Association Of Chronic Kidney Disease Research Articles

#876 Albuminuria and the risk of dementia and different dementia subtypes: the Stockholm Creatinine Measurements (SCREAM) project

Abstract Background and Aims Studies investigating the association of chronic kidney disease and dementia predominantly focused on estimated glomerular filtration rate (eGFR) rather than albuminuria. The few studies focusing on albuminuria reported conflicting results, probably due to a lack of power, not taking into account the different dementia subtypes, not adjusting for eGFR, and the use of different albuminuria measurement techniques. This study therefore investigated the eGFR-independent risk of all-cause and type-specific dementia associated with albuminuria, quantified as urine albumin-creatinine ratio (ACR) and by dipstick, in a large population. Method We included subjects from the Stockholm Creatinine Measurements (SCREAM) project without a history of dementia and with age ≥65 years. The main analyses involved 138 688 subjects with at least one ACR test, and for sensitivity analyses, we involved 170 572 subjects with at least one dipstick proteinuria test. Albuminuria was quantified as KDIGO albuminuria A1-A3 stages. The primary outcome was incidence of all-cause dementia, and the key secondary outcomes were incidence of type-specific dementia. Dementia incidence was ascertained by record linkage with the national dementia registry (SveDem). ICD-10 coding was also used to classify subtypes only when there were no available dementia records in SveDem. Multivariable Cox regression models were used to calculate hazard ratios (HRs, 95% CIs) crude, and adjusted for confounders including baseline eGFR. Results During a median follow-up of 3.9 (IQR, 1.8-7.2) years, 9 970 subjects developed de novo dementia. After multivariable adjustment including baseline eGFR, subjects with an ACR of 30-299 mg/g or ≥300 mg/g had a 26% (HR, 1.26; 95% CI, 1.20-1.32) and 36% (HR, 1.36; 95% CI, 1.24-1.50) higher risk of developing all-cause dementia, respectively, when compared to subjects with an ACR <30 mg/g. Subjects with an ACR of 30-299 mg/g also presented a higher risk of developing several type-specific dementia, including Alzheimer's dementia (HR, 1.09, 95% CI, 1.01-1.17), vascular dementia (HR, 1.35, 95% CI, 1.22-1.48), and unspecified dementia (HR, 1.54, 95% CI, 1.41-1.69). No significant associations between albuminuria and the incidence of Lewy body dementia and Parkinson's Disease with dementia, frontotemporal dementia, as well as other types of dementia were observed. These results were generally robust in several sensitivity analyses, including replicating our main analyses in subjects with a dipstick proteinuria test instead of an ACR. Conclusion Increased albuminuria is associated with a higher risk of all-cause, Alzheimer's, and vascular dementia, independent of baseline eGFR and different albuminuria measurement techniques.

Chronic kidney disease and risk of bloodstream infections and sepsis: a 17-year follow-up of the population-based Trøndelag Health Study in Norway.

Bloodstream infections (BSI) and sepsis are important causes of hospitalization, loss of health, and death globally. Targetable risk factors need to be identified to improve prevention and treatment. In this study, we aimed to evaluate the association of chronic kidney disease (CKD) and risk of and mortality from BSI and sepsis in the general population during a 22-year period. We conducted a prospective cohort study among participants in the population-based Norwegian HUNT Study, where 68,438 participated. The median follow-up time was 17.4 years. The exposures were estimated glomerular filtration rate (eGFR) and albumin-creatinine ratio (ACR) in urine. The outcomes were hazard ratios (HR) of hospital admission or death due to BSI or sepsis. The associations were adjusted for age, sex, diabetes, obesity, systolic blood pressure, smoking status, and cardiovascular disease. Participants with eGFR < 30 ml/min/1.732 had HR 3.35 for BSI (95% confidence intervals (CI) 2.12-5.3) and HR 2.94 for sepsis (95% CI 1.82-4.8) compared to normal eGFR (≥ 90 ml/min/1.732). HRs of death from BSI and sepsis were 4.2 (95% CI 1.71-10.4) and 4.1 (95% CI 1.88-8.9), respectively. Participants with severely increased albuminuria (ACR > 30 mg/mmol) had HR 3.60 for BSI (95% CI 2.30-5.6) and 3.14 for sepsis (95% CI 1.94-5.1) compared to normal albumin excretion (ACR < 3 mg/mmol). HRs of death were 2.67 (95% CI 0.82-8.7) and 2.16 (95% CI 0.78-6.0), respectively. In this large population-based cohort study, CKD was clearly associated with an increased risk of BSI and sepsis and related death.

