CKD Cases Research Articles

Chronic kidney disease in patients with psoriatic arthritis: a cohort study

ObjectivesChronic kidney disease (CKD) is a comorbidity in psoriatic arthritis (PsA). We aimed to define the prevalence of CKD in patients with PsA, describe their long-term renal outcomes and identify...

Prediction of subsequent CKD according to eGFR decline slope varies by the presence of hypertension

Abstract Background We reported that a declining slope in eGFR evaluated from 3-year observation could predict subsequent CKD among the relatively healthy population, even adjusted for baseline eGFR. However, its certainty may vary depending on the presence of comorbidities such as diabetes and hypertension, which are also recognized as the risk factors of CKD. Methods Annual health check-up data from a Japanese company spanning from 2009 to 2022 was used. The analyses included participants having 4 times continuous eGFR measurements for 3 years, undergoing health checkups at least once during a follow-up period, with negative for urinary protein (UP), and non-diabetic. Individual ‘eGFR slopes’ were calculated by the regression line with 4 times eGFR measurements. Participants with slopes of < -5 per year were categorized as the “decreased” group and -5 or more were categorized as the “stable” group. The cases of positive UP or less than 45mL/min/1.73m2 in eGFR during a follow-up period were defined as CKD. Cox regression analyses adjusted for sex, age, and eGFR at baseline were performed to calculate the hazard ratios and 95% CIs for CKD in the decreased group (reference; stable), stratified by hypertension. Results Out of 5598 study participants(men 36%, mean age 48.2±10.1years, mean follow-up period 4.3 years), 260 CKD cases (4.6%) were observed. CKD cases accounted for 4.5% (235/5218) in the stable group and 6.6% (25/380) in the decreased group. Multivariate-adjusted hazard ratios [95%CIs] of CKD by eGFR decline was 1.50[0.99-2.27]. The eGFR decline increased the risk of CKD only in participants with hypertension (2.09[1.09-4.04]), but not in those without hypertension (1.25[0.73-2.13]). After excluding individuals with eGFR slopes exceeding 10 per year to consider for hyperfiltration of eGFR, the results were consistent. Conclusions The eGFR decline over a 3-year observation may predict subsequent CKD only in individuals with hypertension. Key messages • With a relatively short-term evaluation period of three years, eGFR decline can predict subsequent CKD only in hypertensive individuals. • In middle-aged hypertensive patients, it would be important for the prevention of CKD to pay attention not only to low eGFR but also to the progression of eGFR decline.

Genetics in nephrology - any news?

While genetic kidney diseases were long regarded as a rare cause of kidney failure, it has been shown in recent years that they account for a relevant proportion of cases. In cohorts of kidney transplant recipients, a monogenic cause is found in up to 30% of cases. Identifying the genetic cause of kidney disease has become much easier thanks to technological advances in DNA sequencing. The focus has now shifted to understanding the significance of the findings and identifying diagnostic gaps. It is still not possible to clarify all CKD cases of unclear aetiology. Besides very effective generic treatments for monogenic kidney disease (e.g., ACE-inhibitor use in Alport Syndrome), increasing knowledge of the pathophysiology of genetic kidney diseases has led to a growing number of targeted therapies. These include the treatment of ADPKD with Tolvaptan, which has now been in use for 10 years. Recently, exciting, and completely new approaches have been added, such as the first siRNA therapies in nephrology for primary hyperoxaluria type 1, the targeted treatment of hyperphagia in Bardet-Biedl syndrome, the therapy of APOL1-associated kidney disease or the use of the HIF-2 antagonist Belzutifan for renal cell carcinoma associated with Von-Hippel-Lindau syndrome. The new possibilities in the treatment of patients with genetic kidney diseases have also clearly revealed deficits in current patient care. Centers of excellence with extensive experience in this area therefore play an important role in improving care. This also applies to the further training of colleagues in the field. In Germany, the National Action Alliance for People with Rare Diseases (NAMSE) and the nationwide establishment of - to date - 36 centers for rare diseases play an important role in this regard.

