Can Comprehensive Lifestyle Change Alter the Course of Chronic Kidney Disease?

Health behaviors and risk factors associated with chronic kidney disease in Korean patients with diabetes: the Fourth Korean National Health and Nutritional Examination Survey

PURPOSE

The purpose of this study was to identify health behavior and risk factors for chronic kidney disease (CKD) in Korean patients with diabetes.

METHODS

This study was a secondary analysis of the Fourth Korean National Health and Nutritional Examination Survey (2007-2009). Of the 24,871 participants, 1,239 aged over 19 years with diagnosis of diabetes were included. Stratified and cluster variables in the analysis-plan file for a weighted, complex sample were analyzed. CKD was confirmed by the estimated glomerular filtration rate level of 15.0-59.9 mL/min/1.732 m(2). Odds ratios between the variables and CKD were calculated using logistic regression analysis with adjustment for gender, age, educational background, income, and duration of diagnosis.

RESULTS

The results showed that 14.7% of participants with diabetes were accompanied with CKD. The risk of developing CKD in those who made efforts to take proper nutrition but failed was 1.76 times higher than those taking nutrition properly. In those who used to smoke compared to their nonsmoking counterparts, the risk was 2.06 times higher; in those who did not do vigorous exercise compared to those who did, the risk was 2.12 times higher; in those with hypertension than those without, the risk was 2.4 times higher; and in those with anemia compared to those without, the risk was 2.32 times higher. Only 19% of the participants received health education for diabetes, which did not affect the incidence of CKD.

CONCLUSION

Since renal functions are affected by lifestyle factors, it is critical for healthcare professionals to provide diabetic patients with health education focused on changing their behavior so that it is conducive to health. It is also necessary to consider that diabetes education should be made more available and provided more effectively to these patients.

Direct and indirect effects of obesity on the kidney

Over the last few decades, much of the world has experienced an epidemic of obesity. In the year 2008, 1.4 billion people worldwide were overweight, and 500 million were obese. Even more alarming is a fact that in the year 2010, 40 million children under the age of 5 years were overweight or obese. In the same time period, the incidence of CKD has also increased worldwide. Obesity has been recognized as a driving force of another global epidemic-diabetes, the leading cause of ESRD. Recent studies are confirming that in addition to risk associated with diabetes per se, increased body mass index is independently linked to increased risk for various kidney disorders, prominently CKD, but also renal cell carcinoma and nephrolithiasis. The purpose of this article is to review current knowledge regarding adverse effects of obesity on the kidney.

High burden and unmet patient needs in chronic kidney disease

Chronic kidney disease (CKD) is a complex debilitating condition affecting more than 70 million people worldwide. With the increased prevalence in risk factors such as diabetes, hypertension, and cardiovascular disease in an aging population, CKD prevalence is also expected to increase. Increased awareness and understanding of the overall CKD burden by health care teams (patients, clinicians, and payers) is warranted so that overall care and treatment management may improve. This review of the burden of CKD summarizes available evidence of the clinical, humanistic, and economic burden of CKD and the current unmet need for new treatments and serves as a resource on the overall burden. Across countries, CKD prevalence varies considerably and is dependent upon patient characteristics. The prevalence of risk factors including diabetes, hypertension, cardiovascular disease, and congestive heart failure is noticeably higher in patients with lower estimated glomerular filtration rates (eGFRs) and results in highly complex CKD patient populations. As CKD severity worsens, there is a subsequent decline in patient health-related quality of life and an increased use of health care resources as well as burgeoning costs. With current treatment, nearly half of patients progress to unfavorable renal and cardiovascular outcomes. Although curative treatment that will arrest kidney deterioration is desired, innovative agents under investigation for CKD to slow kidney deterioration, such as atrasentan, bardoxolone methyl, and spherical carbon adsorbent, may offer patients healthier and more productive lives.

Lifestyle of hemodialysis patients in comparison with outpatients

INTRODUCTION

Nowadays, the chronic diseases are known to be associated with lifestyle risk factors. Hemodialysis patients encounter considerable amount of physical, mental and social pressure. Lifestyle is important because it affects quality of life and has important role in prevention. This study aimed to compare the lifestyle of hemodialysis patients and outpatients in health clinics of Tabriz.

