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Sun N, Guo Y, Liu W, Densmore M, Shalhoub V, Erben RG, Ye L, Lanske B, Yuan Q. FGF23 neutralization improves bone quality and osseointegration of titanium implants in chronic kidney disease mice. Sci Rep 2015; 5:8304. [PMID: 25665715 PMCID: PMC4322353 DOI: 10.1038/srep08304] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 12/16/2014] [Indexed: 02/05/2023] Open
Abstract
Chronic kidney disease (CKD) is a worldwide health problem. Serum levels of FGF23, a phosphaturic hormone, increase at the earliest stages of CKD, and have been found to be independently associated with the mortality and morbidity of CKD patients. The purpose of this study was to evaluate whether FGF23 neutralization was able to improve bone quality and osseointegration of titanium implants. Uremia was induced by 5/6 nephrectomy in adult female mice. Postsurgery, the mice were injected with vehicle or FGF23 neutralizing antibody (5 mg/kg body weight) 3 times a week. Experimental titanium implants were inserted in the distal end of the femurs. FGF23 neutralization significantly increased serum phosphate, 1,25(OH)2D and BUN, and decreased serum PTH and FGF23, relative to vehicle-treated CKD mice. Histomorphometric analysis of the tibiae indicated that FGF23 neutralization normalized the osteoidosis observed in vehicle-treated CKD mice. Although bone-implant contact ratio remained unchanged by anti-FGF23 antibody treatment, the strength of osseointegration, as evidenced by a biomechanical push-in test, was significantly improved by FGF23 neutralization. Our findings revealed that FGF23 neutralization effectively improves bone quality and osseointegration of titanium implants in CKD mice, suggesting FGF23 as a key factor of CKD related bone diseases.
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Affiliation(s)
- Ningyuan Sun
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yuchen Guo
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Weiqing Liu
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Michael Densmore
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA
| | | | - Reinhold G Erben
- Department of Biomedical Sciences, University of Veterinary Medicine, Vienna, Austria
| | - Ling Ye
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Beate Lanske
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA
| | - Quan Yuan
- 1] State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China [2] Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA
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202
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van Dijk PR, Kramer A, Logtenberg SJJ, Hoitsma AJ, Kleefstra N, Jager KJ, Bilo HJG. Incidence of renal replacement therapy for diabetic nephropathy in the Netherlands: Dutch diabetes estimates (DUDE)-3. BMJ Open 2015; 5:e005624. [PMID: 25636789 PMCID: PMC4316478 DOI: 10.1136/bmjopen-2014-005624] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Describe the incidence, prevalence and survival of patients needing renal replacement therapy (RRT) for end-stage renal disease (ESRD) due to diabetes mellitus (DM)-related glomerulosclerosis or nephropathy (diabetic nephropathy, DN) in the Netherlands. DESIGN Using the national registry for RRT (RENINE-registry), data of all Dutch individuals initiating RRT for ESRD and having DN as primary diagnosis in the period 2000-2012 were obtained. SETTING Observational study in the Netherlands. PATIENTS Patients with ESRD needing RRT for DN. OUTCOME MEASUREMENTS Age and gender adjusted incidence and prevalence of RRT for DN in the period 2000-2012. In addition, trends in time and patient's survival were examined. RESULTS The prevalence of DM in the general population increased from approximately 466 000 in 2000 to 815 000 in 2011. The number of individuals who started RRT with DN as primary diagnosis was 17.4 per million population (pmp) in 2000 and 19.1 pmp in 2012, with an annual percentage change (APC) of 0.8% (95% CI -0.4 to 2.0). For RRT due to type 1 DN, the incidence decreased from 7.3 to 3.5 pmp (APC -4.8%, 95% CI -6.5 to -3.1) while it increased for type 2 DN from 10.1 to 15.6 pmp (APC 3.1%, 95% CI 1.3 to 4.8). After 2009, the prevalence of RRT for DN remained stable (APC 1.0%, 95% CI -0.4 to 2.5). Compared to the period 2000-2004, patients initiating RRT and dialysis in 2005-2009 had better survival, HRs 0.8 (95% CI 0.7 to 0.8) and 0.8 (95% CI 0.7 to 0.9), respectively, while survival after kidney transplantation remained stable, HR 0.8, 95% CI 0.5 to 1.1). CONCLUSIONS Over the last decade, the incidence of RRT for DN was stable, with a decrease in RRT due to type 1 DN and an increase due to type 2 DN, while survival increased.
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Affiliation(s)
| | - Anneke Kramer
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, ERA-EDTA Registry, Amsterdam, The Netherlands
| | - Susan J J Logtenberg
- Diabetes Centre, Isala, Zwolle, The Netherlands
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Andries J Hoitsma
- Department of Nephrology, Radboud University Medical Centre, Nijmegen, The Netherlands
- RENINE Registry, Leiden, The Netherlands
| | - Nanne Kleefstra
- Diabetes Centre, Isala, Zwolle, The Netherlands
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Kitty J Jager
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, ERA-EDTA Registry, Amsterdam, The Netherlands
| | - Henk J G Bilo
- Diabetes Centre, Isala, Zwolle, The Netherlands
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Department of Internal Medicine, Isala, Zwolle, The Netherlands
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Toyoda K. Cerebral small vessel disease and chronic kidney disease. J Stroke 2015; 17:31-7. [PMID: 25692105 PMCID: PMC4325633 DOI: 10.5853/jos.2015.17.1.31] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 11/24/2014] [Accepted: 11/24/2014] [Indexed: 01/23/2023] Open
Abstract
Chronic kidney disease, defined by a decreased glomerular filtration rate or albuminuria, is recognized as a major global health burden, mainly because it is an established risk factor for cardiovascular and cerebrovascular diseases. The magnitude of the effect of chronic kidney disease on incident stroke seems to be higher in persons of Asian ethnicity. Since the kidney and brain share unique susceptibilities to vascular injury due to similar anatomical and functional features of small artery diseases, kidney impairment can be predictive of the presence and severity of cerebral small vessel diseases. Chronic kidney disease has been reported to be associated with silent brain infarcts, cerebral white matter lesions, and cerebral microbleeds, independently of vascular risk factors. In addition, chronic kidney disease affects cognitive function, partly via the high prevalence of cerebral small vessel diseases. Retinal artery disease also has an independent relationship with chronic kidney disease and cognitive impairment. Stroke experts are no longer allowed to be ignorant of chronic kidney disease. Close liaison between neurologists and nephrologists can improve the management of cerebral small vessel diseases in kidney patients.
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Affiliation(s)
- Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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204
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Assessment of residual alveolar bone volume in hemodialysis patients using CBCT. Clin Oral Investig 2015; 19:1619-24. [PMID: 25617025 DOI: 10.1007/s00784-014-1393-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 12/18/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND The study aims to assess the residual alveolar bone volume in Chinese chronic kidney disease (CKD) patients undergoing hemodialysis (HD) using cone-beam computed tomography (CBCT). MATERIALS AND METHODS Two hundred and eight HD patients and healthy controls were enrolled to undergo CBCT examination. To evaluate residual alveolar bone volume, bone height was measured from the alveolar crest (AC) to the maxillary sinus floor or the mandibular nerve canal, whereas bone width was measured at a depth of 1.0, 3.0, and 6.0 mm apical to the AC. RESULTS There was no significant difference in demographics and the extent of tooth loss between HD patients and control group. Both groups showed abundant residual bone volume. However, the heights of residual alveolar bone at the upper premolars and first molar in HD patients were significantly lower than those of the control group (p < 0.05). No significant difference was observed for alveolar bone at the lower premolars and molars. The bone width showed statistical differences for HD patients' upper second molars, lower first premolars, and second molars (p < 0.05). CONCLUSIONS While the residual bone was sufficient for implant placement, HD patients exhibited with significantly lower residual bone height at the sites of the upper premolars and first molar and varied residual bone width depending on the location. CLINICAL RELEVANCE Owing to these changes, special cautions need to be taken for patients undergoing HD or with chronically impaired renal functions during implant treatment planning.
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205
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Jelaković B, Vuković Lela I, Karanović S, Dika Ž, Kos J, Dickman K, Šekoranja M, Poljičanin T, Mišić M, Premužić V, Abramović M, Matijević V, Miletić Medved M, Cvitković A, Edwards K, Fuček M, Leko N, Teskera T, Laganović M, Čvorišćec D, Grollman AP. Chronic dietary exposure to aristolochic acid and kidney function in native farmers from a Croatian endemic area and Bosnian immigrants. Clin J Am Soc Nephrol 2015; 10:215-23. [PMID: 25587102 DOI: 10.2215/cjn.03190314] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Improvements in agricultural practices in Croatia have reduced exposure to consumption of aristolochic acid-contaminated flour and development of endemic (Balkan) nephropathy. Therefore, it was hypothesized that Bosnian immigrants who settled in an endemic area in Croatia 15-30 years ago would be at lower risk of developing endemic nephropathy because of reduced exposure to aristolochic acid. To test this hypothesis, past and present exposure to aristolochic acid, proximal tubule damage as a hallmark of endemic nephropathy, and prevalence of CKD in Bosnian immigrants were analyzed. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In this cross-sectional observational study from 2005 to 2010, 2161 farmers were divided into groups: indigenous inhabitants from endemic nephropathy and nonendemic nephropathy villages and Bosnian immigrants; α-1 microglobulin-to-creatinine ratio >31.5 mg/g and eGFR<60 ml/min per 1.73 m(2) were considered to be abnormal. RESULTS CKD and proximal tubule damage prevalence was significantly lower in Bosnian immigrants than inhabitants of endemic nephropathy villages (6.9% versus 16.6%; P<0.001; 1.3% versus 7.3%; P=0.003, respectively); 20 years ago, Bosnian immigrants observed fewer Aristolochia clematitis in cultivated fields (41.9% versus 67.8%) and fewer seeds among wheat seeds (6.1% versus 35.6%) and ate more purchased than homemade bread compared with Croatian farmers from endemic nephropathy villages (38.5% versus 14.8%, P<0.001). Both Croatian farmers and Bosnian immigrants observe significantly fewer Aristolochia plants growing in their fields compared with 15-30 years ago. Prior aristolochic acid exposure was associated with proximal tubule damage (odds ratio, 1.64; 95% confidence interval, 1.04 to 2.58; P=0.02), whereas present exposure was not (odds ratio, 1.31; 95% confidence interval, 0.75 to 2.30; P=0.33). Furthermore, immigrant status was an independent negative predictor of proximal tubule damage (odds ratio, 0.40; 95% confidence interval, 0.19 to 0.86; P=0.02). CONCLUSIONS Bosnian immigrants and autochthonous Croats residing in endemic areas are exposed significantly less to ingestion of aristolochic acid than in the past. The prevalence of endemic nephropathy and its associated urothelial cancers is predicted to decrease over time.
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Affiliation(s)
- Bojan Jelaković
- Departments of Nephrology, Hypertension, Dialysis and Transplantation and
| | - Ivana Vuković Lela
- Departments of Nephrology, Hypertension, Dialysis and Transplantation and
| | - Sandra Karanović
- Departments of Nephrology, Hypertension, Dialysis and Transplantation and
| | - Živka Dika
- Departments of Nephrology, Hypertension, Dialysis and Transplantation and
| | - Jelena Kos
- Departments of Nephrology, Hypertension, Dialysis and Transplantation and
| | - Kathleen Dickman
- Department of Pharmacological Sciences, State University of New York at Stony Brook, Stony Brook, New York
| | - Maja Šekoranja
- Faculty for Natural Sciences, University of Zagreb, Zagreb, Croatia
| | | | | | - Vedran Premužić
- Departments of Nephrology, Hypertension, Dialysis and Transplantation and
| | | | | | | | - Ante Cvitković
- Institute for Public Health County Brodsko-Posavska, Slavonski Brod, Croatia
| | - Karen Edwards
- Department of Epidemiology, Genetic Epidemiology Research Institute, School of Medicine, University of California, Irvine, Irvine, CA; and
| | - Mirjana Fuček
- Clinical Laboratory Diagnostics, School of Medicine, University of Zagreb, University Hospital Center Zagreb, Zagreb, Croatia
| | - Ninoslav Leko
- General Hospital, "Josip Benčević", Department of Internal Medicine, Dialysis Unit
| | - Tomislav Teskera
- General Hospital, "Josip Benčević", Department of Internal Medicine, Dialysis Unit
| | - Mario Laganović
- Departments of Nephrology, Hypertension, Dialysis and Transplantation and
| | - Dubravka Čvorišćec
- Clinical Laboratory Diagnostics, School of Medicine, University of Zagreb, University Hospital Center Zagreb, Zagreb, Croatia
| | - Arthur P Grollman
- Department of Pharmacological Sciences, State University of New York at Stony Brook, Stony Brook, New York
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Morton RL, Schlackow I, Mihaylova B, Staplin ND, Gray A, Cass A. The impact of social disadvantage in moderate-to-severe chronic kidney disease: an equity-focused systematic review*. Nephrol Dial Transplant 2015; 31:46-56. [DOI: 10.1093/ndt/gfu394] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 11/28/2014] [Indexed: 11/12/2022] Open
Abstract
Abstract
It is unclear whether a social gradient in health outcomes exists for people with moderate-to-severe chronic kidney disease (CKD). We critically review the literature for evidence of social gradients in health and investigate the ‘suitability’ of statistical analyses in the primary studies. In this equity-focused systematic review among adults with moderate-to-severe CKD, factors of disadvantage included gender, race/ethnicity, religion, education, socio-economic status or social capital, occupation and place of residence. Outcomes included access to healthcare, kidney disease progression, cardiovascular events, all-cause mortality and suitability of analyses. Twenty-four studies in the pre-dialysis population and 34 in the dialysis population representing 8.9 million people from 10 countries were included. In methodologically suitable studies among pre-dialysis patients, a significant social gradient was observed in access to healthcare for those with no health insurance and no home ownership. Low income and no home ownership were associated with higher cardiovascular event rates and higher mortality [HR 1.94, 95% confidence interval (CI) 1.27–2.98; HR 1.28, 95% CI 1.04–1.58], respectively. In methodologically suitable studies among dialysis patients, females, ethnic minorities, those with low education, no health insurance, low occupational level or no home ownership were significantly less likely to access cardiovascular healthcare than their more advantaged dialysis counterparts. Low education level and geographic remoteness were associated with higher cardiovascular event rates and higher mortality (HR 1.54, 95% CI 1.01–2.35; HR 1.21, 95% CI 1.08–1.37), respectively. Socially disadvantaged pre-dialysis and dialysis patients experience poorer access to specialist cardiovascular health services, and higher rates of cardiovascular events and mortality than their more advantaged counterparts.