Low estimated glomerular filtration rate and proteinuria among adult diabetic patients in a tertiary hospital in Eastern Uganda - a cross-sectional study

BackgroundChronic kidney disease (CKD) is one of the most common complications of diabetes mellitus (DM). Diabetes mellitus contributes to about 66% of CKD cases globally. CKD results in increased morbidity and mortality and advanced stages often require kidney replacement therapy that is unaffordable for the majority of the patients. Developing countries have scanty data regarding CKD burden in diabetic patients.ObjectivesThis study aimed at determining the prevalence of low estimated glomerular filtration rate (eGFR) and proteinuria and associated clinical and socio-demographic factors among adult diabetic patients attending the diabetic clinic of Mbale Regional Referral Hospital (MRRH).MethodsA cross-sectional study was conducted at the adult diabetic clinic of MRRH in Eastern Uganda. A total of 374 adult diabetic patients were enrolled. A urine sample for urine albumin creatinine ratio (UACR) determination and a venous blood sample for measurement of serum creatinine were obtained from each participant. The eGFR was determined using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and CKD was staged according to the Kidney Disease Improving Global Outcomes (KDIGO) classification.ResultsA total of 318 (85%) participants had an eGFR of ≤ 60 mL/min/1.73m2, UACR of ≥ 30g/g, or both. Only 6.1% were aware. Age, duration of DM, hypertension, and dyslipidemia were associated with low eGFR and proteinuria.ConclusionThere is a high prevalence of low eGFR and proteinuria among DM patients, 85% of the participants had these markers of CKD and the majority of them were undiagnosed. Over half of the DM patients had an eGFR consistent with advanced CKD. Strengthening routine screening for CKD biomarkers and equipping DM clinics with more diagnostic resources is recommended.

Systematic Screening of Autosomal Dominant Tubulointerstitial Kidney Disease- MUC1 27dupC Pathogenic Variant through Exome Sequencing.

The MUC1 gene is associated with autosomal dominant tubulointerstitial kidney disease (ADTKD), leading to CKD. Current methods of sequencing, like exome sequencing, rarely detect MUC1 pathogenic variants because of the variable number of tandem repeats (VNTR) in MUC1 exon2. We demonstrated that combining fast read filtering with a sensitive VNTR genotyping strategy enables systematic screening of 27dupC pathogenic MUC1 variant from exome data. We initially validated our bioinformatics pipeline in a proof-of-concept cohort incorporating exome data from 33 participants with a known MUC1 pathogenic variant identified by Snapshot PCR and confirmed by 54 MUC1-negative individuals for negative control. We then retrospectively analyzed exome sequencing data from January 2019 to October 2023 from 3512 adult participants with nephropathy of unknown origin. Finally, we prospectively validated our pipeline in 825 additional participants enrolled from November 2023. SharkVNTyper accurately identified MUC1 variants in 32 out of 33 participants and excluded its presence in all the 54 negative controls in the proof-of-concept cohort (sensitivity of 97%, specificity of 100%). Integration of Shark tool with VNTyper significantly reduced running time from 6-12 hours to 5-10 minutes per sample, allowing both retrospective and prospective analysis. In the retrospective cohort, SharkVNTyper identified 23 additional positive cases that were not suspected clinically and had been missed in the initial exome analysis; 18 of these cases were confirmed as carrying the MUC1 27dupC mutation by low-throughput Snapshot PCR. In the prospective cohort of 825 CKD cases, systematic screening discovered 13 positive cases, with 12 confirmed by PCR. Overall, of 63 participants (1.4% of 4653) with molecularly confirmed ADTKD-MUC1, comprehensive diagnoses and descriptions of the disease were available for 24 participants. Median age of kidney failure was 50 years, 38% exhibited bilateral multiple kidney cysts, 8% had early-onset gout, and 58% had arterial hypertension. SharkVNTyper enables the analysis of highly repeated regions, such as the MUC1 VNTR, and facilitates the systematic screening of ADTKD-MUC1 from exome data, fostering 27dupC variation identification.

