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Sánchez-Calavera MA, Navarro RG, Otal EA, González IB, Pardo DE, Celma LH, Lamarre M, Esteban PL, Lozano Del Hoyo ML, Mahulea L, Gallego IM, Romero-Vigara JC, Allué SS, Hueso ST, Gil FA. Prevalence and characteristics of chronic kidney disease in people with type 2 diabetes mellitus in the Autonomous Community of Aragon. Prim Care Diabetes 2024; 18:555-560. [PMID: 38991895 DOI: 10.1016/j.pcd.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/05/2024] [Accepted: 06/02/2024] [Indexed: 07/13/2024]
Abstract
AIMS The main objective in this study was to determine the prevalence of Chronic Kidney Disease (CKD) in people with Type 2 Diabetes Mellitus (T2DM) in the Autonomous Community (AC) of Aragon (Spain) and to detect whether or not there is under-registration in the patient's history. As a secundary objetive, it was proposed to study the most relevant demographic and clinical characteristics of people with CKD. METHODS Observational and retrospective real world data study of the population over 18 years of age with a diagnosis of T2DM, between January 2017 and December 2021. A descriptive analysis of qualitative and quantitative variables, and a comparison using the parametric Student's t-test or the non-parametric Mann-Whitney U-test between both groups was performed. RESULTS The prevalence of T2DM was 8.07 % and that of CKD 31.4 %, with an under-reporting of 47 %. The main risk factor associated with CKD was arterial hypertension (p<0.001), followed by dyslipidemia (p<0.001). The main treatment used for diabetes control was metformin, both in patients with and without CKD (p<0.001). A total of 56.81 % of people with T2DM and CKD did not undergo annual monitoring of their renal function (glomerular filtration rate) or determination of albuminuria. CONCLUSIONS The prevalence of CKD increases in patients with T2DM (31.4 %), and in almost half of patients the diagnosis is not registered (47 %). This under-reporting delays the implementation of measures needed to prevent CKD progression.
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Affiliation(s)
- María Antonia Sánchez-Calavera
- Health Service of Aragon, Spain; Instituto de Investigación Sanitaria de Aragón (IISA, Aragon Health Research Institute), Spain; Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Spain; Red de Grupos de Estudio de la Diabetes en Atención Primaria de Salud (redGDPS, Network of Diabetes Study Groups in Primary Healthcare), Spain
| | - Rafael Gómez Navarro
- Health Service of Aragon, Spain; Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Spain; Red de Grupos de Estudio de la Diabetes en Atención Primaria de Salud (redGDPS, Network of Diabetes Study Groups in Primary Healthcare), Spain.
| | - Elena Asso Otal
- Health Service of Aragon, Spain; Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Spain; Red de Grupos de Estudio de la Diabetes en Atención Primaria de Salud (redGDPS, Network of Diabetes Study Groups in Primary Healthcare), Spain
| | - Isabel Blasco González
- Health Service of Aragon, Spain; Instituto de Investigación Sanitaria de Aragón (IISA, Aragon Health Research Institute), Spain; Red de Grupos de Estudio de la Diabetes en Atención Primaria de Salud (redGDPS, Network of Diabetes Study Groups in Primary Healthcare), Spain
| | - Daniel Escribano Pardo
- Health Service of Aragon, Spain; Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Spain; Red de Grupos de Estudio de la Diabetes en Atención Primaria de Salud (redGDPS, Network of Diabetes Study Groups in Primary Healthcare), Spain
| | - Laia Homedes Celma
- Health Service of Aragon, Spain; Red de Grupos de Estudio de la Diabetes en Atención Primaria de Salud (redGDPS, Network of Diabetes Study Groups in Primary Healthcare), Spain
| | - Michelot Lamarre
- Health Service of Aragon, Spain; Red de Grupos de Estudio de la Diabetes en Atención Primaria de Salud (redGDPS, Network of Diabetes Study Groups in Primary Healthcare), Spain
| | - Pilar López Esteban
- Health Service of Aragon, Spain; Red de Grupos de Estudio de la Diabetes en Atención Primaria de Salud (redGDPS, Network of Diabetes Study Groups in Primary Healthcare), Spain
| | - María Luisa Lozano Del Hoyo
