Cases Of Chronic Kidney Disease Research Articles

Bilirubin not just a routine parameter plays an important role in chronic kidney disease

Background: Chronic kidney disease (CKD) is a major health burden in India as well as throughout the world. Imbalance between antioxidant defense and oxidative stress plays a major role in this multifactorial disorder. Recent studies have shown that serum total bilirubin plays an important role in the progression of CKD. Aims and Objectives: The aim of the study is to estimate serum total bilirubin, estimated glomerular filtration rate (eGFR), urea, creatinine and to find out whether there is correlation between serum total bilirubin, eGFR, and different stages of CKD. Materials and Methods: The study is conducted in the department of biochemistry after getting ethical clearance. Two hundred and sixty-nine samples of controls and cases of CKD collected. Serum total bilirubin, urea, and creatinine were calculated in autoanalyzer using standard protocol. eGFR is calculated using a standard formula. Results: There is a significant positive correlation (spearman’s correlation r=0.196, P=0.001) between serum total bilirubin and eGFR value. There is also a significant negative correlation (r=−0.239, P<0.0001) between serum total bilirubin and stages of CKD. Median value of serum urea is also high in cases compared to control. Conclusion: The serum bilirubin may be an important biomarker in the pathogenesis of CKD.

Upper Gastrointestinal Bleeding in Patients with Chronic Renal Failure: What are the Particularities?

Introduction: Upper Gastrointestinal bleeding (UGIB) is a major cause of mortality in patients with renal failure. The aim of our study is to determine the epidemiological, lesional and prognostic profile of UGIB in chronic kidney disease (CKD) patients. Materials and Methods: This was a single-center study conducted from September 2017 to August 2023, including all patients with CKD admitted to the emergency department for upper GI bleeding who underwent Esogastroduodenoscopy (EGD). The various data were collected from endoscopy registries. Results: Of 662 patients admitted via the emergency department for UGIB, 59 cases of CKD (8.9%) were included, of which 43 cases were at the hemodialysis stage (72.88%). The mean age was 57.17 years, with a male predominance (sex ratio M/F 1.55). Isolated melena was the main reason for admission in 35 cases (59.32%), followed by hematemesis with melena in 9 cases (15.25%), and hematemesis without melena in 10 cases (16.94%), while massive rectal bleeding was present in 5 cases (8.47%). Esogastroduodenoscopy established the etiological diagnosis of UGIB in 40 cases (67.8%) and revealed the following lesions: 25 cases of peptic ulcer (62. 5%):2 cases (8%) of antral gastric ulcer,1 case (4%) of Forrest IIc bulbar ulcer, 12 cases (48%) of Forrest III bulbar ulcer and 10 cases (40%) of ulcerative bulbitis, 12 cases (30%) of gastric and duodenal angiodysplasia, 2 cases (5%) of Los Angelos grade B and C esophagitis and 1 case (2. 5%) of grade II of oesophageal varices ligatured in an unknown patient with portal hypertension. EGD was negative in 32.2% of cases. Conclusion: Upper GI bleeding is common in patients with chronic renal failure and is primarily caused by peptic ulcer disease and angiodysplasia.

Association of LDLR Gene Polymorphism with the Risk of Cardiovascular Disease in End-Stage Kidney Disease Patients on Maintenance Hemodialysis

Background The low-density lipoprotein receptor (LDLR) is essential for regulating intracellular cholesterol levels. Mutations in the LDLR gene can cause a increase in LDL cholesterol levels in the blood, elevating the vulnerability to cardiovascular disease (CVD). This study evaluated the correlation between the LDLR rs688 polymorphism and CVD risk in chronic kidney disease (CKD). Materials and Methods Polymorphism in this case-control study was genotyped using the TaqMan real-time polymerase chain reaction in a cohort of 100 CKD patients (Group I) and 100 healthy controls (Group II). We examined the LDLR rs688 allele and genotype distribution in 50 CKD cases with CVD and 50 cases without CVD. Results There was a significantly greater frequency of CT variant of LDL SNP rs688 in Group I than in Group II (p = 0.006). CT and TT genotypes were significantly higher in CKD patients with CVD, with odds ratios (ORs) (95% CI) of 4.3 (1.6–11.8, p = 0.004) and 7.6 (2.3–24.8, p = 0.001), respectively. Conclusion SNP rs688 C>T detection in the LDLR gene showed that CT and TT genotypes are associated with elevated CVD risk in CKD.

