1
|
Rahmawati BA, Rochmawati E. Trying to understand the illness: A qualitative investigation of health literacy of patients undergoing maintenance hemodialysis. Nurs Health Sci 2024; 26:e13120. [PMID: 38605631 DOI: 10.1111/nhs.13120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/19/2023] [Accepted: 03/28/2024] [Indexed: 04/13/2024]
Abstract
Limited health literacy is high among patients with chronic kidney disease, which can pose challenges in health care. Evidence of health literacy in Indonesia, particularly regarding patients undergoing hemodialysis, is lacking. In this study, we aimed to explore health literacy in adult patients undergoing maintenance hemodialysis. An inductive qualitative study was conducted. Individual semi-structured interviews were conducted with 10 adult patients undergoing hemodialysis, four family caregivers, and four healthcare professionals. Interviews were transcribed verbatim and analyzed thematically. Three themes emerged from the data: "Trying to understand the illness," "searching and obtaining health information," and "applying health information." Understanding and accepting the illness included raising awareness of the changes in their lives and accepting these changes. Participants actively sought information from healthcare professionals and other sources and used it carefully. Behavioral changes included patients' adherence to therapy, although participants often felt bored during the illness trajectory. Understanding the illness and being willing to seek and critically evaluate health information before implementing it are important. These aspects may affect patient outcomes and require further intervention and research.
Collapse
Affiliation(s)
- Berlian Ayu Rahmawati
- School of Nursing, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
- Muhammadiyah Siti Aminah Bumiayu Hospital, Brebes, Indonesia
| | - Erna Rochmawati
- School of Nursing, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
| |
Collapse
|
2
|
Ding X, Li X, Ye Y, Jiang J, Lu M, Shao L. Epidemiological patterns of chronic kidney disease attributed to type 2 diabetes from 1990-2019. Front Endocrinol (Lausanne) 2024; 15:1383777. [PMID: 38694939 PMCID: PMC11061475 DOI: 10.3389/fendo.2024.1383777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/28/2024] [Indexed: 05/04/2024] Open
Abstract
Background This study investigates the burden of chronic kidney disease attributed to type 2 diabetes (CKD-T2D) across different geographical locations and time periods from 1990 to 2019. A total of 204 countries and regions are included in the analysis, with consideration given to their socio-demographic indexes (SDI). The aim is to examine both spatial and temporal variations in CKD-T2D burden. Methods This research utilized data from the 2019 Global Burden of Diseases Study to evaluate the age-standardized incidence rates (ASIR), Disability-Adjusted Life Years (DALYs), and Estimated Annual Percentage Change (EAPC) associated with CKD-T2D. Results Since 1990, there has been a noticeable increase of CKD age-standardized rates due to T2D, with an EAPCs of 0.65 (95% confidence interval [CI]: 0.63 to 0.66) for ASIR and an EAPC of 0.92 (95% CI: 0.8 to 1.05) for age-standardized DALYs rate. Among these regions, Andean Latin America showed a significant increase in CKD-T2D incidence [EAPC: 2.23 (95% CI: 2.11 to 2.34) and North America showed a significant increase in CKD-T2D DALYs [EAPC: 2.73 (95% CI: 2.39 to 3.07)]. The burden was higher in male and increased across all age groups, peaking at 60-79 years. Furthermore, there was a clear correlation between SDI and age-standardized rates, with regions categorized as middle SDI and High SDI experiencing a significant rise in burden. Conclusion The global burden of CKD-T2D has significantly risen since 1990, especially among males aged 60-79 years and in regions with middle SDI. It is imperative to implement strategic interventions to effectively address this escalating health challenge.
Collapse
Affiliation(s)
- Xiaoxiao Ding
- Department of Clinical Pharmacy, Beilun District People’s Hospital, Ningbo, China
| | - Xiang Li
- Department of Clinical Laboratory, The Second Hospital of Anhui University of Traditional Chinese Medicine, Hefei, Anhui, China
| | - Yun Ye
- Department of Clinical Pharmacy, Beilun District People’s Hospital, Ningbo, China
| | - Jing Jiang
- Department of Clinical Pharmacy, Beilun District People’s Hospital, Ningbo, China
| | - Mengsang Lu
- Department of Clinical Pharmacy, Beilun District People’s Hospital, Ningbo, China
| | - Lv Shao
- Department of Clinical Pharmacy, Yuyao People’s Hospital, Ningbo, Zhejiang, China
| |
Collapse
|
3
|
Suarilah I, Widyawati IY, Umam K, Lin CC, Purwanti R, Supriyono S, Mundt K. The Javanese Cultural Beliefs and Practices Among Patients With End-Stage Renal Disease Undergoing Hemodialysis. J Transcult Nurs 2024:10436596241239304. [PMID: 38526031 DOI: 10.1177/10436596241239304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
Introduction: Poor prognosis and higher mortality of chronic kidney disease are linked with cultural beliefs and practices. This study explored cultural beliefs and practices of Javanese people with end-stage renal disease undergoing hemodialysis for ≥5 years. Methods: A qualitative narrative inquiry was applied in this study. Data were collected through in-depth narrative interviews, followed by text messages, calls, and audio-visual calls for 6 weeks. Results: There were 14 participants; their mean age was 51.15 years and hemodialysis duration was 5 years and 2 months up to 10 years and 9 months. Four themes emerged: life-and-death acceptance, expectation of end-of-life care, contemplation of withdrawal from hemodialysis, and wishing for a good death. Discussion: Life values guided the ability to survive for the individual. Adherence to renal disease management regimen clashed with cultural values on occasions, such as social gatherings. Therefore, the unmet needs of patients should be addressed with a transcultural approach to modify personal health behaviors.