METHODS

This was a case-control study on 155 hemodialysis patients and 155 outpatients referring to five dialysis centers and clinics, who met the inclusion criteria. Demographic data and some questions about lifestyle in nutrition, stress, physical activity and smoking were asked.

RESULTS

The history of hypertension among hemodialysis patients was 34.6% greater than outpatients. High daily salt consumption (more than two tablespoons a day) was 40.5% higher among hemodialysis patients than outpatients. In terms of saturated oil intake, it was 30.8%higher among hemodialysis patients. Problem in communicating with family members was 69.8% higher in hemodialysis patients. In terms of physical activity, 46.4% of outpatients had higher physical activity like walking.

CONCLUSION

Lifestyle in different dimensions was associated with chronic kidney disease (CKD); therefore, the officials of health system are recommended to develop a program to combat chronic diseases and integrate it with providing the first-level health services. It seems that public education can have a major role in life-style modification and in chronic kidney diseases prevention.

Association of waist circumference and body mass index with all-cause mortality in CKD: The REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study

BACKGROUND

Obesity management requires understanding the mortality risks associated with different adiposity measures.

STUDY DESIGN

Prospective cohort.

SETTING & PARTICIPANTS

5,805 adults with body mass index (BMI) ≥18.5 kg/m(2) and stages 1-4 chronic kidney disease, defined as a spot urine albumin-creatinine ratio ≥30 mg/g and/or estimated glomerular filtration rate <60 mL/min/1.73 m(2), enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study.

PREDICTOR

BMI categorized as 18.5-24.9, 25.0-29.9, 30.0-34.9, 35.0-39.9, and ≥40 kg/m(2) and waist circumference categorized as <80, 80-87.9, 88-97.9, 98-107.9, and ≥108 cm in women and <94, 94-101.9, 102-111.9, 112-121.9, and ≥122 cm in men.

OUTCOMES

All-cause mortality.

MEASUREMENTS

BMI and waist circumference were measured using a standardized protocol during the home visit.

RESULTS

686 (11.8%) deaths occurred during a median follow-up of 4 years. Compared with the referent BMI category of 25-29.9 kg/m(2), HRs for mortality were 1.27 (95% CI, 0.96-1.69) for BMI <25 kg/m(2) and 0.84 (95% CI, 0.62-1.13), 0.81 (95% CI, 0.52-1.26), and 0.95 (95% CI, 0.54-1.65) for BMI categories 30-34.9, 35-39.9, and ≥40 kg/m(2) after adjustment for covariates including waist circumference, respectively. In contrast, after adjustment for covariates including BMI, higher mortality rates were noted for all waist circumference categories compared with the referent (<80 cm in women and <94 cm in men), with HRs of 1.04 (95% CI, 0.77-1.41) for waist circumference of 80-87.9 cm in women and 94-101.9 cm in men, 1.29 (95% CI, 0.92-1.81) for waist circumference of 88-97.9 cm in women and 102-111.9 cm in men, 1.72 (95% CI, 1.12-2.62) for waist circumference of 98-107.9 cm in women and 112-121.9 cm in men, and 2.09 (95% CI, 1.26-3.46) for waist circumference ≥108 cm in women and ≥122 cm in men.

LIMITATIONS

BMI and waist circumference measured at baseline only.

CONCLUSIONS

Waist circumference should be considered in conjunction with BMI when assessing mortality risk associated with obesity in adults with chronic kidney disease.

Proteomics database in chronic kidney disease

Databases which are useful for proteomic analysis of human kidney tissue and urine have been discussed in this article. Integration of the gene-centric and protein-centric general databases with those of human kidney tissue and urine proteomes may open a new window for research in nephrology. Proteins present in the kidney and urine provide basic tools for investigation of kidney function and disease. By comparing such databases between the healthy and diseased populations, we may be able to identify the following: proteins involved in the development of renal disease, proteins involved in progression of CKD, or new biomarker candidate proteins for either the development of renal disease or the progression of CKD.