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de Souza RAF, da Silva EF, de Oliveira DM, Colodette RM, Cotta RMM, da Silva LS, Moreira TR. Low-grade albuminuria and its relationship with cardiovascular disease risk in hypertensive and diabetic patients in primary health care. BMC Nephrol 2022; 23:257. [PMID: 35858835 PMCID: PMC9301844 DOI: 10.1186/s12882-022-02884-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 07/12/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the presence of LGA and the relationship with the 10-year risk of a cardiovascular event in hypertensive and diabetic patients in Primary Health Care. STUDY DESIGN The study design used is cross-sectional. METHODS This study was based on the application of questionnaires, anthropometric measurements, and laboratory tests carried out from August 2017 to April 2018. Logistic regression was used to evaluate the odds ratio of the explanatory variables in relation to the highest tercile of LGA. The Framingham risk score was used to assess the 10-year risk of cardiovascular event. The comparison of this score with the LGA terciles was analyzed using ANOVA. RESULTS An increase in the 10-year risk of cardiovascular event score was observed with an increasing LGA tercile, and this pattern prevailed after adjusting for confounding variables. CONCLUSION An association between LGA and the 10-year risk of cardiovascular event was observed in a representative sample of hypertensive and diabetic patients.
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Affiliation(s)
| | | | | | | | | | | | - Tiago Ricardo Moreira
- Departamento de Medicina e Enfermagem, Universidade Federal de Viçosa, Viçosa, MG, Brazil.
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Luxardo R, Ceretta L, González-Bedat M, Ferreiro A, Rosa-Diez G. The Latin American Dialysis and Renal Transplantation Registry: report 2019. Clin Kidney J 2022; 15:425-431. [PMID: 35211302 PMCID: PMC8862045 DOI: 10.1093/ckj/sfab188] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Indexed: 11/23/2022] Open
Abstract
Background Chronic kidney disease (CKD) in Latin America (LA) continues to represent a challenge due to the burden of disease it causes and the difficulty in accessing treatment. LA has a total population of 652 million people living in 20 countries that occupy an area of 19.2 million km2. The Latin American Dialysis and Renal Transplantation Registry (LADRTR), founded in 1991, has collected data and reports on patients receiving kidney replacement therapy (KRT) since 1993. This article summarizes the registry data for 2019. Methods Participating countries complete an annual survey collecting aggregated data on incident and prevalent patients on KRT in all modalities. The different treatment modalities considered were hemodialysis (HD), peritoneal dialysis (PD) and living functioning kidney graft (LFG). National gross domestic product per capita (GDP, expressed in US dollars) and life expectancy at birth (LEB) corresponding to the year 2019 were collected from the World Bank Data Bank. Prevalence and incidence were compared with previous years and were also correlated with GDP and LEB. Results On 31 December 2019 a total of 432 610 patients were in KRT in LA, corresponding to an overall unadjusted prevalence of 866 per million population (pmp). Regarding treatment modality, 66.7% of the prevalent patients were treated with HD and 9.3% with PD while 24% of the patients had an LFG. A total of 85 224 patients started KRT in LA, representing a total unadjusted incidence rate of 168 pmp. Diabetic nephropathy as a cause of CKD continues to be a relevant percentage (36%) and five countries reported CKD of nontraditional causes. The kidney transplant rate in the region was 22 pmp, varying from 1 to >60 pmp. The total prevalence of KRT correlated positively with GDP per capita (r2 = 0.6, P < 0.01) and LEB (r2 = 0.23, P < 0.05). The overall incidence rate also significantly correlated with GDP (r2 = 0.307, P < 0.05). The overall unadjusted mortality rate was 13%. Conclusion Accessibility to KRT is still limited in LA. It is necessary to continue the efforts made by each country and the Latin American Society of Nephrology and Hypertension to guarantee equal access to treatment.
