Quality of life, cardiovascular disease and mortality in advanced chronic kidney disease

Chronic kidney disease (CKD) patients suffer from impaired Health-related Quality of Life (HRQoL). Impaired HRQoL has important implications for their prognosis. Cardiovascular disease (CVD) is common in CKD patients, leading to excess morbidity and mortality in this population. Risk factors unique to the CKD population add to the traditional risk factors. A multi-faceted treatment approach to improve the HRQoL and prognosis of CKD patients is needed. Correctly assessing a patient’s prognosis would be helpful in tailoring treatment. A Chronic Arterial Disease, Quality of Life and Mortality in Chronic Kidney Injury (CADKID) Study enrolled 210 participants with advanced non-dialysis CKD. The cardiovascular system was assessed by exercise test, echocardiography, evaluation of abdominal aortic calcification (AAC) and vascular ultrasound. A wide selection of biomarkers and HRQoL were measured . HRQoL was associated with cardiac biomarkers, Troponin T (TnT), N-terminal Pro-B-type Natriuretic Peptide (proBNP) and echocardiographic measure of cardiac systolic function, global longitudinal strain (GLS). A measure of the physical aspect of HRQoL, Physical Component Summary, was associated with mortality. In the longitudinal study of HRQoL, kidney transplantation improved kidney disease-specific aspects compared to dialysis. Cardiovascular determinants of mortality in the CADKID study were TnT, proBNP, serum albumin, AAC, exercise performance and an echocardiographic measure of cardiac diastolic function, E/e’. The incidence and prevalence of atrial fibrillation in the study cohort were high. Age, elevated TnT and increased left atrial volume index were associated with the incidence of atrial fibrillation. HRQoL is associated with biochemical and echocardiographic markers of cardiac function. Kidney transplantation is the renal replacement therapy of choice for the eligible CKD patients. Readily available methods investigating cardiovascular health help to determine the prognosis in advanced CKD and thus guide treatment.Elämänlaatu, sydän- ja verisuonitaudit ja kuolleisuus pitkälle edennyttä kroonista munuaistautia sairastavilla Krooninen munuaistauti heikentää elämänlaatua vaikuttaen potilaiden jokapäiväisen elämän lisäksi heidän ennusteeseensa. Sydän- ja verisuonitaudit ovat yleisiä kroonista munuaistautia sairastavilla ja aiheuttavat ylimääräistä kuolleisuutta ja sairastavuutta. Tavanomaisten riskitekijöiden lisäksi krooniseen munuaistautiin liittyvät tekijät lisäävät riskiä. Näiden potilaiden elämänlaadun ja ennusteen parantamiseksi tarvitaan monitahoista hoitostrategiaa. Olisi tärkeää pystyä arvioimaan potilaan ennuste oikein, jotta hoito voitaisiin sovittaa yksilöllisesti. Krooninen valtimotauti, elämänlaatu ja mortaliteetti vaikeaa munuaisten vajaatoimintaa sairastavilla (CADKID) –tutkimukseen osallistui 210 potilasta, joilla oli pitkälle edennyt krooninen munuaistauti mutta ei vielä dialyysihoitoa tutkimuksen alkaessa. Sydäntä ja verisuonistoa tutkittiin rasituskokeella, ultraäänitutkimuksilla ja vatsa-aortan kalkkiutumisen aste (AAC) arvioitiin. Verikokeita tutkittiin laajalti ja elämänlaatua mitattiin. Elämänlaatu oli yhteydessä sydänmerkkiaineisiin troponiini T (TnT) ja B-tyypin natriureettisen peptidin esiaste (proBNP) sekä sydämen systolisen toiminnan mittariin, pitkittäissupistuvuuteen (GLS). Elämänlaatumittarin fyysisen osan yhteen-vetopisteet olivat yhteydessä kuolleisuuteen. Seurantatutkimuksessa munuaissiirto paransi munuaistautiin liittyvää elämänlaatua merkitsevästi verrattuna dialyysiin. CADKID-tutkimuksessa kuolleisuutta ennustivat TnT, proBNP, matala albumiini, AAC, suorituskyky rasituskokeessa ja sydämen diastolisen toiminnan mittari, E/e’. Eteisvärinän esiintyvyys ja ilmaantuvuus oli suurta tutkimusaineistossa. Ikä, koholla oleva TnT ja suurentunut sydämen vasemman eteisen tilavuusindeksi olivat yhteydessä eteisvärinän ilmaantumiseen. Elämänlaatu on yhteydessä sydämen toimintaa kuvaaviin merkkiaineisiin ja ultraäänilöydöksiin. Munuaisensiirto on elämänlaadullisesti paras hoitomuoto loppuvaiheen munuaisten vajaatoimintaan. Yleisesti saatavilla olevilla tutkimuksilla voidaan määrittää potilaan ennuste ja ohjata hoitoa