Collapse
|
4
|
Vanholder R, Annemans L, Braks M, Brown EA, Pais P, Purnell TS, Sawhney S, Scholes-Robertson N, Stengel B, Tannor EK, Tesar V, van der Tol A, Luyckx VA. Inequities in kidney health and kidney care. Nat Rev Nephrol 2023; 19:694-708. [PMID: 37580571 DOI: 10.1038/s41581-023-00745-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/16/2023]
Abstract
Health inequity refers to the existence of unnecessary and unfair differences in the ability of an individual or community to achieve optimal health and access appropriate care. Kidney diseases, including acute kidney injury and chronic kidney disease, are the epitome of health inequity. Kidney disease risk and outcomes are strongly associated with inequities that occur across the entire clinical course of disease. Insufficient investment across the spectrum of kidney health and kidney care is a fundamental source of inequity. In addition, social and structural inequities, including inequities in access to primary health care, education and preventative strategies, are major risk factors for, and contribute to, poorer outcomes for individuals living with kidney diseases. Access to affordable kidney care is also highly inequitable, resulting in financial hardship and catastrophic health expenditure for the most vulnerable. Solutions to these injustices require leadership and political will. The nephrology community has an important role in advocacy and in identifying and implementing solutions to dismantle inequities that affect kidney health.
Collapse
Affiliation(s)
- Raymond Vanholder
- European Kidney Health Alliance, Brussels, Belgium.
- Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital Ghent, Ghent, Belgium.
| | - Lieven Annemans
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Marion Braks
- European Kidney Health Alliance, Brussels, Belgium
- Association Renaloo, Paris, France
| | - Edwina A Brown
- Imperial College Healthcare NHS Trust, Imperial College Renal and Transplant Center, London, UK
| | - Priya Pais
- Department of Paediatric Nephrology, St John's Medical College, Bengaluru, India
| | - Tanjala S Purnell
- Departments of Epidemiology and Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Simon Sawhney
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, UK
| | | | - Bénédicte Stengel
- Clinical Epidemiology Team, Center for Research in Epidemiology and Population Health (CESP), University Paris-Saclay, UVSQ, Inserm, Villejuif, France
| | - Elliot K Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Renal Unit, Directorate of Medicine, Komfo Anokye, Teaching Hospital, Kumasi, Ghana
| | - Vladimir Tesar
- Department of Nephrology, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Arjan van der Tol
- Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital Ghent, Ghent, Belgium
| | - Valérie A Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| |
Collapse
|
5
|
Murphy F, Byrne G. Promoting kidney health in people with type 2 diabetes: part 1. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:874-880. [PMID: 37830853 DOI: 10.12968/bjon.2023.32.18.874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
The incidence of chronic kidney disease is increasing internationally with risk factors for the condition being the same as those for type 2 diabetes. It is important therefore for nurses to use primary, secondary and tertiary prevention to minimise the incidence of chronic kidney disease when caring for individuals with type 2 diabetes. This article is the first of a two-part series on the interrelationship between these long-term conditions. This article, part 1, addresses the significance of primary prevention in promoting kidney health in adults living with type 2 diabetes, while part 2 will discuss the use of secondary and tertiary prevention relevant to these long-term conditions.
Collapse
Affiliation(s)
- Fiona Murphy
- Assistant Professor, Renal Educational Facilitator, School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Gobnait Byrne
- Assistant Professor, School of Nursing and Midwifery, Trinity College Dublin, Ireland
| |
Collapse
|
6
|
Nursultanova L, Kabulbayev K, Ospanova D, Tazhiyeva A, Datkhayev U, Saliev T, Tanabayeva S, Fakhradiyev I. Prevalence of chronic kidney disease in Kazakhstan: evidence from a national cross-sectional study. Sci Rep 2023; 13:14710. [PMID: 37679536 PMCID: PMC10485008 DOI: 10.1038/s41598-023-42031-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/04/2023] [Indexed: 09/09/2023] Open
Abstract
To date, there have been no large-scale national studies of the prevalence of chronic kidney disease in Kazakhstan. It includes the research based on the analysis of the estimated glomerular filtration rate (eGFR). The aim of this study was to investigate the population prevalence of CKD and associated risk factors in Kazakhstan. The cross-sectional study consisted of a nationally representative sample of n = 6 720 adults aged 18 to 69 from 14 regions and 3 major cities in Kazakhstan. The study covered the period from October 2021 to May 2022. The WHO STEPS questionnaire was used for the survey. For the diagnosis of CKD, creatinine levels in collected blood samples were measured to assess eGFR. Demographic characteristics were collected and studied. The total and adjusted prevalence of factors associated with the presence of CKD were calculated and analysed using logistic regression. 73.5% (n = 4940) of participants had normal eGFR, while 25.2% (n = 1695) had mild CKD (eGFR = 60-89 mL/min/1.7 m2). The overall prevalence of CKD with eGFR < 60 ml/min/1.7 m2 was 1.3% (n = 85), of which 0.2% (n = 15) had eGFR < 45 ml/min/1.7 m2. A mild degree of CKD was most often determined in residents of the East Kazakhstan region in 10.4%, and in 7.8-8.0% of cases. The majority of CKD patients was detected in the East Kazakhstan region and Almaty city, 15.3% and 10.6% of cases respectively. In mild and CKD with GFR < 60 ml/min/1.7 m2, the age of participants was 50-69 years in 61.5% and 78.8% of cases, respectively (p < 0.001). In addition to the association with the place of residence, a statistically significant relationship was found between the risk of developing CKD and underweight (OR 1.43, 95% CI (1.09-1.88), p < 0.001), as well as the presence of obesity (OR 1.24, 95% CI (0.99-1.53), p = 0.04). We observed the prevalence of CKD with eGFR < 60 ml/min/1.7 m2 at the level of 1.3%. However, a fairly large part of study participants had a mild CKD (25.2%). The results of this study can be used for the optimization of the doctors workload and the timely provision of care to patients with CKD.
