Chronic Kidney Disease In Adults Research Articles

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.

Persistent albuminuria and chronic kidney disease in adults with sickle cell anaemia: Results from a multicenter natural history study.

Clinical and laboratory correlates of chronic kidney disease (CKD) in sickle cell anaemia remain incompletely defined. In a multicenter cohort study, we evaluated the prevalence of persistent albuminuria (PA) and characteristics associated with PA, albumin-creatinine ratio (ACR) and decreased estimated glomerular filtration rate (eGFR) using logistic, linear and multinomial regression models, respectively. Of 269 participants (median age: 30 years; 57.2% females), the prevalence of PA was 35.7%. Using baseline ACR values of <100 and ≥100 mg/g, the probabilities of PA were 30.0% and 94.6%, respectively. In multivariable logistic regression analyses, male sex (β = 0.80 [SE = 0.36], p = 0.024) and ACE inhibitors/ARBs use (β = 1.54 [SE = 0.43], p < 0.001) were associated with higher likelihoods of PA, while higher haemoglobin (β = -0.33 [SE = 0.13], p = 0.009) and HbF (β = -0.04 [SE = 0.02], p = 0.041) were associated with lower likelihoods of PA. In multivariable multinomial regression analyses, older age (β = 0.06 [SE = 0.02], p = 0.004) and higher alkaline phosphatase (β = 0.01 [SE = 0.00], p = 0.004) were associated with higher odds of having eGFR 60-90 versus eGFR>90 mL/min/1.73 m2 using the cystatin C-based CKD-EPI-2012 equation. Additionally, higher systolic blood pressure (β = 0.11 [SE = 0.03], p = 0.001) and blood urea nitrogen (β = 0.45 [SE = 0.12], p < 0.001) were associated with higher odds, while higher haemoglobin (β = -1.22 [SE = 0.43], p = 0.004) was associated with lower odds of having eGFR<60 versus eGFR>90 mL/min/1.73 m2. PA and decreased eGFR are associated with measures of disease severity and comorbid conditions (Clinicaltrials.gov Identifier: NCT03277547).

P-652 Chronic kidney disease and female reproductive hormonal profile: A multi-centre cohort study

Abstract Study question Does Chronic Kidney Disease (CKD) impact female reproductive hormone profiles? Summary answer Women with CKD had significantly lower AMH and testosterone, and significantly higher LH levels. There were no differences in FSH, oestradiol, prolactin and progesterone. What is known already Chronic diseases, such as CKD, is rising in women of reproductive age. It is expected that the prevalence of CKD in adults will increase to 16.7% in 2030.Coupled with improvements in obstetric care and advancement in assisted reproductive technology, more women with CKD are seeking to conceive with ART. It is known that CKD reduces fertility, but underlying mechanisms are not fully understood. It is proposed that CKD leads to dysregulation of the hypothalamus-pituitary-ovarian (HPO) axis, but studies are small, use outdated assays, are done at different times in the menstrual cycle and do not compare with healthy controls. Study design, size, duration Observational cohort study involving women with CKD and healthy women of reproductive age without underlying medical conditions was conducted between August 2021-September 2022.Women with CKD were identified from four units to attend a study visit at a tertiary fertility unit.Healthy controls were recruited via word of mouth and from couples within the unit undergoing treatment for male factor infertility.For the study to be powered 100 women with CKD and 50 healthy controls were recruited. Participants/materials, setting, methods Ethical approval was provided by the Health Research Authority (IRAS 285546) and written informed consent was obtained from participants.Serum Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), prolactin, testosterone, oestradiol, progesterone, Anti Mullerian Hormone (AMH) and b-HCG were taken between the first and fifth day of menstrual cycle. If there was amennorhoea, bloods were taken on a day suiting them. Comparisons between controls and CKD Stage utilised t-test and Mann Whitney U tests according to data-distribution. Main results and the role of chance 101 women with CKD and 63 healthy women were recruited. The mean age of women in the CKD group was 35.1± 6.7 years and of controls was 33.44 ±4.8 years, median BMI for CKD women was 25.45 kg/m2 (IQR 22.7,29.4) and controls was 24.5 kg/m2 (IQR 22,26.7).The renal cohort had similar numbers in each of the four CKD stages. 20.8% women had renal transplants.The two cohorts were matched for age and BMI. Median AMH (13.6(IQR 3,4,28.7) vs 18.4 (IQR 11.2,33.6) pmol/L;p=0.03) was significantly lower in the renal group than controls. Median testosterone concentrations (0.6 (IQR 0.5,0.9) vs 0.5 (IQR 0.4,0.7)nmol/L; p = 0.01) were significantly lower in women with CKD even from stage 1 CKD. LH (4.4 (IQR 3.2,5.5) vs 5.9 (IQR 3.8,9.4) IU/L;p=0.001) concentrations were significantly higher in women with CKD compared to controls but there were no differences in FSH, oestradiol, prolactin and progesterone. LH increased and testosterone and AMH concentrations fell with CKD severity. Interestingly, b-HCG was &amp;gt;6 IU/L in 3.0% (3/101) patients with CKD. When stratified by CKD stage; CKD stage 2 and onwards had significantly higher LH concentrations (p = 0.03).CKD stage 3 and above participants had significant lower AMH concentrations (p = 0.002).This is at a later stage of CKD than previously published. Limitations, reasons for caution Although this is the largest study of its kind known to explore female hormonal profiles in women with CKD, the numbers are still limited. In addition, our population had a mixed ethnic background but due to the small numbers we were unable to analyse the results per ethnic category. Wider implications of the findings This is the largest prospective study comparing fertility hormonal profiles in women with CKD and healthy controls. Unfortunately, there remains a paucity of evidence on the effects of CKD on female fertility. Future work includes exploring longitudinal changes which will better facilitate patients to make informed and timely fertility-related decisions. Trial registration number 285546

