Risk factors for chronic kidney disease progression in VACTERL-association Korean patients: a retrospective study

The Impact of APOL1 on Chronic Kidney Disease and Hypertension.

Aggressive blood pressure reduction and renin–angiotensin system blockade in chronic kidney disease: time for re-evaluation?

To have and have not: Health and health care disparities in chronic kidney disease

Too Many for Too Few: Finding Appropriate Nephrology Referrals for Patients With CKD That Optimize Outcomes

Perceived knowledge among patients cared for by nephrologists about chronic kidney disease and end-stage renal disease therapies

Chronic kidney disease is an increasingly common diagnosis in the very elderly and identifying the patients who benefit from a nephrologist’s intervention and the ones who would not might avoid wasteful or harmful interventions. The aim of this study is to identify the risk factors for progressive versus non -progressive chronic kidney disease in a population aged over 80 years old. We performed a cohort single -center retrospective study including 101 patients over 80 years old with chronic kidney disease diagnosed for at least five years and followed regularly by a nephrologist. Progressive disease was defined as glomerular filtration rate declines greater than 5 mL/min/1.73 m2/year. Of the 101 patients, 33.7% had progressive chronic kidney disease. The median glomerular filtration progression rate was 3.0 [2.1 -6.0] mL/ min/1.73m2/year. Hypertension and diabetes mellitus prevalence was similar between groups. Nephrology follow -up time was longer in the progressive group (5.0 vs 2.0 years, p=0.01). Regarding chronic kidney disease complications, 37.6% had anemia and half of these needed erythropoiesis -stimulating agents. None of the patients had hyperphosphatemia. About 18.8% presented metabolic acidosis. In multivariable analysis, after adjusting for covariables such as age, hypertension, and diabetes mellitus only the presence of metabolic acidosis (OR 0.4, CI: 0.1 -0.8) was associated with the development of progressive chronic kidney disease. Progressive chronic kidney disease group presented higher mortality (log rank 4.5, p=0.03). Ischemic cardiomyopathy (OR: 0.5, CI: 0.2 -0.9) and progressive chronic kidney disease (OR: 0.6, CI:0.3 -0.8) were associated with all -cause mortality. Our results showed that most elderly patients have non -progressive chronic kidney disease. Patients with metabolic acidosis seem to be at an increased risk for developing progressive disease. Most elderly patients die before reaching end -stage kidney disease, so it is important to look at progressive kidney disease in those patients as an important marker of comorbidity and privilege cardioprotective measures.

Genomic approaches to the burden of kidney disease in Sub-Saharan Africa: the Human Heredity and Health in Africa (H3Africa) Kidney Disease Research Network

Hypokalemic Nephropathy

Chronic Kidney Disease and Kidney Cancer Surgery: New Perspectives.