Collapse
Affiliation(s)
- Liza Nursultanova
- Kazakhstan's Medical University "KSPH", Almaty, Republic of Kazakhstan
| | - Kairat Kabulbayev
- S.D. Asfendiyarov Kazakh National Medical University, 94, Tole-Bi Str., Almaty, 050020, Republic of Kazakhstan
| | - Dinara Ospanova
- Al Farabi Kazakh National University, Almaty, Republic of Kazakhstan
| | - Aigul Tazhiyeva
- S.D. Asfendiyarov Kazakh National Medical University, 94, Tole-Bi Str., Almaty, 050020, Republic of Kazakhstan
| | - Ubaidilla Datkhayev
- S.D. Asfendiyarov Kazakh National Medical University, 94, Tole-Bi Str., Almaty, 050020, Republic of Kazakhstan
| | - Timur Saliev
- S.D. Asfendiyarov Kazakh National Medical University, 94, Tole-Bi Str., Almaty, 050020, Republic of Kazakhstan
| | - Shynar Tanabayeva
- S.D. Asfendiyarov Kazakh National Medical University, 94, Tole-Bi Str., Almaty, 050020, Republic of Kazakhstan
| | - Ildar Fakhradiyev
- S.D. Asfendiyarov Kazakh National Medical University, 94, Tole-Bi Str., Almaty, 050020, Republic of Kazakhstan.
| |
Collapse
|
7
|
Xie X, Lou H, Shi Y, Gan G, Deng H, Ma X, Meng M, Gao X. A network pharmacological-based study of the mechanism of Liuwei Dihuang pill in the treatment of chronic kidney disease. Medicine (Baltimore) 2023; 102:e33727. [PMID: 37171332 PMCID: PMC10174353 DOI: 10.1097/md.0000000000033727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a progressive disease that poses a huge economic burden to society. Liuwei Dihuanng pill is an effective treatment for chronic kidney disease, but its treatment mechanism is unclear. The rapid development of network pharmacology has provided new strategies for studying Chinese medicine. METHOD The traditional Chinese medicine systems pharmacology database and analysis platform was used to obtain the bioactive components and targets of Liuwei Dihuanng pill. The sources for the CKD-related targets were then obtained from the Genecards, OMIM, TTD, and DisGeNET databases. R was used to identify the intersecting genes for Liuwei Dihuang pill and CKD-related targets. Analysis of protein-protein interactions (PPI) was performed using STRING, and PPI networks and drug-component-target networks were constructed using Cytoscape software. Kyoto encyclopedia of genes and genomes pathway and gene ontology enrichment analyses were performed using R. Finally, molecular docking was performed to determine the binding activity between bioactive components and the targets. RESULT After screening and data de-duplication of 74 active components, 209 drug targets, and 14,794 disease targets, a total of 204 drug-disease targets were acquired. Subsequently, a drug-component-target network and PPI network were established. The primary components of Liuwei Dihuang pill included quercetin, stigmasterol, kaempferol, beta-sitosterol, tetrahydroalstonine, kadsurenone, hederagenin, hancinone C, diosgenin, and sitosterol. In addition, JUN, AKT1, TP53, RELA, MAPK1, FOS, TNF, IL6, ESR1, and RXRA were identified as the main targets. Gene ontology function enrichment analysis revealed that these targets were involved in reactive oxygen species metabolic processes, responses to metal ions and to chemical stimuli, G protein-coupled amine receptor activity, and nuclear factor receptor activity. Kyoto encyclopedia of genes and genomes enrichment analysis showed that these targets were involved in the AGE-RAGE signaling pathway, IL-17 signaling pathway, TNF signaling pathway, and so on. Molecular docking results indicated good binding activity between the core targets and core components. CONCLUSION The potential mechanism of Liuwei Dihuanng pill in the treatment of CKD was preliminarily discussed in this study, providing a theoretical basis and evidence for further experimental research.
Collapse
Affiliation(s)
- Xi Xie
- The First Clinical Medical College of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Hongjun Lou
- The First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Ye Shi
- College of Integrated Chinese and Western Medicine, Hunan University of Traditional Chinese Medicine, Changsha, China
| | - Guang Gan
- College of Integrated Chinese and Western Medicine, Hunan University of Traditional Chinese Medicine, Changsha, China
| | - Hanqing Deng
- The First Clinical Medical College of Hunan University of Traditional Chinese Medicine, Changsha, China
| | - Xinwei Ma
- The First Clinical Medical College of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Mingfang Meng
- The First Clinical Medical College of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Xi Gao
- The First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| |
Collapse
|
8
|
Feng X, Hou N, Chen Z, Liu J, Li X, Sun X, Liu Y. Secular trends of epidemiologic patterns of chronic kidney disease over three decades: an updated analysis of the Global Burden of Disease Study 2019. BMJ Open 2023; 13:e064540. [PMID: 36931681 PMCID: PMC10030786 DOI: 10.1136/bmjopen-2022-064540] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
OBJECTIVES To assess the characteristics of the global death burden imposed by chronic kidney disease (CKD) and the attributable risk factors from 1990 to 2019 to help inform a framework for policy discussions, resource allocation and research priorities. DESIGN A population-based observational study. SETTING The death data and relative risk factors were obtained from the Global Burden of Disease (GBD) Study 2019 database. MAIN OUTCOME MEASURES Based on the GBD database, we estimated the death burden attributable to CKD stratified by sociodemographic index (SDI), geographic location, sex, age group, time period and risk factors from 1990 to 2019. RESULTS Over three decade study period, the global number of CKD-related deaths increased from 0.60 million (95% uncertainty interval (UI): 0.57-0.63 million) in 1990 to 1.43 million (95% UI: 1.31-1.52 million) in 2019. The age-standardised death rate (ASDR) of CKD, among all causes, increased from 15th in 1990 to 10th in 2019. Globally, the ASDR in males was higher than that in females. CKD-related deaths mainly occurred in those aged over 50 years, especially in regions with higher SDIs. The ASDR was negatively related to SDI (ρ=-0.603, p<0.0001). Among risk factors, metabolic risk factors, especially systolic blood pressure, fasting plasma glucose and body mass index, were the main contributors to CKD-related deaths. Although the high-temperature-related death burden was low, the trend increased sharply in lower SDI regions. CONCLUSIONS CKD-related deaths continue to increase, with the majority occurring in elderly adults. The CKD-related death burden is higher in males than in females. Additionally, the increasing high-temperature-related death burdens in lower SDI regions should receive social attention.
