56) had wRF, while the remainder had mRF. In addition, in patients with no prior history of chronic kidney disease (CKD), 25.5% developed de novo CKD. On multivariable logistic regression, only New York Heart Association (NYHA) class ≥III (odds ratio OR: 3.9, 95% confidence interval CI: 1.6–9.3), history of ischemic heart disease (IHD) (OR: 0.3, 95% CI: 0.1–0.7), and not receiving SGLT‐2i (OR: 0.1, 95% CI: 0.02–0.5) were significant predictors of wRF.
Conclusion
Our study demonstrated that the development of de novo renal dysfunction or wRF is common following the diagnosis of ATTR‐CA. Additionally, we identified worse NYHA class and no prior history of IHD as significant predictors associated with developing wRF, while receiving SGLT‐2i therapy appeared to be protective in this population.
Our study demonstrated that the development of de novo renal dysfunction or worsening renal function is common following the diagnosis of ATTR‐CA. Additionally, we identified worse NYHA class and no history of IHD as significant predictors associated with developing worsening renal function, while receiving SGLT2i therapy appeared to be protective.
Abstract
Purpose
Despite our understanding of diabetes as an established risk factor for progressive kidney disease and cardiac complications, the prognostic significance of prediabetes in patients ...with chronic kidney disease (CKD) remains largely unknown.
Methods
Participants of the Chronic Renal Insufficiency Cohort (CRIC) were categorized as having normoglycemia, prediabetes, or diabetes according to fasting plasma glucose, glycated hemoglobin A1c (HbA1c), and treatment with antidiabetic drugs at baseline. Unadjusted and adjusted proportional hazards models were fit to estimate the association of prediabetes and diabetes (versus normoglycemia) with: (1) composite renal outcome (end-stage renal disease, 50% decline in estimated glomerular filtration rate to ≤ 15 mL/min/1.73 m2, or doubling of urine protein-to-creatinine ratio to ≥ 0.22 g/g creatinine); (2) composite cardiovascular (CV) outcome (congestive heart failure, myocardial infarction or stroke); and (3) all-cause mortality.
Results
Of the 3701 individuals analyzed, 945 were normoglycemic, 847 had prediabetes and 1909 had diabetes. The median follow-up was 7.5 years. Prediabetes was not associated with the composite renal outcome (adjusted hazard ratio aHR 1.13; 95% confidence interval CI, 0.96–1.32; P = 0.14), but was associated with proteinuria progression (aHR 1.23; 95% CI, 1.03–1.47; P = 0.02). Prediabetes was associated with a higher risk of the composite CV outcome (aHR 1.38; 95% CI, 1.05–1.82; P = 0.02) and a trend towards all-cause mortality (aHR 1.28; 95% CI, 0.99–1.66; P = 0.07). Participants with diabetes had an increased risk of the composite renal outcome, the composite CV outcome, and all-cause mortality.
Conclusions
In individuals with CKD, prediabetes was not associated with composite renal outcome, but was associated with an increased risk of proteinuria progression and adverse CV outcomes.
Aim
To compare the associations of individual sodium‐glucose co‐transporter‐2 (SGLT2) inhibitors with adverse renal outcomes in patients with type 2 diabetes mellitus (T2DM).
Methods
PubMed, EMBASE, ...CENTRAL and ClinicalTrials.gov were searched for studies published up to May 24, 2016, without language or date restrictions. Randomized trials that reported at least 1 renal‐related adverse outcome in patients with T2DM treated with SGLT2 inhibitors were included. Pairwise and network meta‐analyses were carried out to calculate the odds ratios (ORs) with 95% confidence intervals (CIs), and a cumulative meta‐analysis was performed to assess the robustness of evidence.
Results
In total, we extracted 1334 composite renal events among 39 741 patients from 58 trials, and 511 acute renal impairment/failure events among 36 716 patients from 53 trials. Dapagliflozin was significantly associated with a greater risk of composite renal events than placebo (OR 1.64, 95% CI 1.26‐2.13). Empagliflozin seemed to confer a lower risk than placebo (OR 0.63, 95% CI 0.54‐0.72), canagliflozin (OR 0.48, 95% CI 0.29‐0.82) and dapagliflozin (OR 0.38, 95% CI 0.28‐0.51). With regard to acute renal impairment/failure, only empagliflozin was significantly associated with a lower risk than placebo (OR 0.72, 95% CI 0.60‐0.86). The cumulative meta‐analysis indicated the robustness of our significant findings.
