1
|
Meier R, Grischott T, Rachamin Y, Jäger L, Senn O, Rosemann T, Burgstaller JM, Markun S. Importance of different electronic medical record components for chronic disease identification in a Swiss primary care database: a cross-sectional study. Swiss Med Wkly 2023; 153:40107. [PMID: 37854021 DOI: 10.57187/smw.2023.40107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Primary care databases collect electronic medical records with routine data from primary care patients. The identification of chronic diseases in primary care databases often integrates information from various electronic medical record components (EMR-Cs) used by primary care providers. This study aimed to estimate the prevalence of selected chronic conditions using a large Swiss primary care database and to examine the importance of different EMR-Cs for case identification. METHODS Cross-sectional study with 120,608 patients of 128 general practitioners in the Swiss FIRE ("Family Medicine Research using Electronic Medical Records") primary care database in 2019. Sufficient criteria on three individual EMR-Cs, namely medication, clinical or laboratory parameters and reasons for encounters, were combined by logical disjunction into definitions of 49 chronic conditions; then prevalence estimates and measures of importance of the individual EMR-Cs for case identification were calculated. RESULTS A total of 185,535 cases (i.e. patients with a specific chronic condition) were identified. Prevalence estimates were 27.5% (95% CI: 27.3-27.8%) for hypertension, 13.5% (13.3-13.7%) for dyslipidaemia and 6.6% (6.4-6.7%) for diabetes mellitus. Of all cases, 87.1% (87.0-87.3%) were identified via medication, 22.1% (21.9-22.3%) via clinical or laboratory parameters and 19.3% (19.1-19.5%) via reasons for encounters. The majority (65.4%) of cases were identifiable solely through medication. Of the two other EMR-Cs, clinical or laboratory parameters was most important for identifying cases of chronic kidney disease, anorexia/bulimia nervosa and obesity whereas reasons for encounters was crucial for identifying many low-prevalence diseases as well as cancer, heart disease and osteoarthritis. CONCLUSIONS The EMR-C medication was most important for chronic disease identification overall, but identification varied strongly by disease. The analysis of the importance of different EMR-Cs for estimating prevalence revealed strengths and weaknesses of the disease definitions used within the FIRE primary care database. Although prioritising specificity over sensitivity in the EMR-C criteria may have led to underestimation of most prevalences, their sex- and age-specific patterns were consistent with published figures for Swiss general practice.
Collapse
Affiliation(s)
- Rahel Meier
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Grischott
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Yael Rachamin
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Levy Jäger
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jakob M Burgstaller
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stefan Markun
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
2
|
Quality and variation of care for chronic kidney disease in Swiss general practice: A retrospective database study. PLoS One 2022; 17:e0272662. [PMID: 35951667 PMCID: PMC9371276 DOI: 10.1371/journal.pone.0272662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/24/2022] [Indexed: 11/19/2022] Open
Abstract
Background Chronic kidney disease (CKD) is a common condition in general practice. Data about quality and physician-level variation of CKD care provided by general practitioners is scarce. In this study, we evaluated determinants and variation of achievement of 14 quality indicators for CKD care using electronic medical records data from Swiss general practice during 2013–2019. Methods We defined two patient cohorts from 483 general practitioners, one to address renal function assessment in patients with predisposing conditions (n = 47,201, median age 68 years, 48.7% female) and one to address care of patients with laboratory-confirmed CKD (n = 14,654, median age 80 years, 57.5% female). We investigated quality indicator achievement with mixed-effect logistic regression and expressed physician-level variation as intraclass correlation coefficients (ICCs) and range odds ratios (rORs). Results We observed the highest quality indicator achievement rate for withholding non-steroidal anti-inflammatory drug prescription in patients with CKD staged G2–3b within 12 months of follow-up (82.6%), the lowest for albuminuria assessment within 18 months of follow-up (18.1%). Highest physician-level variation was found for renal function assessment during 18 months of follow-up in patients with predisposing conditions (diabetes: ICC 0.31, rOR 26.5; cardiovascular disease: ICC 0.28, rOR 17.4; hypertension: ICC 0.24, rOR 17.2). Conclusion This study suggests potentially unwarranted variation in general practice concerning RF assessment in patients affected by conditions predisposing for CKD. We further identified potential gaps in quality of CKD monitoring as well as lower quality of CKD care for female patients and patients not affected by comorbidities.