Implementation of Extreme Learning Machine Method with Particle Swarm Optimization to Classify of Chronic Kidney Disease

Kidney Disease (CKD) appears as a pathological condition due to infection of the kidneys and blockages due to the formation of kidney stones. In the Indonesian context, kidney disease is the second most common disease after heart disease based on BPJS Health data. Notably, in this scenario, medical practitioners and individuals with specialized knowledge in the field are still faced with challenges in effectively classifying CKD cases, thereby making them vulnerable to erroneous diagnostic conclusions. The main objective underlying this particular research effort revolves around increasing the level of accuracy that characterizes the CKD classification process by orchestrating the incorporation of Particle Swarm Optimization (PSO) techniques into the operational framework of Extreme Learning Machines (ELM) with the aim of ensuring optimal results. Configuration of input weights and critical biases to achieve superior diagnostic results. The results obtained from the investigation process include many numerical parameters including but not limited to determining the ideal number of hidden nodes set at 11, population size 80, identification of the most preferred number of iterations denoted by the Best value of 20, aggregate inertia weight assessed at 0.5, along with the constants 1 (c1) and 2 (c2) each registering a value of 1, culminating in the achievement of an accuracy metric pegged at an impressive level of 98.50%. Consequently, the implications obtained from this empirical investigation strengthen the assertion that the use of PSO optimization strategies within the operational framework of ELM has the potential to yield major advances in the classification evaluation domain related to CKD diagnosis.

Abstract MP67: Estimated Health Impact, Cost, and Cost-Effectiveness of Mandating Sodium Benchmarks in Australia’s Packaged Foods

Objectives: To estimate the potential health impact, cost, and cost-effectiveness of Australia mandating either A) the World Health Organization’s (WHO) global sodium benchmarks or B) the currently non-mandatory national sodium reformulation targets. Methods: We used a multiple cohort proportional multi-state life table model to simulate the impact of the interventions on the adult (≥ 20 years) population. We estimated sodium intake in the base case (i.e., maintaining current sodium intake) and intervention scenarios, using nationally representative data on dietary intake, sodium levels in packaged foods, and food sales volume. Blood pressure and disease burden data were obtained from the Global Burden of Disease study. The effect of sodium reduction on blood pressure and disease risk was modelled using evidence from meta-analyses of randomized trials and prospective studies. Net costs, including implementation and healthcare costs, were used to calculate the incremental cost per health-adjusted life year (HALY) gained. Outcomes were discounted at 3%. Results: Compared to the base case scenario, mandating the WHO benchmarks was projected to be cost saving over the first 25 years (99% probability), with 19K deaths (95% uncertainty interval [UI]: 11-28), 138K incident CVD events (95% UI: 81-200), and 100K new CKD cases (95% UI: 60-150) averted (Figure). The intervention could generate around 76K HALYs (95% UI: 44-110) and save $770 million (95% UI: 118-1,715) in healthcare costs. Mandating the less comprehensive and less stringent national targets could also be cost saving (97% probability), but with only about 1/3 of the health benefits of to the WHO benchmarks (Figure). Conclusions: Our findings support mandating sodium thresholds for packaged foods as a cost-effective strategy to prevent death and disease in Australia. Making Australia’s voluntary reformulation targets mandatory may save thousands of lives, but mandating the WHO global benchmarks could generate substantially larger health gains.

AHA Life's Essential 8 and new-onset CKD: a prospective cohort study from the UK Biobank.

The AHA has recently introduced a novel metric, Life's Essential 8, to assess cardiovascular health (CVH). Nevertheless, the association between varying levels of LE8 and the propensity for CKD is still unclear from a large prospective cohort. Our objective is to meticulously examine the relationship between LE8 and its associated susceptibilities to CKD. A total of 251,825 participants free of CKD from the UK Biobank were included. Cardiovascular health was scored using LE8 and categorized as low, moderate, and high. Cox proportional hazard models were employed to evaluate the associations of LE8 scores with new-onset CKD. The genetic risk score for CKD was calculated by a weighted method. Over a median follow-up of 12.8years, we meticulously documented 10,124 incident cases of CKD. Remarkably, an increased LE8 score correlated with a significant reduction of risk in new-onset CKD (high LE8 score vs. low LE8 score: HR = 0.300, 95% CI 0.270-0.330, p < 0.001; median LE8 score vs. low LE8 score: HR = 0.531, 95% CI 0.487-0.580, p < 0.001). This strong LE8-CKD association remained robust in extensive subgroup assessments and sensitivity analysis. Additionally, these noteworthy associations between LE8 scores and CKD remained unaffected by genetic predispositions to CKD. An elevated degree of CVH, as delineated by the discerning metric LE8, exhibited a pronounced and statistically significant correlation with a marked reduction in the likelihood of CKD occurrence.

