Chronic Kidney Disease In Adults Research Articles

Associations of dietary macronutrients with glomerular filtration rate and kidney dysfunction: Tehran lipid and glucose study.

Although dietary components may play a role in the development of chronic kidney disease (CKD), data on this topic are scarce. The objective of this study was to investigate the association between macronutrient intakes and CKD in a large non-diabetic adult population-based study. This cross-sectional study recruited 5,316 participants aged ≥27 years without diabetes within the framework of the Tehran lipid and glucose study. Dietary intake was collected using a validated food-frequency questionnaire. Macronutrients intake including total-, animal-, and plant-protein, carbohydrate, simple sugar, fructose, total fat, saturated fatty acids, poly- and monounsaturated-fatty acids (PUFA and MUFA), and n-3 and n-6 fatty acids was categorized into quartiles. Anthropometrics, blood pressure, serum creatinine, and fasting plasma glucose and lipids were measured. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease Study equation. CKD was defined as eGFR <60 ml/min/1.73 m(2). Mean age of participants was 45.0 ± 12.2 years. Mean eGFR was 71.9 ± 11.1 ml/min/1.73 m(2), and 13% had CKD. After adjustment for serum triglycerides and cholesterol, body mass index, and hypertension, the risk of CKD decreased in the highest quartile compared to lowest quartile of plant protein (OR, 95% CI) (0.70, 0.51-0.97), PUFA (0.73, 0.55-0.99), and n-6 fatty acids (0.75, 0.57-0.97). However, the risk of CKD increased in the highest quartile of animal protein (1.37, 1.05-1.79) compared to the lowest. Plant protein, PUFA, and n-6 fatty acids are associated with a lower risk of CKD, independently of hypertension and diabetic mellitus, while animal protein may be a risk factor for CKD in adults.

Prevalence and Correlates of Renal Disease in Older Lithium Users: A Population-Based Study

Lithium is an important treatment for mood disorders, but concern about its association with renal disease has contributed to its limited use, particularly in older adults. Because high-quality evidence examining renal disease in this population is lacking, this study aims to quantify the prevalence and identify clinical correlates of renal disease in geriatric lithium users. In a population-based cross-sectional study on 2,480 lithium users aged 70 or more years, the authors searched the provincial administrative health data from Ontario, Canada between April 1, 2005 and March 31, 2011. Prevalence of chronic kidney disease (CKD), acute kidney injury (AKI), and nephrogenic diabetes insipidus (NDI) was measured using International Classification of Diseases, Tenth Revision codes. Logistic regression analyses were used to identify independent correlates of renal disease. The 6-year prevalence rates of CKD, AKI, and NDI were 13.9%, 1.3%, and 3.0%, respectively. Hypertension (odds ratio [OR]: 2.05; 95% confidence interval [CI]: 1.50-2.79), diabetes mellitus (OR: 1.86; 95%CI: 1.45-2.38), ischemic heart disease (OR: 1.65; 95% CI: 1.24-2.20), NDI (OR: 2.54; 95% CI: 1.47-4.40), AKI (OR: 11.7; 95% CI: 5.26-26.1), lithium use for more than 2 years (OR: 1.71; 95% CI: 1.05-2.81), loop diuretic use (OR: 1.74; 95% CI: 1.26-2.41), hydrochlorothiazide use (OR: 1.48; 95% CI: 1.07-2.05), and atypical antipsychotic use(OR: 1.49; 95% CI: 1.17-1.89) were all independently associated with CKD. Older lithium users have high rates of CKD. Lithium use duration was independently associated with CKD. Longitudinal studies including individuals without lithium exposure will be necessary to confirm whether lithium is indeed a risk factor for CKD in older adults.

Epidemiology of chronic kidney disease in adults of Salvadoran agricultural communities.

