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Obesity and chronic kidney disease
Eknoyan,G.;
Nefrología (Madrid) , 2011,
Abstract: obesity is associated with the early onset of glomerulomegaly, hemodynamic changes of a hyperfiltering kidney, and increased albuminuria, which are potentially reversible with weight loss. however, pathologic lesions of focal segmental glomerulosclerosis develop in experimental models of sustained obesity, and are observed in morbidly obese humans presenting with massive proteinuria. in addition, several observational, cross sectional and longitudinal studies document that obesity is as an independent risk factor for the onset, aggravated course, and poor outcomes of chronic kidney disease, even after adjustment for confounding co-morbidities including metabolic syndrome, diabetes and hypertension, the major causes of chronic kidney disease. early dietary intervention to reduce weight, and where necessary bariatric surgery, should be considered in the management of overweight and obese chronic kidney disease (ckd) patients.
Angiogenesis and chronic kidney disease
Yohei Maeshima, Hirofumi Makino
Fibrogenesis & Tissue Repair , 2010, DOI: 10.1186/1755-1536-3-13
Abstract: Further analysis of the involvement of angiogenesis-related factors in the development of CKD is required. Determining the disease stage at which therapy is most effective and developing an effective drug delivery system targeting the kidney will be essential for pro-or anti-angiogenic strategies for patients with CKD.The number of patients with chronic kidney disease (CKD) progressing to end-stage renal disease (ESRD) and requiring renal replacement therapy is increasing worldwide. CKD currently affects over 20 million adults in the USA and over 13 million adults in Japan [1,2]. Of the various renal disorders predisposing to CKD, including glomerulonephritis and hypertensive nephrosclerosis, diabetic nephropathy is the most frequent cause of ESRD development.Angiogenesis - the development of new blood vessels from pre-existing ones - is involved in physiological events and in pathological disorders including tumor growth and metastasis, proliferative retinopathy, rheumatoid arthritis, psoriasis and neointimal formation [3]. Angiogenesis is controlled by the balance between pro-angiogenic and anti-angiogenic factors. Angiogenesis-associated factors are involved in the development of the kidney [4-6]. Recent experimental studies have demonstrated the involvement of an imbalance of angiogenesis-related factors in the progression of CKD [7-13], and the potential therapeutic effects on CKD of modulating these factors have been identified [14-22]. Vascular endothelial growth factor (VEGF)-A, a potent pro-angiogenic factor, is involved in the development of the kidney [4,5], and also plays an important role in maintaining the glomerular capillary structure and in the repair process following injuries of glomerular endothelial cells and peritubular capillaries (PTC) [14,15,17]. Physiological levels of VEGF-A are also required for maintenance of the glomerular filtration barrier [23]. In the early stages of diabetic nephropathy, increases in the number of glomerular capilla
Ghrelin in Chronic Kidney Disease  [PDF]
Wai W. Cheung,Robert H. Mak
International Journal of Peptides , 2010, DOI: 10.1155/2010/567343
Abstract: Patients with chronic kidney disease (CKD) often exhibit symptoms of anorexia and cachexia, which are associated with decreased quality of life and increased mortality. Chronic inflammation may be an important mechanism for the development of anorexia, cachexia, renal osteodystrophy, and increased cardiovascular risk in CKD. Ghrelin is a gastric hormone. The biological effects of ghrelin are mediated through the growth hormone secretagogue receptor (GHSR). The salutary effects of ghrelin on food intake and meal appreciation suggest that ghrelin could be an effective treatment for anorexic CKD patients. In addition to its appetite-stimulating effects, ghrelin has been shown to possess anti-inflammatory properties. The known metabolic effects of ghrelin and the potential implications in CKD will be discussed in this review. The strength, shortcomings, and unanswered questions related to ghrelin treatment in CKD will be addressed. 