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Affiliation(s)
- Rachael Lisa Morton
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Iryna Schlackow
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Borislava Mihaylova
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Natalie Dawn Staplin
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
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De Nicola L, Donfrancesco C, Minutolo R, Lo Noce C, Palmieri L, De Curtis A, Iacoviello L, Zoccali C, Gesualdo L, Conte G, Vanuzzo D, Giampaoli S. Prevalence and cardiovascular risk profile of chronic kidney disease in Italy: results of the 2008-12 National Health Examination Survey. Nephrol Dial Transplant 2014; 30:806-14. [PMID: 25523453 DOI: 10.1093/ndt/gfu383] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 11/19/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND National surveys in countries outside Europe have reported a high prevalence (11-13%) of chronic kidney disease (CKD). Studies in Europe have provided a variable prevalence likely due to differences in study design, including age and extent of geographic areas, equation used to evaluate estimated glomerular filtration rate (eGFR) and CKD stages examined. METHODS The 2008-12 National Health Examination Survey in Italy randomly extracted samples from the general population aged 35-79 years, stratified by age and gender, from the resident list of each Italian region (440 persons/1.5 million of residents). We estimated the prevalence of CKD by means of urinary albumin : creatinine ratio and eGFR (CKD-EPI equation-enzymatic assay of serum creatinine). Cardiovascular (CV) risk profile was also evaluated. RESULTS Three thousand eight hundred and forty-eight men and 3704 women were examined. In the whole population, mean age was 57 ± 12 and 56 ± 12 years in men and women, respectively; hypertension was prevalent in men and women, respectively (56 and 43%) and the same held true for overweight (48 and 33%), obesity (26 and 27%), diabetes (14 and 9%) and smoking (21 and 18%), whereas CV disease was less frequent (9 and 6%). Overall, the prevalence of CKD (95% confidence interval) was 7.05% (6.48-7.65). Early stages constituted 59% of the CKD population [Stage G1-2 A2-3: 4.16% (3.71-4.61) and Stage G3-5: 2.89% (2.51-3.26)]. At multivariate regression analysis, age, obesity, hypertension, diabetes, CV disease and smoking were all independent correlates of CKD. CONCLUSIONS CKD has a relatively lower prevalence in Italy, in particular for advanced stages, when compared with similar national surveys outside Europe. This occurs despite older age and unfavourable CV risk profile of the whole population.
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Affiliation(s)
- Luca De Nicola
- Italian Society of Nephrology, Italy Division of Nephrology, Second University of Naples, Naples, Italy
| | - Chiara Donfrancesco
- Cardiovascular Epidemiology Observatory, National Institute of Health, Roma, Italy
| | - Roberto Minutolo
- Italian Society of Nephrology, Italy Division of Nephrology, Second University of Naples, Naples, Italy
| | - Cinzia Lo Noce
- Cardiovascular Epidemiology Observatory, National Institute of Health, Roma, Italy
| | - Luigi Palmieri
- Cardiovascular Epidemiology Observatory, National Institute of Health, Roma, Italy
| | - Amalia De Curtis
- Laboratory of Molecular and Nutritional Epidemiology, Department of Epidemiology and Prevention, IRCCS Mediterranean Neurologic Institute Neuromed, Pozzilli, IS, Italy
| | - Licia Iacoviello
- Laboratory of Molecular and Nutritional Epidemiology, Department of Epidemiology and Prevention, IRCCS Mediterranean Neurologic Institute Neuromed, Pozzilli, IS, Italy
| | - Carmine Zoccali
- Italian Society of Nephrology, Italy Nephrology Division, Center of National Research, Institute of Biomedicine and Molecular Immunology Hospital, Reggio Calabria, Italy
| | - Loreto Gesualdo
- Italian Society of Nephrology, Italy Division of Nephrology, University of Bari, Bari, Italy
| | - Giuseppe Conte
- Italian Society of Nephrology, Italy Division of Nephrology, Second University of Naples, Naples, Italy
| | - Diego Vanuzzo
- National Association of Hospital Cardiologists, ANMCO (Associazione Nazionale Medici Cardiologi Ospedalieri) and Heart Care Foundation (Fondazione per il Tuo Cuore) Onlus, Firenze, Italy Center for Cardiovascular Prevention, ASS 4 'Medio Friuli', Udine, Italy
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209
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Shimizu M, Furusyo N, Mitsumoto F, Takayama K, Ura K, Hiramine S, Ikezaki H, Ihara T, Mukae H, Ogawa E, Toyoda K, Kainuma M, Murata M, Hayashi J. Subclinical carotid atherosclerosis and triglycerides predict the incidence of chronic kidney disease in the Japanese general population: results from the Kyushu and Okinawa Population Study (KOPS). Atherosclerosis 2014; 238:207-12. [PMID: 25528429 DOI: 10.1016/j.atherosclerosis.2014.12.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 11/28/2014] [Accepted: 12/02/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine whether or not subclinical atherosclerosis independently predicts the incidence of chronic kidney disease (CKD) in the Japanese general population. METHODS This study is part of the Kyushu and Okinawa Population Study (KOPS), a survey of vascular events associated with lifestyle-related diseases. Participants who attended both baseline (2004-2007) and follow-up (2009-2012) examinations were eligible. The common carotid intima-media thickness (IMT) was assessed for each participant at baseline. The end point was the incidence of CKD, defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m(2) during the follow-up of participants without CKD at baseline. RESULTS During the five-year follow-up, 224 of the 1824 participants (12.3%) who developed CKD had higher carotid IMT (0.74 ± 0.22 vs. 0.65 ± 0.14 mm, P < 0.001), higher triglycerides (1.6 ± 0.8 vs. 1.3 ± 0.7 mmol/L, P < 0.001), and lower high density lipoprotein cholesterol (1.5 ± 0.4 vs. 1.6 ± 0.4 mmol/L, P < 0.001) at baseline than those who did not. In logistic regression analysis adjusted for significant covariates, eGFR (Odds ratio [OR] 0.83, 95% confidence interval (CI) 0.80-0.85, P < 0.001), carotid IMT (0.10 mm increase: OR 1.17, 95% CI 1.04-1.33, P = 0.010), and triglycerides (OR 1.35, 95% CI 1.06-1.73, P = 0.015) at baseline were independent predictors for the development of CKD. CONCLUSIONS Higher carotid IMT and hypertriglyceridemia were independently associated with the development of CKD in the population studied.
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Affiliation(s)
- Motohiro Shimizu
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan.
| | - Norihiro Furusyo
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan.
| | - Fujiko Mitsumoto
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Koji Takayama
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Kazuya Ura
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Satoshi Hiramine
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Hiroaki Ikezaki
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Takeshi Ihara
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Haru Mukae
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Eiichi Ogawa
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Kazuhiro Toyoda
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Mosaburo Kainuma
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Masayuki Murata
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Jun Hayashi
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan; Kyushu General Internal Medicine Center, Haradoi Hospital, Fukuoka, Japan
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Chase HS, Hirsch JS, Mohan S, Rao MK, Radhakrishnan J. Presence of early CKD-related metabolic complications predict progression of stage 3 CKD: a case-controlled study. BMC Nephrol 2014; 15:187. [PMID: 25431293 PMCID: PMC4258953 DOI: 10.1186/1471-2369-15-187] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 11/18/2014] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Only a subset of patients who enter stage 3 chronic kidney disease (CKD) progress to stage 4. Identifying which patients entering stage 3 are most likely to progress could improve outcomes, by allowing more appropriate referrals for specialist care, and spare those unlikely to progress the adverse effects and costliness of an unnecessarily aggressive approach. We hypothesized that compared to non-progressors, patients who enter stage 3 CKD and ultimately progress have experienced greater loss of renal function, manifested by impairment of metabolic function (anemia, worsening acidosis and mineral abnormalities), than is reflected in the eGFR at entry to stage 3. The purpose of this case-controlled study was to design a prediction model for CKD progression using laboratory values reflecting metabolic status. METHODS Using data extracted from the electronic health record (EHR), two cohorts of patients in stage 3 were identified: progressors (eGFR declined >3 ml/min/1.73 m2/year; n=117) and non-progressors (eGFR declined <1 ml/min/1.713 m2; n=364). Initial laboratory values recorded a year before to a year after the time of entry to stage 3, reflecting metabolic complications (hemoglobin, bicarbonate, calcium, phosphorous, and albumin) were obtained. Average values in progressors and non-progressors were compared. Classification algorithms (Naïve Bayes and Logistic Regression) were used to develop prediction models of progression based on the initial lab data. RESULTS At the entry to stage 3 CKD, hemoglobin, bicarbonate, calcium, and albumin values were significantly lower and phosphate values significantly higher in progressors compared to non-progressors even though initial eGFR values were similar. The differences were sufficiently large that a prediction model of progression could be developed based on these values. Post-test probability of progression in patients classified as progressors or non-progressors were 81% (73% - 86%) and 17% (13% - 23%), respectively. CONCLUSIONS Our studies demonstrate that patients who enter stage 3 and ultimately progress to stage 4 manifest a greater degree of metabolic complications than those who remain stable at the onset of stage 3 when eGFR values are equivalent. Lab values (hemoglobin, bicarbonate, phosphorous, calcium and albumin) are sufficiently different between the two cohorts that a reasonably accurate predictive model can be developed.