Collapse
Affiliation(s)
- Xiaojin Feng
- Department of Endocrinology and Metabolism, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
- Department of Clinical Research Center, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Ningning Hou
- Department of Endocrinology and Metabolism, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Zhenna Chen
- Department of Ophthalmology, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Jing Liu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Xue Li
- Department of Clinical Research Center, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
- Department of Pathology, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Xiaodong Sun
- Department of Endocrinology and Metabolism, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
- Department of Clinical Research Center, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Yongping Liu
- Department of Endocrinology and Metabolism, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
- Department of Clinical Research Center, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| |
Collapse
|
9
|
George C, Hill J, Nqebelele U, Peer N, Kengne AP. Leveraging the South African Diabetes Prevention Programme to screen for chronic kidney disease: an observational study. BMJ Open 2023; 13:e068672. [PMID: 36609330 PMCID: PMC9827250 DOI: 10.1136/bmjopen-2022-068672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To evaluate the viability of leveraging an existing screening programme (the South African Diabetes Prevention Programme (SA-DPP)) to screen for chronic kidney disease (CKD), by assessing the yield of CKD cases among those participating in the programme. DESIGN Observational study conducted between 2017 and 2019. SETTING 16 resource-poor communities in Cape Town, South Africa. PARTICIPANTS 690 participants, aged between 25 and 65 years, identified as at high risk for type 2 diabetes mellitus (T2DM) by the African Diabetes Risk Score. PRIMARY OUTCOME MEASURE The prevalence of CKD among those participating in the SA-DPP. RESULTS Of the 2173 individuals screened in the community, 690 participants underwent further testing. Of these participants, 9.6% (n=66) and 18.1% (n=125) had screen-detected T2DM and CKD (defined as an estimated glomerular filtration rate (eGFR) of<60 mL/min/1.73 m2 and/or albumin-to-creatinine ratio >3 mg/mmol), respectively. Of those with CKD, 73.6% (n=92), 17.6% (n=22) and 8.8% (n=11) presented with stages 1, 2 and 3, respectively. Of the participants with an eGFR <60 mL/min/1.73 m2, 36.4% had no albuminuria and of those with normal kidney function (eGFR ≥90 mL/min/1.73 m2), 10.2% and 3.8% had albuminuria stages 2 and 3, respectively. Of those with T2DM and hypertension, 22.7% and 19.8% had CKD, respectively. CONCLUSION The fact that almost one in five participants identified as high risk for T2DM had CKD underscores the value of including markers of kidney function in an existing screening programme. By using an opportunistic approach to screen high-risk individuals, those with CKD can be identified and appropriately treated to reduce disease progression.
Collapse
Affiliation(s)
- Cindy George
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Jillian Hill
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Unati Nqebelele
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
- Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Nasheeta Peer
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - A P Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| |
Collapse
|
10
|
Al-Ghamdi S, Abu-Alfa A, Alotaibi T, AlSaaidi A, AlSuwaida A, Arici M, Ecder T, El Koraie AF, Ghnaimat M, Hafez MH, Hassan M, Sqalli T. Chronic Kidney Disease Management in the Middle East and Africa: Concerns, Challenges, and Novel Approaches. Int J Nephrol Renovasc Dis 2023; 16:103-112. [PMID: 37051319 PMCID: PMC10084934 DOI: 10.2147/ijnrd.s363133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/22/2022] [Indexed: 04/14/2023] Open
Abstract
The burden of chronic kidney disease (CKD) and other comorbidities, such as hypertension and diabetes, which increase the risk of developing CKD, is on the rise in the Middle East and Africa. The Middle East and Africa CKD (MEA-CKD) steering committee, comprising eminent healthcare specialists from the Middle East and Africa, was formed to identify and propose steps to address the gaps in the management of CKD in these regions. The current article lists the MEA-CKD steering committee meeting outcomes and evaluates the available evidence supporting the role of novel therapeutic options for patients with CKD. The need of the hour is to address the gaps in awareness and screening, early diagnosis, along with referral and management of patients at risk. Measures to bring about appropriate changes in healthcare policies to ensure access to all benefit-proven protective therapies, including novel ones, at community levels are also vital for reducing the overall burden of CKD on the healthcare system as well as governing bodies, especially in developing countries of the Middle East and Africa.
Collapse
Affiliation(s)
- Saeed Al-Ghamdi
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom Saudi of Arabia
| | - Ali Abu-Alfa
- Department of Nephrology and Hypertension, American University of Beirut, Beirut, Lebanon
| | - Turki Alotaibi
- Department of Transplant Nephrology, Hamed Al-Essa Organ Transplant Center, Kuwait City, Kuwait
| | - Ali AlSaaidi
- Department of Nephrology, College of Medicine, University of Baghdad, Nephrology and Transplantation Center, Medical City Complex, Baghdad, Iraq
| | | | - Mustafa Arici
- Department of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Tevfik Ecder
- Department of Nephrology, Demiroglu Bilim University Faculty of Medicine, Istanbul, Turkey
| | - Ahmed F El Koraie
- Department of Internal Medicine and Nephrology, Alexandria Faculty of Medicine, Alexandria, Egypt
| | | | - Mohamed H Hafez
- Department of Nephrology and Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Hassan
- Department of Medical Affairs, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
- Correspondence: Mohamed Hassan, Department of Medical Affairs, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates, Tel +971 508187944, Email
| | - Tarik Sqalli
- Department of Nephrology, Moroccan Society of Nephrology, Casablanca, Morocco
| |
Collapse
|
11
|
Oni OO, Akinwusi PO, Owolabi JI, Odeyemi AO, Israel GM, Ala O, Akande JO, Durodola A, Israel OK, Ajibola I, Aremu AO. Chronic Kidney Disease and Its Clinical Correlates in a Rural Community in Southwestern Nigeria. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:774-783. [PMID: 38018719 DOI: 10.4103/1319-2442.390257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
Chronic kidney disease (CKD) is a burgeoning problem globally, and more than a billion adults were affected as of 2016, with 1.2 million people dying from renal failure in 2017. To arrest the seemingly relentless progression of CKD to renal failure, there is a need to detect CKD early in the community. A community-based study was carried out to look at the prevalence and risk factors of CKD. Anthropometric and other clinical variables were measured. Blood samples were taken for determining creatinine, uric acid, urea, and lipids. CKD was defined as an estimated glomerular filtration rate of ≤60 mL/min/1.73 m2. Electrocardiograms and renal ultrasound scans were performed. In total, 201 people were recruited. Those with CKD had a male:female ratio of 1:3.9 and were older. The prevalence of autosomal-dominant polycystic kidney disease and CKD was 531.9 persons/100,000 population and 46.3%, respectively. Systolic blood pressure, pulse pressure, total cholesterol, triglycerides, high-density lipoprotein (HDL), uric acid, QTc interval, and electrocardiographic left ventricular hypertrophy were higher in those with CKD. Age, female sex, and HDL were independently associated with CKD. There was a steep rise in CKD at the community level. Increased awareness of CKD and prompt interventions are therefore imperative.