Associations of body mass index and waist circumference with risk of chronic kidney disease in adults in China

Objective: To examine the associations of BMI and waist circumference (WC) with the risk of chronic kidney disease (CKD) and its subtypes in adults in China. Methods: The data from the China Kadoorie Biobank were used. After excluding those with cancer, coronary heart disease, stroke, or CKD at baseline survey, 480 430 participants were included in this study. Their body height and weight, and WC were measured at baseline survey. Total CKD was defined as diabetic kidney disease (DKD), hypertensive nephropathy (HTN), glomerulonephritis (GN), chronic tubulointerstitial nephritis (CTIN), obstructive nephropathy (ON), CKD due to other causes, and chronic kidney failure. Cox proportional hazards regression model was used to estimate the associations between exposure factors and risks of outcomes. Results: During a follow-up period of (11.8±2.2) years, 5 486 cases of total CKD were identified, including 1 147 cases of DKD, 340 cases of HTN, 1 458 cases of GN, 460 cases of CTIN, 598 cases of ON, 418 cases of CKD due to other causes, and 1 065 cases of chronic kidney failure. After adjusting for socio-demographic factors, lifestyle factors, baseline prevalence of hypertension and diabetes, and WC and compared to participants with normal BMI (18.5-23.9 kg/m2), the hazard ratios (HRs) of total CKD for underweight (<18.5 kg/m2), overweight (24.0-27.9 kg/m2), and obese (≥28.0 kg/m2) were 1.42 (95%CI: 1.23-1.63), 1.00 (95%CI: 0.93-1.08) and 0.98 (95%CI: 0.87-1.10), respectively. Stratification analysis by WC showed that BMI was negatively associated with risk for total CKD in non-central obese participants (WC: <85.0 cm in men and <80.0 cm in women) (HR=0.97, 95%CI: 0.96-0.99), while the association was positive in central obese participants (≥90.0 cm in men and ≥85.0 cm in women) (HR=1.03, 95%CI: 1.01-1.05). The association between BMI and GN was similar to that of total CKD. BMI was associated with an increased risk for HTN, with a HR of 1.12 (95%CI: 1.06-1.18) per 1.0 kg/m2 higher BMI. After adjusting for potential confounders and BMI, compared to participants with non-central obesity, the HRs for pre-central obesity (WC: 85.0-89.9 cm in men and 80.0-84.9 in women) and central obesity were 1.26 (95%CI: 1.16-1.36) and 1.32 (95%CI: 1.20-1.45), respectively. With the exception of HTN and CTIN, WC was positively associated with risks for all CKD subtypes. Conclusions: BMI-defined underweight and central obesity were independent risk factors for total CKD, and BMI and WC had different associations with risks for disease subtypes.

Examining chronic kidney disease screening frequency among diabetics: a POMDP approach.

Forty percent of diabetics will develop chronic kidney disease (CKD) in their lifetimes. However, as many as 50% of these CKD cases may go undiagnosed. We developed screening recommendations stratified by age and previous test history for individuals with diagnosed diabetes and unknown proteinuria status by race and gender groups. To do this, we used a Partially Observed Markov Decision Process (POMDP) to identify whether a patient should be screened at every three-month interval from ages 30-85. Model inputs were drawn from nationally-representative datasets, the medical literature, and a microsimulation that integrates this information into group-specific disease progression rates. We implement the POMDP solution policy in the microsimulation to understand how this policy may impact health outcomes and generate an easily-implementable, non-belief-based approximate policy for easier clinical interpretability. We found that the status quo policy, which is to screen annually for all ages and races, is suboptimal for maximizing expected discounted future net monetary benefits (NMB). The POMDP policy suggests more frequent screening after age 40 in all race and gender groups, with screenings 2-4 times a year for ages 61-70. Black individuals are recommended for screening more frequently than their White counterparts. This policy would increase NMB from the status quo policy between $1,000to $8,000 per diabetic patient at a willingness-to-pay of $150,000 per quality-adjusted life year (QALY).

Loneliness, social isolation and incident chronic kidney disease among patients with diabetes

BackgroundIndividuals with diabetes have a significantly higher risk of developing chronic kidney disease (CKD) and higher levels of social isolation and loneliness compared with those without diabetes. Recently, the American...

