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Latest & greatest articles for chronic kidney disease
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Chronickidneydisease and the risks of death, cardiovascular events, and hospitalization. End-stage renaldisease substantially increases the risks of death, cardiovascular disease, and use of specialized health care, but the effects of less severe kidney dysfunction on these outcomes are less well defined.We estimated the longitudinal glomerular filtration rate (GFR) among 1,120,295 adults within a large, integrated system of health care delivery in whom serum creatinine had been measured (...) , community-based population. These findings highlight the clinical and public health importance of chronicrenal insufficiency.Copyright 2004 Massachusetts Medical Society
estimated rather than measured glomerular filtration rate.During the period examined, growth in incident ESRD outpaced growth in prevalent chronicrenal insufficiency, demonstrating that the ESRD epidemic in the United States is not merely a function of more cases of kidneydisease. Future research should examine other potential contributors to ESRD growth, such as improved survival from nonrenal diseases and more liberal entry into treatment programs. (...) The incidence of end-stage renaldisease is increasing faster than the prevalence of chronicrenal insufficiency. The steady increase in end-stage renaldisease (ESRD) incidence is a worldwide public health crisis.To determine whether the increasing incidence of ESRD in the United States is preceded by increased prevalence of chronicrenal insufficiency.Birth cohort analysis.Nationally representative Second and Third National Health and Nutrition Examination Surveys (NHANES II [1976-1980
The metabolic syndrome and chronickidneydisease in U.S. adults. The metabolic syndrome is a common risk factor for cardiovascular disease.To examine the association between the metabolic syndrome and risk for chronickidneydisease and microalbuminuria.Cross-sectional study.The Third National Health and Nutrition Examination Survey.Participants 20 years of age or older were studied in the chronickidneydisease (n = 6217) and microalbuminuria (n = 6125) analyses.The metabolic syndrome (...) with the metabolic syndrome compared with participants without the metabolic syndrome were 2.60 (95% CI, 1.68 to 4.03) and 1.89 (CI, 1.34 to 2.67), respectively. Compared with participants with 0 or 1 component of the metabolic syndrome, participants with 2, 3, 4, and 5 components of chronickidneydisease had multivariate-adjusted odds ratios of 2.21 (CI, 1.16 to 4.24), 3.38 (CI, 1.48 to 7.69), 4.23 (CI, 2.06 to 8.63), and 5.85 (CI, 3.11 to 11.0), respectively. The corresponding multivariate-adjusted odds
The prevalence of nontraditional risk factors for coronary heart disease in patients with chronickidneydisease. Risk for coronary heart disease is high among patients with chronickidney disease.To compare the prevalence of low apolipoprotein A1 levels and elevated apolipoprotein B, plasma fibrinogen, lipoprotein(a), homocysteine, and C-reactive protein levels by estimated glomerular filtration rate (GFR).Cross-sectional study.Third National Health and Nutrition Examination survey.12 547 (...) , 3180, and 744 persons with estimated GFRs of at least 90, 60 to 89, or less than 60 mL/min per 1.73 m2, respectively, who were at least 18 years of age.Chronic kidneydisease was defined as an estimated GFR of less than 60 mL/min per 1.73 m2 based on the abbreviated Modification of Diet in RenalDisease formula.After standardization for age, race or ethnicity, and sex, lower estimated GFR (> or =90, 60 to 89, or <60 mL/min per 1.73 m2) was associated with lower average levels of apolipoprotein A1
A, Sarnak M J CRD summary This systematic review concluded that N-acetylcysteine is effective in the prevention of renal contrast nephropathy in patients with pre-existing chronickidneydisease. Although there were some limitations of the review in terms of measures taken to minimise reviewer bias and possible statistical diversity, overall, the authors' conclusions appear reliable. Authors' objectives To assess the effects of N-acetylcysteine (NAC) in the prevention of renal contrast nephropathy (RCN (...) Prevention of radiocontrast nephropathy with N-acetylcysteine in patients with chronickidneydisease: a meta-analysis of randomized, controlled trials Prevention of radiocontrast nephropathy with N-acetylcysteine in patients with chronickidneydisease: a meta-analysis of randomized, controlled trials Prevention of radiocontrast nephropathy with N-acetylcysteine in patients with chronickidneydisease: a meta-analysis of randomized, controlled trials Alonso A, Lau J, Jaber B L, Weintraub
