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Beros A, Sluyter J, Hughes A, Hametner B, Wassertheurer S, Scragg R. Arterial stiffness and incident chronic kidney disease: a large population-based cohort study. J Nephrol 2024:10.1007/s40620-024-01968-x. [PMID: 38809361 DOI: 10.1007/s40620-024-01968-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/27/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND/AIMS Evidence from large population-based cohorts as to the association of arterial stiffness and incident chronic kidney disease (CKD) is mixed. This large population-based study aimed to investigate whether arterial stiffness, assessed oscillometrically, was associated with incident CKD. METHODS The study population comprised 4838 participants from the Vitamin D Assessment (ViDA) Study without known CKD (mean ± SD age = 66 ± 8). Arterial stiffness was assessed from 5 April, 2011 to 6 November, 2012 by way of aortic pulse wave velocity, estimated carotid-femoral pulse wave velocity, and aortic pulse pressure. Incident CKD was determined by linkage to national hospital discharge registers. Cox proportional hazards regression was used to assess the risk of CKD in relation to chosen arterial stiffness measures over the continuum and quartiles of values. RESULTS During a mean ± SD follow-up of 10.5 ± 0.4 years, 376 participants developed incident CKD. Following adjustment for potential confounders, aortic pulse wave velocity (hazard ratio (HR) per SD increase 1.69, 95% CI 1.45-1.97), estimated carotid-femoral pulse wave velocity (HR per SD increase 1.84, 95% CI 1.54-2.19), and aortic pulse pressure (HR per SD increase 1.37, 95% CI 1.22-1.53) were associated with the incidence of CKD. The risk of incident CKD was, compared to the first quartile, higher in the fourth quartile of aortic pulse wave velocity (HR 4.72, 95% CI 2.69-8.27; Ptrend < 0.001), estimated carotid-femoral pulse wave velocity (HR 4.28, 95% CI 2.45-7.50; Ptrend < 0.001) and aortic pulse pressure (HR 2.71, 95% CI 1.88-3.91; Ptrend < 0.001). CONCLUSIONS Arterial stiffness, as measured by aortic pulse wave velocity, estimated carotid-femoral pulse wave velocity, and aortic pulse pressure may be utilised in clinical practice to help identify people at risk of future CKD. TRIAL REGISTRATION www.anzctr.org.au identifier:ACTRN12611000402943.
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Affiliation(s)
- Angela Beros
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - John Sluyter
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Alun Hughes
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Bernhard Hametner
- Center for Health and Bioresources, AIT Austrian Institute of Technology, Vienna, Austria
| | | | - Robert Scragg
- School of Population Health, University of Auckland, Auckland, New Zealand.
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Yu D, Osuagwu UL, Pickering K, Baker J, Cutfield R, Wang Z, Cai Y, Orr-Walker BJ, Sundborn G, Zhao Z, Simmons D. Adverse Clinical Outcomes Attributable to Socioeconomic and Ethnic Disparities Among People with Type 2 Diabetes in New Zealand Between 1994-2018: A Multiple Linked Cohort Study. Clin Epidemiol 2023; 15:511-523. [PMID: 37153075 PMCID: PMC10162107 DOI: 10.2147/clep.s402307] [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: 01/10/2023] [Accepted: 04/17/2023] [Indexed: 05/09/2023] Open
Abstract
Purpose The study aimed to examine the separate population-level contributions of the ethnic and socioeconomic disparities among people with type 2 diabetes mellitus (T2DM) and residence in New Zealand (NZ). Patients and Methods A prospective cohort enrolled T2DM patients from 01/01/1994 into the Diabetes Care Support Service, a primary care audit program in Auckland, NZ. The cohort was linked to national registry databases (socioeconomic status, pharmaceutical claim, hospitalization, and death registration). Each cohort member was followed up till death or the study end time (31/12/2019), whichever came first. Incident clinical events (stroke, myocardial infarction (MI), heart failure (HF), end-stage renal disease (ESRD), and premature mortality (PM)) were used as outcomes. The attributable fractions (AFs) were estimated for the whole population and for specific population with NZ Europeans (NZE) and/or least deprived population as reference, both unadjusted and with adjustment for covariables by Cox Regression models. Results Among 36,267 patients, adjusted population AFs indicated 6.6(-30.8-33.3)% of PM, 17.1(5.8-27.0)% of MI, 35.3(22.6-46.0)% of stroke, 14.3(3.2-24.2)% of HF, and 15.9(6.7-24.2)% of ESRD could be attributed to deprivation; while 14.3(3.3-25.4)% of PM, -3.3(-8.3-1.5)% of MI, -0.5(-6.7-5.3)% of stroke, 4.7(0.3-8.8)% of HF, 13.3(9.9-16.6)% of ESRD could be attributed to ethnicity. Deprivation contributed a significant AF to stroke, while ethnicity was important for ESRD. Gradient of AF for deprivation indicated NZE and Asians were most affected by deprivation across outcomes. Conversely, Māori, with the highest AFs for ethnicity of PM and ESRD, were unaffected by deprivation. At same deprivations, the AFs of MI and stroke were greatest among NZE compared with other ethnic groups; the AF of ESRD was greatest among Māori and Pasifika. Conclusion Both socioeconomic deprivation and ethnicity are strongly associated with outcomes in patients with T2DM in NZ, although the extent of the deprivation gradient is greatest among NZE and Asians, and least among Māori.
