Kidney & blood pressure research最新文献

{"title":"Thromboxane A2 or Activated Platelets Slightly Lower Fgf23 Expression in vitro.","authors":"Elena Kohm, Steffen Rausch, Julia Vogt, Martina Feger, Michael Föller","doi":"10.1159/000545696","DOIUrl":"10.1159/000545696","url":null,"abstract":"<p><strong>Introduction: </strong>Fibroblast growth factor 23 (FGF23) has emerged as an important endocrine regulator of renal phosphate and vitamin D metabolism and as a factor implicated in pathophysiological processes in further organs, including the heart. In myocardial infarction, elevations of plasma FGF23 can be observed that may be related to left ventricular hypertrophy or fibrosis. A critical event in the development of myocardial infarction and thrombosis is platelet aggregation due to thromboxane A2 (TxA2) formation. We studied whether TxA2 is a regulator of FGF23.</p><p><strong>Methods: </strong>Experiments were performed in rat UMR-106 osteoblast-like cells and differentiated mouse MC3T3-E1 cells upon exposure to TxA2, pharmacological manipulation of TxA2 signaling, or co-incubation with platelets isolated from healthy volunteers. Fgf23 transcripts were analyzed by qRT-PCR and FGF23 protein by enzyme-linked immunosorbent assay.</p><p><strong>Results: </strong>As a result, TxA2 or stable TxA2 receptor agonists I-BOP or U46619 significantly suppressed Fgf23 gene expression, an effect abrogated by TxA2 receptor antagonist SQ29548. TxA2 signaling also down-regulated FGF23 protein concentration in the cell culture supernatant. Co-incubation of UMR-106 cells with freshly isolated human thrombocytes activated by thrombin, but not with non-activated platelets or thrombin alone, significantly lowered Fgf23 gene expression in UMR-106 cells.</p><p><strong>Conclusion: </strong>Taken together, TxA2 signaling suppresses FGF23 production in UMR-106 and MC3T3-E1 bone cells. TxA2-dependent regulation of FGF23 synthesis may be particularly relevant for common diseases associated with enhanced platelet aggregation.</p>","PeriodicalId":17813,"journal":{"name":"Kidney & blood pressure research","volume":" ","pages":"375-384"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Cacna1d D307G Mutation on Blood Pressure and Kidney Function in Rats with Salt Loading.","authors":"Lan Cheng, Hui Chen, R Nfornah Maboh, Huan Wang","doi":"10.1159/000542828","DOIUrl":"10.1159/000542828","url":null,"abstract":"<p><strong>Introduction: </strong>Our recent findings revealed that CACNA1D D307G mutation participates in the early-onset hypertension.</p><p><strong>Methods: </strong>We used the CRISPR/Cas9 technique to generate the Cacna1d D307G mutation rat model and investigated the effects of Cacna1d D307G mutation on blood pressure (BP) and renal function. Rats fed normal-salt diet had normal plasma aldosterone levels but higher plasma ET-1 and mildly elevated systolic BP (SBP) in D307G and G307G rats compared with the wild type (WT) until 24 weeks. Renal function and renal histopathology did not significantly differ among the three groups.</p><p><strong>Results: </strong>When fed high-salt diet (HSD), D307G and G307G rats showed more sensitivity to HSD. The results showed a further increase in SBP than in WT rats. Plasma and vascular endothelin-1 (ET-1) level and cortex and renal artery endothelin type A (ETA) receptor protein expression were significantly increased. Enhanced renal injury was also noted as indicated by an increased ratio of kidney weight/body weight, elevated urinary protein and albumin/creatinine ratio, higher kidney injury molecule-1 (KIM-1) levels, advanced fibrosis and apoptosis, and inflammation. Further experiments revealed a reduction in urinary sodium excretion and creatinine clearance. Higher protein expression of renal cortex epithelial sodium channel α subunit (αENaC) was confirmed in D307G and G307G rats fed HSD. However, a selective ETA receptor blockade (ABT-627) could partially reverse the increased SBP, increased serum KIM-1 level, upregulated renal cortex protein expression of αENaC, and reduced urinary sodium excretion with reduced creatinine clearance in D307G rats fed HSD.</p><p><strong>Conclusion: </strong>Activation of the ET-1/ETA system in D307G mutation rats might have contributed to increased sensitivity to salt loading, augmented hypertension, and exacerbated the renal injury.