National Kidney Foundation practice guidelines for chronickidneydisease: evaluation, classification, and stratification. Chronickidneydisease is a worldwide public health problem with an increasing incidence and prevalence, poor outcomes, and high cost. Outcomes of chronickidneydisease include not only kidney failure but also complications of decreased kidney function and cardiovascular disease. Current evidence suggests that some of these adverse outcomes can be prevented or delayed (...) by early detection and treatment. Unfortunately, chronickidneydisease is underdiagnosed and undertreated, in part as a result of lack of agreement on a definition and classification of its stages of progression. Recent clinical practice guidelines by the National Kidney Foundation 1) define chronickidneydisease and classify its stages, regardless of underlying cause, 2) evaluate laboratory measurements for the clinical assessment of kidneydisease, 3) associate the level of kidney function
Environmental lead exposure and progression of chronicrenaldiseases in patients without diabetes. Previous research suggests that environmental lead exposure correlates with age-related decreases in renal function.Two hundred two patients with chronicrenal insufficiency (indicated by a serum creatinine level between 1.5 mg per deciliter and 3.9 mg per deciliter) who had a normal total-body lead burden and no history of exposure to lead were observed for 24 months. After the observation (...) than that in the controls during the 24-month period of repeated chelation therapy or placebo.Low-level environmental lead exposure may accelerate progressive renal insufficiency in patients without diabetes who have chronicrenaldisease. Repeated chelation therapy may improve renal function and slow the progression of renal insufficiency.Copyright 2003 Massachusetts Medical Society
The timing of specialist evaluation in chronickidneydisease and mortality. Care for chronicrenal failure involves management of complications and preparation for possible dialysis. Patients often are not evaluated by nephrologists in a timely manner.To identify factors associated with late evaluation by a nephrologist and to assess whether late evaluation is associated with worse survival once patients develop end-stage renaldisease (ESRD).National prospective cohort study.81 dialysis (...) characteristics, and socioeconomic status in Cox proportional hazards regression analysis. After additional adjustment for such factors as the presence and severity of comorbid conditions, the association remained graded (hazard ratio, 1.2 [CI, 0.73 to 1.82] for patients evaluated at an intermediate point and 1.6 [CI, 1.04 to 2.39] for those evaluated late).Late evaluation of patients with chronicrenal failure by a nephrologist is associated with greater burden and severity of comorbid disease, black
Chronicrenaldiseases: renoprotective benefits of renin-angiotensin system inhibition. Progression to renal parenchymal damage and end-stage renaldisease, which seems to be largely independent of the initial insult, is the final common pathway for chronic, proteinuric nephropathies in animals and humans. The key event is enhanced glomerular capillary pressure; this impairs glomerular permeability to proteins and permits excessive amounts of proteins to reach the lumen of the proximal tubule (...) . Clinical data strongly suggest that remission can now be achieved in some patients with chronicrenaldisease. Because of the current lag time between starting treatment and remission, however, a substantial proportion of patients still progress to end-stage renaldisease before renal function begins to stabilize. A multimodal approach that centers on reducing or removing all risk factors associated with the progression of renaldisease may decrease the time to remission of the disease for most
