Burden Of Chronic Kidney Disease Research Articles

Late diagnosis of CKD and associated survival after initiation of renal replacement therapy in Kazakhstan: analysis of nationwide electronic healthcare registry 2014–2019

Chronic kidney disease (CKD) presents a significant global health challenge, often progressing to end-stage renal disease (ESRD) necessitating renal replacement therapy (RRT). Late referral (LR) to nephrologists before RRT initiation is linked with adverse outcomes. However, data on CKD diagnosis and survival post-RRT initiation in Kazakhstan remain limited. This study aims to investigate the impact of late CKD diagnosis on survival prognosis after RRT initiation. Data were acquired from the Unified National Electronic Health System (UNEHS) for CKD patients initiating RRT between 2014 and 2019. Survival post-RRT initiation was assessed using the Cox Proportional Hazards Model. Totally, 211,655 CKD patients were registered in the UNEHS databases and 9,097 (4.3%) needed RRT. The most prevalent age group among RRT patients is 45–64 years, with a higher proportion of males (56%) and Kazakh ethnicity (64%). Seventy-four percent of patients were diagnosed late. The median follow-up time was 537 (IQR: 166–1101) days. Late diagnosis correlated with worse survival (HR = 1.18, p < 0.001). Common comorbidities among RRT patients include hypertension (47%), diabetes (21%), and cardiovascular diseases (26%). The history of transplantation significantly influenced survival. Regional disparities in survival probabilities were observed, highlighting the need for collaborative efforts in healthcare delivery. This study underscores the substantial burden of CKD in Kazakhstan, with a majority of patients diagnosed late. Early detection strategies and timely kidney transplantation emerge as crucial interventions to enhance survival outcomes.

Exploring the Renoprotective Potential of Bioactive Nutraceuticals in Chronic Kidney Disease Progression: A Narrative Review.

Chronic kidney disease (CKD) is a condition that is characterized by progressive loss of kidney function over time. A substantial increase in the burden of CKD is evident globally, attributed to multifactorial conditions like an expanding aging population, rising diabetes and hypertension rates, and more significant exposures to risk factors associated with the environment and lifestyle. Nutraceuticals are substances that are usually considered a food or an active part of a food that provides medical or health benefits, including the prevention and treatment of a disease. The aim is to review the positive role of nutraceuticals in managing CKD. A narrative review is generated, extracting the papers from databases like Web of Science, Scopus, ScienceDirect, ResearchGate, and PubMed. Animal and human trials focusing on the effect of different nutraceuticals on the initial stage of kidney disease, i.e., stages 1, 2, and 3 of CKD, were included. The review's outcome is understanding the effectiveness of nutraceuticals that have shown positive results in CKD conditions. Active compounds include ubiquinone, curcumin, nitrates, nitrites, lycopene, and resveratrol. These bioactive components are also beneficial for other comorbid conditions like diabetes, hypertension, and cardiovascular conditions that have an eminent adverse effect on CKD. Lycopene, coenzyme Q10 (CoQ10), resveratrol, curcumin, and flavonoids have positively impacted CKD complications. Nutraceuticals hold great promise for individuals with CKD in the coming years, offering diverse potential benefits. These include delivering vital antioxidant and anti-inflammatory support to alleviate oxidative stress and inflammation, helping to regulate blood pressure and lipid levels for improved cardiovascular health, promoting optimal renal function to sustain kidney health, assisting in maintaining electrolyte balance, warding off complications, influencing gut microbiota for enhanced digestive well-being, and ultimately elevating the overall quality of life, for those managing CKD.

Prevalence of Chronic Kidney Disease and Associated Factors among the Diabetic and Prediabetic Population in the Bandare-Kong Cohort Study; A Population-Based Study.