In El Salvador, chronic kidney disease is a serious and growing public health problem. Chronic renal failure was the first cause of hospital deaths in men and the fifth in women in 2011. Determine prevalence of CKD, CKD risk factors (traditional and nontraditional) and renal damage markers in the adult population of specific rural areas in El Salvador; measure population distribution of renal function; and identify associated risk factors in CKD patients detected. A cross-sectional analytical epidemiological study was conducted based on active screening for chronic kidney disease and risk factors in persons aged ≥18 years during 2009-2011. Epidemiological and clinical data were gathered through personal history, as well as urinalysis for renal and vascular damage markers, determinations of serum creatinine and glucose, and estimation of glomerular filtration rates. Chronic kidney disease cases were confirmed at three months. Multiple logistical regression was used for statistical analysis. Prevalence of chronic kidney disease was 18% (23.9% for men and 13.9% for women) in 2388 persons: 976 men and 1412 women from 1306 families studied. Chronic kidney disease with neither diabetes nor hypertension nor proteinuria ≥1 g/L (51.9%) predominated. Prevalence of chronic renal failure was 11% (17.1% in men and 6.8% in women). Prevalence of renal damage markers was 12.5% (higher in men): microalbuminuria, 6.9%; proteinuria (0.3 g/L), 1.7%; proteinuria (1g/L), 0.6%; proteinuria (2 g/L), 0.4 %; and hematuria, 1.5%. Prevalence of chronic kidney disease risk factors was: diabetes mellitus, 9%; hypertension, 20.9%; family history of chronic kidney disease, 16.5%; family history of diabetes mellitus, 18.5%; family history of hypertension, 30.6%; obesity, 21%; central obesity, 24.9%; NSAID use, 84.2%; smoking, 9.9%; alcohol use, 15%; agricultural occupation, 31.2%; and contact with agrochemicals, 46.7%. Chronic kidney disease was significantly associated with male sex, older age, hypertension, agricultural occupation, family history of chronic kidney disease and contact with the agrochemical methyl parathion. The results of this study support suggestions from other research that we are facing a new form of kidney disease that could be called agricultural nephropathy.

Prevalence Of Nocurnal Enuresis and Proteinuria In Children With Sickle Cell Disease and Its Relation To Severity Of Painful Crises

Nocturnal enuresis and albuminuria or proteinuria are markers of renal damage in sickle cell disease (SCD) and commonly develop early on in life. Proteinuria progresses with age, leading to chronic kidney disease in adulthood. The aims of this study were to identify the prevalence of enuresis and albuminuria/proteinuria in paediatric patients with SCD in London and to determine the relationship between these and various demographic and clinical variables. Methods A cross sectional, single centre study was conducted. Questionnaire-based interviews themed on nocturnal enuresis were undertaken for patients between the ages of 6 and 17. Urinalysis was performed for the presence of albuminuria or proteinuria. Hospital patient records were accessed for clinical data. Results A total of 56 patients were recruited to the study, of which 27 (51.8%) were female. Twenty patients (35.7%) had a history of enuresis and met the DSM IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) criteria for nocturnal enuresis compared to 5% prevalence in children in the general population1. There was a statistically significant association between enuresis and age, overactive bladder (OAB) symptoms, sleep-disordered breathing (SDB), painful crises and regular transfusions (Table 1). Fourteen out of 29 patients (48.3%) with OAB symptoms reported nocturnal enuresis compared to six out of 27 patients (22.2%) who did not (p&lt;0.05). Of the patients reporting SDB, 48.6% were enuretic compared to 14.3% who did not (p&lt;0.01). Incidence of painful crises per month was higher for the enuretic group (2.29 vs. 0.88, p&lt;0.05) but the mean number of emergency admissions in the preceding 18 months was similar. Of the 14 regular blood transfusion patients, only one (7.1%) was currently enuretic compared to 14 out of 32 (40.6%) who were not receiving any treatment (p&lt;0.05). Seven patients (13.4%) had albuminuria/proteinuria. (Table 2) There was no difference in albuminuria/proteinuria prevalence between the hydroxycarbamide or blood transfusion group compared to the non-treatment group. There was no difference in HbF percentage, systolic BP, frequency of emergency admissions, painful crises per month, haemoglobin levels and estimated glomerular filtration rates (eGFR) in patients with albuminuria/proteinuria and those without. The prevalence of haematuria increased with age; 6.7% in the 6-9 age category compared to 36.4% in the 16 to 17 age category (p=&lt;0.05). Conclusions Nocturnal enuresis and albuminuria or proteinuria is prevalent at an early age in many children with SCD. Early identification and initiation of treatment such as Angiotensin Converting Enzyme inhibitors2 may delay onset of complications especially alongside beneficial sickle cell treatments such as hydroxycarbamide and regular blood transfusions. Questioning parents on enuresis, OAB and SDB sumptoms and undertaking regular urinalysis on younger age groups is a practical and cost-effective surveillance method.