Impact of a pharmacy-led screening and intervention in people at risk of or living with chronic kidney disease in a primary care setting: a cluster randomised trial protocol

IntroductionChronic kidney disease (CKD) is increasingly recognised as a growing global public health problem. Early detection and management can significantly reduce the loss of kidney function. The proposed trial aims...

A Nomogram for Predicting the Risk of CKD Based on Cardiometabolic Risk Factors.

In China, the spectrum of causes for CKD has been changing in recent years, and the proportion of CKD caused by cardiometabolic diseases, such as diabetes and hypertension continues to increase. Thus, predicting CKD based on cardiometabolic risk factors can to a large extent help identify those at increased risk and facilitate the prevention of CKD. In this study, we aimed to develop a nomogram for predicting CKD risk based on cardiometabolic risk factors. We developed a nomogram for predicting CKD risk by using a subcohort population of the 4C study, which was located in central China. The prediction model was designed by using a logistic regression model, and a backwards procedure based on the Akaike information criterion was applied for variable selection. The performance of the model was evaluated by the concordance index (C-index), and Hosmer‒Lemeshow goodness-of-fit test. The bootstrapping method was applied for internal validation. During the 3-years follow-up, 167 cases of CKD developed. By using univariate and multivariate logistic regression models, the following factors were identified as predictors in the nomogram: age, sex, HbA1c, baseline eGFR, low HDL-C levels, high TC levels and SBP. The bootstrap-corrected C-index for the model was 0.84, which indicated good discrimination ability. The Hosmer‒Lemeshow goodness-of-fit tests yielded chi-square of 13.61 (P=0.192), and the calibration curves demonstrated good consistency between the predicted and observed probabilities, which indicated satisfactory calibration ability. We developed a convenient and practicable nomogram for the 3‑year risk of incident CKD among a population in central China, which may help to identify high-risk individuals for CKD and contribute to the prevention of CKD.

1314-P: Adherence to Life’s Essential 8 and Incident Chronic Kidney Disease—A Prospective Study of 142,567 UK Biobank Participants

Background: The American Heart Association (AHA) recently updated an improved method for evaluating cardiovascular health (CVH): Life’s essential 8 (LE8). We aimed to investigate the association between levels of CVH and the risk of CKD in UK biobank. Methods: A total of 142,567 participants free of CKD and CVD were included. LE8 score at baseline was created including DASH diet, physical activity, smoking, sleep, BMI, non-HDL cholesterol, HbA1c, and BP. CVH levels were categorized as low, moderate, and high. Cox proportional hazard model was used to investigate the association between LE8 and CKD. Results: During a median follow-up of 11.8 years, 4,914 CKD cases were documented. We observed a linear dose-response relationship. Compared to participants with a low CVH, those with a moderate CVH were associated with a 35% lower risk of developing CKD (HR=0.65, 95% CI: 0.59, 0.73). Participants with a high CVH had a 48% lower risk of CKD incidence (HR=0.52, 95% CI: 0.45, 0.60) after adjustment for covariates. Additionally, the HR (95% CI) for each SD increment in behavior subscale score was 0.46 (0.39, 0.53) for CKD, and the HR (95% CI) for each SD increment in biological subscale score was 0.86 (0.76, 0.98) for CKD. Conclusion: Participants with high CVH, defined by LE8, were significantly associated with a lower risk of CKD. The burden of CKD may be reduced by promoting adherence to optimal CVH levels. Disclosure R.Tang: None. X.Wang: None. X.Li: None. H.Ma: None. Y.Heianza: None. L.Qi: None.

