BACKGROUND: This retrospective real-world study used data from two registries, International Pediatric Peritoneal Dialysis Network (IPPN) and International Pediatric Hemodialysis Network (IPHN), to characterize the efficacy and safety of continuous erythropoietin receptor activator (C.E.R.A.) in pediatric patients with chronic kidney disease (CKD) on peritoneal dialysis (PD) or hemodialysis (HD). METHODS: IPPN and IPHN collect prospective data (baseline and every 6 months) from pediatric PD and HD centers worldwide. Demographics, clinical characteristics, dialysis information, treatment, laboratory parameters, number and causes of hospitalization events, and deaths were extracted for patients on C.E.R.A. treatment (IPPN: 2007-2021; IPHN: 2013-2021). RESULTS: We analyzed 177 patients on PD (median age 10.6 years) and 52 patients on HD (median age 14.1 years) who had ≥ 1 observation while being treated with C.E.R.A. The median (interquartile range [IQR]) observation time under C.E.R.A. exposure was 6 (0-12.5) and 12 (0-18) months, respectively. Hemoglobin concentrations were stable over time; respective means (standard deviation) at last observation were 10.9 (1.7) g/dL and 10.4 (1.7) g/dL. Respective median (IQR) monthly C.E.R.A. doses at last observation were 3.5 (2.3-5.1) μg/kg, or 95 (62-145) μg/m2 and 2.1 (1.2-3.4) μg/kg, or 63 (40-98) μg/m2. Non-elective hospitalizations occurred in 102 (58%) PD and 32 (62%) HD patients. Seven deaths occurred (19.8 deaths per 1000 observation years). CONCLUSIONS: C.E.R.A. was associated with efficient maintenance of hemoglobin concentrations in pediatric patients with CKD on dialysis, and appeared to have a favorable safety profile. The current analysis revealed no safety signals.
- MeSH
- chronická renální insuficience * terapie farmakoterapie MeSH
- chronické selhání ledvin * terapie MeSH
- dialýza ledvin škodlivé účinky MeSH
- dítě MeSH
- erythropoetin * MeSH
- hemoglobiny analýza MeSH
- lidé MeSH
- mladiství MeSH
- prospektivní studie MeSH
- registrace MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- Publikační typ
- časopisecké články MeSH
The 9th Cardiovascular Outcome Trial (CVOT) Summit: Congress on Cardiovascular, Kidney, and Metabolic Outcomes was held virtually on November 30-December 1, 2023. This reference congress served as a platform for in-depth discussions and exchange on recently completed outcomes trials including dapagliflozin (DAPA-MI), semaglutide (SELECT and STEP-HFpEF) and bempedoic acid (CLEAR Outcomes), and the advances they represent in reducing the risk of major adverse cardiovascular events (MACE), improving metabolic outcomes, and treating obesity-related heart failure with preserved ejection fraction (HFpEF). A broad audience of endocrinologists, diabetologists, cardiologists, nephrologists and primary care physicians participated in online discussions on guideline updates for the management of cardiovascular disease (CVD) in diabetes, heart failure (HF) and chronic kidney disease (CKD); advances in the management of type 1 diabetes (T1D) and its comorbidities; advances in the management of CKD with SGLT2 inhibitors and non-steroidal mineralocorticoid receptor antagonists (nsMRAs); and advances in the treatment of obesity with GLP-1 and dual GIP/GLP-1 receptor agonists. The association of diabetes and obesity with nonalcoholic steatohepatitis (NASH; metabolic dysfunction-associated steatohepatitis, MASH) and cancer and possible treatments for these complications were also explored. It is generally assumed that treatment of chronic diseases is equally effective for all patients. However, as discussed at the Summit, this assumption may not be true. Therefore, it is important to enroll patients from diverse racial and ethnic groups in clinical trials and to analyze patient-reported outcomes to assess treatment efficacy, and to develop innovative approaches to tailor medications to those who benefit most with minimal side effects. Other keys to a successful management of diabetes and comorbidities, including dementia, entail the use of continuous glucose monitoring (CGM) technology and the implementation of appropriate patient-physician communication strategies. The 10th Cardiovascular Outcome Trial Summit will be held virtually on December 5-6, 2024 ( http://www.cvot.org ).
