Prevalence of chronic kidney disease and associated factors among the Chinese population in Taian, China

Unlocking the night: Exploring the health impacts of night-time walking environments on health outcomes of older adults

Walking remains the primary form of physical activity for many older adults in China, and the quality of the walking environment at night may determine the frequency and duration of evening outings. This study reveals how night-time environmental features influence the health outcomes of older adults. Using the medical check-up records of 87,578 older adults from a public health service in the Beilin district of Xi'an city, China, the role of the night-time walking environment in managing chronic conditions was examined. A favorable night-time walking environment reduced the prevalence of chronic conditions and comorbidities among older adults. However, the health effects stemming from the night-time walking environment exhibited heterogeneity, with significant impacts only on metabolic conditions, such as hypertension and diabetes, while the effects on other conditions were not significant. Our findings supplement the theory of healthy aging by highlighting the potential value of the environment in managing chronic conditions, which may serve as a cost-effective health intervention for aging societies.

Prevalence and associated risk factors for chronic kidney disease in the elderly physically disabled population in Shanghai, China: a cross-sectional study

BACKGROUND

The global prevalence of chronic kidney disease (CKD) in the general population is relatively clear. Our previous study showed that elderly individuals who are physically disabled are more likely to experience kidney function impairment, and the main purpose of this study was to determine the prevalence and risk factors associated with CKD in elderly patients with physical disabilities.

METHODS

A total of 2679 elderly individuals with physical disabilities from the 2018 Shanghai Disability Health Survey were screened to calculate the prevalence of CKD. Multiple logistic regression was performed to identify the factors associated with CKD. Detailed subgroup analyses of disability level were also conducted.

RESULTS

We confirmed CKD in 287 of 2679 (10.7%) participants. Female sex, age, history of hypertension, red blood cell count, albumin, urea, and uric acid (UA) were independently correlated with CKD. Age and UA abnormalities were common risk factors for different levels of disabilities.

CONCLUSION

The prevalence of CKD is higher in the mild level of older physically handicapped individuals. Age and the level of UA should also be considered in this population. The preventive strategies for patients with two levels of elderly disability should have different focuses.

Pathogenesis of Chronic Kidney Disease Is Closely Bound up with Alzheimer's Disease, Especially via the Renin-Angiotensin System

Chronic kidney disease (CKD) is a clinical syndrome secondary to the definitive change in function and structure of the kidney, which is characterized by its irreversibility and slow and progressive evolution. Alzheimer's disease (AD) is characterized by the extracellular accumulation of misfolded β-amyloid (Aβ) proteins into senile plaques and the formation of neurofibrillary tangles (NFTs) containing hyperphosphorylated tau. In the aging population, CKD and AD are growing problems. CKD patients are prone to cognitive decline and AD. However, the connection between CKD and AD is still unclear. In this review, we take the lead in showing that the development of the pathophysiology of CKD may also cause or exacerbate AD, especially the renin-angiotensin system (RAS). In vivo studies had already shown that the increased expression of angiotensin-converting enzyme (ACE) produces a positive effect in aggravating AD, but ACE inhibitors (ACEIs) have protective effects against AD. Among the possible association of risk factors in CKD and AD, we mainly discuss the RAS in the systemic circulation and the brain.

Prevalence of chronic kidney disease and associated factors among patients visiting renal unit of St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia: A cross-sectional study design

Objective:

This study aimed to assess the magnitude of chronic kidney disease among patients attending the renal unit of St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia.

Methods:

Institution-based cross-sectional study was conducted among 620 randomly selected patients who visited St. Paul’s Hospital Millennium Medical College renal unit from 1 January to 31 December, 2019. Data on sociodemographic characteristics, clinical conditions, behavioral risk factors, electrolytes, and renal function tests were extracted from patients’ medical records. To enter and analyze data, EpiData 3.1 and SPSS 22 were used, respectively. Bivariable and multivariable logistic regression analyses were conducted to see the association between predictor variables and chronic kidney disease. Adjusted odds ratio at 95% confidence interval was used to describe significant association. A p-value <0.05 was considered to declare an association between chronic kidney disease and independent variables.