Collapse
|
3
|
Yoon H, Lee JH. Relationship between the Estimated Glomerular Filtration Rate and the Urine Microalbumin/Creatinine Ratio and Ferritin in Korean Adults. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2019. [DOI: 10.15324/kjcls.2019.51.2.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Hyun Yoon
- Department of Clinical Laboratory Science, Wonkwang Health Science University, Iksan, Korea
| | - Jun Ho Lee
- Department of Clinical Laboratory Science, Wonkwang Health Science University, Iksan, Korea
| |
Collapse
|
4
|
Wahl TS, Graham LA, Morris MS, Richman JS, Hollis RH, Jones CE, Itani KM, Wagner TH, Mull HJ, Whittle JC, Telford GL, Rosen AK, Copeland LA, Burns EA, Hawn MT. Association Between Preoperative Proteinuria and Postoperative Acute Kidney Injury and Readmission. JAMA Surg 2018; 153:e182009. [PMID: 29971429 DOI: 10.1001/jamasurg.2018.2009] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Proteinuria indicates renal dysfunction and is a risk factor for morbidity among medical patients, but less is understood among surgical populations. There is a paucity of studies investigating how preoperative proteinuria is associated with surgical outcomes, including postoperative acute kidney injury (AKI) and readmission. Objective To assess preoperative urine protein levels as a biomarker for adverse surgical outcomes. Design, Setting, and Participants A retrospective, population-based study was conducted in a cohort of patients with and without known preoperative renal dysfunction undergoing elective inpatient surgery performed at 119 Veterans Affairs facilities from October 1, 2007, to September 30, 2014. Data analysis was conducted from April 4 to December 1, 2016. Preoperative dialysis, septic, cardiac, ophthalmology, transplantation, and urologic cases were excluded. Exposures Preoperative proteinuria as assessed by urinalysis using the closest value within 6 months of surgery: negative (0 mg/dL), trace (15-29 mg/dL), 1+ (30-100 mg/dL), 2+ (101-300 mg/dL), 3+ (301-1000 mg/dL), and 4+ (>1000 mg/dL). Main Outcomes and Measures Primary outcome was postoperative predischarge AKI and 30-day postdischarge unplanned readmission. Secondary outcomes included any 30-day postoperative outcome. Results Of 346 676 surgeries, 153 767 met inclusion criteria, with the majority including orthopedic (37%), general (29%), and vascular procedures (14%). Evidence of proteinuria was shown in 43.8% of the population (trace: 20.6%, 1+: 16.0%, 2+: 5.5%, 3+: 1.6%) with 20.4%, 14.9%, 4.3%, and 0.9%, respectively, of the patients having a normal preoperative estimated glomerular filtration rate (eGFR). In unadjusted analysis, preoperative proteinuria was significantly associated with postoperative AKI (negative: 8.6%, trace: 12%, 1+: 14.5%, 2+: 21.2%, 3+: 27.6%; P < .001) and readmission (9.3%, 11.3%, 13.3%, 15.8%, 17.5%, respectively, P < .001). After adjustment, preoperative proteinuria was associated with postoperative AKI in a dose-dependent relationship (trace: odds ratio [OR], 1.2; 95% CI, 1.1-1.3, to 3+: OR, 2.0; 95% CI, 1.8-2.2) and 30-day unplanned readmission (trace: OR, 1.0; 95% CI, 1.0-1.1, to 3+: OR, 1.3; 95% CI, 1.1-1.4). Preoperative proteinuria was associated with AKI independent of eGFR. Conclusions and Relevance Proteinuria was associated with postoperative AKI and 30-day unplanned readmission independent of preoperative eGFR. Simple urine assessment for proteinuria may identify patients at higher risk of AKI and readmission to guide perioperative management.
Collapse
Affiliation(s)
- Tyler S Wahl
- Birmingham and Tuscaloosa Health Services Research and Development Unit, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama.,Department of Surgery, University of Alabama at Birmingham
| | - Laura A Graham
- Birmingham and Tuscaloosa Health Services Research and Development Unit, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama.,Department of Surgery, University of Alabama at Birmingham
| | - Melanie S Morris
- Birmingham and Tuscaloosa Health Services Research and Development Unit, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama.,Department of Surgery, University of Alabama at Birmingham
| | - Joshua S Richman
- Birmingham and Tuscaloosa Health Services Research and Development Unit, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama.,Department of Surgery, University of Alabama at Birmingham
| | - Robert H Hollis
- Birmingham and Tuscaloosa Health Services Research and Development Unit, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama.,Department of Surgery, University of Alabama at Birmingham
| | - Caroline E Jones
- Birmingham and Tuscaloosa Health Services Research and Development Unit, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama.,Department of Surgery, University of Alabama at Birmingham
| | - Kamal M Itani
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Boston Healthcare System, Boston, Massachusetts.,Department of Surgery, Boston University School of Medicine, Boston, Massachusetts.,School of Medicine, Harvard University, Boston, Massachusetts
| | - Todd H Wagner
- Veterans Affairs Palo Alto Healthcare System, Palo Alto, California.,Department of Surgery, Stanford University, Stanford, California
| | - Hillary J Mull
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Boston Healthcare System, Boston, Massachusetts.,Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Jeffrey C Whittle
- Milwaukee Veterans Affairs Medical Center, Milwaukee, Wisconsin.,Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Gordon L Telford
- Milwaukee Veterans Affairs Medical Center, Milwaukee, Wisconsin.,Department of Surgery, Medical College of Wisconsin, Milwaukee
| | - Amy K Rosen
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Boston Healthcare System, Boston, Massachusetts.,Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Laurel A Copeland
- Veterans Affairs Central Western Massachusetts Health Care System, Leeds.,Center for Applied Health Research, Baylor Scott and White Health, Temple, Texas.,Department of Medicine, Texas A&M Health Science Center, Temple
| | - Edith A Burns
- Milwaukee Veterans Affairs Medical Center, Milwaukee, Wisconsin.,Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Mary T Hawn
- Veterans Affairs Palo Alto Healthcare System, Palo Alto, California.,Department of Surgery, Stanford University, Stanford, California
| |
Collapse
|
5
|
Abd ElHafeez S, Bolignano D, D’Arrigo G, Dounousi E, Tripepi G, Zoccali C. Prevalence and burden of chronic kidney disease among the general population and high-risk groups in Africa: a systematic review. BMJ Open 2018; 8:e015069. [PMID: 29326180 PMCID: PMC5780690 DOI: 10.1136/bmjopen-2016-015069] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 08/25/2017] [Accepted: 09/01/2017] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES While increasing attention is paid to the rising prevalence of chronic diseases in Africa, there is little focus on chronic kidney disease (CKD). This systematic review assesses CKD burden among the general population and high-risk groups on the entire African continent. DESIGN, SETTING AND PARTICIPANTS We searched Medline and PubMed databases for articles published between 1 January 1995 and 7 April 2017 by sensitive search strategies focusing on CKD surveys at the community level and high-risk groups. In total, 7918 references were evaluated, of which 7766 articles were excluded because they did not meet the inclusion criteria. Thus, 152 studies were included in the final analysis. OUTCOME MEASUREMENT The prevalence of CKD in each study group was expressed as a range and pooled prevalence rate of CKD was calculated as a point estimate and 95% CI. No meta-analysis was done. Data were presented for different populations. RESULTS In the community-level studies, based on available medium-quality and high-quality studies, the prevalence of CKD ranged from 2% to 41% (pooled prevalence: 10.1%; 95% CI 9.8% to 10.5%). The prevalence of CKD in the high-risk groups ranged from 1% to 46% (pooled prevalence: 5.6%; 95% CI 5.4% to 5.8%) in patients with HIV (based on available medium-quality and high-quality studies), 11%-90% (pooled prevalence: 24.7%; 95% CI 23.6% to 25.7%) in patients with diabetes (based on all available studies which are of low quality except four of medium quality) and 13%-51% (pooled prevalence: 34.5%; 95 % CI 34.04% to 36%) in patients with hypertension (based on all available studies which are of low quality except two of medium quality). CONCLUSION In Africa, CKD is a public health problem, mainly attributed to high-risk conditions as hypertension and diabetes. The poor data quality restricts the validity of the findings and draws the attention to the importance of designing future robust studies.
