0
selected
-
1.
Impact of Sacubitril-Valsartan on Markers of Glomerular Function.
Tersalvi, G, Dauw, J, Martens, P, Mullens, W
Current heart failure reports. 2020;(4):145-152
Abstract
PURPOSE OF REVIEW To provide pathophysiological and clinical insights into the effects of sacubitril/valsartan on glomerular function. RECENT FINDINGS Heart failure and glomerular dysfunction are closely intertwined. In addition to reduced heart failure hospitalization and all-cause mortality, patients treated with sacubitril/valsartan have a slower deterioration of glomerular filtration rate over time compared with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. The effects of sacubitril/valsartan are probably mediated through enhancement of natriuretic peptides, reduction of glomerular inflammation and fibrosis, and relaxation of mesangial cells and podocytes. Further studies will elucidate underlying pathophysiological mechanisms of sacubitril/valsartan on glomerular function and their prognostic significance in subjects with and without heart failure.
-
2.
Dose discordance of direct acting oral anticoagulants using different equations for estimating GFR: a literature review.
Nabiee, M, Dashti-Khavidaki, S, Khajeh, B
Expert review of clinical pharmacology. 2020;(8):857-863
Abstract
INTRODUCTION Direct oral anticoagulants (DOACs) are widely prescribed nowadays. Available DOACs are renally eliminated to some extent and need dose adjustment in patients with kidney dysfunction. Cockcroft-Gault (CG) formula has been used to estimate creatinine clearance in DOACs trials. Nowadays, Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) are preferred equations for estimating glomerular filtration rate (GFR). We reviewed studies that simulated DOACs dosing in patients with atrial fibrillation by MDRD, CKD-EPI, and CG. AREAS COVERED DOACs dose discordance varies from 28.8% underdosing to 59.2% overdosing when MDRD or CKD-EPI equations are substituted for CG. MDRD and CKD-EPI overestimate the GFR in lower thresholds of kidney function especially in elderly and females and result in overestimation of DOACs dosing or misclassifying the patients to be eligible for receiving DOACs when they are contraindicated. Compared with CG, MDRD and CKD-EPI underestimate the level of kidney function in higher GFR extremes and in these patients suggest DOACs when they are not recommended or suggest lower doses. EXPERT OPINION Until running large clinical studies on efficacy/safety of DOACs dosing using MDRD or CKD-EPI equations, use of CG method for DOACs dosing is recommended in real practice.
-
3.
Individualized Hemodialysis Treatment: A Perspective on Residual Kidney Function and Precision Medicine in Nephrology.
Hur, I, Lee, YK, Kalantar-Zadeh, K, Obi, Y
Cardiorenal medicine. 2019;(2):69-82
Abstract
BACKGROUND Residual kidney function (RKF) is often expected to inevitably and rapidly decline among hemodialysis patients and, hence, has been inadvertently ignored in clinical practice. The importance of RKF has been revisited in some recent studies. Given that patients with end-stage renal disease now tend to initiate maintenance hemodialysis therapy with higher RKF levels, there seem to be important opportunities for incremental hemo-dialysis by individualizing the dose and frequency according to their RKF levels. This approach is realigned with precision medicine and patient-centeredness. SUMMARY In this article, we first review the available methods to estimate RKF among hemodialysis patients. We then discuss the importance of maintaining and monitoring RKF levels based on a variety of clinical aspects, including volume overload, blood pressure control, mineral and bone metabolism, nutrition, and patient survival. We also review several potential measures to protect RKF: the use of high-flux and biocompatible membranes, the use of ultrapure dialysate, the incorporation of hemodiafiltration, incremental hemodialysis, and a low-protein diet, as well as general care such as avoiding nephrotoxic events, maintaining appropriate blood pressure, and better control of mineral and bone disorder parameters. Key Message: Individualized hemodialysis regimens may maintain RKF, lead to a better quality of life without compromising long-term survival, and ensure precision medicine and patient-centeredness in nephrology practice.
-
4.
ACE inhibitors and ARBs: Managing potassium and renal function.
Momoniat, T, Ilyas, D, Bhandari, S
Cleveland Clinic journal of medicine. 2019;(9):601-607
Abstract
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are used primarily to treat hypertension and are also useful for conditions such as heart failure and chronic kidney disease, independent of their effect on blood pressure. This article reviews the indications for ACE inhibitors and ARBs and offers advice for managing their adverse effects, particularly declining renal function and hyperkalemia.