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Affiliation(s)
- Rosario Luxardo
- Latin American Dialysis and Renal Transplantation Registry, Montevideo, Uruguay
- Hospital Italiano de Buenos Aires, Nephrology, Buenos Aires, Argentina
| | - Laura Ceretta
- Latin American Dialysis and Renal Transplantation Registry, Montevideo, Uruguay
| | - María González-Bedat
- Latin American Dialysis and Renal Transplantation Registry, Montevideo, Uruguay
- Sociedad Latinoamericana de Nefrología e Hipertensión, Panama City, Panama
| | - Alejandro Ferreiro
- Latin American Dialysis and Renal Transplantation Registry, Montevideo, Uruguay
- Universidad de la Republica Uruguay, Centro de Nefrología. Facultad de Medicina, Montevideo, Uruguay
| | - Guillermo Rosa-Diez
- Latin American Dialysis and Renal Transplantation Registry, Montevideo, Uruguay
- Hospital Italiano de Buenos Aires, Nephrology, Buenos Aires, Argentina
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Hettithanthri O, Sandanayake S, Magana-Arachchi D, Wanigatunge R, Rajapaksha AU, Zeng X, Shi Q, Guo H, Vithanage M. Risk factors for endemic chronic kidney disease of unknown etiology in Sri Lanka: Retrospect of water security in the dry zone. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 795:148839. [PMID: 34328928 DOI: 10.1016/j.scitotenv.2021.148839] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
The prevalence of chronic kidney disease of unknown etiology (CKDu) is receiving considerable attention due to the serious threat to human health throughout the world. However, the roles of geo-socio-environmental factors in the prevalence of the CKDu endemic areas are still unknown. Sri Lanka is one of the countries most seriously affected by CKDu, where 10 out of 25 districts have been identified as the areas with the high prevalence of CKDu (10-20%). This review summarizes the geographical distribution of CKDu and its probable geochemical, behavioral, sociological, and environmental risk factors based on research related to hydrogeochemical influences on CKDu in Sri Lanka. More than 98% of CKDu patients have consumed groundwater as their primary water source in daily life, indicating the interactions of geogenic contaminants (such as F-, total dissolved solids, Hofmeister ions) in groundwater is responsible for the disease. Apart from the hydrogeochemical factors, mycotoxins, cyanotoxins, use of some herbal medicines, dehydration, and exposure to agrochemicals were alleged as risk factors. Sociological factors, including poverty, living habits and anthropogenic activities, may also provoke the emergence of CKDu. Therefore, the interaction of geo-socio environmental risk factors should be sociologically and scientifically considered to prevent the prevalence of CKDu. Future in-depth studies are required to reveal the individual role of each of the postulated etiological factors, possibly using machine learning and advanced statistics.
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Affiliation(s)
- Oshadi Hettithanthri
- Ecosphere Resilience Research Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Sandun Sandanayake
- Ecosphere Resilience Research Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Dhammika Magana-Arachchi
- Molecular Microbiology and Human Diseases, National Institute of Fundamental Studies, Kandy, Sri Lanka
| | - Rasika Wanigatunge
- Department of Plant and Molecular Biology, Faculty of Science, University of Kelaniya, Sri Lanka
| | - Anushka Upamali Rajapaksha
- Ecosphere Resilience Research Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka; Instrument Center, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Xianjiang Zeng
- School of Water Resources and Environment, China University of Geosciences, Beijing, China
| | - Qiutong Shi
- School of Water Resources and Environment, China University of Geosciences, Beijing, China
| | - Huaming Guo
- School of Water Resources and Environment, China University of Geosciences, Beijing, China.
| | - Meththika Vithanage
- Ecosphere Resilience Research Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka; Instrument Center, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
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Aguiar LKD, Prado RR, Gazzinelli A, Malta DC. Factors associated with chronic kidney disease: epidemiological survey of the National Health Survey. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200044. [PMID: 32520099 DOI: 10.1590/1980-549720200044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 03/07/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To identify the prevalence of chronic kidney disease (CKD) self-reported in Brazil and characterize the factors associated with it. METHODS This study was a cross-sectional health survey with a household-based, the National Health Survey, performed in 2013. The outcome in the present study was the prevalence of CKD. The groups of explanatory variables were socio-demographic characteristics, lifestyles, chronic self-reported diseases, anthropometry, and health evaluation. The prevalence of CKD, e their 95% respective confidence interval were estimated, univariate analysis and the multiple logistic regression model were calculated, and remained the variables statistically significant (p < 0.05). RESULTS It noticed that 1.42% (95%CI 1.33 - 1.52) of the 60,202 interviewees self-reported CKD. The OR increased progressively with age, being 2.68 among the elderly with 65 years or more (95%CI 1.75 - 4.09). Having health plans with OR = 1.51 (95%CI 1.28 - 1.78), as well as smoking, hypertension and high cholesterol and poor self-reported health with OR = 1.75 (95%CI 1.45 - 2.12), OR = 1.20 (95%CI 1.02 - 1.42), OR = 1.83 (95%CI 1.56 - 2.15), OR = 4.70 (95%CI 3.75 - 5.88), respectively, showed a higher chance of CKD. CONCLUSIONS The associated variables were increasing age, health plan coverage, smoking, hypertension, hypercholesterolemia, and regular or poor health status. The knowledge of CKD prevalence in Brazil and risk and protection factors are essential for disease prevention and the establishment of supporting public health policies.