Low protein diets delay end-stage renaldisease in non diabetic adults with chronicrenal failure. Since more than fifty years, low protein diets are proposed to patients with kidney failure. However, the effects of these diets in preventing severe renal failure and the need for maintenance dialysis is still controversial.To determine the efficacy of low protein diets in delaying the need to start maintenance dialysis.Medline and Embase search from January 1966 through June 1999. Congress (...) a reduced protein intake and 741 a larger protein intake. Collection of the number of "renal death" being the need for starting dialysis, the death of a patient or the transplantation of a kidney during the trials.242 renal deaths were recorded, 101 in the low protein diet and 141 in the larger protein diet group, giving an odds ratio of low protein to control of 0.62 with a 95% confidence interval of 0.46 to 0.83 (p<0.001, Peto odds ratio). To spare one extra renal death, 17 patients need to be treated
Diuretics acting on the distal renal tubule for preterm infants with (or developing) chronic lung disease. The aim of this review is to assess the risks and benefits of diuretics acting on distal segments of the renal tubule (distal diuretics) in preterm infants with or developing chronic lung disease (CLD). Primary objectives are to assess changes in need for oxygen or ventilatory support and effects on long-term outcome, and secondary objectives are to assess changes in pulmonary mechanics (...) and potential complications of therapy.We used the standard method of the Cochrane Neonatal Review Group. We used the following keywords: ¿ or <chronic lung disease>¿ and , limited to and limited to or . We searched Medline (1966-1998), Embase (1974-1998) and the Cochrane Controlled Trials Register (CCTR) from the Cochrane Library (1999, issue 2). In addition, we hand searched several abstract books of national
across a spectrum of disease causes and renal dysfunction. Research: The authors do not report any research implications of the review. Funding Division of Nephrology and Hypertension, University of North Carolina. Bibliographic details Kshirsagar A V, Joy M S, Hogan S L, Falk R J, Colindres R E. Effect of ACE inhibitors in diabetic and nondiabetic chronicrenaldisease: a systematic overview of randomized placebo-controlled trials. American Journal of KidneyDiseases 2000; 35(4): 695-707 PubMedID (...) Effect of ACE inhibitors in diabetic and nondiabetic chronicrenaldisease: a systematic overview of randomized placebo-controlled trials Effect of ACE inhibitors in diabetic and nondiabetic chronicrenaldisease: a systematic overview of randomized placebo-controlled trials Effect of ACE inhibitors in diabetic and nondiabetic chronicrenaldisease: a systematic overview of randomized placebo-controlled trials Kshirsagar A V, Joy M S, Hogan S L, Falk R J, Colindres R E Authors' objectives
Cross sectional longitudinal study of spot morning urine protein:creatinine ratio, 24 hour urine protein excretion rate, glomerular filtration rate, and end stage renal failure in chronicrenaldisease in patients without diabetes. To evaluate whether the protein:creatinine ratio in spot morning urine samples is a reliable indicator of 24 hour urinary protein excretion and predicts the rate of decline of glomerular filtration rate and progression to end stage renal failure in non-diabetic (...) patients with chronic nephropathy.Cross sectional correlation between the ratio and urinary protein excretion rate. Univariate and multivariate analysis of baseline predictors, including the ratio and 24 hour urinary protein, of decline in glomerular filtration rate and end stage renal failure in the long term.Research centre in Italy.177 non-diabetic outpatients with chronicrenaldisease screened for participation in the ramipril efficacy in nephropathy study.Rate of decline in filtration rate
Growth hormone in children (for growth hormone deficiency, Turner's syndrome, chronicrenal failure and idiopathic short stature) Growth hormone in children (for growth hormone deficiency, Turner's syndrome, chronicrenal failure and idiopathic short stature) Growth hormone in children (for growth hormone deficiency, Turner's syndrome, chronicrenal failure and idiopathic short stature) Anthony D, Stevens A Record Status This is a critical abstract of an economic evaluation that meets (...) the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology The study examined the use of growth hormone treatment in children with growth hormone deficiency (GHD), Turner's syndrome (TS), chronicrenal failure (CRF) and idiopathic short stature (ISS). Type of intervention Treatment. Economic study type Cost-utility analysis