Association of chronic kidney disease and end-stage renal disease with procedural complications and inpatient outcomes of leadless pacemaker implantations across the United States

Leadless pacemakers have emerged as a promising alternative to transvenous pacemakers in patients with kidney disease. However, studies investigating leadless pacemaker outcomes and complications based on kidney dysfunction are limited. To evaluate the association of chronic kidney disease (CKD) and end-stage renal disease (ESRD) with inpatient complications and outcomes of leadless pacemaker implantations. National Inpatient Sample and International Classification of Diseases, Tenth Revision codes were used to identify CKD and ESRD patients who underwent leadless pacemaker implantations in the U.S. from 2016-2020. Study endpoints assessed included inpatient complications, outcomes and resource utilization of leadless pacemaker implantations. A total of 29,005 leadless pacemaker placements were identified. Patients with CKD (n=5,245, 18.1%) and ESRD (n=3,790, 13.1%) were younger and had higher prevalence of important comorbidities than patients without CKD. In crude analysis, ESRD was associated with higher prevalence of major complications, peripheral vascular complications, and inpatient mortality. After multivariable adjustment, CKD and ESRD were associated with inpatient mortality (aOR 1.62, 95% CI 1.40 - 1.86; aOR 1.38, 95% CI 1.18 - 1.63) and prolonged length of stay (aOR 1.55, 95% CI 1.46 - 1.66; aOR 1.81, 95% CI 1.67 - 1.96). ESRD was also associated with higher hospitalization costs (aOR 1.63, 95% CI 1.50 - 1.77) and major complications (aOR 1.62, 95% CI 1.40 - 1.86) after leadless pacemaker implantation. Approximately one-third of patients undergoing leadless pacemaker implantation had CKD or ESRD. CKD and ESRD were associated with greater length and cost of stay, and inpatient mortality.

Circulating metabolomic markers linking diabetic kidney disease and incident cardiovascular disease in type 2 diabetes: analyses from the Hong Kong Diabetes Biobank

Aims/hypothesisThe aim of this study was to describe the metabolome in diabetic kidney disease (DKD) and its association with incident CVD in type 2 diabetes, and identify prognostic biomarkers.MethodsFrom a prospective cohort of individuals with type 2 diabetes, baseline sera (N=1991) were quantified for 170 metabolites using NMR spectroscopy with median 5.2 years of follow-up. Associations of chronic kidney disease (CKD, eGFR<60 ml/min per 1.73 m2) or severely increased albuminuria with each metabolite were examined using linear regression, adjusted for confounders and multiplicity. Associations between DKD (CKD or severely increased albuminuria)-related metabolites and incident CVD were examined using Cox regressions. Metabolomic biomarkers were identified and assessed for CVD prediction and replicated in two independent cohorts.ResultsAt false discovery rate (FDR)<0.05, 156 metabolites were associated with DKD (151 for CKD and 128 for severely increased albuminuria), including apolipoprotein B-containing lipoproteins, HDL, fatty acids, phenylalanine, tyrosine, albumin and glycoprotein acetyls. Over 5.2 years of follow-up, 75 metabolites were associated with incident CVD at FDR<0.05. A model comprising age, sex and three metabolites (albumin, triglycerides in large HDL and phospholipids in small LDL) performed comparably to conventional risk factors (C statistic 0.765 vs 0.762, p=0.893) and adding the three metabolites further improved CVD prediction (C statistic from 0.762 to 0.797, p=0.014) and improved discrimination and reclassification. The 3-metabolite score was validated in independent Chinese and Dutch cohorts.Conclusions/interpretationAltered metabolomic signatures in DKD are associated with incident CVD and improve CVD risk stratification.Graphical

