Publications by authors named "Ziad A Massy"
Background And Hypothesis: Cardiovascular diseases are a leading cause of morbidity and mortality in patients with chronic kidney disease (CKD). Acute kidney injury (AKI) has been increasingly recognized as a potential exacerbating factor for cardiovascular events in these patients. The CKD-REIN study aims to explore the relationship between AKI and the risk of major adverse cardiovascular events (MACE) in a cohort of CKD patients.
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- People with chronic kidney disease (CKD) face a higher risk of cognitive impairment (CI), and this study investigates the link between anticholinergic medications and cognitive performance in CKD patients.
- The research involved a prospective cohort study of 3007 nephrology outpatients, where data on medication prescriptions and cognitive function were collected over five years.
- Findings revealed that over half of the participants were prescribed anticholinergic drugs, with those having a high anticholinergic burden more likely to experience cognitive impairment, particularly if they had a history of neurological disorders or were on multiple medications.
Article Synopsis
- Blood pressure (BP) control is crucial for preventing complications in chronic kidney disease (CKD), yet many patients struggle to reach target levels; this study evaluates how antihypertensive prescriptions change over time in CKD patients.
- Conducted with 2,755 hypertensive CKD patients in France, the study tracked factors influencing prescription changes, such as patient demographics and healthcare provider interactions.
- Results showed that over five years, there was a high rate of changes in medication; poor adherence to medications increased the likelihood of needing additional drugs, while having a lower education level led to more frequent withdrawals of antihypertensive medications.
Background And Objective: The efficacy and safety of empagliflozin in the treatment of chronic kidney disease (CKD) were demonstrated in the EMPA-KIDNEY trial, which showed a 28% reduction in combined risks of kidney disease or death from cardiovascular causes (hazard ratio, 0.72; 95% confidence interval, 0.64-0.
View Article and Find Full Text PDFTranslational research on cognitive impairment in chronic kidney disease.
Nephrol Dial Transplant
October 2024
Article Synopsis
- * Both traditional risk factors (like diabetes and high blood pressure) and kidney-specific factors (such as uremic toxins and chronic inflammation) can damage the blood-brain barrier and promote neuroinflammation, leading to cognitive impairments.
- * Recent animal model studies suggest new prevention and treatment strategies, focusing on the role of the blood-brain barrier, physical activity, and innovative therapies like SGLT2 inhibitors and GLP-1 receptor agonists in addressing cognitive decline in kidney disease.
Associations of chronic kidney disease (CKD) with metabolic syndrome and cardiovascular disease (CVD) have long been recognized. Until recently, such associations were mainly limited to interrelationships between either heart and kidney, heart and metabolic syndrome, or metabolic syndrome and kidney. It is the merit of the American Heart Association (AHA) to have set up a work group of cardiologists, endocrinologists, and nephrologists for the purpose of combining all 3 disorders in a single entity, as an appreciation of their pathophysiological interrelatedness.
View Article and Find Full Text PDFThe impact of chronic kidney disease on cognitive function.
Curr Opin Nephrol Hypertens
November 2024
Purpose Of Review: The risk of cognitive impairment is higher in people with CKD than in the general population. The complex relationship between CKD and cognitive dysfunction has not been extensively characterized. Here, we review epidemiological associations, specific patterns of CKD-related cognitive impairment, the underlying mechanisms, and recently published data on relevant biomarkers.
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- The link between chronic kidney disease (CKD) and cognitive function is gaining attention, particularly focusing on the effects of antibacterial agents (ABs) used in CKD patients who are more prone to infections.
- This review highlights how ABs can have direct neurotoxic effects on the central nervous system (CNS) and discusses how these medications can also alter gut microbiota, impacting cognitive symptoms through the brain-gut-kidney axis.
- The findings emphasize the need for careful monitoring of AB therapies in CKD patients to manage adverse drug reactions, particularly antibiotic-associated encephalopathy.
Article Synopsis
- * In a cohort of 2505 CKD patients, researchers found that while urea levels did not significantly predict new antidepressant prescriptions, higher urea was linked to worsening depressive symptoms over a 5-year follow-up.
- * The findings suggest a connection between serum urea levels and depression symptoms, highlighting the need for further research to clarify the mechanisms involved.
Adjusting drug dose levels based on equations that standardize the estimated glomerular filtration rate (eGFR) to a body surface area (BSA) of 1.73 m can pose challenges, especially for patients with extremely high or low body mass index (BMI). The objective of the present study of patients with CKD and diabetes was to assess the impact of deindexing creatinine-based equations on estimates of kidney function and on the frequency of inappropriate prescriptions of oral antidiabetic drugs (OADs).
View Article and Find Full Text PDFBackground: Statins are widely used to reduce the risk of cardiovascular disease (CVD). Patients with end-stage renal disease (ESRD) on hemodialysis have significantly increased risk of developing CVD. Statin treatment in these patients however did not show a statistically significant benefit in large trials on a patient cohort level.
