May 21, 2010

Abnormal kidney disease markers associated with increased mortality risk over 8 year average period

A meta-analysis conducted by the Chronic Kidney Disease Prognosis Consortium published on May 18, 2010 in The Lancet concluded that elevations in urinary albumin and albumin to creatinine ratio, which indicate kidney damage, as well as a reduction in the estimated glomerular filtration rate (eGFR) of the kidneys predict an increased risk of death from all causes over 2.1 to 11.6 years of follow-up.

The Consortium, which was established in 2009 by KDIGO (Kidney Disease: Improving Global Outcomes), selected 21 studies including a total of 1,234,182 participants from 14 countries for their analysis. Over the follow-up periods, 45,584 deaths occurred.

When the rate at which the glomerulii of the kidneys filter the blood dropped below a specific level, a greater risk of dying over follow-up occurred, which increased with declining rates. Additionally, an increase in albumin, a protein that is elevated in the urine when the kidneys are damaged, and a greater ratio of urinary albumin to creatinine (a product of creatine breakdown) were associated with significantly increased all-cause mortality risk. A similar elevation in risk was observed for deaths from cardiovascular disease. "eGFR less than 60 mL/min/1.73 m2 and albumin to creatinine ratio 10 mg/g or more are independent predictors of mortality risk in the general population," the authors conclude. "This study provides quantitative data for use of both kidney measures for risk assessment and definition and staging of chronic kidney disease."

"People with high levels of albumin in their urine were at markedly higher risk of mortality than people with low levels of albumin in the urine," noted lead author Kunihiro Matsushita, MD, PhD, who is a postdoctoral fellow with the Johns Hopkins Bloomberg School of Public Health's Department of Epidemiology. "The risk of mortality was elevated by nearly 50 percent at 30 mg/gram albumin to creatinine ratio, which is the threshold for defining chronic kidney disease. In addition, mortality risk increased more than four-fold at high levels of albuminuria compared to an optimal level of 5 mg/gram. The data presented in this analysis confirm that the current thresholds are indicative of increased all-cause and cardiovascular mortality risk with both kidney filtration function and urine protein contributing to risk."

Chronic kidney disease

You may be surprised to learn that until 2002, no standard definition for chronic kidney disease (CKD) existed within the medical community. Before then, conflicting classifications had created a state of confusion as to how many Americans were afflicted with this progressive, life-threatening condition.

Life Extension® has long emphasized the need for vigilance through regular testing (at least once a year) to monitor kidney health. In addition to the standard tests for creatinine, albumin, and BUN/creatinine ratio, certain individuals should insist their doctor test for cystatin-C, a largely overlooked blood marker which provides a far more precise measure of renal function. Optimal levels are less than .91 mg/L.

Individuals should also keep a record of their test results. Once any sign of disease is detected (such as an increase in creatinine), it is imperative that immediate steps be taken to halt its progress, as kidney function can decline precipitously and may be irreversible. Fortunately, many Life Extension® members are already taking a variety of nutrients that support kidney health.

Life Extension Foundation Recommendations

• Coenzyme Q10: Ubiquinol: 100 mg–300 mg daily, anytime Ubiquinone: 200 mg–600 mg daily, best with fat-containing meals
• Silymarin: 720 mg silymarin along with 270 mg silibinin daily, with meals
• Resveratrol: 100 mg–250 mg daily in divided doses
• R-Lipoic Acid: 200 mg once or twice daily, 30 minutes before meals
• Carnitine: 500 mg–1,500 mg daily, on an empty stomach
• Omega-3’s (from fish oil): 4,000 mg–6,000 mg daily, with meals
• Vitamin E: Roughly 350 mg of mixed tocopherols with at least 200 mg gamma tocopherol daily
• Vitamin C: Up to, but not exceeding 3,000 mg daily
• Folic acid (as methylfolate): 1,000 mcg daily

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Life Extension Update

• Clinical trial of vitamin B1 helps reverse early kidney disease in diabetics
• Vitamin D treatment in kidney disease cuts deaths by one-fourth
• Half of dialysis patients fail to receive life-saving vitamin

What's Hot

• Vitamin D deficiency common among kidney disease patients
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Life Extension Magazine®

• Innovative strategies to combat kidney disease
• FDA seeks to ban pyridoxamine

If you have questions or comments concerning this issue or past issues of Life Extension Update, send them to ddye@lifeextension.com or call 954 202 7716.

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