Munuaispotilaan sydän- ja verisuonitautien riskit

Munuaistauti on sydän- ja verisuonitautien itsenäinen riskitekijä, ja potilailla on runsaasti myös yleisiä ja erityisiä munuaisvaurioon liittyviä riskitekijöitä.Kroonista munuaistautia sairastavan riski sairastua sydän- ja verisuonitauteihin alkaa lisääntyä, kun glomerulusten suodatusnopeus pienenee tasolle 60 ml/min.Albuminuria lisää sydän- ja verisuonitautiriskiä ja liittyy munuaistaudin etenemiseen.</p

Progression of Aortic Calcification in Stage 4-5 Chronic Kidney Disease Patients Transitioning to Dialysis and Transplantation

Background and Aims: Abdominal aortic calcification (AAC) is common in chronic kidney disease (CKD) patients and associated with increased mortality. Comparative data on the AAC score progression in CKD patients transitioning from conservative treatment to different modalities of renal replacement therapy (RRT) are lacking and were examined. Methods: 150 study patients underwent lateral lumbar radiograph to study AAC in the beginning of the study before commencing RRT (AAC1) and at 3 years of follow-up (AAC2). We examined the associations between repeated laboratory tests taken every 3 months, echocardiographic and clinical variables and AAC increment per year (ΔAAC), and the association between ΔAAC and outcomes during follow-up. Results: At the time of AAC2 measurement, 39 patients were on hemodialysis, 39 on peritoneal dialysis, 39 had a transplant, and 33 were on conservative treatment. Median AAC1 was 4.8 (0.5-9.0) and median AAC2 8.0 (1.5-12.0) (p p = 0.19). ΔAAC was independently associated with mean left ventricular mass index (LVMI) (log LVMI: β = 0.97, p = 0.02) and mean phosphorus through follow-up (log phosphorus: β = 1.19, p = 0.02) in the multivariable model. Time to transplantation was associated with Delta AAC in transplant recipients (per month on the waiting list: β = 0.04, p = 0.001). Delta AAC was associated with mortality (HR 1.427, 95% confidence interval 1.044-1.950, p = 0.03). Conclusion: AAC progresses rapidly in patients with CKD, and ΔAAC is similar across the CKD treatment groups including transplant recipients. The increment rate is associated with mortality and in transplant recipients with the time on the transplant waiting list.</p

Reconfigurable Pilot Lines Enabling Industry Digitalization: An Approach for Transforming Industry and Academia Needs to Requirements Specifications

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Dental health assessed using panoramic radiograph and adverse events in chronic kidney disease stage 4-5 patients transitioning to dialysis and transplantation-A prospective cohort study