Collapse
Affiliation(s)
- Samar Abd ElHafeez
- Department of Epidemiology, High Institute of Public Health – Alexandria University, Alexandria, Egypt
| | - Davide Bolignano
- Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Cal Unit, CNR/IFC, Reggio Calabria, Italy
| | - Graziella D’Arrigo
- Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Cal Unit, CNR/IFC, Reggio Calabria, Italy
| | - Evangelia Dounousi
- Department of Nephrology, School of Health Sciences – University of Ioannina, Ioannina, Greece
| | - Giovanni Tripepi
- Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Cal Unit, CNR/IFC, Reggio Calabria, Italy
| | - Carmine Zoccali
- Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Cal Unit, CNR/IFC, Reggio Calabria, Italy
| |
Collapse
|
6
|
Jämsä PP, Oksala NKJ, Eskelinen AP, Jämsen ER. Chronic Kidney Diseases Among Patients Undergoing Elective Arthroplasty: Risk Groups and the Value of Serum Creatinine. J Arthroplasty 2018; 33:230-234.e1. [PMID: 28887023 DOI: 10.1016/j.arth.2017.07.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 07/10/2017] [Accepted: 07/31/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In arthroplasty clinics, we tend to evaluate patient's kidney function looking at serum creatinine (SCr), while estimated glomerular filtration rate (eGFR) is recommended. We reported the prevalence of chronic kidney disease (CKD; eGFR <60 mL/min/1.73 m2) in different patient groups and investigated whether CKD is missed by evaluation based on SCr. METHODS Preoperative SCr values were used to calculate eGFR in 20,575 consecutive hip or knee arthroplasties. RESULTS Prevalence of CKD was 9%-12%. It was higher among older women, knee arthroplasty patients, and patients with hypertension, diabetes, or coronary disease. Using SCr instead of eGFR leads to missing CKD in up to 7% of the cases. In older women and older patients with body mass index <25 kg/m2, half of CKD cases were missed. CONCLUSION Use of eGFR instead of SCr to detect CKD more accurately is recommended.
Collapse
Affiliation(s)
- Pyry P Jämsä
- Coxa Hospital for Joint Replacement, Tampere, Finland; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Niku K J Oksala
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland; Department of Vascular Surgery, Tampere University Hospital, Tampere, Finland
| | | | - Esa R Jämsen
- Coxa Hospital for Joint Replacement, Tampere, Finland; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| |
Collapse
|
7
|
Herrera-Añazco P, Taype-Rondan A, Lazo-Porras M, Alberto Quintanilla E, Ortiz-Soriano VM, Hernandez AV. Prevalence of chronic kidney disease in Peruvian primary care setting. BMC Nephrol 2017; 18:246. [PMID: 28724362 PMCID: PMC5517816 DOI: 10.1186/s12882-017-0655-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 07/05/2017] [Indexed: 12/02/2022] Open
Abstract
Background Chronic Kidney Disease (CKD) is a worldwide public health problem. There are few studies in Latin America, especially in primary care settings. Our objective was to determine the prevalence, stages, and associated factors of CKD in primary care setting. Methods We did a retrospective secondary analysis of a database from the Diabetes and Hypertension Primary Care Center of the Peruvian Social Security System (EsSalud) in Lima, Peru. We defined CKD as the presence of eGFR <60 mL/min and/or albuminuria >30 mg/day in 24 h, according to Kidney Disease: Improving Global Outcomes (KDIGO). Factors associated with CKD were evaluated with Poisson Regression models; these factors included age, gender, type 2 diabetes mellitus (DM2), hypertension (HTN), body mass index (BMI), and uric acid. Associations were described as crude and adjusted prevalence ratios (PR) and their 95% confidence intervals (95% CI). Results We evaluated 1211 patients (women [59%], mean age 65.8 years [SD: 12.7]). Prevalence of CKD was 18%. Using the estimated glomerular filtration rate (eGFR), the prevalence was 9.3% (95% CI 5.3 – 13.3) in patients without HTN or DM2; 20.2% (95% CI 17.6 – 22.8) in patients with HTN, and 23.9% (95% CI 19.4 – 28.4) in patients with DM2. The most common stages were 1 and 2 with 41.5% and 48%, respectively. Factors associated with CKD in the adjusted analysis were: age in years (PR = 1.03, 95% CI 1.01 – 1.04), DM2 (PR = 3.37, 95% CI 1.09 – 10.39), HTN plus DM2 (PR = 3.90, 95% CI 1.54 – 9.88), and uric acid from 5 to <7 mg/dL (PR = 2.04, 95% CI 1.31 – 3.19) and ≥7 mg/dL (PR = 5.19, 95% CI 3.32 – 8.11). Conclusions Prevalence of CKD in the primary care setting population was high. CKD is more frequent in the early stages of the disease, and individuals with hypertension, DM2, older age and hyperuricemia have higher prevalence of CKD. Electronic supplementary material The online version of this article (doi:10.1186/s12882-017-0655-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Percy Herrera-Añazco
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Olavegoya 1879 dpto 701 Jesus Maria, Lima, Peru. .,Hospital Nacional Dos de Mayo, Lima, Peru.