This investigation aims to examine the relationship between diabetes and prediabetes with chronic kidney disease (CKD) while taking into account key risk factors such as gender, age, lifestyle, smoking habits, and blood pressure. Between November 17, 2016, and November 22, 2018, 4063 subjects aged 35 to 70 years were enrolled in the first phase of the Bandare-Kong Non-Communicable Disease (BKNCD) Cohort Study, which is part of the PERSIAN (Prospective Epidemiological Research Studies in IrAN) cohort and was conducted in a coastal region of the Hormozgan province in southern Iran. CKD was calculated using the Modification of Diet in Renal Disease (MDRD) formula based on glomerular filtration rate (GFR)<60 mL/min per 1.73 m2 , or albumin/Cr>30 mg/g in random urine, self-reported kidney failure, or dialysis. Urine albumin and creatinine were determined by standard kits (Pars Azmoon, Tehran, Iran) and the BT1500 automatic chemistry analyzer (Biotecnica Instruments, Rome, Italy). The prevalence of CKD was found to be 15.3%, with 29.6% identified in diabetic individuals and 16.5% in prediabetic patients. So, the prevalence of CKD in diabetics was higher than prediabetics and normal people. Increased age, dysglycemia (diabetes or prediabetes), hypertension, and use of angiotensin receptor blockers were markedly associated with an elevated risk of CKD in adults. The study emphasizes the importance of early detection and management of CKD risk factors, particularly among high-risk individuals, to mitigate CKD progression and associated complications. By addressing modifiable risk factors, proactive screening, and enhanced awareness, significant strides can be made in reducing CKD burden and improving patient outcomes.

Association of Thallium Exposure with Decreased Renal Function among Chinese Adults - China, 2017-2018.

Thallium (Tl) is significantly more toxic than heavy metals such as lead, cadmium, and mercury. However, previous studies examining the relationship between Tl exposure and the risk of chronic kidney disease (CKD) have yielded inconsistent results. The study demonstrated that elevated urinary Tl levels were associated with a higher prevalence of CKD and a reduced estimated glomerular filtration rate (eGFR), particularly among older adults. These findings were consistent in the restricted cubic spline (RCS) analyses. This study identified Tl as a risk factor for decreased renal function, underscoring the need to enhance surveillance of Tl to mitigate the disease burden of CKD.

The Lived Experience of Patients with Chronic Kidney Disease: Insights From DISCOVER CKD

Introduction: Chronic kidney disease (CKD) can have a profound impact on patients’ lives. However, multinational data on patients’ lived experience with CKD are scarce. Methods: Individuals from the prospective cohort of DISCOVER CKD (NCT04034992), an observational cohort study, were recruited to participate in one-to-one telephone interviews to explore their lived experience with CKD. A target of 100 participant interviews was planned across four countries (Japan, Spain, the UK, and the USA). These qualitative interviews, lasting ∼60–90 min, were conducted in the local language by trained interviewers with specific experience in CKD, between January and June 2023. Transcribed interviews were translated into English for coding and analysis. Data were coded using qualitative research software. Results: Of the 105 participants interviewed, 103 were included in the final analysis. The average time since CKD diagnosis was 9.5 years, and at least half (50.5%) of participants had CKD stage 3A or 3B. CKD diagnosis was an emotional experience, driven by worry (n = 29/103; 28.2%) and shock (n = 26/103; 25.2%), and participants often reported feeling inadequately informed. Additional information was frequently sought, either online or via other healthcare providers. The proportion of participants reporting no impacts of CKD on their lives was highest in those with CKD stage 1 and 2 (64.3%). Conversely, every participant in the CKD stage 5 on dialysis group reported some impact of CKD on their lives. Across all participants, the most reported impacts were anxiety or depression (37.9%) or ability to sleep (37.9%). The frequency of the reported impacts appeared to increase with disease severity, with the highest rates observed in the dialysis group. In that group, the most frequently reported impact was on the ability to work (80.0%). Conclusion: Findings from this multinational qualitative study suggest that patients may experience symptoms and signs of disease prior to diagnosis; however, these are often nonspecific and may not be directly associated with CKD. Once diagnosed, the burden of CKD can have a diverse, negative impact on various aspects of patients’ lives. This highlights the need for early identification of at-risk individuals, and the importance of early CKD diagnosis and management with guideline-directed therapies to either prevent further deterioration of CKD or slow its progression, thus reducing symptom burden and improving quality of life.

Inside ANEMIA of CKD: Projecting the Future Burden of Anemia of Chronic Kidney Disease and Benefits of Proactive Management: A Microsimulation Model of the Chinese Population.