Risk-Based Triage for Nephrology Referrals: The Time is Now

Background: Diabetic patients with chronic kidney disease were at high risk of end stage renal disease. Previous studies showed that HMG-CoA reductase inhibitors (statins) could reduce proteinuria in patients with chronic kidney disease and slow the progression of renal function deterioration. In 2010, one population based cohort study in England revealed that statin increased the risk of acute renal failure. Till now, few studies investigate the effect of statin on the progression of chronic kidney disease to end stage renal disease。Therefore, our aim is try to identify whether statins could slow the progression of chronic kidney disease to end stage renal disease in diabetic patients by using big BNHI (Bureau of National Health Insurance) claim database. Materials and Methods: This is a retrospective cohort study using 2000 National Health Insurance diabetes cohort database. We identified 21719 diabetic patients with chronic kidney disease in 2002. Patients who used statin in 2002 were classified as statin user group and those who did not use statin in 2002 were classified as non-user group. The first statin prescription date in 2002 was defined as index date in statin users. We assigned a day which was chosen by the same distribution in statin users group as index date in non-users. Patients who had cancer or AIDS in 2002 were excluded. Patients who used statins or had end stage renal disease before index date were excluded, too. Total 13272 diabetic patients with chronic kidney disease were analyzed in our study. There were 1637 statin users and 11635 patients were non-users. Patients’ comorbidities and medical resource utilization were used to construct propensity score. Statin user group and non-user group are matched by propensity score. After matching for propensity score, there were 1637 statin users and non-users. Cox proportional hazard model was used to discover the hazard ratio of end stage renal disease and all cause mortality between these 2 groups. Sensitivity analysis was done by excluding patients with follow up time less than one year to test the robustness of study result. Result: End stage renal disease outcome analysis: The follow-up person-years in statin users were 3303.4 and the annual incidence rate was 0.058. The follow-up person-years in non-users were 3749.9 and the annual incidence rate was 0.041. The end stage renal disease hazard ratio between these 2 group was 1.36(1.10-1.68). Sensitivity analysis showed that the hazard ratio is 1.34 (1.07-1.68). Mortality outcome analysis: The follow-up person-years in statin users were 3447.9 and the annual incidence rate was 0.037. The follow-up person-years in non-users were 3926.6 and the annual incidence rate was 0.071. The mortality hazard ratio between these 2 group was 0.51(0.41-0.63). Sensitivity analysis showed that the hazard ratio is 0.45 (0.33-0.61). Conclusion: Our study showed that statins decrease the risk of mortality in diabetic patients with chronic kidney disease. On the other hand, the result of increasing risk of end stage renal disease in statin users needed further investigation because of residual immortal time bias.

The most important contribution of the systematic reviews by Matchar and colleagues and Kunz and associates is that they tell us what we do not know, which is the adverse effects of long-term thera...

Unleashing the Power of Renal Nutrition in Value-Based Models of Kidney Care Choices: Leveraging Dietitians’ Expertise and Medical Nutrition Therapy to Delay Dialysis Initiation

ABSTRACTBackgroundCardiorenal syndrome highlights the bidirectional relationship between kidney and heart dysfunction. N-terminal pro-B-type natriuretic peptide (NT-proBNP), which is the gold standard biomarker in heart failure (HF), may be an important biomarker for chronic kidney disease (CKD) progression. However, NT-proBNP is negatively related with estimated glomerular filtration rate (eGFR). In this study, we investigated the association of NT-proBNP, eGFR, and progression of kidney disease in CKD patients without HF.MethodsThis multicentric retrospective cohort study recruited 23 860 CKD patients without HF, who had at least one NT-proBNP record from China Renal Data System database. Linear regression model evaluated the relationship between eGFR and NT-proBNP. Cox regression analysis assessed the association between NT-proBNP and CKD progression. Sensitivity analysis examined the robustness of the main findings.ResultsThis study involved 23 860 CKD patients without HF, distributed across different CKD stages: 10 526 in stages G1-2, 4665 in G3a, 3702 in G3b, 2704 in G4, and 2263 in G5. NT-proBNP was negatively correlated with eGFR, particularly in stages 4–5 CKD. A 15-unit decrease in eGFR was associated with increases in log (NT-proBNP) levels by 1.04-fold, 1.27-fold, 1.29-fold, 1.80-fold, and 3.50-fold for stages 1–2, 3a, 3b, 4, and 5, respectively. After excluding patients who developed CKD progression within 1 year, the Cox regression analysis revealed that the relationship between NT-proBNP and CKD progression was not significant in stages 4 and 5. However, for stages 1–3, each standard deviation increase in log (NT-proBNP) was associated with a 26%, 36%, and 28% higher risk of CKD progression, with P interaction ≤.001. The hazard ratios were 1.26 (95% confidence intervals (CI), 1.18 to 1.35), 1.36 (95% CI, 1.22 to 1.51), and 1.28 (95% CI, 1.14 to 1.43) for stages 1–2, stage 3a, and stage 3b, respectively.ConclusionsDespite its strong inverse association with eGFR, NT-proBNP was positively associated with the risk of progression of kidney disease in CKD patients with stages 1–3 without HF. Future studies should investigate the effectiveness of NT-proBNP as a predictive biomarker for the progression of kidney disease across diverse racial groups and healthcare settings.

World Kidney Day: An Idea Whose Time Has Come