#1433 Geographical variation in chronic kidney disease: a nationwide cohort study in Denmark

Abstract Background and Aims Chronic kidney disease (CKD) represents a significant and growing global health challenge, especially among aging populations. Despite declines in mortality from other non-communicable diseases, CKD-related mortality has remained stable, underscoring the need for enhanced management strategies. Primary care physicians play a crucial role in early detection and appropriate intervention. Understanding geographical variation in CKD prevalence and incidence is essential for clinicians and policy makers, informing the development of targeted interventions and resource allocation strategies. This study investigates CKD in Denmark, assessing variations in prevalence and incidence across rural and urban areas. Method This nationwide cohort study included all Danish residents aged ≥18 years as of January 1, 2019. Patients with CKD were identified using measurements of eGFR from the Register of Laboratory results for Research. CKD was defined according to KDIGO as at least two reported outpatient eGFR &amp;lt;60 ml/min/1.73 m2 at least 90 days apart. Population characteristics, CKD prevalence and CKD incidence were analyzed by urbanicity of residence municipality (capital, large city, provincial, sub-rural and rural municipalities). Two different models were used to estimate incidence rates; a crude model and a model using propensity score weighting for standardization, accounting for age and sex. Results The study included 4,466,041 Danish residents. There was variation in population characteristics and CKD incidence between urban and rural areas such as CKD prevalence, hypertension, diabetes, and Charlson Comorbidity Index. The crude model showed geographical differences in CKD incidence rates varying between 7.4 and 12.8 per 1,000 person-years in large city municipalities and rural municipalities, respectively. The standardized model showed less variation, with incidence rates ranging from 9.2 to 10.5 cases of CKD per 1,000 person years. Conclusion The study illuminates geographical variations in CKD prevalence and incidence across Danish rural and urban municipalities. After standardization for age and sex, there was only minor variation in incidence rates of CKD, suggesting that variation could largely be explained by differences in demographic, highlighting the need for targeted interventions accounting for diverse population characteristics in different geographic regions.

#2116 Socioeconomic position and incidence of chronic kidney disease in Central Italy

Abstract Background and Aims Socioeconomic position is strongly related to most chronic conditions, with higher prevalence, higher incidence, and more adverse outcomes in disadvantaged groups of the population compared to well-off counterparts. Similar to other pathologies, several studies reported inequalities in the prevalence of chronic kidney disease (CKD). Few studies investigated socioeconomic differences in disease incidence, and some analyzed socioeconomic inequalities in long-term outcomes, such as mortality or end-stage renal disease, with conflicting results. We aimed to investigate the association between educational level and CKD in the Lazio Region Longitudinal Study, i.e., the 2011 census cohort of all residents followed through administrative databases from 1 Jan 2012 to 31 Dec 2022. Method The Lazio region is one of the twenty Italian regions. With its 5.5 million inhabitants, it is located in central Italy and includes Rome, the Italian capital city. We considered the population enrolled in the Lazio Region Longitudinal Study aged 35-90 years. We used a validated algorithm to identify prevalent cases of CKD at baseline (1 Jan 2012) and incident CKD cases during the follow-up (1 Jan 2012 to 31 Dec 2022). We used the education available for each individual from the census questionnaire to indicate socioeconomic position. We used Cox proportional hazard models to investigate the association between educational level and incidence of CKD. We used age as the time scale to punctually adjust for age, and we adjusted the multivariable models for place of residence, citizenship, marital status, and occupational status. Results We selected 3 752 190 25-90-year-olds included in the Lazio Longitudinal Study. We excluded 66 376 prevalent cases, obtaining a study population of 3 685 814 CKD-free individuals. The prevalent cases were more likely males than females, increased with age, were more Italians than foreigners, were diabetics, and residents in Rome compared to the general population. The study population comprised 1 754 781 men with a mean age of 52 years and 1 997 409 women with a mean age of 54 years. During the 11 years of follow-up, we identified 88 784 new CKD cases among men and 70 217 among women, with crude incidence rates of 540 and 364 per 100, 000 person-years, respectively. The age-adjusted models showed a strong association between educational level and CKD incidence in both men and women (Table 1). In men, compared to those with a university degree, those with upper secondary education had a 30% higher risk of suffering from CKD, those with lower secondary education had a 54% higher risk, while the primary educated men had a 70% higher risk. Among women, the excess risk of low-educated compared to those with a university degree was even higher than in men, with HR = 1.33 (95% CI 1.28-1.38), HR = 1.76 (95% CI 1.69-1.82), and HR = 2.24 (95% CI 2.16-2.32) in upper secondary, lower secondary and primary school educated, respectively. The socioeconomic gap was slightly reduced when we adjusted for possible confounders. Conclusion We found strong socioeconomic inequalities in CKD incidence. Further analyses will investigate the clinical risk factors that mediate the association between educational level and CKD incidence.

#1942 Social deprivation and chronic kidney disease: a population based cohort study in Italy

Abstract Background and Aims The impact of social deprivation on the progression of Chronic Kidney Disease (CKD) to End Stage Kidney Disease (ESKD) requiring Renal Replacement Therapies (RRTs) and death has been demonstrated by large cohort studies produced both in the US and the UK. Nonetheless, there is still insufficient evidence, which might depend on the difficulty of comparing Health Care Systems from different countries, the lack of a standardized measure of social deprivation and the difficulty of obtaining follow-ups long enough to intercept all clinical outcomes. This study aims to fill this gap by analyzing a large cohort of patients affected by CKD identified in Healthcare Electronic Records through a validated algorithm. Method The study population consisted of all adult incident CKD cases treated conservatively, residents in the Lazio Region, that occurred between the 1st of January 2012 and the 31st of December 2021. The exposure was the deprivation index (DI), a composite indicator at the census block level, which integrates many aspects: low level of education, unemployment, non-home ownership, one parent family and overcrowding. The DI divided the Lazio residents in 5 classes according to the quintiles of its distribution (form very low to very high deprivation). The study outcomes were all-cause mortality and ESKD. The health status of CKD patients was characterized using the hospital discharges for hypertension, heart failure, diabetes, ischemic cardiopathy, obesity and other conditions, in the two years before the identification. Patients were followed form the incident date up to the date of death, ESKD, emigration from Lazio region or 31/12/2022, whichever came first. Cox regression analyses were performed to study the association between DI and adverse outcomes, estimating crude and adjusted Hazard Ratios (HR) and 95% Confidence Intervals (95% CI). The interaction between DI and sex was tested. Results From 2012 to 2021, there were 127 457 new CKD cases, 55.9% males. The average age was 72.2 (±13.7 SD) for males and 74.4 (±14.8 SD) for females, characteristics by deprivation index are reported in Table 1. During the follow-up, on average 4.3 years (±3.2 SD), 57 158 patients (45%) died and 5994 developed ESKD requiring RRTs (5%). The mortality analysis showed a statistically significant interaction between DI and sex. In males, there was a strong association between DI and mortality in both age-adjusted and fully-adjusted models (Fig. 1A), with a statistically significant trend across DI classes. In females, there was an association with a statistically significant trend across DI categories but the only statistically significant different HR was very high DI VS. very low DI (HR = 1.05; 95% CI = 1.00-1.09) (Fig. 1B). The association was much stronger for males then for females. In the ESKD outcome analysis there was not an interaction between sex and DI; hence, sex was used as confounder. The age-adjusted HR and the fully-adjusted HR of DI on ESKD did not show any trend across the DI categories and then the low and medium deprived had a lower ESKD risk compared to the very deprived. Conclusion The present study is so far the largest European prospective cohort regarding the association between socioeconomic position and CKD. The HR of mortality was inferior to the one found in the UK studies (HR 1.6). The most likely explanation is that we have stratified by sex and adjusted for comorbidities. In our study the most deprived patients have a higher risk of death, but not of ESKD requiring RRTs, showing socioeconomic inequalities in the worst possible outcome, that probably occurred before the progression of the disease in most deprived patients. Further studies are needed to confirm this association that can lead both individual and Public Health decisions.

#2489 The prevalence of chronic kidney disease in different altitude areas: results from the China multi-ethnic cohort study

Abstract Background and Aims Chronic Kidney Disease (CKD) poses a significant public health challenge with substantial implications for human well-being. In China, there are significant geographical differences in the prevalence of CKD, with the highest prevalence in the southwest region, which may be related to differences in geographical environment and lifestyle. This study aimed to investigate variances in the prevalence of CKD across different altitude areas in southwest China. Method In this cross-sectional study, we used data from the China Multi-Ethnic Cohort (CMEC). CMEC was established in five provinces of Southwest China and recruited a total of 99,556 participants between 2018 and 2019. Altitude information for each participant was extracted from the Shuttle Radar Topography Mission (SRTM) (version 4) data based on their residential address. To facilitate analysis, we categorized them into groups of low altitude (0-1499 m) and high altitude (≥1500 m). CKD was defined as an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m2, using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Crude and age-standardized prevalence of CKD was calculated by using R. Results A total of 92,163 participants were included in the study, and 39.7% were men. Among the current cohort, 30,904 were high-altitude residents, and 61,259 were from low altitude. Among the participants, 1636 cases of CKD were identified, corresponding to a prevalence of 1.78%. We found, the prevalence of CKD in high altitude group was higher than that in low altitude group, and the former is 2.53%, the latter is 1.40%. The age-standardized prevalence were 1.35% and 2.73% for the low and high altitude groups, respectively, and 1.38% and 2.57% for the sex-standardized groups. Conclusion In southwestern China, the prevalence of CKD was higher in the high altitude group than the low altitude group. And after adjusting for age and gender, the prevalence of CKD remained lower in the low-altitude group, and the gap slightly increased.

#2617 Impact of CKD screening in high‑risk populations and guideline-directed therapy on RRT, CV events, and mortality in Europe: an IMPACT CKD analysis

Abstract Background and Aims Despite the rising and substantial burden of chronic kidney disease (CKD), there is a lack of recognition of CKD as a health priority in Europe. This contributes to underdiagnosis of CKD despite the potential for early detection and effective intervention to delay progression to late-stages (associated with costly and resource-intensive renal replacement therapy [RRT; i.e., dialysis and transplantation]). Further, diagnosed patients are undertreated when compared to current and upcoming CKD guidelines, leading to increased risk for progression to RRT and cardiovascular (CV) or other events. Early detection and intervention in high-risk populations, such as those with diabetes mellitus (DM) and hypertension (HTN) have shown cost-effectiveness; however, the broader implications of these strategies on CKD progression and clinical outcomes in a European context remains underexplored. Our study aims to illustrate the clinical benefit of targeted screening followed by an optimal compliance to guideline-directed treatment use to provide insight into potential CKD policies across Europe. Method Four country populations (Germany, Netherlands, Spain, United Kingdom [UK]) were simulated for 10-years (baseline: 2022; simulated years: 2023-2032) using the validated IMPACT CKD model to compare two scenarios: targeted screening for people with DM and/or HTN followed by 90% compliance to guideline-directed therapy versus current practice (i.e., underdiagnosis without screening and low treatment rates). Annual targeted screening was modelled using estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) testing. Initiation of therapies for people with diagnosed CKD was based on Kidney Disease Improving Global Outcomes guidelines. A 90% compliance to guideline-directed therapies was assumed to approximate maximum clinical benefit. Current practice was modelled based on the observed diagnosed rate without screening and the observed treatment rate in each country. The incremental population initiated on recommended therapies were modelled to experience a multiplicative treatment effect on GFR decline, CV events, and acute kidney injury (AKI) events. The model projected CKD and RRT prevalence, incidence of CV and AKI events with results shown for year 10 (2032), as well as cumulative all-cause mortality over the simulated 10-years. Results Results compare the high-risk population screening followed by guideline-directed treatment scenario to continuation of current practices for the four countries (Fig. 1). The identification of undiagnosed CKD, as well as lower rates of progression due to guideline-directed treatment was associated with a small rise in the number of total CKD patients, with increases in stage 1-2 by 3.5% to 5.0%, and stage 3-5 by 0.2% to 1.2%. There was a reduction in the number of undiagnosed CKD stage 1-2 patients by 49.2% to 71.6%, and stage 3-5 by 60.2% to 69.8%. The largest reductions were predicted for CV events (44.6% to 49.1%) followed by dialysis (22.6% to 41.9%). The strategy resulted in a decrease in cumulative 10-year all-cause mortality between 4.5% to 9.1% in CKD patients. Conclusion The study predicted significant clinical benefits from targeted CKD screening followed by guideline-directed interventions across all four European countries. Notably, this approach was forecasted to reduce undiagnosed CKD cases, dialysis, CV events, and mortality. These findings underscore the potential of acting earlier on CKD to mitigate the future CKD burden.

Using the Nephrology Referral Form in Italian primary care to improve the care pathway of patients with anemia or other complications related to chronic kidney disease: survey findings

Introduction: Anemia is a potentially reversible condition in early chronic kidney disease (CKD) that requires timely intervention. General practitioners (GPs) play a crucial role in recognizing CKD. A new Nephrology Referral Form (NRF) was developed and tested in the Italian setting. Methods: This mixed-methods survey, conducted between 2021 and 2022, introduced the NRF through focus group discussions involving a scientific committee. The NRF was tested in a 6-month trial involving 24 GPs each from Lazio and Puglia regions. GPs provided feedback on the use of the NRF in clinical practice through a questionnaire sent via Microsoft Form. The data were analyzed descriptively. Results: After 6 months, 41.67% of the GPs were using the NRF at least once a week. Diabetes mellitus and hypertension were common triggers for NRF assessments. GPs overwhelmingly agreed (96%) on the NRF’s utility in identifying CKD cases, with 92% citing its effectiveness in diagnosing well-defined cases. The NRF facilitated specialist referrals, with 83% of GPs reporting increased referrals compared to the prior 6 months. Feedback underscored the NRF’s positive impact, suggesting improvements such as additional referral centers, regional/national networks, enhanced GP training, and increased collaboration. Conclusion: GPs regularly used the NRF to identify and diagnose cases of CKD, streamlining the referral process and increasing referrals to specialists. Feedback emphasized the NRF’s positive impact and highlighted its potential as a valuable tool for enhancing early CKD detection, interventions, and fostering multidisciplinary management in primary care for better patient outcomes.

