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- Alderson, Helen V., et al.
(författare)
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FGF-23 and Osteoprotegerin but not Fetuin-A are associated with death and enhance risk prediction in non-dialysis chronic kidney disease stages 3-5
- 2016
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Ingår i: Nephrology (Carlton. Print). - : Wiley. - 1320-5358 .- 1440-1797. ; 21:7, s. 566-573
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Tidskriftsartikel (refereegranskat)abstract
- AIM: Numerous biomarkers have been shown to associate with clinical endpoints in chronic kidney disease (CKD). There is limited evidence whether biomarkers improve risk prediction in relation to clinical outcomes. Our study investigates whether a small suite of key chronic kidney disease-mineral and bone disorder biomarkers could be used to enhance risk assessment in CKD.METHODS: Fetuin-A, fibroblast growth factor-23 and osteoprotegerin were measured on baseline plasma samples from 463 patients recruited to the Chronic Renal Insufficiency Standards Implementation Study. The biomarkers were analysed in relation to progression to end stage kidney disease, death and major cardiovascular events.RESULTS: Over a median follow up of 46 months (interquartile range 21-69), fibroblast growth factor-23 was associated with risk for renal replacement therapy (hazard ratio (HR) 1.35, P = 0.05, 95% confidence interval (CI) 1.001-1.820), cardiovascular events (HR 1.74 P < 0.001, 95% CI 1.303-1.305) and death (HR 1.4 P = 0.005, 95% CI 1.109-1.767). Osteoprotegerin was associated with risk for death (HR 1.06, P = 0.03, 95% CI 1.006-1.117). There was no clear association between Fetuin-A and any of the clinical endpoints. The addition of biomarkers to risk models led to marginal improvement in model discrimination and reclassification.CONCLUSION: Biomarkers are often associated with clinical endpoints, and we observed such associations in our study of patients with advanced CKD. However, the markers analysed in our study were of limited benefit in improving the prediction of these outcomes. Any extra information biomarkers may provide to improve risk prediction in clinical practice needs to be carefully balanced against the potential cost of these tools.
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- Clyne, Naomi, et al.
(författare)
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Relationship between declining GFR and measures of cardiac and vascular autonomic neuropathy.
- 2015
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Ingår i: Nephrology. - : Wiley. - 1320-5358. ; 21:12, s. 1047-1055
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Tidskriftsartikel (refereegranskat)abstract
- Cardiac and vascular autonomic neuropathy contributes to increased morbidity and mortality in patients with chronic kidney disease. The aim of this study was to analyze the effects of a decline in GFR on heart rate variability (HRV) and nocturnal blood pressure dipping.
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| 7. |
- Greenwood, A. M., et al.
(författare)
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Clinical presentation, treatment and outcome of focal segmental glomerulosclerosis in Far North Queensland Australian adults
- 2017
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Ingår i: Nephrology. - : Wiley. - 1320-5358. ; 22:7, s. 520-530
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Tidskriftsartikel (refereegranskat)abstract
- AimThe aim is to describe the clinical features, treatment and outcomes in Australian adults with focal segmental glomerulosclerosis and identify predictors of disease progression and all-cause mortality. MethodsThe study included all patients with biopsy confirmed focal segmental glomerulosclerosis between January 1997 and June 2014 at participating hospitals. Clinical factors, histopathological findings, biochemical markers and treatments were analysed and potential predictors of doubling serum creatinine, end stage kidney disease or death identified. ResultsA total of 98 patients were included with a median follow up of 4.3years. Thirty-four (35%) patients were Aboriginal or Torres Strait Islander. Focal segmental glomerulosclerosis not-otherwise-specified was the most common variant. Seventeen (59%) patients initially treated with immunosuppression experienced an improvement in renal function. At the end of follow up, 43 (44%) patients had progressed to the composite outcome. Baseline tubulointerstitial scarring and lower haemoglobin predicted shorter time to doubling serum creatinine. Dual diagnosis, higher serum creatinine, lower estimated glomerular filtration rate and doubling creatinine were associated with shorter time to end stage kidney disease with remission the only protective factor. Age was the only variable associated with all-cause mortality. ConclusionFocal segmental glomerulosclerosis holds serious implications for patients. Concomitant diabetic nephropathy, higher serum creatinine and lower estimated glomerular filtration rate at renal biopsy were associated with poorer renal prognosis. Indigenous people had a female predominance and are over-represented in relation to their population size, however, were not associated with poorer prognosis. Remission was the only modifiable variable and thus should be at the forefront of patient management goals and future studies.
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- Hellberg, Matthias, et al.
(författare)
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Decline in measured glomerular filtration rate is associated with a decrease in endurance, strength, balance and fine motor skills
- 2017
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Ingår i: Nephrology. - : Wiley. - 1320-5358. ; 22:7, s. 513-519
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Tidskriftsartikel (refereegranskat)abstract
- AIM: Physical performance in chronic kidney disease affects morbidity and mortality. The aim was to find out which measures of physical performance are important in CKD and if there are associations with declining measured GFR.METHODS: Endurance was assessed by 6-minute walk test (6-MWT) and stair climbing, muscular endurance by 30-seconds sit to stand, heel rises and toe lifts, strength by quadriceps- and handgrip strength, balance by functional reach and Berg´s balance scale, and fine motor skills by Moberg´s picking-up test. GFR was measured by Iohexol clearance.RESULTS: The study comprised 101 patients with CKD 3b-5 not started dialysis, 40 women and 61 men, with a mean age of 67 ± 13 (range: 22 - 87) years. All measures of physical performance were impaired. A decrease in GFR of 10 ml/min/1.73 m(2) corresponded to a 35 metre shorter walking distance in the 6-MWT. Multivariable linear regression analysis showed significant relationships between decline in GFR and the 6-MWT (p = 0.04), isometric quadriceps strength left (p = 0.04), balance measured as functional reach (p = 0.02) and fine motor skills in the left hand as measured by Moberg´s picking-up test (p = 0.01), respectively, after sex, age, comorbidity and the interaction between sex and age had been taken into account.CONCLUSION: Endurance, muscular endurance, strength, balance and fine motor skills were impaired in patients with CKD 3b-5. Walking capacity, isometric quadriceps strength, balance, and fine motor skills were associated with declining GFR. The left extremities were more susceptible to GFR, ageing and comorbidities and seem thus to be more sensitive.
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