1. Introduction The cachexia syndrome in patients with chronic kidney disease (CKD) consists of muscle wasting, anorexia, and increased elevated energy expenditure. Cachexia is an important risk factor for mortality in patients with CKD, which is 100-fold to 200-fold higher than in the general population. Cachexia, a common feature in many chronic inflammatory diseases, is distinct from malnutrition, which is defined as the consequence of insufficient nutrients [1]. Responses in malnutrition are adaptive, whereas those in cachexia are maladaptive. In malnutrition, such as in simple starvation, fats are preferentially utilized and lean body mass is preserved. In cachexia, muscle mass is wasted and fats are relatively underutilized. Anorexia, defined as the loss of desire for food, is prevalent in patients CKD. Anorexia in CKD patients can arise from decreased taste and smell of food, early satiety, dysfunctional hypothalamic membrane adenylate cyclase, increased brain tryptophan, and increased cytokine production. Anorexia reduces oral energy and protein intakes and contributes to the development of cachexia. Elevated resting energy expenditure was associated with increased mortality and cardiovascular death in CKD and was closely correlated with the prevalence of cachexia among these patients [2]. To date, there is no effective therapy for cachexia in CKD. Nutritional strategies such as caloric supplementation and appetite stimulants have been largely unsuccessful. Thus, there is an urgent need for the development of new therapeutic agents for this potentially fatal complication of CKD [3]. 2. Energy Metabolism in CKD New
Cardiovascular disease in patients with chronic kidney disease  [cached]
Julian Wright,Alastair Hutchison
Vascular Health and Risk Management , 2009,
Abstract: Julian Wright, Alastair HutchisonManchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Manchester, UKAbstract: Patients with chronic kidney disease have a high burden of cardiovascular morbidity and mortality. The vast majority of patients with chronic kidney disease do not progress to end stage renal failure, but do have a significantly higher incidence of all cardiovascular co-morbidities. Traditional cardiovascular risk factors only partially account for this increased incidence of cardiovascular disease. In patients with kidney disease the basic biology underlying cardiovascular disease may be similar to that in patients without kidney disease, but it would seem many more risk factors are involved as a consequence of renal dysfunction. Although emphasis is placed on delaying the progression of chronic kidney disease, it must be appreciated that for many patients it is vital to address their cardiovascular risk factors at an early stage to prevent premature cardiovascular death. This review examines available epidemiological evidence, discusses common cardiovascular risk factors in patients with chronic kidney disease, and suggests possible treatment strategies. Potential areas for important research are also described.Keywords: cardiovascular risk factors, chronic kidney disease, hypertension, diabetes
Cardiovascular Biomarkers in Chronic Kidney Disease
Mirjana eri , Velibor S. abarkapa
Journal of Medical Biochemistry , 2010, DOI: 10.2478/v10011-010-0033-8
Abstract: Cardiovascular morbidity and mortality are markedly increased in chronic renal failure patients. Although it cannot be regarded as a cardiovascular disease risk equivalent, kidney dysfunction is considered an independent predictor of increased cardiovascular risk that increases with deteriorating kidney function. The association is a very complex one, and the term cardiorenal syndrome is now widely used. Cardiovascular disease in chronic kidney disease patients usually manifests as ischemic heart disease (in the form of angina, acute coronary syndrome or sudden cardiac death), cerebrovascular disease, peripheral vascular disease, and congestive heart failure. Vascular disease includes atherosclerosis and vascular calcifications, and cardiomyopathy comprises left ventricular hypertrophy, cardiac fibrosis and left ventricular systolic and diastolic dysfunction. In addition to the well-established traditional risk factors such as hypertension, hyperlipidemia, insulin resistance and diabetes mellitus, the association is supported by synergistic action of non-traditional risk factors such as excessive calcium-phosphorus load, hyperparathyroidism, anemia, hemodynamic overload, malnutrition, inflammation, hyperhomocysteinemia, altered nitric oxide synthase and increased oxidative stress. This paper summarizes the current understanding of the significance of specific uremic retention solutes, natriuretic peptides, biochemical markers of disorders in calcium-phosphorus homeostasis, systemic inflammation, oxidative stress, and dyslipidemia.
