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Samaan F, Damiani BB, Kirsztajn GM, Sesso R. A Cross-Sectional Study on the Prevalence and Risk Stratification of Chronic Kidney Disease in Cardiological Patients in São Paulo, Brazil. Diagnostics (Basel) 2023; 13:diagnostics13061146. [PMID: 36980454 PMCID: PMC10047703 DOI: 10.3390/diagnostics13061146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
Chronic kidney disease (CKD) provides a worse prognosis for patients with heart disease. In Latin America, studies that analyzed the prevalence and risk stratification of CKD in this population are scarce. We aimed to evaluate CKD prevalence and risk categories in patients of a public referral cardiology hospital in São Paulo, Brazil. This was a cross-sectional study based on a laboratory database. Outpatient serum creatinine and proteinuria results performed between 1 January 2021 and 31 December 2021 were analyzed. CKD was defined by estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 and proteinuria, by the albumin/creatinine ratio in a spot urine sample (UACR) >30 mg/g. A total of 36,651 adults were identified with serum creatinine levels (median age 72.4 [IQR, 51.0–73.6] years, 51% male). Among them, 51.9% had UACR dosage (71.5% with UACR < 30 mg/g, 22.6%, between 30–300 mg/g, and 5.9% with UACR > 300 mg/g). The prevalence of CKD was 30.9% (15.3% stage 3a, 10.2% stage 3b, 3.6% stage 4, and 1.7% stage 5), and the distribution of patients in the risk categories of the disease was: 52.0% with low-risk, 23.5%, moderate risk, 13.0%, high risk, and 11.2%, very high. In an outpatient setting, the prevalence of CKD in cardiological patients was almost three times (31%) that of the general population; about half of the individuals evaluated (48%) were not screened for an important risk marker (proteinuria), and approximately a quarter of these patients (24%) were in the high or very high CKD risk categories.
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Affiliation(s)
- Farid Samaan
- Research Division, Dante Pazzanese Cardiology Institute, São Paulo 04012-909, SP, Brazil;
- Correspondence:
| | - Bruna Bronhara Damiani
- Research Division, Dante Pazzanese Cardiology Institute, São Paulo 04012-909, SP, Brazil;
| | | | - Ricardo Sesso
- Nephrology Division, Universidade Federal de São Paulo, São Paulo 04023-900, SP, Brazil; (G.M.K.); (R.S.)
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Sertsu A, Worku T, Fekadu G, Tura AK. 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. SAGE Open Med 2022; 10:20503121221116942. [PMID: 35966210 PMCID: PMC9373155 DOI: 10.1177/20503121221116942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Addisu Sertsu
- Department of Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Teshager Worku
- Department of Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Gelana Fekadu
- Department of Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abera Kenay Tura
- Department of Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Department of Obstetrics and Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Animaw Z, Walle Ayehu G, Abdu H. Prevalence of chronic kidney disease and associated factors among patients with chronic illness in Ethiopia: A systematic review and meta-analysis. SAGE Open Med 2022; 10:20503121221089442. [PMID: 35465636 PMCID: PMC9019378 DOI: 10.1177/20503121221089442] [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: 07/20/2021] [Accepted: 03/06/2022] [Indexed: 11/22/2022] Open
Abstract
Objective: The main aim of this systematic review and meta-analysis is to provide summarized evidence on the prevalence of chronic kidney disease and associated factors among patients with chronic illness in Ethiopia. Method: Databases of MEDLINE/PubMed, Embase, Google Scholar, CINAHL, Cochrane library, and ScienceDirect were searched. In addition, gray literatures were searched manually from university repositories. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used to select potential studies. Microsoft Excel 2013 sheet template was used to extract data. The quality of included studies was assessed by utilizing the Newcastle-Ottawa Scale. STATA software version 14.0 is used to compute the estimated pooled prevalence and associated factors of chronic kidney disease. Result: Twelve articles that fulfilled the inclusion criteria were included. The pooled estimate of chronic kidney disease among patients with chronic illnesses in Ethiopia is 21.71% (95% confidence interval: 17.67, 25.74). The highest prevalence of chronic kidney disease among patients with chronic illnesses is from Oromia (32.55% (confidence interval: 19.91, 45.19)). Glomerular filtration rate showed a comparable pooled prevalence from Cockroft-Gault and MDRD methods; 22.38% (confidence interval: 15.83, 28.92), 22.18 (confidence interval: 18.01, 26.34), respectively. Hypertensives become more likely to have chronic kidney disease compared with normotensive patients, (odds ratio = 3.01, 95% confidence interval: 1.33, 6.81). Conclusion: Prevalence of chronic kidney disease among chronic illness patients was significantly high. Hypertension is significantly associated with chronic kidney disease. Hence, we recommend that continuous screening of possible risk factors and proper follow-up and management strategies should be designed.