Results:

Of 620 patients, 139 (22.4%; 95% confidence interval: 19.2, 25.6) and 61 (9.8%; 95% confidence interval: 7.4, 12.3) had chronic kidney disease using cut-off value of 90 and 60 ml/min/1.73 m², respectively. Having urinary tract obstruction (adjusted odds ratio = 2.32; 95% confidence interval: 1.32, 4.06), hypertension (adjusted odds ratio = 4.06; 95% confidence interval: 2.50, 6.59), diabetes mellitus (adjusted odds ratio = 2.80; 95% confidence interval: 1.62, 4.85), cardiovascular disease (adjusted odds ratio = 2.54; 95% confidence interval: 1.60, 4.01), and age (adjusted odds ratio = 1.83; 95% confidence interval: 1.44, 3.57), family history of chronic kidney disease (adjusted odds ratio = 2.26; 95% confidence interval: 1.36, 3.75) were factors positively associated with having chronic kidney disease.

Conclusion:

Nearly, one out of five and one out of ten patients who visited the renal unit had chronic kidney disease using the two thresholds as a cut value. Patients with concomitant urinary tract obstruction, age, hypertension, diabetes mellitus, cardiovascular disease, and a family history of chronic kidney disease were more likely to develop chronic kidney disease. Regular screening for chronic kidney disease, optimal blood sugar, and blood pressure management should be practiced.

Chronic Kidney Disease and Associated Factors among Diabetic Patients at the Diabetic Clinic in a Police Hospital, Addis Ababa

Background

Diabetes mellitus remains the leading cause of end-stage renal disease in most countries in the world. In Ethiopia, renal complications of diabetes may remain unrecognized due to limited diagnostic resources. As a result, the prevalence of chronic kidney disease among adult diabetics in Ethiopia has not been well described. Hence, this study was aimed at assessing the prevalence of chronic kidney disease and associated factors among diabetic patients who attended the federal police hospital diabetic clinic in Addis Ababa.

Methods

A cross-sectional study was conducted among 362 Diabetes Mellitus. Data were collected using face-to-face interviewing questionnaires and analyzed using SPSS version 21.0. Binary logistic regression analyses were performed to identify predictors.

Results

The prevalence of chronic kidney disease diagnosed by Cockcroft-Gault equation and Modification of Diet in Renal Disease equation was 14.6% and 7.7% respectively. This finding shows the prevalence of chronic kidney disease among Diabetic patients was low. Age 50-59 years [(AOR= 4.0; 95% CI:(1.2, 13)] by Cockroft-Gault equation (CG), age 60-69 years [(AOR=5.8 95% CI:(1.5,21.0)] by Modification of Diet in Renal Disease (MDRD) and (AOR;22.9 95%CI:7.1,74.2) by CG, age 70 years and above (AOR=4.7; 95 CI: 1.1, 19.7) by MDRD and (AOR= 22.9; 95%CI:7.1,74.2) by CG, BMI (AOR=0.2; 95% CI:0.1,0.4) by CG, and previous kidney disease (AOR=6.2 95%CI:2.0,8.4) by MDRD and (AOR;4.6 95%CI:1.9,10.8) C-G equation have a significant association with chronic kidney disease after an adjustment done.

Conclusion

The prevalence of chronic kidney disease among Diabetic patients in this study was lower. Age, BMI, and previous recurrent kidney disease were associated with chronic kidney disease. Preventive measures like giving health education and screening of patients with risk factors should get more attention.

The impact of uremic toxins on Alzheimer's disease

Alzheimer's disease (AD) is the most common type of dementia, pathologically characterized by accumulation of senile plaques and neurofibrillary tangles. Chronic kidney disease (CKD) is highly prevalent in elderly population closely associated with occurrence of dementia. Recent epidemiological and experimental studies suggest a potential association of CKD with AD. Both diseases share a panel of identical risk factors, such as type 2 diabetes; and hypertension. However, the relationship between CKD and AD is unclear. Lower clearance of a panel of uremic toxin including cystatin-C, guanidine, and adiponectin due to CKD is implied to contribute to AD pathogenesis. In this review we summarize the current evidence from epidemiological, experimental and clinical studies on the potential contribution of uremic toxins to AD pathogenesis. We describe outstanding questions and propose an outlook on the link between uremic toxins and AD.