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Affiliation(s)
- Lilian Kelen de Aguiar
- Escola de Enfermagem, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil.,Escola Superior de Saúde, Universidade do Estado do Amazonas - Boca do Acre (AM), Brasil
| | | | - Andrea Gazzinelli
- Escola de Enfermagem, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil
| | - Deborah Carvalho Malta
- Escola de Enfermagem, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil
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Ricardo AC, Loop MS, Gonzalez F, Lora CM, Chen J, Franceschini N, Kramer HJ, Toth-Manikowski SM, Talavera GA, Daviglus M, Lash JP. Incident Chronic Kidney Disease Risk among Hispanics/Latinos in the United States: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL). J Am Soc Nephrol 2020; 31:1315-1324. [PMID: 32300066 DOI: 10.1681/asn.2019101008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 03/05/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Although Hispanics/Latinos in the United States are often considered a single ethnic group, they represent a heterogenous mixture of ancestries who can self-identify as any race defined by the U.S. Census. They have higher ESKD incidence compared with non-Hispanics, but little is known about the CKD incidence in this population. METHODS We examined rates and risk factors of new-onset CKD using data from 8774 adults in the Hispanic Community Health Study/Study of Latinos. Incident CKD was defined as eGFR <60 ml/min per 1.73 m2 with eGFR decline ≥1 ml/min per 1.73 m2 per year, or urine albumin/creatinine ratio ≥30 mg/g. Rates and incidence rate ratios were estimated using Poisson regression with robust variance while accounting for the study's complex design. RESULTS Mean age was 40.3 years at baseline and 51.6% were women. In 5.9 years of follow-up, 648 participants developed CKD (10.6 per 1000 person-years). The age- and sex-adjusted incidence rates ranged from 6.6 (other Hispanic/mixed background) to 15.0 (Puerto Ricans) per 1000 person-years. Compared with Mexican background, Puerto Rican background was associated with 79% increased risk for incident CKD (incidence rate ratios, 1.79; 95% confidence interval, 1.33 to 2.40), which was accounted for by differences in sociodemographics, acculturation, and clinical characteristics. In multivariable regression analysis, predictors of incident CKD included BP >140/90 mm Hg, higher glycated hemoglobin, lower baseline eGFR, and higher baseline urine albumin/creatinine ratio. CONCLUSIONS CKD incidence varies by Hispanic/Latino heritage and this disparity may be in part attributed to differences in sociodemographic characteristics. Culturally tailored public heath interventions focusing on the prevention and control of risk factors might ameliorate the CKD burden in this population.
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Affiliation(s)
- Ana C Ricardo
- Department of Medicine, University of Illinois, Chicago, Illinois
| | - Matthew Shane Loop
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Franklyn Gonzalez
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Claudia M Lora
- Department of Medicine, University of Illinois, Chicago, Illinois
| | - Jinsong Chen
- Department of Medicine, University of Illinois, Chicago, Illinois
| | - Nora Franceschini
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Holly J Kramer
- Department of Public Health Sciences. Loyola University, Chicago, Illinois
| | | | - Gregory A Talavera
- School of Public Health, San Diego State University, San Diego, California
| | - Martha Daviglus
- Institute for Minority Health Research, University of Illinois, Chicago, Illinois
| | - James P Lash
- Department of Medicine, University of Illinois, Chicago, Illinois
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Souza DA, Silva GEB, Fernandes IL, de Brito DJA, Muniz MPR, Neto OMV, Costa RS, Dantas M, Neto MM. The Prevalence of Nondiabetic Renal Diseases in Patients with Diabetes Mellitus in the University Hospital of Ribeirão Preto, São Paulo. J Diabetes Res 2020; 2020:2129459. [PMID: 32626777 PMCID: PMC7312549 DOI: 10.1155/2020/2129459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/25/2020] [Accepted: 05/18/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the prevalence of nondiabetic renal diseases (NDRDs) in renal biopsies of patients with diabetes mellitus (DM) in the University Hospital of Ribeirão Preto, São Paulo. Research Design and Methods. We conducted a retrospective study including kidney biopsies performed in diabetic patients between 1987 and 2013. We evaluated 79 biopsies during this period. The primary variable was the prevalence of NDRD in patients with DM. The secondary variables were the presence of systemic arterial hypertension (SAH), hematuria, time since diagnosis of DM, serum creatinine, and proteinuria levels. The cases were divided into the following groups: isolated diabetic nephropathy (DN-group I), isolated nondiabetic renal diseases (NDRD-group II), associated NDRD/DN (group III), and associated NDRD+NDRD/DN (group IV). RESULTS Most of the patients (58.22%) presented only alterations arising from