THE SYSTEMATIC REVIEW OF THE ASSOCIATION OF PREGNANCY OUTCOMES AND CHRONIC KIDNEY DISEASE

Background: Pregnancy as a metabolic stress test that might reveal underlying endothelial dysfunction and vascular illness. Maternal cardiovascular disease risk is heightened in cases of adverse pregnancy outcomes, including hypertensive disorders of pregnancy, gestational diabetes, and premature birth. Aims : This systematic review is to review the association of chronic kidney disease to its outcomes at pregnant women. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2014 and 2024 were taken into account. Several different online reference sources, like Pubmed and SCIENCE DIRECT, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search brought up 661 articles, whereas the results of our search on SCIENCE DIRECT brought up 3.6314 articles. The results of the search conducted for the last year of 2014 yielded a total 12 articles for PubMed and 96 articles for SCIENCE DIRECT. In the end, we compiled a total of 5 papers, 4 of which came from PubMed and 1 of which came from SCIENCE DIRECT. We included five research that met the criteria. Conclusion: In summary, an increased risk of chronic kidney disease was linked to exposure to unfavorable pregnancy outcomes, such as hypertensive disorders of pregnancy, gestational diabetes, and premature birth. Preeclamptic women had the highest chance of developing ESKD. To identify women who are more likely to develop kidney disease, especially following hypertensive disorders during pregnancy, a systematic strategy may be necessary to maximize the patients' long-term follow-up.

Association of chronic kidney disease with hidradenitis suppurativa: A retrospective study

Association of chronic kidney disease with hidradenitis suppurativa: A retrospective study

Blood‐based Biomarkers, Kidney Disease, and Albuminuria in the Systolic Blood Pressure Intervention Trial (SPRINT)

AbstractBackgroundThere is significant current interest in the use of non‐invasive blood biomarkers to characterize risk for, and progression to, Alzheimer’s’ disease (AD) and related dementias. Population‐based cohorts have examined the relationship between protein markers of AD and neurodegeneration, showing consistent associations with the presence of comorbidity, and in particular, chronic kidney disease (CKD). However, these studies have had limited racial diversity, and have not examined relationships with urinary albumin excretion.MethodWe assayed amyloid beta 40 (Aβ40), Aβ42, total tau, and neurofilament light chain (NfL) in stored blood samples from 508 participants (≥60 years) in SPRINT. We computed the ratio of Aβ42/Aβ40, and converted all measures to standardized Z‐scores in order to compare estimates. Using linear models, we examined the association of chronic kidney disease (CKD) with the blood measures, defined as a baseline estimated glomerular filtration rate (eGFR)&lt;60 mL/min/1.73 m2. We also considered several additional analyses, including utilizing eGFR based on Cystatin‐C versus serum creatinine, as well as examining the relationship of albuminuria and race/ethnicity with the blood measures in participants without CKD at trial baseline.ResultParticipants (42.7% female, 31.9% non‐white) with a mean age of 69.9 years. There was a significant association between CKD and total tau, Nfl (p&lt;0.001), but not with Aβ42/Aβ40 (p = 0.09). Participants with CKD exhibited higher levels of both total tau (least squares (LS) mean = 0.27, 95% CI: 0.12, 0.43) and NfL (LS mean = 0.67, 95% CI: 0.52, 0.83). Relationships were similar for eGFR based on cystatin C versus serum creatinine. After excluding participants with CKD (N = 352, 39.8% female, 34.1% non‐white, mean age of 68.8), there were not significant relationships between albuminuria with any of the biomarkers (p&gt;0.05), nor was there a significant association between race/ethnicity and total tau, NfL, or Aβ42/Aβ40 (p&gt;0.05).ConclusionIn a racially diverse subgroup of SPRINT participants, there were significant relationships between kidney function, defined via eGFR, with total tau and NfL, but not for the ratio of Aβ42/Aβ40. We did not observe any association between albuminuria and these blood measures of Alzheimer’s disease and non‐disease‐specific neurodegeneration.