Metabolic syndrome and C-reactive protein concentration as independent correlates of chronic kidney disease

Inflammation is a common phenotype for cardiometabolic disorders. In this study, we attempted to investigate inter-relationships between metabolic syndrome (MetS), C-reactive protein (an inflammatory biomarker) and chronic kidney disease (CKD). We performed a cross-sectional analysis of data from a representative sample of 4425 Chinese adults in Taiwan. The MetS was defined by a unified criteria set by several major organizations. A CKD event was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m2. Additionly, a CRP cutpoint of 3 mg/L was used to differentiate high and low CRP levels. Overall, 1000 participants had MetS, resulting in a prevalence rate of 22.6%. High CRP level was noted in 782 (17.6%) subjects. In addition, a total of 508 (11.5%) persons qualified as having CKD. Subjects with the MetS had 1.55-fold [95% confidence interval (CI), 1.03–2.32] increased odds of CKD compared with their counterparts without the MetS after multiple adjustments. In addition, there was a significantly graded relationship between increasing levels of serum CRP and prevalent CKD (p for trend = 0.001). Participants in the highest category of serum CRP had a significantly elevated odds of CKD as compared with those in the lowest category [odds ratio (OR), 1.60; 95% CI, 1.21–2.12]. However, there was no interaction in excess of additive scale between the presence of MetS and high CRP level (p = 0.83). These findings suggest that MetS and high CRP were independently associated with increased prevalence of CKD in Chinese adults.

A population-based study on the prevalence and incidence of chronic kidney disease in the Netherlands

Because most population-based studies on the epidemiology of chronic kidney disease (CKD) are cross-sectional, there is, except for end-stage renal disease, hardly any information on incidence rates. We conducted a retrospective cohort study in a dynamic population, using data of 784,563 adult participants retrieved from the Integrated Primary Care Information database, a primary care database containing the complete electronic longitudinal medical records. CKD (both incidence and prevalence) was based on (1) an increased urine albumin-to-creatinine ratio, (2) a decreased estimated glomerular filtration rate, or (3) explicit statement in the medical record. Results were stratified by age according to the WHO standard population, sex, and diabetes mellitus. Based on a single measurement only, the incidence rate of CKD in adults was 1,213 per 100,000 person-years, and 6.7 percent of the adult population had a prevalent diagnosis of CKD. The incidence rate increased by age and was the highest in participants with diabetes with an incidence of 25,000 per 100,000 person-years, affecting over 75 percent of participants with diabetes. This is the first study to report the incidence rates of all stages of CKD for the entire adult population, stratified by sex, 5-year age groups, and diabetes. Our data demonstrate that the incidence of CKD increases with age and is the highest in participants with diabetes mellitus.

Metabolic syndrome in children with chronic kidney disease and after renal transplantation

Visceral obesity and metabolic abnormalities typical for metabolic syndrome (MS) are the new epidemic in adolescence. MS is not only the risk factor for cardiovascular disease but also for chronic kidney disease (CKD). Thus, there are some reasons to recognize MS as a new challenge for pediatric nephrologists. First, hypertensive and diabetic nephropathy, the main causes of CKD in adults, both share the same pathophysiological abnormalities associated with visceral obesity and insulin resistance and have their origins in childhood. Secondly, as the obesity epidemic also affects children with CKD, MS emerges as the risk factor for progression of CKD. Thirdly, metabolic abnormalities typical for MS may pose additional risk for cardiovascular morbidity and mortality in children with CKD. Finally, although the renal transplantation reverses uremic abnormalities it is associated with an exposure to new metabolic risk factors typical for MS and MS has been found to be the risk factor for graft loss and cardiovascular morbidity after renal transplantation. MS is the result of imbalance between dietary energy intake and expenditure inducing disproportionate fat accumulation. Thus, the best prevention and treatment of MS is physical activity and maintenance of proper relationship between lean and fat mass.

Evaluation and Management of Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2012 Clinical Practice Guideline

The Kidney Disease: Improving Global Outcomes (KDIGO) organization developed clinical practice guidelines in 2012 to provide guidance on the evaluation, management, and treatment of chronic kidney disease (CKD) in adults and children who are not receiving renal replacement therapy. The KDIGO CKD Guideline Development Work Group defined the scope of the guideline, gathered evidence, determined topics for systematic review, and graded the quality of evidence that had been summarized by an evidence review team. Searches of the English-language literature were conducted through November 2012. Final modification of the guidelines was informed by the KDIGO Board of Directors and a public review process involving registered stakeholders. The full guideline included 110 recommendations. This synopsis focuses on 10 key recommendations pertinent to definition, classification, monitoring, and management of CKD in adults.

