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Degenaar A, Jacobs A, Kruger R, Delles C, Mischak H, Mels C. Cardiovascular risk and kidney function profiling using conventional and novel biomarkers in young adults: the African-PREDICT study. BMC Nephrol 2023; 24:96. [PMID: 37055746 PMCID: PMC10103421 DOI: 10.1186/s12882-023-03100-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/02/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Low- and middle-income countries experience an increasing burden of chronic kidney disease. Cardiovascular risk factors, including advancing age, may contribute to this phenomenon. We (i) profiled cardiovascular risk factors and different biomarkers of subclinical kidney function and (ii) investigated the relationship between these variables. METHODS We cross-sectionally analysed 956 apparently healthy adults between 20 and 30 years of age. Cardiovascular risk factors such as high adiposity, blood pressure, glucose levels, adverse lipid profiles and lifestyle factors were measured. Various biomarkers were used to assess subclinical kidney function, including estimated glomerular filtration rate (eGFR), urinary albumin, uromodulin and the CKD273 urinary proteomics classifier. These biomarkers were used to divide the total population into quartiles to compare extremes (25th percentiles) on the normal kidney function continuum. The lower 25th percentiles of eGFR and uromodulin and the upper 25th percentiles of urinary albumin and the CKD273 classifier represented the more unfavourable kidney function groups. RESULTS In the lower 25th percentiles of eGFR and uromodulin and the upper 25th percentile of the CKD273 classifier, more adverse cardiovascular profiles were observed. In multi-variable adjusted regression analyses performed in the total group, eGFR associated negatively with HDL-C (β= -0.44; p < 0.001) and GGT (β= -0.24; p < 0.001), while the CKD273 classifier associated positively with age and these same risk factors (age: β = 0.10; p = 0.021, HDL-C: β = 0.23; p < 0.001, GGT: β = 0.14; p = 0.002). CONCLUSION Age, lifestyle and health measures impact kidney health even in the third decade.
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Affiliation(s)
- A Degenaar
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - A Jacobs
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
- MRC Research Unit: Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - R Kruger
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
- MRC Research Unit: Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - C Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - H Mischak
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Mosaiques Diagnostics GmbH, Hannover, Germany
| | - Cmc Mels
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
- MRC Research Unit: Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
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Cardone KE, Maxson R, Cho KH, Davis JM, El Nekidy WS, Kane-Gill SL, McNamara A, Wazny L, Wong L, Battistella M. Pharmacy Practice Standards for Outpatient Nephrology Settings. Kidney Med 2022; 4:100509. [PMID: 35991693 PMCID: PMC9386099 DOI: 10.1016/j.xkme.2022.100509] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Patients with kidney disease represent a medically complex group of patients with high medication burdens that could benefit from clinical pharmacy services as part of the interdisciplinary care team to optimize medication use. The "Advancing American Kidney Health" executive order includes new value-based reimbursement models to be tested by the Center for Medicare and Medicaid Innovation beginning January 2021 and January 2022. Advancing American Kidney Health executive order poses opportunities for the inclusion of comprehensive medication management. Following an iterative process integrating input from a diverse expert panel, published standards, clinical practice guidelines, peer review, and stakeholder feedback, our group developed practice standards for pharmacists caring for patients with kidney disease in health care settings. The standards focus on activities that are part of direct patient care and also include activities related to public health and advocacy, population health, leadership and management, and teaching, education and dissemination of knowledge. These standards are intended to be used by a variety of professionals, from pharmacists starting new practices to practice managers looking to add a pharmacist to the clinical team, to create standardization in services provided.
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Affiliation(s)
- Katie E. Cardone
- Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, NY
| | - Rebecca Maxson
- Auburn University Harrison School of Pharmacy, Birmingham, AL
| | - Katherine H. Cho
- Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, PA
| | - Joseph M. Davis
- Department of Pharmacy, Vidant Medical Center, Greenville, NC
| | - Wasim S. El Nekidy
- Department of Pharmacy, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH
| | - Sandra L. Kane-Gill
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
| | - Anusha McNamara
- San Francisco Department of Public Health, San Francisco, CA
| | - Lori Wazny
- Manitoba Renal Program, Winnipeg, Manitoba, Canada
| | - Lana Wong
- South Texas Veterans Health Care System, San Antonio, TX
| | - Marisa Battistella
- Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada
- Department of Nephrology, University Health Network Toronto, Ontario, Canada
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Mudiayi D, Shojai S, Okpechi I, Christie EA, Wen K, Kamaleldin M, Elsadig Osman M, Lunney M, Prasad B, Osman MA, Ye F, Khan M, Htay H, Caskey F, Jindal KK, Klarenback S, Jha V, Rondeau E, Turan Kazancioglu R, Ossareh S, Jager KJ, Kovesdy CP, O’Connell PJ, Muller E, Olanrewaju T, Gill JS, Tonelli M, Harris DC, Levin A, Johnson DW, Bello AK. Global Estimates of Capacity for Kidney Transplantation in World Countries and Regions. Transplantation 2022; 106:1113-1122. [PMID: 34495014 PMCID: PMC9128615 DOI: 10.1097/tp.0000000000003943] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/20/2021] [Accepted: 08/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Kidney transplantation (KT) is the optimal treatment for kidney failure and is associated with better quality of life and survival relative to dialysis. However, knowledge of the current capacity of countries to deliver KT is limited. This study reports on findings from the 2018 International Society of Nephrology Global Kidney Health Atlas survey, specifically addressing the availability, accessibility, and quality of KT across countries and regions. METHODS Data were collected from published online sources, and a survey was administered online to key stakeholders. All country-level data were analyzed by International Society of Nephrology region and World Bank income classification. RESULTS Data were collected via a survey in 182 countries, of which 155 answered questions pertaining to KT. Of these, 74% stated that KT was available, with a median incidence of 14 per million population (range: 0.04-70) and median prevalence of 255 per million population (range: 3-693). Accessibility of KT varied widely; even within high-income countries, it was disproportionately lower for ethnic minorities. Universal health coverage of all KT treatment costs was available in 31%, and 57% had a KT registry. CONCLUSIONS There are substantial variations in KT incidence, prevalence, availability, accessibility, and quality worldwide, with the lowest rates evident in low- and lower-middle income countries. Understanding these disparities will inform efforts to increase awareness and the adoption of practices that will ensure high-quality KT care is provided around the world.
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Affiliation(s)
- Dominic Mudiayi
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Soroush Shojai
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Ikechi Okpechi
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | - Emily A. Christie
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Kevin Wen
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Mostafa Kamaleldin
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Mohamed Elsadig Osman
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Meaghan Lunney
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Bhanu Prasad
- Section of Nephrology, Department of Medicine, Regina General Hospital, Regina, SK, Canada
| | - Mohamed A. Osman
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Maryam Khan
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Fergus Caskey
- UK Renal Registry, Learning and Research, Southmead Hospital, Bristol, United Kingdom
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
- The Richard Bright Renal Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Kailash K. Jindal
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Scott Klarenback
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Vivekanand Jha
- George Institute for Global Health, UNSW, New Delhi, India
- School of Public Health, Imperial College London, London, United Kingdom
- Department of Medicine, Manipal Academy of Higher Education, Manipal, India
| | - Eric Rondeau
- Intensive Care Nephrology and Transplantation Department, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
- Faculty of Medicine, Sorbonne Université, Paris, France
| | | | - Shahrzad Ossareh
- Section of Nephrology and Hemodialysis, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran
| | - Kitty J. Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Csaba P. Kovesdy
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Philip J. O’Connell
- Renal Unit, Westmead Clinical School, University of Sydney at Westmead Hospital, Sydney, NSW, Australia
- The Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Elmi Muller
- Division of General Surgery, Department of Surgery, University of Cape Town, Cape Town, South Africa
| | | | - John S. Gill
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Pan-American Health Organization/World Health Organization’s Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, AB, Canada
| | - David C. Harris
- Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - David W. Johnson
- Department of Nephrology, Metro South Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
| | - Aminu K. Bello
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Gityamwi NA, H. Hart K, Engel B. A Cross-Sectional Analysis of Dietary Intake and Nutritional Status of Patients on Haemodialysis Maintenance Therapy in a Country of Sub-Saharan Africa. Int J Nephrol 2021; 2021:1826075. [PMID: 34055412 PMCID: PMC8147542 DOI: 10.1155/2021/1826075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 03/18/2021] [Accepted: 04/15/2021] [Indexed: 11/23/2022] Open
Abstract
Malnutrition is common among dialysis patients, but there is insufficient literature on the problem from resource-poor settings of the sub-Saharan region. We conducted a cross-sectional investigation of dietary intake and nutritional status of haemodialysis (HD) patients to inform the current status of this population group in the region. HD patients aged ≥18 years, with dialysis vintage of ≥3 months, at one nephrology unit in Tanzania were assessed for their habitual diet and nutrient intake. Anthropometric measures and biochemistry tests were also performed. The diet was predominantly starchy food based, accompanied by a limited selection of vegetables. Fruits and animal protein were also minimally consumed (1 portion/day each). Fruit consumption was higher in females than males (median (25th, 75th) = 2 (1, 2.3) versus 0.5 (0, 1.7) portions, p = 0.008). More than 70% of participants had suboptimal measures for protein and energy intake, dietary iron, serum albumin, muscle mass, and hand grip strength (HGS). Inadequacies in protein and energy intake and dialysis clearance (URR) increased with the increase in body weight/BMI and other specific components (MAMC and FMI). Consumption of red meats correlated significantly and positively with serum creatinine (r = 0.46, p = 0.01), potassium (r = 0.39, p = 0.03), and HGS (r = 0.43, p = 0.02) and was approaching significance for a correlation with serum iron (r = 0.32, p = 0.07). C-RP correlated negatively with albumin concentration (r = -0.32, p = 0.02), and participants with C-RP within acceptable ranges had significantly higher levels of haemoglobin (p = 0.03, effect size = -0.28). URR correlated negatively with haemoglobin concentration (r = -0.36, p = 0.02). Patients will benefit from improved nutritional services that deliver individually tailored and culturally practical dietary advice to enable them to make informed food choices whilst optimizing disease management.