#2537 EPIDEMIOLOGY OF CHRONIC KIDNEY DISEASE IN THE REPUBLIC OF UZBEKISTAN

Abstract Background and Aims Chronic kidney disease (CKD) is an emerging global health problem, currently affecting up to 15% of the global adult population, and is independently associated with an increased risk of cardiovascular disease (CVD) similar to that of diabetes mellitus or coronary artery disease. heart [Reddy K.S., Shah B., Varghese S., Ramados A. 2005; 366: 1744-1749]. To assess the epidemiological characteristics of the development of CKD in the Republic of Uzbekistan (RUz) for 2020. Method The object of the study is the database of the Republican Specialized Scientific and Practical Medical Center for Nephrology and Kidney Transplantation of the Republic of Uzbekistan. Results According to the Institute of Health and Medical Statistics of the Ministry of Health of the Republic of Uzbekistan, the number of patients with end-stage renal disease (ESRD) decreased between 2011 and 2015. However, according to the data for 2020, the number of patients with stage 5 CKD reached 23,773 thousand and its increase is expected. The proportion of patients with chronic renal failure older than 18 years was registered 21,003 thousand in 2011 and 19,149 thousand in 2015, in those years there was a decrease. However, according to the national registry for 2020, CKD cases in the Republic of Uzbekistan, identified in all regions, amounted to 118026, there were 23773 patients with chronic renal failure receiving hemodialysis - 5149. The number of registered patients with CKD in the Autonomous Republic of Karakalpakstan was 9013, with CRF - 912, in need of hemodialysis - 115, receiving hemodialysis - 98, in need of transplantation - 21. In Andijan region, 416 persons were registered, with CRF - 201, in need of replacement therapy 137, receiving dialysis - 137, needing in transplantation - 11. In the Bukhara region, 4500 such patients were registered, CKD - 501, in need of substitution therapy - 172, receiving dialysis - 164 and in need of transplantation - 36. Conclusion With a general increase in the prevalence of CKD in the Republic of Uzbekistan in the dynamics of 2020, there is an improvement in the quality of diagnosing complications at earlier stages, at a later age and with a longer duration of CKD. Advances in the management of patients with CKD in recent years do not reduce the risk of end-stage chronic renal failure, but delay its development. Pronounced interregional differences in the frequency of registration of CKD in the database indicate problems in diagnosing CKD in a number of regions where the standard for examining patients with CKD with a mandatory assessment of glomerular filtration rate (GFR) and albuminuria at least once a year is not met.

#3118 ERECTILE DYSFUNCTION IS A HARBINGER OF CHRONIC KIDNEY DISEASE

Abstract Background and Aims Chronic kidney disease (CKD) shares similar cardiovascular risk factors with erectile dysfunction (ED). ED is an early warning sign for future cardiovascular events, however it is not yet known whether it also behaves as a harbinger of future CKD. Method We identified cases of ED and CKD using diagnostic codes from primary care records, hospital episode statistics, Death Register records, and self-reported diagnoses in a prospective cohort of 94,955 male participants of UK Biobank who had linkage to primary care records, from 01/01/2000 until 01/09/2017. We excluded participants with CKD diagnosed prior to this period as well as before the age of 35. We compared risk of CKD using cause-specific Cox proportional hazards models with competing risk of death, using age as time scale and adjusted for time-fixed covariates (birth cohort, ethnicity, body mass index [BMI], Townsend deprivation index [TDI], and smoking status) and time-dependent covariates (hypertension, diabetes mellitus, ischaemic heart disease, and ischaemic stroke/transient ischaemic attack). We imputed missing values for BMI, TDI, and smoking status (percentage missing ranging between 0.16-0.71%) using multiple imputation with predictive mean matching. As a sensitivity analysis, we repeated the analyses in a propensity score-matched cohort. Results Among 15,848 men diagnosed with ED, 830 developed CKD (71.9/10,000 person-years) median 5.9 years later (IQR 2.8-10.4), compared with 3,452 among 79,107 men without ED (39.6/10,000 person-years). Men with a diagnosis of ED had higher BMIs than men without (28.7 vs 27.7 kg/m2) and were more likely to have other diagnoses such as hypertension (38% at time of diagnosis of ED/56% at any time vs 40% at any time) and diabetes mellitus (21% at time of diagnosis of ED/30% at any time vs 12% at any time). A diagnosis of ED (without hypertension or diabetes mellitus) carried an increased risk of subsequent CKD (Figure 1), with an adjusted cause-specific hazard ratio of 1.53 (95% CI 1.33-1.77). There was significant interaction with hypertension (p&amp;lt;0.001), i.e. the increase in hazard of CKD by ED was smaller (adjusted hazard ratio 1.10, 95% CI 1.00-1.20), whereas there was no significant interaction with diabetes mellitus; i.e. men with a diagnosis of ED had a similar hazard ratio for CKD regardless of presence of diabetes mellitus (p = 0.33 for interaction). These results were numerically similar in a propensity score matched analysis. Conclusion Men who are diagnosed with ED are at a higher risk of developing CKD, independent of comorbidities such as diabetes mellitus. A diagnosis of ED should therefore prompt screening for CKD and its risk factors.