Quality of life in chronic kidney disease
Rodrigues Fructuoso,M.; Castro,R.; Oliveira,I.; Prata,C.; Morgado,T.;
Nefrología (Madrid) , 2011,
Abstract: background: the evaluation of health-related quality of life (qol) in chronic kidney disease intends to quantify its consequences, according to the patient's subjective perception. aim: to evaluate the health-related qol in four groups of patients followed at our nephrology department: chronic kidney disease (ckd) stages 1-4, kidney transplant (kt), haemodialysis (hd) and peritoneal dialysis (pd) patients. patients and methods: thirty patients with ckd stages 1-4 and 30 kt patients were randomly selected. all patients from our haemodialysis and peritoneal dialysis units with capacity to answer the inquiry (37 and 14, respectively) were also selected. the instruments applied were the sf-36 and kdqol-sf 1.3. results: the four groups presented better results in the ?social functioning? scale (77.68 ± 18.46 in pd; 74.17 ± 29.53 in kt; 66.81 ± 31.39 in ckd 1-4; 62.16 ± 32.84 in hd; p = 0.192). the lowest results appeared in the ?general health? scale (39.92 ± 19.12 in ckd; 45.95 ± 21.56 in hd; 47.13 ± 23.15 in kt; 51.79 ± 18.89 in pd; p = 0.321). peritoneal dialysis patients achieved the best results in the physical health component, but this difference disappeared after adjustment to confounding factors. age, gender and haemoglobin level were the variables related with qol. however, pd patients obtained better scores comparing to hd patients in the following kdqol-sf scales: ?effects of kidney disease?, ?burden of kidney disease? and ?patient satisfaction? (p <0.05). conclusions: health-related qol was better in peritoneal dialysis patients comparing to haemodialysis patients in specific scales of chronic kidney disease. age, gender and haemoglobin level interfered with health-related qol.
Hypertension in Chronic Kidney Disease: Navigating the Evidence  [PDF]
F. M. Tedla,A. Brar,R. Browne,C. Brown
International Journal of Hypertension , 2011, DOI: 10.4061/2011/132405
Abstract: Hypertension is both an important cause and consequence of chronic kidney disease. Evidence from numerous clinical trials has demonstrated the benefit of blood pressure control. However, it remains unclear whether available results could be extrapolated to patients with chronic kidney diseases because most studies on hypertension have excluded patients with kidney failure. In addition, chronic kidney disease encompasses a large group of clinical disorders with heterogeneous natural history and pathogenesis. In this paper, we review current evidence supporting treatment of hypertension in various forms of chronic kidney disease and highlight some of the gaps in the extant literature.
Cardiovascular disease in patients with chronic kidney disease
Julian Wright, Alastair Hutchison
Vascular Health and Risk Management , 2009, DOI: http://dx.doi.org/10.2147/VHRM.S6206
Abstract: rdiovascular disease in patients with chronic kidney disease Review (8510) Total Article Views Authors: Julian Wright, Alastair Hutchison Published Date August 2009 Volume 2009:5 Pages 713 - 722 DOI: http://dx.doi.org/10.2147/VHRM.S6206 Julian Wright, Alastair Hutchison Manchester Institute of Nephrology and Transplantation, Manchester Royal Infirmary, Manchester, UK Abstract: Patients with chronic kidney disease have a high burden of cardiovascular morbidity and mortality. The vast majority of patients with chronic kidney disease do not progress to end stage renal failure, but do have a significantly higher incidence of all cardiovascular co-morbidities. Traditional cardiovascular risk factors only partially account for this increased incidence of cardiovascular disease. In patients with kidney disease the basic biology underlying cardiovascular disease may be similar to that in patients without kidney disease, but it would seem many more risk factors are involved as a consequence of renal dysfunction. Although emphasis is placed on delaying the progression of chronic kidney disease, it must be appreciated that for many patients it is vital to address their cardiovascular risk factors at an early stage to prevent premature cardiovascular death. This review examines available epidemiological evidence, discusses common cardiovascular risk factors in patients with chronic kidney disease, and suggests possible treatment strategies. Potential areas for important research are also described.