Collapse
Affiliation(s)
- Opeyemi O Oni
- Department of Medicine, Bowen University, Iwo, Nigeria
| | | | | | | | | | | | - Joel O Akande
- Department of Chemical Pathology, Bowen University, Iwo, Nigeria
| | | | | | - Idowu Ajibola
- Department of Community Medicine, Bowen University, Iwo, Nigeria
| | - Ayodele O Aremu
- Department of Community Medicine, Bowen University, Iwo, Nigeria
| |
Collapse
|
12
|
Lin MY, Fiorentino M, Wu IW. Editorial: Public health for chronic kidney disease prevention and care. Front Public Health 2022; 10:1021075. [PMID: 36176535 PMCID: PMC9514552 DOI: 10.3389/fpubh.2022.1021075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/30/2022] [Indexed: 01/28/2023] Open
Affiliation(s)
- Ming-Yen Lin
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan,*Correspondence: Ming-Yen Lin
| | - Marco Fiorentino
- Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari “Aldo Moro”, Bari, Italy
| | - I-Wen Wu
- Department of Nephrology, Keelung Chang Gung Memorial Hospital Keelung, Keelung, Taiwan
| |
Collapse
|
13
|
Kalyesubula R, Conroy AL, Calice-Silva V, Kumar V, Onu U, Batte A, Kaze FF, Fabian J, Ulasi I. Screening for Kidney Disease in Low- and Middle-Income Countries. Semin Nephrol 2022; 42:151315. [DOI: 10.1016/j.semnephrol.2023.151315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
|
14
|
Ammar YA, Maharem DA, Mohamed AH, Khalil GI, Shams-Eldin RS, Dwedar FI. Fibroblast growth factor-23 rs7955866 polymorphism and risk of chronic kidney disease. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2022. [DOI: 10.1186/s43042-022-00289-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
A missense gain-of-function fibroblast growth factor-23 (FGF23) gene single nucleotide polymorphism (SNP) (rs7955866) has been associated with FGF23 hypersecretion, phosphaturia, and bone disease. Excess circulating FGF23 was linked with atherosclerosis, hypertension, initiation, and progression of chronic kidney disease (CKD).
Methods
The study included 72 CKD stage 2/3 Egyptian patients (27–71 years old, 37 females) and 26 healthy controls matching in age and sex. Repeated measures of blood pressure were used to quantify hypertension on a semiquantitative scale (grades 0 to 5). Fasting serum urea, creatinine, uric acid, total proteins, albumin, calcium, phosphorus, vitamin D3, intact parathyroid hormone (iPTH), and intact FGF23 (iFGF23) were measured. DNA extracted from peripheral blood leucocytes was used for genotyping of FGF23 rs7955866 SNP using the TaqMan SNP genotyping allelic discrimination method.
Results
Major causes of CKD were hypertension, diabetic kidney disease, and CKD of unknown etiology. There was no significant difference in minor allele (A) frequency between the studied groups (0.333 in GI and 0.308 in GII). Median (IQR) serum iFGF23 was significantly higher in GI [729.2 (531.9–972.3)] than in GII [126.1 (88.5–152.4)] pg/mL, P < 0.001. Within GI, the minor allele (A) frequency load, coded for codominant inheritance, had a significant positive correlation with both hypertension grade (r = 0.385, P = 0.001) and serum iFGF23 (r = 0.259, P = 0.028). Hypertension grade had a significant positive correlation with serum phosphorus and iFGF23.
Conclusions
For the first time in an Egyptian cohort, we report a relatively high frequency of the rs7955866 SNP. It may remain dormant or become upregulated in response to some environmental triggers, notably dietary phosphorus excess, leading to increased circulating iFGF23 with ensuing hypertension and/or renal impairment. Subjects with this SNP, particularly in the homozygous form, are at increased risk for CKD of presumably “unknown” etiology, with a tendency for early onset hypertension and increased circulating iFGF23 out of proportion with the degree of renal impairment. Large-scale population studies are needed to confirm these findings and explore the role of blockers of the renin–angiotensin–aldosterone system and sodium chloride cotransporters in mitigating hypertension associated with FGF23 excess.