Background and aimsOral health could potentially be a modifiable risk factor for adverse outcomes in chronic kidney disease (CKD) patients transitioning from predialysis treatment to maintenance dialysis and transplantation. We aimed to study the association between an index of radiographically assessed oral health, Panoramic Tomographic Index (PTI), and cardiovascular and all-cause mortality, major adverse cardiovascular events (MACEs) and episodes of bacteremia and laboratory measurements during a three-year prospective follow-up in CKD stage 4–5 patients not on maintenance dialysis at baseline.MethodsAltogether 190 CKD stage 4–5 patients without maintenance dialysis attended panoramic dental radiographs in the beginning of the study. The patients were followed up for three years or until death. MACEs and episodes of bacteremia were recorded during follow-up. Laboratory sampling for C-reactive protein and leukocytes was repeated tri-monthly.ResultsPTI was not associated with baseline laboratory parameters or C-reactive protein or leukocytes examined as repeated measures through the 3-year follow-up. During follow-up, 22 patients had at least one episode of bacteremia, but only 2 of the bacteremias were considered to be of oral origin. PTI was not associated with incident bacteremia during follow-up. Thirty-six patients died during follow-up including 17 patients due to cardiovascular causes. During follow-up 42 patients were observed with a MACE. PTI was independently associated with all-cause (HR 1.074 95% CI 1.029–1.122, p = 0.001) and cardiovascular (HR 1.105, 95% CI 1.057–1.157, pConclusionsRadiographically assessed dental health is independently associated with all-cause and cardiovascular mortality and MACEs but not with the incidence of bacteremia in CKD stage 4–5 patients transitioning to maintenance dialysis and renal transplantation during follow-up.</p

Maximal Exercise Capacity in Chronic Kidney Disease Stage 4-5 Patients Transitioning to Renal Replacement Therapy or Continuing Conservative Care: A Longitudinal Follow-Up Study

Introduction: Chronic kidney disease (CKD) is associated with impaired maximal exercise capacity (MEC). However, data are scarce on the development of MEC in CKD stage 4-5 patients transitioning to renal replacement therapy (RRT).Methods: We explored the change in MEC measured in watts (Wlast4) with 2 consecutive maximal bicycle stress ergometry tests in 122 CKD stage 4-5 patients transitioning to dialysis and transplantation in an observational follow-up study.Results: Mean age was 58.9 ± 13.9 years and 43 (35.2%) were female. Mean time between the baseline and follow-up ergometry tests was 1,012 ± 327 days and 29 (23.8%) patients had not initiated RRT, 50 (41.0%) were undergoing dialysis, and 43 (35.2%) had received a kidney transplant at the time of the follow-up ergometry test. The mean Wlast4 was 91 ± 37 W and 84 ± 37 W for the baseline and follow-up ergometry tests, respectively (p Conclusion: MEC declined or remained poor in advanced CKD patients transitioning to RRT or continuing conservative care in this observational study. Mean capillary blood bicarbonate was independently associated with the development of MEC.</p

Interatrial block, P terminal force or fragmented QRS do not predict new-onset atrial fibrillation in patients with severe chronic kidney disease

Background: The prevalence of left atrial enlargement (LAE) and fragmented QRS (fQRS) diagnosed using ECG criteria in patients with severe chronic kidney disease (CKD) is unknown. Furthermore, there is limited data on predicting new-onset atrial fibrillation (AF) with LAE or fQRS in this patient group. Methods: We enrolled 165 consecutive non-dialysis patients with CKD stage 4-5 without prior AF diagnosis between 2013 and 2017 in a prospective follow-up cohort study. LAE was defined as total P-wave duration >= 120ms in lead II >1 biphasic P-waves in leads II, III or aVF; or duration of terminal negative portion of P-wave >40ms or depth of terminal negative portion of P-wave >1mm in lead V-1 from a baseline ECG, respectively. fQRS was defined as the presence of a notched R or S wave or the presence of >= 1 additional R waves (R') or; in the presence of a wide QRS complex (>120ms), >2 notches in R or S waves in two contiguous leads corresponding to a myocardial region, respectively. Results: Mean age of the patients was 59 (SD 14) years, 56/165 (33.9%) were female and the mean estimated glomerular filtration rate was 12.8ml/min/1.73m(2). Altogether 29/165 (17.6%) patients were observed with new-onset AF within median follow-up of 3 [IQR 3, range 2-6] years. At baseline, 137/165 (83.0%) and 144/165 (87.3%) patients were observed with LAE and fQRS, respectively. Furthermore, LAE and fQRS co-existed in 121/165 (73.3%) patients. Neither findings were associated with the risk of new-onset AF within follow-up. Conclusion: The prevalence of LAE and fQRS at baseline in this study on CKD stage 4-5 patients not on dialysis was very high. However, LAE or fQRS failed to predict occurrence of new-onset AF in these patients