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Affiliation(s)
- Dahai Yu
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, People’s Republic of China
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Uchechukwu Levi Osuagwu
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, NSW, Australia
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | | | - John Baker
- Diabetes Foundation Aotearoa, Auckland, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, Auckland, New Zealand
| | - Richard Cutfield
- Diabetes Foundation Aotearoa, Auckland, New Zealand
- Department of Diabetes and Endocrinology, Waitemata District Health Board, Auckland, New Zealand
| | - Zheng Wang
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, People’s Republic of China
| | - Yamei Cai
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, People’s Republic of China
| | - Brandon J Orr-Walker
- Diabetes Foundation Aotearoa, Auckland, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, Auckland, New Zealand
| | - Gerhard Sundborn
- Section of Pacific Health, The University of Auckland, Auckland, New Zealand
| | - Zhanzheng Zhao
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, People’s Republic of China
| | - David Simmons
- Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, People’s Republic of China
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, NSW, Australia
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
- Correspondence: David Simmons; Zhanzheng Zhao, Department of Nephrology, The First Affiliated Hospital Zhengzhou University, Zhengzhou, 450052, People’s Republic of China, Tel +61 2 4620 3899; +86 139 3852 5666, Fax +61 2 4620 3890; +86 371 6698 8753, Email ;
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Yu D, Wang Z, Cai Y, Osuagwu UL, Pickering K, Baker J, Cutfield R, Orr-Walker BJ, Sundborn G, Jayanatha K, Zhao Z, Simmons D. Ethnic differences in 25-year risk of incident chronic kidney disease among people with type 2 diabetes in New Zealand. BMJ Open Diabetes Res Care 2022; 10:10/6/e003077. [PMID: 36521879 PMCID: PMC9756147 DOI: 10.1136/bmjdrc-2022-003077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/14/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Insights into ethnic differences in the natural history of chronic kidney disease (CKD) among people with type 2 diabetes mellitus (T2DM) might inform clinical strategies to address disparities in hospitalization and mortality. Risks of CKD II-V stages over a 25-year period between New Zealand Europeans (NZEs), Māori and Pasifika, and with T2DM in Auckland, New Zealand (NZ) were compared. RESEARCH DESIGN AND METHODS As a primary care audit program in Auckland, the Diabetes Care Support Service was linked with national registration databases. People with existing CKD II-V were ruled out. To balance potential confounders, we applied a tapered matching method . 'Quasi-trial'-matched cohorts were set up separately between Māori and NZE and between Pasifika and NZE. Ethnic population differences in risk of any and each stage of CKD over 1994-2018 were examined by weighted Cox regression model. RESULTS The HRs for developing any CKD, CKD stages II-V for Māori (n=2215) versus NZE (n=2028) were 1.18 (95% CI 0.99 to 1.41), 1.10 (95% CI 0.91 to 1.32), 1.70 (95% CI 1.19 to 2.43), 3.93 (95% CI 2.16 to 7.14), and 3.74 (95% CI 1.74 to 8.05), respectively. Compared with NZE (n=2474), the HRs for developing any CKD, CKD stages II-V for Pasifika (n=3101) were 1.31 (95% CI 1.09 to 1.57), 1.26 (95% CI 1.05 to 1.52), 1.71 (95% CI 1.14 to 2.57), 3.75 (95% CI 1.40 to 10.05), and 4.96 (95% CI 1.56 to 15.75), respectively. CONCLUSIONS Among people with T2DM in NZ, significant ethnic differences exist in the risk of progressing to each stage of CKD (stage V in particular). Mechanism studies underlying these differences, as well as the need for identification of biomarkers to predict the early onset renal lesion, are warranted.