Collapse
|
15
|
Ke C, Liang J, Liu M, Liu S, Wang C. Burden of chronic kidney disease and its risk-attributable burden in 137 low-and middle-income countries, 1990-2019: results from the global burden of disease study 2019. BMC Nephrol 2022; 23:17. [PMID: 34986789 PMCID: PMC8727977 DOI: 10.1186/s12882-021-02597-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 10/22/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a global public health concern, but its disease burden and risk-attributable burden in CKD has been poorly studied in low - and middle-income countries (LMICs). This study aimed to estimate CKD burden and risk-attributable burden in LMICs from 1990 to 2019. METHODS Data were collected from the Global Burden of Disease (GBD) Study 2019, which measure CKD burden using the years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs) and calculate percentage contributions of risk factors to age-standardized CKD DALY using population attributable fraction (PAF) from 1990 to 2019. Trends of disease burden between 1990 and 2019 were evaluated using average annual percent change (AAPC). The 95% uncertainty interval (UI) were calculated and reported for YLDs, YLLs, DALYs and PAF. RESULTS In 2019, LICs had the highest age-standardized DALY rate at 692.25 per 100,000 people (95%UI: 605.14 to 785.67), followed by Lower MICs (684.72% (95%UI: 623.56 to 746.12)), Upper MICs (447.55% (95%UI: 405.38 to 493.01)). The age-standardized YLL rate was much higher than the YLD rate in various income regions. From 1990 to 2019, the age-standardized DALY rate showed a 13.70% reduction in LICs (AAPC = -0.5, 95%UI: - 0.6 to - 0.5, P < 0.001), 3.72% increment in Lower MICs (AAPC = 0.2, 95%UI: 0.0 to 0.3, P < 0.05). Age-standardized YLD rate was higher in females than in males, whereas age-standardized rates of YLL and DALY of CKD were all higher in males than in females in globally and LMICs. Additionally, the YLD, YLL and DALY rates of CKD increased with age, which were higher in aged≥70 years in various income regions. In 2019, high systolic blood pressure, high fasting plasma glucose, and high body-mass index remained the major causes attributable age-standardized CKD DALY. From 1990 to 2019, there were upward trends in the PAF of age-standardized DALY contributions of high fasting plasma glucose, high systolic blood pressure, and high body-mass index in Global, LICs, Lower MICs and Upper MICs. The greatest increase in the PAF was high body-mass index, especially in Lower MICs (AAPC = 2.7, 95%UI: 2.7 to 2.8, P < 0.001). The PAF of age-standardized DALY for high systolic blood pressure increased the most in Upper MICs (AAPC = 0.6, 95%UI: 0.6 to 0.7, P < 0.001). CONCLUSIONS CKD burden remains high in various income regions, especially in LICs and Lower MICs. More effective and targeted preventive policies and interventions aimed at mitigating preventable CKD burden and addressing risk factors are urgently needed, particularly in geographies with high or increasing burden.
Collapse
Affiliation(s)
- Changrong Ke
- School of Public Health, Weifang Medical University, 261053, Weifang, China
| | - Juanjuan Liang
- School of Public Health, Weifang Medical University, 261053, Weifang, China
| | - Mi Liu
- School of Public Health, Weifang Medical University, 261053, Weifang, China
| | - Shiwei Liu
- Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Chunping Wang
- School of Public Health, Weifang Medical University, 261053, Weifang, China.
| |
Collapse
|
16
|
Kachimanga C, Williams AJ, Bangura M, Lado M, Kanawa S, Lavallie D, Mhango M, Wurie HI, Rodriguez MP. High Prevalence of Chronic Kidney Disease Among People Living with Hypertension in Rural Sierra Leone: A Cross-Sectional Study. Int J Nephrol Renovasc Dis 2021; 14:459-474. [PMID: 34992425 PMCID: PMC8710521 DOI: 10.2147/ijnrd.s342099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/09/2021] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Currently, there are no data on prevalence and associated risk factors of chronic kidney disease (CKD) among patients with hypertension in rural Sierra Leone. PURPOSE To estimate the prevalence and associated risk factors of CKD in rural Sierra Leone. PATIENTS AND METHODS A cross-sectional study of hypertension patients aged between 18 and 75 years attending a non-communicable disease clinic at Koidu Government Hospital, Kono District, Sierra Leone was conducted between February and December 2020. Using systematic random sampling, a structured questionnaire, which comprised of questions on social demographic characteristics and past and current clinical history, was administered followed by measurement of creatinine and urinary protein and glucose. Estimated glomerular filtration rate (eGFR) was estimated using CKD-epidemiology formula without race as a factor. Baseline eGFR between 60-89 min/mL/1.73m2 and <60 min/mL/1.73m2 defined reduced eGFR and renal impairment, respectively. Estimated GFR less than 60 min/mL/1.73m2 measured two times at least 3 months apart was used to define CKD. RESULTS Ninety-six percent (n = 304) patients out of 317 patients were included in the study. Among all included patients, only 3.9% (n = 12) had eGFR of 90 min/mL/1.73m2 and above. The prevalence of renal impairment and CKD was 52% (158/304, CI 46.2-57.7) and 29.9% (91/304, CI 24.8-34.5), respectively. In adjusted logistic regression analysis, currently taking herbal medications as treatment of hypertension (OR 4.11 (CI 1.14-14.80), p = 0.03) and being overweight and/or obese (OR 2.16 (CI 1.24-3.78), p < 0.001) was associated with CKD. Additionally, receiving some education was associated with a 48% (OR 0.52 (CI 0.29-0.91), p = 0.02) reduced likelihood of CKD. CONCLUSION The prevalence of renal impairment and CKD is high among hypertensive patients in rural Sierra Leone. CKD was associated with current history of taking herbal medications and being overweight and/or obese. Additionally, CKD was associated with reduced likelihood in patients who received some education.