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Affiliation(s)
- Zelalem Animaw
- Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gashaw Walle Ayehu
- Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Hussen Abdu
- School of Medicine, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Tolossa T, Fetensa G, Regassa B, Yilma MT, Besho M, Fekadu G, Wakuma B, Bekele D, Mulisa D. Burden and Determinants of Chronic Kidney Disease Among Diabetic Patients in Ethiopia: A Systematic Review and Meta-Analysis. Public Health Rev 2021; 42:1603969. [PMID: 34692175 PMCID: PMC8377585 DOI: 10.3389/phrs.2021.1603969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 02/24/2021] [Indexed: 01/18/2023] Open
Abstract
Background: Chronic kidney disease (CKD) among diabetic patients is becoming a global health burden with a high economic cost to health systems. The incidence of CKD is higher in low-income countries such as Ethiopia. In Ethiopia, there is no national representative evidence on the burden and determinants of CKD among patients with diabetes. Therefore, this review aimed to estimates the pooled burden and determinants of CKD among patients with diabetes. Methods: Published articles from various electronic databases such as Pub Med, Google Scholar, CINAHL, Scopes, Cochrane library, the Web of Science, and African Journals Online were accessed. Also, unpublished studies from Addis Ababa digital library were identified. We included all observational studies (cross-sectional, case-control, and cohort) in the review. Data were extracted on the Microsoft Excel spreadsheet and analyzed using STATA 14.1 version. A random-effects model was used to estimate the pooled estimate with a 95% confidence interval (CI). Forest plots were used to visualize the presence of heterogeneity and estimate the pooled burden and determinants of chronic kidney disease among diabetic patients. The presence of publication bias was assessed by funnel plots and Egger's statistical tests. Results: Published (297) and unpublished (2) literature were identified from several databases and digital libraries, of which twelve articles were selected for final meta-analysis. Significant heterogeneity was observed across studies (I2 = 85.2%), which suggests a random-effects model to estimate pooled burden. The analysis found that the pooled burden of CKD among patients with diabetes was 18.22% (95% CI: 15.07-21.38). Factors such as hypertension (OR = 2.65, 95%, CI: 1.38, 5.09), type of DM (OR = 0.33, 95%, CI: 0.14-0.76), and duration of DM (OR = 0.51, 95%, CI: 0.34-0.77) were found to have significant association with CKD. Conclusion: The current review revealed a higher burden of CKD among patients with diabetes in Ethiopia. The presence of hypertension, type II diabetes, and duration of diabetes for a longer duration were found to be independent determinants of CKD among patients with diabetes. For better control of chronic kidney disease, integrated management of hypertension and DM should be designed with a special focus on chronic diabetic patients.
