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Martino FK, Fanton G, Zanetti F, Carta M, Nalesso F, Novara G. Stage 5 Chronic Kidney Disease: Epidemiological Analysis in a NorthEastern District of Italy Focusing on Access to Nephrological Care. J Clin Med 2024; 13:1144. [PMID: 38398457 PMCID: PMC10888946 DOI: 10.3390/jcm13041144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/29/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND We conducted a retrospective epidemiological study about the prevalence of stage 5 chronic kidney disease (CKD) in a high-income district, comparing some demographic characteristics and outcomes of those patients who had nephrological consultations and those who had not. RESULTS In a district of 400,000 adult subjects in 2020, 925 patients had an estimated glomerular filtration rate (eGFR) under 15 mL/min and CKD. In the same period, 747 (80.4%) patients were assessed by nephrologists, while 178 (19.6%) were not. Age (88 vs. 75, p < 0.0001), female gender (66.3% vs. 47%, p < 0.001), and eGFR (12 vs. 9 mL/min, p < 0.001) were significantly different in the patients assessed by a nephrologist as compared those who did not have nephrological care. Furthermore, unfollowed CKD patients had a significantly higher death rate, 83.1% versus 14.3% (p < 0.0001). CONCLUSIONS About 20% of ESKD patients did not receive a nephrologist consultation. Older people and women were more likely not to be referred to nephrology clinics. Unfollowed patients with stage 5 CKD had a significantly higher death rate.
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Affiliation(s)
- Francesca K. Martino
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, 35124 Padua, Italy;
| | - Giulia Fanton
- International Renal Research Institute Vicenza, 36100 Vicenza, Italy; (G.F.); (F.Z.)
| | - Fiammetta Zanetti
- International Renal Research Institute Vicenza, 36100 Vicenza, Italy; (G.F.); (F.Z.)
| | - Mariarosa Carta
- Department of Laboratory Medicine, San Bortolo Hospital, 36100 Vicenza, Italy;
| | - Federico Nalesso
- Nephrology, Dialysis, Transplantation Unit, Department of Medicine (DIMED), University of Padova, 35124 Padua, Italy;
| | - Giacomo Novara
- Department of Surgery, Oncology and Gastroenterology, Urology Clinic University of Padua, 35124 Padua, Italy
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Husain‐Syed F, Singam NSV, Viehman JK, Vaughan L, Bauer P, Gall H, Tello K, Richter MJ, Yogeswaran A, Romero‐González G, Rosner MH, Ronco C, Assmus B, Ghofrani HA, Seeger W, Birk H, Kashani KB. Changes in Doppler-Derived Kidney Venous Flow and Adverse Cardiorenal Outcomes in Patients With Heart Failure. J Am Heart Assoc 2023; 12:e030145. [PMID: 37577933 PMCID: PMC10492931 DOI: 10.1161/jaha.123.030145] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023]
Abstract
Background The impact of changes in Doppler-derived kidney venous flow in heart failure (HF) is not well studied. We aimed to investigate the association of Doppler-derived kidney venous stasis index (KVSI) and intrakidney venous-flow (IKVF) patterns with adverse cardiorenal outcomes in patients with HF. Methods and Results In this observational cohort study, consecutive inpatients with HF referred to a nephrologist because of a history of diuretic resistance and abnormal kidney function (n=216) underwent spectral kidney assessments after admission (Doppler 1) and 25 to 35 days later (Doppler 2) to identify IKVF patterns (continuous/pulsatile/biphasic/monophasic) and KVSI levels. Cox proportional hazard regression models were used to evaluate the associations between KVSI/IKVF patterns at Doppler 1 as well as changes from Doppler 1 to Doppler 2 and risk of cardiorenal events up to 18 months after admission. Worsening HF or death occurred in 126 patients. Both baseline KVSI (hazard ratio [HR], 1.49 [95% CI, 1.37-1.61] per 0.1-unit increase) and baseline IKVF pattern (HR, 2.47 [95% CI, 2.01-3.04] per 1 pattern severity increase) were significantly associated with worsening HF/death. Increases in both KVSI and IKVF pattern severity from Doppler 1 to 2 were also associated with an increased risk of worsening HF/death (HR, 3.00 [95% CI, 2.08-4.32] per 0.1-unit increase change; and HR, 6.73 [95% CI, 3.27-13.86] per 1 pattern increase in severity change, respectively). Similar results were observed for kidney outcomes. Conclusions Baseline kidney venous flow predicted adverse cardiorenal events, and inclusion of serial kidney venous flow in cardiorenal risk stratification could facilitate clinical decision-making for patients with HF. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03039959.