- Health Service of Aragon, Spain; Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Spain; Red de Grupos de Estudio de la Diabetes en Atención Primaria de Salud (redGDPS, Network of Diabetes Study Groups in Primary Healthcare), Spain
| | - Liliana Mahulea
- Health Service of Aragon, Spain; Red de Grupos de Estudio de la Diabetes en Atención Primaria de Salud (redGDPS, Network of Diabetes Study Groups in Primary Healthcare), Spain
| | - Inés Mera Gallego
- Red de Grupos de Estudio de la Diabetes en Atención Primaria de Salud (redGDPS, Network of Diabetes Study Groups in Primary Healthcare), Spain; Sociedad Española de Farmacia Clínica, Familiar y Comunitaria (Spanish Society of Clinical, Family and Community Pharmacy), Spain
| | - Juan Carlos Romero-Vigara
- Health Service of Aragon, Spain; Instituto de Investigación Sanitaria de Aragón (IISA, Aragon Health Research Institute), Spain; Red de Grupos de Estudio de la Diabetes en Atención Primaria de Salud (redGDPS, Network of Diabetes Study Groups in Primary Healthcare), Spain
| | - Sandra Soler Allué
- Health Service of Aragon, Spain; Red de Grupos de Estudio de la Diabetes en Atención Primaria de Salud (redGDPS, Network of Diabetes Study Groups in Primary Healthcare), Spain
| | - Sira Telmo Hueso
- Health Service of Aragon, Spain; Red de Grupos de Estudio de la Diabetes en Atención Primaria de Salud (redGDPS, Network of Diabetes Study Groups in Primary Healthcare), Spain
| | - Fran Adán Gil
- Health Service of Aragon, Spain; Red de Grupos de Estudio de la Diabetes en Atención Primaria de Salud (redGDPS, Network of Diabetes Study Groups in Primary Healthcare), Spain
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León-Figueroa DA, Aguirre-Milachay E, Barboza JJ, Valladares-Garrido MJ. Prevalence of hypertension and diabetes mellitus in Peruvian patients with chronic kidney disease: a systematic review and meta-analysis. BMC Nephrol 2024; 25:160. [PMID: 38730295 PMCID: PMC11088108 DOI: 10.1186/s12882-024-03595-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 04/30/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Chronic Kidney Disease (CKD) represents a major challenge for public health, with hypertension and diabetes being the main causes of its occurrence. Therefore, this study aims to determine the prevalence of hypertension (HTN) and diabetes mellitus (DM) in Peruvian patients with CKD. METHODS A systematic search for studies about CKD in Peru was carried out in PubMed, Scopus, Embase, Web of Science, ScienceDirect, Google Scholar, Virtual Health Library (VHL), and Scielo from 2011 to December 2023. The protocol of this research was registered in the international registry of systematic reviews, the Prospective International Registry of Systematic Reviews (PROSPERO), with registration number CRD42023425118. Study selection, quality assessment, and data extraction were performed independently by two authors. Study quality was assessed using the Joanna Briggs Institute Statistical Meta-Analysis Assessment and Review Instrument. A random-effects model with inverse variance weighting was used to estimate the combined prevalence of HTN and DM in Peruvian patients with CKD. To analyze data heterogeneity, the I2 statistical test was used. Statistical analysis was performed with R version 4.2.3. RESULTS A total of 1425 studies were retrieved, of which 23 were included in the final meta-analysis. A total of 43,321 patients with CKD were evaluated, of whom 52.22% were male and 47.78% were female. The combined prevalence of HTN in Peruvian patients with CKD was 38% (95% CI: 30-46%; 41,131 participants; 21 studies, I2 = 99%, p = 0), while the combined prevalence of DM in Peruvian patients with CKD was 33% (95% CI: 26-40%; 43,321 participants; 23 studies, I2 = 99%, p = 0). CONCLUSION Approximately one-third of Peruvian patients with CKD have HTN and DM. These findings highlight the importance of implementing prevention and control measures for these chronic noncommunicable diseases in the Peruvian population, such as promoting healthy lifestyles, encouraging early detection and proper management of hypertension and diabetes, and improving access to medical care and health services.