DN. NDRDs were present in 41.77% of the patients. Membranous glomerulonephritis (30.3%) and IgA nephropathy (24.24%) were the most prevalent NDRDs. We found no differences between female and male patients with NDRD when assessing the secondary variables. A time since diagnosis of five years or less revealed a statistical difference (p = 0.0005) in the comparison between the isolated DN (group I) and the NDRD+NDRD/DN (group IV). The other secondary variables were not significant in the comparison of the groups. CONCLUSIONS We concluded that the prevalence of NDRD is 41.77%. Membranous glomerulonephritis was the most prevalent NDRD in our study. We also conclude that the probability of the presence of NDRD with or without concomitant DN is greater for patients who had biopsies with a time since diagnosis of five years or less. A time since diagnosis of ten years or more does not allow the exclusion of the presence of NDRD.
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Affiliation(s)
- Diego Agra Souza
- Pathology Service of the Ribeirão Preto Medical School Hospital, University of São Paulo, São Paulo, Brazil
| | - Gyl Eanes Barros Silva
- Pathology Service of the Ribeirão Preto Medical School Hospital, University of São Paulo, São Paulo, Brazil
| | - Igor Lima Fernandes
- Pathology Service of the Ribeirão Preto Medical School Hospital, University of São Paulo, São Paulo, Brazil
| | | | | | | | - Roberto Silva Costa
- Laboratory of Renal Pathology, Nephrology Division, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Márcio Dantas
- Nephrology Division, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Miguel Moyses Neto
- Nephrology Division, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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Gonzalez-Bedat MC, Rosa-Diez G, Ferreiro A. El Registro Latinoamericano de Diálisis y Trasplante Renal: la importancia del desarrollo de los registros nacionales en Latinoamérica. NEFROLOGÍA LATINOAMERICANA 2017. [DOI: 10.1016/j.nefrol.2016.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Banaga ASI, Mohammed EB, Siddig RM, Salama DE, Elbashir SB, Khojali MO, Babiker RA, Elmusharaf K, Homeida MM. Causes of end stage renal failure among haemodialysis patients in Khartoum State/Sudan. BMC Res Notes 2015; 8:502. [PMID: 26419536 PMCID: PMC4589074 DOI: 10.1186/s13104-015-1509-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 09/21/2015] [Indexed: 11/24/2022] Open
Abstract
Background End stage renal failure (ESRF) has become a major health problem in Sub Saharan Africa (SSA). There were limited data about causes of ESRF in the Sudan. Methods This is a cross sectional hospital based descriptive study. The subjects of the study are ESRF adults’ patients on regular haemodialysis treatment in 15 haemdoialysis centres in Khartoum State—Sudan. Clinical and epidemiological data were obtained from 1583 patients. The medical files of each patient were reviewed to identify the cause of ESRF. Concerning the causes of ESRF, diabetes was diagnosed based on the past medical history and result of the glucose tolerance test, hypertension was diagnosed based on past history of hypertension based on blood pressure of more than 140/90 mmHg, glomerulonephritis was diagnosed based on results of previous kidney biopsies and on clinical grounds, polycystic kidney disease and obstructive uropathy were diagnosed based on abdominal ultrasound and other imaging modalities, sickle cell anaemia was diagnosed based on the result of haemoglobin electrophoresis, systemic lupus erythematosus was diagnosed based on the clinical criteria in addition to lab results of auto antibodies, and analgesic nephropathy was diagnosed based on past medical history of chronic analgesic drugs usage with no other identifiable risk factors. We included all ESRF patients on regular haemodialysis treatment. We excluded ESRF patients less than 18 years old. Results The results showed that the mean age of ESRF Patients was 49 ± 15.8 (years) and 63.4 % were male and 76.3 % were unemployed. The mean duration of haemodialysis is 4.38 ± 4.24 (years). The most common cause of ESRF in our patients was hypertension (34.6 %) followed by chronic glomerulonephritis (17.6 %), diabetes mellitus (12.8 %), obstructive uropathy (9.6 %), autosomal dominant poly cystic kidney disease (ADPKD) (4.7 %), chronic pyelonephritis (4.6 %), analgesic nephropathy (3.5 %). However in (10.7 %) no cause was found. In patient aged less than 40 years old the leading cause of ESRF was glomerulonephritis (29.3 %) followed by hypertension (25 %). In patient aged between 40 to 60 years old the leading cause of ESRF was hypertension (38.5 %) followed by diabetes mellitus (14 %). In patient aged older than 60 years the leading cause of ESRF was hypertension (38.4 %) followed by diabetes mellitus (23.3 %). Conclusions ESRF in Sudan affects the economically productive age group; unemployment rate among ESRF patients is high. The study showed that hypertension is a leading cause of ESRF in Sudan followed by chronic glomerulonephritis. Hypertension and diabetes mellitus are the leading causes of ESRF among patients over 40 years old.
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Affiliation(s)
- Amin S I Banaga
- Haemodialysis Unit, Department of Medicine and Nephrology, University of Medical Sciences and Technology, Academy Charity Teaching Hospital, P.O. Box. 12810, Khartoum, Sudan.
| | - Elaf B Mohammed
- Department of Nephrology, Academy Charity Teaching Hospital, P.O. Box. 12810, Khartoum, Sudan.
| | - Rania M Siddig
- Department of Nephrology, Academy Charity Teaching Hospital, P.O. Box. 12810, Khartoum, Sudan.
| | - Diana E Salama
- Department of Nephrology, Academy Charity Teaching Hospital, P.O. Box. 12810, Khartoum, Sudan.
| | - Sara B Elbashir
- Department of Nephrology, Academy Charity Teaching Hospital, P.O. Box. 12810, Khartoum, Sudan.
| | - Mohamed O Khojali
- Department of Nephrology, Academy Charity Teaching Hospital, P.O. Box. 12810, Khartoum, Sudan.
| | - Rasha A Babiker
- Department of Basic Sciences, Faculty of Medicine, University of Medical Sciences and Technology, P.O. Box. 12810, Khartoum, Sudan.
| | - Khalifa Elmusharaf
- Epidemiology and Public Health, Faculty of Medicine, Royal College of Surgeon in Ireland RCSI Bahrain, P.O. Box. 15503, Adliya, Bahrain.
| | - Mamoun M Homeida
- Department of Medicine, Faculty of Medicine, University of Medical Sciences and Technology, P.O. Box. 12810, Khartoum, Sudan.
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Lebov JF, Valladares E, Peña R, Peña EM, Sanoff SL, Cisneros EC, Colindres RE, Morgan DR, Hogan SL. A population-based study of prevalence and risk factors of chronic kidney disease in León, Nicaragua. Can J Kidney Health Dis 2015; 2:6. [PMID: 25926994 PMCID: PMC4414463 DOI: 10.1186/s40697-015-0041-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 01/31/2015] [Indexed: 01/13/2023] Open
Abstract
Background Recent studies have shown an excess of chronic kidney disease (CKD) among younger adult males in the Pacific coastal region of Nicaragua and suggest a non-conventional CKD etiology in this region. These studies have been conducted in small, non-representative populations. Objectives We conducted a large population-based cross-sectional study to estimate CKD prevalence in León, Nicaragua, and to evaluate the association between previously investigated risk factors and CKD. Methods Estimated glomerular filtration rate, derived using the MDRD equation, was assessed to determine CKD status of 2275 León residents. Multivariable logistic regression was used to estimate adjusted prevalence odds ratios. León CKD prevalence was also standardized to the demographic distributions of the León Health and Demographic Surveillance System and the León 2005 Census. Results CKD prevalence was 9.1%; twice as high for males (13.8%) than females (5.8%). In addition to gender, older age, rural zone, lower education level, and self-reported high blood pressure, more years of agricultural work, lija (unregulated alcohol) consumption, and higher levels of daily water consumption were significantly associated with CKD. Notably, self-reported diabetes was associated with CKD in adjusted models for females but not males. Conclusions Our findings are comparable to those found in regional studies and further support the hypothesis of a Mesoamerican Nephropathy. Electronic supplementary material The online version of this article (doi:10.1186/s40697-015-0041-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jill F Lebov
- UNC Kidney Center, 7024 Burnett-Womack CB # 7155, Chapel Hill, NC 27599-7155 USA
| | | | - Rodolfo Peña
- Centro de Investigaciones e Intervenciones en Salud, León, Nicaragua
| | - Edgar M Peña
- Centro de Salud Torre Ramona, Unidad Docente de Medicina Familiar y Comunitaria, Sector II, Zaragoza, España
| | | | | | - Romulo E Colindres
- UNC Kidney Center, 7024 Burnett-Womack CB # 7155, Chapel Hill, NC 27599-7155 USA
| | - Douglas R Morgan
- Department of Medicine, Vanderbilt University, Nashville, TN USA ; Department of Medicine, UNC Chapel Hill, NC USA
| | - Susan L Hogan
- UNC Kidney Center, 7024 Burnett-Womack CB # 7155, Chapel Hill, NC 27599-7155 USA
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The gap between estimated incidence of end-stage renal disease and use of therapy. PLoS One 2013; 8:e72860. [PMID: 24023651 PMCID: PMC3758352 DOI: 10.1371/journal.pone.0072860] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 07/13/2013] [Indexed: 11/30/2022] Open
Abstract
Background Relatively few data exist on the burden of end-stage renal disease (ESRD) and use of renal replacement therapy (RRT)–a life-saving therapy–in developing regions. No study has quantified the proportion of patients who develop ESRD but are unable to access RRT. Methods We performed a comprehensive literature search to estimate use and annual initiation of RRT worldwide, and present these estimates according to World Bank regions. We also present estimates of survival and of etiology of diseases in patients undergoing RRT. Using data on prevalence of diabetes and hypertension, we modeled the incidence of ESRD related to these risk factors in order to quantify the gap between ESRD and use of RRT in developing regions. Results We find that 1.9 million patients are undergoing RRT worldwide, with continued use and annual initiation at 316 and 73 per million population respectively. RRT use correlates directly (Pearson’s r = 0.94) with regional income. Hemodialysis remains the dominant form of RRT but there is wide regional variation in its use. With the exception of the Latin American and Caribbean region, it appears that initiation of RRT in developing regions is restricted to fewer than a quarter of patients projected to develop ESRD. This results in at least 1.2 million premature deaths each year due to lack of access to RRT as a result of diabetes and elevated blood pressure and as many as 3.2 million premature deaths due to all causes of ESRD. Conclusion Thus, the majority of patients projected to reach ESRD due to diabetes or hypertension in developing regions are unable to access RRT; this gap will increase with rising prevalence of these risk factors worldwide.
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Nicaragua revisited: evidence of lower prevalence of chronic kidney disease in a high-altitude, coffee-growing village. J Nephrol 2012; 25:533-40. [PMID: 21956767 DOI: 10.5301/jn.5000028] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2011] [Indexed: 12/19/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is found at epidemic levels in certain populations of the Pacific Coast in northwestern Nicaragua especially in younger men. There are knowledge gaps concerning CKD's prevalence in regions at higher altitudes. METHODS A cross-sectional study of adults between the ages of 20 and 60 years in 1 coffee-growing village in Nicaragua located at 1,000 m above sea level (MASL) altitude was performed. Predictors included participant sex, age, occupation, conventional CKD risk factors and other factors associated with CKD suggested by previous surveys in Central America. Outcomes included serum creatinine (SCr) values >1.2 mg/dL for men and >0.9 mg/dL for women, estimated glomerular filtration rate (GFR) <60 ml/min per 1.73 m2, dipstick proteinuria stratified as microalbuminuria (30-300 mg/dL) and macroalbuminuria (>300 mg/dL), hypertension and body mass index. RESULTS Of 324 eligible participants, 293 were interviewed (90.4%), and 267 of those received the physical exam (82.4% overall). Of the sample, 45% were men. Prevalence rate of estimated GFR <60 ml/min per 1.73 m2 was 0 for men (0%) and 2 for women (1.4%). The prevalence of at least microalbuminuria was significantly higher among men compared with women (27.5% vs. 21.4%, respectively; p=0.02). CONCLUSIONS The CKD prevalence in this village is comparable to a previously studied Nicaraguan coffee-farming region and much lower than previously screened portions of northwestern Nicaragua. There is heterogeneity in CKD prevalence across Nicaragua. At this time, screenings should target individuals living in previously identified, higher risk regions. More work is needed to understand determinants of CKD in this resource-poor nation.