| | - Alvaro Taype-Rondan
- CRONICAS Centro de Excelencia de Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Peru.,Unidad de Conocimiento y Evidencia (CONEVID - UPCH), Lima, Peru
| | - María Lazo-Porras
- CRONICAS Centro de Excelencia de Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Peru.,Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru.,Unidad de Conocimiento y Evidencia (CONEVID - UPCH), Lima, Peru
| | - E Alberto Quintanilla
- Centro de Atención Integral de Diabetes e Hipertensión (CEDHI) - EsSalud, Lima, Peru
| | | | - Adrian V Hernandez
- University of Connecticut/Hartford Hospital Evidence-based Practice Center, Hartford, CT, 06102, USA
| |
Collapse
|
8
|
Hu W, Wu XJ, Ni YJ, Hao HR, Yu WN, Zhou HW. Metabolic syndrome is independently associated with a mildly reduced estimated glomerular filtration rate: a cross-sectional study. BMC Nephrol 2017; 18:192. [PMID: 28610620 PMCID: PMC5470228 DOI: 10.1186/s12882-017-0597-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 05/19/2017] [Indexed: 01/28/2023] Open
Abstract
Background Association between metabolic syndrome (MS) and mildly reduced estimated glomerular filtration rates (eGFRs) remains unclear. Therefore, we aimed to evaluate the association between MS and a mildly reduced eGFR in Chinese adults. Methods Anthropometric and biochemical examinations were performed in 2992 individuals. The eGFR was calculated from the creatinine level. MS was defined according to the Adult Treatment Panel III criteria as the presence of three or more risk factors. Mildly reduced eGFR was defined as a value between 60 and 90 mL/min/1.73 m2. Multiple linear regression and multiple logistic regression analysis were used to evaluate association between metabolic syndrome and estimate glomerular filtration rate. Results After adjusting for several potential confounders, the participants with MS showed a 1.29-fold increased odds ratio for a mildly reduced eGFR compared with those without MS. Additionally, the odds ratios (and 95% confidence intervals (CIs)) for mildly reduced eGFR in participants with elevated triglycerides (TG), decreased high-density lipoprotein (HDL), obesity and elevated fasting blood glucose (FPG) after multivariable adjustment were 1.25 (1.05–1.49), 1.23 (1.03–1.48), 1.22 (1.03–1.45) and 0.64 (0.52–0.78), respectively. The odds ratios (95% CIs) for hyperfiltration in participants with elevated FPG and HbA1c levels after multivariable adjustment were 1.53 (1.30–1.81) and 2.86 (2.00–4.09), respectively. Conclusions MS is associated with an increased risk of a mildly reduced eGFR in the Chinese population, and several individual components of MS have different impacts on eGFR levels. MS had dual roles on renal damage. Trial registration ChiCTR-TRC-14005029. Registered 28 July 2014. Electronic supplementary material The online version of this article (doi:10.1186/s12882-017-0597-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Wen Hu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China.,Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical University and Huai'an Second People's Hospital, Huai'an, 223001, China
| | - Xiao-Juan Wu
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical University and Huai'an Second People's Hospital, Huai'an, 223001, China
| | - Yao-Jun Ni
- Department of Cardiothoracic Surgery, Hospital Affiliated to Nanjing Medical University and Huai'an First People's Hospital, Huai'an, 223001, China
| | - Hai-Rong Hao
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical University and Huai'an Second People's Hospital, Huai'an, 223001, China
| | - Wei-Nan Yu
- Department of Endocrinology and Metabolism, Huai'an Hospital Affiliated to Xuzhou Medical University and Huai'an Second People's Hospital, Huai'an, 223001, China
| | - Hong-Wen Zhou
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China. .,Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, China.