Prevention of Chronic Kidney Disease and Its Complications in Older Adults.

In an era marked by a global demographic shift towards an aging society, there is a heightened prevalence of chronic kidney disease (CKD) among older adults. The burden of CKD spans from kidney-related complications to impacting psychological well-being, giving rise to depressive symptoms and caregiver burnout. This article delves into CKD prevention strategies within the context of aging, contributing to the discourse by exploring its multifaceted aspects. The prevention of CKD in the older adults necessitates a comprehensive approach. Primary prevention is centered on the modification of risk factors, acknowledging the intricate interplay of various comorbidities. Secondary prevention focuses on early CKD identification. Tertiary prevention aims to address factors contributing to CKD progression and complications, emphasizing the importance of timely interventions. This comprehensive strategy aims to enhance the quality of life for individuals affected by CKD, decelerating the deterioration of functional status. By addressing CKD at multiple levels, this approach seeks to effectively and compassionately care for the aging population.

#939 Association between alcohol consumption and the risk of incident chronic kidney disease in community-dwelling older adults

Abstract Background and Aims The relationship between alcohol consumption and kidney function decline is not well established, especially in older adults. This study aimed to investigate the effects of alcohol consumption on the risk of incident chronic kidney disease (CKD) in community-dwelling older adults. Method Adults aged ≥ 65 years with an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 and without proteinuria between 2009 and 2010 were recruited and followed through December 2018 from a Korean national population-based cohort. Alcohol consumption was categorised into non-, mild, moderate, and heavy drinking groups based on self-administered questionnaires. New-onset CKD was defined as an eGFR &amp;lt;60 mL/min/1.73 m2. Results Of the total 122,319 subjects, the non-, mild, moderate, and heavy drinking groups were 99,091 (81.0%), 14,842 (12.1%), 4,257 (3.5%), and 4,139 (3.4%), respectively. During follow-up, 19,796 (20.0%), 4,636 (31.2%), 1,696 (39.8%), and 1,695 (41.0%) developed CKD in the non-, mild, moderate, and heavy drinking groups. Univariate Cox regression analyses showed a significantly increased risk of incident CKD in older adults in all drinking groups compared to non-drinkers (all P &amp;lt; 0.001). However, hazard ratios (HR) for developing CKD were 0.90 (95% confidence interval [CI] 0.87–0.94, P &amp;lt; 0.001) for mild, 0.89 (95% CI 0.84–0.95, P &amp;lt; 0.001) for moderate, and 0.93 (95% CI 0.88–0.99, P = 0.027) for heavy drinkers after fully adjusting for confounding variables. This inverse relationship between alcohol consumption and CKD risk was observed in males in all drinking groups, whereas in females it was found only in mild drinkers. Conclusion In the subgroup analysis, the beneficial effect of alcohol consumption on incident CKD was prominent among moderate drinkers aged 65–75 years, male mild drinkers aged ≥ 75 years, and female mild drinkers aged &amp;lt; 85 years. This study shows that alcohol consumption is inversely associated with the risk of incident CKD in older adults. Further studies are required to elucidate the effects of alcohol on kidney damage in older adults.