Conclusions
The present meta‐analysis indicated that dapagliflozin may increase the risk of adverse renal events, while empagliflozin may have a protective effect among patients with T2DM. Further data from large well‐conducted randomized controlled trials and a real‐world setting are warranted.
Objectives: To explore the effects of empagliflozin (25 mg) on metabolic and renal parameters in patients with type 2 diabetes mellitus (T2DM). Methods: This retrospective observational comparative ...study was conducted at a military hospital in southern Saudi Arabia. All adults (aged >18 years) with T2DM who attended diabetic clinics between October 2021 to March 2022 (6 months), with or without insulin treatment, were eligible for inclusion in the study. Results: Following the initiation of empagliflozin treatment, statistically significant reductions in patient weight (kg) were observed at 1, 3-5, and 6 months. In addition, low-density lipoprotein levels significantly decreased 3-5 months post-treatment initiation (p=0.011). However, serum creatinine level decreased gradually with time during the treatment with empagliflozin, from 87.45±31.78 (0.105) to 78.39±27.43 (0.033). Furthermore, after empagliflozin treatment, the urinary albumin-to-creatinine ratio significantly decreased at 3-5 and 6 months. Moreover, HbA1c levels exhibited statistically significant decreases at 3-5 months (p<0.001) and at 6 months (p<0.001) following the initiation of empagliflozin treatment. Notably, systolic and diastolic blood pressure significantly reduced 6 months after empagliflozin treatment. Conclusion: In the current study, empagliflozin has demonstrated efficacy in controlling blood pressure and body weight, and improving renal function, short-term dyslipidemia, and glycemic control in patients with T2DM.
Background Estimated glomerular filtration rate (eGFR) trajectories of people entering chronic kidney disease (CKD) stage 4 and their associations with subsequent kidney disease outcomes or death are ...not known. Study Design Longitudinal observational cohort study. Setting & Participants 26,246 patients in the Veterans Affairs Healthcare System who entered CKD stage 4 in fiscal year 2008 followed up until October 2013. Factors 5-year eGFR trajectories, demographic and health characteristics. Outcomes Composite kidney disease outcome of kidney failure, dialysis therapy or transplantation, and death. Results Latent class group modeling and functional characterization suggest the presence of 3 distinct trajectory classes: class 1 (72%), consistent slow decline with absolute eGFR change of −2.45 (IQR, −3.89 to −1.16) mL/min/1.73 m2 per year; class 2 (18%), consistent fast decline and eGFR change of −8.60 (IQR, −11.29 to −6.66) mL/min/1.73 m2 per year; and class 3 (10%), early nondecline and late fast decline with eGFR change of −0.4 mL/min/1.73 m2 per year in years 1 to 3 and −7.98 and −21.36 mL/min/1.73 m2 per year in years 4 and 5, respectively. During 4.34 years of follow-up, 9,809 (37%) patients had the composite kidney disease outcome and 14,550 (55%) patients died. Compared to the referent group (trajectory class 1), HRs for 1-year risk for composite kidney disease outcome for trajectory classes 2 and 3 were 1.13 (95% CI, 1.05-1.22) and 0.67 (95% CI, 0.59-0.75), whereas HRs for 1-year risk for death for classes 2 and 3 were 1.17 (95% CI, 1.10-1.28) and 1.29 (95% CI, 1.18-1.42), respectively. The 1-year risk for composite kidney disease outcome was 32% and was 42% more likely than the risk for death in trajectory classes 1 and 2, respectively, whereas the risk for death was 67% more likely than the risk for composite kidney disease outcome in trajectory class 3. Limitations Inclusion criteria and mostly male participants limit generalizability of study results. Conclusions We characterized 3 different eGFR trajectory classes of people entering CKD stage 4. Our results suggest that the pattern of eGFR trajectory informs the risk for kidney disease outcomes and death.
Purpose
Obesity increases the risk of incident chronic kidney disease (CKD) and is one of the strongest risk factors for new-onset CKD even in the absence of metabolic risk factors. Weight loss has ...been shown to reduce renal hyperfiltration and proteinuria. Metabolic bariatric surgery (MBS) remains an effective treatment for obesity and its metabolic-related complications. However, literature on its impact on renal function remains limited.
Materials and Methods
This was an observational retrospective study in a tertiary centre in Singapore. MBS cases performed at the centre between 2008 and 2019 were included. The primary outcome measures were estimated glomerular filtration rate (eGFR), calculated using the CKD epidemiology collaboration equation, and albuminuria (defined as urine albumin-creatinine ratio (uACR) > 3.5 mg/mmol) at baseline and 1-year post-MBS.