Attenuative Effects of Fluoxetine and Triticum aestivum against Aluminum-Induced Alzheimer's Disease in Rats: The Possible Consequences on Hepatotoxicity and Nephrotoxicity

BACKGROUND

Alzheimer's disease (AD) is a chronic neurological illness that causes considerable cognitive impairment. Hepatic and renal dysfunction may worsen AD by disrupting β-amyloid homeostasis at the periphery and by causing metabolic dysfunction. Wheatgrass (Triticum aestivum) has been shown to have antioxidant and anti-inflammatory properties. This work aims to study the effect of aluminum on neuronal cells, its consequences on the liver and kidneys, and the possible role of fluoxetine and wheatgrass juice in attenuating these pathological conditions.

METHOD

Rats were divided into five groups. Control, AD (AlCl₃), Fluoxetine (Fluoxetine and AlCl₃), Wheatgrass (Wheatgrass and AlCl₃), and combination group (fluoxetine, wheatgrass, and AlCl₃). All groups were assigned daily to different treatments for five weeks.

CONCLUSIONS

AlCl₃ elevated liver and kidney enzymes, over-production of oxidative stress, and inflammatory markers. Besides, accumulation of tau protein and Aβ, the elevation of ACHE and GSK-3β, down-regulation of BDNF, and β-catenin expression in the brain. Histopathological examinations of the liver, kidney, and brain confirmed this toxicity, while treating AD groups with fluoxetine, wheatgrass, or a combination alleviates toxic insults.

CONCLUSION

Fluoxetine and wheatgrass combination demonstrated a more significant neuroprotective impact in treating AD than fluoxetine alone and has protective effects on liver and kidney tissues.

Alteration of normal level of serum urate may contribute to decrease in estimated glomerular filtration rate decline in healthy Japanese men

INTRODUCTION

Serum uric acid (SUA) levels have a linear relationship with the estimated glomerular filtration rate (eGFR). It is unclear whether further changes, subsequent to normal level of SUA can attenuate eGFR decline in a healthy population, so we aimed to determine the normal level of SUA that can contribute to preventing kidney dysfunction.

METHODS

In this retrospective cohort study from Japan, annual health checkup data from 2009 to 2014 was collected. After propensity score matching (1:1), data from 2,634 individuals with basal SUA ≤7.0 mg/dL (normal; mean age, 39 y; mean eGFR, 80.8 mL/min/1.73 m²) and 1,642 individuals with basal SUA >7.0 mg/dL (elevated; mean age, 42 y; mean eGFR, 75.0 mL/min/1.73 m²) were collected to determine the relationship between followed-up SUA level and the rate of change in eGFR.

RESULTS

In individuals with normal level SUA at baseline, the elevation of SUA (>7.0 mg/dL) accelerated eGFR decline compared to those with normal SUA levels at 5-year follow-up (-4.1 ± 9.6% vs -9.9 ± 9.0%, p < .0001). Digression of SUA level (≤7.0 mg/dL) reduced eGFR decline compared with persistent SUA level over 7.0 mg/dL (-1.5 ± 11.5% vs -7.0 ± 10.1, p < .0001). In multiple linear regression analysis, there was strong association between the rate of change in SUA and eGFR in individuals with basal SUA ≤7.0 and >7.0 mg/dL (standardized coefficient; -0.3348, p < .001 and -.2523, p < .001, respectively).

CONCLUSION

Subsequent to normal level of SUA (under 7.0 mg/dL) may contribute to a decrease in eGFR decline in apparently healthy men.

[Chronic kidney disease among adults in Rio Branco, State of Acre: a population-based survey]

The scope of this study was to establish the prevalence of CKD and associated factors among young adults (18-59 years of age) from Rio Branco in the State of Acre. It involved a population-based survey conducted in 2014, in the urban and rural areas of the municipality and CKD was defined as the glomerular filtration rate (GFR) < 60ml/min/1.73m², estimated by the CKD-EPI, and the presence of albuminuria > 29 mg/g. Association measures were estimated by logistic regression, with a confidence level of 95%. The overall prevalence of CKD was 6.2%. The presence of CKD was higher among women, aged 40 to 59 years, with non-white skin color, with lower schooling, and of sedentary disposition. There were statistically significant differences in the distribution according to the presence of CKD in the hypertension, diabetes and hospitalization variables over the past 12 months. CKD among adults was associated with the female sex (OR: 2.41, 95%CI: 1.14-5.12), diabetes (OR: 4.67, 95%CI: 1.28-17.03) and arterial hypertension (OR: 1.98; 95%CI: 1.16-3.37). CKD reveals a high prevalence and is associated with chronic diseases, calling for the need for public health measures for early detection and prevention of its progression.