| |
Collapse
|
9
|
Hill NR, Fatoba ST, Oke JL, Hirst JA, O’Callaghan CA, Lasserson DS, Hobbs FDR. Global Prevalence of Chronic Kidney Disease - A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0158765. [PMID: 27383068 PMCID: PMC4934905 DOI: 10.1371/journal.pone.0158765] [Citation(s) in RCA: 2066] [Impact Index Per Article: 258.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 06/21/2016] [Indexed: 12/11/2022] Open
Abstract
Chronic kidney disease (CKD) is a global health burden with a high economic cost to health systems and is an independent risk factor for cardiovascular disease (CVD). All stages of CKD are associated with increased risks of cardiovascular morbidity, premature mortality, and/or decreased quality of life. CKD is usually asymptomatic until later stages and accurate prevalence data are lacking. Thus we sought to determine the prevalence of CKD globally, by stage, geographical location, gender and age. A systematic review and meta-analysis of observational studies estimating CKD prevalence in general populations was conducted through literature searches in 8 databases. We assessed pooled data using a random effects model. Of 5,842 potential articles, 100 studies of diverse quality were included, comprising 6,908,440 patients. Global mean(95%CI) CKD prevalence of 5 stages 13·4%(11·7-15·1%), and stages 3-5 was 10·6%(9·2-12·2%). Weighting by study quality did not affect prevalence estimates. CKD prevalence by stage was Stage-1 (eGFR>90+ACR>30): 3·5% (2·8-4·2%); Stage-2 (eGFR 60-89+ACR>30): 3·9% (2·7-5·3%); Stage-3 (eGFR 30-59): 7·6% (6·4-8·9%); Stage-4 = (eGFR 29-15): 0·4% (0·3-0·5%); and Stage-5 (eGFR<15): 0·1% (0·1-0·1%). CKD has a high global prevalence with a consistent estimated global CKD prevalence of between 11 to 13% with the majority stage 3. Future research should evaluate intervention strategies deliverable at scale to delay the progression of CKD and improve CVD outcomes.
Collapse
Affiliation(s)
- Nathan R. Hill
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Samuel T. Fatoba
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Jason L. Oke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Jennifer A. Hirst
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | | | - Daniel S. Lasserson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - F. D. Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
10
|
Risch M, Risch L, Purde MT, Renz H, Ambühl P, Szucs T, Tomonaga Y. Association of the cystatin C/creatinine ratio with the renally cleared hormones parathyroid hormone (PTH) and brain natriuretic peptide (BNP) in primary care patients: a cross-sectional study. Scandinavian Journal of Clinical and Laboratory Investigation 2016; 76:379-85. [DOI: 10.1080/00365513.2016.1183262] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Martin Risch
- Kantonsspital Graubünden, Zentrallabor, Chur, Switzerland
- Labormedizinisches Zentrum Dr. Risch, Liebefeld, Switzerland
| | - Lorenz Risch
- Labormedizinisches Zentrum Dr. Risch, Liebefeld, Switzerland
- Faculty of Medical Sciences, Private University, Triesen, Liechtenstein
- University Institute of Clinical Chemistry, University Hospital and University of Bern, Bern, Switzerland
| | - Mette-Triin Purde
- Faculty of Science, Tallinn University of Technology, Tallinn, Estonia
| | - Harald Renz
- Institute of Laboratory Medicine, Philipps University Marburg, Marburg, Germany
| | - Patrice Ambühl
- Division of Nephrology, Stadtspital Waid, Zurich, Switzerland
| | - Thomas Szucs
- European Center of Pharmaceutical Medicine, University of Basel, Basel, Switzerland
| | - Yuki Tomonaga
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| |
Collapse
|
11
|
Jiwa M, Chakera A, Dadich A, Meng X, Kanjo E. The profile of patients with chronic kidney disease who regularly present at an Australian general practice. Curr Med Res Opin 2016; 32:183-9. [PMID: 26473553 DOI: 10.1185/03007995.2015.1109505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a common, serious and mostly asymptomatic condition that places considerable burden on the Australian healthcare system. Yet there is limited information on the patients with CKD who present to Australian primary care services, which represent the gateway to specialized care. METHODS Data pertaining to 31,897 patients who presented to a general practice in Western Australia, from 1 January 2013 to 30 June 2014 (inclusive), were extracted for review. Data included attendance records, comorbidities, diagnoses, and demographic details. Binary logistic regression was used to compare patients diagnosed with CKD by the consulting general practitioner with those without this diagnosis. RESULTS Of the 8629 patients who regularly attended the practice, 184 (2%) were diagnosed with CKD (mean age: 77.7 years; male: 57.1%). The stage of CKD was recorded in only 8.4% of cases. Patients with CKD averaged 11 more consultations in the past 18 months (mean difference 10.8, 95% CI [9.3, 12.3], p < .001). They were also more likely to: be male; be ex-smokers; be widowed; and to have a carer. Their most common comorbidities included acute infections, cerebrovascular or ischemic heart disease, osteopenia or osteoporosis, and cancer; 8.7% had died within the previous year. CONCLUSIONS Despite the prevalence of CKD, only one in five cases were recorded within this large practice. This reveals lost opportunities to monitor and manage patients with this chronic and common disease. Although this represents an important finding, this study is limited by the reliance on practice records, some of which were incomplete. Nevertheless, this study reveals two key findings. First, this disease is under-diagnosed and/or under-recorded. Second, patients with CKD have other, potentially unrelated, problems that may warrant attention.