Anemia is a common comorbidity of chronic kidney disease (CKD) that has been associated with increased risk of complications, healthcare expenditure, and reduced quality of life. In China, the treatment of anemia of CKD has been reported to be suboptimal in part because of a lack of awareness of the condition and its management. It is therefore important to raise awareness of the condition by estimating the future health and economic burden of anemia of CKD and also to understand how it may be addressed through proactive policies. This study aims to project the health and economic burden of anemia of CKD, in China, from 2023 to 2027 and to estimate the impact of a hypothetical intervention on related clinical and cost outcomes. A virtual Chinese population was simulated using demographic, clinical, and economic statistics within a validated CKD microsimulation model. Each individual was assigned a CKD stage, anemia stage, comorbidity status (type2 diabetes, hypertension), complication status (stroke, heart failure, and/or myocardial infarction), and a probability of receiving treatments and therapies. Annual direct healthcare costs were assigned and based on these factors. The hypothetical intervention reduced the prevalence of moderate and severe anemia by 5% annually. This hypothetical scenario was chosen to highlight the impact of implementing policies that could reduce anemia of CKD, and is aligned with the Healthy China 2030 policy, which aims to reduce mortality from noncommunicable diseases by 30%. Interventions could consist of early screening and intervention to reduce the escalation of anemia from mild to moderate or severe. Results were compared with a baseline "no change" scenario which reflects current trends. The number of patients with moderate/severe anemia of CKD was projected to increase from 3.0 to 3.2million patients, with associated costs increasing from ¥22.0 billion (B) to ¥24.4B between 2023 and 2027, respectively. Compared with the no change scenario, the hypothetical intervention reduced the prevalence of moderate and severe anemia of CKD, saving ¥3.9B in healthcare costs in 2027 (¥24.4B vs ¥20.6B, respectively). Consistent with trends in CKD burden in China, the prevalence of anemia of CKD is projected to increase, leading to greater related healthcare costs. The introduction of healthcare interventions designed to screen for and treat anemia more effectively could therefore reduce its future burden and related costs.

IMPACT CKD: Holistic Disease Model Projecting 10-Year Population Burdens

IntroductionThe significant burden of chronic kidney disease (CKD) is not recognized as a global public health priority, although policies aimed at delaying progression to later stages are required. Hence, there is need for a holistic disease model to inform decision-making that accounts for the multi-dimensional impact of CKD, and the interrelated factors that modulate progression. MethodsIMPACT CKD is a microsimulation model that simulates CKD progression and incorporates the effect of clinical events and comorbidities. CKD status is assigned using estimated glomerular filtration rate (eGFR) and albuminuria levels, and CKD progression is predicted by an annual eGFR decline rate. The model projects clinical, healthcare resource use, economic, patient, societal, and environmental burdens from 2022-2032. During development, face, technical, and external validity were evaluated, with calibration conducted to population data. Further, cross-validation was conducted against two published models. The United Kingdom (UK) was selected as the case study for validation. ResultsA 7.7% increase in the CKD population by 2032 was predicted, with increasing numbers of patients with CKD stage 3-5 (21.7%), dialysis (75.3%), and transplantation (58.7%). The rise of renal replacement therapy patients results in an increase of 75% across freshwater use, fossil fuel depletion, and CO2 emissions over the next decade, and an estimated cost of £1.95 billion in 2032. Projections reflect validated findings from other models. ConclusionThe IMPACT CKD model is a robust simulation that delivers validated forecasts of the holistic CKD burden, which can support evaluation of diverse health policies and treatment strategies.

