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Drugs with a negative impact on cognitive functions (Part 2): drug classes to consider while prescribing in CKD patients

Hafez, Gaye ; Malyszko, Jolanta ; Golenia, Aleksandra ; [et al.]

Oxford University Press (OUP) ; 2023

In: Clinical Kidney Journal Vol. 16, No. 12 ( 2023-11-30), p. 2378-2392

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In: Clinical Kidney Journal, Oxford University Press (OUP), Vol. 16, No. 12 ( 2023-11-30), p. 2378-2392

Abstract: 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. These drugs are frequently included in the treatment regimen of CKD patients. The first review of this series described how CKD could represent a risk factor for adverse drug reactions affecting the central nervous system. This second review will describe some of the most common medications associated with cognitive impairment (in the general population and in CKD) and describe their effects.

Type of Medium: Online Resource

ISSN: 2048-8505 , 2048-8513

URL: Article

DOI: 10.1093/ckj/sfad239

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2023

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2

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MO572BONE BIOPSY AND MINERAL METABOLISM, CARDIOVASCULAR DISEASE AND PATIENT SURVIVAL IN END-STAGE RENAL PATIENTS

Ferreira, Ana Carina ; Cotovio, Patrícia ; Aires, Inês ; [et al.]

Oxford University Press (OUP) ; 2021

In: Nephrology Dialysis Transplantation Vol. 36, No. Supplement_1 ( 2021-05-29)

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In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 36, No. Supplement_1 ( 2021-05-29)

Abstract: Chronic kidney disease-mineral and bone disorder (CKD-MBD) is frequent in end-stage renal disease (ESRD) patients, increasing morbid-mortality. The aim of this study was to determine the prevalence and phenotype of bone disease before transplantation; and to correlate FGF23, klotho and sclerostin serum levels with bone histomorphometric parameters and CV disease. The secondary aim was to correlate bone biopsies data with other bone related parameters, as PTH, bone alkaline phosphatase, 25-hidroxivitamin D3, calcitonin, calcium, phosphorus, and magnesium. Method We performed a prospective cohort study of a sample of ESRD patients listed for renal transplant. All patients were submitted to renal transplant and were followed for 12 months. Patient and graft survival were recorded. At inclusion, demographic and clinical data were collected, laboratorial evaluation; bone biopsy and X-ray of the pelvis and hands (Adragão score) were performed. Continuous variables are presented as medians and categorical variables as frequencies. Associations between variables were performed using Wilcoxon rank sum test, Fisher and Kruskal Wallis test. Multivariate analysis was performed using logistic regression. STATA software was used and p & lt; 0.05 was considered statistically significant. Results We included 84 patients. Median age 53.5 (IQ range: 40.5 – 61.5) years, 59 men (70.2%), 65 caucasian (77.4%). The median left ventricular mass index was 108.5 (92 – 129) g/m2, with 32 patients presenting left ventricular hypertrophy and 19 valve calcifications. Median Adragão score was 1 (0 – 2). We diagnosed adynamic bone disease in 15 patients; hyperparathyroid bone disease in 19 patients; osteomalacia in 1 patient and mixed renal osteodystrophy in 3 patients. At the end of 12 months, 4 patients died, 5 had graft failure (non-primary function) and 4 had a cardiovascular event. Sclerostin was found to be a risk factor for low bone volume; whereas low phosphorus, low FGF23 and high bAP risk factors for abnormal mineralization. High turnover was mainly present in patients with high bAP and phosphorus and low sclerostin levels. The presence of valve calcifications was associated with low volume and with low or high turnover disorder. FGF23 appears as an important independent factor for vascular calcifications [as well age (p=0.009), BMI (p=0.02), presence of diabetes (p=0.01)], and for cardiovascular events. Sclerostin emerged as a risk factor for vascular calcifications and lower levels of sclerostin were associated with patient survival at the end of 12 months. Conclusion From the bone-derived hormones, sclerostin and FGF23 seem to act as risk factors for vascular calcifications and worse outcomes.