Chronic Kidney Disease in Disadvantaged Populations  [PDF]
David Martins,Lawrence Agodoa,Keith Norris
International Journal of Nephrology , 2012, DOI: 10.1155/2012/469265
Abstract: Disadvantaged populations across the globe exhibit a disproportionate burden of chronic kidney disease (CKD) because of differences in CKD occurrence and outcomes. Although many CKD risk factors can be managed and modified to optimize clinical outcomes, the prevailing socioeconomic and cultural factors in disadvantaged populations, more often than not, militate against optimum clinical outcomes. In addition, disadvantaged populations exhibit a broader spectrum of CKD risk factors and may be genetically predisposed to an earlier onset and a more rapid progression of chronic kidney disease. A basic understanding of the vulnerabilities of the disadvantaged populations will facilitate the adaptation and adoption of the kidney disease treatment and prevention guidelines for these vulnerable populations. The purpose of this paper is to examine recent discoveries and data on CKD occurrence and outcomes in disadvantaged populations and explore strategies for the prevention and treatment of CKD in these populations based on the established guidelines. 1. Background and Epidemiology The global prevalence of chronic kidney disease (CKD) is increasing and creating enormous socioeconomic burdens for patients, families, society, and the health care system across the globe. Data from the third National Health and Nutrition Examination Survey (NHANES 1999–2004) suggest that about 1 out of 8 adult Americans exhibit evidence of CKD [1]. Comparable estimates have been reported in Asia [2], Australia [3], and across Europe [4–6]. The lack of national registries and limited representative national surveys in developing countries make the estimation of the burden of CKD in these countries difficult. However, the risk factors for CKD are known to be just as prevalent in many developing countries as in the developed countries. Therefore, the burden of CKD in those developing countries may be comparable to those of the developed countries. In addition, developing countries exhibit a disproportionate burden of infectious and environmental factors that broaden the spectrum of CKD risk factors and is apt to increase CKD burden. A greater understanding of CKD onset and progression among racial/ethnic minorities and socioeconomically disadvantaged persons in the US may provide insights into CKD burdens in similar populations globally. The Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines by the National Kidney Foundation in 2002 defined CKD as functional and structural abnormalities of the kidneys that persist for more than three months. This widely publicized and
Recommendations for early diagnosis of chronic kidney disease  [cached]
Bosan I
Annals of African Medicine , 2007,
Abstract: Background : Chronic kidney disease is an important component of chronic non– communicable diseases that are now of pandemic proportions and are the major cause of morbidity and mortality worldwide. Patients with reduced renal function represent a population not only at risk for progression of kidney disease and development of end stage renal disease (ESRD), but also at a greater risk of cardiovascular disease and mortality. Unfortunately, chronic kidney disease is under diagnosed and undetected resulting in lost opportunities for improving the clinical outcome. Early diagnosis with appropriate interventions will improve the quality of care of patients and prevent or delay progression to end stage renal disease. Our objective is to review existing recommendations and examine their adaptation to improving the quality of care for patients with chronic kidney disease in our environment. Method : Hand searches of published articles and electronic data were the primary sources. Only articles published in the English language were consulted excluding case reports, letters and conference abstracts. Articles of original data were searched from 1980 while review articles and expert committee reports were from 2000. Results : Early diagnosis of chronic kidney disease is crucial to improving the clinical outcome and reducing the incidence of end stage renal disease. Certain individuals with specific socio demographic and clinical factors are at increased risk of chronic renal disease. All individuals should be assessed as part of routine health encounter, to determine whether they are at increased risk of developing chronic kidney disease based on clinical and socio demographic factors. Individuals at increased risk of developing chronic kidney disease should undergo testing for markers of kidney damage, and to estimate the level of GFR.Individuals found to have chronic kidney disease should be evaluated and treated appropriately. A clinical action plan should be developed for each patient based on the type and stage of renal disease, co-morbid conditions, complications of the disease and risk factors for progression of renal disease or development of cardiovascular disease. Conclusion : Individuals at increased risk, but found not to have chronic kidney disease, should be advised to follow of risk factor reduction, if appropriate, and undergo repeat periodic evaluation.
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