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Abukwaik WM, Baracco R, Jain A, Gregory M, Valentini RP, Kapur G. Clinical profile of children incidentally found to have advanced kidney failure. Pediatr Nephrol 2022; 37:1097-1103. [PMID: 34626243 DOI: 10.1007/s00467-021-05293-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION No data exist on the epidemiology of children incidentally diagnosed with advanced kidney failure (KF) during evaluation for non-specific symptoms. This is likely related to unrecognized symptoms and signs of CKD. The objective of our study was to evaluate incidentally diagnosed patients with advanced KF requiring long-term kidney replacement therapy (KRT). METHODS An IRB-approved retrospective chart review of children who started KRT with dialysis (hemo- or peritoneal) was conducted. Included were children with no prior knowledge or diagnosis of underlying kidney disease with chronic kidney disease (CKD) disease stage 4 (GFR 15-29 mL/min/1.73 m2) or 5 (GFR < 15 mL/min/1.73 m2) at initial presentation and started on chronic KRT within 2 months of presentation. RESULTS Of 177 patients initiating KRT during the study period, 26 (15%) were categorized as incidental advanced KF. This cohort with mean age 12.25 years consisted of 42% males, 54% African Americans included 46% with glomerular, and 54% with non-glomerular etiology for kidney failure. Vomiting (42%) and fatigue (39%) were most common, while growth failure (19%) and hyperkalemia (7%) were less frequent on initial presentation. Anemia (100%), hypertension (96%), hyperparathyroidism (96%), and hyperphosphatemia (92%) were the most frequently seen CKD comorbidities. Chronic KRT was started within 24 h in 62% and within 2 weeks in 88% of the cohort. CONCLUSION Under-diagnosis of patients with advanced KF is most likely related to milder non-specific clinical symptoms and normal growth in the majority of patients. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Wael M Abukwaik
- Children's Hospital of Michigan, Central Michigan University, Detroit, USA
| | - Rossana Baracco
- Children's Hospital of Michigan, Central Michigan University, Detroit, USA
| | - Amrish Jain
- Children's Hospital of Michigan, Central Michigan University, Detroit, USA
| | - Melissa Gregory
- Children's Hospital of Michigan, Central Michigan University, Detroit, USA
| | | | - Gaurav Kapur
- Children's Hospital of Michigan, Central Michigan University, Detroit, USA.
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Rai PK, Rai P, Bhat RG, Bedi S. Chronic Kidney Disease among Middle-Aged and Elderly Population: A cross-sectional screening in a Hospital Camp in Varanasi, India. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2020; 30:795-802. [PMID: 31464235 DOI: 10.4103/1319-2442.265454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Chronic kidney disease (CKD) is no longer considered just a health burden, but a major health priority owing to its high treatment costs and poor outcome. The lack of community-based screening programs has led to the detection of CKD patients at advanced stages. This study aims to estimate the prevalence of CKD and patterns of known risk factors among the general population (middle-aged and elderly) attending a screening camp in a community-based setting. The study participants constituted a part of the general population of Varanasi (aged ≥45 years) who volunteered in a screening camp that was organized as part of the World Kidney Day Initiative at Opal Hospital. Information on age, sex, height, weight, smoking and drug history, history of diabetes, hypertension, and family history of kidney disease was extensively interrogated, while laboratory investigations such as urinalysis and serum creatinine levels were recorded. More than three-fifths of the participants were middle-aged adults (i.e., 45-64 years) and the remaining 34.8% were elderly population, i.e., ≥65 years. The overall prevalence of CKD in the 198 studied participants was 29.3%. Higher number of participants (40.6%) of elderly population had CKD (P = 0.011). The serum creatinine, albuminuria, and estimated glomerular filtration rate levels were strongly associated with CKD (P <0.05). Our study suggests that elderly individuals are at risk with higher serum creatinine levels and would benefit from early detection of CKD to prevent disease progression and associated morbidity and mortality.