Aetiology of chronic kidney disease and risk factors for disease progression in Chinese subjects: A single-centre retrospective study in Beijing

AIM

To assess the aetiological factors of chronic kidney disease (CKD) and factors associated with disease progression.

METHODS

Single-centre retrospective study evaluating thorough electronic medical records of patients diagnosed with CKD at Peking University People's Hospital (April 2010-April 2015). The objectives were to identify the aetiological factors of CKD in Chinese patients and risk factors associated with CKD progression.

RESULTS

Of 15 425 CKD patients, 12 380 had aetiology recorded. The leading aetiologies associated with CKD were chronic glomerulonephritis (CGN; 36.8%), hypertensive nephropathy (HTN; 28.5%) and diabetic nephropathy (DN; 27.1%). CGN was most common in patients with early stage disease (stages 1-2); DN and HTN were common in advanced-stages (stages 3-4). In a longitudinal subcohort of 2923 patients with ≥6-month follow-up, 19.6% experienced CKD progression. Patients with CKD progression were significantly older in age and had a greater number of comorbidities and laboratory anomalies, and were more likely to have DN (40.5%) and CGN (40.5%) than HTN (5.5%) at baseline than patients without progression. In a multivariate analysis, factors associated with disease progression included macro- and micro-albuminuria, anaemia, hyperkalaemia, hyperphosphataemia, metabolic acidosis, CKD stage 4 and type 2 diabetes mellitus (T2DM).

CONCLUSION

This study identified CGN, DN and HTN as the leading aetiological factors for CKD in Chinese patients. DN was a strong predictor of faster disease progression, with albuminuria (a complication of T2DM) associated with highest risk for disease progression.

Renal Contributions in the Pathophysiology and Neuropathological Substrates Shared by Chronic Kidney Disease and Alzheimer's Disease

Chronic kidney disease and Alzheimer's disease are chronic conditions highly prevalent in elderly communities and societies, and a diagnosis of them is devastating and life changing. Demanding therapies and changes, such as non-compliance, cognitive impairment, and non-cognitive anomalies, may lead to supplementary symptoms and subsequent worsening of well-being and quality of life, impacting the socio-economic status of both patient and family. In recent decades, additional hypotheses have attempted to clarify the connection between these two diseases, multifactorial in their nature, but even so, the mechanisms behind this link are still elusive. In this paper, we sought to highlight the current understanding of the mechanisms for cognitive decline in patients with these concurrent pathologies and provide insight into the relationship between markers related to these disease entities and whether the potential biomarkers for renal function may be used for the diagnosis of Alzheimer's disease. Exploring detailed knowledge of etiologies, heterogeneity of risk factors, and neuropathological processes associated with these conditions opens opportunities for the development of new therapies and biomarkers to delay or slow their progression and validation of whether the setting of chronic kidney disease could be a potential determinant for cognitive damage in Alzheimer's disease.

The association between socioeconomic status and prevalence of chronic kidney disease: A cross-sectional study among rural residents in eastern China

To investigate the prevalence of chronic kidney disease (CKD) among eastern Chinese rural residents and analyze the relationship between socioeconomic conditions and CKD.A cross-sectional survey of 1713 adults, enrolled from 4 villages in the north-central part of Zhejiang province in eastern China was conducted by collecting data on socioeconomic status, physical examination, and laboratory investigations. CKD was defined as estimated glomerular filtration rate < 60 mL/min per 1.73 m or urinary albumin/creatinine ratio more than 30 mg/g. The crude and adjusted prevalence of CKD was estimated and the association of socioeconomic status was analyzed by logistic regression.A total of 1654 adults (96.53%) completed the screening, and 1627 (98.37%) of them had complete questionnaire and test information. The standardized prevalence of CKD adjusted by age and sex was 9.21% (95% confidence interval, 7.8-10.63). People with hypertension, hyperglycemia, hyperuricemia, high fasting blood glucose, and high body mass index had higher risk for CKD. Socioeconomic status was found to be partly related to CKD, especially educational level and occupational nature.A high prevalence of CKD was observed among rural residents in north-central Zhejiang province in eastern China. Socioeconomic statuses were partly related to the prevalence of CKD.

