Additional diagnostic capabilities of water-salt loadings in patients with chronic kidney disease stage І–ІІІ
Background. The number of patients with chronic kidney disease (CKD) increases every year, including those requiring renal replacement therapy. According the Kidney Disease Improving Global Outcomes guidelines, we use the category of albuminuria and estimated glomerular filtration rate (eGFR) to assess the CKD prognosis, but there are many researchers searching for new diagnostic markers for early detection of CKD progression. It would be interesting to use for this aim such an available indicator as uric acid. So, the objective was to assess the changes in serum uric acid level in patients with CKD stage I–III after water-salt loading of 0.5% sodium chloride at a rate of 0.5% of body weight, and to identify the relationship of this indicator with a decrease in eGFR after one year. Materials and methods. The study included 102 patients with CKD stage I–III. We used the renal functional reserve test proposed by A.I. Hozhenko, adapted to ambulatory medical care services with measuring serum uric acid level before and after water-salt loading with 0.5% sodium chloride. Results. During the year of observation, patients whose serum uric acid level increased after water-salt loading, or remained the same, or decreased by less than 5 mmol/l had a statistically greater decrease in the glomerular filtration rate: 9.2 ± 10.7 ml/min/1.73 m2 in comparison with patients who had a decrease in uric acid level of more than 5 mmol/l after water-salt loading: 4.1 ± 10.0 ml/min/1.73 m2. Conclusions. When expanding the capabilities of the renal functional reserve test by determining the change in uric acid level, we can individualize the patient’s prognosis in terms of eGFR decline.
Full Text:PDF (Українська)
Aitken GR, Roderick PJ, Fraser S, et al. Change in prevalence of chronic kidney disease in England over time: comparison of nationally representative cross-sectional surveys from 2003 to 2010. BMJ Open. 2014;4(9):e005480. doi: 10.1136/bmjopen-2014-005480.
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004 Sep 23;351(13):1296-305. doi: 10.1056/NEJMoa041031.
Wang H, Naghavi M, Allen C, et al; GBD 2015 Mortality and Causes of Death Collaborators. GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1459-1544. doi: 10.1016/S0140-6736(16)31012-1.
Chevalier RL. The proximal tubule is the primary target of injury and progression of kidney disease: role of the glomerulotubular junction. Am J Physiol Renal Physiol. 2016 Jul 1;311(1):F145-61. doi: 10.1152/ajprenal.00164.2016.
Golik A, Weissgarten J, Cotariu D, et al. Renal uric acid handling in non-insulin-dependent diabetic patients with elevated glomerular filtration rates. Clin Sci (Lond). 1993;85(6):713-716. doi: 10.1042/cs0850713.
Hozhenko AI, Kravchuk AV, Sirman VM, Nikitenko OP, Romaniv LV. Functional renal reserve: physiological value of renal reserve and substantiation of the method of its determination. Pocki. 2015;(14):7-11. (in Ukrainian). doi: 10.22141/2307-12184.108.40.206.2015.74890. (in Ukrainian).
Gozhenko AI, Kravchuk AV, Nikitenko OP, Moskolenko OM, Sirman VM. Funktsіonal'nii nirkovii rezerv: Monografіia [Renal functional reserve: Monograph]. Odesa: Feniks; 2015. 180 p. (in Ukrainian).
Copyright (c) 2019 KIDNEYS
This work is licensed under a Creative Commons Attribution 4.0 International License.
© "Publishing House "Zaslavsky", 1997-2019