Extracellular fluid volume: A suitable indexation variable to assess impact of bariatric surgery on glomerular filtration rate in patients with chronic kidney disease
2
Citation
33
Reference
10
Related Paper
Citation Trend
Abstract:
Bariatric surgery (BS) might be a nephroprotective treatment in obese patients with chronic kidney disease (CKD), and the non-linear relation between body surface area (BSA) and extracellular fluid volume (ECFV) in obese people raises the question of the most relevant way to scale glomerular filtration rate (GFR) for assessing renal function changes after BS.We screened 1774 BS candidates and analysed 10 consecutive participants with CKD stage 3. True GFR (mGFR), measured by the renal clearance of 51Cr-ethylenediaminetetraacetic acid (EDTA), was scaled either to BSA (mGFRBSA) or to ECFV measured by 51Cr-EDTA distribution volume (mGFRECFV) before and one year after BS.The 10 candidates for BS had a mean body mass index of 43.3 ± 3.6 kg/m2 and a mean GFR of 48 ± 8 mL/min/1.73 m2. Six participants had a sleeve gastrectomy and four had a Roux-en-Y gastric bypass. One year after BS, ECFV decreased (23.2 ± 6.2 to 17.9 ± 4.3 L, p = 0.001), absolute mGFR was not significantly modified (74 ± 23 versus 68 ±19 mL/min), mGFRBSA did not change significantly (53 ± 18 versus 56 ± 17 mL/min/1.73 m2) whereas mGFRECFV significantly increased (42 ± 13 versus 50 ± 14 mL/min/12.9 L, p = 0.037). The relation between mGFRECFV and mGFRBSA was different from the identity line before (p = 0.014) but not after BS (p = 0.09).There is a difference between mGFRBSA and mGFRECFV following BS and the latter might better reflect the adequacy between renal function and corpulence.Background: Chronic kidney disease is a life threatening disease, which is a common cause of mortality and morbidity. The chronic kidney disease patients are at high risk of developing end stage renal disease, cardiovascular complications and stroke. Therefore, we carried out this study to know the functional status of kidneys in chronic kidney disease cases and to classify the chronic kidney disease into different stages by calculating estimated glomerular filtration rate. Material and Methods: Twenty five cases of chronic kidney disease, between 25-70 years of age of either sex, admitted at R.L.Jalappa Hospital and Research Centre, Kolar, India and twenty five healthy age and gender matched controls were enrolled into the study. For calculating estimated glomerular filtration rate serum creatinine values, age, sex, race, and weight of the patients are considered. Results: The mean estimated glomerular filtration rate in cases was 22.096 and in control group 118.28(p<0.001) as per Cockcroft Gault Equation and as per Modification of Diet in Renal Disease equation in cases it was 18.176 and in controls 113.796(p<0.001). The estimated glomerular filtration rate was significantly low in cases when compared with healthy subjects. Conclusion: Estimated glomerular filtration rate better predicts the functional status of kidneys and is more accurate than serum creatinine and can be used to classify chronic kidney disease. Key words: Chronic kidney disease (CKD), Cockcroft Gault Equation (CCG), Estimated Glomerular Filtration Rate (eGFR), End Stage Renal Disease (ESRD), glomerular filtration rate (GFR), Modification of Diet in Renal Disease(MDRD), Serum creatinine.
Cite
Citations (0)
Pathogenesis
Intracellular Fluid
Compartment (ship)
Primary (astronomy)
Homeostasis
Cite
Citations (0)
Dogs partially depleted of extracellular electrolytes by intraperitoneal glucose injections and then maintained on a salt-free diet showed absence of fluid intake and a negative water balance while the intracellular volumes were above normal. When these volumes had been reduced to stable minimal levels, water was taken by mouth and the negative water balance corrected. Although the intakes now rose to polydipsic levels, a positive balance was not established despite the fact that the extracellular volumes were still reduced. Intracellular volumes were not restored to the preëxperi-mental level. When NaCl was given, extracellular electrolytes and volumes were restored toward normal. The initial response was an increased intake which, however, was not sustained. The intracellular compartment, originally decreased, showed a delayed rehydration to normal levels. Hence the voluntary water intake showed more positive correlation with changes in intracellular volume than with extracellular volume change. Fluid balance was affected both by intracellular hydration and electrolyte levels in the extracellular fluid.
