The Effects of Simvastatin on Proteinuria and Renal Function in Patients with Chronic Kidney Disease.

Current data suggests that statins might have beneficial effects on renal outcomes. Beneficial effects of statin treatment on renal progression in advanced chronic kidney disease (CKD) are obviously controversial. In a retrospective, controlled study, the authors have evaluated the effects of 53-week treatment with simvastatin, versus no treatment on proteinuria and renal function among 51 patients with CKD stages III-IV. By the end of the 53-week treatment, urine protein excretion decreased from 0.96 (IQR 0.54, 2.9) to 0.48 (IQR 0.18, 0.79) g/g creatinine (P < 0.001) in patients treated with simvastatin in addition to ACEI and ARBs, while no change was observed among the untreated patients. Moreover, a significantly greater decrease in urine protein excretion was observed in the simvastatin group as compared with the untreated group. The mean changes of serum creatinine and eGFR did not significantly differ in both groups. A significantly greater decrease in total cholesterol and LDL-cholesterol was found in the simvastatin group than in the untreated group. In summary, apart from lipid lowering among CKD patients, ingesting simvastatin was associated with a decrease in proteinuria. These statin effects may become important for supportive therapy in renal damage in the future.

Vitamin D insufficiency and deficiency with stages of chronic kidney disease in an Asian population.

BACKGROUND: Vitamin D insufficiency is associated with proteinuria and could be a risk factor for end-stage renal disease (ESRD). However, few studies have examined the significance of vitamin D insufficiency as a contributing factor for the development of ESRD in the Asian chronic kidney disease (CKD) population. METHODS: Authors examined the relationship between vitamin D status and the staging of CKD using data from an outpatient clinic-based screening in 2,895 Thai CKD patients. Serum levels of 25-hydroxyvitamin D were analyzed according to CKD stages. Vitamin D deficiency and insufficiency were defined as a serum 25-hydroxyvitamin D concentration < 10 ng/mL and 10-30 ng/mL, respectively. RESULTS: The mean (SD) 25-hydroxyvitamin D levels were significantly lower according to severity of renal impairment (CKD stage 3a: 27.84 ± 14.03 ng/mL, CKD stage 3b: 25.86 ± 11.14 ng/mL, CKD stage 4: 24.09 ± 11.65 and CKD stage 5: 20.82 ± 9.86 ng/mL, p<0.001). The prevalence of vitamin D deficiency/insufficiency was from CKD stage 3a, 3b, 4 to 5, 66.6%, 70.9%, 74.6%, and 84.7% (p<0.001). The odds ratio (95% CI) of vitamin D insufficiency/deficiency (serum 25-hydroxyvitamin D ≤ 30 ng/mL) and vitamin D deficiency (serum 25-hydroxyvitamin D < 10 ng/mL) for developing ESRD, after adjustment for age, gender, hemoglobin, serum albumin, calcium, phosphate and alkaline phosphatase were 2.19 (95% CI 1.07 to 4.48) and 16.76 (95% CI 4.89 to 57.49), respectively. CONCLUSION: This study demonstrates that 25-hydroxyvitamin D insufficiency and deficiency are more common and associated with the level of kidney function in the Thai CKD population especially advanced stage of CKD.

Apolipoprotein E genetic polymorphisms and the development of nephropathy in type 2 diabetes.

BACKGROUND: Apolipoprotein E (ApoE) polymorphisms have been proposed as the risk factor for the development of diabetic nephropathy (DN). A number of studies have investigated the association between the ApoE isoforms and DN. However the findings remain inconclusive. OBJECTIVE: To determine the association between the ApoE polymorphisms and DN. MATERIAL AND METHOD: Two hundred thirty patients with type 2 diabetes were divided into two groups, patients with clinically diagnosed DN and normoalbuminuric patients. ApoE genotypes were determined by RT-PCR analysis. Student's t-test, ANOVA test, Chi-square test, odds ratio, and logistic regression was performed. RESULTS: The frequency of ApoE4 genotype was significantly lower in DN patients (8.7%) than in normoalbuminuric patients (21.7%). Logistical regression analysis showed that subjects with ApoE4 genotype (adjusted OR = 0.43; 95% CI: 0.19-0.99) were less likely to have DN than subjects with ApoE3 genotype. Furthermore, when analyzed only in patients with overt DN vs. patients with normoalbuminuria, the frequency of e4 allele was decreased in overt DN (2.8% vs. 21.7%, adjusted OR = 0.13; 95% CI: 0.03-0.57) and the frequency of e2 allele was increased (25.4% vs. 13.0%, adjusted OR = 2.34; 95% CI: 1.02- 5.38). CONCLUSION: ApoE4 genotype is associated with protection from type 2 DN, and subjects with e2 allele have increased risk of developing type 2 overt DN.