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Moradi S, Kerman SRJ, Rohani F, Salari F. Association between diabetes complications and leukocyte counts in Iranian patients. J Inflamm Res 2012; 5:7-11. [PMID: 22334791 PMCID: PMC3278259 DOI: 10.2147/jir.s26917] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The long term complications of diabetes can be fatal. They are also renowned for being an economic burden. Previous studies have demonstrated a relationship between inflammatory markers and complications of diabetes. The objective of this study was to evaluate the relationship between leukocyte counts and these complications. METHODS The study included 184 patients diagnosed with type 2 diabetes. The study was carried out in Iran during 2007 and 2008. Data collected on the subjects were as follows: age, gender, weight, height, blood pressure, smoking history, lipid profile including low density lipoprotein (LDL), high density lipoprotein (HDL), total cholesterol, triglycerides, and leukocyte count, albuminuria, and retinopathy. Furthermore, information on cardiac history for 100 patients was collected. The subjects were split into two groups according to their leukocyte levels: low (≤7000/mm(3)) and high (>7000/mm(3)); and then analyzed by Student's t-test or Mann-Whitney U-test as appropriate. RESULTS The average leukocyte count in these patients was 7594 ± 1965/mm(3). Leukocyte count was significantly different in patients with and without retinopathy and albuminuria (P < 0.0001). According to this analysis, a leukocyte count of 6750/mm(3) with a sensitivity of 80.2% and a specificity of 56.4%, and a count of 7550/mm(3) with a sensitivity of 63.2% and a specificity of 74.6% indicated at least one diabetes complication. CONCLUSION An elevated leukocyte count even within the normal range was associated with chronic complications in type 2 diabetes.
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Affiliation(s)
- Sedigheh Moradi
- Endocrine and Metabolism Research Center (Firouzgar), Hemmat Campus, Tehran University of Medical Sciences, Tehran, Iran
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Silva GDD, Acúrcio FDA, Cherchiglia ML, Guerra Júnior AA, Andrade EIG. Medicamentos excepcionais para doença renal crônica: gastos e perfil de utilização em Minas Gerais, Brasil. CAD SAUDE PUBLICA 2011; 27:357-68. [DOI: 10.1590/s0102-311x2011000200017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 10/26/2010] [Indexed: 11/21/2022] Open
Abstract
No Brasil, os medicamentos para o tratamento da doença renal crônica são disponibilizados gratuitamente pelo Sistema Único de Saúde (SUS). Este estudo teve como objetivos descrever os gastos públicos com esses medicamentos em Minas Gerais, Brasil, e o perfil dos usuários; objetivou, também, analisar os fatores associados ao gasto médio mensal individual. Observou-se que o gasto total com os medicamentos estudados (R$ 41,6 milhões) representa uma parcela significativa do gasto total com procedimentos ambulatoriais no SUS (9,6%). A maioria dos usuários é do sexo masculino, adultos jovens e teve como causa principal de doença renal crônica a hipertensão arterial. A análise multivariada indicou tendência de menor gasto entre indivíduos que eram mais idosos, que tinham como causa principal da doença o diabetes, que fizeram uso de hidróxido de ferro e que residiam em municípios de menor IDH-M (p < 0,05). Finalmente, o estudo indicou a importância de ferramentas gerenciais que permitam visualizar a trajetória dos pacientes no sistema de saúde, as quais sejam capazes de subsidiar o processo de formulação de políticas de saúde.