Towards equitable renal care: Strategies for enhancing kidney transplantation in Africa

Chronic kidney disease (CKD) is defined as the presence of kidney damage persisting for 3 months or more. Kidney transplantation stands as a vital intervention for individuals grappling with end-stage renal disease (ESRD) in Africa, offering the promise of extended life and improved quality of life. However, numerous challenges hinder its widespread implementation across the continent. This paper explored kidney transplantation in Africa, aiming to illuminate key strategies for bridging gaps and building pathways to enhanced renal care. There is a disproportionate burden of CKD on the region's population. Therefore, there is a critical need for early diagnosis and intervention. This paper outlines comprehensive strategies for improving kidney transplantation in Africa. Results indicate that financial support systems, infrastructure enhancement, public awareness campaigns, and legal frameworks are essential for addressing renal care barriers. Active measures such as government subsidy programs, international funding collaboration, and engagement with community leaders are highlighted as effective approaches. Drawing from global standards and best practices, the paper shows the importance of tailored approaches that address Africa's unique socio-economic and healthcare landscape. By leveraging collaborative efforts, regulatory frameworks, and public engagement, African nations can overcome barriers to kidney transplantation and pave the way for equitable access to life-saving treatment.

Experience of Chronic Kidney Disease and Perceptions of Transplantation by Sex

The pathway to kidney transplantation (KT) begins with the patient's acceptance of this surgical procedure after discussion with the nephrologist. The patients' perceptions of the disease and of KT may influence their willingness to undergo transplantation. To describe patients' experiences of kidney disease and their perceptions of KT and the nephrologists' perceptions of the patient experience. This qualitative study collected data through semistructured interviews with patients with chronic kidney disease and nephrologists in the Bretagne, Île-de-France and Normandie regions, France. Researchers involved in the study in each region purposely selected 99 patients with chronic kidney disease who initiated dialysis in 2021, based on their age, sex, dialysis facility ownership, and also 45 nephrologists, based on their sex and years of experience. Data analysis was performed from January to October 2023. Themes were identified using inductive thematic analysis. Specific characteristics of men and women as well as the nephrologist's views for each theme were described. This study included 42 men and 57 women (56 [57%] aged 60 years or older) who started dialysis in 2021 and 45 nephrologists (23 women and 22 men). Six major themes were identified: (1) burden of chronic kidney disease on patients and their families, (2) health care professional-patient relationship and other factors that modulate chronic kidney disease acceptance, (3) dialysis perceived as a restrictive treatment, (4) patients' representation of the kidney graft, (5) role of past experiences in KT perception, and (6) dualistic perception of KT. In some cases, women and nephrologists indicated that women's perceptions and experiences were different than men's; for example, the disease's psychological impact and the living donor KT refusal were mainly reported by 8 women. Patients' past experience of chronic kidney disease in general and of KT in particular, as well as their relationship with their family and nephrologist, were substantial determinants of KT perception in this qualitative study. Targeted policies on these different factors might help to improve access to KT, and more research is needed to understand whether there are sex-based disparities.

A descriptive study of the single-nucleotide polymorphisms known to affect the Tacrolimus trough concentration per dose, among a population of kidney failure patients in a tertiary hospital in Ghana

BackgroundThe burden of chronic kidney disease (CKD) and kidney failure in Ghana is on the ascendency, with the prevalence of CKD estimated at 13.3%. Patients with CKD who progress to kidney failure require life sustaining kidney replacement therapy (KRT) which is almost exclusively available in Ghana as haemodialysis. Kidney transplantation is considered the best KRT option for patients with irreversible kidney failure due to its relative cost efficiency as well as its superiority in terms of survival and quality of life. However, because transplants may trigger an immune response with potential organ rejection, immunosuppressants such as tacrolimus dosing are required.ObjectiveThis study sought to determine single nucleotide polymorphisms in CYP3A5, CYP3A4 and MDR1 genes that affect the pharmacokinetics of Tacrolimus in a population of Ghanaian patients with kidney failure.MethodThis cross-sectional study comprised of 82 kidney failure patients undergoing maintenance haemodialysis at the Renal and Dialysis unit of Korle-Bu Teaching Hospital (KBTH). Clinical and demographic data were collected and genomic DNA isolated. Samples were genotyped for specific SNPs using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP).ResultsParticipants, 58/82 (70.73%) harbored the wildtype CYP3A5*1/*1 AA genotype, 20/82 (24.39%) carried the heterozygous CYP3A5*1/*3 AG genotype, and 4/82 (4.88%) had the homozygous mutant CYP3A5*3/*3 GG genotype. Also, 6/82 (7.32%) carried the wildtype AA genotype, 11/82 (13.41%) had the heterozygous AG genotype, and 65/82 (79.27%) harbored the homozygous mutant GG genotype of CYP3A4*1B (-290 A>G). For MDR1_Ex21 (2677 G>T), 81/82 (98.78%) carried the wildtype GG genotype, while 1/82 (1.22%) had the heterozygous GT genotype. For MDR1_Ex26 (3435 C>T), 63/82 (76.83%) had the wildtype CC genotype, while 18/82 (21.95%) carried the heterozygous CT genotype, and 1/82 (1.22%) harbored the mutant TT genotype.ConclusionSNPs in CYP3A4, CYP3A5, and MDR1 genes in a population of Ghanaian kidney failure patients were described. The varying SNPs of the featured genes suggest the need to consider the genetic status of Ghanaians kidney failure patients prior to transplantation and tacrolimus therapy.