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Affiliation(s)
- Tadesse Tolossa
- Department of Public Health, Institute of Health Science, Wollega University, Nekemte, Ethiopia
| | - Getahun Fetensa
- Department of Nursing, Institute of Health Science, Wollega University, Nekemte, Ethiopia
| | - Bikila Regassa
- Department of Public Health, Institute of Health Science, Wollega University, Nekemte, Ethiopia
| | - Mekdes Tigistu Yilma
- Department of Public Health, Institute of Health Science, Wollega University, Nekemte, Ethiopia
| | - Merga Besho
- Department of Midwifery, Institute of Health Science, Wollega University, Nekemte, Ethiopia
| | - Ginenus Fekadu
- Department of Pharmacy, Institute of Health Science, Wollega University, Nekemte, Ethiopia.,School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Bizuneh Wakuma
- Department of Nursing, Institute of Health Science, Wollega University, Nekemte, Ethiopia
| | - Daniel Bekele
- Department of Statistics, College of Computational Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Diriba Mulisa
- Department of Nursing, Institute of Health Science, Wollega University, Nekemte, Ethiopia
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Li Y, Yan J, Wang M, Lv J, Yan F, Chen J. Uremic toxin indoxyl sulfate promotes proinflammatory macrophage activation by regulation of β-catenin and YAP pathways. J Mol Histol 2021; 52:197-205. [PMID: 33387144 PMCID: PMC8012310 DOI: 10.1007/s10735-020-09936-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/26/2020] [Indexed: 12/12/2022]
Abstract
Evidence has been shown that indoxyl sulfate (IS) could impair kidney and cardiac functions. Moreover, macrophage polarization played important roles in chronic kidney disease and cardiovascular disease. IS acts as a nephron-vascular toxin, whereas its effect on macrophage polarization during inflammation is still not fully elucidated. In this study, we aimed to investigate the effect of IS on macrophage polarization during lipopolysaccharide (LPS) challenge. THP-1 monocytes were incubated with phorbol 12-myristate-13-acetate (PMA) to differentiate into macrophages, and then incubated with LPS and IS for 24 h. ELISA was used to detect the levels of TNFα, IL-6, IL-1β in THP-1-derived macrophages. Western blot assay was used to detect the levels of arginase1 and iNOS in THP-1-derived macrophages. Percentages of HLA-DR-positive cells (M1 macrophages) and CD206-positive cells (M2 macrophages) were detected by flow cytometry. IS markedly increased the production of the pro-inflammatory factors TNFα, IL-6, IL-1β in LPS-stimulated THP-1-derived macrophages. In addition, IS induced M1 macrophage polarization in response to LPS, as evidenced by the increased expression of iNOS and the increased proportion of HLA-DR+ macrophages. Moreover, IS downregulated the level of β-catenin, and upregulated the level of YAP in LPS-stimulated macrophages. Activating β-catenin signaling or inhibiting YAP signaling suppressed the IS-induced inflammatory response in LPS-stimulated macrophages by inhibiting M1 polarization. IS induced M1 macrophage polarization in LPS-stimulated macrophages via inhibiting β-catenin and activating YAP signaling. In addition, this study provided evidences that activation of β-catenin or inhibition of YAP could alleviate IS-induced inflammatory response in LPS-stimulated macrophages. This finding may contribute to the understanding of immune dysfunction observed in chronic kidney disease and cardiovascular disease.
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Affiliation(s)
- Ying Li
- Department of General Practice, Zhejiang Hospital, 12 Lingyin Road, West Lake District, Hangzhou, 310013, Zhejiang, People's Republic of China
| | - Jing Yan
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, 310013, Zhejiang, People's Republic of China
| | - Minjia Wang
- Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, 310013, Zhejiang, People's Republic of China
| | - Jing Lv
- Department of General Practice, Zhejiang Hospital, 12 Lingyin Road, West Lake District, Hangzhou, 310013, Zhejiang, People's Republic of China
| | - Fei Yan
- Department of General Practice, Zhejiang Hospital, 12 Lingyin Road, West Lake District, Hangzhou, 310013, Zhejiang, People's Republic of China
| | - Jin Chen
- Department of General Practice, Zhejiang Hospital, 12 Lingyin Road, West Lake District, Hangzhou, 310013, Zhejiang, People's Republic of China.