and short stature in Turner's syndrome. It has recently been licensed for use by children with short stature due to chronicrenal failure. The authors aim to examine how effective this treatment is, and whether it actually has any positive effects, medical or psychological. Authors' conclusions Almost all the trial results show an improvement in height for all children treated with growth hormone regardless of their growth disorder. This height improvement enables the majority of treated children (...) Analysis; Growth Disorders Growth Hormone; Kidney Failure, Chronic; Turner Syndrome Language Published English Country of organisation England Address for correspondence Pauline King. Wessex Institute for Health Research and Development, Boldrewood Medical School, Bassett Crescent East, Highfield, Southampton SO16 7PX. Tel. +44 1703 595661 Fax +44 1703 595662 AccessionNumber 31998008875 Date bibliographic record published 10/08/1998 Date abstract record published 10/08/1998 Health Technology Assessment
The effects of dietary protein restriction and blood-pressure control on the progression of chronicrenaldisease. Modification of Diet in RenalDisease Study Group. Restricting protein intake and controlling hypertension delay the progression of renaldisease in animals. We tested these interventions in 840 patients with various chronicrenal diseases.In study 1, 585 patients with glomerular filtration rates of 25 to 55 ml per minute per 1.73 m2 of body-surface area were randomly assigned (...) in the glomerular filtration rate during the first four months after randomization and a slower decline thereafter. In study 2, the very-low-protein group had a marginally slower decline in the glomerular filtration rate than did the low-protein group (P = 0.07). There was no delay in the time to the occurrence of end-stage renaldisease or death. In both studies, patients in the low-blood-pressure group who had more pronounced proteinuria at base line had a significantly slower rate of decline
Aluminum accumulation during treatment with aluminum hydroxide and dialysis in children and young adults with chronicrenaldisease. The control of hyperphosphatemia is a major clinical problem in patients with chronicrenal failure receiving regular dialysis treatment. Despite continuing concern about aluminum toxicity, aluminum-containing antacids are still used in many of these patients as phosphate-binding agents. Although maximal acceptable doses of aluminum hydroxide have been recommended (...) than in those receiving calcium carbonate. The skeletal lesions of secondary hyperparathyroidism improved in 7 of 10 patients receiving calcium carbonate but persisted or progressed in 6 of 7 patients given aluminum hydroxide (P less than 0.025).Aluminum hydroxide is less effective than calcium carbonate as a phosphate-binding agent for the control of hyperphosphatemia and is associated with aluminum retention in children and young adults with chronicrenal failure who are receiving dialysis
Effects of sulindac and ibuprofen in patients with chronic glomerular disease. Evidence for the dependence of renal function on prostacyclin. We investigated whether the glomerular synthesis of prostacyclin modulates the renal blood flow and glomerular filtration rate in chronic glomerular disease. The urinary excretion of 6-keto-prostaglandin F1 alpha, a stable breakdown product of prostacyclin, was significantly (P less than 0.01) reduced in 20 women with chronic glomerular disease (...) ) to the basal urinary excretion of 6-keto-prostaglandin F1 alpha but not of prostaglandin E2. No functional changes were detected in five healthy women, despite a similar suppression of renal prostacyclin synthesis by ibuprofen. In contrast, one week of treatment with sulindac did not affect renal prostacyclin synthesis or renal function in the other 10 patients, despite a marked inhibition of extrarenal cyclooxygenase activity. We conclude that in patients with mild impairment of renal function, the renal
renaldisease. Medical Care 1968; 6(1): 48-54 Indexing Status Subject indexing assigned by CRD MeSH Cost-Benefit Analysis; Hemodialysis Units, Hospital /economics; Hemodialysis, Home /economics; Hospitalization /economics; Kidney Failure, Chronic /therapy; Kidney Transplantation /economics; Treatment Outcome AccessionNumber 21995005212 Date bibliographic record published 09/08/1996 Date abstract record published 09/08/1996 NHS Economic Evaluation Database (NHS EED) Produced by the Centre for Reviews (...) Cost effectiveness analysis applied to the treatment of chronicrenaldisease Cost effectiveness analysis applied to the treatment of chronicrenaldisease Cost effectiveness analysis applied to the treatment of chronicrenaldisease Klarman H E, Francis J O, Rosenthal G D Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed