Adult Chronic Disease Research Articles

Emerging roles of frailty and inflammaging in risk assessment of age-related chronic diseases in older adults: the intersection between aging biology and personalized medicine

Emerging roles of frailty and inflammaging in risk assessment of age-related chronic diseases in older adults: the intersection between aging biology and personalized medicine

Use of Disinfectants and Cleaning Products Associated with Respiratory Disease: A Scoping Review

Introduction: there is extensive evidence on the harmful respiratory effects of exposure to disinfectants and cleaning products. Methodology: an exploratory systematic review was carried out in five databases: LILACS, PubMed, MEDLINE and BIREME. Twenty articles from 2013 to 2024 were selected for the present review. Results: chemical compounds present in some disinfectants and cleaning products such as Polyhexamethylene guanidine (PHMG) and Chloromethylisothiazolinone/Methylisothiazolinone (CMIT/MIT) influence the development of Humidifier Respiratory Distress Syndrome (HDRS) and increased incidence of asthma and Chronic Obstructive Pulmonary Disease (COPD) in adults. Conclusions: There is a relationship between exposure to chemical compounds in certain disinfectants and lung health impairment. It is imperative to increase the general population’s awareness of the effects of these substances will lead to improved self-care in those who are in daily contact with these elements.

Research progress on epigenetic mechanism of reproductive disorders

The "Developmental Origins of Health and Disease, DOHaD" theory suggests that adverse factors in early life can lead to the occurrence of chronic diseases in adulthood. In recent years, it has been discovered that maternal factors, intrauterine development environment and environmental exposure during pregnancy can mediate the changes of early egg/embryo development, promote the occurrence of reproductive disorders such as polycystic ovary syndrome, diminished ovarian reserve, and endometriosis, and induce intergenerational genetic effects. This article has reviewed the progress of research on maternal factors which may affect the pathogenesis of reproductive disorders, and expounds its mechanism from the perspectives of epigenetic mechanisms such as DNA methylation, histone modification and non-coding small RNA (miRNA) modification, with an aim to provide insights for studying the occurrence of adult reproductive disorders in early life and before pregnancy.

Adverse childhood experiences and diet quality in the national sample of poles: The mediating role of emotion regulation

Adverse childhood experiences (ACEs) increase the risk of adverse psychological and physical outcomes and chronic disease in adulthood. The mechanism of this relationship is still unclear. ACEs might exert their negative influence on adult health via both dietary and psychological axes. Our study aimed to examine the relationship between ACEs and diet quality in the national sample of Poles. We also aimed to determine whether difficulty in regulating emotions act as a mediator of this relationship. The national Polish sample of adults (n = 3557) took part in this study. ACEs were assessed via the Adverse Childhood Experiences Questionnaire. Data on food consumption frequency over the past year, body weight and height were collected using the self-administered version of the Dietary Habits and Nutrition Beliefs Questionnaire (KomPAN®). Two diet quality scores were evaluated: Pro-Healthy-Diet-Index-10 (pHDI) and Non-Healthy-Diet-Index-14 (nHDI). Emotion regulation (ER) was evaluated via the Difficulties in Emotion Regulation Scale (DERS). Path analysis was used to examine the associations between the variables, firstly formulated by theoretical assumptions expressed by directed acyclic graphs (DAGs). A higher number of ACEs was related to higher difficulties in ER in adults (p < 0.001), which in turn was related to lower pHDI (p < 0.001) and higher nHDI (p = 0.027). Our findings strengthen the rationale for ACEs screening as a potential risk factor for diet-related chronic disease in adulthood. They provide a framework for public health prevention strategies via interventions targeting diet quality and emotional regulation in the setting of multidisciplinary practice.

Mapping the 9-year sleep trajectory and its implications for chronic disease risks among middle-aged and older adults

ObjectiveTo identify the 9-year trajectories of sleep duration and to assess the relationship between time-dependent sleep duration and sleep trajectories with 14 chronic diseases in adults. MethodsThis study used five waves of data of the China Health and Retirement Longitudinal Survey. Participants with complete sleep duration data and at least one record of 14 chronic diseases were included. The group-based trajectory model was used to identify sleep trajectories from 2011 to 2020. Time-dependent survival analysis and logistic regression were used to examine the relationship between time-dependent sleep duration and sleep trajectories with chronic diseases. ResultsA total of 9063 participants were included, with a mean (standard deviation, SD) sleep duration of 6.37 (1.83) h/d. Sleeping <7 h/d predicted higher risks of 11 chronic diseases at follow-up, with hazard ratios (HR) and 95 % confidence intervals (CI) ranging from 1.71 (1.26–2.33) for psychiatric disease to 1.15 (1.04–1.27) for dyslipidemia. Five sleep trajectories were identified and labeled as group 1–5 based on ascending order of sleep duration. Consistently sleeping <4 h/d (group 1) and 4–6 h/d predicted higher risks of most chronic diseases, with the highest HR (95 %CI) of 3.50 (1.73–6.92) and 2.94 (1.82–4.49) for psychiatric diseases, respectively. Consistently sleeping 6–7 h/d (group 3) predicted higher risks of digestive diseases and arthritis. Decreasing sleep (group 4) predicted higher risks of psychiatric diseases and memory-related diseases. ConclusionsConsistently sleeping <6 h/d predicted higher risks of most chronic diseases, especially psychiatric diseases. Digestive disease and arthritis were more sensitive to consistently inadequate sleep.

Health literacy of pregnant women in Hungary

Abstract Health literacy determines our state of health and through this our quality of life. The health behavior of women of reproductive age should be treated with priority, since the lifestyle of pregnant women shows a correlation with the occurrence of premature birth and intrauterine development, and also between fetal development and the occurrence of chronic diseases in adulthood. The aim of our research is to explore the factors influencing the health behavior of pregnant women, to analyze regional differences, and to identify the causes of regional differences and inequalities. During a prospective, cross-sectional study, the health behavior of pregnant women living in Hungary was assessed using a questionnaire. In the course of our research, we examined health literacy using two measuring instruments, the Chew questionnaire and The Newest Vital Sign test. A total of 2,000 questionnaires were distributed of which 1,655 evaluable questionnaires were returned, the willingness to answer was 75%. The most people considered their own health to be good or very good (59.7%). 59.5% of the respondents changed their health behavior because of their pregnancy, mainly for the sake of the health of the fetus. 18.1% of pregnant women most likely have insufficient, 15.0% probably limited and 48.1% most likely have adequate functional health literacy. Age, education, place of residence and financial situation of pregnant women show a significant correlation with health literacy. Our results confirmed that sociodemographic factors, especially age and education, significantly influence the health literacy, perceived health status and health behavior of pregnant women. The two health literacy questionnaires we use can be combined well with each other and complement each other. The results greatly contribute to the development of health literacy, and thus to the development of individual and community-level strategies for improving health behavior in the field of pregnant women’s care. Key messages • Health literacy of pregnant women in Hungary. • Health literacy in health promotion.

Increasing trends in hypertension-related mortality in European Union 27 countries from 2011 to 2019

Abstract Background Arterial Hypertension (HT) is one of the most common chronic cardiovascular disease in adults and a leading cause of disability and mortality worldwide. However, update data regarding the HT-related mortality trends in Europe are lacking. Therefore, we assess the age- and sex- specific trends in HT-related mortality in the 27 European Union Member States (EU-27) between years 2011 and 2029. Methods Data were retrieved from the free publicly available EUROSTAT death certificate database to examine age-adjusted HT-related mortality rates (AAMR) (per 100.000 people) and relative average annual percentage change (AAPC) across all European Union 27 countries (EU27) from 2011 to 2019 using the International Classification of diseases, Tenth Revision (ICD-10) codes I10-I13 and I15. To calculate annual trends in HT-related mortality, we assessed the average annual percent change (AAPC) and relative 95% confidence intervals (CIs) using Joinpoint regression analysis. Results Over the study period, 254.540 HT-related deaths (157,081 males) were listed in EU27. Age-adjusted HT-related death increased from 9.12 to 10.7 per 100,000 people [AAPC: +1.5% (95% CI: 0.8-2.0), p&amp;lt;0.001]. Specifically, the HT-related mortality increased in males [AAPC: +1.8 (95% CI: 0.9-2.6) while decreased in women [AAPC: -1.1 (95% CI: -2.0 to 0.2), p=0.001]. Additionally, the HT-related mortality rates increased in northern [+1.5 (95% CI: 0.7 to 2.3), p&amp;lt;0.001] and eastern [AAPC: +3.9 (95% CI: 2.3 to 5.4), p&amp;lt;0.001] EU-27 states. Conversely, the AAMR plateaued in southern [AAPC: -0.1 (95% ci: 0.6 to 0.7), p=0.96)] and western EU-27 countries [AAPC: 1.0 (95% CI: -0.1 to 2.1, p=0.07] over the same period. Conclusions In EU27, HT-related mortality increased from 2011 to 2019, especially in men. However, significant disparities in HT-related mortality rates still exist between different European regions.

Dose–Response Relationship Between Serum 25(OH)D and the Risk of Abnormal Glycemic Status in Chinese Older Adults

Background/Objectives: The relationship between serum 25-hydroxyvitaminD (25(OH)D) concentration and the risk of abnormal glycemic status remains contradictory. Whether sufficient 25(OH)D plays a role in reducing the risk of diabetes and prediabetes is debatable. Its dose–response relationship and the optimal 25(OH)D threshold are not clear. This study investigated the relationship between serum 25(OH)D and the risk of abnormal glycemic status to explore the optimal cut-off value. Methods: This study included 5856 Chinese older adults aged 60 years and above from the China Adult Chronic Disease and Nutrition Survey (CACDNS 2015–2017). Serum 25(OH)D concentration was measured via an enzyme-linked immuosorbent assay. Abnormal glycemic status in the present study includes diabetes and prediabetes. Statistical methods such as a locally weighted regression and smoothing scatterplot (LOESS), restricted cubic spline regression (RCS) and binary and trend logistic regression were used to explore the dose–response relationship and the optimal 25(OH)D threshold. Results: The concentration of 25(OH)D was nonlinearly related to the levels of FPG and HbA1C in the LOESS curves. The nonlinear relation between 25(OH)D and the risk of diabetes and prediabetes was illustrated in the RCS curves and the optimal 25(OH)D threshold beneficial for diabetes was preliminarily explored to be 29.06 ng/mL, but no threshold for prediabetes was found. The dose–response results showed that for each 1 ng/mL increase in 25(OH)D, the risk of the fasting glucose type of diabetes reduced by 2.1%, the risk of the abnormal HbA1C type of diabetes reduced by 2.2% and the risk of the mixed type of diabetes reduced by 1.7%, whereas a dose–response relationship was not found for prediabetes. Conclusions: Higher serum 25(OH)D concentrations in Chinese older adults were associated with a reduced risk of glycemic abnormalities. The optimal 25(OH)D cut-off value was sufficiently beneficial if the diseased diabetes risk was 29.06 ng/mL, but no threshold was found for prediabetes.

Perceptions of the 2D short animated videos for literacy against chronic diseases among adults with diabetes and/or hypertension: a qualitative study in primary care clinics.

Animation has promise for teaching complex health content through smartphone applications. However, smartphones have had limited use in Thailand for health literacy improvement among adults with chronic diseases. This study aims to explore the perceptions of adults with diabetes and/or hypertension resulting from 2D short animated videos for literacy against chronic disease that are available via smartphones. Four animated videos were initially developed based on clinical practice guidelines and nursing experience. Physicians, an expert in health education, and an animation team developed and revised scripts and storyboards of the animated videos. Lastly, videos were validated by physicians and health educators for content breadth and depth and by media experts for motion graphics and illustration. Each video presents a different situation in diabetes, hypertension, missing appointments, and obesity, ranging from 2.18 to 4.14min in duration. The inclusion criteria were adults 35-70 years old with diabetes or hypertension who received care from primary care units. Thematic analysis was performed on the extracted data. Twenty participants with a mean age of 58.4 years (SD 6.7; ranged 41-68) were focus-group interviewed. Three animation elements were assessed, including presentation, impacts, and suggestions. Participants had positive responses regarding the presentation (suitability of images and smooth motion graphics, short length of videos, simple language, understandable content, and clear sound) and impacts (recalling information, enhancing engagement, and motivating health awareness and behavior change). Suggested improvements were for a bigger font size for subtitles and considering the use of spoken text instead of on-screen text for recommendations at the end of the animations. Animated videos are acceptable for delivering health information. Pilot testing animated videos for promoting literacy against chronic diseases in adults with diabetes and hypertension is needed for optimal utility.

Association between dietary fiber intake and chronic kidney disease in adults with and without hypertension in the United States: a cross-sectional study of NHANES 2009–2020

While previous research has highlighted the potential advantages of increasing dietary fiber intake (DFI) for managing hypertension and chronic kidney disease (CKD), there is a gap in large-scale empirical studies examining the relationship between DFI and CKD among hypertensive and nonhypertensive cohorts independently. This study involved 22,871 participants sourced from the NHANES database spanning 2009 to 2020, who were divided into hypertensive (n = 9,861) and nonhypertensive (n = 13,010) groups. The analysis revealed a significant inverse correlation between DFI and CKD prevalence across the sample after adjusting for various covariates (OR = 0.98, 95% CI: 0.97–0.99, p = 0.001). Within the subset of hypertensive individuals, this inverse association mirrors the findings of the overall sample, indicating that a higher DFI was associated with a reduced occurrence of CKD (OR = 0.97, 95% CI: 0.96–0.99, p < 0.001). However, this correlation was not detected in the nonhypertensive group (OR = 0.99, 95% CI: 0.98–1.01, p = 0.285). The RCS analysis further confirmed a pronounced nonlinear inverse relationship between DFI and CKD prevalence in both the entire cohort and the hypertensive group but not in the nonhypertensive group. Further scrutiny of the hypertensive group revealed that individuals with a higher DFI had 33% lower odds of CKD progression for the moderate risk level and 36% lower odds for the high to very high risk level. Subgroup analyses confirmed the consistency of these relationships across various demographics. In summary, this investigation revealed a significant inverse relationship between DFI and CKD prevalence in US adults with hypertension, a relationship not observed in nonhypertensive individuals.

Impact of renal impairment on the pharmacokinetic profile of intravenous difelikefalin, a kappa opioid receptor agonist for the treatment of pruritus

BackgroundDifelikefalin is a selective kappa opioid receptor agonist that is approved for the treatment of moderate-to-severe pruritus associated with chronic kidney disease in adults undergoing hemodialysis (HD). In this study, we assessed the pharmacokinetics (PK) of intravenous (IV) difelikefalin in healthy subjects, in non–dialysis-dependent (NDD) subjects with varying stages of kidney disease, and in subjects with end-stage renal disease (ESRD) undergoing HD.MethodsThe PK and safety of single IV doses of difelikefalin (3.0 mcg/kg) were initially evaluated in NDD subjects with mild, moderate, or severe renal impairment compared with matched healthy subjects. Based on those data, the PK and safety of 3 dose levels of IV difelikefalin (0.5, 1.0, or 2.5 mcg/kg) were compared with matched placebo in subjects undergoing HD with each dose administered following dialysis, 3 times over a 1-week treatment period).ResultsSingle IV dosing of difelikefalin in NDD subjects (N = 36) with mild renal impairment demonstrated comparable exposure to healthy subjects with normal renal function, while subjects with moderate or severe renal impairment had higher total exposure. NDD subjects with severe renal impairment had higher total exposure compared with those with moderate renal impairment (i.e., exposure in severe NDD > moderate NDD > mild NDD ≈ healthy subjects). Clearance of difelikefalin correspondingly decreased with increasing renal impairment. In the multiple-dose study in subjects with ESRD undergoing HD (N = 19), IV difelikefalin demonstrated dose proportionality and was shown to be mostly cleared by dialysis; steady state was achieved with the second dose on day 3. Safety findings for all subjects were consistent with the known profile of IV difelikefalin.ConclusionsIV difelikefalin was well tolerated. Similar exposure was observed in NDD subjects with mild renal impairment compared with healthy subjects with normal renal function, with reduced clearance and higher exposure in NDD subjects with moderate or severe renal impairment. Dose proportionality was demonstrated in subjects with ESRD undergoing HD administered IV difelikefalin 3 times per week following dialysis and was shown to be mostly cleared by dialysis.Trial registrationSingle-dose study: NA; multiple-dose study: ClinicalTrials.gov registration number NCT02229929, first registration 03/09/2014.