Hemodynamic gain index and risk of chronic kidney disease: A prospective cohort study of middle-aged and older men.

The hemodynamic gain index (HGI), a novel non-invasive hemodynamic marker, represents a promising advancement in cardiovascular risk assessment. Cardiovascular disease and chronic kidney disease (CKD) are closely intertwined and share bidirectional relationships. We aimed to assess the association of HGI with CKD risk in a prospective study. Hemodynamic gain index was calculated using heart rate and systolic blood pressure (SBP) responses measured in 1765 men aged 42-61years with normal kidney function during exercise testing using the formula: [(Heart ratemax x SBPmax)-(Heart raterest x SBPrest)]/(Heart raterest x SBPrest). Multivariable adjusted hazard ratios (HRs) (95% confidence intervals, CIs) were estimated for CKD. Over a median follow-up duration of 25.9years, 175 CKD cases occurred. In analysis adjusted for established risk factors, a unit (bpm/mmHg) higher HGI was associated with a decreased risk of CKD (HR 0.78, 95% CI 0.65-0.95). Comparing extreme tertiles of HGI, the corresponding adjusted HR (95% CI) for CKD was 0.53 (0.33-0.85). Addition of HGI to a CKD risk prediction model containing established risk factors improved risk discrimination and reclassification (p-value for difference in -2 log likelihood = .011; net-reclassification-improvement = 59.37%, p = .018; integrated-discrimination-improvement = 0.0064, p = .008). Higher HGI is associated with a lower CKD risk and improves the prediction and classification of CKD beyond common established risk factors.

Urine Biomarkers of Kidney Tubule Health and Risk of Incident CKD in Persons Without Diabetes: The ARIC, MESA, and REGARDS Studies

Rationale & ObjectiveTubulointerstitial damage is a feature of early chronic kidney disease (CKD), but current clinical tests capture it poorly. Urine biomarkers of tubulointerstitial health may identify risk of CKD. Study DesignProspective cohort (ARIC) and case-cohort (MESA and REGARDS). Setting & ParticipantsAdults with eGFR ≥60 mL/min/1.73m2 and without diabetes in the ARIC, REGARDS, and MESA studies. ExposureBaseline urine monocyte chemoattractant protein-1 (MCP-1), alpha-1-microglobulin (α1m), kidney injury molecule-1 (KIM-1), epidermal growth factor (EGF), and chitinase-3-like protein 1 (YKL-40). OutcomeIncident CKD or ESKD (end-stage kidney disease). Analytical ApproachMultivariable Cox proportional hazards regression for each cohort; meta-analysis of results from all three cohorts. Results872 ARIC participants (444 cases of incident CKD), 636 MESA participants (158 cases), and 924 REGARDS participants (488 cases) were sampled. Across cohorts, mean age ranged from 60±10 to 63±8 years and baseline eGFR ranged from 88±13 to 91±14 mL/min/1.73m2. In ARIC, higher concentrations of urine MCP-1, α1m, and KIM-1 were associated with incident CKD. In MESA, higher concentration of urine MCP-1 and lower concentration of EGF was each associated with incident CKD. In REGARDS, none of the biomarkers were associated with incident CKD. In meta-analysis of all three cohorts, each two-fold higher α1m concentration was associated with incident CKD (HR=1.19 [1.08, 1.31]). LimitationsObservational design susceptible to confounding; competing risks during long follow-up period; meta-analysis limited to three cohorts. ConclusionsIn three combined cohorts of adults without prevalent CKD or diabetes, higher urine α1m was independently associated with incident CKD. Four biomarkers were associated with incident CKD in at least one of the cohorts when analyzed individually. Kidney tubule health markers might inform CKD risk independent of eGFR and albuminuria.