High urate concentration is associated with elevated blood pressure in schoolchildren

Background Studies in adults have shown a relationship between high blood pressure and hyperuricemia, but few studies have investigated this association in children and adolescents. The aim of the present study was to associate urate concentration with systolic blood pressure (SBP) and diastolic blood pressure (DBP) in schoolchildren. Methods This cross-sectional study used a sample of 2335 schoolchildren in basic education between 7 and 17 years old. Blood pressure was classified by percentile according to Brazilian parameters for sex and age, reclassified into two categories: normal and borderline/hypertension. Blood collection to obtain serum for urate concentration analysis was performed after a 12-h fast. Values above 5.5 mg/dL were considered hyperuricemia. Descriptive data were presented in frequency and percentage. Linear regression and Poisson regression (prevalence ratio [PR]) was used to test the association between urate concentration and blood pressure. Results Urate concentration was weakly associated with SBP (β: 0.05; 95% CI: 0.02-0.08) and DBP (β: 0.03; 95% CI: 0.01-0.05) z-scores. Schoolchildren with hyperuricemia had a higher prevalence of high SBP (PR: 1.12; p<0.001) and DBP (PR: 1.08; p<0.001). Conclusions Elevated urate concentration is associated with altered blood pressure in schoolchildren.

A Novel Perspective Linkage Between Kidney Function and Alzheimer's Disease

It has long been believed that kidney function is linked to brain activity. Clinical studies demonstrate that patients with chronic kidney disease (CKD) are more prone to cognitive impairment and Alzheimer's disease (AD), and the degree of cognitive impairment is closely related to CKD progression and renal failure. Moreover, the fact that cognitive function in CKD patients is significantly improved after successful kidney transplantation reveals a linkage between CKD and AD. However, the mechanisms behind this linkage are unclear. The physiological function of the kidney is to maintain the stability of the internal environment, including the cerebrovascular circulation, whereas abnormal kidney function often leads to ischemia and hypoxia. Many CKD patients experience chronic hypoxia, and many urinary toxins accumulate after renal function is impaired. In this mini review, we will propose a novel perspective on the association between AD and CKD and the connection between the kidney and brain.

Prevalence and risk factors associated with chronic kidney disease in adults living in 3 different altitude regions in the Tibetan Plateau

BACKGROUND

Living at high altitude may have undesirable effects on the kidney. We explored the chronic kidney disease (CKD) prevalence and risk factors among the residents living at different altitude in Tibetan Plateau.

METHODS

A cross-sectional study was carried out in 2014 to 2016 in Linzhi (2900 m altitude), Lhasa (3650 m) and Anduo (4700 m). Information on the cardiovascular risk factors was collected and blood and urine samples were measured.

RESULTS

The data of 1707 subjects aged ≥35 y were analyzed. The age-standardized prevalence of CKD in Linzhi, Lhasa and Anduo was 27.7% (95% CI: 22.1-33.3%), 18.3% (12.7-24.0%) and 30.4% (23.5-37.3%) in men and 37.7% (31.8-43.6%), 29.5% (24.6-34.4%) and 36.7% (29.0-44.4%) in women, respectively. Multivariable logistic regression showed that age, female gender, systolic blood pressure, fasting serum glucose, with primary school education or lower were associated with higher risk of CKD and living in Lhasa was associated with lower risk of CKD.

CONCLUSION

A higher prevalence of CKD was found in the residents living in the Tibetan Plateau. However, for the highlanders living at higher altitude does not mean higher risk. The CKD risk factors found in this study are similar to those in other studies.

Associations between socioeconomic status and chronic kidney disease: a meta-analysis

BACKGROUND

Socioeconomic status (SES) has long been conjectured to be associated with the incidence and progression of chronic kidney disease (CKD), but few studies have examined this quantitatively. This meta-analysis aims to fill this gap.