</p>","PeriodicalId":17813,"journal":{"name":"Kidney & blood pressure research","volume":" ","pages":"46-60"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11844681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unravelling the Role of Serum Kallistatin on Cardiorenal Outcomes in Kidney Transplant Survivors.","authors":"Krzysztof Batko, Anna Sączek, Małgorzata Banaszkiewicz, Jolanta Małyszko, Ewa Koc-Żórawska, Marcin Żórawski, Karolina Niezabitowska, Katarzyna Siek, Andrzej Kraśniak, Marcin Krzanowski, Katarzyna Krzanowska","doi":"10.1159/000543652","DOIUrl":"10.1159/000543652","url":null,"abstract":"<p><strong>Introduction: </strong>Kallistatin, a serine protease inhibitor, has been implicated in cardiovascular and renal protection. This study investigates its association with clinical characteristics and outcomes in long-term kidney transplant recipients (KTRs).</p><p><strong>Methods: </strong>In this longitudinal observational cohort study, we enrolled 101 KTRs between September 2016 and October 2017. The median (interquartile range) time post-transplant was 52 (36-97) months, and the follow-up time was 83 (41-85) months. All patients had documented graft function of ≥24 months and no record of acute rejection or active or chronic infection at presentation. Serum kallistatin and high-sensitivity interleukin-6 were measured at baseline using commercially available enzyme-linked immunosorbent assays. A control group of 32 healthy volunteers was also recruited.</p><p><strong>Results: </strong>Higher serum kallistatin levels were observed in KTRs compared to healthy controls (15.9 vs. 13.8 µg/mL; p = 0.007). Concentrations were lower in diabetic versus non-diabetic KTR (14.8 vs. 16.4 µg/mL; p = 0.021). A significant interaction between diabetic status and body mass index indicated a positive association with kallistatin levels only in diabetic KTRs (p = 0.046). Linear mixed models assessing estimated glomerular filtration rate (eGFR) change over time showed improved fit after kallistatin was included in a base model with age, sex, and baseline eGFR (p = 0.024). Cox regression showed that higher kallistatin levels were associated with an increased risk of graft loss (HR: 1.120; p = 0.049), but also remained independent of time after transplantation (HR: 1.147; p = 0.030). No association was observed for all-cause mortality. The best performance was estimated for kallistatin models adjusting for time post-transplant (c-index 0.779) and diabetic status (c-index 0.707).</p><p><strong>Conclusion: </strong>This study highlights the complex interactions between kallistatin, renal function, and cardiometabolic status in stable, long-term KTRs. Higher kallistatin levels are associated with an increased risk of graft loss in non-diabetic patients while showing a protective effect in diabetic patients. These findings support integrated management of cardio-reno-metabolic health in KTRs.</p>","PeriodicalId":17813,"journal":{"name":"Kidney & blood pressure research","volume":" ","pages":"221-231"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing Precision Medicine for Hypertensive Nephropathy: A Novel Prognostic Model Incorporating Pathological Indicators.","authors":"Yunlong Qin, Jin Zhao, Yan Xing, Zixian Yu, Panpan Liu, Yuwei Wang, Anjing Wang, Yueqing Hui, Wei Zhao, Mei Han, Meng Liu, Xiaoxuan Ning, Shiren Sun","doi":"10.1159/000545524","DOIUrl":"10.1159/000545524","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to assess the long-term renal prognosis of patients with hypertensive nephropathy (HN) diagnosed through renal biopsy, utilizing the random survival forest (RSF) algorithm.</p><p><strong>Methods: </strong>From December 2010 to December 2022, HN patients diagnosed by renal biopsy in Xijing Hospital were enrolled and randomly divided into training set and testing set at a ratio of 7∶3. The study's composite endpoint was defined as a ≥50% decline in estimated glomerular filtration rate (eGFR), end-stage renal disease, or death. RSF and Cox regression were used to establish a renal prognosis prediction model based on the factors screened by the RSF algorithm. The Concordance index (C-index), integrated Brier score, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to evaluate discrimination, calibration, and risk classification, respectively.</p><p><strong>Results: </strong>A total of 225 patients were included in this study, with 72 (32.0%) patients experiencing combined events after a median follow-up of 29.9 (16.6, 52.1) months. Six eligible variables (overall chronicity grade of renal pathology, eGFR, high-density lipoprotein cholesterol, hematocrit, monocyte, and stroke volume) were selected from clinical data and introduced into the RSF model. The RSF model had a higher C-index in both the training set (0.904 [95% CI: 0.842-0.938] vs. 0.831 [95% CI: 0.768-0.894], p < 0.001) and the testing set (0.893 [95% CI: 0.770-0.944] vs. 0.841 [95% CI: 0.751-0.931], p = 0.021) compared to the Cox model. NRI and IDI indicated that the RSF model outperformed the Cox model regarding risk classification.