A single-centre experience: peritoneal dialysis-related infections in patients on long-term dialysis.

OBJECTIVE: Peritoneal dialysis is a convenient way of maintaining patients with end stage renal disease (ESRD) and in the present days, the Thai government supports all payments for ESRD patients. Continuous ambulatory peritoneal dialysis-(CAPD) related infections are the major cause of morbidity and mortality. The present study was conducted to identify the incidence and epidemiological data of CAPD-related infection. MATERIAL AND METHOD: Medical records of 333 CAPD patients attending the Dialysis Unit of Phramongkutklao Hospital from January 1983 to June 2007 were reviewed. The historical cohort study was focused on the incidence of CAPD-related infections, causing pathogens, risk factors, and patient outcome. RESULTS: In total, 73.3% of episodes developed peritoneal infection. The incidences of peritonitis, exit site infection, and tunnel infection were 0.864, 0.213, and 0.034 episodes per patient per year, respectively. The most common infecting organisms were gram positive cocci (49.1%). The main pathogens were Coagulase-negative staphylococcus (15.9%), Staphylococcus aureus (15.2%) and Pseudomonas spp. (14.2%). CAPD-related infections increased in patients who had age > 60. A total of 81% of the infections responded to initial antibiotic therapy administered in the dialysis fluid. Overall, there were 10 episodes (1.9%) of the refractory group and 83 episodes (15.4%) of peritoneal catheter loss, with an overall mortality rate of 1.1%. Non-vancomycin based regimens were applied in 63.9% of peritoneal infected patients. CONCLUSION: The authors' center's CAPD-related infection rate achieved the International Society for Peritoneal Dialysis (ISPD) recommendation. A significantly enhanced incidence of CAPD-related infection occurred in advanced age. Coagulase-negative staphylococcus is still a very common organism that generally responds well to antibiotic therapy.

Insulin resistance in dialysis versus non dialysis end stage renal disease patients without diabetes.

OBJECTIVE: Insulin resistance is frequently recognized in uremic patients and is a predictor of cardiovascular mortality in end stage renal disease (ESRD) patients. However sparse data are available regarding the effects of different methods of renal dialysis on insulin resistance in ESRD without diabetes. The present study was conducted to evaluate the levels of insulin resistance in dialysis versus non dialysis ESRD patients without diabetes. MATERIAL AND METHOD: A cross-sectional study was carried out in 45 non diabetic ESRD patients including continuous ambulatory peritoneal dialysis (CAPD), hemodialysis (HD), and non dialysis ESRD patients. The value of insulin resistance was obtained by homeostasis model assessment (HOMA). Estimation of the glomerular filtration rate (GFR) was obtained by the four-variable Modification of Diet in Renal Disease equation and ESRD was defined when GFR was below 15 ml/min/1.73 m2. RESULTS: Non diabetic ESRD patients were studied: 12 patients on CAPD treatment for 67.4 months, 18 patients on HD treatment for 89.3 months, and 15 patients on conservative treatment. HOMA scores (CAPD 5.4 +/- 2.3, HD 6.0 +/- 1.9 vs. non dialysis 1.5 +/- 0.9, p < 0.05) and fasting plasma insulin levels (CAPD 21.9 +/- 7.7 microU/mL, HD 19.5 +/- 8.4 microU/mL vs. non dialysis 4.4 +/- 2.5 microU/mL, p < 0.05) of the CAPD and HD groups were significantly higher than the non dialysis ESRD group, with no significant differences observed between CAPD and HD groups. However, fasting plasma glucose was significantly lower in the HD group than the CAPD and non dialysis ESRD groups (CAPD 98.2 +/- 10.6 mg/dL, non dialysis 93.0 +/- 11.5 mg/dL vs. HD 76.2 +/- 7.8 mg/dL, p < 0.05). All groups showed no significant differences for blood pressure, body weight, body mass index, fat free mass, body fat, and serum levels of albumin, total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglycerides. CONCLUSION: Impaired insulin sensitivity in both dialysis groups after long term dialysis was still higher than that of the non dialysis ESRD group. However, no significant differences were noted between CAPD and HD treatments.

Metabolic syndrome and its relation to chronic kidney disease in a Southeast Asian population.