Multimorbidity in patients with monoclonal gammopathy of undetermined significance.

Monoclonal gammopathy of undetermined significance (MGUS), a precursor to multiple myeloma, is present in over 5% of adults aged 70 and older, a population with a high prevalence of multimorbidity. MGUS is often diagnosed incidentally when patients seek care for unrelated conditions. Our study sought to examine patterns of multimorbidity among MGUS patients, as overall health may impact patient care and the prioritization of MGUS surveillance. We examined patterns of comorbidities in 429 patients diagnosed with MGUS (2007-2015) and 1287 matched controls. Twenty-seven conditions were defined at diagnosis/index date using algorithms developed by the Centers for Medicare and Medicaid Chronic Conditions Warehouse. Patterns of common comorbidities were identified individually, in dyads and triads, and compared between MGUS cases and controls. We conducted a latent class analysis to identify comorbidity patterns among cases only. We also examined comorbidity patterns among a subset of 32 MGUS cases who progressed to cancer during the study period. The most common comorbidities among both MGUS cases and controls included hypertension and hyperlipidemia. Anemia (cases: 43%; controls: 16%) and chronic kidney disease (CKD; cases: 36%; controls: 18%), and dyads and triads containing those conditions, were more common among cases. Latent class analysis identified three classes of comorbidity among MGUS cases: hypertension-hyperlipidemia plus anemia and CKD (31%); low comorbidity burden (17%); and hypertension-hyperlipidemia alone (52%). The higher prevalence among cases of anemia and CKD, which may be involved in the pathogenesis of, or surveillance for, MGUS, warrants additional investigation.

A STUDY OF THYROID PROFILE AND FASTING LIPID PROFILE IN CHRONIC KIDNEY DISEASE

Background: Chronic kidney disease [CKD] is associated with specific abnormalities in the thyroid and lipoprotein metabolism both in the early and in the advanced stages of chronic renal failure. Regardless of age, heart disease is a major cause of morbidity and mortality among patients with renal failure.Our study aimed at to estimate thyroid profile and dyslipidemia in CKD patients on conservative management,on haemodialysisand to compare with healthy controls. Methods: This was a prospective study conducted among the 100 CKD patients and controls over 18 months admitted in the department of general medicine at our hospital. Results: Hundred CKD cases with 70 male and 30 female in a M: F ratio of 2.3:1 were found to be in different stages CKD (12, 29 and 59 in stage-3 to stage-5 respectively). In 59 cases of stage-5 CKD, 32 were on HD and 27 on conservative management. In each grade of CKD, the mean age, eGFR, urea, creatinine, thyroid profile, and lipid profile were computed individually. The levels of urea, creatinine, and eGFR differed significantly across CKD grades 3-5.The thyroid profile differed significantly across CKD grades 3-5. The lipid profile differed significantly across CKD grades 3-5, with p=0.000, &gt;0.05, 0.000, &gt;0.05, &gt;0.05 for total cholesterol, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL) levels, respectively. Conclusions: The number of patients increases with decreasing T3 and T4 and increasing TSH proportionate to the severity of the renal failure, hypothyroidism is becoming more common in people with chronic renal disease.All lipid abnormalities found in CKD on HD have reduced HDL levels in serum along with significant rise in serum triglyceride, serum cholesterol serum LDL level and serum VLDL level.Dyslipidemia in CKD worsened as patientsprogresssed to severe stages with significant increase in TG, TC, VLDLc and TC/HDLc confirming presence of atherogenic lipid profile needing early intervention to prevent cardiovascular complications.