</p><p><strong>Conclusion: </strong>In this study, the RSF algorithm was employed to identify the risk factors affecting the prognosis of HN patients, and a clinical prognostic RSF model was constructed to predict the adverse outcomes of HN patients based on renal pathology. Compared to the traditional Cox regression model, the RSF model offers superior performance and can provide valuable new insights for clinical diagnosis and treatment strategies.</p>","PeriodicalId":17813,"journal":{"name":"Kidney & blood pressure research","volume":" ","pages":"309-320"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Meta-Analysis of the Relationship between Stroke and Alzheimer's Disease: Therapeutic and Prognostic Implications.","authors":"Olalla Saiz-Vázquez, Silvia Ubillos-Landa, Alicia Puente-Martínez","doi":"10.1159/000546395","DOIUrl":"10.1159/000546395","url":null,"abstract":"<p><strong>Introduction: </strong>Several population-based studies have highlighted an association between stroke and dementia. Alzheimer's disease (AD)-related dementia and vascular dementia are the most common causes of dementia, with clear pathophysiological mechanisms for the latter. Given the ongoing debate surrounding the link between stroke and AD, a systematic meta-analysis was performed to determine their relationship and the possible influence of some moderators (sex, age, and region).</p><p><strong>Methods: </strong>We searched five databases (ISI Web of Science, Scopus, PubMed, Elsevier ScienceDirect, and Google Scholar) with no initial publication date restriction, and the last search was conducted in 2022. We included longitudinal population-based studies assessing the stroke-AD association, selecting those with reported effect sizes, standardized AD diagnosis, and an AMSTAR score ≥9. Case reports, reviews, animal studies, and non-English publications were also excluded. The meta-analysis, conducted using Comprehensive Meta-Analysis 3.1, presented pooled log odds ratios (LogOR) with 95% confidence intervals, heterogeneity analysis (Cochran's Q, I2), and moderator analyses by age, sex, and region.</p><p><strong>Results: </strong>The meta-analysis included 3 meta-analyses and 12 primary studies, comprising a total of 14,207 stroke cases and 1,952 AD cases. Our analysis revealed a significant association between ischemic stroke (IS), hemorrhagic stroke (HS), and microinfarcts (MI) and the risk of AD. Despite some heterogeneity across studies, no significant differences were observed in the stroke-AD association based on age, sex, or region.</p><p><strong>Conclusion: </strong>Our study describes the risk of AD in patients with episodes of stroke (IS, HS, and MI) and suggests that the risk of AD may be higher in stroke patients than in matched controls without stroke incidence. Moreover, the moderator analysis supports the robustness of our results. The link between stroke and AD suggests that stroke may accelerate cognitive decline. This calls for tighter vascular control and indicates worse prognosis in dementia progression.</p>","PeriodicalId":17813,"journal":{"name":"Kidney & blood pressure research","volume":" ","pages":"481-495"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12263138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperatory FLOT Regimen for Gastroesophageal Cancer and Renal Function: A New Onco-Nephrological Perspective.","authors":"Matteo Floris, Andrea Angioi, Nicole Liscia, Michele Ghidini, Alessandra Cinque, Marco Puzzoni, Antonello Pani, Nicola Lepori, Mario Scartozzi, Manuela Dettori, Gianfranca Cabiddu, Paola Testoni, Stefano Cascinu, Elena Mazza, Francesco Trevisani","doi":"10.1159/000545638","DOIUrl":"10.1159/000545638","url":null,"abstract":"<p><strong>Background: </strong>The FLOT regimen, a combination of fluorouracil, leucovorin, oxaliplatin, and docetaxel, is a standard treatment for gastric and esophagogastric junction cancers, but concerns exist about its potential renal toxicity. The exact prevalence and severity of renal toxicity need to be well documented, and this knowledge gap could impact the optimal use of the FLOT regimen in clinical practice. We aimed to evaluate the renal toxicity profile of the FLOT regimen with a specific focus on acute kidney disease (AKD) onset in a real-life setting and explore associated risk factors.</p><p><strong>Methods: </strong>We conducted a multicenter retrospective study involving 96 patients treated with preoperatory FLOT. The incidence of AKD and potential risk factors were identified.</p><p><strong>Results: </strong>AKD occurred in 3 patients (incidence rate of 0.0122 cases/month of follow-up). Oral antidiabetic agents and prostate hypertrophy emerged as significant predictors of AKD.