Global burden and risk factors of chronic kidney disease in adolescents and young adults: a study from 1990 to 2019.

Few studies have evaluated the global burden of chronic kidney disease (CKD) in adolescents and young adults (AYAs). Age-standardized rates of incidence (ASIR), mortality (ASMR), and disability-adjusted life-years (ASDR) were used to describe the CKD burden in AYAs. The estimated annual percentage changes (EAPCs) were calculated to evaluate the temporal trends from 1990 to 2019. Risk factors were calculated by population attributable fractions. In 2019, the ASIR, ASMR, and ASDR of CKD in AYAs were 32.21 (95% uncertainty interval [UI], 23.73-40.81) per 100,000, 2.86 (2.61-3.11) per 100,000 and 236.85 (209.03-268.91) per 100,000, respectively. The ASIR was higher among females than males, whereas the ASMR was higher among males than females in 2019. From 1990 to 2019, significant increases in ASIR were found for CKD (EAPC, 0.98%; 95% confidence interval [CI], 0.95%-1.01%), although the ASMR had decreased (EAPC, -0.40%; 95% CI, -0.56% to -0.24%). The largest increase in ASIR was observed in countries with a middle sociodemographic index (SDI) (EAPC, 1.30%; 95% CI, 1.28%-1.33%), while the largest increase in ASMR was observed in high SDI. Globally, the proportional contribution of risk factors for CKD mortality varied across regions, with the highest proportions of high fasting plasma glucose being 14.04% in low SDI, compared with 24.01% in high SDI. CKD is a growing global health problem in AYAs, especially in countries with a middle SDI. Targeted measures are needed to address the rising burden of CKD in AYAs, focusing on prevention, early diagnosis, and reducing disparities.

Burden of Chronic Kidney Disease of Undetermined Aetiology (CKDu) in a Tertiary Care Public Hospital in North India.

Chronic kidney disease of undetermined aetiology (CKDu) is an important public health problem. Indian data are mostly based on studies from rural regions in south and east India. We examined the burden and profile of CKDu in patients attending a tertiary care hospital in north India. We assessed records of consecutive new CKD patients registered in a nephrology clinic from January 2015 to June 2022. Patients were classified as having CKDu based on predefined inclusion and exclusion criteria. Clinical and laboratory parameters at presentation and kidney biopsy when done were noted. Records of 32,369 patients with CKD were screened, and 29,663 were included (2,706 excluded due to inadequate data). A total of 370 (1.2%) patients were categorized as CKDu. Mean age was 41 ± 14.7 years, 58.1% being male. Of them, 158 (42.7%) patients were in CKD stage 3, 89 (24.1%) in stage 4, 84 (22.7%) in stage 5, and 39 (10.5%) were dialysis dependent at presentation; 232 (62.7%) patients had proteinuria &lt;0.5 gm/day and 138 (37.3%) between 0.5 and 1 gm/day. Renal histology was available for 65 CKDu patients: 62 had chronic tubulointerstitial nephritis (CTIN) and 3 had non-specific changes. When defined using strict criteria with intensive diagnostic workup, burden of CKDu is low in our hospital-based cohort of CKD patients. CTIN is the predominant histopathological finding in kidney biopsy.

The impact of population ageing on the burden of chronic kidney disease.