-
5.
Nonvitamin K Oral Anticoagulants in Patients With Atrial Fibrillation and Severe Renal Dysfunction.
Mahmood, M, Lip, GYH
Revista espanola de cardiologia (English ed.). 2018;(10):847-855
Abstract
Both atrial fibrillation (AF) and chronic kidney disease (CKD) are highly prevalent, especially with increasing age and associated comorbidities, such as hypertension, diabetes, heart failure, and vascular disease. The relationship between both AF and CKD seems to be bidirectional: CKD predisposes to AF while onset of AF seems to lead to progression of CKD. Stroke prevention is the cornerstone of AF management, and AF patients with CKD are at higher risk of stroke, mortality, cardiac events, and bleeding. Stroke prevention requires use of oral anticoagulants, which are either vitamin K antagonists (eg, warfarin), or the nonvitamin K antagonist oral anticoagulants (NOACs). While NOACs have been shown to be effective in mild-to-moderate renal dysfunction, there are a paucity of data regarding NOACs in severe and end-stage renal dysfunction. This review first discusses the evidence for NOACs in CKD. Second, we summarize the current knowledge regarding the efficacy and safety of NOACs to prevent AF-related stroke and systemic embolism in severe and end-stage renal disease.
-
6.
Longitudinal assessment of renal function in native kidney after bariatric surgery.
Favre, G, Schiavo, L, Lemoine, S, Esnault, VLM, Iannelli, A
Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2018;(9):1411-1418
Abstract
The epidemic of obesity parallels that of chronic kidney disease (CKD). Obesity worsens the course of CKD, mainly defined by an abnormal glomerular filtration rate (GFR). Patients with severe obesity stages (II and III with body mass index >35 kg/m2) are eligible for bariatric surgery (BS), which is the most efficient method of achieving durable weight loss. BS may reverse glomerular hyperfiltration and albuminuria, improve adipocytokine profile, and relieve diabetes and hypertension. Obesity remission after BS might prevent the progression of renal failure in populations with morbid obesity. However, evidence for the beneficial effect of BS on renal function is scant. This lack of knowledge is mainly due to methodologic reasons, which are addressed in this review. The reversibility of hyperfiltration due to the presence of functional renal reserve hampers the interpretation of changes in true GFR after BS. This true GFR is only obtained with the renal clearance of an exogenous filtration marker. Estimation of GFR is generally provided by prediction equations, namely by modification of diet in renal diseases or by chronic kidney disease-epidemiology collaborative group. These equations are not accurate because the serum levels of both creatinine and cystatin C depend on extrarenal factors, which are modified by BS. Comparing the slopes of measured GFR according to various durations of exposure with morbid obesity would be critical in providing reliable data. Herein, we review the current knowledge on the effects of BS on kidney function; we specify the methodologic issues and particularities of the dietary management of CKD patients to propose reliable directions for future clinical research.
-
7.
Older Adult Kidney Function Assessment and Rounding Creatinine Led to Medication Dosing Error.
Nguyen, T, Foster, Y, Cekaj, S
American journal of therapeutics. 2018;(4):e439-e446
Abstract
BACKGROUND/AREAS OF UNCERTAINTY Kidney function assessment in older adults can be unreliable because of many factors, and inaccurate assessment can lead to medication dosing error. Practitioners may have adopted the method of rounding creatinine to an arbitrary number 1.0 because of change in muscle mass and age-related change. This has in fact proven to cause more harm than good, potentially leading to underdosing of many medications. DATA SOURCES A literature search performed using PubMed with the following key words (rounding serum creatinine, rounding serum creatinine AND pharmacist or pharmacy, rounding serum creatinine AND doctor or physician or healthcare, rounding serum creatinine AND kidney function) with no restrictions (dates or any other requirement). RESULTS From the PubMed results, articles related to rounding of serum creatinine (Scr) and kidney function assessments were identified and reviewed. Most studies were retrospectives, 1 cross-sectional, 1 meta-analysis, and others were unidentified. These studies included various ways of estimating kidney functions (Tc DTPA clearance, Cockcroft-Gault creatinine clearance, 24-hour urine collection, Modification of Diet in Renal Disease, Chronic Kidney Disease-Epidemiology Collaboration), used various weights (actual body weight, ideal body weight, adjusted body weight), and most studies used 1.0 for rounding up Scr (other studies used 0.8 and 0.85). There was no associated relationship found as related to practicing professions (pharmacists vs. physician) to the practice of rounding Scr. CONCLUSIONS All studies yielded inaccurate kidney function upon rounding of Scr and leading to medication dosing error. All studies suggested against rounding Scr when assessing kidney function in older adults.