Prevalence of and risk factors for chronic kidney disease in ten metropolitan areas of China: a cross-sectional study using three kidney damage markers

Introduction To estimate the up-to-date prevalence of chronic kidney disease among the health check-up population in economically developed areas of China using estimated glomerular filtration rate, urinary albumin creatinine ratio, and kidney ultrasound. Methods Healthcare data from 38,093 subjects in 10 megalopolises of China who had an annual health check-up in 2021 were used. The overall and stratified prevalence of chronic kidney disease by sex, age, region and comorbidity group was reported. The association between chronic kidney disease and covariates of demographics, and comorbidities were analyzed in the multivariable-adjusted logistic regression model. Results A total of 3837 CKD cases were detected meeting any of the three CKD diagnostic criteria, with a crude prevalence of 10.1% in the study population. Using one criterion of decreased glomerular filtration rate, albuminuria and kidney structural abnormalities alone detected 204 (5.3%), 3289 (85.7%) and 563 (14.7%) cases, respectively. The addition of kidney ultrasound detected 427 (11.1%) structural abnormality cases without decreased GFR and albuminuria. The most common abnormalities were renal masses, hydronephrosis due to obstruction and congenital anomalies of kidney and urinary tract. Female, older age, low city-tier, hypertension, diabetes, obesity, hypertriglyceridemia as well as early disease stages such as pre-hypertension, impaired fasting glucose and overweight were significantly associated with chronic kidney disease. Conclusion Kidney ultrasound helps to amplify the detection of CKD patients, which is a supplement to kidney function and urine protein.

Musculoskeletal Ultrasound Evaluates Renal Injury and Predicts Renal Outcome in Patients with Gout

Introduction: Kidney injury diagnosis is often delayed in patients with gout. We aimed to determine the characteristics of gout patients with CKD using musculoskeletal ultrasound (MSUS) and whether MSUS could be used as an auxiliary assessment to evaluate kidney injury and predict renal outcome in patients with gout. Methods: Clinical information, laboratory indicators, and MSUS findings were collected and compared between gout-only patients (gout – CKD) and gout patients with CKD (gout + CKD). Multivariate logistic regression was applied to identify risk factors for clinical and MSUS characteristics in both groups. Correlation analysis between MSUS signs and kidney-related indicators was performed, and the effects of MSUS characteristics on renal prognosis were evaluated. Results: In total, 176 patients with gout were included, namely, 89 gout – CKD and 87 gout + CKD cases. After adjusting for confounders, the gout patients with CKD showed more frequent episodes in the previous year, higher ultrasound semiquantitative scores, and more tophi than gout patients without CKD. Additionally, the number of tophi, bone erosion, and synovial hypertrophy measured by MSUS was found to be negatively correlated with the eGFR. The existence of tophi was independently associated with an increased risk of a ≥10% decline in eGFR in the first-year follow-up (OR, 3.56; 95% CI, 1.382–9.176). Conclusions: Ultrasound-detected tophi, bone erosion, and synovial hypertrophy were associated with kidney injury in gout patients. The existence of tophi was associated with faster renal function deterioration. MSUS could be a potential auxiliary diagnostic method to evaluate kidney injury and predict renal outcome in gout patients.

Acute and chronic kidney disease and risk of hospital mortality during COVID-19 pandemic waves in the pre-vaccination era.

Chronic kidney disease (CKD) is a risk factor for death from coronavirus disease 2019 (COVID-19), and COVID-19 may cause acute kidney injury (AKI) which also influences outcomes. There is little information on the independent contribution of CKD and AKI to the risk of death in COVID-19 on different waves, as CKD is a key risk factor for AKI. We have studied the epidemiology of CKD and AKI in 2878 patients hospitalized for COVID-19 and their independent association with in-hospital mortality in the two largest pre-vaccination COVID-19 waves in Madrid, Spain. Hospitalized COVID-19 patients were grouped into four mutually exclusive categories: previous-CKD, community-acquired AKI (CA-AKI), hospital-acquired AKI (HA-AKI) and normal renal function throughout hospitalization. Pre-existent or acquired kidney involvement was observed in 35.5% and 36.8% of COVID-19 patients in the 1st and 3rd waves, respectively. Overall, 13.9% of patients with normal kidney function on arrival developed HA-AKI. In the 3rd wave, CA-AKI was more common than in the 1st wave. Overall, 9%-20% of CKD cases and 22%-40% of AKI cases remained undiagnosed in the discharge report. CKD, CA-AKI and HA-AKI were independently associated with risk of death in multivariate analysis, with HA-AKI, which was usually mild, being the most relevant independent risk factor for in-hospital mortality. A model including kidney involvement category, age, Charlson index, admission lactate dehydrogenase and lymphocytes predicted death with a receiver operating characteristic area under the curve of 0.898. In conclusion, CKD and AKI were common in pre-vaccination waves among hospitalized COVID-19 patients and were independent risk factors for death, even when AKI was mild to moderate, and despite improvements in treatment.