- MeSH
- chronická renální insuficience * diagnóza epidemiologie terapie MeSH
- diabetes mellitus 2. typu * farmakoterapie MeSH
- diabetes mellitus * farmakoterapie MeSH
- kardiovaskulární nemoci * diagnóza epidemiologie prevence a kontrola MeSH
- krevní glukóza MeSH
- ledviny MeSH
- lidé MeSH
- obezita komplikace MeSH
- selfmonitoring glykemie MeSH
- srdeční selhání * komplikace MeSH
- tepový objem MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- dopisy MeSH
Tento článek shrnuje poznatky v oboru nefrologie za poslední rok. Studie EMPA ‐KIDNEY potvrdila výrazný renoprotektivní efekt SGLT‐2 inhibitorů u nemocných bez diabetu, zatímco renoprotektivní efekt u nemocných s diabetem byl potvrzen u finerenonu. Studie STOP ‐ACEi ukázala, že přerušování léčby inhibitory systému renin‐angiotesin‐aldosteron nemá smysl u pokročilého chronického onemocnění ledvin. Studie CHAP prokázala významný efekt včasné léčby krevního tlaku při jeho vzestupu nad 140/90 mm Hg u těhotných žen. Dále bylo potvrzeno, že jak systémová, tak topická kortikoterapie představuje možnosti léčby IgA nefropatie. Rovněž ve studii CONVINCE bylo prokázáno, že hemodiafiltrace má mortalitní benefity oproti hemodialýze. Studií NOSTONE byla zpochybněna role thiazidových diuretik v prevenci urolitiázy. Potenciálně zásadní novinkou pro vysoce senzitizované pacienty čekající na transplantaci ledviny představuje IgG ‐degradující enzym Streptococcus pyogenes – imlifidáza. Tyto nové poznatky dávají pacientům naději na zpomalení progrese chronického onemocnění ledvin a rovněž zlepšují jejich vyhlídky v případě nutnosti zahájení náhrady funkce ledvin.
This article summarizes the latest developments in the field of nephrology over the past year. The EMPA-KIDNEY study confirmed a significant renoprotective effect of SGLT-2 inhibitors in patients without diabetes, while a renoprotective effect in patients with diabetes was confirmed for finerenone. The STOP-ACEi study showed that discontinuation of renin-angiotensin-aldosterone system inhibitors does not confer benefit in patients with advanced chronic kidney disease. The CHAP study showed a significant beneficial effect of early treatment of hypertension above 140/90mmHg in pregnant women. It has also been confirmed that both systemic and topical corticosteroids represent viable treatment options for IgA nephropathy. Furthermore, the CONVINCE study showed that hemodiafiltration has mortality benefits over hemodialysis. The role of thiazide diuretics in the prevention of urolithiasis has been questioned by the NOSTONE study. The IgG-degrading enzyme of Streptococcus pyogenes - imlifidase - is a potentially crucial innovation for highly sensitized patients awaiting kidney transplantation. These new findings give patients hope for slowing the progression of chronic kidney disease and also improves their prospects if the need for renal replacement therapy arises.
INTRODUCTION: High indoxyl sulfate (IS) concentration is a serious problem for patients with CKD increasing the risk of cardiovascular diseases and CKD progression. Thus, the methods of decreasing the toxin concentrations are highly desired. The study aimed to discover the role of selected intestine-related factors on IS concentration. METHODS: We evaluated the impact of ABCG2 and ABCC2 polymorphisms influencing activity and protein intake by normalized protein catabolic rate. Additionally, we examined the relation of IS and uric acid (UA) that can share common elimination transporters. A monocentric, prospective, open cohort pilot study was performed on 108 patients undergoing dialysis treatment. RESULTS: The positive effect of residual diuresis on the reduction of IS levels was confirmed (p = 0.005). Also, an increase in IS depending on the dietary protein intake was confirmed (p = 0.040). No significant correlation between ABC gene polymorphisms was observed either, suggesting the negligible role of ABCG2 and ABCC2 in the elimination of IS in small bowel. The significant difference was observed for UA where ABCG2 421C>A (rs72552713) gene polymorphism was higher (505.3 μmol/L) in comparison with a wild-type genotype (360.5 μmol/L). CONCLUSION: No evidence of bowel elimination pathway via ABCC2 and ABCG2 transporters was found in renal replacement therapy patients.
- MeSH
- časná diagnóza MeSH
- chronická renální insuficience diagnóza komplikace terapie MeSH
- COVID-19 komplikace MeSH
- dialýza ledvin MeSH
- ledvinné látky terapeutické užití MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- rozhovory MeSH
V posledních desetiletích stoupá počet nemocných vysokých věkových kategorií s chronickým onemocněním ledvin (CKD). Přes rozvoj dialyzačních technologií a transplantačního programu přibývá nemocných, u kterých biologický věk s dalším orgánovým poškozením neumožňuje úspěšnou transplantaci ledviny, ale často ani dlouhodobou léčbu v dialyzačním programu. V posledních letech se objevily studie o úspěšné dlouhodobé konzervativní léčbě s podáváním modifikovaných nízkobílkovinných diet (NBD) doplněných ketoanalogy esenciálních aminokyselin (KA) u nemocných nad 80 let věku. V naší studii u sedmdesáti nemocných ve věkové kategorii 65–79 let (Sk I) a 80–95 let (Sk II) s CKD léčených konzervativně (navazující na předchozí naše studie u více než 3 000 pacientů) jsme během 48 měsíců sledování prokázali pouze mírnou progresi renální insuficience se stabilizací metabolického stavu. Současně jsme prokázali, že pacienti Sk II se nelišili od pacientů Sk I a lze tedy NBD s KA podávat dlouhodobě úspěšně i u této vysoké věkové kategorie. Při indikaci NBD je třeba přihlédnout k hodnocení glomerulární filtrace (snížení hladiny kreatininu při úbytku svalové hmoty seniorů) a k riziku malnutrice (doplnění NBD a KA enterální nutricí-sipping v renální formuli).