-
8.
Quantification of NGAL in Urine of Endurance Cycling Athletes.
Machado, JCQ, Volpe, CMO, Vasconcellos, LS, Nogueira-Machado, JA
Journal of physical activity & health. 2018;(9):679-682
Abstract
BACKGROUND Neutrophil gelatinase-associated lipocalin (NGAL) is a glycoprotein released during early phases of a postischemic kidney in response to kidney injury, inflammation, and oxidative stress. It can be detected in urine after 2 hours of an ischemic event. The aim was to measure and to correlate the level of urine NGAL (uNGAL) with urea, creatinine, and glomerular filtration rate (GFR) of endurance cycling athletes (n = 19) and physically active individuals (control, n = 17). METHODS Quantification of urea and creatinine were performed by dry chemical method, and GFR was calculated using the modification of diet in renal disease formula, according to Brazilian Society of Nephrology. uNGAL analyses were performed by enzyme linked immunoabsorbent assay. Analyses were performed 48 hours after exercises. RESULTS uNGAL (in ng/mL) levels, expressed as median, minimum, and maximum, in cyclist group, 387.7 (109.7-1691.0), was significantly higher than that observed in control (physically active) group, 141.5 (4.8-657.0), (P < .05). No significant correlations were observed between uNGAL and creatinine, urea, or GFR (P > .05). CONCLUSIONS Results have pointed to increased uNGAL levels in endurance cycling athletes. Increase of uNGAL in absence of clinical signs or alterations in creatinine, urea, or GFR might suggest that there is metabolic adaptation to endurance exercise, or possibly predisposition to acute kidney injury over time.
-
9.
Uromodulin in kidney health and disease.
Garimella, PS, Sarnak, MJ
Current opinion in nephrology and hypertension. 2017;(2):136-142
Abstract
PURPOSE OF REVIEW Although uromodulin or Tamm-Horsfall protein was discovered over 60 years ago, its functional role in humans remains unclear. This review highlights new studies elucidating the clinical correlates of uromodulin, its association with kidney function decline, nephrolithiasis and urinary host defense. RECENT FINDINGS Uromodulin is evolutionarily conserved and has multiple functional roles. In large population studies, higher levels of uromodulin are associated with higher estimated glomerular filtration rate (eGFR) and kidney size, possibly indicating greater kidney functional reserve. Greater uromodulin excretion is associated with markers of volume overload such as fractional excretion of uric acid, sodium and chloride, indicating a possible role in salt and water retention. Recent evidence also suggests that higher uromodulin levels are associated with lower risk of eGFR decline, death and possibly a lower risk of acute kidney injury. Higher levels of uromodulin are associated with lower risk of urinary tract infections in older adults. Serum uromodulin levels are positively associated with eGFR, although its functional role remains unclear. SUMMARY Over the last decade, we have begun to understand the functional role of uromodulin in health and disease. Large prospective studies in generalizable populations are needed to confirm these preliminary results, evaluate the clinical utility of measuring uromodulin and examine whether levels of this biomarker can be altered for therapeutic benefit.
-
10.
Assessment of Glomerular Filtration Rate in Health and Disease: A State of the Art Review.
Levey, AS, Inker, LA
Clinical pharmacology and therapeutics. 2017;(3):405-419
Abstract
Acute and chronic kidney diseases affect pharmacokinetics and pharmacodynamics. There has been substantial progress in the past 20 years in the use of glomerular filtration rate (GFR) estimating equations. In principle, use of a single equation for each filtration marker (creatinine, cystatin C, or the combination) for detection, evaluation, and management of kidney disease and for drug development and dosing would facilitate clinical practice. We review the principles for assessment of GFR, provide historical perspectives and updates regarding use of GFR estimating equations, including assay methods for filtration markers, performance of estimating equations, and recommendations by clinical practice guideline groups and regulatory agencies. We conclude that it is time to change from rigid adherence to the use of the Cockcroft-Gault equation for use in drug development and drug dosing to the more accurate and more widely used Modification of Diet in Renal Disease (MDRD) study and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations.