Chronic kidney disease and the aging population

Understanding the Current Landscape of Kidney Disease in Canada to Advance Precision Medicine Guided Personalized Care

Purpose of Review

To understand the impact of kidney disease in Canada and the priority areas of kidney research that can benefit from patient-oriented, precision medicine research using novel technologies.

Sources of Information

Information was collected through discussions between health care professionals, researchers, and patient partners. Literature was compiled using search engines (PubMed, PubMed central, Medline, and Google) and data from the Canadian Organ Replacement Register.

Methods

We reviewed the impact, prevalence, economic burden, causes of kidney disease, and priority research areas in Canada. After reviewing the priority areas for kidney research, potential avenues for future research that can integrate precision medicine initiatives for patient-oriented research were outlined.

Key Findings

Chronic kidney disease (CKD) remains among the top causes of morbidity and mortality in the world and exerts a large financial strain on the health care system. Despite the increasing number of people with CKD, funding for basic kidney research continues to trail behind other diseases. Current funding strategies favor existing clinical treatment and patient educational strategies. The identification of genetic factors for various forms of kidney disease in the adult and pediatric populations provides mechanistic insight into disease pathogenesis. Allocation of resources and funding toward existing high-yield personalized research initiatives have the potential to significantly affect patient-oriented research outcomes but will be difficult due to a constant decline of funding for kidney research.

Limitations

This is an overview primarily focused on Canadian-specific literature rather than a comprehensive systematic review of the literature. The scope of our findings and conclusions may not be applicable to health care systems in other countries.

The conundrums of chronic kidney disease and aging

Chronic kidney disease (CKD), as presently defined, is a common disorder. Aging is a nearly universal phenomenon that can affect renal anatomy and function, but at variable rates in individuals. Loss of nephrons and a decline in glomerular filtration rate (GFR) is a characteristic of normal aging, called renal senescence. Using fixed and absolute thresholds for defining CKD on the basis of GFR for all ages may lead to diagnostic uncertainty (a conundrum) in both young and older subjects. This brief review will consider the physiological and anatomical changes of the kidney occurring in the process of normal renal senescence focusing on GFR and will examine the relevance of these observation for the diagnosis of CKD using GFR as the distinguishing parameter. Once a better understanding of the pathobiology underlying renal senescence is obtained, specific interventions may become available to slow the process.

Recent trends in the prevalence of chronic kidney disease in Korean adults: Korean National Health and Nutrition Examination Survey from 1998 to 2013

BACKGROUND

Chronic kidney disease (CKD) is associated with aging, diabetes, hypertension, dyslipidemia, obesity, and unhealthy lifestyle behaviors and has become a public health burden worldwide.

METHODS

We investigated the trends of CKD prevalence over a period of 16 years in Korean adults based on the Korean National Health and Nutrition Examination Survey (KNHANES): phase I (1998), II (2001), III (2005), IV (2007-09), V (2010-2012), and VI (2013). Of the 105,504 individuals aged over 20 years who participated in KNHANES I-VI, 55,191 (23,729 men and 31,462 women) were included in the present study.

RESULTS

The sequential percentage of glomerular filtration rate (GFR) <60 ml/min/1.73 m² in KNHANES I-VI was 1.0, 4.2, 3.2, 1.9, 1.6, and 2.1 % in men and 3.6, 9.3, 10.4, 3.1, 1.6, and 2.0 % in women, respectively. The percentage of proteinuria ≥1+ in men rebounded after KNHANES V (3.1, 2.9, 2.8, 1.9, 1.1, and 1.7 % in KNHANES I-VI, respectively), but in women declined across all KNHANES reads (3.4, 2.3, 1.4, 1.6, 1.0, and 0.9 %, respectively). The prevalence of CKD rebounded after KNHANES V for men (3.9, 6.8, 5.5, 3.5, 2.4, and 3.5 % in KNHANES I-VI) while those in women decreased to a plateau level (6.6, 10.9, 11.4, 4.2, 2.4, and 2.4 % in KNHANES I-VI, respectively).

CONCLUSIONS

Our study shows that the prevalence of CKD in Korean adults has decreased overall, but since KNHANES V there has been a rebound in men while no changes in women.

Chronic subdural haematoma associated with disturbance of consciousness: significance of acute-on-chronic subdural haematoma

OBJECTIVE

Detailed features of chronic subdural haematoma (cSDH) associated with disturbance of consciousness and acute-on-chronic subdural haematoma (a/cSDH), in which acute subdural haematoma overlaps cSDH, remain poorly understood. The object of this study was to clarify both characteristics of cSDH associated with disturbance of consciousness and the significance of a/cSDH.

METHODS

Clinical factors and computed tomography (CT) findings were retrospectively investigated in 349 consecutive patients admitted between 2006 and 2013 and diagnosed with cSDH.

RESULTS

Glasgow Coma Scale (GCS) was ≤ 8 in 21 patients (6.0%) and 9-14 in 29 patients excluding aphasia and/or dementia (8.3%). Multiple logistic regression analysis indicated that a/cSDH, female sex and haemodialysis were significantly related to severe disturbance of consciousness (GCS ≤ 8). Predictors for a/cSDH observed in 29 patients (8.3%) were trauma history within 7 days before admission, high prothrombin time-international rate, and use of anticoagulants and/or antiplatelets. Unfavourable outcomes were observed in 29 of 299 patients (9.7%) without consciousness disturbance, compared to 27 of 50 patients (54%) with consciousness disturbance. Predictors of unfavourable outcome were consciousness disturbance, increase in age, malignancy, trauma history within 7 days and haemodialysis.

DISCUSSION

Disturbance of consciousness associated with cSDH, often caused by either a/cSDH or concomitant disease, frequently resulted in unfavourable outcomes. As a result, in cSDH patients associated with disturbance of consciousness, underlying conditions, especially a/cSDH, which is often caused by haemostatic abnormality, should be clarified and managed.