Sex and gender differences in the management of chronic kidney disease and hypertension

No abstract available

Bioimpedance in CKD: an untapped resource?

No abstract available

Bioimpedance indices of fluid overload and cardiorenal outcomes in heart failure and chronic kidney disease: a systematic review

Background: Bioimpedance-based estimates of fluid overload have been widely studied and systematically reviewed in populations of those undergoing dialysis, but data from populations with heart failure or nondialysis chronic kidney disease (CKD) have not. Methods and Results: We conducted a systematic review of studies using whole-body bioimpedance from populations with heart failure and nondialysis CKD that reported associations with mortality, cardiovascular outcomes and/or CKD progression. We searched MEDLINE, Embase databases and the Cochrane CENTRAL registry from inception to March 14, 2022. We identified 31 eligible studies: 20 heart failure and 11 CKD cohorts, with 2 studies including over 1000 participants. A wide range of various bioimpedance methods were used across the studies (heart failure: 8 parameters; CKD: 6). Studies generally reported positive associations, but between-study differences in bioimpedance methods, fluid overload exposure definitions and modeling approaches precluded meta-analysis. The largest identified study was in nondialysis CKD (Chronic Renal Insufficiency Cohort, 3751 participants), which reported adjusted hazard ratios (95% confidence intervals) for phase angle < 5.59 vs ≥ 6.4 of 2.02 (1.67–2.43) for all-cause mortality; 1.80 (1.46–2.23) for heart failure events; and 1.78 (1.56–2.04) for CKD progression. Conclusions: Bioimpedance indices of fluid overload are associated with risk of important cardiorenal outcomes in heart failure and CKD. Facilitation of more widespread use of bioimpedance requires consensus on the optimum device, standardized analytical methods and larger studies, including more detailed characterization of cardiac and renal phenotypes

Socioeconomic deprivation and illness trajectory in the Scottish population after COVID-19 hospitalization

Background The associations between deprivation and illness trajectory after hospitalisation for coronavirus disease-19 (COVID-19) are uncertain. Methods A prospective, multicentre cohort study was conducted on post-COVID-19 patients, enrolled either in-hospital or shortly post-discharge. Two evaluations were carried out: an initial assessment and a follow-up at 28–60 days post-discharge. The study encompassed research blood tests, patient-reported outcome measures, and multisystem imaging (including chest computed tomography (CT) with pulmonary and coronary angiography, cardiovascular and renal magnetic resonance imaging). Primary and secondary outcomes were analysed in relation to socioeconomic status, using the Scottish Index of Multiple Deprivation (SIMD). The EQ-5D-5L, Brief Illness Perception Questionnaire (BIPQ), Patient Health Questionnaire-4 (PHQ-4) for Anxiety and Depression, and the Duke Activity Status Index (DASI) were used to assess health status. Results Of the 252 enrolled patients (mean age 55.0 ± 12.0 years; 40% female; 23% with diabetes), deprivation status was linked with increased BMI and diabetes prevalence. 186 (74%) returned for the follow-up. Within this group, findings indicated associations between deprivation and lung abnormalities (p = 0.0085), coronary artery disease (p = 0.0128), and renal inflammation (p = 0.0421). Furthermore, patients with higher deprivation exhibited worse scores in health-related quality of life (EQ-5D-5L, p = 0.0084), illness perception (BIPQ, p = 0.0004), anxiety and depression levels (PHQ-4, p = 0.0038), and diminished physical activity (DASI, p = 0.002). At the 3-month mark, those with greater deprivation showed a higher frequency of referrals to secondary care due to ongoing COVID-19 symptoms (p = 0.0438). However, clinical outcomes were not influenced by deprivation. Conclusions In a post-hospital COVID-19 population, socioeconomic deprivation was associated with impaired health status and secondary care episodes. Deprivation influences illness trajectory after COVID-19

Cardiovascular complications of chronic kidney disease

Chronic kidney disease (CKD) is a risk factor for premature cardiovascular disease (CVD). In patients with kidney failure requiring replacement therapy (KFRT) with dialysis or transplantation, CVD risk is greater, approximately 20 times that of the general population. Conventional cardiovascular risk factors such as diabetes, hypertension, smoking and dyslipidaemia worsen both CKD and CVD. Factors specific to CKD, such as proteinuria, impaired calcium–phosphate homeostasis, anaemia and inflammation, also contribute to cardiovascular risk. Atypical relationships exist between blood pressure, cholesterol and mortality in KFRT. Although CKD accelerates atherosclerosis, sudden cardiac death, rather than myocardial infarction, is the predominant mode of cardiac death in KFRT. Left ventricular disorders are common in this population and are associated with mortality as well as cardiac failure. Clinical trials of interventions to improve cardiovascular outcomes have been disappointing in KFRT, although two new treatments have emerged to reduce cardiovascular risk in earlier stages of CKD: sodium-glucose co-transporter 2 (SGLT-2) inhibitors and the non-steroidal mineralocorticoid receptor antagonist (MRA) finerenone. Tight blood pressure control and lipid lowering for primary prevention of CVD are beneficial for patients with CKD not on dialysis. Further evidence is required for interventions targeted at sudden death and other non-conventional risk factors in CKD

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios: associations with mortality in a haemodialysis cohort

No abstract available

Effects of empagliflozin on fluid overload, weight and blood pressure in chronic kidney disease

No abstract available