Browsing by Subject "Renal Insufficiency"

Now showing 1 - 8 of 8
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    Ambulatory BP Phenotypes and Their Association with Target Organ Damage and Clinical Outcomes in CKD
    (American Society of Nephrology, 2020-04-07) Georgianos, Panagiotis I.; Agarwal, Rajiv; Medicine, School of Medicine
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    The Case for a Bariatric-Centered Approach to CKD Care
    (American Society of Nephrology, 2019-02-07) Friedman, Allon N.; Medicine, School of Medicine
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    Metabolic Changes with Base-Loading in CKD
    (American Society of Nephrology, 2018-08-07) Scialla, Julia J.; Brown, Landon; Gurley, Susan; Corcoran, David L.; Bain, James R.; Muehlbauer, Michael J.; O’Neal, Sara K.; M. O’Connell, Thomas; Wolf, Myles; Melamed, Michal L.; Hostetter, Thomas H.; Abramowitz, Matthew K.; Otolaryngology -- Head and Neck Surgery, School of Medicine
    In small, randomized studies, treatment with sodium bicarbonate slowed kidney function decline in patients with CKD, possibly by lowering urine ammonium or inhibiting the renin-angiotensin-aldosterone or endothelin-1 pathways (1). Understanding the metabolic effects of alkali supplementation may reveal new candidate mechanisms. With this goal in mind, we profiled changes in systemic metabolites after treatment with sodium bicarbonate within a previously performed crossover trial of oral sodium bicarbonate (2).
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    Personalizing Longitudinal Care Coordination for Patients with Chronic Kidney Disease
    (IOS Press, 2017) Cullen, Theresa A.; Kasthurirathne, Suranga N.; Norton, Jenna M.; Narva, Andrew S.; Family Medicine, School of Medicine
    Chronic care coordination efforts often focus on the needs of the healthcare team and not on the individual needs of each patient. However, developing a personalized care plan for patients with Chronic Kidney Disease (CKD) requires individual patient engagement with the health care team. We describe the development of a CKD e-care plan that focuses on patient specific needs and life goals, and can be personalized according to provider needs.
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    Plant-Based Diets in CKD
    (American Society of Nephrology, 2019-01-07) Clegg, Deborah J.; Gallant, Kathleen M. Hill; Medicine, School of Medicine
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    Shock wave lithotripsy does not impair renal function in a Swine model of metabolic syndrome
    (Mary Ann Liebert, 2015-04) Handa, Rajash K.; Johnson, Cynthia D.; Connors, Bret A.; Evan, Andrew P.; Phillips, Carrie L.; Liu, Ziyue; Department of Anatomy & Cell Biology, IU School of Medicine
    PURPOSE: To determine whether shock wave lithotripsy (SWL) may be a risk factor for renal functional impairment in a swine model of metabolic syndrome (MetS). MATERIALS AND METHODS: Nine-month-old female Ossabaw pigs were fed an excess calorie atherogenic diet to induce MetS. At 15 months of age, the MetS pigs were treated with 2000 SWs or an overtreatment dose of 4000 SWs targeted at the upper pole calyx of the left kidney (24 kV at 120 SWs/min using the unmodified Dornier HM3 lithotripter; n=5-6 per treatment group). Serum creatinine (Cr) and blood urea nitrogen (BUN) levels were measured in conscious pigs before and ∼60 days after SWL to provide a qualitative assessment of how well both kidneys were filtering (glomerular filtration rate [GFR]). Bilateral renal function was assessed at ∼65 days post-SWL in anesthetized pigs with GFR and effective renal plasma flow (ERPF) quantified by the renal clearance of inulin and para-amino hippurate, respectively. RESULTS: Cr and BUN values were within normal limits before SWL and remained unchanged after lithotripsy in both the 2000 SW- and 4000 SW-treated pigs. GFR and ERPF of kidneys treated with SWL at either SW dose were similar to the contralateral nontreated kidney. Chronic histological changes in the SW-treated pole of the kidney included interstitial fibrosis, sclerotic glomeruli, and dilated and atrophic tubules. CONCLUSIONS: Our results are consistent with the view that a single SWL session does not result in renal impairment, even in the presence of MetS.