In last decades, there is growing number of seniors over 65 years with chronic kidney disease (CKD). Beside of development in technology of dialysis and kidney transplantation there is a lot of patients who are not indicated for successful management in dialysis- transplantation programme due to serious other organ damages. In our long-term study comprises 70 patients (Gr I 65–79 years, Gr II 80–95years ) on conservative management with low protein diet (LPD) and keto amino acids (KA) – following our long-term experience in previous 3 000 patients – we confirmed only slight decrease of renal function and stabilized metabolic parameters in 48 months follow-up. There were no significant differences between both groups (Gr I vs Gr II) and LPD + KA can be successfuly used also in very old patients (80–95 years). For indication in LPD should be taken into account also lower level of creatinine due to sarcopenia (calculation of renal function) and risk of malnutrition (supplementation of enteral nutrition-sipping in renal formula).
- Klíčová slova
- ketoanaloga esenciálních aminokyselin,
- MeSH
- chronická renální insuficience * dietoterapie terapie MeSH
- esenciální aminokyseliny farmakologie terapeutické užití MeSH
- klinická studie jako téma MeSH
- lidé MeSH
- nízkoproteinová dieta MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- strava, jídlo, výživa MeSH
- Check Tag
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
The prevalence of atrial fibrillation (AF) in patients with chronic kidney disease (CKD), especially on hemodialysis (HD) is higher compared to the general population without CKD and reaches ~20%. The risk of ischemic stroke in CKD patients is also significantly increased. However, since the risk of bleeding is also significantly increased in CKD patients and the number of bleeding events exceeds the number of thrombotic events, there are great concerns regarding the routine use of anticoagulation in this patient population. No randomized studies were performed to compare anticoagulation with placebo in patients with advanced CKD and AF. This lack of knowledge is reflected in international guidelines which refrain from clear recommendations. The use of anticoagulation for stroke prevention in HD patients with AF should be strictly individualized for each patient. Anticoagulation for stroke prevention in HD patients with AF seems justified only in selected patients with high stroke and low bleeding risk. Reduced-dose direct oral anticoagulants (especially apixaban) may prove beneficial. In patients with high thrombotic and bleeding risk, left atrial appendage closure could be considered. In this article, the results of the most relevant observational studies with anticoagulation in CKD/HD patients with AF have been presented and discussed. Furthermore, results of randomized studies comparing vitamin K antagonists with non-vitamin K antagonists in CKD patients have been discussed in detail. Finally, ongoing randomized studies with reduced doses of apixaban, factor XI inhibitors, and left atrial appendage closure in CKD patients are mentioned. A brief summary of rhythm control strategies in AF is given.
- MeSH
- antikoagulancia terapeutické užití MeSH
- chronická renální insuficience * komplikace terapie MeSH
- dialýza ledvin MeSH
- fibrilace síní * komplikace MeSH
- fibrinolytika MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- chronická obstrukční plicní nemoc diagnóza farmakoterapie komplikace MeSH
- chronická renální insuficience diagnóza komplikace terapie MeSH
- delirium etiologie MeSH
- diabetes mellitus diagnóza terapie MeSH
- komorbidita MeSH
- komplikace diabetu MeSH
- lidé MeSH
- management péče o pacienta MeSH
- nádory komplikace MeSH
- nemoci jater komplikace terapie MeSH
- obezita komplikace terapie MeSH
- péče o pacienty v kritickém stavu * MeSH
- sepse diagnóza etiologie terapie MeSH
- srdeční selhání diagnóza etiologie terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- chronická renální insuficience * komplikace patofyziologie terapie MeSH
- dítě MeSH
- glifloziny farmakologie terapeutické užití MeSH
- lidé MeSH
- monoklonální protilátky farmakologie terapeutické užití MeSH
- polycystická choroba ledvin farmakoterapie MeSH
- tolvaptan farmakologie terapeutické užití MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