Trajectories of atherosclerotic cardiovascular disease risk scores as a predictor for incident chronic kidney disease

BackgroundThe relationship between atherosclerosis and renal function is well established. Atherosclerotic cardiovascular disease (ASCVD) risk scores reflect atherosclerotic burden, which changes over time. We investigated the association between ASCVD risk trajectories and incident chronic kidney disease (CKD) using data from a large community-based Korean cohort with up to 16 years of follow-up.MethodsWe analyzed data from 5032 participants without CKD from the baseline survey of the Korean Genome and Epidemiology Study Ansan-Ansung cohort. Participants were categorized into stable or increasing ASCVD risk groups based on the revised ASCVD risk pooled cohort equation over a median period of exposure of 5.8 years. Incident CKD was defined as two consecutive events of an estimated glomerular filtration rate < 60 mL/min/1.73 m2.ResultsDuring a median 9.9 years of event accrual period, 449 (8.92%) new-onset CKD cases were identified. Multiple Cox proportional regression analyses showed that the hazard ratio (95% confidence interval) for incident CKD in the increasing group, compared to the stable group, was 2.13 (1.74–2.62) in the unadjusted model and 1.35 (1.02–1.78) in the fully-adjusted model. Significant relationships were maintained in subgroups of individuals in their 50s, without diabetes mellitus or hypertension. The prevalence of proteinuria was consistently higher in the increasing group than that in the stable group.ConclusionsAn increasing trend in ASCVD risk scores independently predicted adverse renal outcomes in patients without diabetes mellitus or hypertension. Continuous monitoring of ASCVD risk is not only important for predicting cardiovascular disease but also for predicting CKD.

Exposure to low levels of heavy metals and chronic kidney disease in the US population: A cross sectional study.

Exposure to heavy metals (cadmium, mercury, and lead) has been linked with adverse health outcomes, especially their nephrotoxic effects at high levels of exposure. We conducted a replication study to examine the association of low-level heavy metal exposure and chronic kidney disease (CKD) using a larger NHANES data set compared to previous studies. The large cross-sectional study comprised 5,175 CKD cases out of 55677 participants aged 20-85 years from the 1999-2020 National Health and Nutrition Examination Survey [NHANES]. Logistic regression analysis was applied to estimate the associations between CKD and heavy metals [Cd, Pb, Hg] measured as categorical variables after adjusting with age, race, gender, socioeconomic status, hypertension, diabetes mellitus and blood cotinine level as smoking status. Compared to the lowest quartile of blood Cd, exposures to the 2nd, 3rd and 4th quartiles of blood Cd were statistically significantly associated with higher odds of CKD after adjustment for blood Pb and Hg, with OR = 1.79, [95% CI; 1.55-2.07, p<0.0001], OR = 2.17, [95% CI; 1.88-2.51, p<0.0001] and OR = 1.52, [95% CI; 1.30-1.76, p<0.0001] respectively. The 2nd, 3rd and 4th quartiles of blood Cd remained statistically significantly associated with higher odds of CKD after adjustment for blood cotinine level, with OR = 2.06, [95% CI; 1.80-2.36, p<0.0001], OR = 3.18, [95% CI; 2.79-3.63, p<0.0001] and OR = 5.54, [95% CI; 4.82-6.37, p<0.0001] respectively. Exposure to blood Pb was statistically significantly associated with higher odds of CKD in the 2nd, 3rd and 4th quartile groups, after adjustment for all co-variates (ag, gender, race, socio-economic status, hypertension, diabetes mellitus, blood cadmium, mercury, and cotinine levels) in all the four models. Blood Hg level was statistically significantly associated with lower odds of CKD in the 2nd quartile group in model 2, 3rd quartile group in model 1, 2 and 3, and the 4th quartile group in all the four models. Our findings showed that low blood levels of Cd and Pb were associated with higher odds of CKD while low blood levels of Hg were associated with lower odds of CKD in the US adult population. However, temporal association cannot be determined as it is a cross sectional study.

Distribution of Cardiovascular Dysautonomia Pattern across Different Stages of Chronic Kidney Disease

Context: Autonomic dysfunction (AD) brings up cardiovascular morbidity/mortality and has been reported in chronic kidney disease (CKD). Still, the pattern of AD in CKD is elusive. Aim: To evaluate the distribution of cardiovascular dysautonomia in CKD. Material and Methods: This study was conducted on 33 CKD cases and 30 age and sex matched healthy controls. Five standard autonomic function tests were conducted, namely, heart rate response to Valsalva maneuver, deep breathing, and standing, and BP response to standing and sustained handgrip; based on which the patients were classified as normal, or having early parasympathetic, definite parasympathetic and combined damage. The total autonomic function score was also calculated. Results: All cases belonged to CKD stages of 3, 4, and 5; and came up with autonomic failure. The mean total autonomic function score was higher (P &lt; 0.001) in CKD (5.09 ± 2.33) as compared to the control group (0.97 ± 0.24), using the unpaired “t” test. Most of the CKD patients (45.45%) were involved with combined damage. Of the three stages, combined damage struck stage 5 to the maximum extent (63.63%). Sympathetic failure always co occurred with parasympathetic failure. Conclusion: Combined autonomic failure is more conspicuous in late CKD, predominantly occurring in stage 5. The disease course may contort the parasympathetic system before the sympathetic system.