METHODS

A systematic literature review was performed using Medline and EMBASE to identify observational studies on associations between SES and incidence and progression of CKD, published between 1974 and March 2017. Individual results were meta-analysed using a random effects model, in line with Meta-analysis of Observational Studies in Epidemiology guidelines.

RESULTS

In total, 43 articles met our inclusion criteria. CKD prevalence was associated with several indicators of SES, particularly lower income (OR 1.34, 95% CI (1.18 to 1.53), P<0.001; I²=73.0%, P=0.05); lower education (OR 1.21, 95% CI (1.11 to 1.32), P<0.001; I²=45.20%, P=0.034); and lower combined SES (OR 2.18, 95% CI (1.64 to 2.89), P<0.001; I²=0.0%, P=0.326). Lower levels of income, occupation and combined SES were also significantly associated with progression to end-stage renal disease (risk ratio (RR) 1.24, 95% CI (1.12 to 1.37), P<0.001; I²=66.6%, P=0.006; RR 1.05, 95% CI (1.01 to 1.09), P=0.012; I²=0.0%, P=0.796; and RR 1.39, 95% CI (1.09 to 1.79), P=0.009; I²=74.2%, P=0.009). Subgroup analyses generally confirmed these results, except in a few cases, such as an inverse association related to particular socioeconomic backgrounds and where results were adjusted by more disease-related risk factors.

CONCLUSION

Lower income was most closely associated with prevalence and progression of CKD, and lower education was significantly associated with its prevalence. Evidence for other indicators was inconclusive.

A nationwide cross-sectional survey on prevalence, management and pharmacoepidemiology patterns on hypertension in Chinese patients with chronic kidney disease

Limited data are available on epidemiology and drug use in Chinese hypertensive patients with chronic kidney disease (CKD). We determined the prevalence; awareness, treatment, and control rates of hypertension; anti-hypertensive use, expenditure pattern; and factors associated with hypertension prevalence and control in Chinese patients with CKD. This was one of the largest cross-sectional surveys that enrolled 6079 CKD participants (mean age, 51.0 ± 16.37 years) with or without hypertension from 22 centres across China. The prevalence, awareness, and treatment rates were 71.2%, 95.4%, and 93.7%, respectively. Control rates 1 and 2 (Blood pressure, BP <140/90 and <130/80 mmHg) were 41.1% and 15.0%, respectively. Patients were treated mostly with monotherapy (37.7%) or 2-drug anti-hypertensive combination (38.7%). Factors associated with prevalence of hypertension included age; smoking; body mass index; physical exercise; family history of hypertension; hyperuricaemia; and CKD. Control rate was associated with CKD stage, BP monitoring at home, and use of drug combinations. Despite high rates of awareness and treatment, the control rates are low. CKD stages 4 and 5 adversely affect the control rate. The results suggest the immediate need of comprehensive controlling measures to improve the control of hypertension in Chinese patients with CKD.

The Association of Hypertriglyceridemic Waist Phenotype with Chronic Kidney Disease and Its Sex Difference: A Cross-Sectional Study in an Urban Chinese Elderly Population

Background: The primary objective of this study was to explore the association of hypertriglyceridemic waist (HTGW) phenotype with chronic kidney disease (CKD) and its sex difference in an urban Chinese elderly population. Methods: In a cross-sectional study, a total of 2102 participants aged 60–95 years were recruited and classified into four phenotypes: normal waist-normal triglyceride (NWNT), normal waist-elevated triglycerides (NWET), elevated waist-normal triglycerides (EWNT), and HTGW. Logistic regression analysis was used to estimate the associations of interest. Results: Total prevalence of CKD was 12.6%, and the CKD prevalence in participants with EWNT and HTGW was higher than with NWNT and NWET without regard to sex. Compared to NWNT phenotype, the adjusted OR for CKD was 1.95 (95% CI: 1.32–2.88) in HTGW groups. In contrast with the null findings (OR: 1.66; 95% CI: 0.94–2.94) in women after additional adjustment for diabetes and hypertension, the OR with HTGW remained strong (OR: 1.88; 95% CI: 1.04–3.39) in men. Similar findings appeared with the EWNT phenotype. Conclusions: The HTGW phenotype is positively associated with CKD among Chinese community elderly and may have a greater impact on men. More attention should be paid to the association between triglycerides and waist circumference in clinical practice and to the further identification this uncertain sex-related association.