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Affiliation(s)
- Faeq Husain‐Syed
- Department of Internal Medicine IIUniversity Hospital Giessen and Marburg, Justus‐Liebig‐University GiessenGiessenGermany
- Division of NephrologyUniversity of Virginia School of MedicineCharlottesvilleVA
| | - Narayana Sarma V. Singam
- Division of Pulmonary and Critical Care Medicine, Department of Internal MedicineMayo ClinicRochesterMN
- Departments of Cardiology and Critical CareMedStar Washington Hospital CenterWashingtonDCUSA
| | - Jason K. Viehman
- Division of Clinical Trials and BiostatisticsMayo ClinicRochesterMN
| | - Lisa Vaughan
- Division of Clinical Trials and BiostatisticsMayo ClinicRochesterMN
| | - Pascal Bauer
- Division of Cardiology and Angiology, Department of Internal Medicine IUniversity Hospital Giessen and Marburg, Justus‐Liebig‐University GiessenGiessenGermany
| | - Henning Gall
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center, Institute for Lung Health, Cardio‐Pulmonary Institute, Member of the German Center for Lung ResearchGiessenGermany
| | - Khodr Tello
- Department of Internal Medicine IIUniversity Hospital Giessen and Marburg, Justus‐Liebig‐University GiessenGiessenGermany
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center, Institute for Lung Health, Cardio‐Pulmonary Institute, Member of the German Center for Lung ResearchGiessenGermany
| | - Manuel J. Richter
- Department of Internal Medicine IIUniversity Hospital Giessen and Marburg, Justus‐Liebig‐University GiessenGiessenGermany
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center, Institute for Lung Health, Cardio‐Pulmonary Institute, Member of the German Center for Lung ResearchGiessenGermany
| | - Athiththan Yogeswaran
- Department of Internal Medicine IIUniversity Hospital Giessen and Marburg, Justus‐Liebig‐University GiessenGiessenGermany
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center, Institute for Lung Health, Cardio‐Pulmonary Institute, Member of the German Center for Lung ResearchGiessenGermany
| | - Gregorio Romero‐González
- Department of NephrologyUniversity Hospital Germans Trias i PujolBarcelonaSpain
- International Renal Research Institute of Vicenza, Department of NephrologyDialysis and Transplantation, San Bortolo HospitalVicenzaItaly
| | - Mitchell H. Rosner
- Division of NephrologyUniversity of Virginia School of MedicineCharlottesvilleVA
| | - Claudio Ronco
- International Renal Research Institute of Vicenza, Department of NephrologyDialysis and Transplantation, San Bortolo HospitalVicenzaItaly
- Department of MedicineUniversità di PadovaPaduaItaly
| | - Birgit Assmus
- Division of Cardiology and Angiology, Department of Internal Medicine IUniversity Hospital Giessen and Marburg, Justus‐Liebig‐University GiessenGiessenGermany
| | - Hossein Ardeschir Ghofrani
- Department of Internal Medicine IIUniversity Hospital Giessen and Marburg, Justus‐Liebig‐University GiessenGiessenGermany
- Department of PulmonologyKerckhoff‐KlinikBad NauheimGermany
| | - Werner Seeger
- Department of Internal Medicine IIUniversity Hospital Giessen and Marburg, Justus‐Liebig‐University GiessenGiessenGermany
- Department of Internal MedicineUniversities of Giessen and Marburg Lung Center, Institute for Lung Health, Cardio‐Pulmonary Institute, Member of the German Center for Lung ResearchGiessenGermany
| | - Horst‐Walter Birk
- Department of Internal Medicine IIUniversity Hospital Giessen and Marburg, Justus‐Liebig‐University GiessenGiessenGermany
| | - Kianoush B. Kashani
- Division of Pulmonary and Critical Care Medicine, Department of Internal MedicineMayo ClinicRochesterMN
- Division of Nephrology and Hypertension, Department of Internal MedicineMayo ClinicRochesterMNUSA