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Affiliation(s)
- Herbert S Chase
- />Division of Nephrology, Columbia University, New York, NY USA
- />Department of Biomedical Informatics, Columbia University, 622 West 168th Street, New York, NY 10032 USA
| | - Jamie S Hirsch
- />Division of Nephrology, Columbia University, New York, NY USA
- />Department of Biomedical Informatics, Columbia University, 622 West 168th Street, New York, NY 10032 USA
| | - Sumit Mohan
- />Division of Nephrology, Columbia University, New York, NY USA
| | - Maya K Rao
- />Division of Nephrology, Columbia University, New York, NY USA
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Tan X, He J, Cao X, Zou J, Liu H, Ding X. Effects of oral carbonic adsorbent (AST-120) on kidney of early-stage chronic kidney disease rats. Ren Fail 2014; 37:337-42. [DOI: 10.3109/0886022x.2014.986006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ricardo AC, Anderson CA, Yang W, Zhang X, Fischer MJ, Dember LM, Fink JC, Frydrych A, Jensvold NG, Lustigova E, Nessel LC, Porter AC, Rahman M, Wright Nunes JA, Daviglus ML, Lash JP. Healthy lifestyle and risk of kidney disease progression, atherosclerotic events, and death in CKD: findings from the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis 2014; 65:412-24. [PMID: 25458663 DOI: 10.1053/j.ajkd.2014.09.016] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 09/24/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND In general populations, healthy lifestyle is associated with fewer adverse outcomes. We estimated the degree to which adherence to a healthy lifestyle decreases the risk of renal and cardiovascular events among adults with chronic kidney disease (CKD). STUDY DESIGN Prospective cohort. SETTING & PARTICIPANTS 3,006 adults enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study. PREDICTORS 4 lifestyle factors (regular physical activity, body mass index [BMI] of 20-<25kg/m(2), nonsmoking, and "healthy diet"), individually and in combination. OUTCOMES CKD progression (50% decrease in estimated glomerular filtration rate or end-stage renal disease), atherosclerotic events (myocardial infarction, stroke, or peripheral arterial disease), and all-cause mortality. MEASUREMENTS Multivariable-adjusted Cox proportional hazards. RESULTS During a median follow-up of 4 years, we observed 726 CKD progression events, 355 atherosclerotic events, and 437 deaths. BMI≥25kg/m(2) and nonsmoking were associated with reduced risk of CKD progression (HRs of 0.75 [95% CI, 0.58-0.97] and 0.61 [95% CI, 0.45-0.82] for BMIs of 25 to <30 and ≥30kg/m(2), respectively, versus 20 to <25kg/m(2); HR for nonsmoking of 0.68 [95% CI, 0.55-0.84] compared to the current smoker reference group) and reduced risk of atherosclerotic events (HRs of 0.67 [95% CI, 0.46-0.96] for BMI of 25-<30 vs 20-<25kg/m(2) and 0.55 [95% CI, 0.40-0.75] vs current smoker). Factors associated with reduced all-cause mortality were regular physical activity (HR, 0.64 [95% CI, 0.52-0.79] vs inactive), BMI≥30kg/m(2) (HR, 0.64 [95% CI, 0.43-0.96] vs 20-<25kg/m(2)), and nonsmoking (HR, 0.45 [95% CI, 0.34-0.60] vs current smoker). BMI<20kg/m(2) was associated with increased all-cause mortality risk (HR, 2.11 [95% CI, 1.13-3.93] vs 20-<25kg/m(2)). Adherence to all 4 lifestyle factors was associated with a 68% lower risk of all-cause mortality compared to adherence to no lifestyle factors (HR, 0.32; 95% CI, 0.11-0.89). LIMITATIONS Lifestyle factors were measured only once. CONCLUSIONS Regular physical activity, nonsmoking, and BMI≥25kg/m(2) were associated with lower risk of adverse outcomes in this cohort of individuals with CKD.
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Affiliation(s)
- Ana C Ricardo
- Department of Medicine, University of Illinois at Chicago, Chicago, IL.
| | - Cheryl A Anderson
- Department of Family and Preventive Medicine, University of California, San Diego, CA
| | - Wei Yang
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Xiaoming Zhang
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Michael J Fischer
- Department of Medicine, University of Illinois at Chicago, Chicago, IL; Center for Management of Complex Chronic Care, Jesse Brown VA Medical Center, Chicago, IL
| | - Laura M Dember
- Renal, Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA
| | - Jeffrey C Fink
- Department of Medicine, University of Maryland, Baltimore, MD
| | - Anne Frydrych
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Nancy G Jensvold
- Kaiser Permanente Northern California Division of Research, Oakland, CA
| | - Eva Lustigova
- Department of Epidemiology, Tulane University, New Orleans, LA
| | - Lisa C Nessel
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Anna C Porter
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Mahboob Rahman
- Case Western Reserve University, University Hospitals Case Medical Center and Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | | | - Martha L Daviglus
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - James P Lash
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
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213
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Abstract
CKD is an important public health problem associated with substantial morbidity, impaired quality of life, shortened life expectancy, and excessive health care costs. Given its long preclinical latency, screening of asymptomatic individuals for CKD has been considered as a potentially useful means of early detection, with a goal of reducing CKD progression and its complications. A recent clinical practice guideline from the American College of Physicians that recommended against screening for CKD in asymptomatic adults without risk factors has reignited debate regarding CKD screening. Despite the lack of randomized controlled trial evidence showing benefits of CKD screening, even among individuals at increased risk for CKD, such as those with diabetes or hypertension or who are of certain high-risk racial or ethnic groups, a thoughtful and selective approach to CKD screening seems to be cost-effective and clinically valuable. CKD screening is recommended by several nephrology professional societies and appropriate in at-risk asymptomatic individuals with the intent of identifying and managing CKD, diagnosing the etiology of CKD, limiting or preventing CKD progression and its associated cardiovascular disease risk, and minimizing risk of AKI, inappropriate drug dosing, and nephrotoxic injury.
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Affiliation(s)
- Jeffrey S Berns
- Renal, Electrolyte, and Hypertension Division, Perelman School of Medicine of the University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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214
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Zhao D, Zhang S, Chen X, Liu W, Sun N, Guo Y, Dong Y, Mo A, Yuan Q. Evaluation of Periodontitis and Bone Loss in Patients Undergoing Hemodialysis. J Periodontol 2014; 85:1515-20. [DOI: 10.1902/jop.2014.140119] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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215
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Martínez-Castelao A, Górriz JL, Bover J, Segura-de la Morena J, Cebollada J, Escalada J, Esmatjes E, Fácila L, Gamarra J, Gràcia S, Hernández-Moreno J, Llisterri-Caro JL, Mazón P, Montañés R, Morales-Olivas F, Muñoz-Torres M, de Pablos-Velasco P, de Santiago A, Sánchez-Celaya M, Suárez C, Tranche S. Documento de consenso para la detección y manejo de la enfermedad renal crónica. ACTA ACUST UNITED AC 2014; 61:e25-43. [DOI: 10.1016/j.endonu.2014.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 06/20/2014] [Indexed: 02/07/2023]
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216
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Snijder PM, Frenay ARS, Koning AM, Bachtler M, Pasch A, Kwakernaak AJ, van den Berg E, Bos EM, Hillebrands JL, Navis G, Leuvenink HGD, van Goor H. Sodium thiosulfate attenuates angiotensin II-induced hypertension, proteinuria and renal damage. Nitric Oxide 2014; 42:87-98. [PMID: 25459997 DOI: 10.1016/j.niox.2014.10.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 10/05/2014] [Accepted: 10/09/2014] [Indexed: 01/03/2023]
Abstract
Hypertension and proteinuria are important mediators of renal damage. Despite therapeutic interventions, the number of patients with end stage renal disease steadily increases. Hydrogen sulfide (H(2)S) is an endogenously produced gasotransmitter with vasodilatory, anti-inflammatory and antioxidant properties. These beneficial characteristics make H(2)S an attractive candidate for pharmacological use in hypertensive renal disease. We investigated the protective properties of H(2)S in angiotensin II (Ang II)-induced hypertensive renal disease in rats. Treatment with the H(2)S donor NaHS and major H(2)S metabolite sodium thiosulfate (STS) during three weeks of Ang II infusion reduced hypertension, proteinuria, oxidative stress and renal functional and structural deterioration. In an ex vivo isolated perfused kidney setup, NaHS, but not STS, reduced intrarenal pressure. The effect of NaHS could partially be explained by its activation of the ATP-sensitive potassium channels. In conclusion, treatment with H(2)S attenuates Ang II-associated functional and structural renal deterioration, suggesting that intervention in H(2)S production pathways has potential therapeutic benefit and might be a valuable addition to the already existing antihypertensive and renoprotective therapies.
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Affiliation(s)
- Pauline M Snijder
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anne-Roos S Frenay
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anne M Koning
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Matthias Bachtler
- Department of Nephrology, Hypertension and Clinical Pharmacology, University Hospital Bern, Inselspital, Bern, Switzerland
| | - Andreas Pasch
- Department of Nephrology, Hypertension and Clinical Pharmacology, University Hospital Bern, Inselspital, Bern, Switzerland
| | - Arjan J Kwakernaak
- Kidney Center Groningen, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Else van den Berg
- Kidney Center Groningen, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eelke M Bos
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan-Luuk Hillebrands
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerjan Navis
- Kidney Center Groningen, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Henri G D Leuvenink
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Harry van Goor
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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217
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Martínez-Castelao A, Górriz JL, Bover J, Segura-de la Morena J, Cebollada J, Escalada J, Esmatjes E, Fácila L, Gamarra J, Gràcia S, Hernández-Moreno J, Llisterri-Caro JL, Mazón P, Montañés R, Morales-Olivas F, Muñoz-Torres M, de Pablos-Velasco P, de Santiago A, Sánchez-Celaya M, Suárez C, Tranche S. [Consensus document for the detection and management of chronic kidney disease]. Aten Primaria 2014; 46:501-19. [PMID: 25288498 PMCID: PMC6983829 DOI: 10.1016/j.aprim.2014.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 09/08/2014] [Indexed: 02/07/2023] Open
Abstract
La enfermedad renal crónica (ERC) es un importante problema de salud pública que puede afectar en sus diferentes estadios a cerca del 10% de la población española y que supone una elevada morbimortalidad, así como un importante consumo de recursos al Sistema Nacional de Salud. Diez sociedades científicas involucradas en el manejo del paciente renal nos hemos puesto de acuerdo para hacer una puesta al día del anterior documento de consenso sobre ERC de 2007. El presente es la edición abreviada del documento general extenso, que puede ser consultado en las páginas Web de cada una de las sociedades firmantes. Contiene los siguientes aspectos: definición, epidemiología y factores de riesgo de la ERC; criterios de diagnóstico, evaluación y estadificación de la ERC, albuminuria y estimación del filtrado glomerular; concepto y factores de progresión; criterios de derivación a nefrología; seguimiento del paciente, actitudes y objetivos por especialidad; prevención de la nefrotoxicidad; detección del daño cardiovascular; actitudes, estilo de vida y tratamiento: manejo de la hipertensión arterial, dislipidemia, hiperglucemia, tabaquismo, obesidad, hiperuricemia, anemia, alteraciones del metabolismo mineral y óseo; seguimiento coordinado por atención primaria-otras especialidades-nefrología; manejo del paciente en tratamiento renal sustitutivo, hemodiálisis, diálisis peritoneal y trasplante renal; tratamiento paliativo de la uremia terminal. Esperamos que sirva de gran ayuda en el manejo multidisciplinar del paciente con ERC, a la vista de las recomendaciones más actualizadas.
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Affiliation(s)
| | - José L Górriz
- Sociedad Española de Nefrología (SEN), Barcelona, España
| | - Jordi Bover
- Sociedad Española de Nefrología (SEN), Barcelona, España
| | - Julián Segura-de la Morena
- Sociedad Española de Hipertensión Arterial-Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA), Madrid, España
| | - Jesús Cebollada
- Sociedad Española de Medicina Interna (SEMI), Madrid, España
| | - Javier Escalada
- Sociedad Española de Endocrinología y Nutrición (SEEN), Madrid, España
| | | | | | - Javier Gamarra
- Sociedad Española de Médicos Generalistas (AP) (SEMG), Madrid, España
| | - Silvia Gràcia
- Sociedad Española de Química Clínica (SEQC), Madrid, España
| | | | | | - Pilar Mazón
- Sociedad Española de Cardiología (SEC), Madrid, España
| | | | - Francisco Morales-Olivas
- Sociedad Española de Hipertensión Arterial-Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA), Madrid, España
| | | | | | - Ana de Santiago
- Sociedad Española de Medicina Rural y Generalista (AP) (SEMERGEN), Madrid, España
| | - Marta Sánchez-Celaya
- Sociedad Española de Medicina de Familia y Comunitaria (AP) (SEMFyC), Madrid, España
| | - Carmen Suárez
- Sociedad Española de Medicina Interna (SEMI), Madrid, España
| | - Salvador Tranche
- Sociedad Española de Medicina de Familia y Comunitaria (AP) (SEMFyC), Madrid, España
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218
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Martínez-Castelao A, Górriz JL, Bover J, Segura-de la Morena J, Cebollada J, Escalada J, Esmatjes E, Fácila L, Gamarra J, Gràcia S, Hernández-Moreno J, Llisterri-Caro JL, Mazón P, Montañés R, Morales-Olivas F, Muñoz-Torres M, de Pablos-Velasco P, de Santiago A, Sánchez-Celaya M, Suárez C, Tranche S. [Consensus document for the detection and management of chronic kidney disease]. Semergen 2014; 40:441-59. [PMID: 25282133 DOI: 10.1016/j.semerg.2014.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 06/20/2014] [Indexed: 02/07/2023]
Abstract
Chronic kidney disease (CKD) is an important global health problem, involving to 10% of the Spanish population, promoting high morbidity and mortality for the patient and an elevate consumption of the total health resources for the National Health System. This is a summary of an executive consensus document of ten scientific societies involved in the care of the renal patient, that actualizes the consensus document published in 2007. The central extended document can be consulted in the web page of each society. The aspects included in the document are: Concept, epidemiology and risk factors for CKD. Diagnostic criteria, evaluation and stages of CKD, albuminuria and glomerular filtration rate estimation. Progression factors for renal damage. Patient remission criteria. Follow-up and objectives of each speciality control. Nephrotoxicity prevention. Cardio-vascular damage detection. Diet, life-style and treatment attitudes: hypertension, dyslipidaemia, hyperglycemia, smoking, obesity, hyperuricemia, anemia, mineral and bone disorders. Multidisciplinary management for Primary Care, other specialities and Nephrology. Integrated management of CKD patient in haemodialysis, peritoneal dialysis and renal transplant patients. Management of the uremic patient in palliative care. We hope that this document may be of help for the multidisciplinary management of CKD patients by summarizing the most updated recommendations.