Chronic kidney disease and functional impairment in a longitudinal study of older adults in China

ObjectivesTo examine the associations of chronic kidney disease (CKD) with dynamic functional impairment among older Chinese adults.DesignThis was a prospective longitudinal study.SettingData were derived from the Chinese Longitudinal Healthy Longevity...

Chronic kidney disease prevalence and clinical outcomes in anterior circulation acute ischemic stroke patients with reperfusion therapy: A meta-analysis.

Chronic Kidney Disease (CKD) is a common comorbidity among acute ischaemic stroke (AIS) patients undergoing reperfusion therapies, including intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT). Acknowledging CKD's prevalence in this cohort and understanding its influence on outcomes is crucial for prognosis and optimizing care. This study aims to determine the prevalence of CKD among anterior circulation AIS (acAIS) patients undergoing reperfusion therapies and to analyse the role of CKD in mediating outcomes. A random-effects meta-analysis was conducted to pool and examine prevalence data. A total of 263 633 patients were included in the meta-analysis. The study assessed CKD's association with functional outcomes, symptomatic intracranial haemorrhage (sICH) and mortality. The overall pooled prevalence of CKD among acAIS ranged from 30% to 56% in IVT-treated patients and 16%-42% for EVT-treated patients. CKD was associated with increased odds of unfavourable functional outcome at 90 days in both IVT (OR 1.837; 95% CI: [1.599; 2.110]; p < .001) and EVT (OR 1.804; 95% CI: [1.525; 2.133]; p < .001) groups. In IVT-treated patients, CKD was associated with increased odds of 30-day mortality (OR 6.211; 95% CI: [1.105; 34.909]; p = .038). CKD in IVT-treated patients exhibited increased odds of sICH, albeit statistically non-significant (OR 1.595; 95% CI: [0.567; 3.275]). The high prevalence of CKD and its significant impact on outcomes in acAIS patients treated with reperfusion therapies underscore its clinical significance. This insight can guide personalised care strategies and potentially improve the prognosis in the management of acAIS.

Abstract 13580: Impact of Chronic Kidney Disease on the Association of Ankle Brachial Index With Cardiovascular and All-Cause Mortality

Introduction: The association of low Ankle brachial index (ABI) with increased risk of cardiovascular (CV) as well as all-cause mortality is well established. Similarly, there is an independent association of chronic kidney disease (CKD) with CV and all-cause mortality. Little is known about the association of low ABI with CV and all-cause mortality by CKD status. Methods: We used data on 4,614 subjects from the National Health and Nutritional Examination Survey (NHANES) from January 1, 1999, to December 31, 2002. Those with available data on ABI and CKD status were included. Subjects were categorized as: 1) normal ABI ( &gt; 0.9), no CKD (eGFR &gt; 60 ml/min/m 2 , reference), 2) normal ABI and CKD, 3) Abnormal ABI, no CKD, 4) Abnormal ABI and CKD. NHANES-linked National death index records were used to determine CV and all-cause mortality. We used Cox proportional-hazards models and controlled for age, race, gender, income, educational status, smoking history, diabetes, systolic blood pressure, HDL and total cholesterol levels and history of CV disease. Results: Mean age was 55.7 years with 51% females and 4% blacks. Low ABI was present in 7%, while 6.4% had CKD and 1.3% had both low ABI and CKD. Median follow-up was 10.3 years. ABI&lt;0.9 was associated with risk of all-cause [Hazard ratio: 1.59 (95% confidence interval: 1.21-2.01)] and CV mortality [2.80 (1.72-4.56)] compared to normal ABI. Similarly, CKD was associated with risk of all-cause [1.34 (1.04-1.71)] and CV mortality [1.69 (1.0-2.96)] compared to no CKD. Among categories, the risk was [1.29 (0.9-1.8)], [1.57 (1.1-2.2)] and [1.92 (1.3-2.6)] for all cause mortality, and [1.2 (0.5-2.9)], [2.3 (1.3-4.0)] and [4.72, (2.6-8.4)] for CV mortality in groups normal ABI with CKD, abnormal ABI without CKD and abnormal ABI and CKD both, respectively compared to the reference group. Conclusion: Low ABI confers a much higher risk of CV and all-cause mortality in those with CKD than those without CKD. More aggressive risk factor modification might be warranted in those with CKD and low ABI to lower risk.