Collapse
Affiliation(s)
- Chiyembekezo Kachimanga
- Partners in Health Sierra Leone, Koidu City, Sierra Leone
- Partners in Health Malawi, Neno, Malawi
| | - Anu Jegede Williams
- Central Public Health Reference Laboratory, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Musa Bangura
- Partners in Health Sierra Leone, Koidu City, Sierra Leone
| | - Marta Lado
- World Health Organization, Geneva, Switzerland
| | - Sahr Kanawa
- Koidu Government Hospital, Ministry of Health and Sanitation, Koidu City, Sierra Leone
| | - Daniel Lavallie
- Koidu Government Hospital, Ministry of Health and Sanitation, Koidu City, Sierra Leone
| | - Michael Mhango
- Partners in Health Sierra Leone, Koidu City, Sierra Leone
| | - Haja Isatta Wurie
- Laboratory Science Unit, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | | |
Collapse
|
17
|
McLean MR, Wragg KM, Lopez E, Kiazyk SA, Ball TB, Bueti J, Kent SJ, Juno JA, Chung AW. Serological and cellular inflammatory signatures in end-stage kidney disease and latent tuberculosis. Clin Transl Immunology 2021; 10:e1355. [PMID: 34765193 PMCID: PMC8569694 DOI: 10.1002/cti2.1355] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/08/2021] [Accepted: 10/21/2021] [Indexed: 12/28/2022] Open
Abstract
Objectives Tuberculosis comorbidity with chronic diseases including diabetes, HIV and chronic kidney disease is of rising concern. In particular, latent tuberculosis infection (LTBI) comorbidity with end‐stage kidney disease (ESKD) is associated with up to 52.5‐fold increased risk of TB reactivation to active tuberculosis infection (ATBI). The immunological mechanisms driving this significant rise in TB reactivation are poorly understood. To contribute to this understanding, we performed a comprehensive assessment of soluble and cellular immune features amongst a unique cohort of patients comorbid with ESKD and LTBI. Methods We assessed the plasma and cellular immune profiles from patients with and without ESKD and/or LTBI (N = 40). We characterised antibody glycosylation, serum complement and cytokine levels. We also assessed classical and non‐classical monocytes and T cells with flow cytometry. Using a systems‐based approach, we identified key immunological features that discriminate between the different disease states. Results Individuals with ESKD exhibited a highly inflammatory plasma profile and an activated cellular state compared with those without ESKD, including higher levels of inflammatory antibody Fc glycosylation structures and activated CX3CR1+ monocytes that correlate with increased inflammatory plasma cytokines. Similar elevated inflammatory signatures were also observed in ESKD+/LTBI+ compared with ESKD−/LTBI+, suggesting that ESKD induces an overwhelming inflammatory immune state. In contrast, no significant inflammatory differences were observed when comparing LTBI+ and LTBI− individuals. Conclusion Our study highlights the highly inflammatory state induced by ESKD. We hypothesise that this inflammatory state could contribute to the increased risk of TB reactivation in ESKD patients.
Collapse
Affiliation(s)
- Milla R McLean
- Department of Microbiology and Immunology University of Melbourne at The Peter Doherty Institute for Infection and Immunity Melbourne VIC Australia
| | - Kathleen M Wragg
- Department of Microbiology and Immunology University of Melbourne at The Peter Doherty Institute for Infection and Immunity Melbourne VIC Australia
| | - Ester Lopez
- Department of Microbiology and Immunology University of Melbourne at The Peter Doherty Institute for Infection and Immunity Melbourne VIC Australia
| | - Sandra A Kiazyk
- National HIV and Retrovirology Laboratory National Microbiology Laboratory JC Wilt Infectious Diseases Research Centre Public Health Agency of Canada Winnipeg MB Canada.,Department of Medical Microbiology and Infectious Diseases University of Manitoba Winnipeg MB Canada
| | - Terry Blake Ball
- National HIV and Retrovirology Laboratory National Microbiology Laboratory JC Wilt Infectious Diseases Research Centre Public Health Agency of Canada Winnipeg MB Canada
| | - Joe Bueti
- Department of Internal Medicine University of Manitoba Winnipeg MB Canada.,Section of Nephrology Department of Internal Medicine University of Manitoba MB Canada.,Health Sciences Centre Winnipeg MB Canada
| | - Stephen J Kent
- Department of Microbiology and Immunology University of Melbourne at The Peter Doherty Institute for Infection and Immunity Melbourne VIC Australia.,Australian Research Council Centre for Excellence in Convergent Bio-Nano Science and Technology University of Melbourne Melbourne VIC Australia.,Melbourne Sexual Health Centre and Department of Infectious Diseases Alfred Hospital and Central Clinical School Monash University Melbourne VIC Australia
| | - Jennifer A Juno
- Department of Microbiology and Immunology University of Melbourne at The Peter Doherty Institute for Infection and Immunity Melbourne VIC Australia
| | - Amy W Chung
- Department of Microbiology and Immunology University of Melbourne at The Peter Doherty Institute for Infection and Immunity Melbourne VIC Australia
| |
Collapse
|
18
|
Suarilah I, Lin CC. Factors influencing self-management among Indonesian patients with early-stage chronic kidney disease: A cross-sectional study. J Clin Nurs 2021; 31:703-715. [PMID: 34405484 DOI: 10.1111/jocn.15930] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/18/2021] [Accepted: 06/09/2021] [Indexed: 01/10/2023]
Abstract
AIMS AND OBJECTIVES The purpose of this study was to explore the self-management of patients with early-stage chronic kidney disease (CKD) and its influencing factors. METHODS A convenient sample of 226 patients with early-stage CKD was recruited from 63 Public Health Centers in Indonesia, from June to September 2020. Demographic characteristics, health literacy, illness perception, self-efficacy and self-management were assessed using self-reported questionnaires. Stepwise multiple linear regression analysis was performed to identify the factors influencing self-management. This study adhered to the EQUATOR checklist, STROBE. RESULTS The mean estimated glomerular filtration rate was 63.45 ml/min/1.73 m2 (standard deviation [SD] = 15.34). The average scores for health literacy, illness perception, self-efficacy and self-management were 32.11 (SD = 4.46), 4.57 (SD = 1.46), 183.64 (SD = 38.23) and 76.92 (SD = 9.45), respectively. The influencing factors were education level, monthly income, family history of comorbidity, health literacy and self-efficacy, which accounted for 45% of total self-management score. CONCLUSIONS Indonesian patients with early-stage CKD showed low level of health literacy, but positive illness perception and self-efficacy; these factors significantly affected CKD self-management. Health literacy was found to influence all dimensions of self-management: self-integration, problem-solving, seeking social support and adherence to the recommended regimen. RELEVANCE TO CLINICAL PRACTICE Adherence to the recommended regimen is the most challenging dimension of CKD self-management. Health literacy was found to be a major determinant of self-management. Improving health literacy and motivation of patients with early-stage CKD may help sustain positive illness perception and self-efficacy, and improve self-management.