</p><p><strong>Conclusion: </strong>AKD is uncommon in patients treated with the preoperatory FLOT regimen. Our findings highlight the importance of diligent renal function monitoring and appropriate preventive strategies in patients undergoing FLOT treatment. These results encourage the conduction of further studies and clinical experience in larger populations and patients with lower baseline estimated glomerular filtration rate.</p>","PeriodicalId":17813,"journal":{"name":"Kidney & blood pressure research","volume":" ","pages":"398-407"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pitfalls of Current Diagnostic Criteria of Tumor Lysis Syndrome.","authors":"Naji Alhamid, Bana Sabbagh, Asmaa Alsarraj, Edgar Lerma, Tiffany Caza, Biruh Workeneh, Jacqueline Claudia Barrientos, Kenar D Jhaveri","doi":"10.1159/000538328","DOIUrl":"https://doi.org/10.1159/000538328","url":null,"abstract":"<p><strong>Background: </strong>Tumor Lysis syndrome (TLS) is a well-recognized medical emergency in patients with cancer diagnosis. The diagnostic criteria of TLS have been revised many times since it was recognized, but still have many drawbacks limit diagnosis accuracy.</p><p><strong>Summary: </strong>Autopsy studies in patients with perimortem diagnoses of TLS have shown that they may not have actually had TLS. Therefore, many cancer patients who are at risk for TLS, clinical and laboratory criteria may be fulfilled due to other causes of acute kidney injury. In this review, we aim to cast a spotlight on the shortcomings and pitfalls of the current diagnostic criteria for TLS, and propose a roadmap for developing a more rigorous criteria that improve on the diagnostic accuracy.</p><p><strong>Key messages: </strong>Causes of AKI in patients with cancer other than TLS should be considered. Because current diagnostic criteria may miss those differential diagnosis, specific biomarkers that can tell when TLS is the underlying process is an important need, besides appropriate criteria that can jump over the pitfalls in the current criteria and enhance the recognition of TLS among other causes.</p>","PeriodicalId":17813,"journal":{"name":"Kidney & blood pressure research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140110599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Five-year Trajectory about Screening for Complication of Diabetes Kidney Disease and Cardiovascular Disease Mortality : Focusing on Regional Difference.","authors":"Jina Han, Gawon Kim, Yeong Jun Ju, Soon Young Lee","doi":"10.1159/000538244","DOIUrl":"https://doi.org/10.1159/000538244","url":null,"abstract":"<p><strong>Backgrounds: </strong>The overall screening rate for complication of diabetes kidney disease is improving; however, regional variations are increasing. It is necessary to select regions vulnerable to change and understand their characteristics.</p><p><strong>Methods: </strong>Group-based trajectory analysis was performed to derive change patterns in the complication of diabetes kidney disease screening rate in 244 regions using Community Health Survey data between 2015 and 2019. ANOVA test was conducted to examine the differences in regional characteristics and CVD in each change pattern.</p><p><strong>Results: </strong>The change patterns in complication of diabetes kidney disease screening rate were classified into four groups: high and rapidly increasing (Group 1, 5.2%), steady high (Group 2, 8.2%), moderate and increasing (Group 3, 52.9%), and low and slightly increasing (Group 4, 23.8%). Group 4 had many rural areas and worse socioeconomic status, healthcare systems, health behaviors, and diabetes management, and these regions had higher CVD mortality rates.</p><p><strong>Conclusions: </strong>Regions where the screening for complication of diabetes kidney disease rate did not improve compared to other regions were vulnerable not only in socioeconomic status, healthcare system, and health behavior, but also in disease management. This suggests the need for local and environmental support, as well as aggressive health service interventions in relatively vulnerable areas.</p>","PeriodicalId":17813,"journal":{"name":"Kidney & blood pressure research","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140059784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Protective Effect of Vitexin on Hypertensive Nephropathy Rats.","authors":"Tingting Duan, Minyi Li, Ziyang Lin, Lanqing Meng, Mengqiu Li, Tao Xia, Xianlong Zhang, Guixuan Lin, Lufeng Yan, Mingjie Liang, Quan Zhu, Zhenghai Li, Junzheng Yang","doi":"10.1159/000540618","DOIUrl":"10.1159/000540618","url":null,"abstract":"<p><strong>Introduction: </strong>Vitexin is a natural flavonoid compound extracted from Vitex leaves or seeds, exhibiting various pharmacological activities including anticancer, antihypertensive, anti-inflammatory, and spasmolytic effects. However, its protective effects on hypertensive nephropathy (HN) and the underlying mechanisms remain unclear.