Collapse
Affiliation(s)
- Moyez Jiwa
- a a Melbourne Clinical School , School of Medicine Sydney University of Notre Dame , Werribee, VIC , Australia
| | - Aron Chakera
- b b Renal Medicine, Sir Charles Gairdner Hospital , Perth, WA , Australia
| | - Ann Dadich
- c c School of Business , Western Sydney University , Parramatta, NSW , Australia
| | - Xingqiong Meng
- d d School of Medicine , Flinders University , Adelaide, SA , Australia
| | - Epi Kanjo
- a a Melbourne Clinical School , School of Medicine Sydney University of Notre Dame , Werribee, VIC , Australia
| |
Collapse
|
12
|
Pan L, Ma R, Wu Y, Feng L, Song YS, Ye XD, Zhang YH, Yang ZH, Liao YH. Prevalence and risk factors associated with chronic kidney disease in a Zhuang ethnic minority area in China. Nephrology (Carlton) 2015; 20:807-13. [PMID: 25975719 DOI: 10.1111/nep.12510] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 12/26/2022]
Abstract
AIM Numerous studies have examined and reported a high prevalence of chronic kidney disease (CKD) in the general population in various countries including China. However, the situation may be different in undeveloped rural minority regions in China because of China's economic diversity. The aim of the present study was to estimate the prevalence of CKD and to analyze its associated factors in a Zhuang ethnic minority area in Southwest China. METHODS A cross-sectional survey of a rural minority area populated by people of Zhuang ethnicity in Southwest China using multistage, cluster random sampling methods was performed. The prevalence of indicators of kidney damage and CKD were calculated and risk factors associated with the presence of CKD were analyzed. RESULTS In total, 7588 people participated in the study. After adjustment for age and gender, the prevalence of albuminuria, haematuria and reduced estimated glomerular filtration rate were 2.7%, 3.7%, and 2.2%, respectively. After adjustment for age and gender, the prevalence of CKD was 8.3%, while recognition of the disease was 3.6%. Independent risk factors associated with CKD were age, gender, and hypertension. Risk factors independently associated with kidney damage were age, gender, hyperuricaemia, and hypertension. CONCLUSION Our data exhibited a lower prevalence and awareness of CKD in undeveloped rural minority regions, especially exhibited a low prevalence of albuminuria. This result attributed to the low prevalence of metabolic disorders in the local region. Risk factors associated with CKD in our study is similar to surveys in other regions of China.
Collapse
Affiliation(s)
- Ling Pan
- Renal Division, Department of Medicine, First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University Institute of Urology, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Rui Ma
- Renal Division, Department of Medicine, First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University Institute of Urology, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Yue Wu
- Renal Division, Department of Medicine, First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University Institute of Urology, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Li Feng
- Renal Division, Department of Medicine, First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University Institute of Urology, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Ya-Shan Song
- Renal Division, Department of Medicine, First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University Institute of Urology, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Xu-Dong Ye
- Renal Division, Department of Medicine, First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University Institute of Urology, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Ying-Hua Zhang
- Renal Division, Department of Medicine, First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University Institute of Urology, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Zhen-Hua Yang
- Renal Division, Department of Medicine, First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University Institute of Urology, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Yun-Hua Liao
- Renal Division, Department of Medicine, First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University Institute of Urology, Nanning, Guangxi Zhuang Autonomous Region, China
| |
Collapse
|
13
|
Fasting blood glucose, but not 2-h postload blood glucose or HbA1c, is associated with mild decline in estimated glomerular filtration rate in healthy Chinese. Int Urol Nephrol 2014; 47:147-52. [PMID: 25503445 DOI: 10.1007/s11255-014-0880-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 11/07/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND The association of blood glucose [including fasting blood glucose (FBG), 2-h postload blood glucose, and glycated hemoglobin (HbA1c)] with the risk of a mild decline in the estimated glomerular filtration rate (eGFR) in healthy subjects was unclear. The aim of the study was to investigate this association in middle-aged and elderly healthy Chinese. METHODS The study included 1,112 healthy Chinese who were ≥40 years old, and all the subjects were divided into two groups based on FBG value of 5.6 mmol/L. A mildly reduced eGFR was defined as 60-90 mL/min/1.73 m2. Multiple linear or logistic regression analysis was used to estimate the association of blood glucose with eGFR and the risk of a mildly reduced eGFR, respectively. A generalized additive model was used to explore a possible nonlinear relationship between FBG and eGFR. RESULTS FBG was significantly associated with decreased eGFR and increased risk of a mildly reduced eGFR independent of age, gender, body mass index, waist circumference, systolic blood pressure (BP), diastolic BP, triglyceride, high-density lipoprotein cholesterol, fasting insulin, smoking, and drinking. Additionally, FBG and eGFR showed a nonlinear association (P<0.001). Interestingly, the group with FBG≥5.6 mmol/L significantly increased the risk of a mildly reduced eGFR (OR 2.06, P=0.001) after multivariable adjustment. CONCLUSIONS FBG is closely associated with decreased eGFR and increased risk of a mildly reduced eGFR. The ADA criteria using FBG=5.6 mmol/L instead of 6.1 mmol/L as cutoff point to define prediabetes are more suitable for the prevention of diabetes and related kidney disease.
Collapse
|
14
|
Hou X, Wang C, Zhang X, Zhao X, Wang Y, Li C, Li M, Wang S, Yang W, Ma Z, Ma A, Zheng H, Wu J, Sun Y, Song J, Lin P, Liang K, Gong L, Wang M, Liu F, Li W, Xiao J, Yan F, Yang J, Wang L, Tian M, Liu J, Zhao R, Chen S, Chen L. Triglyceride levels are closely associated with mild declines in estimated glomerular filtration rates in middle-aged and elderly Chinese with normal serum lipid levels. PLoS One 2014; 9:e106778. [PMID: 25275610 PMCID: PMC4183470 DOI: 10.1371/journal.pone.0106778] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 08/08/2014] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To investigate the relationship between lipid profiles [including total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C)] and a mild decline in the estimated glomerular filtration rate (eGFR) in subjects with normal serum lipid levels. DESIGN AND METHODS In this study, we included 2647 participants who were ≥ 40 years old and had normal serum lipid levels. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was used to estimate the GFR. A mildly reduced eGFR was defined as 60-90 mL/min/1.73 m(2). First, multiple linear regression analysis was used to estimate the association of lipid profiles with the eGFR. Then, the levels of each lipid component were divided into four groups, using the 25th, 50th and 75th percentiles as cut-off points. Finally, multiple logistic regression analysis was used to investigate the association of different lipid components with the risk of mildly reduced eGFR. RESULTS In the group with a mildly reduced eGFR, TG and LDL-C levels were significantly increased, but HDL-C levels were significantly decreased. After adjusting for age, gender, body mass index (BMI), systolic blood pressure (SBP), glycated hemoglobin (HbA1c), smoking and drinking, only TC and TG were independently related to the eGFR. Additionally, only TG showed a linear relationship with an increased risk of a mildly reduced eGFR, with the highest quartile group (TG: 108-150 mg/dl [1.22-1.70 mmol/L]) having a significantly increased risk after adjusting for the above factors. CONCLUSIONS Triglyceride levels are closely associated with a mildly reduced eGFR in subjects with normal serum lipid levels. Dyslipidemia with lower TG levels could be used as new diagnostic criteria for subjects with mildly reduced renal function.