TCT-95 Association of Chronic Kidney Disease on Outcomes After Transcatheter Aortic Valve Replacement in Low-Flow Low-Gradient Aortic Stenosis

TCT-95 Association of Chronic Kidney Disease on Outcomes After Transcatheter Aortic Valve Replacement in Low-Flow Low-Gradient Aortic Stenosis

Association of Chronic Kidney Disease With Dietary Inflammatory Index in Adults Aged 50 Years and Older: Dose-Response Analysis of a Nationally Representative Population-Based Study

ObjectiveDietary inflammatory index (DII) is associated with systemic inflammatory markers, which have been linked to the development of chronic kidney disease (CKD). However, epidemiological studies on the association of DII scores with CKD are sparse. This study aimed to quantitatively assess the dose-response relationship of DII scores with the prevalence of CKD. MethodsAdults (≥50 years) from the 2007–2018 National Health and Nutrition Examination Survey (N=12,090) were included. DII scores were calculated based on 27 nutritional parameters. The outcome of interest is the prevalence of CKD 3-5 stages, which is defined as estimated glomerular filtration rate <60 mL/min/1.73 m2. The non-linear dose-response relationship of DII scores with the prevalence of CKD stages 3–5 was assessed with restricted cubic splines. Stratified analyses were conducted by age, sex and race/ethnicity. Covariates included age, sex, body mass index, race/ethnicity, educational, ratio of family income to poverty, smoking, physical activity, hypertension, diabetes, and daily intakes of total plain water, sodium and energy. ResultsThe weighted prevalence of CKD stages 3–5 was 14.77%. The relationship of DII scores with CKD stages 3–5 was linear, and the odds ratios (95% confidence intervals) of CKD stages 3–5 were 0.68 (0.51-0.84) for -2 (DII score), 0.83 (0.74-0.93) for -1, 1.00 for 0 (reference value), 1.20 (1.07-1.32) for 1, 1.41 (1.16-1.66) for 2, 1.63 (1.28-1.98) for 3, 1.84 (1.34-2.34) for 4, and 2.08 (1.30-2.86) for 5. The linear relationship pattern of DII scores with CKD stages 3–5 was observed in stratified analyses by age, sex and race/ethnicity, respectively. ConclusionsHigher DII scores were independently and linearly associated with the odds of CKD stages 3–5, which deserves to be confirmed in further prospective cohort studies.

Albuminuria and the risk of cancer: the Stockholm CREAtinine Measurements (SCREAM) project.

Studies investigating the association of chronic kidney disease and cancer have focused on estimated glomerular filtration (eGFR) rather than on albuminuria. This study aimed to examine whether albuminuria is associated with cancer incidence, and whether this association is independent of eGFR. We included subjects of the Stockholm Creatinine Measurements (SCREAM) project without a history of cancer-250768 subjects with at least one urine albumin-creatinine ratio (ACR) test (primary cohort) and 433850 subjects with at least one dipstick albuminuria test (secondary cohort). Albuminuria was quantified as KDIGO albuminuria stages. The primary outcome was overall cancer incidence. Secondary outcomes were site-specific cancer incidence rates. Multivariable Cox proportional hazards regression models adjusted for confounders including eGFR to calculate hazard ratios and 95% confidence intervals (HRs, 95% CIs). During a median follow-up of 4.3 (interquartile range 2.0-8.2) years, 21901 subjects of the ACR cohort developed de novo cancer. In multivariable analyses, adjusting among others for eGFR, subjects with an ACR of 30-299mg/g or ≥300mg/g had a 23% (HR 1.23; 95% CI 1.19-1.28) and 40% (HR 1.40; 95% CI 1.31-1.50) higher risk of developing cancer, respectively, when compared with subjects with an ACR <30mg/g. This graded, independent association was also observed for urinary tract, gastrointestinal tract, lung and hematological cancer incidence (all P<.05). Results were similar in the dipstick albuminuria cohort. Albuminuria was associated with the risk of cancer independent of eGFR. This association was primarily driven by a higher risk of urinary tract, gastrointestinal tract, lung and hematological cancers.