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Affiliation(s)
- Pradeep Kumar Rai
- Department of Nephrology, Opal Hospital, Varanasi, Uttar Pradesh, India
| | - Punam Rai
- Department of Clinical Physiology, Opal Hospital, Varanasi, Uttar Pradesh, India
| | - Rasika Ganpathi Bhat
- Department of Medical Genetics, College of Nursing, Bombay Hospital and Research Center, Mumbai, Maharashtra, India
| | - Sonam Bedi
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Asserraji M, Bouzerda A, Soukrate S, Maoujoud O, Belarbi M, Zemraoui N, Bendriss L, Khatouri A. Usefulness of ambulatory blood pressure monitoring in chronic kidney disease: The moroccan experience. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2019; 30:913-918. [PMID: 31464249 DOI: 10.4103/1319-2442.265468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Among patients with chronic kidney disease (CKD), hypertension (HTN) is very common and widely recognized to accelerate the progression of CKD and increase the risk for cardiovascular events. Accumulated data indicate that ambulatory blood pressure monitoring (ABPM) is better in detecting HTN than office blood pressure (BP) measurement. The goal of this study is to describe the ABPM characteristics in a group of CKD and hypertensive patients. A transversal study was conducted over a period of six months, to evaluate the ABPM patterns among a group of hypertensive patients with CKD (Group 1) and compared the data with a control group (Group 2). ABPM was performed with measurement rate every 15 min during daytime and 30 min at night. Nondipping BP patterns were defined as the absence of fall in nocturnal systolic and diastolic BP >10% of daytime values. Masked HTN was defined as controlled office BP (<140/90 mm Hg) with an elevated overall average BP by 24-h ABPM (>125/75 mm Hg), and white-coat HTN was defined as association of elevated BP readings (>140/90 mm Hg) in a clinical setting and normal 24-h average BP levels (<130/80 mm Hg). Fifty patients were included in each group. HTN was much longer in duration among hypertensive patients with CKD and frequently associated with obesity, dyslipidemia, and diabetes (64% vs. 39.60%). Positive proteinuria was present in 82% of CKD patients with HTN. CKD patients with HTN received more antihypertensive drugs than Group 2 patients. HTN was much more uncontrolled among CKD patients (60% vs. 24%), more serious with higher daytime and nighttime SBP, and loss of physiologic dipping during nighttime BP measurement (80%). Out-of-office BP monitoring by ABPM may improve the assessment and the successful management of HTN in patients with CKD. Standardized definitions for the diagnosis of masked and white-coat HTN would facilitate research.
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Affiliation(s)
- Mohammed Asserraji
- Department of Nephrology, Avicenne Military Hospital and Marrakech School of Medicine, Cadi Ayyad University, Marrakech, Morocco
| | | | - Safia Soukrate
- Department of Cardiology, Avicenne Armed Forces Hospital, Marrakesh, Morocco
| | - Omar Maoujoud
- Department of Nephrology, Avicenne Military Hospital and Marrakech School of Medicine, Cadi Ayyad University, Marrakech, Morocco
| | - Merouane Belarbi
- Department of Nephrology, Avicenne Military Hospital and Marrakech School of Medicine, Cadi Ayyad University, Marrakech, Morocco
| | - Nadir Zemraoui
- Department of Nephrology, Avicenne Military Hospital and Marrakech School of Medicine, Cadi Ayyad University, Marrakech, Morocco
| | - Leila Bendriss
- Department of Cardiology, Avicenne Armed Forces Hospital, Marrakesh, Morocco
| | - Ali Khatouri
- Department of Cardiology, Avicenne Armed Forces Hospital, Marrakesh, Morocco
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Messinger-Rapport BJ, Little MO, Morley JE, Gammack JK. Clinical Update on Nursing Home Medicine: 2016. J Am Med Dir Assoc 2017; 17:978-993. [PMID: 27780573 DOI: 10.1016/j.jamda.2016.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/07/2016] [Indexed: 12/31/2022]
Abstract
This is the tenth clinical update. It covers chronic kidney disease, dementia, hypotension, polypharmacy, rapid geriatric assessment, and transitional care.
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Affiliation(s)
| | - Milta O Little
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO
| | - John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO.
| | - Julie K Gammack
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO
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Burke J, Kovacs B, Borton L, Sander S. Health Care Utilization and Costs in Type 2 Diabetes Mellitus and Their Association with Renal Impairment. Postgrad Med 2015; 124:77-91. [DOI: 10.3810/pgm.2012.03.2539] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Hall RK, Landerman LR, O'Hare AM, Anderson RA, Colón-Emeric CS. Chronic kidney disease and recurrent falls in nursing home residents: a retrospective cohort study. Geriatr Nurs 2015; 36:136-41. [PMID: 25616732 DOI: 10.1016/j.gerinurse.2014.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 12/09/2014] [Accepted: 12/13/2014] [Indexed: 11/20/2022]
Abstract
This study examined whether chronic kidney disease (CKD) is associated with recurrent falls in older adults in nursing homes (NHs). We used data abstracted over a six month period from 510 NH residents with a history of falls. Thirty-five percent of the NH residents had CKD. In adjusted analyses, the incidence of recurrent falls was similar in those with and without CKD [fall rate ratio (FRR) 1.00, 95% confidence interval (CI) 0.97-1.02]. Orthostatic hypotension (FRR 1.52, 95% CI 1.12-2.05), history of falls during the prior six month period (FRR 1.25, 95% CI 1.05-1.49), cane or walker use (FRR 1.64, 95% CI 1.16-2.33), and ambulatory dysfunction (FRR 1.47, 95% CI 1.23-1.75) were independently associated with increased fall rate. CKD was not an important predictor of falls in this cohort of nursing home residents with prior falls. Instead, traditional fall risk factors were much more strongly associated with recurrent falls.