The metabolic syndrome has been documented to increase the risk of cardiovascular disease and chronic kidney disease (CKD); however, there are few studies of this in developing countries. A total of 15,357 participants of a standardized check-up, included metabolic screening, were enrolled. Metabolic syndrome was defined using criteria modified from the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) and the International Diabetes Federation (IDF). CKD was defined as a glomerular filtration rate <60 m/min per 1.73 m2. Eighty point four percent of participants were men and 2,228 (14.5%) had CKD. Metabolic syndrome was more prevalent among CKD subjects than non-CKD subjects (modified NCEP-ATP III, 30.1% vs 24.4%; p < 0.001; modified IDF 26.9% vs 23.1%; p < 0.001, respectively). Abdominal obesity, high triglycerides, high blood pressure and impaired fasting glucose were significantly associated with an increased prevalence of CKD. There was also a significant graded relationship between the number of metabolic syndrome components and the prevalence of CKD. Participants with metabolic syndrome according to the modified NCEP-ATP III and modified IDF criteria had a 1.34-fold increase in adjusted odds ratio (95% CI 1.21-1.49) and a 1.20-fold increase in adjusted odds ratio (95% CI 1.08-1.33), respectively, compared to those without metabolic syndrome. Our study demonstrated metabolic syndrome defined with modified NCEP-ATP III and modified IDF criteria was significantly associated with increased prevalence of CKD in a Southeast Asian population.

Relationship between serum uric acid levels with chronic kidney disease in a Southeast Asian population.

AIM: Elevated serum uric level has been suggested as a risk factor for chronic kidney disease (CKD). The relationship between serum uric acid level, and CKD in a Southeast Asian population was examined. METHODS: In a cross-sectional study, authors surveyed 5618 subjects, but 5546 participants were included. The glomerular filtration rate (GFR) values were calculated by the Modification of Diet in Renal Disease (MDRD) equation. CKD was defined as a GFR of less than 60 mL/min per 1.73 m(2). Multivariate binary logistic regression was used to determine the association between serum uric acid level and CKD. RESULTS: The prevalence of CKD in serum uric acid quartiles: first quartile, 5.3 mg/dL or less; second quartile, 5.4-6.4 mg/dL; third quartile, 6.5-7.6 mg/dL; and fourth quartile, 7.7 mg/dL or more were 1.8%, 3.6%, 5.5% and 11.9%, respectively (P < 0.001). The mean values of estimated GFR in participants with CKD and without CKD were 53.44 +/- 7.72 and 81.26 +/- 12.48 mL/min per 1.73 m(2) respectively. In the entire participants, there were 6.76% with hypertension and 2.64% with diabetes as a comorbid disease. Compared with serum uric acid first quartile, the multivariate-adjusted odds for CKD of the fourth, third and second quartile were 10.94 (95% confidence interval (CI), 6.62-16.08), 4.17 (95% CI, 2.51-6.92) and 2.38 (95% CI, 1.43-3.95), respectively. CONCLUSION: High serum uric acid level was independently associated with increased prevalence of CKD in the Southeast Asian population. Detection and treatment of hyperuricaemia should be attended as a strategy to prevent CKD.

High levels of uric acid correlate with decline of glomerular filtration rate in chronic kidney disease.

BACKGROUND: Clinical studies have suggested that high levels of uric acid may contribute to the development of hypertension and kidney disease. However the relation between uric acid and chronic kidney disease (CKD) has been inconsistent. OBJECTIVE: To examine the association between plasma concentration of uric acid, and estimated glomerular filtration rate (GFR) in CKD subjects. MATERIAL AND METHOD: In a cross-sectional study, authors surveyed 5,558 subjects, but only 750 CKD subjects in whom GFR was between 15 and 60 ml/min/1.73 m2 were included in the study. The GFR values were calculated by Cockcroft-Gault formula. RESULTS: There were 65.5% males, mean age of 50.29 +/- 6.39 years and body mass index (BMI) of 21.68 +/- 2.64 kg/m2. The mean value of estimated GFR was 53.86 +/- 6.29 ml/min/1.73 m2. In subjects with serum uric acid fourth quartile displayed significantly higher BMI, higher systolic blood pressure (BP), higher diastolic BP, higher BUN, and higher serum creatinine, and lower estimated GFR as compared with the three lower quartiles. The correlation analysis showed that estimated GFR was negatively correlated with serum uric acid (r = -0.208, p < 0.01), age (r = -0.171, p < 0.01), systolic BP (r = -0.148, p < 0.01) and BMI (r = -0.147, p < 0.01). Multiple regression analysis, the presence of high serum uric acid levels were independently associated with a decline of GFR. CONCLUSION: In CKD subjects, high levels of uric acid were independent associated with GFR decline. Our finding suggests that early detection and prevention on hyperuricemia in CKD subjects are critical.