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    Switching to Tenofovir Alafenamide, Coformulated With Elvitegravir, Cobicistat, and Emtricitabine, in HIV-Infected Patients With Renal Impairment: 48-Week Results From a Single-Arm, Multicenter, Open-Label Phase 3 Study
    (Ovid Technologies (Wolters Kluwer) - Lippincott Williams & Wilkins, 2016-04-15) Pozniak, Anton; Arribas, Jose R.; Gathe, Joseph; Gupta, Samir K.; Post, Frank A.; Bloch, Mark; Avihingsanon, Anchalee; Crofoot, Gordon; Benson, Paul; Lichtenstein, Kenneth; Ramgopal, Moti; Chetchotisakd, Ploenchan; Custodio, Joseph M.; Abram, Michael E.; Wei, Xuelian; Cheng, Andrew; McCallister, Scott; SenGupta, Devi; Fordyce, Marshall W.; Department of Medicine, IU School of Medicine
    BACKGROUND: Tenofovir alafenamide (TAF) is a novel tenofovir prodrug with improved renal and bone safety compared with TDF-containing regimens. We report the 48 week safety and efficacy of a once-daily single tablet regimen of elvitegravir 150 mg (E), cobicistat 150 mg (C), emtricitabine 200 mg (F), and TAF 10 mg (E/C/F/TAF) in HIV-1-infected patients with mild to moderate renal impairment. METHODS: We enrolled virologically suppressed HIV-1-infected subjects with estimated creatinine clearance (CrCl) 30-69 mL/min in a single-arm, open-label study to switch regimens to E/C/F/TAF. The primary endpoint was the change from baseline in glomerular filtration rate estimated using various formulae. This study is registered with ClinicalTrials.gov, number NCT01818596. FINDINGS: We enrolled and treated 242 patients with mean age 58 years, 18% Black, 39% hypertension, 14% diabetes. Through week 48, no significant change in estimated CrCl was observed. Two patients (0.8%) discontinued study drug for decreased creatinine clearance, neither had evidence of renal tubulopathy and both had uncontrolled hypertension. Subjects had significant improvements in proteinuria, albuminuria, and tubular proteinuria (P < 0.001 for all). Hip and spine bone mineral density significantly increased from baseline to week 48 (mean percent change +1.47 and +2.29, respectively, P < 0.05). Ninety-two percent (222 patients) maintained HIV-1 RNA <50 copies per milliliter at week 48. INTERPRETATION: Switch to E/C/F/TAF was associated with minimal change in GFR. Proteinuria, albuminuria and bone mineral density significantly improved. These data support the efficacy and safety of once daily E/C/F/TAF in HIV+ patients with mild or moderate renal impairment without dose adjustment.
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    Twenty-Four-Hour Urine Phosphorus as a Biomarker of Dietary Phosphorus Intake and Absorption in CKD: A Secondary Analysis from a Controlled Diet Balance Study
    (American Society of Nephrology, 2018-07-06) Stremke, Elizabeth R.; McCabe, Linda D.; McCabe, George P.; Martin, Berdine R.; Moe, Sharon M.; Weaver, Connie M.; Peacock, Munro; Hill Gallant, Kathleen M.; Department of Medicine, IU School of Medicine
    BACKGROUND AND OBJECTIVES: Twenty-four-hour urine phosphorus is commonly used as a surrogate measure for phosphorus intake and absorption in research studies, but its reliability and accuracy are unproven in health or CKD. This secondary analysis sought to determine the reliability and accuracy of 24-hour urine phosphorus as a biomarker of phosphorus intake and absorption in moderate CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Eight patients with stage 3-4 CKD participated in 2-week balance studies with tightly controlled phosphorus and calcium intakes. Thirteen 24-hour urine collections per patient were analyzed for variability and reliability of 24-hour urine phosphorus and phosphorus-to-creatinine ratio. The accuracy of 24-hour urine phosphorus to predict phosphorus intake was determined using a published equation. The relationships of 24-hour urine phosphorus with phosphorus intake, net absorption, and retention were determined. RESULTS: There was wide day-to-day variation in 24-hour urine phosphorus within and among subjects (coefficient of variation of 30% and 37%, respectively). Two 24-hour urine measures were needed to achieve ≥75% reliability. Estimating dietary phosphorus intake from a single 24-hour urine resulted in underestimation up to 98% in some patients and overestimation up to 79% in others. Twenty-four-hour urine phosphorus negatively correlated with whole-body retention but was not related to net absorption. CONCLUSIONS: From a sample of eight patients with moderate CKD on a tightly controlled dietary intake, 24-hour urine phosphorus was highly variable and did not relate to dietary phosphorus intake or absorption, rather it inversely related to phosphorus retention.