Intracellular Fluid
Body water
Fluid compartments
Water intake
Cite
Citations (3)
These analyses assessed whether creatinine based estimates of glomerular filtration rate (eGFR) accurately represent (1) graft function at different times post-transplant and (2) changes in function over time. These analyses compared iothalamate GFR to eGFR in 684 kidney allograft recipients. Changes in graft function over time (GFR slope) were measured in 360 of 459 recipients (78%) who were followed for at least 3 years. Ninety-five percent of the patients were Caucasians and 72% received kidneys from living donors. All eGFR calculations correlated significantly with GFR at all time points. However, eGFR were less precise and less accurate during the first-year post-transplant than thereafter. The average rate of GFR change (slope) was -2.93 +/- 11.3%/year (-1.06 +/- 5.3 mL/min/1.73 m(2)/year). Fifty-four percent of patients had stable or positive GFR slopes. The GFR and eGFR slopes were highly correlated. However, eGFR slope, particularly when calculated by MDRD, significantly underestimated the number of patients with declining graft function. For example, 165 out of 360 patients (46%) lost GFR faster than -1 mL/min/1.73 m(2)/year. eMDRD identified only 83 of these patients (50%) while the eMayo formula identified 134 (81%). In conclusion, eGFR correlate with GFR but they have relatively low precision and accuracy particularly early post-transplant. eGFR slopes underestimate graft functional loss although some formulas are significantly better than others for this calculation.
Cite
Citations (77)
Intracellular pH
Extracellular polysaccharide
Cite
Citations (64)
Chronic kidney disease from medical causes is present in 25% to 30% of patients before surgery for renal cancer. Although chronic kidney disease due to medical causes is typically associated with a 2% to 5% annual renal functional decline and decreased overall survival, reduced glomerular filtration rate occurring only after surgery may not have the same negative consequences.All patients undergoing surgery for suspected renal malignancy were identified in an institutional registry. Median clinical followup was 6.6 years.Of 4,180 patients 28% had a preoperative glomerular filtration rate of less than 60 ml/minute/1.73 m(2) (chronic kidney disease due to medical causes) and in 22% the glomerular filtration rate decreased to less than 60 ml/minute/1.73 m(2) only after surgery (surgically induced chronic kidney disease). Preoperative glomerular filtration rate was a strong predictor of overall survival on univariable and multivariable analysis. The risk of death after renal surgery was 1.8, 3.5 and 4.4-fold higher in patients with preoperative chronic kidney disease stages 3, 4 and 5, respectively, vs normal preoperative glomerular filtration rate. Average overall loss of renal function was 23%, including 13% within 90 days after surgery and 3.5% annually thereafter. Postoperative glomerular filtration rate only predicted survival for patients with preexisting chronic kidney disease due to medical causes. Neither surgically induced chronic kidney disease nor postoperative glomerular filtration rate was a significant predictor of survival in patients without preexisting chronic kidney disease due to medical causes. Annual renal functional decline was 4.7% and 0.7% for patients with chronic kidney disease due to medical causes and surgically induced chronic kidney disease, respectively, with a greater than 50% reduction in glomerular filtration rate in 7.3% and 2.2%, respectively (p <0.0001). Annual renal functional decline greater than 4.0% was associated with a 43% increase in mortality (p <0.0001).Surgically induced chronic kidney disease is associated with a relatively low risk of progressive renal functional decline and impact on survival does not appear to be substantial during intermediate term followup. In contrast, preoperative chronic kidney disease due to medical causes places patients at increased risk, indicating nephron sparing surgery for such patients.