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Affiliation(s)
- Dahai Yu
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, People's Republic of China
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Zheng Wang
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yamei Cai
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, People's Republic of China
| | | | | | - John Baker
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, Auckland, New Zealand
| | - Richard Cutfield
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Waitemata District Health Board, Auckland, New Zealand
| | - Brandon J Orr-Walker
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, Auckland, New Zealand
| | - Gerhard Sundborn
- Section of Pacific Health, the University of Auckland, Auckland, New Zealand
| | - Kalpa Jayanatha
- Department of Renal Medicine, Counties Manukau Health, Auckland, New Zealand
- Faculty of Medical and Health Sciences, the University of Auckland, Auckland, New Zealand
| | - Zhanzheng Zhao
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, People's Republic of China
| | - David Simmons
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, People's Republic of China
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
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Tafuna'i M, Turner R, Matalavea B, Voss D, Hazelman L, Richards R, Walker R. Results of a community-based screening programme for chronic kidney disease and associated risk factors, (obesity, diabetes and hypertension) in a Samoan cohort. BMJ Open 2022; 12:e056889. [PMID: 35396298 PMCID: PMC8996012 DOI: 10.1136/bmjopen-2021-056889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES In 2019, under the World Kidney Day theme of 'Kidney health for everyone everywhere', the National Kidney Foundation of Samoa undertook an extensive community screening campaign to detect the estimated prevalence of chronic kidney disease (CKD) and its associated risk factors in the community. SETTING Fifteen screening sites, with 11 urban and rural sites on the main island of Upolu, and 4 in different rural areas on the island of Savaii. PARTICIPANTS All participants were self-referrals to the various screening sites. In total, 1163 Samoans were screened, with similar numbers from both urban and rural areas and similar numbers of female and male. SCREENING ACTIVITIES All participants were screened for CKD using point of care serum creatinine determinations, with calculation of estimated glomerular filtration rate using the CKD-EPI formula and dipstix urinalysis. A standardised screening survey was used to capture demographic and medical history with associated risk factors of obesity, diabetes, using point of care determination of HbA1c and hypertension. Logistic regression was used to investigate the association of CKD with risk factors. RESULTS In total, 1163 people were screened for CKD within the month of March 2019. The prevalance of CKD (grades 1-5) was 44.5% (95% CI 41.6% to 47.4) with individual grade prevalence CKD 1: 3.7%, CKD 2: 6.1%, CKD 3: 30.7%, CKD 4: 2.9% and CKD 5: 1.0%. The prevalence of obesity (body mass index ≥32), diabetes and hypertension was 66.3%, 30.8% and 54.3%, respectively. CONCLUSIONS This is the first paper to report the estimated prevalence of CKD in Samoa or any other Pacific Island nation. It reveals an urgent need for further studies on the epidemiology of CKD in Samoa, to develop country-specific prevention strategies to mitigate this growing burden and prevent subsequent CKD associated complications including development of kidney failure and premature death.
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Affiliation(s)
- Malama Tafuna'i
- National Kidney Foundation of Samoa, Apia, Samoa
- Centre for Pacific Health, University of Otago Division of Health Sciences, Dunedin, New Zealand
| | - Robin Turner
- Centre for Biostatistics, University of Otago Division of Health Sciences, Dunedin, New Zealand
| | | | | | | | - Rosalina Richards
- Centre for Pacific Health, University of Otago Division of Health Sciences, Dunedin, New Zealand
| | - Robert Walker
- Medicine, University of Otago Medical School, Dunedin, New Zealand
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Tafuna'i M, Turner RM, Richards R, Sopoaga F, Walker R. The prevalence of chronic kidney disease in Samoans living in Auckland, New Zealand. Nephrology (Carlton) 2022; 27:248-259. [PMID: 34698436 DOI: 10.1111/nep.13990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/11/2021] [Accepted: 10/20/2021] [Indexed: 11/27/2022]
Abstract
AIMS Pacific peoples have higher rates of chronic kidney disease (CKD) and are five times more likely to commence kidney replacement therapy compared with New Zealand (NZ) Europeans. As the majority live Auckland, this study looked at the prevalence of CKD in two Auckland Pacific Island health providers caring for a large proportion of Pacific peoples, of which almost 50% are Samoan, as well as NZ Europeans. METHODS De-identified information was requested on individuals who had two or more CKD tests (serum creatinine and urinary albumin creatinine ratios) more than 3 months apart. CKD prevalence across different demographic groups was determined. Logistic regression was used to look at associations of known risk factors and CKD. RESULTS Data from 25 127 patients was evaluated. Of the total sample, 7451 individuals identified as Samoans. The prevalence of CKD amongst all Samoans in this sample was 17.8% increasing to 36.3% in those Samoans that had been tested for CKD. The prevalence of CKD in this total sample was 13% increasing to 27.5% considering only those who had CKD testing. The odds of Samoans having CKD (adjOR: 1.9 [95%CI 1.7, 2.2]), all other Pacific Island ethnicities identified and NZ Maori (adjOR:1.5 [95%CI 1.3, 1.8]), were increased compared with non-Māori-non-Pacific (likelihood p value <.001). CONCLUSION We report the high prevalence of CKD (15.9%-33.4%) in Samoans living in New Zealand. This reveals an urgent need for further studies to develop strategies to prevent or reduce the development of kidney failure and premature death.