Remnant cholesterol is an independent risk factor for the incidence of chronic kidney disease in newly-diagnosed type 2 diabetes: A nationwide population-based study

AimsTo evaluate the impact of remnant cholesterol (remnant-C) on chronic kidney disease (CKD) incidence in newly-diagnosed type 2 diabetes. MethodsThis retrospective cohort study used Korean National Health Insurance Service data on 212,836 patients with newly-diagnosed type 2 diabetes between 2009 and 2014. We conducted cox regression analysis to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for developing CKD according to remnant-C tertile. ResultsDuring a median follow-up duration of 5.23 years, 6,850 CKD cases developed. In the fully adjusted model, HRs and 95 % CIs for incident CKD increased in the highest tertile of baseline remnant-C compared to the lowest (HR [95 % CI]; 1.234 [1.159–1.314]). This association was more prominent in patients with hypertension or low-income status (P for interaction < 0.05). Increased HRs in the highest tertile of remnant-C was sustained in type 2 diabetes patients within target range of conventional lipid profile such as low-density lipoprotein cholesterol (LDL-C) < 100 mg/dL and < 70 mg/dL (1.165 [1.041–1.304] and 1.308 [1.063–1.609]), high-density lipoprotein cholesterol (HDL-C) (1.243 [1.155–1.338]) and triglyceride (1.168 [1.076–1.268]), respectively. ConclusionsIn newly-diagnosed type 2 diabetes patients, higher remnant-C is independently associated with CKD incidence, even when conventional lipid values are well-controlled.

Manajemen Diet Rendah Kalium pada Pasien dengan Diangnosa Medis Chronic Kidney Disease (CKD) E. C Hiieperkalemia di Ruangan Matahari RSUD dr. TC. HILERS Maumere

Chronic Kidney Disease (CKD) with et causa Hyperkalemia is one of the highest causes of death in Indonesia as well as in Sikka district. Based on data obtained in 2022, there were 300 cases of the largest CKD in 25 sub-districts, based on data in the Matahari room there were 22 cases recorded. The aim of this research is to enable prospective nurses to apply professional practices and manage a low potassium diet in hyperkalemia patients to reduce potassium levels in the Matahari Room at RSUD dr. T.C. HILERS Maumere. This research is a case study research using the case study method which begins with identifying previous nursing care reports or via the internet The results of the study showed that there was a decrease in potassium levels in the participants as evidenced by the results of potassium examinations from 6.5 mmol/L down to 5.0 mmol/L. From the research results it can be concluded that low potassium diet management is very influential in helping to reduce potassium levels in the blood. Suggestions for relevant agencies are that low-chlorium diet management can be used as a nursing care option for patients with Chronic Kidney Disease. It is hoped that by knowing the effect of a low potassium diet on hyperkalemia sufferers, it is hoped that this can be an input for improving the quality of services in further nursing care.

Abstract P421: Smoking Timing, Healthy Diet, and Risk of Incident CKD Among Smokers: A Cohort Study in UK Biobank

Introduction: While smoking is a recognized risk factor for chronic kidney disease (CKD), the relationship between the smoking timing and CKD remains largely unstudied. Hypothesis: We assessed the hypothesis that there is an association between the smoking timing and the risk of CKD. Method: A total of 32,776 participants with complete data on the time from waking to the first cigarette and free of prevalent CKD from UK Biobank were included in this prospective study. The Cox proportional hazard model was used to investigate the associations between smoking timing and risk of CKD. The potential interactions of smoking timing with risk factors in relation to CKD risk were assessed on both multiplicative and additive scales. Results: During a median follow-up of 12 years, 940 incident CKD cases were reported. Shorter time from waking to the first cigarette was significantly associated with a higher risk of incident CKD ( P -trend=0.012). The adjusted hazard ratio (HR) associated with smoking timing was 1.28 (95% CI: 0.92-1.80) for 61-120 minutes, 1.48 (95% CI: 1.11-1.96) for 30-60 minutes, 1.36 (95% CI: 1.01-1.88) for 5-15 minutes, and 1.70 (95% CI: 1.22-2.37) for &lt;5 minutes, respectively. Those who smoke within 5 minutes of waking had a 70% increased risk of CKD incident compared to those who delayed for over 120 minutes. Furthermore, there was a significant positive additive interaction between the timing of smoking and a healthy diet score ( P for additive interaction=0.01). Conclusion: Our findings indicate a significant association between the shorter time from waking to the first cigarette and a higher CKD risk; and the associations are exacerbated in the presence of an unhealthy diet.