Collapse
Affiliation(s)
- Xinguo Hou
- Department of Endocrinology of Qilu Hospital and Institute of Endocrinology and Metabolism, Shandong University, Jinan, Shandong, China
| | - Chuan Wang
- Department of Endocrinology of Qilu Hospital and Institute of Endocrinology and Metabolism, Shandong University, Jinan, Shandong, China
| | - Xiuping Zhang
- Shantui Community Health Center, Jining, Shandong, China
| | - Xiangmin Zhao
- Shantui Community Health Center, Jining, Shandong, China
| | - Yulian Wang
- Department of Endocrinology, Second People's Hospital of Jining, Jining, Shandong, China
| | - Chengqiao Li
- Department of Endocrinology, Second People's Hospital of Jining, Jining, Shandong, China
| | - Mei Li
- Department of Endocrinology, Second People's Hospital of Jining, Jining, Shandong, China
| | | | - Weifang Yang
- Lukang Hospital of Jining, Jining, Shandong, China
| | - Zeqiang Ma
- China National Heavy Duty Truck Group Corporation Hospital, Jinan, Shandong, China
| | - Aixia Ma
- Department of Endocrinology of Qilu Hospital and Institute of Endocrinology and Metabolism, Shandong University, Jinan, Shandong, China
| | - Huizhen Zheng
- Department of Endocrinology of Qilu Hospital and Institute of Endocrinology and Metabolism, Shandong University, Jinan, Shandong, China
| | - Jiahui Wu
- Department of Endocrinology of Qilu Hospital and Institute of Endocrinology and Metabolism, Shandong University, Jinan, Shandong, China
| | - Yu Sun
- Department of Endocrinology of Qilu Hospital and Institute of Endocrinology and Metabolism, Shandong University, Jinan, Shandong, China
| | - Jun Song
- Department of Endocrinology of Qilu Hospital and Institute of Endocrinology and Metabolism, Shandong University, Jinan, Shandong, China
| | - Peng Lin
- Department of Endocrinology of Qilu Hospital and Institute of Endocrinology and Metabolism, Shandong University, Jinan, Shandong, China
| | - Kai Liang
- Department of Endocrinology of Qilu Hospital and Institute of Endocrinology and Metabolism, Shandong University, Jinan, Shandong, China
| | - Lei Gong
- Department of Endocrinology of Qilu Hospital and Institute of Endocrinology and Metabolism, Shandong University, Jinan, Shandong, China
| | - Meijian Wang
- Department of Endocrinology of Qilu Hospital and Institute of Endocrinology and Metabolism, Shandong University, Jinan, Shandong, China
| | - Fuqiang Liu
- Department of Endocrinology of Qilu Hospital and Institute of Endocrinology and Metabolism, Shandong University, Jinan, Shandong, China
| | - Wenjuan Li
- Department of Endocrinology of Qilu Hospital and Institute of Endocrinology and Metabolism, Shandong University, Jinan, Shandong, China
| | - Juan Xiao
- Department of Endocrinology of Qilu Hospital and Institute of Endocrinology and Metabolism, Shandong University, Jinan, Shandong, China
| | - Fei Yan
- Department of Endocrinology of Qilu Hospital and Institute of Endocrinology and Metabolism, Shandong University, Jinan, Shandong, China
| | - Junpeng Yang
- Department of Endocrinology of Qilu Hospital and Institute of Endocrinology and Metabolism, Shandong University, Jinan, Shandong, China
| | - Lingshu Wang
- Department of Endocrinology of Qilu Hospital and Institute of Endocrinology and Metabolism, Shandong University, Jinan, Shandong, China
| | - Meng Tian
- Department of Endocrinology of Qilu Hospital and Institute of Endocrinology and Metabolism, Shandong University, Jinan, Shandong, China
| | - Jidong Liu
- Department of Endocrinology of Qilu Hospital and Institute of Endocrinology and Metabolism, Shandong University, Jinan, Shandong, China
| | - Ruxing Zhao
- Department of Endocrinology of Qilu Hospital and Institute of Endocrinology and Metabolism, Shandong University, Jinan, Shandong, China
| | - Shihong Chen
- Department of Endocrinology, the Second Hospital of Shandong University, Jinan, Shandong, China
- * E-mail: (SC); (LC)
| | - Li Chen
- Department of Endocrinology of Qilu Hospital and Institute of Endocrinology and Metabolism, Shandong University, Jinan, Shandong, China
- * E-mail: (SC); (LC)
| |
Collapse
|
15
|
Wang C, Liang K, Zhang X, Li C, Yang W, Ma Z, Sun Y, Song J, Lin P, Gong L, Wang M, Liu F, Li W, Xiao J, Yan F, Yang J, Wang L, Tian M, Liu J, Zhao R, Hou X, Chen L. Metabolic abnormalities, but not obesity, contribute to the mildly reduced eGFR in middle-aged and elderly Chinese. Int Urol Nephrol 2014; 46:1793-9. [PMID: 25099525 DOI: 10.1007/s11255-014-0797-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 07/21/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The role of obesity as a determinant of kidney dysfunction has not reached an agreement and the underlying reason may be due to the heterogeneity of obese phenotypes. The aim of the study was to explore the associations of different obese phenotypes with the change of estimated glomerular filtration rate (eGFR) and the roles of obesity and metabolic abnormalities in this association. METHODS eGFR was calculated in 8,586 participants (≥ 40 years old). eGFR 60-90 mL/min/1.73 m(2) was defined as the mildly reduced eGFR. Multiple logistic regression analysis was used to determine odds ratios (ORs) for mildly reduced eGFR in the metabolically healthy obese (MHO), metabolically abnormal non-obese (MANO) and metabolically abnormal obese (MAO) groups, using the metabolically healthy non-obese (MHNO) subjects as the reference group. Meanwhile, the associations of body mass index (BMI), waist circumference (WC) and metabolic abnormalities (including hypertension, hyperglycemia and dyslipidemia) with the risk of mildly reduced eGFR were also investigated. RESULTS The proportion of MHNO, MHO, MANO and MAO subjects was 8.3, 17.1, 10.1 and 64.5 %, respectively. Increased ORs were observed in MANO (OR 1.51, P = 0.014) and MAO (OR 1.47, P = 0.015) groups, after adjusting for age, gender, smoking, drinking, BMI and WC. When further adjusting for metabolic abnormalities, MANO (OR 1.24, P = 0.247) and MAO (OR 1.17, P = 0.366) subjects would not present increased risk of mildly reduced eGFR any more. Oppositely, fasting insulin (OR 1.03, P < 0.001), hyperglycemia (OR 1.25, P = 0.002) and dyslipidemia (OR 1.25, P = 0.002), but not hypertension, BMI and WC, significantly increased the risk of mildly reduced eGFR. CONCLUSIONS Metabolic abnormalities, but not simple obesity, may contribute to the mildly reduced eGFR in middle-aged and elderly Chinese.
Collapse
Affiliation(s)
- Chuan Wang
- Department of Endocrinology of Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Wang C, Song J, Ma Z, Yang W, Li C, Zhang X, Hou X, Sun Y, Lin P, Liang K, Gong L, Wang M, Liu F, Li W, Yan F, Yang J, Wang L, Tian M, Liu J, Zhao R, Chen L. Fluctuation between fasting and 2-H postload glucose state is associated with chronic kidney disease in previously diagnosed type 2 diabetes patients with HbA1c ≥ 7%. PLoS One 2014; 9:e102941. [PMID: 25047354 PMCID: PMC4105498 DOI: 10.1371/journal.pone.0102941] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 06/23/2014] [Indexed: 12/16/2022] Open
Abstract
Objective To investigate how the glucose variability between fasting and a 2-h postload glucose state (2-h postload plasma glucose [2hPG]-fasting plasma glucose [FPG]) is associated with chronic kidney disease (CKD) in middle-aged and elderly Chinese patients previously diagnosed with type 2 diabetes. Design and Methods This cross-sectional study included 1054 previously diagnosed type 2 diabetes patients who were 40 years of age and older. First, the subjects were divided into two groups based on a glycated hemoglobin (HbA1c) value of 7%. Each group was divided into two subgroups, with or without CKD. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was used to estimate the glomerular filtration rate (GFR). CKD was defined as eGFR<60 mL/min/1.73 m2. Multiple linear regression analysis was used to estimate the association between the 2hPG-FPG and eGFR. The 2hPG-FPG value was divided into four groups increasing in increments of 36 mg/dl (2.0 mmol/L): 0–72, 72–108, 108–144 and ≥144 mg/dl, based on the quartiles of patients with HbA1c levels ≥7%; then, binary logistic regression analysis was used to investigate the association between 2hPG-FPG and the risk of CKD. Results In the patients with HbA1c levels ≥7%, the 2hPG-FPG was significantly associated with decreased eGFR and an increased risk of CKD independent of age, gender, body mass index (BMI), systolic blood pressure (BP), diastolic BP, smoking, and drinking, as well as fasting insulin, cholesterol, triglyceride, and HbA1c levels. The patients with 2hPG-FPG values ≥144 mg/dl showed an increased odds ratio (OR) of 2.640 (P = 0.033). Additionally, HbA1c was associated with an increased risk of CKD in patients with HbA1c values ≥7%. Conclusions The short-term glucose variability expressed by 2hPG-FPG is closely associated with decreased eGFR and an increased risk of CKD in patients with poor glycemic control (HbA1c≥7%).
Collapse
Affiliation(s)
- Chuan Wang
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Jun Song
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Zeqiang Ma
- China National Heavy Duty Truck Group Corporation Hospital, Jinan, Shandong, China
| | - Weifang Yang
- Lukang Hospital of Jining, Jining, Shandong, China
| | - Chengqiao Li
- Department of Endocrinology, Second People's Hospital of Jining, Jining, Shandong, China
| | - Xiuping Zhang
- Shantui Community Health Center, Jining, Shandong, China
| | - Xinguo Hou
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yu Sun
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Peng Lin
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Kai Liang
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Lei Gong
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Meijian Wang
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Fuqiang Liu
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Wenjuan Li
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Fei Yan
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Junpeng Yang
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Lingshu Wang
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Meng Tian
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Jidong Liu
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Ruxing Zhao
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Li Chen
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China
- * E-mail:
| |
Collapse
|