The burden of chronic kidney disease (CKD) and its risk factors are projected to rise in parallel with the rapidly ageing global population. By 2050, the prevalence of CKD category G3-G5 may exceed 10% in some regions, resulting in substantial health and economic burdens that will disproportionately affect lower-income countries. The extent to which the CKD epidemic can be mitigated depends largely on the uptake of prevention efforts to address modifiable risk factors, the implementation of cost-effective screening programmes for early detection of CKD in high-risk individuals and widespread access and affordability of new-generation kidney-protective drugs to prevent the development and delay the progression of CKD. Older patients require a multidisciplinary integrated approach to manage their multimorbidity, polypharmacy, high rates of adverse outcomes, mental health, fatigue and other age-related symptoms. In those who progress to kidney failure, comprehensive conservative management should be offered as a viable option during the shared decision-making process to collaboratively determine a treatment approach that respects the values and wishes of the patient. Interventions that maintain or improve quality of life, including pain management and palliative care services when appropriate, should also be made available.

Prevalence, Mortality, and Access to Care for Chronic Kidney Disease in Medicaid-Enrolled Adults With Sickle Cell Disease in California: Retrospective Cohort Study.

Chronic kidney disease (CKD) is a significant complication in patients with sickle cell disease (SCD), leading to increased mortality. This study aims to investigate the burden of CKD in Medicaid-enrolled adults with SCD in California, examine differences in disease burden between male and female individuals, and assess mortality rates and access to specialized care. This retrospective cohort study used the California Sickle Cell Data Collection program to identify and monitor individuals with SCD. Medicaid claims, vital records, emergency department, and hospitalization data from 2011 to 2020 were analyzed. CKD prevalence was assessed based on ICD (International Classification of Diseases) codes, and mortality rates were calculated. Access to specialized care was examined through outpatient encounter rates with hematologists and nephrologists. Among the 2345 adults with SCD, 24.4% (n=572) met the case definition for CKD. The SCD-CKD group was older at the beginning of this study (average age 44, SD 14 vs 34, SD 12.6 years) than the group without CKD. CKD prevalence increased with age, revealing significant disparities by sex. While the youngest (18-29 years) and oldest (>65 years) groups showed similar CKD prevalences between sexes (female: 12/111, 10.8% and male: 12/101, 11.9%; female: 74/147, 50.3% and male: 34/66, 51.5%, respectively), male individuals in the aged 30-59 years bracket exhibited significantly higher rates than female individuals (30-39 years: 49/294, 16.7%, P=.01; 40-49 years: 52/182, 28.6%, P=.02; and 50-59 years: 76/157,48.4%, P<.001). During this study, of the 2345 adults, 435 (18.5%) deaths occurred, predominantly within the SCD-CKD cohort (226/435, 39.5%). The median age at death was 53 (IQR 61-44) years for the SCD-CKD group compared to 43 (IQR 33-56) years for the SCD group, with male individuals in the SCD-CKD group showing significantly higher mortality rates (111/242, 45.9%; P=.009) than female individuals (115/330, 34.9%). Access to specialist care was notably limited: approximately half (281/572, 49.1%) of the SCD-CKD cohort had no hematologist visits, and 61.9% (354/572) did not see a nephrologist during this study's period. This study provides robust estimates of CKD prevalence and mortality among Medicaid-enrolled adults with SCD in California. The findings highlight the need for improved access to specialized care for this population and increased awareness of the high mortality risk and progression associated with CKD.

Costs and healthcare use of patients with chronic kidney disease in the Northern Territory, Australia