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Affiliation(s)
| | | | - Joshuan J Barboza
- Vicerrectorado de Investigación, Universidad Norbert Wiener, Lima, 15046, Peru
| | - Mario J Valladares-Garrido
- Universidad Continental, Lima, 15046, Peru.
- Oficina de Epidemiología, Hospital Regional Lambayeque, Chiclayo, 14012, Peru.
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Casey C, Buckley CM, Kearney PM, Griffin MD, Dinneen SF, Griffin TP. Social deprivation and diabetic kidney disease: A European view. J Diabetes Investig 2024; 15:541-556. [PMID: 38279774 PMCID: PMC11060165 DOI: 10.1111/jdi.14156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/10/2024] [Accepted: 01/18/2024] [Indexed: 01/28/2024] Open
Abstract
There is a large body of literature demonstrating a social gradient in health and increasing evidence of an association between social deprivation and diabetes complications. Diabetic kidney disease (DKD) increases mortality in people with diabetes. Socioeconomic deprivation is increasingly recognized as a modifier of risk factors for kidney disease but also an independent risk factor itself for kidney disease. This may not be truly appreciated by clinicians and warrants further attention and exploration. In this review we explore the literature to date from Europe on the relationship between social deprivation and DKD. The majority of the studies showed at least an association with microalbuminuria, an early marker of DKD, while many showed an association with overt nephropathy. This was seen across many countries in Europe using a variety of different measures of deprivation. We reviewed and considered the mechanisms by which deprivation may lead to DKD. Health related behaviors such as smoking and suboptimal control of risk factors such as hypertension, hyperglycemia and elevated body mass index (BMI) accounts for some but not all of the association. Poorer access to healthcare, health literacy, and stress are also discussed as potential mediators of the association. Addressing deprivation is difficult but starting points include targeted interventions for people living in deprived circumstances, equitable roll out of diabetes technology, and flexible outpatient clinic arrangements including virtual and community-based care.
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Affiliation(s)
- Caoimhe Casey
- Centre for Diabetes, Endocrinology and MetabolismGalway University HospitalsGalwayIreland
- School of Public HealthUniversity College CorkCorkIreland
| | | | | | - Matthew D Griffin
- Regenerative Medicine Institute (REMEDI) at CÚRAM SFI Research Centre for Medical Devices, School of MedicineUniversity of GalwayGalwayIreland
- Department of NephrologyGalway University HospitalGalwayIreland
| | - Sean F Dinneen
- Centre for Diabetes, Endocrinology and MetabolismGalway University HospitalsGalwayIreland
- School of MedicineUniversity of GalwayGalwayIreland
| | - Tomás P Griffin
- Centre for Diabetes, Endocrinology and MetabolismGalway University HospitalsGalwayIreland
- School of MedicineUniversity of GalwayGalwayIreland
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Hu Y, Wang X, Xiao S, Wu H, Huan C, Xu T, Guo M, Liu A, Jiang X, Wang J, Zhu H, Pan D. Development and validation of a risk nomogram model for predicting pulmonary hypertension in patients with stage 3-5 chronic kidney disease. Int Urol Nephrol 2022; 55:1353-1363. [PMID: 36562902 PMCID: PMC10105676 DOI: 10.1007/s11255-022-03431-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The occurrence of pulmonary arterial hypertension (PAH) can greatly affect the prognosis of patients with chronic kidney disease (CKD). We aimed to construct a nomogram to predict the probability of PAH development in patients with stage 3-5 CKD to guide early intervention and to improve prognosis. METHODS From August 2018 to December 2021, we collected the data of 1258 patients with stage 3-5 CKD hospitalized at the Affiliated Hospital of Xuzhou Medical University as a training set and 389 patients hospitalized at Zhongda Hospital as a validation set. These patients were divided into PAH and N-PAH groups with pulmonary arterial systolic pressure ≥ 35 mmHg as the cutoff. The results of univariate and multivariate logistic regression analyses were used to establish the nomogram. Then, areas under the receiver operating characteristic curve (AUC-ROCs), a calibration plot, and decision curve analysis (DCA) were used to validate the nomogram. RESULTS The nomogram included nine variables: age, diabetes mellitus, hemoglobin, platelet count, serum creatinine, left ventricular end-diastolic diameter, left atrial diameter, main pulmonary artery diameter and left ventricular ejection fraction. The AUC-ROCs of the training set and validation set were 0.801 (95% confidence interval (CI) 0.771-0.830) and 0.760 (95% CI 0.699-0.818), respectively, which showed good discriminative ability of the nomogram. The calibration diagram showed good agreement between the predicted and observed results. DCA also demonstrated that the nomogram could be clinically useful. CONCLUSION The evaluation of the nomogram model for predicting PAH in patients with CKD based on risk factors showed its ideal efficacy. Thus, the nomogram can be used to screen for patients at high risk for PAH and has guiding value for the subsequent formulation of prevention strategies and clinical treatment.