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Affiliation(s)
| | - José L Górriz
- Sociedad Española de Nefrología (SEN), Barcelona, España
| | - Jordi Bover
- Sociedad Española de Nefrología (SEN), Barcelona, España
| | - Julián Segura-de la Morena
- Sociedad Española de Hipertensión Arterial-Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA), Madrid, España
| | - Jesús Cebollada
- Sociedad Española de Medicina Interna (SEMI), Madrid, España
| | - Javier Escalada
- Sociedad Española de Endocrinología y Nutrición (SEEN), Madrid, España
| | | | | | - Javier Gamarra
- Sociedad Española de Médicos Generalistas (AP) (SEMG), Madrid, España
| | - Silvia Gràcia
- Sociedad Española de Química Clínica (SEQC), Madrid, España
| | | | | | - Pilar Mazón
- Sociedad Española de Cardiología (SEC), Madrid, España
| | | | - Francisco Morales-Olivas
- Sociedad Española de Hipertensión Arterial-Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA), Madrid, España
| | | | | | - Ana de Santiago
- Sociedad Española de Medicina Rural y Generalista (AP) (SEMERGEN), Madrid, España
| | - Marta Sánchez-Celaya
- Sociedad Española de Medicina de Familia y Comunitaria (AP) (SEMFyC), Madrid, España
| | - Carmen Suárez
- Sociedad Española de Medicina Interna (SEMI), Madrid, España
| | - Salvador Tranche
- Sociedad Española de Medicina de Familia y Comunitaria (AP) (SEMFyC), Madrid, España
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219
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Documento de consenso para la detección y manejo de la enfermedad renal crónica. HIPERTENSION Y RIESGO VASCULAR 2014. [DOI: 10.1016/j.hipert.2014.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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220
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Wen CP, Matsushita K, Coresh J, Iseki K, Islam M, Katz R, McClellan W, Peralta CA, Wang H, de Zeeuw D, Astor BC, Gansevoort RT, Levey AS, Levin A. Relative risks of chronic kidney disease for mortality and end-stage renal disease across races are similar. Kidney Int 2014; 86:819-27. [PMID: 24522492 PMCID: PMC4048178 DOI: 10.1038/ki.2013.553] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 10/23/2013] [Accepted: 11/21/2013] [Indexed: 02/08/2023]
Abstract
Some suggest race-specific cutpoints for kidney measures to define and stage chronic kidney disease (CKD), but evidence for race-specific clinical impact is limited. To address this issue, we compared hazard ratios of estimated glomerular filtration rates (eGFR) and albuminuria across races using meta-regression in 1.1 million adults (75% Asians, 21% Whites, and 4% Blacks) from 45 cohorts. Results came mainly from 25 general population cohorts comprising 0.9 million individuals. The associations of lower eGFR and higher albuminuria with mortality and end-stage renal disease (ESRD) were largely similar across races. For example, in Asians, Whites, and Blacks, the adjusted hazard ratios (95% confidence interval) for eGFR 45-59 versus 90-104 ml/min per 1.73 m(2) were 1.3 (1.2-1.3), 1.1 (1.0-1.2), and 1.3 (1.1-1.7) for all-cause mortality, 1.6 (1.5-1.7), 1.4 (1.2-1.7), and 1.4 (0.7-2.9) for cardiovascular mortality, and 27.6 (11.1-68.7), 11.2 (6.0-20.9), and 4.1 (2.2-7.5) for ESRD, respectively. The corresponding hazard ratios for urine albumin-to-creatinine ratio 30-299 mg/g or dipstick 1+ versus an albumin-to-creatinine ratio under 10 or dipstick negative were 1.6 (1.4-1.8), 1.7 (1.5-1.9), and 1.8 (1.7-2.1) for all-cause mortality, 1.7 (1.4-2.0), 1.8 (1.5-2.1), and 2.8 (2.2-3.6) for cardiovascular mortality, and 7.4 (2.0-27.6), 4.0 (2.8-5.9), and 5.6 (3.4-9.2) for ESRD, respectively. Thus, the relative mortality or ESRD risks of lower eGFR and higher albuminuria were largely similar among three major races, supporting similar clinical approach to CKD definition and staging, across races.
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Affiliation(s)
- Chi-Pang Wen
- Institute of Population Science, National Health Research Institutes, Zhunan, Taiwan
- China Medical University Hospital, Taichung, Taiwan
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kunitoshi Iseki
- Dialysis Unit, University Hospital of The Ryukyus, Nishihara, Okinawa, Japan
| | - Muhammad Islam
- Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan
| | - Ronit Katz
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - William McClellan
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Carmen A Peralta
- Division of Nephrology, University of California, San Francisco, California, USA
| | - HaiYan Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
| | - Dick de Zeeuw
- Department of Clinical Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Brad C Astor
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Ron T Gansevoort
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Andrew S Levey
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Adeera Levin
- Division of Nephrology UBC, St. Pauls Hospital, Vancouver, British Columbia, Canada
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221
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Saheb Sharif-Askari F, Syed Sulaiman SA, Saheb Sharif-Askari N, Al Sayed Hussain A, Railey MJ. Adverse outcomes of anticoagulant use among hospitalized patients with chronic kidney disease: a comparison of the rates of major bleeding events between unfractionated heparin and enoxaparin. PLoS One 2014; 9:e106517. [PMID: 25181525 PMCID: PMC4152258 DOI: 10.1371/journal.pone.0106517] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 07/30/2014] [Indexed: 12/29/2022] Open
Abstract
Background Anticoagulation therapy is usually required in patients with chronic kidney disease (CKD) for treatment or prevention of thromboembolic diseases. However, this benefit could easily be offset by the risk of bleeding. Objectives To determine the incidence of adverse outcomes of anticoagulants in hospitalized patients with CKD, and to compare the rates of major bleeding events between the unfractionated heparin (UFH) and enoxaparin users. Methods One year prospective observational study was conducted in patients with CKD stages 3 to 5 (estimated GFR, 10–59 ml/min/1.73 m2) who were admitted to the renal unit of Dubai Hospital. Propensity scores for the use of anticoagulants, estimated for each of the 488 patients, were used to identify a cohort of 117 pairs of patients. Cox regression method was used to estimate association between anticoagulant use and adverse outcomes. Results Major bleeding occurred in 1 in 3 patients who received anticoagulation during hospitalization (hazard ratio [HR], 4.61 [95% confidence interval [CI], 2.05–10.35]). Compared with enoxaparin users, patients who received anticoagulation with unfractionated heparin had a lower mean [SD] serum level of platelet counts (139.95 [113]×103/µL vs 205.56 [123] ×103/µL; P<0.001), and had a higher risk of major bleeding (HR, 4.79 [95% CI, 1.85–12.36]). Furthermore, compared with those who did not receive anticoagulants, patients who did had a higher in-hospital mortality (HR, 2.54 [95% CI, 1.03–6.25]); longer length of hospitalization (HR, 1.04 [95% CI, 1.01–1.06]); and higher hospital readmission at 30 days (HR, 1.79 [95% CI, 1.10–2.91]). Conclusions Anticoagulation among hospitalized patients with CKD was significantly associated with an increased risk of bleeding and in-hospital mortality. Hence, intensive monitoring and preventive measures such as laboratory monitoring and/or dose adjustment are warranted.
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222
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Schernthaner G, Mogensen CE, Schernthaner GH. The effects of GLP-1 analogues, DPP-4 inhibitors and SGLT2 inhibitors on the renal system. Diab Vasc Dis Res 2014; 11:306-23. [PMID: 25116004 PMCID: PMC4230539 DOI: 10.1177/1479164114542802] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Diabetic nephropathy (DN) affects an estimated 20%-40% of patients with type 2 diabetes mellitus (T2DM). Key modifiable risk factors for DN are albuminuria, anaemia, dyslipidaemia, hyperglycaemia and hypertension, together with lifestyle factors, such as smoking and obesity. Early detection and treatment of these risk factors can prevent DN or slow its progression, and may even induce remission in some patients. DN is generally preceded by albuminuria, which frequently remains elevated despite treatment in patients with T2DM. Optimal treatment and prevention of DN may require an early, intensive, multifactorial approach, tailored to simultaneously target all modifiable risk factors. Regular monitoring of renal function, including urinary albumin excretion, creatinine clearance and glomerular filtration rate, is critical for following any disease progression and making treatment adjustments. Dipeptidyl peptidase (DPP)-4 inhibitors and sodium-glucose cotransporter 2 (SGLT2) inhibitors lower blood glucose levels without additional risk of hypoglycaemia, and may also reduce albuminuria. Further investigation of the potential renal benefits of DPP-4 and SGLT2 inhibitors is underway.
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Affiliation(s)
| | - Carl Erik Mogensen
- Medical Department M (Diabetes & Endocrinology), Aarhus University Hospital, Aarhus, Denmark
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223
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Padullés A, Rama I, Llaudó I, Lloberas N. Developments in renal pharmacogenomics and applications in chronic kidney disease. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2014; 7:251-66. [PMID: 25206311 PMCID: PMC4157401 DOI: 10.2147/pgpm.s52763] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Chronic kidney disease (CKD) has shown an increasing prevalence in the last century. CKD encompasses a poor prognosis related to a remarkable number of comorbidities, and many patients suffer from this disease progression. Once the factors linked with CKD evolution are distinguished, it will be possible to provide and enhance a more intensive treatment to high-risk patients. In this review, we focus on the emerging markers that might be predictive or related to CKD progression physiopathology as well as those related to a different pattern of response to treatment, such as inhibitors of the renin–angiotensin system (including angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers; the vitamin D receptor agonist; salt sensitivity hypertension; and progressive kidney-disease markers with identified genetic polymorphisms). Candidate-gene association studies and genome-wide association studies have analyzed the genetic basis for common renal diseases, including CKD and related factors such as diabetes and hypertension. This review will, in brief, consider genotype-based pharmacotherapy, risk prediction, drug target recognition, and personalized treatments, and will mainly focus on findings in CKD patients. An improved understanding will smooth the progress of switching from classical clinical medicine to gene-based medicine.
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Affiliation(s)
- Ariadna Padullés
- Pharmacy Department, IDIBELL-Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Inés Rama
- Nephrology Department, IDIBELL-Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Inés Llaudó
- Nephrology Department, IDIBELL-Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Núria Lloberas
- Nephrology Department, IDIBELL-Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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The need for improved identification and accurate classification of stages 3-5 Chronic Kidney Disease in primary care: retrospective cohort study. PLoS One 2014; 9:e100831. [PMID: 25115813 PMCID: PMC4130474 DOI: 10.1371/journal.pone.0100831] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 05/30/2014] [Indexed: 11/30/2022] Open
Abstract
Background Around ten percent of the population have been reported as having Chronic Kidney Disease (CKD), which is associated with increased cardiovascular mortality. Few previous studies have ascertained the chronicity of CKD. In the UK, a payment for performance (P4P) initiative incentivizes CKD (stages 3–5) recognition and management in primary care, but the impact of this has not been assessed. Methods and Findings Using data from 426 primary care practices (population 2,707,130), the age standardised prevalence of stages 3–5 CKD was identified using two consecutive estimated Glomerular Filtration Rates (eGFRs) seven days apart. Additionally the accuracy of practice CKD registers and the relationship between accurate identification of CKD and the achievement of P4P indicators was determined. Between 2005 and 2009, the prevalence of stages 3–5 CKD increased from 0.3% to 3.9%. In 2009, 30,440 patients (1.1% unadjusted) fulfilled biochemical criteria for CKD but were not on a practice CKD register (uncoded CKD) and 60,705 patients (2.2% unadjusted) were included on a practice CKD register but did not fulfil biochemical criteria (miscoded CKD). For patients with confirmed CKD, inclusion in a practice register was associated with increasing age, male sex, diabetes, hypertension, cardiovascular disease and increasing CKD stage (p<0.0001). Uncoded CKD patients compared to miscoded patients were less likely to achieve performance indicators for blood pressure (OR 0.84, 95% CI 0.82–0.86 p<0.001) or recorded albumin-creatinine ratio (OR 0.73, 0.70–0.76, p<0.001). Conclusions The prevalence of stages 3–5 CKD, using two laboratory reported eGFRs, was lower than estimates from previous studies. Clinically significant discrepancies were identified between biochemically defined CKD and appearance on practice registers, with misclassification associated with sub-optimal care for some people with CKD.