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Affiliation(s)
- Rasheeda K Hall
- Duke University Medical Center, Division of Nephrology, Department of Medicine, Box DUMC 2747, 2424 Erwin Road Suite 605, Durham, NC 27710, USA; Durham VA Geriatric Research, Education and Clinical Center, 508 Fulton Street, Durham, NC 27705, USA.
| | - Lawrence R Landerman
- Duke University Medical Center, Division of Geriatrics, Department of Medicine, Box DUMC 3003, Durham, NC 27710, USA; Duke University School of Nursing, DUMC Box 3322, 307 Trent Drive, Durham, NC 27710, USA
| | - Ann M O'Hare
- VA Puget Sound Healthcare System, Department of Medicine and HSR&D Center of Excellence, 1660 S. Columbian Way, Seattle, WA 98108, USA; University of Washington, Division of Nephrology, Department of Medicine, 1959 NE Pacific Street, Box 356521, HSB, BB1271, Seattle, WA 98195, USA
| | - Ruth A Anderson
- Duke University School of Nursing, DUMC Box 3322, 307 Trent Drive, Durham, NC 27710, USA
| | - Cathleen S Colón-Emeric
- Durham VA Geriatric Research, Education and Clinical Center, 508 Fulton Street, Durham, NC 27705, USA; Duke University Medical Center, Division of Geriatrics, Department of Medicine, Box DUMC 3003, Durham, NC 27710, USA
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McClellan WM, Resnick B, Lei L, Bradbury BD, Sciarra A, Kewalramani R, Ouslander JG. Prevalence and severity of chronic kidney disease and anemia in the nursing home population. J Am Med Dir Assoc 2009; 11:33-41. [PMID: 20129213 DOI: 10.1016/j.jamda.2009.07.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 07/16/2009] [Accepted: 07/17/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Chronic kidney disease (CKD) is an emerging health concern and may have important implications for the management of older people with many other chronic conditions, such as the nursing home (NH) resident population. This study was designed to describe the prevalence of CKD and associated comorbidities in a representative sample of NH residents. DESIGN Cross-sectional descriptive study as a component of a prospective observational study of CKD and anemia in the NH population. SETTING Eighty-two geographically representative NHs in the United States. PARTICIPANTS Participants were 794 NH residents who had complete baseline data collected. MEASUREMENTS Residents for whom consent was obtained underwent a record review focused on identifying a predefined set of comorbid conditions, clinical assessment, and blood and urine collections. Stage of CKD was based on estimated GFR (eGFR) using the MDRD equation: no CKD (eGFR > 60 mL/min/1.73 m(2)), Stage 3a (45-59), Stage 3b (30-44), and Stage 4/5 (< 30). RESULTS Consent was obtained from 847 of 1626 residents screened; 32 were ineligible and 21 dropped out of the study; complete data were available for 794 residents. CKD was present in approximately 50% of residents; of these residents with CKD, 47.6% were stage 3a, 39.27% stage 3b, and 13.2% stage 4/5. Fifty percent of the population had anemia, and anemia was more common in those with CKD. The average number of comorbid conditions in the population was 5.3 (SD 2.2); the proportion of patients with multiple comorbid conditions, especially cardiovascular conditions, increased with increasing stage of CKD. Among those without CKD, 57% had 5 or more comorbidities in comparison to 87% of those with stage 4/5 CKD. CONCLUSIONS In this representative sample of 794 US NH residents, 50% had clinical evidence of CKD. Patients with CKD, particularly those at later stages, were more likely to have cardiovascular comorbidities and anemia. The co-occurrence of these conditions in institutionalized populations may have important implications for the clinical management of this patient population, particularly as it relates to the potential for further renal complications.
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Affiliation(s)
- William M McClellan
- Department ofEpidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd., Atlanta, GA 30322, USA.
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