Nephrology
Cite
Citations (238)
Medulla
Cite
Citations (5)
1. The effects of pentobarbitone sodium (Nembutal) anaesthesia in dogs on extracellular fluid and plasma volumes, plasma protein concentration, haematocrit and extracellular fluid electrolyte composition were measured. 2. Induction of pentobarbitone anaesthesia caused a rapid rise in extracellular fluid volume, accompanied by decreases in the haematocrit, in extracellular fluid potassium concentration, and in plasma calcium, magnesium, and protein concentrations. There were no significant changes in plasma osmolality and extracellular fluid concentrations of sodium and chloride. 3. Extracellular fluid volume did not alter significantly during six hours of anaesthesia, but the haematocrit and extracellular fluid potassium concentration showed an increase towards control values. 4. The relevance of these findings to the interpretation of experiments carried out under pentobarbitone anaesthesia is noted.
Cite
Citations (16)
To describe discrepancies in calculated and measured glomerular filtration rate in patients using PARP (poly ADP ribose polymerase) inhibitors who had an elevation in serum creatinine levels.Retrospective cohort, single center study. Patients included were those with ovarian or endometrial cancer taking olaparib, rucaparib or niraparib, and in in whom an increased serum creatinine was identified. The study cohort included those who also underwent technetium-99m radioisotope renography (glomerular filtration rate (GFR) scan). The main objective is to describe the discrepancies in calculated glomerular filtration rate using the Cockcroft-Gault method and measured glomerular filtration rate using a GFR scan.211 patients were included in the study; 64 (30%) had on-treatment elevated serum creatinine, and 23 (36%) underwent a GFR scan. 32 GFR scans were performed (six patients had more than one scan). Using a clinical cut-off ≥50 mL/min as normal renal function, both calculated and estimated glomerular filtration rates were below normal in 6 of 32 GFR scans. In those patients undergoing a GFR scan, serum creatinine had risen a median 49% (IQR 20-66%, range 0-144%) above baseline. Discordance between a calculated low glomerular filtration rate and an estimated normal glomerular filtration rate occurred in 63% (range of glomerular filtration rate discrepancy: -46% to +237%). Despite increases in serum creatinine on therapy and a subsequent significant decline in the per patient calculated creatinine clearance (mean 65.6 mL/min vs 43.4 mL/min; p<0.0001), the estimated glomerular filtration rate from the renal scan was nearly identical to the patient's baseline (65.6 mL/min vs 66.1 mL/min; p=0.89).Serum creatinine elevation in patients taking PARP inhibitors may not be associated with a true decrease in glomerular filtration rate. A high index of suspicion should be maintained for alternative causes of elevated serum creatinine in patients treated with PARP inhibitors who lack other sources of renal injury.
Cite
Citations (36)
The purpose of this study was to determine the effect on cell survival of extracellular changes that occur during ischemia, over and above the depletion of O2 and substrate. Rabbit retinas were deprived in vitro of both O2 and substrate, and then returned to control medium for 4 h before recovery was assessed by measuring protein synthesis, glucose utilization, and tissue water. Experimental conditions were altered in various ways during the period of O2 and substrate deprivation in order to modify the changes taking place in the interstitial fluid as a result of the failure of energy metabolism. When O2-free, substrate-free extracellular electrolyte solution was added to the retinas to reduce the ischemia-induced changes in the interstitial fluid, there was marked reduction in irreversible damage. But when energy-deprived retinas were exposed to retinas that had already been ischemic, or to interstitial fluid from ischemic retinas, there was an increase in irreversible damage. Removing Ca++ from the extracellular fluid during the period of energy deprivation increased the damage due to short deprivations in a restricted volume of extracellular fluid, but reduced the damage from longer deprivations in a large volume of extracellular fluid. The results demonstrate that several changes occur in the extracellular fluid during ischemia that significantly affect recovery.
Interstitial fluid
Cell damage
Cite
Citations (31)