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Yao H, Hou C, Liu W, Yi J, Su W, Hou Q. Associations of multiple serum biomarkers and the risk of cardiovascular disease in China. BMC Cardiovasc Disord 2020; 20:426. [PMID: 32993518 PMCID: PMC7523396 DOI: 10.1186/s12872-020-01696-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/31/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Previous studies focus on one or several serum biomarkers and the risk of cardiovascular disease (CVD). This study aims to investigate the association of multiple serum biomarkers and the risk of CVD and evaluate the dose-relationship between a single serum metabolite and CVD. METHODS Our case-control study included 161 CVD and 160 non-CVD patients who had a physical examination in the same hospital. We used stratified analysis and cubic restricted analysis to investigate the dose-response relationship of individual serum biomarkers and the CVD incident. Moreover, to investigate serum biomarkers and CVD, we used elastic net regression and logistic regression to build a multi-biomarker model. RESULTS In a single serum biomarker model, we found serum FT4, T4. GLU, CREA, TG and LDL-c were positively associated with CVD. In the male group, serum T4, GLU and LDL-c were positively associated with CVD; and serum TG was positively associated with CVD in the female group. When patients ≤63 years old, serum T4, GLU, CREA and TG were positively associated with CVD, and serum TG and LDL-c were positively associated with CVD when patients > 63 years old. Moreover, serum GLU had nonlinearity relationship with CVD and serum TG and LDL-c had linearity association with CVD. Furthermore, we used elastic regression selecting 5 serum biomarkers (GLU, FT4, TG, HDL-c, LDL-c) which were independently associated with CVD incident and built multi-biomarker model. And the multi-biomarker model had much better sensitivity than single biomarker model. CONCLUSION The multi-biomarker model had much higher sensitivity than a single biomarker model for the prediction of CVD. Serum FT4, TG and LDL-c were positively associated with the risk of CVD in single and multiple serum biomarkers models, and serum TG and LDL-c had linearity relationship with CVD.
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Affiliation(s)
- Huichen Yao
- The third affiliated hospital of Shandong first medical university, Jinan, Shandong, China
| | - Chenyang Hou
- Guangxi Medical University, Nanning, Guangxi, China
| | - Weihua Liu
- Shandong First Medical University (Shandong Academy of Medical Sciences), 169 Great Wall Rd, Taian, 271000, Shandong, China
| | - Jihu Yi
- Shandong First Medical University (Shandong Academy of Medical Sciences), 169 Great Wall Rd, Taian, 271000, Shandong, China
| | - Wencong Su
- Zibo Bashan Wanjie Hospital, Zibo, Shandong, China
| | - Qingzhi Hou
- Shandong First Medical University (Shandong Academy of Medical Sciences), 169 Great Wall Rd, Taian, 271000, Shandong, China.
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Hussien FM, Hassen HY. Dietary Habit and Other Risk Factors of Chronic Kidney Disease Among Patients Attending Dessie Referral Hospital, Northeast Ethiopia. Int J Nephrol Renovasc Dis 2020; 13:119-127. [PMID: 32547157 PMCID: PMC7245461 DOI: 10.2147/ijnrd.s248075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/24/2020] [Indexed: 12/14/2022] Open
Abstract
Background In low- and middle-income countries, the burden of chronic kidney disease (CKD) is rising due to poor access to early detection and management services. In Ethiopia, little is known about the context-specific risk factors and their magnitude, particularly the dietary habit of patients is not studied. Therefore, this study aimed to identify the dietary and other risk factors of CKD in Northeast Ethiopia. Methods We conducted a facility-based unmatched case–control study utilizing quantitative method of data collection. Data were collected on a total of 66 cases and 134 controls using structured questionnaire and anthropometric measurements. Dietary habit was assessed using the Diet History Questionnaire (DHQ). Medical history, patient chart review and physical examination were employed to collect other relevant information. To identify independent predictors of CKD, we conducted a multivariable logistic regression analysis. Results About 54.5% cases and 46.3% of controls were female, while 40.9% of cases and 38.8% of controls were within the age group of 36–55. All cases and 128 (95.5%) controls consumed meat in the last year. Forty-six (69.7%) cases and 74 (55.2%) controls use palm oil as the main cooking oil. History of hypertension (adjusted odds ratio (AOR)=2.39; 95%CI: 1.17–4.89), anemia (AOR=2.38; 95%CI: 1.04–5.42), palm oil use (AOR=2.10; 95%CI: 1.01–4.35) and family history of CKD (AOR=8.77; 95%CI: 3.73–20.63) were significantly associated with the risk of having CKD. Conclusion Meat consumption and use of palm oil are higher among patients with CKD than controls. History of hypertension, anemia, family history of CKD and palm oil consumption were found to be risk factors for CKD. Dietary counseling interventions and dietary modifications might help in CKD prevention. Furthermore, routine urinalysis and estimation of glomerular filtration rate (GFR) for all hospitalized patients with hypertension and anemia could help to detect CKD at an earlier stage for a better prognosis.
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Affiliation(s)
- Foziya Mohammed Hussien
- Department of Public Health Nutrition, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Hamid Yimam Hassen
- Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
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