157-OR: Cystatin C Predicts Major Cardiovascular Events in Patients with Coronary Artery Disease Both among Patients With and among Those Without the Metabolic Syndrome

Cystatin C is an established biomarker for renal function, and, given the close association of chronic kidney disease and cardiovascular disease might indicate new-onset or deteriorating cardiovascular disease. However, evidence for cystatin C as a predictor of cardiovascular events is limited and controversial. We therefore aimed at investigating the role of cystatin C as a predictor of future major adverse cardiovascular events (MACE) in a high risk-cohort of patients with established coronary artery disease (CAD). We prospectively recorded cardiovascular events in 1481 patients with angiographically verified CAD over a mean follow-up of 10.0±5.2 years. At baseline, 684 patients had the metabolic syndrome (MetS) and 797 did not have the MetS. During follow-up, 578 (39%) of our patients suffered MACE. Cystatin C proved to be a strong and independent predictor for MACE in the total study cohort (standardized adjusted HR 1.56 [1.34-1.83], p&amp;lt;0.001). When MetS status was taken into account, cystatin C significantly predicted major cardiovascular events both in patients with the MetS (HR 1.56 [1.28-1.90], p&amp;lt;0.001) and in non-MetS patients (HR 1.44 [1.12-1.84], p=0.004). We conclude that cystatin C predicts major cardiovascular events in patients with coronary artery disease both among patients with the MetS and in non-MetS individuals. Disclosure A.Mader: None. C.H.Saely: None. M.Maechler: None. B.Larcher: None. L.Sprenger: None. A.Leiherer: None. A.Muendlein: None. A.Vonbank: None. T.Plattner: None. H.Drexel: None.

#2499 ALBUMINURIA AND THE RISK OF CANCER: THE STOCKHOLM CREATININE MEASUREMENTS (SCREAM) PROJECT

Abstract Background and Aims Studies investigating the association of chronic kidney disease and cancer have focused on estimated glomerular filtration (eGFR) rather than on albuminuria. The few studies focusing on albuminuria provide results that vary considerably, probably due to a lack of consideration of eGFR, their limited sample sizes, and that different albuminuria measurement techniques were used. This study therefore aimed to investigate the eGFR independent risk of cancer incidence associated with albuminuria measured as ACR as well as by dipstick in a large Swedish population. Method We included subjects of the Stockholm Creatinine Measurements (SCREAM) project without a history of cancer, 250,768 subjects with at least 1 urine albumin-creatinine ratio (ACR) test (primary cohort), and 433,850 subjects with at least 1 dipstick albuminuria test (secondary cohort). Albuminuria was quantified as KDIGO albuminuria stages. The primary outcome was overall cancer incidence. Secondary outcomes were site-specific cancer incidence rates. Multivariable Cox proportional hazards regression models were used to calculate hazard ratios (HRs, 95% CIs) crude, and additionally adjusted for confounders including baseline eGFR. Results During a median follow-up of 4.3 (IQR, 2.0-8.2) years, 21,901 subjects of the ACR cohort developed de novo cancer. In multivariable analyses, adjusting among others for eGFR, subjects with an ACR of 30–299 mg/g or ≥300 mg/g had a 23% (HR, 1.23; 95% CI, 1.19-1.28) and 40% (HR, 1.40; 95% CI, 1.31-1.50) higher risk of developing cancer, respectively, when compared to subjects with an ACR ≪30 mg/g. This graded, independent association was also observed for urinary tract, gastrointestinal tract, lung, and hematological cancer incidence (all P≪0.05). No significant associations of albuminuria with the incidence of melanoma, breast, and prostate cancers were found. Results were similar in the dipstick albuminuria cohort, and were robust in several sensitivity analyses. Conclusion Albuminuria was associated with the risk of cancer independent of eGFR. This association was primarily driven by a higher risk of urinary tract, gastrointestinal tract, lung, and hematological cancers.