Screening for Chronic Kidney Disease

Letters5 March 2013Screening for Chronic Kidney DiseaseIan H. de Boer, MD, MS, Grant A. Olan, MA, and Uptal D. Patel, MD, on behalf of the American Society of Nephrology Chronic Kidney Disease Advisory GroupIan H. de Boer, MD, MSFrom Seattle, Washington; Washington, DC; and Durham, North Carolina.Search for more papers by this author, Grant A. Olan, MAFrom Seattle, Washington; Washington, DC; and Durham, North Carolina.Search for more papers by this author, and Uptal D. Patel, MDFrom Seattle, Washington; Washington, DC; and Durham, North Carolina.Search for more papers by this author, on behalf of the American Society of Nephrology Chronic Kidney Disease Advisory GroupSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-158-5-201303050-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Chronic kidney disease (CKD) is a serious and growing public health threat (1, 2). More than 26 million Americans are estimated to have CKD, and only 1 in 10 is aware that he or she has it. When identified early, however, the progression of CKD to end-stage renal disease can be slowed or halted (3). The American Society of Nephrology (ASN) CKD Advisory Group agrees with the U.S. Preventive Services Task Force (USPSTF) recommendation (4) that insufficient evidence exists to show that screening for CKD in asymptomatic adults translates into use of effective interventions that in turn ...

Acute kidney injury is a frequent complication in critically ill neonates receiving extracorporeal membrane oxygenation: a 14-year cohort study

IntroductionNewborns in need of extracorporeal membrane oxygenation (ECMO) support are at high risk of developing acute kidney injury (AKI). AKI may occur as part of multiple organ failure and can be aggravated by exposure to components of the extracorporeal circuit. AKI necessitates adjustment of dosage of renally eliminated drugs and avoidance of nephrotoxic drugs. We aimed to define systematically the incidence and clinical course of AKI in critically ill neonates receiving ECMO support.MethodsThis study reviewed prospectively collected clinical data (including age, diagnosis, ECMO course, and serum creatinine (SCr)) of all ECMO-treated neonates within our institution spanning a 14-year period. AKI was defined by using the Risk, Injury, Failure, Loss of renal function, and End-stage renal disease (RIFLE) classification. SCr data were reviewed per ECMO day and compared with age-specific SCr reference values. Accordingly, patients were assigned to RIFLE categories (Risk, Injury, or Failure as 150%, 200%, or 300% of median SCr reference values). Data are presented as median and interquartile range (IQR) or number and percentage.ResultsOf 242 patients included, 179 (74%) survived. Median age at the start of ECMO was 39 hours (IQR, 26 to 63); median ECMO duration was 5.8 days (IQR, 3.9 to 9.4). In total, 153 (64%) patients had evidence of AKI, with 72 (30%) qualifying as Risk, 55 (23%) as Injury, and 26 (11%) as Failure. At the end of the study period, only 71 (46%) patients of all 153 AKI patients improved by at least one RIFLE category. With regression analysis, it was found that nitric oxide ventilation (P = 0.04) and younger age at the start of ECMO (P = 0.004) were significant predictors of AKI. Survival until intensive care unit discharge was significantly lower for patients in the Failure category (35%) as compared with the Non-AKI (78%), Risk (82%), and Injury category (76%), with all P < 0.001, whereas no significant differences were found between the three latter RIFLE categories.ConclusionsTwo thirds of neonates receiving ECMO had AKI, with a significantly increased mortality risk for patients in the Failure category. As AKI during childhood may predispose to chronic kidney disease in adulthood, long-term monitoring of kidney function after ECMO is warranted.

