UNASSIGNED: Type 2 diabetes mellitus (T2DM) patients are likely to develop kidney disease. The need to identify more accessible and cheaper diagnostic biomarkers cannot be overemphasized. This study investigated the ability of serum uric and uric acid to creatinine ratio in assessing the kidney function of T2DM patients and determined the relationship between serum uric acid to creatinine ratio and estimated glomerular filtration rate (eGFR).
UNASSIGNED: One hundred and fifty-five (155) consented T2DM patients were recruited from the diabetes clinic of the Cape Coast Teaching hospital. Anthropometric variables and blood pressure were measured. Serum uric acid (SUA), serum creatinine and urine protein were estimated using standard protocols. Uric acid to creatinine ratio (UA:CR), eGFR were then calculated.
UNASSIGNED: From the receiver operator characteristic (ROC) curve obtained, serum uric acid was found to be a better predictor of impaired renal function than UA:CR at p = 0.0001. The uric acid levels of participants in the fourth quartile of each category was found to be significant at p = 0.010 and can be used as indicators of kidney function in these participants. According to the odds ratio, the UA:CR will not be suitable to be used as an indicator of kidney function in any of the participants because their odds ratios were all less than 1. A total of 29(18.7 %) participants were found to have CKD with their eGFR falling below 60 ml/mins per 1.73 m2. A significant positive relationship was found between serum uric acid and the staging of CKD according to eGFR whiles a negative relationship was found with UA:CR and CKD (p < 0.0001).
UNASSIGNED: Serum uric acid is a better indicator of renal impairment (eGFR < 60 ml/mins per 1.73 m2) than UA:CR in patients with type 2 diabetes mellitus.

The effect of the sodium-to-potassium ratio (Na/K) on renal function within the clinically normal range of renal function are limited. We investigated the effects of an estimated 24 h urinary Na/K (e24hUNa/K) on a 6-year renal function decline among 927 urban Japanese community dwellers with no history of cardiovascular diseases and medication for hypertension, diabetes, or dyslipidemia. We partitioned the subjects into quartiles according to the e24hUNa/K. The estimated glomerular filtration rate (eGFR) was calculated using the chronic kidney disease epidemiology collaboration (CKD/EPI) formula and renal function decline was defined as an absolute value at or above the third quartile of the eGFR decline rate. A multivariable logistic regression model was used for estimation. Compared with the first quartile of the e24hUNa/K, multivariable-adjusted odds ratios (ORs) for eGFR decline in the second, third, and fourth quartiles were 0.96 (95% confidence interval: 0.61-1.51), 1.06 (0.67-1.66), and 1.65 (1.06-2.57), respectively. These results were similar when the simple spot urine Na/K ratio was used in place of the e24hUNa/K. Apparently healthy urban residents with an almost within normal range mean baseline eGFR and high e24hUNa/K ratios had an increased risk for a future decline in renal function. Reducing the Na/K ratio may be important in the prevention of chronic kidney disease in its early stage.

BACKGROUND: Renal dysfunction is one of the major causes of in-hospital mortality in STEMI patients. In this study, we evaluated the combined predictive value of eGFR by CKD-EPI equation and shock index for in-hospital mortality and other adverse clinical outcomes in Egyptian patients with STEMI.
RESULTS: A total of 450 STEMI patients were divided into 2 groups according to their eGFR with a cutoff value of 60 ml/min/1.73 m2 and compared as regards mortality, major bleeding, reinfarction, development of heart failure, stroke, and atrial fibrillation during the period of admission. Univariate analysis was performed to define significant factors that affected mortality; then, significant factors were subjected to a multivariate logistic regression. Patients with eGFR < 60 ml/min/1.73 m2 had higher rates of mortality (P  < 0.0005) and atrial fibrillation (P  =  .006) during the hospital admission. A multivariate logistic regression model showed the predictors of mortality were factors SI (OR = 28.56, 95% CI 8-101.97, P < 0.0001), cardiac troponin (OR = 2.89, 95% CI 1.08-7.77, P = 0.03), age (OR = 1.07, 95% CI 1.02-1.2, P = 0.002), and eGFR (OR = 0.98, 95% CI 0.96-0.99, P = 0.04).
CONCLUSIONS: Estimated GFR < 60 ml/min/1.73 m2 in STEMI patients is associated with higher rate of mortality. Estimated GFR, age, shock index, and cardiac troponin were the most significant predictors of mortality in STEMI patients.