Type of Medium: Online Resource

ISSN: 0931-0509 , 1460-2385

URL: Article

DOI: 10.1093/ndt/gfab086.0010

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2021

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P1680MINERAL METABOLISM CHANGES AFTER RENAL TRANSPLANTATION

Ferreira, Ana Carina ; Mendes, Marco ; Silva, Cecília ; [et al.]

Oxford University Press (OUP) ; 2020

In: Nephrology Dialysis Transplantation Vol. 35, No. Supplement_3 ( 2020-06-01)

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In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 35, No. Supplement_3 ( 2020-06-01)

Abstract: Successful renal transplant restores many physiologic abnormalities, including improvement of chronic kidney disease-mineral and bone disorder (CKD-MBD) syndrome, and modifications of bone-related molecules in disease and health can help to understand pathophysiology of this syndrome. The aim of this study was to analyse the evolution of some of the new CKD-MBD players [alpha-klotho, fibroblast grow factor (FGF) 23, sclerostin] pre and post transplantation and the associations between those and the usual markers of the CKD-MBD disease [parathyroid hormone (PTH), bone alkaline phosphatase (bAP), calcitonin, vitamin D (vitD), phosphorus (Pi), Calcium (Ca) and Magnesium (Mg)] pre and post transplant. We also looked at the differences between values in the two time-points (delta). Method We performed a prospective cohort study of a consecutive sample of de novo single renal transplanted patients in our unit. At inclusion, demographic, clinical and transplant-related data were collected, X-ray of the pelvis and hands (for Adragão score) and echocardiographic findings were recorded. All patients were submitted to a bone biopsy and laboratorial evaluation at baseline (time 0). Patients were followed for 12 months (time 1), after which performed laboratorial evaluation, a second bone biopsy, echocardiogram, X-ray of pelvis and hands, bone densitometry and non-contrast cardiac CT (Agatston score). Continuous variables are presented as medians and categorical variables as frequencies. Associations between variables were performed using Wilcoxon matched-pairs test and Spearman correlation test. STATA software was used and p & lt; 0.05 was considered statistically significant. Results We recruited 85 patients from 1st October 2015 to 1st March 2018. At the end of 12 months, 6 patients refuse to perform the 2nd evaluation, 5 had primary non-function of the kidney graft, 1 had no sample on bone biopsy in time 0 and 4 patients died. We performed a 2nd evaluation in 69 patients and included those in this study. Mean age 50.2±12.4 years, 48 men, 53 caucasian (78.8%), median BMI 24.5 (22.7 – 27.8), median dialysis vintage 55 (42 – 84). We observe a significant reduction on phosphorus (delta: -1.1 mg/dl), magnesium (delta: -0.5 mg/dl), PTH (delta: -297.7 pg/ml), Calcitonin (delta: -0.9 ng/L), sclerostin (delta: -1.1 ng/ml), bone alkaline phosphatase (delta: -11.5 U/L) and FGF23 (delta: -1656.5 RU/ml). Both calcium (delta: 0.7 mg/dl) and alpha-klotho (delta: 265.7 pg/ml) serum levels increase, with no significant changes in vitamin D levels. With restoring renal health (time 1) and comparing with time 0, PTH maintain the negative correlation with sclerostin (p=0.02) and the positive correlation with FGF23 (p=0.0002) as in time 0; modify the correlation with Pi, becoming a negative correlation instead of positive (p=0.001) and gain new correlations with Ca (p=0.001) and vitamin D levels (p=0.03). Also, PTH correlated with the delta FGF23 (rho=-0.4, p=0.003) and sclerostin correlated with delta PTH (p=0.01). FGF23 didn’t associate with delta PTH, neither PTH associated with delta sclerostin. FGF23 didn’t reveal statistical association with Pi or Ca levels after transplant, contrasting with positive associations in pre transplant (p=0.002, p & lt;0.0001). On the contrary, sclerostin developed a new correlation with Pi (p=0.0004) and a negative correlation with Ca (p=0.01). We didn’t find correlations between these molecules and alpha-klotho. Conclusion In conclusion, it seems that sclerostin influences PTH levels and that PTH is the stimulus for the increase or decrease of FGF23 serum levels (as we found a positive association between those two molecules in both time-points and a negative association between PTH and the difference of FGF23 pre and post transplant). Levels of Ca and Pi seemed to be directly influenced by the level of PTH in post transplant, and those minerals seemed to be key factors for sclerostin secretion.