Association Between Triglyceride Glucose Index and Chronic Kidney Disease in Normal-Weight Chinese Adults With Hypertension.

This study aimed to examine the association between the triglyceride-glucose (TyG) index and chronic kidney disease (CKD) in normotensive adults with hypertension and further investigate potential effect modifiers of this association. A total of 7975 normoweight hypertensive participants were enrolled from the Chinese H-type hypertension registry (CHHRS) cohort. The TyG index was calculated using the formula: ln (fasting triglyceride [mg/dL] × fasting plasma glucose [mg/dL])/2. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60mL/min/1.73 m2 of body surface area. Multivariate logistic regression analysis revealed a 50% increased risk of CKD (OR: 1.50, 95% CI: 1.26-1.79) for each unit increase in the TyG index. A linear dose-response relationship between the TyG index and CKD risk was observed using restricted cubic spline analysis. Compared to the first quartile of the TyG index, the fourth quartile showed a significantly higher risk of CKD (OR: 1.88; 95% CI: 1.41-2.50). Subgroup analysis identified a stronger association between the TyG index and CKD risk in males and individuals with a history of alcohol consumption (all p values for interaction < 0.05). In conclusions, the TyG index was significantly associated with an increased risk of CKD in normoweight adults with hypertension, particularly in males and those with a history of alcohol consumption.

Difficult-to-Treat Axial Spondyloarthritis: A New Challenge.

Axial spondyloarthritis is a common form of chronic inflammatory rheumatic disease in adults, the treatment of which is based on non-pharmacological elements on the one hand, and pharmacological options on the other, such as non-steroidal anti-inflammatory drugs in the first line, followed by biological or targeted synthetic treatments. The therapeutic objective is remission or a low level of disease activity; if this objective is not achieved, the treatment is rotated or changed. Multiple changes is one factor illustrating the inability to achieve disease control and may lead to the notion of a difficult-to-treat disease (D2T). This requires a consensual definition including, beyond the number or therapeutic changes, the assessment of all the dimensions of the disease (objective signs of inflammation, residual pain, degenerative changes, psychosocial context). Recognising D2T patients will enable us to identify a particular population and the factors associated with this condition. When faced with a D2T disease, we need to analyse the causes of treatment failure and take into account the different components of the disease and the patient. In the absence of any prospect of new therapeutic targets in the short term for this disease, patient management may involve intensification of non-pharmacological means and evaluation of new therapeutic strategies such as combinations of targeted treatments.

Importance of Parental Consanguinity and Family History of Kidney Disease in the Turkish Adult Chronic Kidney Disease Population: An Epidemiologic Study

Importance of Parental Consanguinity and Family History of Kidney Disease in the Turkish Adult Chronic Kidney Disease Population: An Epidemiologic Study

Association of depressive symptoms and incident chronic kidney disease in middle-aged and older adults

BackgroundEmerging evidence suggests that depressive symptoms may be a risk factor for the development of Chronic kidney disease (CKD). This study aimed to investigate the association between depressive symptoms and the incidence of CKD in middle-aged and older Chinese adults. MethodsWe utilized data from the 2011–2020 China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D). Incident CKD was defined based on the estimated glomerular filtration rate ≤ 60 mL/min/m2 or self-reported. Cox proportional hazard models were used to estimate the hazard ratio (HR) and 95 % confidence intervals (95 % CI) for incident CKD, adjusting for potential confounders. ResultsAmong the 10,996 participants without baseline CKD, 890 developed CKD during a median follow-up of 9.0 years. After adjusting for potential covariates, participants with depressive symptoms had a significantly higher risk of developing CKD compared to those without depressive symptoms (HR: 1.450; 95 % CI: 1.249–1.682). The association remained statistically significant when the CES-D was scored according to the severity of depressive symptoms, i.e., quintiles. A linear positive association between total CES-D score and risk of incident CKD was also found using restricted cubic spline regression (Pfor non-linearity = 0.114). ConclusionsDepressive symptoms are significantly associated with an increased risk of incident CKD in middle-aged and older Chinese adults. These findings underscore the importance of mental health screening and interventions in preventing CKD in this population.