Association of Chronic Kidney Disease and Coronary Heart Disease in A Series of Saudi Patients

Association of Chronic Kidney Disease and Coronary Heart Disease in A Series of Saudi Patients

Association of Chronic Kidney Disease With Plasma NfL and Other Biomarkers of Neurodegeneration: The H70 Birth Cohort Study in Gothenburg.

Studies associate chronic kidney disease (CKD) with neurodegeneration. This study investigated the relationship between kidney function, blood, CSF, and structural brain MRI markers of neurodegeneration in a sample including individuals with and without CKD. Participants from the Gothenburg H70 Birth Cohort Study, with data on plasma neurofilament light (P-NfL), estimated glomerular filtration rate (eGFR), and structural brain MRI were included. Participants were invited to also have the CSF collected. The primary endpoint of this study was to determine any association between CKD and P-NfL. Secondary endpoints included cross-sectional associations between CKD, eGFR, and CSF-derived and MRI-derived markers of neurodegeneration and Alzheimer disease (AD) pathology (MRI: cortical thickness, hippocampal volume, lateral ventricle volume, and white matter lesion volume; CSF: β-amyloid (Aβ) 42, Aβ42/40, Aβ42/p-tau, t-tau, p-tau, and NfL). Participants with P-NfL and eGFR at baseline were re-examined on eGFR, 5.5 (5.3-6.1) years (median; IQR) after the first visit, and the predictive value of P-NfL levels on incident CKD was estimated longitudinally, using a Cox proportional hazards model. We included 744 participants, 668 without CKD (age 71 [70-71] years, 50% males) and 76 with CKD (age 71 [70-71] years, 39% males). Biomarkers from the CSF were analyzed in 313 participants. A total of 558 individuals returned for a re-examination of eGFR (75% response rate, age 76 [76; 77] years, 48% males, 76 new cases of CKD). Participants with CKD had higher P-NfL levels than those with normal kidney function (median; 18.8 vs 14.1 pg/mL, p < 0.001), while MRI and CSF markers were similar between the groups. P-NfL was independently associated with CKD after adjustment for confounding variables, including hypertension and diabetes (OR; 3.231, p < 0.001), in a logistic regression model. eGFR and CSF Aβ 42/40: R = 0.23, p = 0.004 correlated in participants with Aβ42 pathology. P-NfL levels in the highest quartile were associated with incident CKD at follow-up (HR; 2.39 [1.21: 4.72]). In a community-based cohort of 70-year olds, P-NfL was associated with both prevalent and incident CKD, while CSF and/or imaging measures did not differ by CKD status. Participants with CKD and dementia presented similar levels of P-NfL.

The Bidirectional Association of Chronic Kidney Disease, Type 2 Diabetes, Atherosclerotic Cardiovascular Disease, and Heart Failure: The Cardio-Renal-Metabolic Syndrome.