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Affiliation(s)
- Nyangi A. Gityamwi
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Kathryn H. Hart
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Barbara Engel
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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de Souza W, de Abreu LC, da Silva LG, Bezerra IMP. Incidence of chronic kidney disease hospitalisations and mortality in Espírito Santo between 1996 to 2017. PLoS One 2019; 14:e0224889. [PMID: 31697772 PMCID: PMC6837757 DOI: 10.1371/journal.pone.0224889] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 10/23/2019] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) has a set of clinical and laboratory abnormalities where renal function loss is noted. The high prevalence of comorbidity of people living with CKD, its economic impact and its prognosis have made it a public health problem, justifying the need to implement preventive measures. OBJECTIVE To analyse the mortality and incidence of hospital admissions for CKD. METHODS Ecological study with a time series design using secondary microdata of deaths and hospital admissions from patients with CKD from 1996 to 2017 in the State of Espírito Santo, Brazil. RESULTS The average mortality rate of CKD during the studied years was 2.92 per 100,000 inhabitants per year. During this period global mortality was a stationary phenomenon. In women, the trend of mortality from 2005 on increased 7,87% per year. Between 2008 and 2017, the average incidence hospital admissions due to CKD per year was 45.76 per 100,000 inhabitants. It was observed that the overall hospital admission increased by the equivalent of 6.23% per year. More than a half of mortality and hospitalisations correspond to male patients over 50 years of age. In terms of mortality, 32.99% corresponded to Caucasian patients, while 35.13% of hospitalisations were mixed race. CONCLUSION We found that age and gender are factors associated with deaths and hospitalisations for chronic kidney disease. While hospitalisation increases 6.23% per year, global mortality remains stationary. However, from 2005 onwards a trend towards increasing of 7.87%/annual in mortality was observed in women.
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Affiliation(s)
- Wesley de Souza
- Programa de Mestrado em Política Públicas e Desenvolvimento Local, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), Vitória, Espírito Santo, Brazil
| | - Luiz Carlos de Abreu
- Programa de Mestrado em Política Públicas e Desenvolvimento Local, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), Vitória, Espírito Santo, Brazil
- Laboratório de Escrita Científica, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), Vitória, Espírito Santo, Brazil
- Laboratório de Delineamento de Estudos e Escrita Científica, Centro Universitário Saúde ABC (CUSABC), Santo André, São Paulo, Brazil
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Leonardo Gomes da Silva
- Laboratório de Escrita Científica, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), Vitória, Espírito Santo, Brazil
| | - Italla Maria Pinheiro Bezerra
- Programa de Mestrado em Política Públicas e Desenvolvimento Local, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), Vitória, Espírito Santo, Brazil
- Laboratório de Escrita Científica, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), Vitória, Espírito Santo, Brazil
- Laboratório de Delineamento de Estudos e Escrita Científica, Centro Universitário Saúde ABC (CUSABC), Santo André, São Paulo, Brazil
- Programa de Mestrado em Ciências da Saúde da Amazônia, Bolsista CAPES Brasil, Universidade Federal do Acre, Rio Branco, Acre, Brazil
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Carrero JJ, Hecking M, Ulasi I, Sola L, Thomas B. Chronic Kidney Disease, Gender, and Access to Care: A Global Perspective. Semin Nephrol 2018; 37:296-308. [PMID: 28532558 DOI: 10.1016/j.semnephrol.2017.02.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Little is known regarding the ways in which chronic kidney disease (CKD) prevalence and progression differ between the sexes. Still less is known regarding how social disparities between men and women may affect access to care for CKD. In this review, we briefly describe biological sex differences, noting how these differences currently do not influence CKD management recommendations. We then describe what is known within the published literature regarding differences in CKD epidemiology between sexes; namely prevalence, progression, and access to treatment throughout the major world regions. We highlight that health care expenditure and social gender disparities ultimately may determine whether women have equitable access to care for CKD and end-stage kidney disease. Among many high- and low-income settings, women more often donate and are less likely to receive kidney transplants when compared with men. Research is needed urgently to elucidate the reasons behind these disparities, as well as to develop CKD treatment strategies tailored to women's unique health care needs.
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Affiliation(s)
- Juan-Jesus Carrero
- Division of Kidney Medicine, Karolinska Institute, Solna, Stockholm, Sweden.
| | - Manfred Hecking
- Medizinische Universität Wien, Universitätsklinik für Innere Medizin III, Klinische Abteilung für Nephrologie und Dialyse, Wein, Austria
| | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Nsukka, Nigeria
| | - Laura Sola
- División Epidemiologia, Ministerio de Salud, Departamento Medicina Preventiva y Social, Universidad de la República, Montevideo, Uruguay
| | - Bernadette Thomas
- Department of Global Health, University of Washington, Seattle, WA, USA
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