</p><p><strong>Methods: </strong>Spontaneous hypertension rats were fed a high-sugar and high-fat diet for 8 weeks to induce the disease HN model. From the 5th week, the rats were administered vitexin via gavage. Blood pressure was measured biweekly using the tail-cuff method. Histopathological changes were assessed using HE staining, and biochemical analyses were performed to evaluate the effects of vitexin on HN rats. The underlying mechanisms of vitexin treatment were investigated through western blotting.</p><p><strong>Results: </strong>The data demonstrated that vitexin significantly lowered systolic, diastolic, and mean arterial pressures and ameliorated histopathological changes in HN rats. Biochemical analyses revealed that vitexin reduced the levels of creatinine (Cr), blood urea nitrogen (BUN), total cholesterol (TC), triglycerides (TG), total protein (TP), low-density lipoprotein cholesterol (LDL-C), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), malondialdehyde (MDA), and advanced glycation end products (AGEs), while increasing the levels of albumin (ALB) and superoxide dismutase (SOD). Western blotting results indicated that vitexin treatment decreased the expression of TNF-α, IL-6, and nuclear factor kappa-B (NF-κB), while increasing the expression of SOD.</p><p><strong>Conclusion: </strong>The findings of this study suggest that vitexin exerts protective effects against HN, providing pharmacological evidence for its potential use in HN treatment.</p>","PeriodicalId":17813,"journal":{"name":"Kidney & blood pressure research","volume":" ","pages":"753-762"},"PeriodicalIF":2.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141855935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Major Bleeding among Patients with Chronic Kidney Disease Treated with Acetylsalicylic Acid.","authors":"Gil Schwartz Yoskovitz, Meytal Schwartz Yoskovitz, Hadar Haim-Pinhas, Mor Saban, David Pereg, Ori Wand, Ilan Rozenberg, Sydney Benchetrit, Keren Cohen-Hagai","doi":"10.1159/000542500","DOIUrl":"10.1159/000542500","url":null,"abstract":"<p><strong>Introduction: </strong>Individuals with chronic kidney disease (CKD) are at increased risk of thrombotic events and bleeding. Acetylsalicylic acid (ASA), an effective antiplatelet agent, is one of the most frequently used medications for both primary and secondary prevention of cardiovascular disease (CVD). However, it can also contribute to bleeding events due to its inherent antiplatelet effect. The objective of this study was to determine the characteristics of CKD patients at increased risk of bleeding under ASA therapy.</p><p><strong>Methods: </strong>This retrospective analysis included patients with non-dialysis-dependent CKD who were treated with ASA for primary prevention of CVD for at least 3 consecutive months and did not receive anti-coagulants or anti-platelets. Data were collected from electronic medical records from January 2014 to December 2018. CKD diagnosis was based on an estimated glomerular filtration rate of <60 mL/min/1.73 m2. CKD patients who experienced major bleeding events during ASA therapy (bleeding group) versus all others (control group) were compared. Additional outcomes included first documented nonfatal cardiovascular event and all-cause mortality.</p><p><strong>Results: </strong>Of the 900 adult CKD patients included in this analysis, 82 (9.1%) had a major bleeding event during 31.6 ± 25.9 months of follow-up. The most common bleeding site was gastrointestinal (52 cases, 63.4% of major bleeding events). Patients who had a major bleeding event were older (76.5 ± 10 vs. 74 ± 10.3 years, p = 0.038). On multivariate analysis, age was the most important predictor of major bleeding event (odds ratio: 1.029, 95% confidence interval: 1.004-1.056).</p><p><strong>Conclusions: </strong>Given its controversial efficacy in primary prevention of CVD in CKD patients, characterizing those at increased risk of bleeding under ASA therapy is important in the era of tailored medicine. Age, CKD stage, and cardiovascular risk are key factors to consider regarding the safety and effectiveness of ASA for CKD patients.</p>","PeriodicalId":17813,"journal":{"name":"Kidney & blood pressure research","volume":" ","pages":"1033-1040"},"PeriodicalIF":2.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}