#1054 Dietary manganese intake and risk of chronic kidney disease: insights from the UK Biobank Study

Abstract Background and Aims Manganese, an essential trace element crucial for various physiological processes, has been linked to metabolic syndrome and cardiovascular health. Despite these associations, the relationship between dietary manganese intake and incident chronic kidney disease (CKD) remains unclear. In this study, the connection between dietary manganese consumption and the development of CKD in individuals with normal kidney function was investigated. Method A total of 135,577 participants enrolled in the UK Biobank were assessed. Dietary manganese intake was determined through a 24-hour dietary recall questionnaire and categorized into quartiles. Individuals with prevalent CKD or an estimated glomerular filtration rate (eGFR) &amp;lt;60 mL/min/1.73 m2 at baseline were excluded. The primary outcome was incident CKD diagnosed using ICD-10 and OPCS-4 codes. Incident CKD, defined as eGFR &amp;lt;60 mL/min/1.73 m2 or a urine albumin-to-creatinine ratio (UACR) ≥30 mg/g, was also evaluated in a sub-cohort that included eGFR and UACR follow-up data. Results During a follow-up period of 1,492,228 person-years (median, 11.2 years), incident CKD occurred in 4,900 (3.6%) participants. The incidence of CKD exhibited a progressive increase among individuals with low manganese intake (2.3, 3.0, 3.6, and 4.2 events per 1000 person-years in Q4–Q1, respectively). In a multivariate Cox proportional hazard model, the adjusted hazard ratios (95% confidence intervals) for the lowest, second, and third quartiles were 1.39 (1.26–1.54), 1.22 (1.11–1.34), and 1.12 (1.02–1.23), respectively, compared to the highest quartile. Similar findings were observed in relation to eGFR or UACR-defined CKD outcomes. Conclusion Lower dietary manganese consumption was found to be associated with an elevated risk of incident CKD in adults with normal kidney function. This implies that a deficiency in dietary manganese intake may contribute to an increased risk of CKD development.

#1215 Association between dietary magnesium intake and incident chronic kidney disease

Abstract Background and Aims Recent studies suggest a close association between low serum magnesium levels and kidney injury. However, whether dietary magnesium intake relates with kidney function is not well known. In this study, the relationship of dietary magnesium intake with the development of chronic kidney disease (CKD) was evaluated. Method This observational prospective study screened 210,965 European adults aged 40-70 who underwent dietary questionnaire from April 2009 to June 2012 in UK Biobank cohort. Participants with underlying CKD (baseline eGFR &amp;lt; 60 mL/min/1.73 m² or urine albumin-to-creatinine ratio &amp;gt;30 mg/g/Cr) or implausible energy intake (reported energy intake &amp;lt; 1.1 × basal metabolic rate [BMR] or 2.5 × BMR) were excluded. Dietary magnesium intake was assessed through online 24-hour recall dietary questionnaire and adjusted for energy intake using residual method. The participants were categorized into quartile according to energy-adjusted dietary magnesium intake. Primary outcome was incident CKD diagnosed through ICD-10 and OPCS-4 codes. Incident CKD defined as eGFR &amp;lt; 60 mL/min/1.73 m² was also assessed as an additional primary outcome in the sub-cohort with primary care creatinine follow-up data. Results A total of 114,916 participants was included in the final analysis. The median age was 57.0 (IQR, 50.0-63.0) years and 56.8% were female. Median magnesium intake amount per person was 345.6 (IQR, 296.8-402.5) mg/day. During a 1,095,128.6 person-year follow-up, CKD outcome occurred in 3,337 patients. Incidence of CKD was progressively lower in patients with higher magnesium intake (3.2%, 2.9%, 2.8%, and 2.7% in Q1-4, respectively). Cox regression analysis revealed that the hazard ratios (HRs) for incident CKD decreased in a stepwise manner towards higher magnesium intake quartiles (2Q: HR, 0.89; 95% CI, 0.81-0.98; 3Q: HR, 0.87; 95% CI, 0.0.79-0.95; 4Q: HR, 0.84; 95% CI, 0.76-0.92) relative to 1Q (P for trend &amp;lt; 0.001). This association was maintained even after adjustments were made for confounding factors. Similar results were observed with eGFR-defined CKD outcome (2Q: adjusted HR [AHR], 0.75; 95% CI, 0.64-0.89; 3Q: AHR, 0.73; 95% CI, 0.61-0.87; 4Q: AHR, 0.70; 95% CI, 0.58-0.85) relative to 1Q (P for trend &amp;lt; 0.001). Conclusion Higher intake of dietary magnesium may relate with lower risk of incident CKD in adults with normal kidney function.