Associations of Undergoing a Routine Medical Examination or Not with Prevalence Rates of Hypertension and Diabetes Mellitus: A Cross-Sectional Study

Background: Undergoing a routine medical examination may be associated with the prevalence rate of chronic diseases from a population-based household interview survey. However, this important issue has not been examined so far. Methods: Data came from the first health service household interview of Hunan province, China, in 2013. A Rao–Scott chi-square test was performed to examine the difference in prevalence rates between subgroups. Adjusted odds ratio (OR) was calculated using the PROC SURVEYLOGISTIC procedure of SAS9.1 statistical software. Results: In total, 24,282 residents of 8400 households were surveyed. A higher proportion of elderly adults had undergone a medical examination within the prior 12 months compared with young adults (≥65 years, 60%; 45–64 years, 46%; 18–44 years, 37%). After controlling for location, sex, and household income per capita, undergoing a medical examination was significantly associated with high prevalence rates of hypertension (adjusted OR: 2.0, 95% CI: 1.1–3.5) and of diabetes mellitus (adjusted OR: 3.3, 95% CI: 1.7–6.5) for young adults aged 18–44 years. The associations were not statistically significant for age groups 45–64 years and 65 years or older. Conclusion: The prevalence rates of hypertension and diabetes mellitus may be seriously underestimated for young adults not undergoing a routine medical examination in a health household interview survey.

Prevalence, awareness, and treatment of anemia in Chinese patients with nondialysis chronic kidney disease: First multicenter, cross-sectional study

This was the first multicenter, cross-sectional survey to assess the prevalence of anemia, patient awareness, and treatment status in China. Data of patients with chronic kidney disease (CKD; age, 18-75 years; both out- and inpatients) from 25 hospitals in Shanghai, seeking medical treatment at the nephrology department, were collected between July 1, 2012 and August 31, 2012. The prevalence, awareness, and treatment of anemia in patients with nondialysis CKD (ND-CKD) were assessed. Anemia was defined as serum hemoglobin (Hb) levels ≤12 g/dL in women and ≤13 g/dL in men. A total of 2420 patients with ND-CKD were included. Anemia was established in 1246 (51.5%) patients: 639 (51.3%) men and 607 (48.7%) women. The prevalence of anemia increased with advancing CKD stage (χtrend = 675.14, P < 0.001). Anemia was more prevalent in patients with diabetic nephropathy (68.0%) than in patients with hypertensive renal damage (56.6%) or chronic glomerulonephritis (46.1%, both P < 0.001). Only 39.8% of the anemic patients received treatment with erythropoietin and 27.1% patients received iron products; furthermore, 22.7% of the patients started receiving treatment when their Hb level reached 7 g/dL. The target-achieving rate (Hb at 11-12 g/dL) was only 8.2%. Of the 1246 anemia patients, only 7.5% received more effective and recommended intravenous supplementation. Anemia is highly prevalent in patients with ND-CKD in China, with a low target-achieving rate and poor treatment patterns. The study highlights the need to improve multiple aspects of CKD management to delay the progression of renal failure.

Determination of Environmental Exposure to Microcystin and Aflatoxin as a Risk for Renal Function Based on 5493 Rural People in Southwest China

Although the nephrotoxicity of microcystin and aflatoxin has been observed in animal and clinical cases, few population data are available. We conducted a cross-sectional study in Southwest China to investigate the association of renal function indicators (RFIs, including BUN, SCr, and eGFR) with exposure to microcystin and aflatoxin in 5493 members of the general population. Microcystin-LR levels in water and aquatic products and aflatoxin B1 levels in daily foods were measured by ELISA, and individual estimated daily intake (EDI) was assessed on the basis of the measurement and questionnaire. We found that participants with abnormal RFIs had a much higher mean level of microcystin-LR EDI than those with normal RFIs and that there was a significant increasing trend for abnormal rates and odds ratios of RFIs with increasing microcystin-LR EDI quartiles (p for trend = 0.000). Compared with the lowest quartile of microcystin-LR exposure, those in the highest quartile had significantly higher risks of abnormal BUN (OR = 1.80, 95% CI = 1.34-2.42), SCr (OR = 4.58, 95% CI = 2.92-7.21), and eGFR (OR = 4.41, 95% CI = 2.55-7.63), respectively, but no higher risk was found in subjects with higher AFB1 exposure. After adjustment for confounding factors, risk associations with microcystin-LR persisted. Consequently, our results suggest that microcystin, rather than aflatoxin, might be one important risk of renal-function impairment.