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Haruyama N, Fujisaki K, Yamato M, Eriguchi M, Noguchi H, Torisu K, Tsuruya K, Kitazono T. Improvement in spatial memory dysfunction by telmisartan through reduction of brain angiotensin II and oxidative stress in experimental uremic mice. Life Sci 2014; 113:55-9. [PMID: 25107329 DOI: 10.1016/j.lfs.2014.07.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 07/19/2014] [Accepted: 07/23/2014] [Indexed: 11/17/2022]
Abstract
AIMS We previously reported that chronic uremia induces spatial working memory dysfunction in mice, and that it is attributed to cerebral oxidative stress. The source of oxidative stress was considered to be uremic toxins, but this remains unclear. In the present study, we examined whether the brain renin-angiotensin system was activated in the CKD mouse model, and whether it contributed to cognitive impairment. MAIN METHODS CKD was induced in 8-week-old male mice by 5/6 nephrectomy. Mice were divided into four groups: control mice administered tap water (Cont-V), control mice treated with 0.5mg/kg/day telmisartan, an angiotensin II (AII) receptor blocker, for 8 weeks (Cont-T), CKD mice administered tap water (CKD-V), and CKD mice treated with 0.5 mg/kg/day telmisartan for 8 weeks (CKD-T). After the treatment period, a radial arm water maze (RAWM) test was performed, and angiotensin II (AII) concentrations and markers of oxidative stress were measured in the brains of mice. KEY FINDINGS Errors in the RAWM test were more frequent in the CKD-V group than in the Cont-V group. In addition, errors in the CKD-T group were comparable to control mice. Tissue brain AII concentrations were greater in the CKD-V group compared with the other groups. Oxidative DNA damage and lipid peroxidation in the brain were also greater in the CKD-V group compared with the other groups. SIGNIFICANCE Our results suggest that brain AII levels were exaggerated in CKD mice, and that this contributes to cognitive impairment through oxidative stress.
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Affiliation(s)
- Naoki Haruyama
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kiichiro Fujisaki
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mayumi Yamato
- Department of REDOX Medicinal Science, Faculty of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahiro Eriguchi
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hideko Noguchi
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kumiko Torisu
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuhiko Tsuruya
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Toyoda K, Ninomiya T. Stroke and cerebrovascular diseases in patients with chronic kidney disease. Lancet Neurol 2014; 13:823-33. [DOI: 10.1016/s1474-4422(14)70026-2] [Citation(s) in RCA: 176] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Stengel B, Combe C, Jacquelinet C, Briançon S, Fouque D, Laville M, Frimat L, Pascal C, Herpe YE, Deleuze JF, Schanstra J, Pisoni RL, Robinson BM, Massy ZA. The French Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort study. Nephrol Dial Transplant 2014; 29:1500-7. [PMID: 24064325 PMCID: PMC4106639 DOI: 10.1093/ndt/gft388] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 08/05/2013] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND While much has been learned about the epidemiology and treatment of end-stage renal disease (ESRD) in the last 30 years, chronic kidney disease (CKD) before the end-stage has been less investigated. Not enough is known about factors associated with CKD progression and complications, as well as its transition to ESRD. We designed the CKD-renal epidemiology and information network (REIN) cohort to provide a research platform to address these key questions and to assess clinical practices and costs in patients with moderate or advanced CKD. METHODS A total of 46 clinic sites and 4 renal care networks participate in the cohort. A stratified selection of clinic sites yields a sample that represents a diversity of settings, e.g. geographic region, and public versus for-profit and non-for-profit private clinics. In each site, 60-90 patients with CKD are enrolled at a routine clinic visit during a 12-month enrolment phase: 3600 total, including 1800 with Stage 3 and 1800 with Stage 4 CKD. Follow-up will continue for 5 years, including after initiation of renal replacement therapy. Data will be collected from medical records at inclusion and at yearly intervals, as well as from self-administered patient questionnaires and provider-level questionnaires. Patients will also be interviewed at baseline, and at 1, 3 and 5 years. Healthcare costs will also be determined. Blood and urine samples will be collected and stored for future studies on all patients at enrolment and at study end, and at 1 and 3 years in a subsample of 1200. CONCLUSIONS The CKD-REIN cohort will serve to improve our understanding of the biological, clinical and healthcare system determinants associated with CKD progression and adverse outcomes as well as of international variations in collaboration with the CKD Outcome and Practice Pattern Study (CKDopps). It will foster CKD epidemiology and outcomes research and provide evidence to improve the health and quality of life of patients with CKD and the performances of the healthcare system in this field.
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Affiliation(s)
- Bénédicte Stengel
- Inserm, U1018, CESP Centre for Research in Epidemiology and Population Health, Team 10, Diabetes, Obesity, and Chronic Kidney Disease Epidemiology Team, Villejuif, France
- Paris Sud Univ, UMRS 1018, Villejuif, France
| | - Christian Combe
- Department of Nephrology Transplantation Dialysis, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Inserm, U1026, Univ Bordeaux Segalen, Bordeaux, France
| | | | - Serge Briançon
- Clinical Epidemiology, Inserm CIC-EC, CHU de Nancy, Vandoeuvre-lès-Nancy, France
| | - Denis Fouque
- Nephrology Department, Centre Hospitalier LYON-SUD, Pierre-Bénite, France
- CarMeN, CENS and Univ Lyon, Lyon, France
| | - Maurice Laville
- Nephrology Department, Centre Hospitalier LYON-SUD, Pierre-Bénite, France
- CarMeN, CENS and Univ Lyon, Lyon, France
| | - Luc Frimat
- Clinical Epidemiology, Inserm CIC-EC, CHU de Nancy, Vandoeuvre-lès-Nancy, France
- Nephrology Department, CHU de Nancy, Vandoeuvre-lès-Nancy
| | - Christophe Pascal
- Jean Moulin Lyon 3 University, The Institute for Education and Research in Health Care and Social Service, Lyon, France
| | - Yves-Edouard Herpe
- Biobanque de Picardie, Amiens, France
- Centre Hospitalier Universitaire, Amiens, France
| | | | - Joost Schanstra
- Institute of Cardiovascular and Metabolic Disease, Inserm U1048, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Ron L. Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | - Ziad A. Massy
- Centre Hospitalier Universitaire, Amiens, France
- Inserm U1088, Amiens University Hospital, Amiens, France
- Nephrology Department, CHU Ambroise Pare, Boulogne, France
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Chen F, Yang W, Weng J, Jia W, Ji L, Xiao J, Shan Z, Liu J, Tian H, Ji Q, Zhu D, Ge J, Lin L, Chen L, Guo X, Zhao Z, Li Q, Zhou Z, Shan G, Lu J. Albuminuria: Prevalence, associated risk factors and relationship with cardiovascular disease. J Diabetes Investig 2014; 5:464-71. [PMID: 25411608 PMCID: PMC4210073 DOI: 10.1111/jdi.12172] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 09/20/2013] [Accepted: 09/25/2013] [Indexed: 02/05/2023] Open
Abstract
AIMS/INTRODUCTION To investigate the prevalence and associated risk factors of microalbuminuria, and to explore the relationship between albuminuria and cardiovascular disease (CVD). MATERIALS AND METHODS A nationally representative sample of 38,203 Chinese participants was categorized by different levels of urinary albumin-to-creatinine ratio (ACR; 0 -10 mg/g, 10 -20 mg/g, 20 -30 mg/g, 30 -300 mg/g). The prevalence of albuminuria was compared by using a single urinary ACR cut-off point and by sex-specific ACR cut-off points. Factors associated with the presence of albuminuria, and the relationship between albuminuria and CVD were analyzed by logistic regression. RESULTS Prevalence of albuminuria as measured by a single ACR cut-point was significantly lower for men compared with women (13.9% vs 19.1% in the normal glucose tolerance group; 20.8% vs 26.8% in the impaired glucose tolerance group, P < 0.01). The prevalence of albuminuria, as measured by sex-specific ACR cut-points, was higher for men than women (31.4% vs 29.6% in the normal glucose tolerance group; 42.2% vs 39.3% in the impaired glucose tolerance group, P < 0.01). The independent risk factors for the presence of albuminuria were aging, female sex, hypertension, hyperglycemia, obesity, dyslipidemia, insulin resistance and metabolic syndrome. The subdivided normal ACR group did not show a linear or statistically significant relationship with CVD after adjusting for conventional CVD risk factors (P > 0.05). CONCLUSIONS The prevalence of albuminuria was high in the general Chinese population. Aging, female sex, hypertension, hyperglycemia, dyslipidemia, insulin resistance, obesity and metabolic syndrome were all independent risk factors for albuminuria. The causal relationship between ACR and CVD might require further follow-up investigation.
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Affiliation(s)
- Fang Chen
- Department of Endocrinology and Metabolism Chinese PLA General Hospital Beijing China
| | | | - Jianping Weng
- Sun Yat-sen University Third Hospital Guangzhou China
| | - Weiping Jia
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China
| | - Linong Ji
- Peking University People's Hospital Beijing China
| | | | - Zhongyan Shan
- First Affiliated Hospital Chinese Medical University Shenyang Liaoning China
| | - Jie Liu
- Shanxi Province People's Hospital Taiyuan Shanxi China
| | - Haoming Tian
- West China Hospital, Sichuan University Chengdu Sichuan China
| | - Qiuhe Ji
- Xijing Hospital Fourth Military Medical University Xi'an Shaanxi China
| | - Dalong Zhu
- The Affiliated Drum Tower Hospital of Nanjing University Medical School Nanjing Jiangsu China
| | - Jiapu Ge
- Xinjiang Uygur Autonomous Region's Hospital Urmqi Xinjiang China
| | - Lixiang Lin
- Fujian Provincial Hospital Fuzhou Fujiang China
| | - Li Chen
- Qilu Hospital of Shandong University Jinan Shandong China
| | - Xiaohui Guo
- Peking University First Hospital Beijing China
| | - Zhigang Zhao
- Henan Province People's Hospital Zhengzhou Henan China
| | - Qiang Li
- Second Affiliated Hospital of Harbin Medical University Harbin Heilongjiang China
| | | | - Guangliang Shan
- Department of Epidemiology and Statistics Institute of Basic Medical Sciences Chinese Academy of Medical Sciences School of Basic Medicine Peking Union Medical College Beijing China
| | - Juming Lu
- Department of Endocrinology and Metabolism Chinese PLA General Hospital Beijing China
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Kumar R, Jhorawat R, Mathur M, Garsa RK, Kimmatkar PD, Sharma S, Singh A, Beniwal P, Malhotra V. Effect of renal transplantation on multiple hormone levels in patients of chronic kidney disease: A single center study. INDIAN JOURNAL OF TRANSPLANTATION 2014. [DOI: 10.1016/j.ijt.2014.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Qian Y, Ren H, Wang ZH, Li X, Chen XN, Chen N. Staging and risk factors of chronic kidney disease of outpatients in Shanghai. Ren Fail 2014; 36:1018-22. [PMID: 24940809 DOI: 10.3109/0886022x.2014.926923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We conducted a survey to determine the stages distribution of chronic kidney disease (CKD) using estimated glomerular filtration rate (eGFR) Study Equation and evaluate the risk factors for these patients. METHODS All participants completed a questionnaire documenting their social demographic status, personal and family medical history and lifestyle behaviors. Blood and urine samples were collected for laboratory testing. The Chi-square test/analysis of variance and multiple/logistic regression were applied for data analysis. There were 530 CKD patients enrolled in this survey. RESULTS The Chi-square analysis showed that there was significant difference among different CKD stages in age, gender, BMI (body mass index), medical insurance and education status. Five factors (age, gender, BMI, hypertension, and hyperuricemia) were associated with decreased kidney function (eGFR<60 mL/min/1.73 m(2)). Five factors (age ≥ 65 years, hypertension, proteinuria, hematuria, and hyperuricemia) were associated with abnormal kidney function (eGFR<90 mL/min/1.73 m(2)). Three factors (low education status, hypertension, and proteinuria) were associated with kidney failure (eGFR<15 mL/min/1.73 m(2)). CONCLUSIONS Older patients, female with higher BMI, proteinuria and hyperuricemia, complicating with hypertension and diabetes tend to be easier for CKD progression. However, patients with higher education have the lower risk of progressing to end-stage renal disease.