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Lobo J, Schargorodsky J, Quiroga MA, Hendel I, Vallvé C, Barone R. Peritoneal Dialysis in Argentina. A Nationwide Study. Perit Dial Int 2011; 31:19-26. [DOI: 10.3747/pdi.2009.00187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jorge Lobo
- Asociación Nefrológica Buenos Aires, Consejo de Diálisis Peritoneal, Buenos Aires, Argentina
| | - Jorge Schargorodsky
- Asociación Nefrológica Buenos Aires, Consejo de Diálisis Peritoneal, Buenos Aires, Argentina
| | - Mabel Alvarez Quiroga
- Asociación Nefrológica Buenos Aires, Consejo de Diálisis Peritoneal, Buenos Aires, Argentina
| | - Irene Hendel
- Asociación Nefrológica Buenos Aires, Consejo de Diálisis Peritoneal, Buenos Aires, Argentina
| | - Cristina Vallvé
- Asociación Nefrológica Buenos Aires, Consejo de Diálisis Peritoneal, Buenos Aires, Argentina
| | - Roberto Barone
- Asociación Nefrológica Buenos Aires, Consejo de Diálisis Peritoneal, Buenos Aires, Argentina
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Cherchiglia ML, Machado EL, Szuster DAC, Andrade EIG, Assis Acúrcio FD, Caiaffa WT, Sesso R, Guerra Junior AA, Queiroz OVD, Gomes IC. Epidemiological profile of patients on renal replacement therapy in Brazil, 2000-2004. Rev Saude Publica 2010; 44:639-49. [PMID: 20676555 DOI: 10.1590/s0034-89102010000400007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Accepted: 02/05/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe the clinical and epidemiological profile of patients under renal replacement therapies, identifying risk factors for death. METHODS This is a non-concurrent cohort study of data for 90,356 patients in the National Renal Replacement Therapies Database. A deterministic-probabilistic linkage was performed using the Authorization System for High Complexity/Cost Procedures and the Mortality Information System databases. All patients who started dialysis between 1/1/2000 and 12/31/2004 were included and followed until death or the end of 2004. Age, sex, region of residence, primary renal disease and causes of death were analyzed. A proportional hazards model was used to identify factors associated with risk of death. RESULTS The prevalence of patients under renal replacement therapies increased an average of 5.5%, while incidence remained stable during the period. Hemodialysis was the predominant initial modality (89%). The patients were majority male with mean age 53 years, residents of the Southeast region and presented unknown causes as the main cause of chronic renal disease, followed by hypertension, diabetes and glomerulonephritis. Of these patients, 42% progressed to death and 7% underwent kidney transplantation. The patients on peritoneal dialysis were older and had higher prevalence of diabetes. The death rate varied from 7% among transplanted patients to 45% among non-transplanted patients. In the final Cox proportional hazards model, the risk of mortality was associated with increasing age, female sex, having diabetes, living in the North and Northeast region, peritoneal dialysis as a first modality and not having renal transplantation. CONCLUSIONS There was an increased prevalence of patients on renal therapy in Brazil. Increased risk of death was associated with advanced age, diabetes, the female sex, residents of the North and Northeast region and lack of renal transplant.
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Affiliation(s)
- Mariangela Leal Cherchiglia
- Departamento de Medicina Preventiva e Social, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
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Mahdavi-Mazdeh M, Saeed Hashemi Nazri S, Hajghasemi E, Nozari B, Zinat Nadia H, Mahdavi A. Screening for Decreased Renal Function in Taxi Drivers in Tehran, Iran. Ren Fail 2010; 32:62-8. [DOI: 10.3109/08860220903491190] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mitra Mahdavi-Mazdeh
- Department of Nephrology, Tehran University of Medical Sciences; Research Center of Iranian Tissue Bank, Tehran, Iran
| | - Seyed Saeed Hashemi Nazri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Behnaz Nozari
- Research Center of Iranian Tissue Bank, Tehran, Iran
| | - Hatmi Zinat Nadia
- Department of Epidemiology, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
As the worldwide prevalence of end-stage renal disease increases it is important to evaluate the rate of living kidney donation in various countries; however there is no comprehensive global assessment of these rates. To measure this, we compiled data from representatives, renal registries, transplant networks, published reports in the literature, and national health ministries from 69 countries and made estimates from regional weighted averages for an additional 25 countries where data could not be obtained. In 2006, about 27,000 related and unrelated legal living donor kidney transplants were performed worldwide, representing 39% of all kidney transplants. The number of living kidney donor transplants grew over the last decade, with 62% of countries reporting at least a 50% increase. The greatest numbers of living donor kidney transplants, on a yearly basis, were performed in the United States (6435), Brazil (1768), Iran (1615), Mexico (1459), and Japan (939). Saudi Arabia had the highest reported living kidney donor transplant rate at 32 procedures per million population (pmp), followed by Jordan (29), Iceland (26), Iran (23), and the United States (21). Our study shows that rates of living donor kidney transplant have steadily risen in most regions of the world, increasing its global significance as a treatment option for kidney failure.
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