Risk Factors and Predictors of Mortality in Chronic Kidney Disease Patients in a Rural Tertiary Care Hospital
Authors/Creators
- 1. Associate Professor, Department of General Medicine, Viswabharathi Medical College, Penchikalapadu, Kurnool, Andhra Pradesh
- 2. Assistant Professor, Department of Pediatrics, Viswabharathi Medical College, Penchikalapadu, Kurnool, Andhra Pradesh
- 3. Associate Professor, Department of Pediatrics, Viswabharathi Medical College, Penchikalapadu, Kurnool, Andhra Pradesh
Description
Background: An increase in the prevalence of Chronic Kidney Disease (CKD) was observed in the recent times. Regression analysis of risk factors and predictive factors of mortality in CKD patients in a community helps the physicians to be on the alert. Aim of the Study: To study and evaluate the risk factors and predictive factors in the course of treating CKD patients for their accuracy using the area under the receiver operating characteristic (ROC) curve (AUC) analysis. Methods: 47 non-transplant CKD patients at all stages of severity of both genders were included and the risk factors like. The Predictive factors for mortality were presented with AUC analysis and its associated 95% confidence interval (CI). AUC of 0.70-0.79 is considered acceptable, 0.80-0.89 is considered excellent, and more than 0.90 is considered outstanding. Results & Conclusions: In view of the rapid increase in mortality of CKD patients due to development of Heart Failure worldwide an intense screening laboratory investigations such as BNPs, LAsR, E GFR, C reactive protein and UCPR are necessary which have a bearing on the mechanism of causing HF. These predictive factors are highly sensitive and caution the treating physician to take appropriate mode of treatment.
Abstract (English)
Background: An increase in the prevalence of Chronic Kidney Disease (CKD) was observed in the recent times. Regression analysis of risk factors and predictive factors of mortality in CKD patients in a community helps the physicians to be on the alert. Aim of the Study: To study and evaluate the risk factors and predictive factors in the course of treating CKD patients for their accuracy using the area under the receiver operating characteristic (ROC) curve (AUC) analysis. Methods: 47 non-transplant CKD patients at all stages of severity of both genders were included and the risk factors like. The Predictive factors for mortality were presented with AUC analysis and its associated 95% confidence interval (CI). AUC of 0.70-0.79 is considered acceptable, 0.80-0.89 is considered excellent, and more than 0.90 is considered outstanding. Results & Conclusions: In view of the rapid increase in mortality of CKD patients due to development of Heart Failure worldwide an intense screening laboratory investigations such as BNPs, LAsR, E GFR, C reactive protein and UCPR are necessary which have a bearing on the mechanism of causing HF. These predictive factors are highly sensitive and caution the treating physician to take appropriate mode of treatment.
Files
IJPCR,Vol16,Issue5,Article179.pdf
Files
(381.9 kB)
| Name | Size | Download all |
|---|---|---|
|
md5:bea718aa62db8fc4a5cf9c4841c421e3
|
381.9 kB | Preview Download |
Additional details
Dates
- Accepted
-
2024-04-26
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/16/IJPCR,Vol16,Issue5,Article179.pdf
- Development Status
- Active
References
- 1. Daniels LB, Maisel AS: Natriuretic peptides. J Am Coll Cardiol. 2007; 50: 2357–2368. 2. Korenstein D, Wisnivesky JP, Wyer P, Adler R, Ponieman D, McGinn T: The utility of Btype natriuretic peptide in the diagnosis of heart failure in the emergency department: a systematic review. BMC Emerg Med. 2007; 7: 6. 3. Fuat A, Murphy JJ, Hungin AP, Curry J, Mehrzad AA, Hetherington A, Johnston JI, Smellie WS, Duffy V, Cawley P: The diagnostic accuracy and utility of a B-type natriuretic peptide test in a community population of patients with suspected heart failure. Br J Gen Pract. 2006; 56: 327–333. 4. Bursi F, Weston SA, Redfield MM, Jacobsen SJ, Pakhomov S, Nkomo VT, Meverden RA, Roger VL: Systolic and diastolic heart failure in the community. JAMA. 2006; 296: 2209– 2216. 5. McCullough PA, Duc P, Omland T, McCord J, Nowak RM, Hollander JE, Herrmann HC, Steg PG, Westheim A, Knudsen CW, Storrow AB, Abraham WT, Lamba S, Wu AH, Perez A, Clopton P, Krishnaswamy P, Kazanegra R, Maisel AS: B-type natriuretic peptide and renal function in the diagnosis of heart failure: an analysis from the Breathing Not Properly Multinational Study. Am J Kidney Dis. 2003; 41: 571–579. 6. Tsutamoto T, Wada A, Sakai H, Ishikawa C, Tanaka T, Hayashi M, Fujii M, Yamamoto T, Dohke T, Ohnishi M, Takashima H, Kinoshita M, Horie M: Relationship between renal function and plasma brain natriuretic peptide in patients with heart failure. J Am Coll Cardiol. 2006; 47: 582–586. 7. Zoccali C, Mallamaci F, Benedetto FA, Tripepi G, Parlongo S, Cataliotti A, Cutrupi S, Giacone G, Bellanuova I, Cottini E, Malatino LS: Cardiac natriuretic peptides are related to left ventricular mass and function and predict mortality in dialysis patients. J Am Soc Nephrol. 2001; 12: 1508–1515. 