Chronic Kidney Disease—A Challenge for All Ages

OVER THE PAST DECADE, CHRONIC KIDNEY DISEASE (CKD), defined as impaired glomerular filtration rate (GFR) or elevated urine albumin excretion, has been increasingly recognized as an important risk factor contributing to cardiovascular disease and death. Moreover, the prevalence of CKD has increased, with CKD now affecting approximately 13.1% of Americans. This increase has been driven by the increasing prevalence of the most common risk factors for CKD, including diabetes, hypertension, and—perhaps most important—older age. Among US adults aged 70 years or older, the prevalence of CKD has been estimated to be more than 45%. However, the clinical implications of CKD in elderly persons remain uncertain. In particular, substantial controversy exists regarding whether CKD represents a true disease or whether loss of GFR is simply part of the natural aging process. In this issue of JAMA, the CKD Prognosis Consortium provides valuable new data regarding the importance of CKD in older adults. Based on findings from more than 2 million participants from 46 cohorts, the authors report that among older adults, CKD is associated with excess mortality risks that are as high as or higher than the excess risks observed among middle-aged adults. For example, after accounting for a number of potential confounding variables, for participants aged 18 to 54, 55 to 64, 65 to 74, or 75 or more years at baseline, an estimated GFR of 45 vs 80 mL/min/1.73 m was associated with 9.0, 12.2, 13.3, or 27.2 additional estimated deaths per 1000 person-years of follow-up, respectively. These data, combined with knowledge that CKD is more prevalent with advancing age, identify older adults as a population for which CKD has exceptional individual and public health importance. Risks of end-stage renal disease (ESRD) were also examined by age. For older adults, absolute incidence rates of ESRD were substantially lower than absolute mortality rates. For example, for participants aged 75 years or older with an estimated GFR of 45 mL/min/1.73 m, the estimated average incidence rate of ESRD was 9.8 per 1000 personyears of follow-up, compared with an estimated average mortality rate of 85.0 per 1000 person-years. In addition, associations of CKD with risk of ESRD were attenuated comparing older with younger participants. These data are consistent with prior reports demonstrating that older adults are less likely to receive kidney replacement treatment for ESRD than younger individuals and that the poor outcomes of older adults with CKD occur predominantly without progression to treated ESRD. The CKD Prognosis Consortium study has 2 main salient features. First, it analyzes data across 46 cohort studies that include more than 2 million participants. This yields results that are broadly applicable and provides adequate statistical power to evaluate whether the association of CKD with health outcomes varies by age. Second, excess risk is evaluated on the clinically relevant additive scale, in addition to the more commonly applied relative scale. Differences in absolute risk calculated on the additive scale reflect the marginal risk of a risk factor, such as CKD, accounting for the “baseline” risk among unexposed members of a population. These absolute risk differences can be easily compared with those of other risk factors or, in the case of treatment studies, can be used to directly compare benefits with harms and calculate the number needed to treat. Moreover, if an exposure is assumed to be causally related to the outcome examined, the absolute risk difference most meaningfully captures the public health benefit that could be achieved by preventing or effectively treating the risk factor. What should the medical community conclude from the new data? Older adults with CKD should be recognized as patients at high risk of death. In CKD, excess mortality risk is largely attributable to cardiovascular disease, although other disease pathways are also important. Therefore, all efforts should be made to apply treatment strategies that are proven effective for the primary or secondary prevention of cardiovascular disease in this population and are appropriate to the individual. These may

Trends in the prevalence of chronic kidney disease in Korean adults: the Korean National Health and Nutrition Examination Survey from 1998 to 2009

Chronic kidney disease (CKD) is associated with a poor quality of life and cardiovascular events and is a great threat to public health. We investigated the trends of CKD prevalence over 12 years in Korean adults at least 20 years old using sampling weight methods based on the Korean National Health and Nutrition Examination Survey (KNHANES) I (1998), II (2001), III (2005) and IV (2007-09). Of the 135 954 subjects participating in KNHANES I-IV, 33 276 (14 307 men, 18 969 women) were included in the present study. The percentage of glomerular filtration rate (GFR) <60 mL/min/1.73 m(2) in KNHANES I-IV was 1.0, 5.4, 3.1 and 2.6% in men and 3.4, 9.7, 10.2 and 4.6% in women, respectively. The percentage of proteinuria ≥ 1+ measured by a dipstick method across KNHANES phases gradually declined in men (3.1, 3.0, 2.8 and 2.2% in KNHANES I-IV, respectively), while those in women rebounded in KNHANES IV after reduction through KNHANES III (3.3, 2.3, 1.4 and 1.9%, respectively). The prevalence of CKD (GFR <60 mL/min/1.73 m(2) or proteinuria ≥ 1+) in KNHANES I-IV was 3.9, 7.9, 5.4 and 4.5% in men and 6.4, 11.3, 12.0 and 6.3% in women, respectively. After stratification by age (20-39 years, 40-59 years and ≥ 60 years), the prevalence trends were similar to those before the stratification by sexes. The prevalence of CKD in Korean adults has decreased since 2001 in men and since 2005 in women.