In non-dialysis chronic kidney disease (CKD), absolute proteinuria (Uprot) depends on the extent of kidney damage and residual glomerular filtration rate (GFR). We therefore evaluated, as compared with Uprot, the strength of association of proteinuria indexed to estimated GFR (eGFR) with end-stage renal disease (ESRD) risk.
In a multi-cohort prospective study in 3957 CKD patients of Stages G3-G5 referred to nephrology clinics, we tested two multivariable Cox models for ESRD risk, with either Uprot (g/24 h) or filtration-adjusted proteinuria (F-Uprot) calculated as Uprot/eGFR ×100.
Mean ± SD age was 67 ± 14 years, males 60%, diabetics 29%, cardiovascular disease (CVD) 34%, eGFR 32 ± 13 mL/min/1.73 m2, median (interquartile range) Uprot 0.41 (0.12-1.29) g/24 h and F-Uprot 1.41 (0.36-4.93) g/24 h per 100 mL/min/1.73 m2 eGFR. Over a median follow-up of 44 months, 862 patients reached ESRD. At competing risk analysis, ESRD risk progressively increased when F-Uprot was 1.0-4.9 and ≥5.0 versus <1.0 g/24 h per 100 mL/min/1.73 m2 eGFR in Stages G3a-G4 (P < 0.001) and Stage G5 (P = 0.002). Multivariable Cox analysis showed that Uprot predicts ESRD in Stages G3a-G4 while in G5 the effect was not significant; conversely, F-Uprot significantly predicted ESRD at all stages. The F-Uprot model allowed a significantly better prediction versus the Uprot model according to Akaike information criterion. Net reclassification improvement was 12.2% (95% confidence interval 4.2-21.1), with higher reclassification in elderly, diabetes and CVD, as well as in diabetic nephropathy and glomerulonephritis, and in CKD Stages G4 and G5.
In patients referred to nephrology clinics, F-Uprot predicts ESRD at all stages of overt CKD and improves, as compared with Uprot, reclassification of patients for renal risk, especially in more advanced and complicated disease.

OBJECTIVE: Creatinine is normally used to evaluate kidney function among elderly patients in clinical practice, which has been reported to be affected by socio-demographic factors like BMI and age. Cystatin C a newly introduced biomarker may be more efficient in identifying kidney function in obese and aged CKD patients. The aim of the current study was to assess the effect of BMI on endogenous biomarkers (cystatin C and creatinine) among elderly CKD patients in Malaysia, a first such study in the country.
METHODS: The current study was conducted at the Hospital University Sains Malaysia, Kelantan. A total of 300 elderly Malay participants ≥ 65 years, with CKD, were taken in study. Demographic data, blood pressure, weight, and height were documented. Serum creatinine was assayed by Chemistry Analyzer Model Architect-C8000 (Jaffe Method), while serum cystatin C was examined by Human cystatin C ELISA kit (Sigma-Aldrich) using Thermo Scientific Varioskan Flash ELISA reader.
RESULTS: The study participants were divided into three groups on the basis of age. There was a statistically significant difference at the p value < 0.05 in serum creatinine level for the three age groups [F (2, 297) = 1.98, p value 0.045]. Patients were divided into four groups on the basis of BMI. The results of one-way ANOVA revealed a statistically significant difference at the p value < 0.05 in the mean serum creatinine level for the four groups [F (3, 396) = 2.99, p value 0.032]. However, no statistically significant differences between mean serum cystatin C levels were observed on the basis of patient\'s age and BMI.
CONCLUSIONS: Cystatin C is not related to BMI and age among elderly chronic kidney disease patients. The study clearly evaluates the role of serum cystatin C as a good competitor of creatinine among the elderly CKD patients.

The role of prediabetes as a risk factor for hyperfiltration and albuminuria in persons who do not develop diabetes is unclear. The lack of evidence is mainly due to the difficulty of accurately assessing the glomerular filtration rate (GFR) in the near-normal range of GFR. We investigated whether prediabetes is an independent risk factor for glomerular hyperfiltration and high-normal urinary albumin-creatinine ratio (ACR) using measured GFR (mGFR) rather than estimated GFR.
Prospective cohort study based on the Renal Iohexol Clearance Survey in Tromsø 6 (RENIS-T6) and the RENIS Follow-Up Study. Median observation time was 5.6 years.
A representative sample of 1,261 persons without diabetes mellitus (DM) from the general population aged 50 to 62 years.
Prediabetes defined by fasting glucose and hemoglobin A1c according to levels suggested by the American Diabetes Association (preDMADA) and the International Expert Committee of 2009 (preDMIEC).
Change in mGFR; hyperfiltration defined as mGFR>90th percentile adjusted for age, sex, weight, and height; and high-normal ACR (>10mg/g) at follow-up.
GFR was measured with iohexol clearance.
Baseline fasting glucose, hemoglobin A1c, and both definitions of prediabetes were predictors of higher mGFR at follow-up and lower annual mGFR decline in multivariable-adjusted regression analyses. Participants with preDMIEC had an OR for hyperfiltration of 1.95 (95% CI, 1.20-3.17) and for high-normal ACR of 1.83 (95% CI, 1.04-3.22) at follow-up. We adjusted for cardiovascular risk factors including ambulatory blood pressure at baseline and change in use of antihypertensive medication between baseline and follow-up.
Only middle-aged white patients participated. There is no consensus on how to define glomerular hyperfiltration.
Our findings imply an independent role of prediabetes in the development of glomerular hyperfiltration and albuminuria. Prediabetes might be a target for early treatment to prevent chronic kidney disease in chronic hyperglycemia.