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- The study investigates the relationship between magnesium levels (both total and ionized) and cardiovascular outcomes/mortality in patients with chronic kidney disease (CKD).
- It finds that serum total magnesium (tMg) is strongly correlated with ionized magnesium (iMg) and both levels are linked to kidney function.
- High levels of tMg are associated with an increased risk of major adverse cardiovascular events (MACE) and mortality, while iMg levels did not show consistent associations across different categories.
Aim: The risk of cardiorenal events remains high among patients with diabetes and chronic kidney disease (CKD), despite the prescription of recommended treatments. We aimed to determine whether the attainment of a combination of nephroprotection targets at baseline (glycated haemoglobin <7.0%, urinary albumin-creatinine ratio <300 mg/g, blood pressure <130/80 mmHg, renin-angiotensin system inhibition) was associated with better cardiorenal outcomes and lower mortality.
View Article and Find Full Text PDFBackground: Randomized controlled trials (RCTs) of direct oral anticoagulants (DOACs) included a low proportion of atrial fibrillation (AF) patients with chronic kidney disease (CKD), and suggested that DOACs are safe and effective in patients with mild-to-moderate CKD. In a metanalysis of RCTs and observational studies, DOACs were associated with better efficacy ( warfarin) in early CKD and had similar efficacy and safety profiles in patients with stages IV-V CKD. But few studies have provided data on the safety and effectiveness of each DOAC warfarin in patients with stage III CKD.
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- Kynurenine, a toxin that increases in patients with chronic kidney disease (CKD), has been linked to poor cardiovascular health outcomes and mortality.
- In a study of over 2400 CKD patients, higher levels of serum-free kynurenine were found to increase the risk of cardiovascular events and mortality, independent of other factors.
- The results suggest that serum-free kynurenine may play a significant role in cardiovascular risks among CKD patients, although it was not linked to overall mortality after adjusting for other compounds.
Article Synopsis
- Over the last few decades, strategies have been developed to improve the removal of retained molecules in patients with kidney failure, helping them tolerate fluid removal better and live longer.
- The effectiveness of these treatments depends on how individual patient factors interact with the characteristics of the devices used and the treatment plans prescribed.
- This article reviews various blood purification techniques, highlighting their unique features and how they aim to enhance patient care in nephrology.
There is growing evidence that chronic kidney disease (CKD) is an independent risk factor for cognitive impairment, especially due to vascular damage, blood-brain barrier disruption and uremic toxins. Given the presence of multiple comorbidities, the medication regimen of CKD patients often becomes very complex. Several medications such as psychotropic agents, drugs with anticholinergic properties, GABAergic drugs, opioids, corticosteroids, antibiotics and others have been linked to negative effects on cognition.
View Article and Find Full Text PDFRationale & Objective: Adverse drug reactions (ADRs) are common in patients with chronic kidney disease (CKD). The impact of kidney function decline on serious ADR risk has been poorly investigated. We comprehensively describe ADRs and assess the relationship between estimated glomerular filtration rate (eGFR) and serious ADR risk.
View Article and Find Full Text PDFBackground: Chronic kidney disease (CKD) is associated with an elevated risk of neurocognitive disorders (NCDs). It remains unclear whether CKD-related NCDs have a specific cognitive pattern or are earlier-onset phenotypes of the main NCDs (vascular NCDs and Alzheimer's disease).
Methods: We used the Mini Mental State Examination score (MMSE) to assess cognitive patterns in 3003 CKD patients (stage 3-4) followed up over 5 years in the Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort.
Background: The trajectories of haemoglobin in patients with chronic kidney disease (CKD) have been poorly described. In such patients, we aimed to identify typical haemoglobin trajectory profiles and estimate their risks of major adverse cardiovascular events (MACE).
Methods: We used 5-year longitudinal data from the CKD-REIN cohort patients with moderate to severe CKD enrolled from 40 nationally representative nephrology clinics in France.
Chronic kidney disease (CKD) affects approximately 850 million people globally and is associated with an increased risk of cognitive impairment. The prevalence of cognitive impairment among CKD patients ranges from 30 to 60%, and the link between CKD and cognitive impairment is partially understood. Methodological challenges and biases in studying cognitive function in CKD patients need to be addressed to improve diagnosis, treatment, and management of cognitive impairment in this population.
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- * Traditional biomarkers and tests for detecting cardiac issues, like troponins and ECG, have limited effectiveness in advanced CKD; alternative methods such as dobutamine stress echocardiography and myocardial scintigraphy are more reliable.
- * Techniques for assessing heart structure and function vary in complexity and cost, while also monitoring heart rhythm through ambulatory methods helps diagnose arrhythmias; standardized blood pressure protocols are recommended for managing hypertension in CKD patients.