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ABSTRACT: Chronic kidney disease is considered an inflammatory state and a high fiber intake is associated with decreased inflammation in the general population. Here, we determined whether fiber intake is associated with decreased inflammation and mortality in chronic kidney disease, and whether kidney disease modifies the associations of fiber intake with inflammation and mortality. To do this, we analyzed data from 14,543 participants in the National Health and Nutrition Examination Survey III. The prevalence of chronic kidney disease (estimated glomerular filtration rate less than 60 ml/min per 1.73 m(2)) was 5.8%. For each 10-g/day increase in total fiber intake, the odds of elevated serum C-reactive protein levels were decreased by 11% and 38% in those without and with kidney disease, respectively. Dietary total fiber intake was not significantly associated with mortality in those without but was inversely related to mortality in those with kidney disease. The relationship of total fiber with inflammation and mortality differed significantly in those with and without kidney disease. Thus, high dietary total fiber intake is associated with lower risk of inflammation and mortality in kidney disease and these associations are stronger in magnitude in those with kidney disease. Interventional trials are needed to establish the effects of fiber intake on inflammation and mortality in kidney disease.
Kidney International 02/2012; 81(3):300-6. · 6.61 Impact Factor
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ABSTRACT: Patients with chronic kidney disease (CKD) have a reduced lifespan, and a substantial proportion of these individuals die from cardiovascular disease. Although a large percentage of patients with CKD have traditional cardiac risk factors such as diabetes, hypertension and abnormalities in cholesterol, interventions to address these factors--which have significantly decreased cardiovascular mortality in the general population--have not shown such benefit in the CKD population. In addition, the severity and extent of cardiovascular complications in patients with CKD is disproportionate to the number and severity of traditional risk factors. This realization has focused attention on nontraditional cardiac risk factors that are particularly relevant to patients with CKD, including decreased hemoglobin levels, microalbuminuria, increased inflammation and oxidative stress, and abnormalities in bone and mineral metabolism. However, large prospective trials in patients with advanced CKD or in those requiring chronic dialysis have not shown that normalization of these nontraditional risk factors improves survival. Moreover, the mechanisms by which these nontraditional risk factors contribute to cardiovascular disease are unknown. Therefore, although current treatment of patients with CKD includes management of traditional and nontraditional risk factors, the value of modifying some nontraditional risk factors remains unclear.
Nature Clinical Practice Nephrology 10/2008; 4(12):672-81. · 6.08 Impact Factor
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ABSTRACT: End-stage renal disease is an independent predictor of mortality after coronary artery bypass grafting. Limited information exists, however, regarding the impact of chronic kidney disease on long-term outcome after bypass grafting. The purpose of this study was to assess the impact of kidney function on long-term outcomes in patients undergoing coronary artery bypass grafting.
We studied 931 consecutive patients undergoing coronary artery bypass grafting in a single center. Demographic and clinical data were collected preoperatively. Chronic kidney disease was defined preoperatively according to the Modification of Diet in Renal Disease equation as an estimated glomerular filtration rate less than 60 mL x min(-1) x 1.73 m(-2). Multivariate Cox proportional hazard analyses were performed to determine the independent prognostic factors after bypass grafting. The primary outcome was a composite, combining death, acute coronary syndrome, stroke or transient ischemic attack, and coronary or peripheral revascularization during follow-up. Secondary outcomes were overall causes of death and cardiovascular death, acute coronary syndrome, and stroke or transient ischemic attack.
One hundred fourteen (12.2%) patients had preoperative chronic kidney disease (estimated glomerular filtration rate range, 20.5-59.8 mL x min(-1) x 1.73 m(-2)). After a mean follow-up of 3.1 +/- 1.4 years (median, 3.3 years), chronic kidney disease was found to be an independent predictor of the composite outcome (hazard ratio and 95% confidence interval, 1.46 [1.01-2.11]; P = .0467) and overall death (hazard ratio and 95% confidence interval, 1.89 [1.16-3.07]; P = .0106).
Beyond the perioperative period, preoperative moderate-to-severe chronic kidney disease is an independent long-term predictor of cardiovascular events and total mortality after coronary artery bypass grafting. Chronic kidney disease status should be incorporated into prediction models and clinical risk assessments.
The Journal of thoracic and cardiovascular surgery 10/2007; 134(3):683-9. · 3.41 Impact Factor