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Affiliation(s)
- Ying Qian
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
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Seidowsky A, Massy ZA, Metzger M, Stengel B. Hypertension résistante et maladie rénale chronique : épidémiologie et pronostic. Nephrol Ther 2014; 10:137-44. [DOI: 10.1016/j.nephro.2013.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 12/20/2013] [Accepted: 12/30/2013] [Indexed: 11/30/2022]
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Mahmoodi BK, Yatsuya H, Matsushita K, Sang Y, Gottesman RF, Astor BC, Woodward M, Longstreth WT, Psaty BM, Shlipak MG, Folsom AR, Gansevoort RT, Coresh J. Association of kidney disease measures with ischemic versus hemorrhagic strokes: pooled analyses of 4 prospective community-based cohorts. Stroke 2014; 45:1925-31. [PMID: 24876078 DOI: 10.1161/strokeaha.114.004900] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Although low glomerular filtration rate (GFR) and albuminuria are associated with increased risk of stroke, few studies compared their contribution to risk of ischemic versus hemorrhagic stroke separately. We contrasted the association of these kidney measures with ischemic versus hemorrhagic stroke. METHODS We pooled individual participant data from 4 community-based cohorts: 3 from the United States and 1 from The Netherlands. GFR was estimated using both creatinine and cystatin C, and albuminuria was quantified by urinary albumin-to-creatinine ratio (ACR). Associations of estimated GFR and ACR were compared for each stroke type (ischemic versus intraparenchymal hemorrhagic) using study-stratified Cox regression. RESULTS Among 29,595 participants (mean age, 61 [SD 12.5] years; 46% men; 17% black), 1261 developed stroke (12% hemorrhagic) during 280,549 person-years. Low estimated GFR was significantly associated with increased risk of ischemic stroke, but not hemorrhagic stroke, whereas high ACR was associated with both stroke types. Adjusted hazard ratios for ischemic and hemorrhagic stroke at estimated GFR of 45 (versus 95) mL/min per 1.73 m2 were 1.30 (95% confidence interval, 1.01-1.68) and 0.92 (0.47-1.81), respectively. In contrast, the corresponding hazard ratios for ACR of 300 (versus 5) mg/g were 1.62 (1.27-2.07) for ischemic and 2.57 (1.37-4.83) for hemorrhagic stroke, with significantly stronger association with hemorrhagic stroke (P=0.04). For hemorrhagic stroke, the association of elevated ACR was of similar magnitude as that of elevated systolic blood pressure. CONCLUSIONS Whereas albuminuria showed significant association with both stroke types, the association of decreased estimated GFR was only significant for ischemic stroke. The strong association of albuminuria with both stroke types warrants clinical attention and further investigations.
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Affiliation(s)
- Bakhtawar K Mahmoodi
- From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (B.K.M., K.M., Y.S., M.W., J.C.); Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (B.K.M., R.T.G.); Department of Public Health, Fujita Health University, Toyoake, Japan (H.Y.); Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD (R.F.G.); Department of Medicine and Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison (B.C.A.); George Institute, University of Sydney, Sydney, New South Wales, Australia (M.W.); Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology and Health Service, University of Washington and Group Health Research Institute, Group Health Cooperative, Seattle (B.M.P.); Division of General Internal Medicine, San Francisco VA Medical Center, University of California San Francisco (M.G.S.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.R.F.)
| | - Hiroshi Yatsuya
- From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (B.K.M., K.M., Y.S., M.W., J.C.); Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (B.K.M., R.T.G.); Department of Public Health, Fujita Health University, Toyoake, Japan (H.Y.); Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD (R.F.G.); Department of Medicine and Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison (B.C.A.); George Institute, University of Sydney, Sydney, New South Wales, Australia (M.W.); Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology and Health Service, University of Washington and Group Health Research Institute, Group Health Cooperative, Seattle (B.M.P.); Division of General Internal Medicine, San Francisco VA Medical Center, University of California San Francisco (M.G.S.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.R.F.)
| | - Kunihiro Matsushita
- From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (B.K.M., K.M., Y.S., M.W., J.C.); Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (B.K.M., R.T.G.); Department of Public Health, Fujita Health University, Toyoake, Japan (H.Y.); Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD (R.F.G.); Department of Medicine and Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison (B.C.A.); George Institute, University of Sydney, Sydney, New South Wales, Australia (M.W.); Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology and Health Service, University of Washington and Group Health Research Institute, Group Health Cooperative, Seattle (B.M.P.); Division of General Internal Medicine, San Francisco VA Medical Center, University of California San Francisco (M.G.S.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.R.F.)
| | - Yinying Sang
- From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (B.K.M., K.M., Y.S., M.W., J.C.); Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (B.K.M., R.T.G.); Department of Public Health, Fujita Health University, Toyoake, Japan (H.Y.); Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD (R.F.G.); Department of Medicine and Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison (B.C.A.); George Institute, University of Sydney, Sydney, New South Wales, Australia (M.W.); Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology and Health Service, University of Washington and Group Health Research Institute, Group Health Cooperative, Seattle (B.M.P.); Division of General Internal Medicine, San Francisco VA Medical Center, University of California San Francisco (M.G.S.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.R.F.)
| | - Rebecca F Gottesman
- From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (B.K.M., K.M., Y.S., M.W., J.C.); Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (B.K.M., R.T.G.); Department of Public Health, Fujita Health University, Toyoake, Japan (H.Y.); Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD (R.F.G.); Department of Medicine and Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison (B.C.A.); George Institute, University of Sydney, Sydney, New South Wales, Australia (M.W.); Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology and Health Service, University of Washington and Group Health Research Institute, Group Health Cooperative, Seattle (B.M.P.); Division of General Internal Medicine, San Francisco VA Medical Center, University of California San Francisco (M.G.S.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.R.F.)
| | - Brad C Astor
- From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (B.K.M., K.M., Y.S., M.W., J.C.); Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (B.K.M., R.T.G.); Department of Public Health, Fujita Health University, Toyoake, Japan (H.Y.); Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD (R.F.G.); Department of Medicine and Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison (B.C.A.); George Institute, University of Sydney, Sydney, New South Wales, Australia (M.W.); Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology and Health Service, University of Washington and Group Health Research Institute, Group Health Cooperative, Seattle (B.M.P.); Division of General Internal Medicine, San Francisco VA Medical Center, University of California San Francisco (M.G.S.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.R.F.)
| | - Mark Woodward
- From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (B.K.M., K.M., Y.S., M.W., J.C.); Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (B.K.M., R.T.G.); Department of Public Health, Fujita Health University, Toyoake, Japan (H.Y.); Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD (R.F.G.); Department of Medicine and Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison (B.C.A.); George Institute, University of Sydney, Sydney, New South Wales, Australia (M.W.); Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology and Health Service, University of Washington and Group Health Research Institute, Group Health Cooperative, Seattle (B.M.P.); Division of General Internal Medicine, San Francisco VA Medical Center, University of California San Francisco (M.G.S.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.R.F.)
| | - W T Longstreth
- From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (B.K.M., K.M., Y.S., M.W., J.C.); Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (B.K.M., R.T.G.); Department of Public Health, Fujita Health University, Toyoake, Japan (H.Y.); Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD (R.F.G.); Department of Medicine and Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison (B.C.A.); George Institute, University of Sydney, Sydney, New South Wales, Australia (M.W.); Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology and Health Service, University of Washington and Group Health Research Institute, Group Health Cooperative, Seattle (B.M.P.); Division of General Internal Medicine, San Francisco VA Medical Center, University of California San Francisco (M.G.S.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.R.F.)
| | - Bruce M Psaty
- From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (B.K.M., K.M., Y.S., M.W., J.C.); Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (B.K.M., R.T.G.); Department of Public Health, Fujita Health University, Toyoake, Japan (H.Y.); Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD (R.F.G.); Department of Medicine and Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison (B.C.A.); George Institute, University of Sydney, Sydney, New South Wales, Australia (M.W.); Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology and Health Service, University of Washington and Group Health Research Institute, Group Health Cooperative, Seattle (B.M.P.); Division of General Internal Medicine, San Francisco VA Medical Center, University of California San Francisco (M.G.S.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.R.F.)
| | - Michael G Shlipak
- From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (B.K.M., K.M., Y.S., M.W., J.C.); Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (B.K.M., R.T.G.); Department of Public Health, Fujita Health University, Toyoake, Japan (H.Y.); Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD (R.F.G.); Department of Medicine and Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison (B.C.A.); George Institute, University of Sydney, Sydney, New South Wales, Australia (M.W.); Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology and Health Service, University of Washington and Group Health Research Institute, Group Health Cooperative, Seattle (B.M.P.); Division of General Internal Medicine, San Francisco VA Medical Center, University of California San Francisco (M.G.S.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.R.F.)
| | - Aaron R Folsom
- From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (B.K.M., K.M., Y.S., M.W., J.C.); Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (B.K.M., R.T.G.); Department of Public Health, Fujita Health University, Toyoake, Japan (H.Y.); Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD (R.F.G.); Department of Medicine and Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison (B.C.A.); George Institute, University of Sydney, Sydney, New South Wales, Australia (M.W.); Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology and Health Service, University of Washington and Group Health Research Institute, Group Health Cooperative, Seattle (B.M.P.); Division of General Internal Medicine, San Francisco VA Medical Center, University of California San Francisco (M.G.S.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.R.F.)
| | - Ron T Gansevoort
- From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (B.K.M., K.M., Y.S., M.W., J.C.); Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (B.K.M., R.T.G.); Department of Public Health, Fujita Health University, Toyoake, Japan (H.Y.); Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD (R.F.G.); Department of Medicine and Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison (B.C.A.); George Institute, University of Sydney, Sydney, New South Wales, Australia (M.W.); Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology and Health Service, University of Washington and Group Health Research Institute, Group Health Cooperative, Seattle (B.M.P.); Division of General Internal Medicine, San Francisco VA Medical Center, University of California San Francisco (M.G.S.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.R.F.)
| | - Josef Coresh
- From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (B.K.M., K.M., Y.S., M.W., J.C.); Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (B.K.M., R.T.G.); Department of Public Health, Fujita Health University, Toyoake, Japan (H.Y.); Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD (R.F.G.); Department of Medicine and Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison (B.C.A.); George Institute, University of Sydney, Sydney, New South Wales, Australia (M.W.); Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology and Health Service, University of Washington and Group Health Research Institute, Group Health Cooperative, Seattle (B.M.P.); Division of General Internal Medicine, San Francisco VA Medical Center, University of California San Francisco (M.G.S.); and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (A.R.F.).
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234
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Picq C, Asplanato M, Bernillon N, Fabre C, Roubeix M, Ricort JM. Effects of water soaking and/or sodium polystyrene sulfonate addition on potassium content of foods. Int J Food Sci Nutr 2014; 65:673-7. [PMID: 24720622 DOI: 10.3109/09637486.2014.908172] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In this study, we determined, by atomic absorption spectrophotometry, the potassium amount leached by soaking or boiling foods identified by children suffering from chronic renal failure as "pleasure food" and that they cannot eat because of their low-potassium diet, and evaluated whether addition of sodium polystyrene sulfonate resin (i.e. Kayexalate®) during soaking or boiling modulated potassium loss. A significant amount of potassium content was removed by soaking (16% for chocolate and potato, 26% for apple, 37% for tomato and 41% for banana) or boiling in a large amount of water (73% for potato). Although Kayexalate® efficiently dose-dependently removed potassium from drinks (by 48% to 73%), resin addition during soaking or boiling did not eliminate more potassium from solid foods. Our results therefore provide useful information for dietitians who elaborate menus for people on potassium-restricted diets and would give an interesting alternative to the systematic elimination of all potassium-rich foods from their diet.
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235
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Ahn JH, Yu JH, Ko SH, Kwon HS, Kim DJ, Kim JH, Kim CS, Song KH, Won JC, Lim S, Choi SH, Han K, Cha BY, Kim NH. Prevalence and determinants of diabetic nephropathy in Korea: Korea national health and nutrition examination survey. Diabetes Metab J 2014; 38:109-19. [PMID: 24851205 PMCID: PMC4021298 DOI: 10.4093/dmj.2014.38.2.109] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 03/10/2014] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Diabetic nephropathy is a leading cause of end stage renal disease and is associated with an increased risk of cardiovascular mortality. It manifests as albuminuria or impaired glomerular filtration rate (GFR), and the prevalence of diabetic nephropathy varies with ethnicity. The prevalence of diabetic nephropathy and its determinants in Korean adults have not previously been studied at the national level. This cross-sectional study was undertaken to ascertain the prevalence and determinants of albuminuria and chronic kidney disease (CKD) in Korean patients with diabetes. METHODS The Korea National Health and Nutrition Examination Survey (KNHANES) V, conducted in 2011, was used to define albuminuria (n=4,652), and the dataset of KNHANES IV-V (2008-2011) was used to define CKD (n=21,521). Selected samples were weighted to represent the entire civilian population in Korea. Albuminuria was defined as a spot urine albumin/creatinine ratio >30 mg/g. CKD was defined as a GFR <60 mL/min/1.73 m(2). RESULTS Among subjects with diabetes, 26.7% had albuminuria, and 8.6% had CKD. Diabetes was associated with an approximate 2.5-fold increased risk of albuminuria, with virtually no difference between new-onset and previously diagnosed diabetes. Only systolic blood pressure was significantly associated with albuminuria, and old age, high serum triglyceride levels, and previous cardiovascular disease (CVD) were related with CKD in subjects with diabetes. CONCLUSION Korean subjects with diabetes had a higher prevalence of albuminuria and CKD than those without diabetes. Blood pressure was associated with albuminuria, and age, triglyceride level, and previous CVD were independent determinants of CKD in subjects with diabetes.