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Affiliation(s)
- Yue Hu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Intensive Care Unit Department, No. 23, Mei Shu Guan Hou Jie, Beijing, 100010, Dongcheng, China
| | - Xiaotong Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Shengjue Xiao
- Department of Cardiology, School of Medicine, Zhongda Hospital, Southeast University, 87 Dingjiaqiao, Nanjing, 210009, Jiangsu, China
| | - Huimin Wu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Intensive Care Unit Department, No. 23, Mei Shu Guan Hou Jie, Beijing, 100010, Dongcheng, China
| | - Chunyan Huan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Tao Xu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Minjia Guo
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Ailin Liu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Xiaoyao Jiang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Intensive Care Unit Department, No. 23, Mei Shu Guan Hou Jie, Beijing, 100010, Dongcheng, China
| | - Jia Wang
- Department of Nephrology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Hong Zhu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Defeng Pan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China.
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Ruiz-Garcia A, Arranz-Martínez E, Iturmendi-Martínez N, Fernández-Vicente T, Rivera-Teijido M, García-Álvarez JC. Tasas de prevalencia de enfermedad renal crónica y su asociación con factores cardiometabólicos y enfermedades cardiovasculares. Estudio SIMETAP-ERC. CLÍNICA E INVESTIGACIÓN EN ARTERIOSCLEROSIS 2022; 35:64-74. [PMID: 35945036 DOI: 10.1016/j.arteri.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/02/2022] [Accepted: 07/07/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Chronic kidney disease (CKD) is a major health problem that contributes to the development of cardiovascular disorders such as heart failure and arteriosclerotic cardiovascular disease (ACVD). The aims of this study were to determine the prevalence of CKD and to assess its association with ACVD and cardiometabolic risk factors. METHODS Cross-sectional observational study conducted in primary care setting. Population-based random sample: 6,588 people between 18 and 102 years old (response rate: 66%). Crude and sex- and age-adjusted prevalence rates of CKD according to KDIGO were determined by assessing albuminuria and estimated glomerular filtration rate according to CKD-EPI, and their associations with cardiometabolic factors and ACVD were determined. RESULTS The crude prevalence of CKD was 11.48% (95%CI: 10.72-12.27%), without significant difference between men (11.64% [95%CI: 10.49-12.86%]) and women (11.35% [95%CI: 10.34-12.41%]). The age- and sex-adjusted prevalence rate of CKD was 9.16% (men: 8.61%; women: 9.69%). The prevalence of low estimated glomerular filtration rate (<60mL/min/1.73m2) and albuminuria (≥30mg/g) were 7.95% (95%CI: 7.30-8.61) and 5.98% (95%CI: 5.41-6.55), respectively. Hypertension, diabetes, prediabetes, increased waist-to-height ratio, heart failure, atrial fibrillation, and ACVD were independently associated with CKD (P<.001). Very high cardiovascular risk according to SCORE was found in 77.51% (95%CI: 74.54-80.49) of the population with CKD. CONCLUSIONS The adjusted prevalence of CKD was 9.2% (low estimated glomerular filtration rate: 8.0%; albuminuria: 6.0%). Most of the patients with CKD had very high cardiovascular risk. Hypertension, diabetes, prediabetes, increased waist-to-height ratio and ACVD were independently associated with CKD.
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