Chronic kidney disease in low- and middle-income countries

Most of the global burden of chronic kidney disease (CKD) is occurring in low- and middle-income countries (LMICs). As a result of rapid urbanization in LMICs, a growing number of populations are exposed to numerous environmental toxins, high infectious disease burdens and increasing rates of noncommunicable diseases. For CKD, this portends a high prevalence related to numerous etiologies, and it presents unique challenges. A better understanding of the epidemiology of CKD in LMICs is urgently needed, but this must be coupled with strong public advocacy and broad, collaborative public health efforts that address environmental, communicable, and non-communicable risk factors.

Spatial Clustering and Local Risk Factors of Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease (COPD) mortality has been steadily increasing in Taiwan since 2009. In order to understand where the hotspot areas are and what the local risk factors are, we integrated an ecological and a case-control study. We used a two-stage approach to identify hotspots and explore the possible risk factors for developing COPD. The first stage used the annual township COPD mortality from 2000 to 2012 and applied the retrospective space-time scan statistic to calculate the local relative risks in each township. In the second stage, we conducted a case-control study, recruiting 200 patients from one local hospital within the one identified hotspot area located in southern Taiwan. Logistic regression was applied for analyzing the personal risk factors of COPD. The univariate analyses showed that higher percentages of aborigines, patients with tuberculosis (TB) history, and those with smoking history had COPD (p < 0.05). After controlling for demographic variables, aboriginal status (adjusted odds ratios (AORs): 3.01, 95% CI: 1.52-5.93) and smoking history (AORs: 2.64, 95% CI: 1.46-4.76) were still the two significant risk factors. This two-stage approach might be beneficial to examine and cross-validate the findings from an aggregate to an individual scale, and can be easily extended to other chronic diseases.

Allopurinol and progression of CKD and cardiovascular events: long-term follow-up of a randomized clinical trial

BACKGROUND

Asymptomatic hyperuricemia increases renal and cardiovascular (CV) risk. We previously conducted a 2-year, single-blind, randomized, controlled trial of allopurinol treatment that showed improved estimated glomerular filtration rate and reduced CV risk.

STUDY DESIGN

Post hoc analysis of a long-term follow-up after completion of the 2-year trial.

SETTING & PARTICIPANTS

113 participants (57 in the allopurinol group and 56 in the control group) initially followed up for 2 years and 107 participants followed up to 5 additional years.

INTERVENTION

Continuation of allopurinol treatment, 100mg/d, or standard treatment.

OUTCOME

Renal event (defined as starting dialysis therapy and/or doubling serum creatinine and/or ≥50% decrease in estimated estimated glomerular filtration rate) and CV events (defined as myocardial infarction, coronary revascularization or angina pectoris, congestive heart failure, cerebrovascular disease, and peripheral vascular disease).

RESULTS

During initial follow-up, there were 2 renal and 7 CV events in the allopurinol group compared with 6 renal and 15 CV events in the control group. In the long-term follow-up period, 12 of 56 participants taking allopurinol stopped treatment and 10 of 51 control participants received allopurinol. During long-term follow-up, an additional 7 and 9 participants in the allopurinol group experienced a renal or CV event, respectively, and an additional 18 and 8 participants in the control group experienced a renal or CV event, respectively. Thus, during the initial and long-term follow-up (median, 84 months), 9 patients in the allopurinol group had a renal event compared with 24 patients in the control group (HR, 0.32; 95% CI, 0.15-0.69; P=0.004; adjusted for age, sex, baseline kidney function, uric acid level, and renin-angiotensin-aldosterone system blockers). Overall, 16 patients treated with allopurinol experienced CV events compared with 23 in the control group (HR, 0.43; 95% CI, 0.21-0.88; P=0.02; adjusted for age, sex, and baseline kidney function).

LIMITATIONS

Small sample size, single center, not double blind, post hoc follow-up and analysis.

CONCLUSIONS

Long-term treatment with allopurinol may slow the rate of progression of kidney disease and reduce CV risk.