#1427 Comparison of METS-IR and HOMA-IR for predicting new-onset CKD in middle-aged and older adults

Abstract Background and Aims Chronic kidney disease (CKD) has emerged as a mounting public health issue worldwide; therefore, prompt identification and prevention are imperative in mitigating CKD-associated complications and mortality rate. We aimed to compare the predictive powers of the homeostatic model assessment for insulin resistance (HOMA-IR) and the metabolic score for insulin resistance (METS-IR) for CKD incidence in middle-aged and older adults. Method This study used longitudinal prospective cohort data from the Korean Genome and Epidemiology Study. A total of 10,030 participants, aged 40–69 years, residing in the Ansung or Ansan regions of the Republic of Korea, were recruited between 2001 and 2002 through a two-stage cluster sampling method. We compared the predictive powers of METS-IR and HOMA-IR for CKD prevalence and incidence, respectively. CKD prevalence was measured by the area under the receiver operating characteristic (ROC) curve (AUC), and the indices’ predictive performance for CKD incidence were assessed using Harrell's concordance index and time-dependent ROC curve analysis. Results A total of 9261 adults aged 40–69 years at baseline and 8243 adults without CKD were included in this study. The AUCs and 95% confidence intervals (CIs) of HOMA-IR and METS-IR for CKD prevalence at baseline were 0.577 (0.537–0.618) and 0.599 (0.560–0.637), respectively, with no significant difference (p = 0.337). The Heagerty's integrated AUC for METS-IR in predicting CKD incidence was 0.772 (95% CI 0.750–0.799), which was significantly higher than that of HOMA-IR (0.767 [95% CI 0.742–0.791], p = 0.015). Conclusion METS-IR surpassed HOMA-IR in predicting CKD incidence and was as effective as HOMA-IR in predicting CKD prevalence. This implies that METS-IR could be a valuable indicator for early detection and prevention of CKD among Korean adults.

Association between blood pressure and new onset of chronic kidney disease in non-diabetic Japanese adults: A population-based longitudinal study from 1998 to 2023

Background and aimsHypertension is a risk factor for developing chronic kidney disease (CKD). Studies of adult participants in the USA reported that hypertension increased the risk of developing CKD even in the non-diabetic population. However, studies in non-diabetic populations are limited and additional studies in other races are required. This study aimed to examine the relationship between hypertension and the development of CKD in non-diabetic Asian adults. Methods and resultsIn this longitudinal study, non-diabetic Japanese adults who took annual checkups from 1998 to 2023 were included. CKD was defined as <60 mL/min/1.73 m2, and hypertension was classified into four levels according to the guidelines of the American College of Cardiology/American Heart Association. The Weibull accelerated failure time model was selected because the proportional hazards assumption was violated. Of the 7363 (men: 40.3%) people in the final cohort, 2498 (men: 40.1%) developed CKD after a mean follow-up of 7.99 years. Elevated blood pressure (BP) and hypertension stage 2 had a 9% (95% confidence interval [CI]: 1%–16%) and 11% (95% CI: 5%–17%) shorter survival time to CKD onset, respectively, than normal BP. Hypertension stage 1 also had a shorter survival to CKD onset by point estimate, but all 95% CIs crossed 1 in all models. ConclusionsIn a relatively healthy Asian population without diabetes, controlling BP to an appropriate range reduces the risk of developing CKD.

Establishment and application of a database for hereditary kidney disease in Chinese children

Hereditary kidney diseases are common causes of chronic kidney disease (CKD) in children and adolescents, and also has an important role in the onset and progression of CKD in adulthood. Constructing a data sharing registration system for hereditary kidney disease and forming representative data with Chinese population specificity, is of great significance for achieving phenotype and genotype characterization, improving precision management level and mechanism research. The high heterogeneity of the disease and the scattered distribution of patients have led to a lack of understanding and unified management standards for hereditary kidney disease. Led by pediatric nephrology specialists and geneticists, integrating data sources from various centers can leverage clinical resource advantages. Focusing on different subtype disease cohorts, integrating and analyzing data such as genotype, multi-omics, and clinical outcomes, can achieve breakthroughs in the key points of disease diagnosis and treatment.