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Affiliation(s)
- Malama Tafuna'i
- National Kidney Foundation of Samoa, Apia, Samoa
- Centre for Pacific Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Robin M Turner
- Centre for Biostatistics, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Rosalina Richards
- Centre for Pacific Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Fa'afetai Sopoaga
- Centre for Pacific Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Robert Walker
- Department of Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
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Ethnic differences in mortality and hospital admission rates between Māori, Pacific, and European New Zealanders with type 2 diabetes between 1994 and 2018: a retrospective, population-based, longitudinal cohort study. LANCET GLOBAL HEALTH 2021; 9:e209-e217. [DOI: 10.1016/s2214-109x(20)30412-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 07/07/2020] [Accepted: 09/09/2020] [Indexed: 01/06/2023]
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Tafuna'i M, Matalavea B, Voss D, Turner RM, Richards R, Sopoaga F, Hazelman L, Walker R. Kidney failure in Samoa. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2020; 5:100058. [PMID: 34327396 PMCID: PMC8315401 DOI: 10.1016/j.lanwpc.2020.100058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND There is limited literature on kidney disease in the Pacific Region, despite it being recognised as a leading cause of death in some Pacific Island nations. Kidney replacement therapy is only available in a handful of Pacific Islands. This paper reports the epidemiology of haemodialysis patients in Samoa. METHODS Registry data from the National Kidney Foundation of Samoa was analysed to estimate the incidence and prevalence rates of kidney failure from the rates of haemodialysis in Samoa and to explore some of the demographic features related to kidney failure in Samoa. FINDINGS In total, 393 patients have received long-term haemodialysis in the National Kidney Foundation of Samoa since its inception in 2005 until August 2019. 43% of the haemodialysis population were women and the mean age of people dialysed was 54.9 years. The crude mean incidence rate of kidney failure in Samoa, based on treated kidney failure cases, is 224 patients per million population with a crude prevalence of 629 patients per million population. Diabetic nephropathy (69.4%) was the leading cause of kidney failure. INTERPRETATION This is the first paper to report the epidemiology of haemodialysis patients in Samoa and reveals an urgent need for further studies on the extent of chronic kidney disease, and kidney failure, in Samoa to develop country specific prevention strategies to mitigate this growing burden and optimise care for kidney failure patients in Samoa. FUNDING : No funding was received for this study.
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Affiliation(s)
- Malama Tafuna'i
- National Kidney Foundation of Samoa, Apia, Samoa
- Centre for Pacific Health, Division of Health Sciences, University of Otago, Dunedin, PO Box 56, Dunedin 9054, New Zealand
| | | | - David Voss
- KidneyKare, Glen Innes, Auckland, New Zealand
| | - Robin M. Turner
- Centre for Biostatistics, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Rosalina Richards
- Centre for Pacific Health, Division of Health Sciences, University of Otago, Dunedin, PO Box 56, Dunedin 9054, New Zealand
| | - Fa'afetai Sopoaga
- Centre for Pacific Health, Division of Health Sciences, University of Otago, Dunedin, PO Box 56, Dunedin 9054, New Zealand
| | | | - Robert Walker
- Department of Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
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Abstract
Chronic kidney disease (CKD) disproportionately affects Māori (the indigenous people of New Zealand [NZ]) as well as Pacific people, particularly from Samoa, Tonga, and Fiji. As New Zealand is home to the largest population of Pacific people, New Zealand and the Pacific Islands fulfil the definition of a CKD 'hotspot'. Although diabetic nephropathy is the major cause of CKD, with disproportionately higher rates in NZ Māori and Pacific people, there is increasing evidence that there is a familial predisposition to CKD that is not due to diabetes. Further studies are required to understand the reasons for this pre-disposition.
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Affiliation(s)
- Robert J Walker
- Department of Medicine, University of Otago, Dunedin, New Zealand.
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Lloyd H, Li G, Tomlin A, Tilyard MW, Walker R, Schollum J. Prevalence and risk factors for chronic kidney disease in primary health care in the southern region of New Zealand. Nephrology (Carlton) 2018; 24:308-315. [PMID: 29717528 DOI: 10.1111/nep.13395] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2018] [Indexed: 11/27/2022]
Abstract
AIM While the prevalence of end stage kidney disease in New Zealand (NZ) is well defined, the prevalence of chronic kidney disease (CKD) in NZ is unknown. To estimate the prevalence of and risk factors for CKD in the southern region of New Zealand. METHODS A retrospective electronic health record cohort study using data from the Southern Primary Care register covering 94% of the population. Patients, 20 years or older were identified and linked to laboratory results for serum creatinine and urinary albumin excretion. Chronic kidney disease was defined as an estimated glomerular filtration rate of less than 60 mL/min per 1.73 m2 (G3-5) or the presence of albuminuria of greater than 3 mg/mmol (A2-3). Diabetes was identified from a national virtual diabetes database. From this, we estimated the prevalence of CKD by age, gender, ethnicity, deprivation and the presence of diabetes mellitus. RESULTS Of a total adult population of 211 980, 159 799 had a serum creatinine checked and 27 905 had an estimate of albuminuria. The estimated prevalence of CKD was 11.8%. 6.3% of total population had CKD stage G3a, 2.4% G3b, 0.8% G4, 0.2% G5, 1.8% A2 albuminuria and 0.3% A3 albuminuria. Increasing age, female sex, ethnic group, social deprivation and diabetes mellitus were associated with an increased risk of CKD. 11 351 patients had a diagnosis of diabetes mellitus and were almost universally tested (99.3%) for CKD. The presence of albuminuria was strongly correlated with ethnic group, male sex and living in a deprived area. The retrospective electronic health record study with associated selection and testing bias are potential limitations of the present study. CONCLUSION Chronic kidney disease prevalence in this region appears to be similar to other reported populations. The majority of those at risk for CKD were tested for reduced eGFR. The presence of albuminuria, an integral component of CKD diagnostic criteria, was under utilized in the non-diabetic population.