Type of Medium: Online Resource

ISSN: 0931-0509 , 1460-2385

URL: Article

DOI: 10.1093/ndt/gfaa142.P1680

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2020

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Bone densitometry versus bone histomorphometry in renal transplanted patients: a cross‐sectional study

Ferreira, Ana Carina ; Mendes, Marco ; Silva, Cecília ; [et al.]

Frontiers Media SA ; 2021

In: Transplant International Vol. 34, No. 6 ( 2021-06), p. 1065-1073

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In: Transplant International, Frontiers Media SA, Vol. 34, No. 6 ( 2021-06), p. 1065-1073

Type of Medium: Online Resource

ISSN: 0934-0874 , 1432-2277

URL: Issue

URL: Article

DOI: 10.1111/tri.v34.6

DOI: 10.1111/tri.13888

Language: English

Publisher: Frontiers Media SA

Publication Date: 2021

detail.hit.zdb_id: 1463183-0

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Drugs with a negative impact on cognitive function (Part 1): chronic kidney disease as a risk factor

Liabeuf, Sophie ; Pešić, Vesna ; Spasovski, Goce ; [et al.]

Oxford University Press (OUP) ; 2023

In: Clinical Kidney Journal ( 2023-09-18)

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In: Clinical Kidney Journal, Oxford University Press (OUP), ( 2023-09-18)

Abstract: People living with chronic kidney disease (CKD) frequently suffer from mild cognitive impairment and/or other neurocognitive disorders. This review in two parts will focus on adverse drug reactions resulting in cognitive impairment as a potentially modifiable risk factor in CKD patients. Many patients with CKD have a substantial burden of comorbidities leading to polypharmacy. A recent study found that patients seen by nephrologists were the most complex to treat because of their high number of comorbidities and medications. Due to polypharmacy, these patients may experience a wide range of adverse drug reactions. Along with CKD progression, the accumulation of uremic toxins may lead to blood–brain barrier (BBB) disruption and pharmacokinetic alterations, increasing the risk of adverse reactions affecting the central nervous system (CNS). In patients on dialysis, the excretion of drugs that depend on kidney function is severely reduced such that adverse and toxic levels of a drug or its metabolites may be reached at relatively low doses, unless dosing is adjusted. This first review will discuss how CKD represents a risk factor for adverse drug reactions affecting the CNS via (i) BBB disruption associated with CKD and (ii) the impact of reduced kidney function and dialysis itself on drug pharmacokinetics.

Type of Medium: Online Resource

ISSN: 2048-8505 , 2048-8513

URL: Article

DOI: 10.1093/ckj/sfad241

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2023

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MP627INFLUENCE OF VASCULAR ACCESS TYPE IN SURVIVAL OUTCOMES FOR INCIDENT ELDERLY HEMODIALYSIS PATIENTS

Azevedo, Ariana ; Fonseca, Nuno ; Ferreira, Ana Carina ; [et al.]

Oxford University Press (OUP) ; 2017

In: Nephrology Dialysis Transplantation Vol. 32, No. suppl_3 ( 2017-05-01), p. iii664-iii664

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In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 32, No. suppl_3 ( 2017-05-01), p. iii664-iii664

Type of Medium: Online Resource

ISSN: 0931-0509 , 1460-2385

URL: Article

DOI: 10.1093/ndt/gfx178.MP627

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2017

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Improvement of Mineral and Bone Disorders After Renal Transplantation

Ferreira, Ana Carina ; Mendes, Marco ; Silva, Cecília ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2022