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Affiliation(s)
- Jae Hee Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Ansan, Korea
| | - Ji Hee Yu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Ansan, Korea
| | - Seung-Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hyuk-Sang Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chul Sik Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Kee-Ho Song
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jong Chul Won
- Department of Internal Medicine, Mitochondrial Research Group, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Soo Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sung Hee Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyungdo Han
- Department of Biostatistics, The Catholic University of Korea, Seoul, Korea
| | - Bong-Yun Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Nan Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Ansan, Korea
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236
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Goleg FA, Kong NCT, Sahathevan R. Dialysis-treated end-stage kidney disease in Libya: epidemiology and risk factors. Int Urol Nephrol 2014; 46:1581-7. [DOI: 10.1007/s11255-014-0694-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 03/17/2014] [Indexed: 11/29/2022]
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237
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Lopez-Vargas PA, Tong A, Sureshkumar P, Johnson DW, Craig JC. Prevention, detection and management of early chronic kidney disease: a systematic review of clinical practice guidelines. Nephrology (Carlton) 2014; 18:592-604. [PMID: 23815515 DOI: 10.1111/nep.12119] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2013] [Indexed: 11/27/2022]
Abstract
AIM In response to the increase in Chronic Kidney Disease (CKD) worldwide, several professional organizations have developed clinical practice guidelines to manage and prevent its progression. This study aims to compare the scope, content and consistency of published guidelines on CKD stages I-III. METHODS Electronic databases of the medical literature, guideline organizations, and the websites of nephrology societies were searched to November 2011. The Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument and textual synthesis was used to appraise and compare recommendations. RESULTS One consensus statement and 15 guidelines were identified and included. Methodological rigour across guidelines was variable, with average domain scores ranging from 24% to 95%. For detection of CKD, all guidelines recommended estimated glomerular filtration rate measurement, some also recommended serum creatinine and dipstick urinalysis. The recommended protein and albumin creatinine ratios and proteinuria definition thresholds varied (>150-300 mg/day to >500 mg/day). Blood pressure targets ranged (<125/75 to <140/90 mmHg). Angiotensin converting enzyme inhibitor and angiotensin receptor blockers were recommended for hypertension, as combined or as monotherapy. Protein intake recommendations varied (no restriction or 0.75 g/kg per day-1.0 g/kg per day). Salt intake of 6 g/day was recommended by most. Psychosocial support and education were recommended by few but specific strategies were absent. CONCLUSION CKD guidelines were consistent in scope but were variable with respect to their recommendations, coverage and methodological quality. To promote effective primary and secondary prevention of CKD, regularly updated guidelines that are based on the best available evidence and augmented with healthcare context-specific strategies for implementation are warranted.
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Affiliation(s)
- Pamela A Lopez-Vargas
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
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238
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Xie T, Yang Z, Dai G, Yan K, Tian Y, Zhao D, Zou H, Deng F, Chen X, Yuan Q. Evaluation of the oral health status in Chinese hemodialysis patients. Hemodial Int 2014; 18:668-73. [PMID: 24593805 DOI: 10.1111/hdi.12149] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Tian Xie
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu China
| | - Ziliang Yang
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu China
| | - Guanyu Dai
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu China
| | - Kaixiao Yan
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu China
| | - Yuan Tian
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu China
| | - Dan Zhao
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu China
| | - Huawei Zou
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu China
| | - Fei Deng
- Sichuan Academy of Medical Sciences; Sichuan Provincial People's Hospital; Chengdu China
| | - Xiaolei Chen
- Department of Nephrology; West China Hospital; Sichuan University; Chengdu China
| | - Quan Yuan
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu China
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239
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Anand S, Khanam MA, Saquib J, Saquib N, Ahmed T, Alam DS, Cullen MR, Barry M, Chertow GM. High prevalence of chronic kidney disease in a community survey of urban Bangladeshis: a cross-sectional study. Global Health 2014; 10:9. [PMID: 24555767 PMCID: PMC3944963 DOI: 10.1186/1744-8603-10-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 02/06/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The burden of chronic kidney disease (CKD) will rise in parallel with the growing prevalence of type two diabetes mellitus in South Asia but is understudied. Using a cross-sectional survey of adults living in a middle-income neighborhood of Dhaka, Bangladesh, we tested the hypothesis that the prevalence of CKD in this group would approach that of the U.S. and would be strongly associated with insulin resistance. METHODS We enrolled 402 eligible adults (>30 years old) after performing a multi-stage random selection procedure. We administered a questionnaire, and collected fasting serum samples and urine samples. We used the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation to estimate glomerular filtration rate, and sex-specific cut offs for albuminuria: > 1.9 mg/mmol (17 mg/g) for men, and >2.8 mg/mmol (25 mg/g) for women. We assessed health-related quality of life using the Medical Outcomes Study Short Form-12 (SF-12). RESULTS A total of 357 (89%) participants with serum samples comprised the analytic cohort. Mean age of was 49.5 (± 12.7) years. Chronic kidney disease was evident in 94 (26%). Of the participants with CKD, 58 (62%) had albuminuria only. A participant with insulin resistance had a 3.6-fold increase in odds of CKD (95% confidence interval 2.1 to 6.4). Participants with stage three or more advanced CKD reported a decrement in the Physical Health Composite score of the SF-12, compared with participants without CKD. CONCLUSION We found an alarmingly high prevalence of CKD--particularly CKD associated with insulin resistance-in middle-income, urban Bangladeshis.
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Affiliation(s)
- Shuchi Anand
- Stanford University School of Medicine, 291 Campus Dr, Stanford, CA 94305, USA
- Division of Nephrology, Stanford University School of Medicine, 777 Welch Road, Suite DE, Palo Alto, CA 94304, USA
| | - Masuma Akter Khanam
- International Center for Diarrheal Disease Research, 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh
- Centre of Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Australia
| | - Juliann Saquib
- Stanford University School of Medicine, 291 Campus Dr, Stanford, CA 94305, USA
| | - Nazmus Saquib
- Stanford University School of Medicine, 291 Campus Dr, Stanford, CA 94305, USA
| | - Tahmeed Ahmed
- International Center for Diarrheal Disease Research, 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh
| | - Dewan S Alam
- International Center for Diarrheal Disease Research, 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh
| | - Mark R Cullen
- Stanford University School of Medicine, 291 Campus Dr, Stanford, CA 94305, USA
| | - Michele Barry
- Stanford University School of Medicine, 291 Campus Dr, Stanford, CA 94305, USA
| | - Glenn M Chertow
- Stanford University School of Medicine, 291 Campus Dr, Stanford, CA 94305, USA
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240
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Pokroy-Shapira E, Gelernter I, Molad Y. Evolution of chronic kidney disease in patients with systemic lupus erythematosus over a long-period follow-up: a single-center inception cohort study. Clin Rheumatol 2014; 33:649-57. [PMID: 24535410 DOI: 10.1007/s10067-014-2527-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 12/15/2013] [Accepted: 02/05/2014] [Indexed: 12/15/2022]
Abstract
The objective is to investigate the accrual rate and risk factors of chronic kidney disease (CKD) in an inception cohort of patients with systemic lupus erythematosus (SLE) followed at a single tertiary center. A prospectively collected database of 256 consecutive patients with SLE followed over a 25-year period was systematically interrogated for demographic, disease manifestations, co-morbidities, and outcome. Standardized SLE activity and damage scores were determined for the first and last study visits, and estimated glomerular filtration rate (eGFR; MDRD formula) was calculated at the time of diagnosis and at each year of the follow-up. CKD was defined as eGFR <60 ml/min/1.73 m(2). Results were analyzed with univariate and multivariate models and Kaplan-Meier curves, as appropriate. The cohort was predominantly female (90 %) and Jewish (91.1 %). Mean age at diagnosis was 38 ± 15.5 years, mean SLE activity score 6.4 ± 3.8, mean disease duration 8.8 ± 6.6 years, and mean damage score 0.2 ± 0.6. Seventy-five patients (30.8 %) were diagnosed with American College of Rheumatology (ACR)-defined lupus renal disease during the study period. There was a progressive decrease in eGFR over time. The prevalence of CKD was 46.7 % in patients with ACR-defined renal lupus disease and 16.4 % in those without. The hazards ratio for CKD was significantly higher in patients with lupus nephritis (LN) than without (p < 0.001). Earlier CKD was positively associated with hypertension (p = 0.01), older age at diagnosis (p = 0.01), and LN (p < 0.001), and negatively associated with hydroxychloroquine treatment (p < 0.001). The prevalence of CKD increases cumulatively in patients with SLE, also in those without overt lupus renal disease. Lupus renal disease poses a significant hazard for earlier development of CKD, and hypertension is a major risk factor for patients with and without nephritis. Antimalarial treatment is associated with renal preservation only in patients with lupus nephritis.
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Affiliation(s)
- Elisheva Pokroy-Shapira
- Lupus Clinic, Rheumatology Unit, Beilinson Hospital, Rabin Medical Center, Beilinson Campus, Petach Tikva, 49100, Israel
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Pani A, Bragg-Gresham J, Masala M, Piras D, Atzeni A, Pilia MG, Ferreli L, Balaci L, Curreli N, Delitala A, Loi F, Abecasis GR, Schlessinger D, Cucca F. Prevalence of CKD and its relationship to eGFR-related genetic loci and clinical risk factors in the SardiNIA study cohort. J Am Soc Nephrol 2014; 25:1533-44. [PMID: 24511125 DOI: 10.1681/asn.2013060591] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The prevalence of CKD and of renal failure vary worldwide, yet parallel increases in leading risk factors explain only part of the differential prevalence. We measured CKD prevalence and eGFR, and their relationship with traditional and additional risk factors, in a Sardinian founder population cohort. The eGFR was calculated using equations from the CKD Epidemiology Collaboration and Modification of Diet in Renal Disease studies. With use of the Kidney Disease Improving Global Outcomes guidelines, a cross-sectional analysis of 4842 individuals showed that CKD prevalence was 15.1%, including 3.6% of patients in the high-risk and 0.46% in the very-high-risk categories. Longitudinal analyses performed on 4074 of these individuals who completed three visits with an average follow-up of 7 years revealed that, consistent with other populations, average eGFR slope was -0.79 ml/min per 1.73 m(2) per year, but 11.4% of the participants had an eGFR decline >2.3 ml/min per 1.73 m(2) per year (fast decline). A genetic score was generated from 13 reported eGFR- and CKD-related loci, and univariable and multivariable analyses were applied to assess the relationship between clinical, ultrasonographic, and genetic variables with three outcomes: CKD, change in eGFR, and fast eGFR decline. Genetic risk score, older age, and female sex independently correlated with each outcome. Diabetes was associated with CKD prevalence, whereas hypertension and hyperuricemia correlated more strongly with fast eGFR decline. Diabetes, hypertension, hyperuricemia, and high baseline eGFR were associated with a decline of eGFR. Along with differential health practices, population variations in this spectrum of risk factors probably contributes to the variable CKD prevalence worldwide.
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Affiliation(s)
- Antonello Pani
- Struttura complessa di Nefrologia e Dialisi, Azienda Ospedaliera "G. Brotzu", Cagliari, Italy;
| | | | - Marco Masala
- Istituto di Ricerca Genetica e Biomedica (IRGB), CNR, Monserrato, Italy
| | - Doloretta Piras
- Struttura complessa di Nefrologia e Dialisi, Azienda Ospedaliera "G. Brotzu", Cagliari, Italy
| | - Alice Atzeni
- Struttura complessa di Nefrologia e Dialisi, Azienda Ospedaliera "G. Brotzu", Cagliari, Italy
| | - Maria G Pilia
- Center ProgeNIA, Istituto di Ricerca Genetica e Biomedica (IRGB), CNR, Lanusei, Italy
| | - Liana Ferreli
- Center ProgeNIA, Istituto di Ricerca Genetica e Biomedica (IRGB), CNR, Lanusei, Italy
| | - Lenuta Balaci
- Center ProgeNIA, Istituto di Ricerca Genetica e Biomedica (IRGB), CNR, Lanusei, Italy
| | - Nicolò Curreli
- Center ProgeNIA, Istituto di Ricerca Genetica e Biomedica (IRGB), CNR, Lanusei, Italy
| | - Alessandro Delitala
- Center ProgeNIA, Istituto di Ricerca Genetica e Biomedica (IRGB), CNR, Lanusei, Italy
| | - Francesco Loi
- Center ProgeNIA, Istituto di Ricerca Genetica e Biomedica (IRGB), CNR, Lanusei, Italy
| | - Gonçalo R Abecasis
- Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan
| | - David Schlessinger
- Laboratory of Genetics, National Institute on Aging, Baltimore, Maryland; and
| | - Francesco Cucca
- Istituto di Ricerca Genetica e Biomedica (IRGB), CNR, Monserrato, Italy; Dipartimento di Scienze Biomediche, Università di Sassari, Sassari, Italy
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Carlsson AC, Larsson TE, Helmersson-Karlqvist J, Larsson A, Lind L, Ärnlöv J. Soluble TNF receptors and kidney dysfunction in the elderly. J Am Soc Nephrol 2014; 25:1313-20. [PMID: 24511129 DOI: 10.1681/asn.2013080860] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The importance of TNF-α and its soluble receptors (sTNFR1 and sTNFR2) in the development of kidney disease is being unraveled. Yet, community-based data regarding the role of sTNFRs are lacking. We assessed serum sTNFRs and aspects of kidney damage cross-sectionally in two independent community-based cohorts of elderly participants: Prospective Investigation of the Vasculature in Uppsala Seniors (n=815; mean age, 75 years; 51% women) and Uppsala Longitudinal Study of Adult Men (n=778; mean age, 78 years). Serum sTNFR1 correlated substantially with different aspects of kidney pathology in the Uppsala Longitudinal Study of Adult Men cohort (R=-0.52 for estimated GFR, R=0.22 for urinary albumin-to-creatinine ratio, and R=0.17 for urinary kidney injury molecule-1; P<0.001 for all), with similar correlations in the Prospective Investigation of the Vasculature in Uppsala Seniors cohort. These associations remained significant after adjustment for age, sex, inflammatory markers, and cardiovascular risk factors and were also evident in participants without diabetes. Serum sTNFR2 was associated with all three markers in the Prospective Investigation of the Vasculature in Uppsala Seniors cohort (P<0.001 for all). Our findings from two independent community-based cohorts confirm and extend results of previous studies supporting circulating sTNFRs as relevant biomarkers for kidney damage and dysfunction in elderly individuals, even in the absence of diabetes.