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Affiliation(s)
- Hywel Lloyd
- Department of General Practice & Rural Health, University of Otago, Dunedin, New Zealand
| | - Grace Li
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Murray W Tilyard
- Department of General Practice & Rural Health, University of Otago, Dunedin, New Zealand
| | - Robert Walker
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - John Schollum
- Department of Medicine, University of Otago, Dunedin, New Zealand
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Obrador GT, Schultheiss UT, Kretzler M, Langham RG, Nangaku M, Pecoits-Filho R, Pollock C, Rossert J, Correa-Rotter R, Stenvinkel P, Walker R, Yang CW, Fox CS, Köttgen A. Genetic and environmental risk factors for chronic kidney disease. Kidney Int Suppl (2011) 2017; 7:88-106. [PMID: 30675423 DOI: 10.1016/j.kisu.2017.07.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
In order to change the current state of chronic kidney disease knowledge and therapeutics, a fundamental improvement in the understanding of genetic and environmental causes of chronic kidney disease is essential. This article first provides an overview of the existing knowledge gaps in our understanding of the genetic and environmental causes of chronic kidney disease, as well as their interactions. The second part of the article formulates goals that should be achieved in order to close these gaps, along with suggested timelines and stakeholders that are to be involved. A better understanding of genetic and environmental factors and their interactions that influence kidney function in healthy and diseased conditions can provide novel insights into renal physiology and pathophysiology and result in the identification of novel therapeutic or preventive targets to tackle the global public health care problem of chronic kidney disease.
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Affiliation(s)
- Gregorio T Obrador
- Department of Epidemiology, Biostatistics and Public Health, Universidad Panamericana School of Medicine, Mexico City, Mexico
| | - Ulla T Schultheiss
- Institute of Genetic Epidemiology, Medical Center and Faculty of Medicine-University of Freiburg, Freiburg, Germany.,Renal Division, Department of Medicine IV, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Matthias Kretzler
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA
| | - Robyn G Langham
- Monash Rural Health, Monash University, Clayton VIC, Australia
| | - Masaomi Nangaku
- Department of Hemodialysis and Apheresis, Division of Nephrology and Endocrinology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Roberto Pecoits-Filho
- Department of Internal Medicine, School of Medicine, Pontificia Universidade Catolica do Paraná, Curitiba, Brazil
| | - Carol Pollock
- Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | | | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zuibrán, Mexico City, Mexico
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Robert Walker
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Chih-Wei Yang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Caroline S Fox
- Genetics and Pharmacogenomics, Merck Research Laboratories, Boston, Massachusetts, USA
| | - Anna Köttgen
- Institute of Genetic Epidemiology, Medical Center and Faculty of Medicine-University of Freiburg, Freiburg, Germany
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Tan J, Zwi LJ, Collins JF, Marshall MR, Cundy T. Presentation, pathology and prognosis of renal disease in type 2 diabetes. BMJ Open Diabetes Res Care 2017; 5:e000412. [PMID: 28878938 PMCID: PMC5574462 DOI: 10.1136/bmjdrc-2017-000412] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 07/07/2017] [Accepted: 07/11/2017] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Non-diabetic renal disease (NDRD) is common in patients with type 2 diabetes (T2D), but the relationship between its presentation and prognosis is unknown. RESEARCH DESIGN AND METHODS In a retrospective cohort study, we compared renal and patient survival among 263 patients with T2D who had native renal biopsies between 2002 and 2008 from three Auckland hospitals in New Zealand. The presence of diabetic nephropathy (DN), NDRD or mixed (DN and NDRD) was determined from biopsy. We examined clinical associations according to NDRD etiologies and mode of presentation-acute (defined by acute kidney injury (AKI)) or non-acute. Patients were followed until end-stage renal disease, death or December 2015. Survival was compared using Log-rank test. RESULTS 94 (36%) patients had DN, 72 (27%) had NDRD, and 97 (37%) had mixed pathologies. Obesity-related focal segmental glomerulosclerosis was the most common NDRD (46%) in patients with non-acute presentations, whereas interstitial nephritis or immune-complex glomerulonephritides were the most prevalent in those with acute presentations (60%). DN was commonly associated with AKI (p<0.001). The prevalence of DN increased with diabetes duration (p<0.001), but NDRD was still found in 55% of subjects with ≥14 years T2D. NDRD was strongly associated with the absence of retinopathy (p<0.001). Renal survival was best in the NDRD group (p<0.001). Among those with DN, renal prognosis was worse in those with more advanced DN lesions and those with an acute presentation (p<0.001). The proportion of all-cause mortality was similar in all three groups, but overall survival was poorest in the DN group (p=0.025). CONCLUSIONS Renal disease in patients with T2D is heterogeneous. The renal prognosis differs markedly according to histopathological diagnosis and mode of presentation.