Collapse
Affiliation(s)
- Ira Suarilah
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | - Chiu-Chu Lin
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| |
Collapse
|
19
|
Gurudas S, Nugawela M, Prevost AT, Sathish T, Mathur R, Rafferty JM, Blighe K, Rajalakshmi R, Mohan AR, Saravanan J, Majeed A, Mohan V, Owens DR, Robson J, Sivaprasad S. Development and validation of resource-driven risk prediction models for incident chronic kidney disease in type 2 diabetes. Sci Rep 2021; 11:13654. [PMID: 34211028 PMCID: PMC8249456 DOI: 10.1038/s41598-021-93096-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 06/14/2021] [Indexed: 12/23/2022] Open
Abstract
Prediction models for population-based screening need, for global usage, to be resource-driven, involving predictors that are affordably resourced. Here, we report the development and validation of three resource-driven risk models to identify people with type 2 diabetes (T2DM) at risk of stage 3 CKD defined by a decline in estimated glomerular filtration rate (eGFR) to below 60 mL/min/1.73m2. The observational study cohort used for model development consisted of data from a primary care dataset of 20,510 multi-ethnic individuals with T2DM from London, UK (2007-2018). Discrimination and calibration of the resulting prediction models developed using cox regression were assessed using the c-statistic and calibration slope, respectively. Models were internally validated using tenfold cross-validation and externally validated on 13,346 primary care individuals from Wales, UK. The simplest model was simplified into a risk score to enable implementation in community-based medicine. The derived full model included demographic, laboratory parameters, medication-use, cardiovascular disease history (CVD) and sight threatening retinopathy status (STDR). Two less resource-intense models were developed by excluding CVD and STDR in the second model and HbA1c and HDL in the third model. All three 5-year risk models had good internal discrimination and calibration (optimism adjusted C-statistics were each 0.85 and calibration slopes 0.999-1.002). In Wales, models achieved excellent discrimination(c-statistics ranged 0.82-0.83). Calibration slopes at 5-years suggested models over-predicted risks, however were successfully updated to accommodate reduced incidence of stage 3 CKD in Wales, which improved their alignment with the observed rates in Wales (E/O ratios near to 1). The risk score demonstrated similar model performance compared to direct evaluation of the cox model. These resource-driven risk prediction models may enable universal screening for Stage 3 CKD to enable targeted early optimisation of risk factors for CKD.
Collapse
Affiliation(s)
- Sarega Gurudas
- Institute of Ophthalmology, University College London, London, UK
| | - Manjula Nugawela
- Institute of Ophthalmology, University College London, London, UK
| | - A Toby Prevost
- Nightingale-Saunders Clinical Trials and Epidemiology Unit, King's College London, London, UK
| | | | - Rohini Mathur
- Institute of Applied Data Science, Queen Mary's University London, London, UK
| | | | - Kevin Blighe
- Institute of Ophthalmology, University College London, London, UK
| | | | - Anjana R Mohan
- Madras Diabetes Research Foundation, Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Jebarani Saravanan
- Madras Diabetes Research Foundation, Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Azeem Majeed
- School of Public, Health Imperial College London, London, UK
| | - Viswanthan Mohan
- Madras Diabetes Research Foundation, Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | | | - John Robson
- Institute of Applied Data Science, Queen Mary's University London, London, UK
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, University College London, City Road, London, 162EC1V 2PD, UK.
| |
Collapse
|
20
|
Inequalities in the Global Burden of Chronic Kidney Disease Due to Type 2 Diabetes Mellitus: An Analysis of Trends from 1990 to 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094723. [PMID: 33925259 PMCID: PMC8124442 DOI: 10.3390/ijerph18094723] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 12/11/2022]
Abstract
The prevalence of type 2 diabetes mellitus (T2DM) and the burden of complications are increasing worldwide. Chronic kidney disease (CKD) is one serious complication. Our aim was to investigate the trends and inequalities of the burden of CKD due to T2DM between 1990 and 2019. Data were obtained from the Global Health Data Exchange database. Age-standardized incidence, mortality, and DALYs rates of CKD were used to estimate the disease burden across the Human Development Index (HDI). Joinpoint regression was performed to assess changes in trend, and the Gini coefficient was used to assess health inequality. A higher incidence was observed in more developed countries (p < 0.001), while higher mortality and DALYs rates were experienced in low and middle HDI countries in 2019 (p < 0.001). The trend of incidence has increased since 1990 (AAPC: 0.9–1.5%), while slight decrease was observed in low HDI countries in mortality (APC: −0.1%) and DALYs (APC: −0.2%). The Gini coefficients of CKD incidence decreased from 0.25 in 2006 to 0.23 in 2019. The socioeconomic development was associated with disease burden. Our findings indicate that awareness of complications should be improved in countries with high incidence, and cost-effective preventive, diagnostic, and therapeutic tools are necessary to implement in less developed regions.
Collapse
|
21
|
Ameh OI, Ekrikpo U, Bello A, Okpechi I. Current Management Strategies of Chronic Kidney Disease in Resource-Limited Countries. Int J Nephrol Renovasc Dis 2020; 13:239-251. [PMID: 33116755 PMCID: PMC7567536 DOI: 10.2147/ijnrd.s242235] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/12/2020] [Indexed: 12/12/2022] Open
Abstract
The incidence and prevalence of chronic kidney disease (CKD) and kidney failure continues to increase worldwide, especially in resource-limited countries. Many countries in this category already have a massive burden of communicable diseases, as well as socio-economic and socio-demographic challenges. The rising CKD burden and exorbitant economic cost associated with treatment are mainly responsible for the alarming mortality rate associated with kidney disease in these regions. There is often poor risk factor (diabetes and hypertension) and CKD awareness in these countries and limited availability and affordability of treatment options. Given these observations, early disease detection and preventive measures remain the best options for disease management in resource-limited settings. Primary, secondary and tertiary preventive strategies need to be enhanced and should particularly include measures to increase awareness, regular assessment to detect hypertension, diabetes and albuminuria, options for early referral of identified patients to a nephrologist and options for conservative kidney management where kidney replacement therapies may not be available or indicated. Much is still needed to be done by governments in these regions, especially regarding healthcare funding, improving the primary healthcare systems and enhancing non-communicable disease detection and treatment programs as these will have effects on kidney care in these regions.
Collapse
Affiliation(s)
| | - Udeme Ekrikpo
- Renal Unit, Department of Internal Medicine, University of Uyo, Uyo, Nigeria
| | - Aminu Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ikechi Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| |
Collapse
|