Results
Five hundred fifty-seven patients were included. One-year post-MBS, median eGFR increased from 110.9 mL/min/1.73 m
2
(IQR 92.4 to 121.5) to 112.6 mL/min/1.73 m
2
(IQR 97.3 to 122.3),
p
< 0.001. Median uACR decreased from 1.00 mg/mmol (IQR 0.40 to 3.55) to 0.70 mg/mmol (IQR 0.40 to 1.80) 1-year post-MBS (
p
= 0.001). 12.9% of patients had improved CKD staging. The proportion of patients with albuminuria decreased from 24.8% at baseline to 1.89% 1-year post-MBS (
p
< 0.001). One-year post-MBS, the subgroup with reduced eGFR had significant increases in eGFR (
p
< 0.001), with a trend towards a reduction in uACR.
Conclusions
MBS had a positive impact on renal function with modest but statistically significant improvement in eGFR and reduction in albuminuria at 1-year post-surgery. Longer-term data is required to investigate the durability of this impact.
Graphical abstract
Abnormalities in calcium metabolism are common in chronic kidney disease (CKD). Diminished urinary calcium excretion may promote vascular calcification and increased urinary calcium excretion may ...lead to nephrolithiasis and nephrocalcinosis, conditions associated with CKD.
To study predictors of urinary calcium excretion and its association with adverse clinical outcomes in CKD.
This study assessed 3768 nondialysis participants in the Chronic Renal Insufficiency Cohort study from April 2003 to September 2008. Participants were followed up to October 2018.
Clinically plausible predictors of urinary calcium excretion and 24-h urinary calcium excretion at baseline.
Urinary calcium excretion; incident end stage kidney disease (ESKD), CKD progression 50% estimated glomerular filtration rate (eGFR) decline or incident ESKD, all-cause mortality, and atherosclerotic cardiovascular disease events.
eGFR was positive correlated with 24-h urinary calcium excretion. The variables most strongly associated with 24-h urinary calcium excretion in males and females were 24-h urinary sodium (β = 0.19 and 0.28, respectively), serum parathyroid hormone (β = -0.22 and -0.20, respectively), loop diuretics (β = 0.36 and 0.26, respectively), thiazide diuretics (β = -0.49 and -0.53, respectively), and self-identified black race (β = -0.23 and -0.27, respectively). Lower urinary calcium excretion was associated with greater risks of adverse outcomes, but these associations were greatly attenuated or nullified after adjustment for baseline eGFR.
Urinary calcium excretion is markedly lower in individuals with CKD compared to the general population. Determinants of urinary calcium excretion differed between sexes and levels of CKD. Associations between urinary calcium excretion and adverse clinical events were substantially confounded by eGFR.
Background
Tubulointerstitial nephritis and uveitis syndrome (TINU) is a rare condition characterised by bilateral uveitis and interstitial nephritis. There is no nationally, or internationally ...agreed upon treatment regimen. A systematic review was undertaken to report the renal outcomes in TINU, and treatments used.
Methods
Medline (1969–2021) and EMBASE (1988–2021) databases were searched for primary studies, clinical practice guidelines and case reports of adult and paediatric TINU cases, as defined by Mandeville criteria. Two reviewers identified articles meeting inclusion criteria (registered with PROSPERO). Data were extracted into a synthesis table and meta-analysis performed. Quality of case series was also assessed.
Results
One hundred twenty-two articles were identified, totalling 257 cases included in the meta-analysis. Females were more commonly affected than males (2:1), and median age was 19 years. GFR at follow-up correlated with nadir GFR, and the proportion with GFR <90 ml/min/1.73 m
2
was statistically different between adult and paediatric groups. Of the entire cohort, 40% had GFR <90 ml/min/1.73 m
2
at follow-up. Glucocorticoid monotherapy was the most common treatment (70%); other strategies included no treatment (9%) and immunosuppressant drugs (e.g. azathioprine), mostly in steroid-resistant cases, or as ‘steroid-sparing’ alternatives.
Conclusions
The majority of literature regarding TINU is limited to case reports and case series. There are no prospective trials assessing the effects of different treatments on renal outcomes, and currently employed treatment strategies are physician-specific without a reliable evidence-base. Prospective data collection as part of multicentre trials should be a research focus to improve the evidence-base.
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