Screening for Chronic Kidney Disease: U.S. Preventive Services Task Force Recommendation Statement

New U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for chronic kidney disease (CKD). The USPSTF reviewed evidence on screening for CKD, including evidence on screening, accuracy of screening, early treatment, and harms of screening and early treatment. This recommendation applies to asymptomatic adults without diagnosed CKD. Testing for and monitoring CKD for the purpose of chronic disease management (including testing and monitoring patients with diabetes or hypertension) are not covered by this recommendation. The USPSTF concludes that the evidence is insufficient to assess the balance of benefits and harms of routine screening for CKD in asymptomatic adults (I statement).

A better diet quality is associated with a reduced likelihood of CKD in older adults

Background and aimsStudies of diet in relation to chronic kidney disease (CKD) have focused on individual nutrients. The relationship between overall patterns of food intake and renal function has not been well explored. We aimed to investigate the associations between diet quality with the prevalence, incidence and progression of CKD in a cohort of older adults. Methods and Results1952 participants aged ≥50 years at baseline were examined between 1992–1994 and 2002–2004. Dietary data were collected using a semi-quantitative food frequency questionnaire. A modified version of the Healthy Eating Index for Australians was developed to determine total diet scores (TDS). Baseline biochemistry including serum creatinine was measured. CKD was defined as MDRD estimated glomerular filtration rate (eGFR) <60 mL min−1.1.73 m−2.Participants in the highest quartile of mean TDS compared to those in the first quartile (reference), had a 41% reduced likelihood of having eGFR <60 mL min−1.1.73 m−2, [multivariable-adjusted odds ratio, OR, 0.59 (95% confidence intervals, CI, 0.41–0.85), P-trend = 0.005]. Each unit increase in TDS was associated with a 15% decrease in the odds of having prevalent CKD, multivariable-adjusted OR 0.85 (95% CI 0.74–0.97). A non-significant, inverse association between TDS and CKD incidence was observed (P-trend = 0.10). ConclusionOlder adults with better diet quality had a reduced likelihood of having eGFR <60 mL min−1.1.73 m−2. Adherence to dietary guidelines were not prospectively associated with CKD incidence or progression. Further studies with adequate power are warranted to assess the longitudinal association between diet quality and CKD.

Impact of metabolic syndrome on the incidence of chronic kidney disease: A Chinese cohort study

Metabolic syndrome (MetS) is a major culprit in cardiovascular disease and chronic kidney disease (CKD) in Western populations. We studied the longitudinal association between MetS and incident CKD in Chinese adults. A cohort study was conducted in a nationally representative sample of 4248 Chinese adults in Taiwan. The MetS was defined according to a unified criteria set by several major organizations and CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min per 1.73 m(2). Cox proportional hazards regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) adjusted for sex, age, body mass index (BMI) and serum levels of total cholesterol. The prevalence of MetS among participants at baseline recruitment was 15.0% (637/4248). During a median follow-up period of 5.40 years, 208 subjects (4.9%) developed CKD. The multivariate-adjusted HR of CKD in participants with MetS compared with those without was 1.42 (95% CI = 1.03, 1.73). Additionally, there was a significantly graded relationship between the number of the MetS components and risk of CKD. Further, the relation between MetS and incident CKD was more robust in subjects with BMI >27.5 kg/m(2) than in those with lower BMI. The results suggest that the presence of MetS was significantly associated with increased risk of incident CKD in a Chinese population. These findings warrant future studies to test the impact of preventing and treating MetS on the reduction of the occurrence of CKD.