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Al Sudani H, Lo KB, Essa H, Wattoo A, Gulab A, Akhtar H, Angelim L, Helfman B, Peterson E, Brousas S, Whybrow-Huppatz I, Yazdanyar A, Soman S, Sankaranarayanan R, Rangaswami J. Differences in ejection fraction as inclusion criterion in randomized controlled trials among patients with heart failure with reduced ejection fraction: a systematic review. Expert Rev Cardiovasc Ther 2022; 20:481-484. [PMID: 35654018 DOI: 10.1080/14779072.2022.2085687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Heart failure (HF) with reduced ejection fraction (HFrEF) has been defined by varying ejection fraction (EF) criteria in clinical trials, leading to differences in quantifying treatment effects. AREAS COVERED The definitions of HFrEF in randomized controlled trials from 2010 until 2020 were collected. The EF ranges were clustered into very low (<30%), low (30-39%) and mildly reduced (40-49%) stratified by intervention. Time series regression analysis was performed.A total of 3052 articles were screened and 706 were included. Interventions included were pharmacologic (37%), device therapy (10%) and 53% a combination of programs, procedural, and laboratory testing. By EF cutoffs, 41% of the studies utilized <40% while 26% used <35%. About 31% did not have a clearly defined EF. Between 2010-2020, studies with HFrEF ranges 30-39% have significantly decreased (p value<0.001 for trend) but those which included very low EF (<30%) and mildly reduced EF (40-49%) have remained the same. Expert opinion:EF definitions across clinical trials in HFrEF varied widely. Defining the specific target HF population phenotype when designing trials or in patient treatment is important as various beneficial effects of different heart failure treatment modalities can be modified or even attenuated across the spectrum of EF.
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Affiliation(s)
- Hussein Al Sudani
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Kevin Bryan Lo
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Hani Essa
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, Liverpool Heart & Chest Hospital, Liverpool, UK.,University of Liverpool, Liverpool, UK
| | - Ammaar Wattoo
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Asma Gulab
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Hamza Akhtar
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Lucas Angelim
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Beth Helfman
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Eric Peterson
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Sophia Brousas
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | | | - Sandeep Soman
- Department of Nephrology, Henry Ford Hospital, Detroit, MI 48202 USA
| | - Rajiv Sankaranarayanan
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, Liverpool Heart & Chest Hospital, Liverpool, UK.,University of Liverpool, Liverpool, UK
| | - Janani Rangaswami
- George Washington University School of Medicine, Washington, DC, USA
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Rangaswami J, Bhalla V, Chertow GM, Harrington RA, Staruschenko A, Tuttle K, Braunwald E. Changing the Trajectory of Heart Failure and Kidney Disease. Clin J Am Soc Nephrol 2022; 17:742-745. [PMID: 35232819 PMCID: PMC9269572 DOI: 10.2215/cjn.00470122] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Janani Rangaswami
- Division of Nephrology, George Washington University School of Medicine, Washington, DC
| | - Vivek Bhalla
- Division of Nephrology, Stanford University School of Medicine, Stanford, California
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Glenn M. Chertow
- Division of Nephrology, Stanford University School of Medicine, Stanford, California
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Robert A. Harrington
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Alexander Staruschenko
- Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, Florida
| | - Katherine Tuttle
- Providence Medical Research Center, Providence Health Care, Spokane, Washington
- Division of Nephrology, University of Washington School of Medicine, Seattle, Washington
| | - Eugene Braunwald
- Thrombolysis in Myocardial Infarction Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
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