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Affiliation(s)
- Jasmine Tan
- Auckland Diabetes Centre, Green Lane Clinical Centre, Auckland, New Zealand
- Department of Renal Medicine, North Shore Hospital, Auckland, New Zealand
| | - L Jonathan Zwi
- Department of Anatomical Pathology, Auckland City Hospital, Auckland, New Zealand
| | - John F Collins
- Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Mark R Marshall
- Department of Renal Medicine, Middlemore Hospital, Auckland, New Zealand
| | - Tim Cundy
- Auckland Diabetes Centre, Green Lane Clinical Centre, Auckland, New Zealand
- Department of Medicine, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
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Burling F, Ng J, Thein H, Ly J, Marshall MR, Gow P. Ethnic, clinical and immunological factors in systemic lupus erythematosus and the development of lupus nephritis: results from a multi-ethnic New Zealand cohort. Lupus 2016; 16:830-7. [PMID: 17895308 DOI: 10.1177/0961203307080225] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The aim of this study was to identify risk factors for lupus nephritis including clinical, laboratory, and ethnic factors in a cohort of lupus patients in New Zealand. A retrospective study of patients from two teaching hospitals in Auckland, New Zealand. Patients were selected if they had attended as either an inpatient, or a rheumatology outpatient between 2000 and 2005. 170 patients had SLE according to ACR classification. Lupus nephritis (LN) was diagnosed according to ACR criteria. Clinical, laboratory, and ethnic data were gathered from the patient notes. Twenty-four patients had LN at diagnosis and 32 patients developed LN after diagnosis. LN was associated with serositis ( P = 0.008), cutaneous vasculitis ( P = 0.026), anaemia ( P = 0.005), CRP elevation >6 months ( P < 0.001), hypocomplementaemia >6 months ( P < 0.0001). Patients with elevated doublestranded DNA (dsDNA) (>5 × normal) were more likely to develop type IV LN ( P = 0.0096). Forty-one percent of patients were Caucasian, 12% Maori, 23% Pacific People, 16% Asian, 6% Indian. Maori patients with SLE (odds ratio (OR) = 8.47, 95% confidence interval (CI) = 2.11—33.96, P = 0.002), and Pacific People (OR = 3.11, 95% CI = 1.29—11.48, P = 0.014) had increased risk for developing LN. Anaemia at presentation (hazard ratio (HR) 3.2, 95% CI = 1.4—7.1, P = 0.004), and low complement >6 months (HR = 3.4, 95% CI = 1.4—8.7, P = 0.008) were independent risk factors for developing LN after SLE diagnosis. In New Zealand, Pacific People and Maori patients with SLE have a higher incidence of LN, and patients with anaemia and hypocomplementaemia are more likely to develop LN after diagnosis. Patients with high dsDNA levels are more likely to develop Type IV lupus nephritis. Lupus (2007) 16, 830—837.
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Affiliation(s)
- F Burling
- Department of Medicine, Middlemore Hospital, Private Bag 93311, Auckland, New Zealand.
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Kenealy T, Elley CR, Collins JF, Moyes SA, Metcalf PA, Drury PL. Increased prevalence of albuminuria among non-European peoples with type 2 diabetes. Nephrol Dial Transplant 2011; 27:1840-6. [DOI: 10.1093/ndt/gfr540] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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McCarthy A, Shaban R, Stone C. Fa’afaletui: A Framework for the Promotion of Renal Health in an Australian Samoan Community. J Transcult Nurs 2010; 22:55-62. [DOI: 10.1177/1043659610387154] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: Samoan communities in Australia exhibit a disproportionate rate of kidney disease compared with other Australians. This article describes a research project that used a culturally sensitive framework, Fa’afaletui, to help reduce the barriers of language and culture and increase our understanding of the factors contributing to kidney disease, in one Samoan community in Australia. Design: Semistructured group interviews were undertaken with Samoan community families and groups. The interviews were analyzed according to key concepts embedded in the Fa’afaletui framework. Findings: Four factors associated with health risks in this Samoan community emerged: diet and exercise, issues related to the collective (incorporating the village, church, and family), tapu or cultural protocols, and the importance of language. Conclusions: The findings suggest that future kidney health promotion initiatives within this Samoan community will be more effective if they are sensitive to Samoan cultural norms, language, and context.
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Affiliation(s)
- Alexandra McCarthy
- Queensland University of Technology, Kelvin Grove, Queensland, Australia,
| | - Ramon Shaban
- Griffith University, Meadowbrook, Queensland, Australia
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15
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Thomas MC, Macisaac RJ, Jerums G, Weekes A, Moran J, Shaw JE, Atkins RC. Nonalbuminuric renal impairment in type 2 diabetic patients and in the general population (national evaluation of the frequency of renal impairment cO-existing with NIDDM [NEFRON] 11). Diabetes Care 2009; 32:1497-502. [PMID: 19470839 PMCID: PMC2713618 DOI: 10.2337/dc08-2186] [Citation(s) in RCA: 154] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2008] [Accepted: 05/06/2009] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Most diabetic patients with impaired renal function have a urinary albumin excretion rate in the normal range. In these patients, the etiology of renal impairment is unclear, and it is also unclear whether this nonalbumunuric renal impairment is unique to diabetes. RESEARCH DESIGN AND METHODS In this study, we examined the frequency and predictors of nonalbumunuric renal impairment (estimated glomerular filtration rate [eGFR] <60 ml/min per 1.73 m(2)) in a nationally representative cohort of 3,893 patients with type 2 diabetes and compared our findings with rates observed in the general population from the Australian Diabetes, Obesity and Lifestyle Study (AusDiab) survey (n = 11,247). RESULTS Of the 23.1% of individuals with type 2 diabetes who had eGFR <60 ml/min per 1.73 m(2) (95% CI 21.8-24.5%), more than half (55%) had a urinary albumin excretion rate that was persistently in the normal range. This rate of renal impairment was predictably higher than that observed in the general population (adjusted odds ratio 1.3, 95% CI 1.1-1.5, P < 0.01) but was solely due to chronic kidney disease associated with albuminuria. In contrast, renal impairment in the absence of albuminuria was less common in those with diabetes than in the general population, independent of sex, ethnicity, and duration of diabetes (0.6, 0.5-0.7, P < 0.001). CONCLUSIONS Nonalbuminuric renal impairment is not more common in those with diabetes. However, its impact may be more significant. New studies are required to address the pathogenesis, prevention, and treatment of nonalbuminuric renal disease.