BackgroundThe burden of chronic kidney disease (CKD) is high in the Northern Territory (NT), Australia. This study aims to describe the healthcare use and associated costs of people at risk of CKD (e.g. acute kidney injury, diabetes, hypertension, and cardiovascular disease) or living with CKD in the NT, from a healthcare funder perspective.MethodsWe included a retrospective cohort of patients at risk of, or living with CKD, on 1 January 2017. Patients on kidney replacement therapy were excluded from the study. Data from the Territory Kidney Care database, encompassing patients from public hospitals and primary health care services across the NT was used to conduct costing. Annual healthcare costs, including hospital, primary health care, medication, and investigation costs were described over a one-year follow-up period. Factors associated with high total annual healthcare costs were identified with a cost prediction model.ResultsAmong 37,398 patients included in this study, 23,419 had a risk factor for CKD while 13,979 had CKD (stages 1 to 5, not on kidney replacement therapy). The overall mean (± SD) age was 45 years (± 17), and a large proportion of the study cohort were First Nations people (68%). Common comorbidities in the overall cohort included diabetes (36%), hypertension (32%), and coronary artery disease (11%). Annual healthcare cost was lowest in those at risk of CKD (AUD$7,958 per person) and highest in those with CKD stage 5 (AUD$67,117 per person). Inpatient care contributed to the majority (76%) of all healthcare costs. Predictors of increased total annual healthcare cost included more advanced stages of CKD, and the presence of comorbidities. In CKD stage 5, the additional cost per person per year was + $53,634 (95%CI 32,769 to 89,482, p < 0.001) compared to people in the at risk group without CKD.ConclusionThe total healthcare costs in advanced stages of CKD is high, even when patients are not on dialysis. There remains a need for effective primary prevention and early intervention strategies targeting CKD and related chronic conditions.

Finerenone: Who should prescribe it for CKD? The physician associate's perspective.

Diabetic kidney disease (DKD) affects 30-40% of all patients with diabetes and contributes significantly to the cardiovascular burden of chronic kidney disease (CKD). Despite the availability of evidence-based medications like finerenone and simple screening tests such as Urinary Albumin-to-Creatinine Ratio (UACR), more resources are still needed to care for DKD patients. Physician Associates (PAs) play a crucial role in the multidisciplinary team responsible for DKD diagnosis, monitoring, and management. A nonsteroidal mineralocorticoid receptor antagonist, namely finerenone, was approved by the FDA in adults with CKD associated with type 2 diabetes to reduce the risk of renal and cardiovascular outcomes. Finerenone is considered among the pillars of care for DKD, furthermore, the addition of finerenone in combination with renin-angiotensin system inhibitors and/or other renal protective medications may offer additional benefits. Primary care providers prescribe finerenone less frequently than specialized care providers, indicating a need to empower physician associates in medication prescription and other renal protection strategies. As part of a multidisciplinary team, physician associates can play an important role in evaluating risk factors that contribute to heart disease and metabolic health. They can also monitor not only kidney function by ordering tests, such as serum creatinine and urinary albumin-to-creatinine ratio every 3-12months, but also serum potassium levels. Additionally, physician associates can encourage patients to take responsibility for their health by regularly monitoring their blood pressure, blood glucose levels, and body weight. With early detection and management, kidney failure and cardiovascular events may be preventable. Specialized physician associates also play a significant role in the comprehensive care of DKD patients, especially in the later stages. DKD care can be hindered by numerous factors such as lack of patient engagement during counseling, cost disparities, and a complex referral system that requires multidisciplinary guidelines to improve professional communication. It is necessary to re-envision the physician associates' role in primary care and empower them in goal-directed therapies.

An Unusual Case of Relapsing and Remitting Acute Kidney Injury

Paroxysmal nocturnal haemoglobinuria (PNH), although a rare type of acquired hemolytic anemia, can be life-threatening if not diagnosed early. Kidney involvement in PNH varies from reversible acute kidney injury to irreversible chronic damage. Here, we report a case of recurrent acute kidney injury in a young male requiring renal replacement support. Repeated history of AKI with coombs negative hemolytic anemia led us to perform PNH profile after ruling out other causes. Although kidney involvement in PNH is not apparent, this case shows the importance of having a high index of suspicion which will help in preventing further episodes of AKI and thus, chronic kidney disease burden.