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Affiliation(s)
- Axel C Carlsson
- Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden;
| | - Tobias E Larsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | | | - Anders Larsson
- Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden; and
| | - Lars Lind
- Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden; and
| | - Johan Ärnlöv
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden; School of Health and Social Studies, Dalarna University, Falun, Sweden
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243
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Christensen AS, Møller JB, Hasselbalch HC. Chronic kidney disease in patients with the Philadelphia-negative chronic myeloproliferative neoplasms. Leuk Res 2014; 38:490-5. [PMID: 24630365 DOI: 10.1016/j.leukres.2014.01.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 01/17/2014] [Accepted: 01/28/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The progression of kidney function and frequency of chronic kidney disease (CKD) in patients with the Philadelphia-negative myeloproliferative neoplasms (MPN) is unknown, although CKD is linked to increased mortality. METHODS This longitudinal retrospective study evaluates the estimated glomerular filtration rate (eGFR) in 143 MPN patients over a period of 9 years. RESULTS 29% of patients had CKD stage 3 or 4 at time of diagnosis. 20% of patients had a rapid annual loss of eGFR (>3mL/min/1.73m(2)) and eGFR was negatively correlated to monocyte and neutrophil counts. CONCLUSION Kidney impairment might contribute to the increased mortality observed in MPN patients.
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Affiliation(s)
| | - Jonas Bech Møller
- Quantitative Clinical Pharmacology, Novo Nordisk A/S, Søborg, Denmark
| | - Hans Carl Hasselbalch
- Department of Hematology, Roskilde Hospital, University of Copenhagen, Roskilde, Denmark
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244
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de Jager DJ, Vervloet MG, Dekker FW. Noncardiovascular mortality in CKD: an epidemiological perspective. Nat Rev Nephrol 2014; 10:208-14. [DOI: 10.1038/nrneph.2014.8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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245
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Christensson A, Melander O, Fjellstedt E, Ohlson-Andersson M. Family history of myocardial infarction increases risk of renal dysfunction in middle age. Am J Nephrol 2014; 39:85-91. [PMID: 24481112 DOI: 10.1159/000358259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 12/20/2013] [Indexed: 01/13/2023]
Abstract
BACKGROUND/AIMS Chronic kidney disease (CKD) is common in the general population, may lead to end-stage renal disease, and is most frequently found among males. Familial clustering of kidney diseases has been observed. We aimed to study a potential association between the family history of myocardial infarction (MI) and renal dysfunction. METHODS 22,297 males and 10,828 females, aged 33-60 years, from a population-based cohort study were studied. Estimated glomerular filtration rate (eGFR) was assessed by the CKD-EPI creatinine equation. Every participant filled in a self-administered questionnaire including family history. Heredity for MI was defined as mother or father having had MI and/or died from MI, and/or brother or sister having had MI. Binary logistic regression and multiple linear regression were used in the analyses. RESULTS Multiple linear regression revealed a significantly increased risk of renal dysfunction in those with a positive heredity for MI (the whole cohort p = 0.01, males p = 0.000, females p = 0.169). Binary logistic regression showed that males with heredity for MI with a mean age of 43 years have a 2 times higher risk (p = 0.02) of belonging to the group with GFR <45 ml/min/1.73 m(2) compared to those without heredity. For the whole cohort the increased risk was 1.6 times (p = 0.07). There was no significant association for females (p = 0.88). CONCLUSION These findings demonstrate that a familial burden of MI is associated with renal dysfunction, in men, already in middle age. Genetic variants may underlie predisposition to CKD in those with heredity for MI.
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Affiliation(s)
- Anders Christensson
- Department of Nephrology and Transplantation, Skåne University Hospital, Lund University, Malmö, Sweden
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246
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Abstract
OBJECTIVES Whilst several antiretroviral drugs have been associated with moderate chronic kidney disease (CKD), their contribution to advanced CKD and end-stage renal disease (ESRD) remain unknown. DESIGN D:A:D participants with at least three estimated glomerular filtration rates (eGFR) after February 2004 were followed until the first of advanced CKD (confirmed eGFR ≤ 30 ml/min, ≥3 months apart), ESRD (dialysis ≥3 months/ transplantation), 6 months after last visit or February 2012. METHODS Poisson regression was used to assess risk factors for advanced CKD/ESRD including exposure to potential nephrotoxic antiretroviral drugs and antiretroviral drug discontinuation rates according to latest eGFR. RESULTS Among 35 192 persons contributing 200 119 person years of follow-up (PYFU), 135 (0.4%) developed advanced CKD (n = 114)/ESRD (n = 21); incidence rate = 0.67 [95% confidence interval (CI), 0.56-0.79]/1000 PYFU. Tenofovir (TDF) was particularly frequently discontinued as eGFR declined. After adjustment, those previously exposed but currently off TDF had similar advanced CKD/ESRD rate ratios compared with those unexposed [1.00 (95% CI, 0.66-1.51)], while those currently on TDF had reduced rates [0.23 (95% CI, 0.13-0.41)]. No consistent associations with other antiretroviral drugs were seen. Results were robust after time-lagging antiretroviral drug exposure, stratifying by baseline eGFR, and allowing for competing risks. Other predictors were diabetes, hypertension, baseline eGFR, smoking and current CD4 cell count. The incidence rate in nonsmokers with baseline eGFR > 60 and no diabetes or hypertension was 0.16 (95% CI 0.09-0.26)/1000 PYFU. CONCLUSION Neither current nor recent antiretroviral drug use predicted advanced CKD/ESRD during 6 years median follow-up in a large, heterogenenous and primarily white cohort. TDF discontinuation rates increased with decreasing eGFR, leaving a selected group still on TDF at lower advanced CKD/ESRD risk. Traditional renal risk factors and current CD4 cell count were the strongest advanced CKD/ESRD predictors.
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247
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Crews DC, Kuczmarski MF, Grubbs V, Hedgeman E, Shahinian VB, Evans MK, Zonderman AB, Burrows NR, Williams DE, Saran R, Powe NR. Effect of food insecurity on chronic kidney disease in lower-income Americans. Am J Nephrol 2014; 39:27-35. [PMID: 24434743 DOI: 10.1159/000357595] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 11/24/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND The relation of food insecurity (inability to acquire nutritionally adequate and safe foods) and chronic kidney disease (CKD) is unknown. We examined whether food insecurity is associated with prevalent CKD among lower-income individuals in both the general US adult population and an urban population. METHODS We conducted cross-sectional analyses of lower-income participants of the National Health and Nutrition Examination Survey (NHANES) 2003-2008 (n = 9,126) and the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study (n = 1,239). Food insecurity was defined based on questionnaires and CKD was defined by reduced estimated glomerular filtration rate or albuminuria; adjustment was performed with multivariable logistic regression. RESULTS In NHANES, the age-adjusted prevalence of CKD was 20.3, 17.6, and 15.7% for the high, marginal, and no food insecurity groups, respectively. Analyses adjusting for sociodemographics and smoking status revealed high food insecurity to be associated with greater odds of CKD only among participants with either diabetes (OR = 1.67, 95% CI: 1.14-2.45 comparing high to no food insecurity groups) or hypertension (OR = 1.37, 95% CI: 1.03-1.82). In HANDLS, the age-adjusted CKD prevalence was 5.9 and 4.6% for those with and without food insecurity, respectively (p = 0.33). Food insecurity was associated with a trend towards greater odds of CKD (OR = 1.46, 95% CI: 0.98-2.18) with no evidence of effect modification across diabetes, hypertension, or obesity subgroups. CONCLUSION Food insecurity may contribute to disparities in kidney disease, especially among persons with diabetes or hypertension, and is worthy of further study.
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Affiliation(s)
- Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Md., USA
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248
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Dhaun N, Bellamy CO, Cattran DC, Kluth DC. Utility of renal biopsy in the clinical management of renal disease. Kidney Int 2014; 85:1039-48. [PMID: 24402095 DOI: 10.1038/ki.2013.512] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 09/23/2013] [Accepted: 09/26/2013] [Indexed: 12/31/2022]
Abstract
Characterizing chronic kidney disease (CKD) at all stages is an essential part of rational management and the renal biopsy plays a key role in defining the processes involved. There remain no global guidelines available to the renal community on indications for this important diagnostic, prognostic, and relatively safe test. Although most nephrologists recognize several clear indications for a renal biopsy, it is still underutilized. It not only helps the clinician to manage the patient with CKD, but it can also help clarify the epidemiology of CKD, and aid research into the pathobiology of disease with the aim of discovering new therapies. It may be useful for instance in elderly patients with CKD, those with diabetes and presumed 'hypertensive nephropathy', and in some patients with advanced CKD as part of the pretransplant work-up. In some populations (for example, immunoglobulin A nephropathy and ANCA vasculitis), renal biopsy allows disease classification that may predict CKD progression and response to therapy. For the individual, interval renal biopsy may be of use in providing ongoing therapeutic and prognostic information. Molecular advances will change the landscape of renal pathology and add a new dimension to the diagnostic precision of kidney biopsy. Organizing the multiplicity of information available in a renal biopsy to maximize benefits to the patient, as well as to the epidemiologist and researcher, is one of the challenges that face the nephrology community.
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Affiliation(s)
- Neeraj Dhaun
- 1] BHF Centre of Research Excellence, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK [2] Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Daniel C Cattran
- University Health Network, Toronto General Hospital, Toronto, Canada
| | - David C Kluth
- Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
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249
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Heramb L, Hallan S, Aasarød K. Bruk av diuretika ved nyresykdom. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2014; 134:840-4. [DOI: 10.4045/tidsskr.13.0721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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250
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Bikbov B, Perico N, Remuzzi G. Mortality landscape in the global burden of diseases, injuries and risk factors study. Eur J Intern Med 2014; 25:1-5. [PMID: 24084027 DOI: 10.1016/j.ejim.2013.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 08/25/2013] [Accepted: 09/05/2013] [Indexed: 12/21/2022]
Abstract
The Global Burden of Diseases, Injuries and Risk Factors Study 2010 (GBD 2010) is an initiative that involved 486 scientists from 302 institutions in 50 countries, under the leadership of a consortium formed by the Institute for Health Metrics and Evaluation of the University of Washington, World Health Organization, the University of Queensland School of Population Health, the Harvard School of Public Health, the Johns Hopkins Bloomberg School of Public Health, the University of Tokyo and Imperial College London. The study has provided a state of the art understanding of the burden of 67 risk factors and their clusters, 291 diseases and injuries on global, regional and national levels in period from 1990 to 2010 for 187 countries. GBD 2010 estimates covered both mortality (expressed in number of deaths, years of life lost (YLL) due to premature mortality) and morbidity (mainly expressed as years lived with disability (YLD)), while the incidence and prevalence were not reported for majority of causes so far, although they were accounted and used for YLD calculations. Finally, each disease and risk factor was presented in terms of the disability-adjusted years of life (DALY) that is merely a sum of YLL and YLD. The major published results of GBD 2010 cover global and regional levels for all diseases and risk factors. Reports focused on specific conditions are also available. At country-level detailed estimates are published for UK, China and USA, and data on other countries are accessible only as aggregate partial representation via web-based tools.
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Affiliation(s)
- Boris Bikbov
- Chair of Nephrology, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation; Department of Nephrology Issues of Transplanted Kidney, Academician V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs, Moscow, Russian Federation; Moscow City Nephrology Center, Moscow City Hospital 52, Moscow, Russian Federation.
| | - Norberto Perico
- IRCCS, Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy
| | - Giuseppe Remuzzi
- IRCCS, Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy; Unit of Nephrology, Dialysis and Transplantation, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
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