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Affiliation(s)
- Merlin C Thomas
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
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Joshy G, Dunn P, Fisher M, Lawrenson R. Ethnic differences in the natural progression of nephropathy among diabetes patients in New Zealand: hospital admission rate for renal complications, and incidence of end-stage renal disease and renal death. Diabetologia 2009; 52:1474-8. [PMID: 19436991 DOI: 10.1007/s00125-009-1380-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Accepted: 04/09/2009] [Indexed: 11/26/2022]
Abstract
AIMS/HYPOTHESIS We estimated the incidence of chronic renal failure, the incidence of end-stage renal disease (ESRD) and renal mortality rates among New Zealand European and Maori patients with diabetes and estimated the ethnic difference in the risk of developing renal failure. METHODS A renal complication-free cohort of adult diabetes patients registered with Waikato regional diabetes service, diagnosed with diabetes before 2003, were retrospectively followed for 4 years. Events of interest were renal hospital admission, ESRD and death coded with renal disease. Incidences of renal hospital admission, ESRD and death from renal disease were calculated for NZ Europeans and Maori patients with diabetes. Ethnic and sex differences in the risks of these renal outcomes were estimated using a Cox proportional hazards model. RESULTS Of the 7,900 patients followed up, 116 (1.5%) had a renal admission, 42 (0.5%) started dialysis/transplantation and 21 (0.27%) died from renal disease. Maori diabetes patients had significantly higher incidences of dialysis or transplantation and rates of renal admission and renal death. Adjusted hazard ratios indicate that, compared with NZ Europeans with diabetes, Maori diabetes patients had a significantly higher risk of ESRD, renal admission and renal death (46-fold, seven-fold and four-fold increases, respectively). Maori patients progressed at a significantly faster rate from first hospital admission for chronic renal disease to ESRD. CONCLUSIONS/INTERPRETATION There were huge ethnic disparities in outcomes from renal disease. Screening for early kidney disease among Maori diabetes patients, intensive management of risk factors and further research on the aetiology of renal disease among Maoris is recommended.
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Affiliation(s)
- G Joshy
- Waikato Clinical School, Waikato Hospital Hamilton, Private Bag 3200, Hamilton, New Zealand.
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Lim S, Chellumuthi C, Crook N, Rush E, Simmons D. Low prevalence of retinopathy, but high prevalence of nephropathy among Maori with newly diagnosed diabetes-Te Wai o Rona: Diabetes Prevention Strategy. Diabetes Res Clin Pract 2008; 80:271-4. [PMID: 18242758 DOI: 10.1016/j.diabres.2007.12.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Accepted: 12/19/2007] [Indexed: 10/22/2022]
Abstract
AIMS/HYPOTHESIS To describe the prevalence of retinopathy and microalbuminuria at diagnosis of diabetes in a predominantly Maori study population. METHODS Biomedical assessment including photographic retinal examination was undertaken among 157 (68.9% of eligible) members of Maori families (3.3% non-Maori) diagnosed with diabetes during a community screening programme (n=5240) as part of a diabetes prevention strategy. RESULTS Mean HbA1c of those with newly diagnosed diabetes was 7.8+/-1.5% with 34.4% having an HbA1c >/=8.0%. Retinopathy was present in 3 (1.7%) subjects, cataracts in 3.2%, microalbuminuria in 29.6% and albuminuria in 7.7%. After adjusting for covariates, only smoking was a risk factor for microalbuminuria/proteinuria (current and former smokers: increased 3.81(1.32-11.0) and 3.67(1.30-10.4) fold, respectively). CONCLUSIONS The prevalence of retinopathy at diagnosis was lower than in previous studies, yet that of microalbuminuria/proteinuria remained high. The retinopathy data suggest that case detection for diabetes in the community may be improving, but that other strategies among those at risk of diabetes, including those promoting smoking cessation, will be needed to reduce the risk of renal disease among Maori with diabetes.