한국 비당뇨 성인의 신체계측지수, 혈중 지방성분과 당화혈색소 수치 간 상관관계 연구

Diabetes mellitus is a chronic adult disease whose prevalence increases with age, with a high prevalence of 30% in people in their 70s, leading to fatal complications. Risk factors for diabetes include weight, waist circumference, BMI, weight-corrected waist circumference index (WWI), and cholesterol and triglyceride levels, which are blood fat levels. In this study, using data from the South Korean 8th National Health and Nutrition Examination Survey, the average values of these risk factors by age group were investigated for men and women among 4,497 adults over 30 years of age without diabetes. In addition, the Pearson correlation coefficient and significance probability between the glycated hemoglobin level and each risk factor were calculated in all subjects. The investigation of average weight and waist circumference by age group showed that men's weight decreased with age and waist circumference remained constant, while women's weight decreased and waist circumference increased with age. Cholesterol levels increased and then decreased with age, showing the highest values in men in their 40s and women in their 50s. In the 40s, triglyceride levels were highest in men, and the difference between men and women was greatest. However, in men, it decreased with age, and vice versa in women, so it showed almost no difference at 70 and older. The correlation between the risk factors of the anthropometric indices and the glycated hemoglobin level was highest for WWI, with a correlation coefficient of 0.333. The correlation was in the following order from high: WWI &gt; waist circumference &gt; BMI &gt; weight. The blood triglyceride level had a correlation coefficient of 0.121 with the glycated hemoglobin level, which was twice as large as the correlation coefficient with cholesterol of 0.600. All risk factors strongly correlated with the glycated hemoglobin level, with a significance probability below 10-6.

Brain activation in older adults with hypertension and normotension during standing balance task: an fNIRS study.

Hypertension (HT) is a common chronic disease in older adults. It not only leads to dizziness and other symptoms affecting balance in older adults with HT but also affects the hemodynamics of the cerebral cortex. At present, potential neural mechanisms of balance control in older adults with HT are still unclear. Therefore, this study aimed to explore the differences in the center of pressure (COP) and cerebral cortex activation between older adults with HT and normotension (NT) during standing balance tasks. This study May provide guidance for the early detection of the risk of falls among older adults with HT and the development of clinical rehabilitation strategies. In this cross-sectional study, 30 older adults with NT (NT group) and 27 older adults with HT (HT group) were subjected to three conditions: task 1, standing with eyes open on a stable surface; task 2, standing with eyes closed on a stable surface; and task 3, standing with eyes open on the surface of the foam pad. Cortical hemodynamic reactions were measured using functional near-infrared spectroscopy, and COP parameters were measured using a force plate. The mean velocity of the COP in the medial-lateral direction in the NT group was significantly higher than that in the HT group (F = 5.955, p = 0.018) during task 3. When proprioception was disturbed, the activation of the left premotor cortex and supplementary motor cortex in the HT group was significantly lower than that in the NT group (F = 14.381, p < 0.001). The standing balance function of older adults with HT does not appear to be worse based on COP parameters than those of older adults with NT. This study revealed that the changes in the central cortex related to standing balance appear to be more indicative of balance control deficits in older adults with HT than changes in peripheral COP parameters, suggesting the importance of the early evaluation of cortical activation in older adults with HT at risk of falls.

KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease in Children and Adults: a commentary from the European Renal Best Practice (ERBP)

ABSTRACT The Kidney Disease: Improving Global Outcomes (KDIGO) 2024 Guideline for Identification and Management of Chronic Kidney Disease (CKD) is a welcome development, coming 12 years after the paradigm-changing 2012 guidelines. We are living in an unprecedented era in nephrology with novel therapies, including sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists and non-steroidal mineralocorticoid receptor antagonists, now being proven in multiple randomized controlled clinical trials to reduce both the progression of CKD and cardiovascular morbidity and mortality. The KDIGO 2024 CKD Guideline is aimed at a broad audience looking after children and adults with CKD and provide practical and actionable steps to improve care. This commentary reviews the guideline sections pertaining to the evaluation and risk assessment of individuals with CKD from a European perspective. We feel that despite the last guideline being published 12 years ago, and the fact that the assessment of CKD has been emphasized by many other national/international nephrology, cardiology and diabetology guidelines and societies, the diagnosis and treatment of CKD remains poor across Europe. As such, the KDIGO 2024 CKD Guideline should be seen as an urgent call to action to improve diagnosis and care of children and adults with CKD across Europe. We know what we need to do. We now need to get on and do it.

Retinal nerve fiber layer defects and chronic kidney disease: the Kailuan Eye Study.

To investigate whether retinal nerve fiber layer defects (RNFLDs) is a potential risk factor for chronic kidney disease (CKD) in Chinese adults. The Kailuan Eye Study was a population-based study that included 14 440 participants. All participants underwent detailed assessments, RNFLDs were diagnosed using color fundus photographs. Overall, 12 507 participants [8533 males (68.23%)] had complete systemic examination data and at least one evaluable fundus photograph. RNFLDs were found in 621 participants [5.0%; 95% confidence interval (CI): 4.6%-5.34%], and 70 cases of multiple RNFLDs were found (11.27%). After adjusting multiple factors, RNFLDs was significantly associated with CKD severity, the ORs of CKD stage 3, stage 4 and stage 5 were 1.698, 4.167, and 9.512, respectively. Multiple RNFLDs were also associated with CKD severity after adjusting multiple factors, the ORs of CKD stage 3 and stage 5 were 4.465 and 11.833 respectively. Furthermore, 2294 participants had CKD (18.34%, 95%CI: 17.68%-18.99%). After adjusting for other factors, CKD presence was significantly correlated with the presence of RNFLDs. The strongest risk factors for RNFLDs are CKD and hypertension. Conversely, RNFLDs can be an ocular feature in patients with CKD. Fundoscopy can help detect systemic diseases, and assessment for RNFLDs should be considered in CKD patients.

Global burden of chronic kidney disease in adolescents and young adults, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019.

The global status of chronic kidney disease (CKD) is underestimated, particularly the burden on adolescents and young adults (early-onset, aged 15-39). We aim to investigate the pattern and trend of early-onset CKD from 1990 to 2019. We analyzed age-specific rates of early-onset CKD incidence, death, and disability-adjusted life years (DALY) using Global Burden of Disease Study 2019 data. We examined the global, regional, national, gender-based, age group-based, and temporal changes of early-onset CKD burden from 1990 to 2019, as well as proportional DALY attributions of various risk factors. From 1990 to 2019, the global age-specific incidence rate (per 100,000 population) significantly increased from 25.04 (95% confidence interval 18.51, 31.65) to 32.21 (23.73, 40.81) for early-onset CKD. However, the global age-specific death rate significantly decreased from 2.96 (2.76, 3.15) to 2.86 (2.61, 3.11), and the age-specific DALY rate remained stable. Regarding sociodemographic indexes (SDI), countries with middle SDI had the highest incidence rates and the fastest increasing trends, while those with low and low-middle SDI experienced the highest death and DALY rates. Women had a generally higher age-specific incidence rate than men, whereas men showed higher age-specific death and DALY rates. In addition, the burdens of CKD increased with age among adolescents and young adults. Moreover, the main attributable risk factors for DALY of early-onset CKD were high systolic blood pressure (SBP), fasting plasma glucose (FPG), and body mass index (BMI). The age-specific incidence rate of early-onset CKD increased significantly from 1990 to 2019, and the age-specific DALY rate remained stable. High SBP, high FPG, and high BMI were the primary risk factors. Targeted prevention and healthcare measures should be developed considering age, gender, and region.