Background: The cardiometabolic syndrome focuses on the association between type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD), whereas the cardiorenal syndrome focuses on the association between chronic kidney disease (CKD) and heart failure (HF). Consideration of these two syndromes as a single entity has not been well described. Methods: We used the electronic medical records of Kaiser Permanente Northwest to identify 387,985 members aged 18+ years with a serum creatinine measured from 2005 to 2017. If the estimated glomerular filtration rate was <60 mL/min per 1.73 m2, we required a second confirmatory measurement 3-12 months later. Patients were followed through 2019. We calculated the age- and gender-adjusted incidence and progression of CKD per 1000 person-years using generalized estimating equations. We used Cox proportional hazard models to assess the time-dependent effect of each condition on incidence of the other conditions. Results: CKD incidence rates were highest in patients with T2DM, ASCVD, and HF (27.0 per 1000 person-years [95% confidence interval (CI) 24.8-29.4] vs. 5.9 [5.8-6.0] in patients with none of these conditions). Similar results were obtained for CKD progression (309.0, 283.9-336.4 for all three conditions vs. 147.9, 143.3-152.4 for no condition). In time-dependent models, all three conditions were independently associated with CKD incidence, being highest for HF (hazard ratio 2.14, 95% CI 2.07-2.21). All relationships between CKD, T2DM, ASCVD, and HF were significant and bidirectional. Conclusions: The presence of CKD, T2DM, HF, and ASCVD each conveys risk on the others. A cardiometabolic renal syndrome comprising these conditions may be an important disease entity that requires a comprehensive treatment approach.

Association of Chronic Kidney Disease With Atrial Fibrillation in the General Adult Population: A Nationwide Population-Based Study.

Background The incidences of atrial fibrillation (AF) and chronic kidney disease (CKD) are increasing, and AF is prevalent in patients with CKD. However, few studies have investigated the incidence or association of AF in a large CKD population from a longitudinal study. Methods and Results From a nationwide cohort, a total of 4 827 987 Korean individuals without prior AF, who received biennial health checkups provided by the National Health Insurance Service between 2009 and 2012 in Korea, were analyzed. Incidence of AF was ascertained through the end of 2018. During a median follow-up of 8.1 years, the annual incidence rate of AF was 1.17 per 1000 person-years among subjects without CKD, 1.55 for stage 1 CKD, 1.86 for stage 2 CKD, 2.1 for stage 3 CKD, and 4.33 for stage 4 CKD. In Fine-Gray regression models, CKD was associated with an increased risk of AF; the adjusted hazard ratios and 95% CIs of AF occurrence were 1.77 (1.69-1.85), 1.85 (1.80-1.91), 1.99 (1.95-2.04), and 4.04 (3.07-5.33) in individuals with CKD stages 1, 2, 3, and 4, respectively, compared with non-CKD. The association between CKD and incident AF remained statistically significant after adjustment for multiple confounding factors and was consistent across subgroups stratified by sex and age. Conclusions CKD is associated with an increased incidence of AF. Even mild CKD is associated with incident AF, and there was a stepwise increase in the risk of incident AF with a decrease in renal function.

Vitamin D and Chronic Kidney Disease Association with Mineral and Bone Disorder: An Appraisal of Tangled Guidelines.

Chronic kidney disease (CKD) is a highly prevalent condition worldwide in which the kidneys lose many abilities, such as the regulation of vitamin D (VD) metabolism. Moreover, people with CKD are at a higher risk of multifactorial VD deficiency, which has been extensively associated with poor outcomes, including bone disease, cardiovascular disease, and higher mortality. Evidence is abundant in terms of the association of negative outcomes with low levels of VD, but recent studies have lowered previous high expectations regarding the beneficial effects of VD supplementation in the general population. Although controversies still exist, the diagnosis and treatment of VD have not been excluded from nephrology guidelines, and much data still supports VD supplementation in CKD patients. In this narrative review, we briefly summarize evolving controversies and useful clinical approaches, underscoring that the adverse effects of VD derivatives must be balanced against the need for effective prevention of progressive and severe secondary hyperparathyroidism. Guidelines vary, but there seems to be general agreement that VD deficiency should be avoided in CKD patients, and it is likely that one should not wait until severe SHPT is present before cautiously starting VD derivatives. Furthermore, it is emphasized that the goal should not be the complete normalization of parathyroid hormone (PTH) levels. New developments may help us to better define optimal VD and PTH at different CKD stages, but large trials are still needed to confirm that VD and precise control of these and other CKD-MBD biomarkers are unequivocally related to improved hard outcomes in this population.