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References. Am J Kidney Dis 2007. [DOI: 10.1053/j.ajkd.2006.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Freedman BI, Volkova NV, Satko SG, Krisher J, Jurkovitz C, Soucie JM, McClellan WM. Population-based screening for family history of end-stage renal disease among incident dialysis patients. Am J Nephrol 2005; 25:529-35. [PMID: 16179780 DOI: 10.1159/000088491] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2005] [Accepted: 08/18/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND We determined the familial aggregation of end-stage renal disease (ESRD) in a large, population-based sample of incident ESRD cases to assess the feasibility of developing a targeted screening and prevention program directed at members of families at high risk for kidney disease. METHODS Between January 1, 1995, and December 31, 2003, incident dialysis patients in ESRD Network 6 facilities were asked to complete a voluntary questionnaire on family history (FH) of ESRD. Cases with ESRD attributed to Mendelian diseases or urologic causes were excluded. FH was considered present if first- or second-degree relatives had ESRD. De-identified FH data were collated with demographic data at dialysis initiation. RESULTS More than 46% of eligible patients (25,883/55,929) provided FH information and 22.8% (5,901/25,883) of these reported having a FH of ESRD. FH of ESRD was positively associated with female gender, earlier age at ESRD onset, and primary cause of ESRD, and negatively associated with white race. FH associations with age, race, gender, and primary cause of renal failure remained statistically significant after simultaneous adjustment in a multivariate logistic regression model. CONCLUSIONS Approximately 23% of incident dialysis patients have close relatives with ESRD. Far more are likely to have relatives with clinically silent proteinuria or chronic kidney disease (CKD), both risk factors for future cardiovascular events and ESRD. Physicians caring for patients with CKD should be aware of the marked familial aggregation of ESRD and consider focusing screening efforts on high-risk family members in an attempt to slow the exponential growth rate of kidney disease.
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Affiliation(s)
- Barry I Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1053, USA.
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Abstract
Kidney disease is highly prevalent in the United States population and groups at high risk for increased prevalence of CKD include individuals with a family history of ESRD, diabetes, hypertension, and cardiovascular disease. Despite the increased risk of ESRD observed for blacks compared with whites, racial disparities in the prevalence of kidney disease have not been consistently demonstrated in the United States population. Although the reasons for discrepancy in risk of ESRD and CKD have not been established, clinicians should be aware that more rapid progression of CKD among blacks is a possible explanation for this observation and that closer monitoring and intensive care of risk factors associated with progressive renal injury is warranted for blacks with CKD and in other high-risk groups. Therapeutic interventions that delay or prevent progressive kidney disease are well established and incorporated into widely disseminated clinical practice guidelines. These interventions include aggressive blood pressure control with agents that block the renin-angiotensin system, reduction of dietary protein to recommended levels for the American diet, weight loss, smoking cessation, and control of hyperlipidemia. These interventions also reduce the risk of cardiovascular disease and should be regarded as essential components of care of CKD. Achieving high levels of medically appropriate care of CKD patients and reduction in risk of progression to ESRD may be delayed by barriers created by individual and regional poverty.
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Affiliation(s)
- William M McClellan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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Zhu XX, Pan CY, Li GW, Shi HL, Tian H, Yang WY, Jiang J, Sun XC, Davies C, Chow WH. Addition of rosiglitazone to existing sulfonylurea treatment in chinese patients with type 2 diabetes and exposure to hepatitis B or C. Diabetes Technol Ther 2003; 5:33-42. [PMID: 12725705 DOI: 10.1089/152091503763816445] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The effects of adding rosiglitazone to existing sulfonylurea (SU) treatment have not previously been studied in Chinese patients with type 2 diabetes and no known pre-existing hepatic impairment. Patients were randomized to receive rosiglitazone 2 mg twice daily (R4 + SU) or 4 mg twice daily (R8 + SU) or placebo (SU + P) for 24 weeks in addition to existing SU treatment. Most patients were taking concomitant glibenclamide (34%) or gliclazide (25%). Changes in glycosylated hemoglobin (HbA(1c)), fasting plasma glucose (FPG), and plasma insulin concentrations were measured. Of the 530 patients enrolled (45% male, mean age 59 years), 105 were in the SU + P group, 215 in the R4 + SU group, and 210 in the R8 + SU group. The mean baseline HbA(1c) was 9.8%, and FPG was 183.8 mg/dL. Compared with placebo, addition of rosiglitazone (2 or 4 mg twice daily) produced significant decreases in mean HbA(1c) (1.04% and 1.44%, respectively; p < 0.0001) and FPG (21.6 and 36.0 mg/dL, respectively; p < 0.0001). There were statistically significant (p < 0.0001) reductions from baseline in insulin concentration of 23.3 and 30.4 pmol/L in the R4 + SU and R8 + SU groups, respectively. Despite the high prevalence of seropositivity for hepatitis B and/or C at baseline (56%), there was no evidence of hepatotoxicity. No clinically significant changes in routine hematology, biochemistry, or electrocardiogram were observed. The addition of rosiglitazone to SU produced clinically significant improvements in glycemic control in Chinese patients with type 2 diabetes. Rosiglitazone plus SU was well tolerated irrespective of hepatitis B and C serological status.
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Affiliation(s)
- X-X Zhu
- Shanghai Huashan Hospital, Shanghai, China
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