Dietary salt intake and kidney function in rural Senegalese populations: a cross-sectional study

IntroductionHigh salt intake is a major risk factor for hypertension and its complications such as chronic kidney disease (CKD) and cardiovascular diseases. The present study aimed to determine level of sodium consumption and its relation with kidney function in the rural populations of Ferlo (centre of Senegal).Subjects and methodsWe performed a cross-sectional study including 400 volunteers aged > 18 years. Clinical, biological and dietary data were collected during household visits. Daily sodium intake was measured in the 24 h-urine outpout and CKD was defined as eGFR < 60 ml/min. Linear regression analysis was used to assess association between sodium intake and covariates.ResultsMean age was 46.42 ± 15.60 and sex-ratio was 1.05. Prevalence of hypertension, CKD and overweight were 21.5, 11.7 and 20.5%, respectively. The median daily salt intake was 11.7 g with interquartile range of 14.8 g. Only 11.25% of participants consumed less than 5 g/day. After multivariate analysis, high salt intake was associated with age > 60 years, overweight and CKD. However, gender and hypertension were not significantly associated with salt intake. Industrial broths (91.5%) and bread (85%) represented the main sources of dietary salt.ConclusionThis study revealed high levels of daily salt intake contrasting with low potassium intakes in the majority of participants. Participants with CKD, overweight and age > 60 years presented higher salt consumption. Stategies to reduce salt consumption are urgently needed to reduce burden of CKD in rural Senegalese populations.

Cost-effectiveness of add-on empagliflozin versus standard of care in management of CKD in Malaysia, Thailand and Vietnam – findings from a modelling study assessing an EMPA-KIDNEY eligible population, using CKD progression model

Background and objectives Nearly one in ten individuals in South-East Asia are estimated to be affected by chronic kidney disease (CKD). The burden of end-stage kidney disease is significant and can be heavy on the healthcare system. The recent EMPA-KIDNEY trial demonstrated a significant reduction in the risk of kidney disease progression or cardiovascular death in patients with CKD with a broad range of kidney function using add-on empagliflozin versus standard of care (SoC) alone. The objective of this study was to estimate the economic benefit of empagliflozin for patients with CKD in Malaysia, Thailand and Vietnam. Methods An individual patient level simulation model with an annual cycle that estimates the progression of kidney function and associated risk-factors was employed. Local costs and mortality rates were estimated from a wide range of published literature. A healthcare perspective was used over a 50-year time horizon. Results The use of add-on empagliflozin versus SoC alone was found to be cost-saving in Malaysia and Thailand and cost-effective (ICER: 77,838,407 Vietnam Dong/QALY vs. a willingness to pay threshold of 96,890,026/QALY) in Vietnam. The bulk of the costs avoided over a lifetime is derived from the prevention or delay of dialysis initiation or kidney transplant – the cost offsets were nearly twice the additional treatment cost. The results were similar in patients with and without diabetes and across broad range of albuminuria. Conclusions The use of add-on empagliflozin in a broad population of patients with CKD is expected to be cost-saving in Malaysia and Thailand and cost-effective in Vietnam and will help alleviate the increasing burden of CKD in the region.

Strategies to address diabetic kidney disease burden in Mexico: a narrative review by the Mexican College of Nephrologists.

Chronic kidney disease (CKD) is a growing global public health challenge worldwide. In Mexico, CKD prevalence is alarmingly high and remains a leading cause of morbidity and mortality. Diabetic kidney disease (DKD), a severe complication of diabetes, is a leading determinant of CKD. The escalating diabetes prevalence and the complex regional landscape in Mexico underscore the pressing need for tailored strategies to reduce the burden of CKD. This narrative review, endorsed by the Mexican College of Nephrologists, aims to provide a brief overview and specific strategies for healthcare providers regarding preventing, screening, and treating CKD in patients living with diabetes in all care settings. The key topics covered in this review include the main cardiometabolic contributors of DKD (overweight/obesity, hyperglycemia, arterial hypertension, and dyslipidemia), the identification of kidney-related damage markers, and the benefit of novel pharmacological approaches based on Sodium-Glucose Co-Transporter-2 Inhibitors (SGLT2i) and Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RA). We also address the potential use of novel therapies based on Mineralocorticoid Receptor Antagonists (MRAs) and their future implications. Emphasizing the importance of multidisciplinary treatment, this narrative review aims to promote strategies that may be useful to alleviate the burden of DKD and its associated complications. It underscores the critical role of healthcare providers and advocates for collaborative efforts to enhance the quality of life for millions of patients affected by DKD.