8. Takami Y, Horio T, Iwashima Y, Takiuchi S, Kamide K, Yoshihara F, Nakamura S, Nakahama H, Inenaga T, Kangawa K, Kawano Y: Diagnostic and prognostic value of plasmabrain natriuretic peptide in non-dialysisdependent CRF. Am J Kidney Dis. 2004; 44: 420–428. 9. Vickery S, Price CP, John RI, Abbas NA, Webb MC, Kempson ME, Lamb EJ: B-type natriuretic peptide (BNP) and amino-terminal proBNP in patients with CKD: relationship to renal function and left ventricular hypertrophy. Am J Kidney Dis. 2005; 46: 610–620. 10. Luchner A, Hengstenberg C, Lowel H, Riegger GA, Schunkert H, Holmer S: Effect of compensated renal dysfunction on approved heart failure markers: direct comparison of brain natriuretic peptide (BNP) and N-terminal proBNP. Hypertension. 2005; 46: 118–123. 11. Yu CM, Lin H, Yang H, Kong SL, Zhang Q, Lee SW: Progression of systolic abnormalities in patients with "isolated" diastolic heart failure and diastolic dysfunction. Circulation. 2002; 105: 1195–1201. 12. Vinereanu D, Nicolaides E, Tweddel AC, Fraser AG: "Pure" diastolic dysfunction is associated with long-axis systolic dysfunction: implications for the diagnosis and classification of heart failure. Eur J Heart Fail. 2005; 7: 820– 828. 13. Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, Kusek JW, Van Lente F: Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006; 145: 247–254. 14. Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, Gutgesell H, Reichek N, Sahn D, Schnittger I, et al: Recommendations for quantitation of the left ventricle by two-dimensional echocardiography: American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr. 1989; 2: 358– 367. 15. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ: Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 200518: 1440–1463. 16. Teichholz LE, Kreulen T, Herman MV, Gorlin R: Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence of absence of asynergy. Am J Cardiol. 1976; 37: 7–11. 17. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N: Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986; 57: 450–458. 18. Pritchett AM, Jacobsen SJ, Mahoney DW, Rodeheffer RJ, Bailey KR, Redfield MM: Left atrial volume as an index of left atrial size: a population-based study. J Am Coll Cardiol. 2003; 41: 1036–1043. 19. Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, Tajik AJ: Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation. 2000; 102: 1788–1794. 20. Redfield MM, Jacobsen SJ, Burnett JC Jr, Mahoney DW, Bailey KR, Rodeheffer RJ: Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA. 2003; 289: 194–202. 21. Paulus WJ, Tschope C, Sanderson JE, Rusconi C, Flachskampf FA, Rademakers FE, Marino P, Smiseth OA, De Keulenaer G, LeiteMoreira AF, Borbely A, Edes I, Handoko ML, Heymans S, Pezzali N, Pieske B, Dickstein K, Fraser AG, Brutsaert DL: How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J. 2007; 28: 2539–2550. 22. Vanderheyden M, Bartunek J, Goethals M: Brain and other natriuretic peptides: molecular aspects. Eur J Heart Fail. 2004; 6: 261–268. 23. Wahl HG, Graf S, Renz H, Fassbinder W: Elimination of the cardiac natriuretic peptides B-type natriuretic peptide (BNP) and Nterminal proBNP by hemodialysis. Clin Chem. 2004; 50: 1071–1074. 24. Hall C: NT-ProBNP: the mechanism behind the marker. J Card Fail. 2005; 11[Suppl]: S81– S83. 25. Troughton RW, Prior DL, Pereira JJ, Martin M, Fogarty A, Morehead A, Yandle TG, Richards AM, Starling RC, Young JB, Thomas JD, Klein AL: Plasma B-type natriuretic peptide levels in systolic heart failure: importance of left ventricular diastolic function and right ventricular systolic function. J Am Coll Cardiol. 2004; 43: 416–422. 26. van Kimmenade RR, Pinto Y, Januzzi, JL Jr: When renal and cardiac insufficiencies intersect: is there a role for natriuretic peptide test-ing in the "cardio-renal syndrome?" Eur Heart J. 2007;28: 2960–2961. 27. Gardner RS, Chong KS, O'Meara E, Jardine A, Ford I, McDonagh TA: Renal dysfunction, as measured by the modification of diet in renal disease equations, and outcome in patients with advanced heart failure. Eur Heart J. 2007; 28: 3027–3033. 28. Forman DE, Butler J, Wang Y, Abraham WT, O'Connor CM, Gottlieb SS, Loh E, Massie BM, Rich MW, Stevenson LW, Young JB, Krumholz HM: Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure. J Am Coll Cardiol. 2004; 43: 61–67. 29. Davis ME, Richards AM, Nicholls MG, Yandle TG, Frampton CM, Troughton RW: Introduction of metoprolol increases plasma B-type cardiac natriuretic peptides in mild, stable heart failure. Circulation. 2006; 113: 977–985. 30. Ohta Y, Watanabe K, Nakazawa M, Yamamoto T, Ma M, Fuse K, Ito M, Hirono S, Tanabe T, Hanawa H, Kato K, Kodama M, Aizawa Y: Carvedilol enhances atrial and brain natriuretic peptide mRNA expression and release in rat heart. J Cardiovasc Pharmacol. 2000; 36[Suppl 2]: S19–S23. 31. Van den Meiracker AH, Lameris TW, van de Ven LL, Boomsma F: Increased plasma concentration of natriuretic peptides by selective beta1-blocker bisoprolol. J Cardiovasc Pharmacol. 2003; 42: 462–468. 32. Luchner A, Burnett JC Jr, Jougasaki M, Hense HW, Riegger GA, Schunkert H: Augmentation of the cardiac natriuretic peptides by betareceptor antagonism: evidence from a population-based study. J Am Coll Cardiol. 1998; 32: 1839–1844.