Chronic kidney disease in cancer patients, the analysis of a large oncology database from Eastern Europe.

IntroductionKidney dysfunction is prevalent in oncology patients and has an impact on their treatment and quality of life. The aim of our study was to analyze the prevalence of CKD in a large cohort of several types of cancer patients in an East European Region.Material and methodsWe conducted an observational retrospective cohort study on 5831 consecutive, biopsy-diagnosed cancer patients between January 2019 –December 2020 in the largest oncology hospital and outpatient clinic in Western Romania. 4342 subjects were included in the statistical analysis.Results and discussionFrom the 24 cancer types, the most prevalent cancers were represented by: breast (22.02%), lung (10.18%) and colonic cancer (9.51%). The prevalence of CKD (G3 –G5) was 12.27% after the first year of follow-up and 13.42 after the second year. The prevalence of CKD was higher in patients with renal (50%), urinary tract (33.6%) and pancreatic cancers (19.6%) and lower in patients with colonic cancers (5.3%) and brain tumors (2.5%). At the end of our 2-year survey period, 0,7% of the CKD cases had an eGFR around 6 ml/min/1.73m2 –an indication for renal replacement therapy.ConclusionOncology patients have a significantly higher prevalence of CKD compared to the general population, dependent of the age of the patients and the type of cancer. The prevalence of advanced CKD was surprisingly high (stages G4-G5 Pre-Dialysis 22.15%) one third of the CKD- G5 patients having indication for initiation of renal replacement therapy. An onco- nephrology team should be needed for the best medical care of these patients.

Nationwide study of sudden cardiac death in young persons diagnosed with chronic kidney disease

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): This work was supported by Novo Nordisk Foundation, Copenhagen, Denmark. Background Chronic kidney disease (CKD) is associated with increased risk of cardiovascular morbidity and mortality. The increased cardiovascular mortality is partly explained by an increased risk of sudden cardiac death (SCD) among patients with CKD. Purpose The purpose of this study was to compare short- and long-term risk of SCD in individuals with and without CKD aged 18-49 years. Methods &amp; Results Using the Danish nationwide health registries, all persons aged 18-49 years diagnosed with non-failure stage CKD or kidney failure from 1st of July 1995 through 2009 were identified. Non-exposed subjects matched on sex and birth-year were included 50:1. All SCD in the Danish population aged 18-49 years in 2000-2009 have previously been identified by thoroughly examining the Danish Registries, the Danish death certificates, autopsy reports and discharge summaries. In total, 9,476 incident cases of non-failure stage CKD and 1,283 incident cases of kidney failure were included. For patients with non-failure stage CKD and kidney failure, the absolute risk of all-cause mortality 10-year after diagnosis was 8.7% and 23.6%, respectively. Among patients with non-failure stage CKD, the absolute risk of SCD 1, 5 and 10 years after diagnosis was 0.14%, 0.37%, and 0.68%, respectively. Compared with age- and sex matched subjects the corresponding relative risk was 20 (95%-CI 8.4-48.8), 7.1 (95%-CI 4.2-12.0), and 6.1 (95%-CI 3.8-9.7), respectively. Among patients with kidney failure, the absolute 1, 5, and 10 year risk of SCD was 0.17%, 0.56% and 2.07%, respectively. The corresponding relative risk was 12.5 (95%-CI 1.4-111.6), 7.9 (95%-CI 2.3-27.0) and 10.1 (95%-CI 4.5-22.6), respectively. Conclusions Persons with non-failure stage CKD and kidney failure had increased risk of SCD compared with the background population with a 20- and 13-fold increased risk one year after diagnosis, respectively. These findings underline the importance of early cardiovascular risk monitoring and assessment in persons with CKD.