Serum Fibroblast Growth Factor 21 Is Associated with Renal Function and Chronic Kidney Disease in Community‐Dwelling Adults

Serum Fibroblast Growth Factor 21 Is Associated with Renal Function and Chronic Kidney Disease in Community‐Dwelling Adults

Effects of multidisciplinary models of care for adult pre-dialysis patients with chronic kidney disease: a systematic review

To compare the effectiveness of multidisciplinary care with traditional medical care on the progression of chronic kidney disease (CKD) in adult pre-dialysis patients (stages 3-5). Eleven databases were searched for articles published between January 1990 and July 2009. The Joanna Briggs Institute-Meta Analysis of Statistics Assessment and Review Instrument was used to assess the methodological quality of retrieved articles and extract data. Only four articles out of 927 were included in the systematic review. Two reported the results of randomised controlled trials and two reported observational studies. The data were not presented in a format that allowed a meta-analysis to be performed and therefore a narrative summary of these articles is presented. Multidisciplinary care is deemed to be effective in delaying the progression of CKD in adults who are in the pre-dialysis phase of this condition. Education that aims to increase the knowledge and understanding of the causes of CKD is an important component of the care. Members of the multidisciplinary team should draw on their specific expertise to educate the patient about CKD. The nephrologist or a nurse practitioner should devise a management plan jointly with the patient and provide regular reviews.

Managing Older Adults With CKD: Individualized Versus Disease-Based Approaches

The last decade has seen the evolution and ongoing refinement of a disease-oriented approach to chronic kidney disease (CKD). Disease-oriented models of care assume a direct causal association between observed signs and symptoms and underlying disease pathophysiologic processes. Treatment plans target underlying disease mechanisms with the goal of improving disease-related outcomes. Because average glomerular filtrate rates tend to decrease with age, CKD becomes increasingly prevalent with advancing age and those who meet criteria for CKD are disproportionately elderly. However, several features of geriatric populations may limit the utility of disease-oriented models of care. In older adults, complex comorbid conditions and geriatric syndromes are common; signs and symptoms often do not reflect a single underlying pathophysiologic process; there can be substantial heterogeneity in life expectancy, functional status, and health priorities; and information about the safety and efficacy of recommended interventions often is lacking. For all these reasons, geriatricians have tended to favor an individualized patient-centered model of care over more traditional disease-based approaches. An individualized approach prioritizes patient preferences and embraces the notion that observed signs and symptoms often do not reflect a single unifying disease process and instead reflect the complex interplay between many different factors. This approach emphasizes modifiable outcomes that matter to the patient. Prognostic information related to these and other outcomes generally is used to shape rather than dictate treatment decisions. We argue that an individualized patient-centered approach to care may have more to offer than a traditional disease-based approach to CKD in many older adults.

Age, eGFR, and CKD Complications

Age, eGFR, and CKD Complications

Risk Factors for Chronic Kidney Disease in Adults with Cystic Fibrosis

Adults with cystic fibrosis (CF) possess multiple potential risk factors for chronic kidney disease, including CF-related diabetes (CFRD) and lifetime nephrotoxic drug exposure. To determine whether cumulative intravenous (IV) aminoglycoside exposure and CFRD increase the risk of chronic kidney disease in adults with CF. This was a cohort study using adults (≥ 18 yr) in the CF Foundation registry from 2001-2008. Chronic kidney disease (stage 3 or greater) was defined by an estimated glomerular filtration rate of less than 60 ml/min/1.73 m(2). Time-dependent multivariable Cox proportional hazards models were used to determine whether cumulative number of acute pulmonary exacerbations (surrogate for IV aminoglycoside exposure) and CFRD requiring insulin increase the risk of chronic kidney disease, adjusting for confounders. The study cohort included 11,912 adults with a median follow-up of 4 years. During the study period, 204 subjects had chronic kidney disease, with an annual disease prevalence of 2.3%. Disease prevalence doubled with every 10-year increase in age. CFRD requiring insulin therapy substantially increased the risk of chronic kidney disease (1-4 yr of CFRD requiring insulin vs. no CFRD, hazard ratio [HR] = 2.40, 95% confidence interval [CI] 1.74-3.32; ≥ 5 yr, HR = 4.56, 95% CI 2.84-7.31). Pulmonary exacerbations did not significantly increase the risk of chronic kidney disease (one to five exacerbations vs. none, HR = 0.79, 95% CI 0.56-1.11; six to nine exacerbations, HR = 0.92, 95% CI 0.58-1.46; ≥ 10 exacerbations, HR = 1.16, 95% CI 0.75-1.81). CF-related diabetes is a significant risk factor for chronic kidney disease in adults with CF, but additional studies examining IV aminoglycoside exposure directly are required.