In: Transplantation Vol. 106, No. 5 ( 2022-05), p. e251-e261

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In: Transplantation, Ovid Technologies (Wolters Kluwer Health), Vol. 106, No. 5 ( 2022-05), p. e251-e261

Abstract: Posttransplant mineral and bone diseases are causes of fractures, and their association with cardiovascular events is being studied. Methods. We analyzed the evolution of biochemical, histological, and imaging parameters pre– and 1 y post–renal transplantation in 69 patients and correlated mineral and bone findings with coronary calcifications. At inclusion and after 12 mo, clinical data and echocardiographic findings were recorded, and laboratory evaluations, radiography of the pelvis and hands, and bone biopsy were performed. Noncontrast cardiac computed tomography was performed during the second evaluation. Results. Serum levels of fibroblast growth factor 23 and sclerostin decreased in all patients, parathyroid hormone levels decreased in 89.8% of patients, bone alkaline phosphatase levels decreased in 68.1% of patients, and alpha-Klotho levels increased in 65.2% of patients. More than half of the patients presented with renal osteodystrophy at both biopsies, but histological findings improved: a significant transition from high to normal or low turnover and no significant differences in volume, mineralization defect, or cortical porosity at the 2 evaluations. Alpha-Klotho, sclerostin, and bone alkaline phosphatase shifts affect bone changes. Neither echocardiographic findings nor vascular calcification scores differed between the 2 points. Both the pretransplant period (dialysis vintage, sclerostin, and low bone volume at baseline) and the maintenance of abnormalities in the posttransplant period (high turnover posttransplant) were the most reliable predictors of the severity of the coronary calcification percentile. Conclusions. Renal transplantation improved bone and mineral abnormalities. The pretransplant period determines the severity of calcification.

Type of Medium: Online Resource

ISSN: 0041-1337

URL: Article

DOI: 10.1097/TP.0000000000004099

RVK:

XA 10000

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2022

detail.hit.zdb_id: 2035395-9

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SP762EXTERNAL VALIDATION OF KDRI/KDPI SCORES IN GRAFT SURVIVAL PREDICTION AND THE ROLE OF HLA MATCHING

Moreira Fonseca, Nuno ; Ferreira, Ana Carina ; Cacheira, Eunice ; [et al.]

Oxford University Press (OUP) ; 2019

In: Nephrology Dialysis Transplantation Vol. 34, No. Supplement_1 ( 2019-06-01)

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In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 34, No. Supplement_1 ( 2019-06-01)

Type of Medium: Online Resource

ISSN: 0931-0509 , 1460-2385

URL: Article

DOI: 10.1093/ndt/gfz103.SP762

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2019

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SP764DECEASED DONOR GRAFT QUALITY ASSESSMENT FOR KIDNEY TRANSPLANT BEYOND THE STANDARD VERSUS EXPANDED CRITERIA DICHOTOMY

Moreira Fonseca, Nuno ; Ferreira, Ana Carina ; Cacheira, Eunice ; [et al.]

Oxford University Press (OUP) ; 2019

In: Nephrology Dialysis Transplantation Vol. 34, No. Supplement_1 ( 2019-06-01)

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In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 34, No. Supplement_1 ( 2019-06-01)

Type of Medium: Online Resource

ISSN: 0931-0509 , 1460-2385

URL: Article

DOI: 10.1093/ndt/gfz103.SP764

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2019

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MP688MARGINAL DONORS WITH DIABETIC NEPHROPATHY: WORSE OUTCOMES?

Navarro, David ; Ferreira, Ana Carina ; Cotovio, Patrícia ; [et al.]

Oxford University Press (OUP) ; 2016

In: Nephrology Dialysis Transplantation Vol. 31, No. suppl_1 ( 2016-05), p. i568-i568

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In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 31, No. suppl_1 ( 2016-05), p. i568-i568

Type of Medium: Online Resource

ISSN: 1460-2385 , 0931-0509

URL: Article

DOI: 10.1093/ndt/gfw200.12

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2016

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