Association between famine exposure during infancy and childhood and the risk of chronic kidney disease in adulthood.

Famine exposure in childhood is proven to be associated with multiple chornic disease in adult but has not been studied with chronic kidney disease (CKD). This study was conducted to identify the relationship between famine exposure during infancy and childhood - specifically, the Chinese famine of 1959-1961 - and the risk of adult-onset chronic kidney disease (CKD) among Chinese individuals. This study included 2937 individuals from the Qingdao Diabetes Prevention Program. They were stratified by birth year into infancy-exposed (1956-1958), childhood-exposed (1950-1955) and unexposed (1963-1971) groups. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. CKD was defined as an eGFR of <90 mL/min/1.73 m2 . The mean eGFR values for the infancy-exposed and childhood-exposed groups were 107.23 ± 12.53 and 103.23 ± 12.44 mL/min/1.73 m2 , respectively, both of which were lower than that of the unexposed group (114.82 ± 13.39 mL/min/1.73 m2 ; P < 0.05). In the crude model, the odds ratio (OR) for CKD was 2.00 (95% confidence interval (CI): 1.39-2.88) in the infancy-exposed group and 2.92 (95% CI: 2.17-3.93) in the childhood-exposed group. Further adjustments for urban/rural residence, body mass index, age, current smoking, type 2 diabetes, systolic blood pressure, diastolic blood pressure and total cholesterol did not significantly alter the association between famine exposure and CKD. The corresponding ORs were 1.71 (95% CI: 1.17-2.50) and 2.48 (95% CI: 1.81-3.40) for the infancy-exposed and childhood-exposed groups respectively. Famine exposure during infancy and childhood is associated with a long-term decline in eGFR and an increased adult-onset CKD risk. Early intervention for high-risk individuals may mitigate the risk of adult-onset CKD.

Factors Associated with the Development of Chronic Kidney Disease in Patients with Arterial Hypertension.

Chronic kidney disease affects a large part of the population with hypertension, diabetes mellitus as well as those over 50 years of age. Research reported that male sex and other comorbidities such as obesity and anemia are more frequent in Chronic kidney disease, as well as uncontrolled diabetes mellitus or hypertension. To determine the risk factors associated with the development of chronic kidney disease in adults with arterial hypertension. Retrospective cohort study of 455 patients with hypertension treated in a primary health care hospital. Medical records and laboratory information were reviewed for the diagnosis of chronic kidney disease and its staging. Patients aged 40 years and older, of both sexes and evaluated between the years 2015 -2017 were included. Logistic regression analysis allowed the identification of risk factors associated with the development of chronic kidney disease. 63.7% were female and 36.3% male. The average age for 2015 was 69.79 ± 9.03, more than half of participants had diabetes mellitus and controlled hypertension and the predominant nephroprotection was with Losartan (53%) that year. Male sex (OR 1.68, CI 1.03-2,76), age: 60 years or older (OR 6.38, CI 2.65-15,37) and anemia (OR 1.71, CI 1.03-2,85), were risk factors for the development of chronic kidney disease (p < 0.05), whereas nephroprotection (OR 0.39, CI 0.18-0,88) and controlled diabetes mellitus (OR: 0.18, CI 0.07-0,47) were shown to be protective factors (p < 0.05). The prevalence of chronic kidney disease between 2015 and 2017 was 19% and 45%, respectively, with predominance of category G2. The comparison group is the same cohort analyzed in each year under study. Male sex, age over 60 years, and anemia are risk factors for chronic kidney disease. Nephroprotection, controlled diabetes mellitus, and patient follow-up are factors that prevent its development.

Dietary Intake of Antioxidant Vitamins and Its Relation to the Progression of Chronic Kidney Disease in Adults With Preserved Renal Function

It is expected that antioxidants contribute to slow the progression of chronic kidney disease (CKD). However, there are no data on the protective effect of dietary antioxidant vitamins on CKD. The purpose of study was to evaluate the renoprotective effect of dietary antioxidant vitamins in the general population. The study participants were 127,081 Korean adults with preserved renal function with estimated glomerular filtration rate ≥60mL/min/1.73m2. They were categorized into 3 groups by tertile levels of dietary antioxidant vitamins intake including vitamins C, E, and A. Cox proportional hazard assumption was used to calculate multivariable hazard ratios and 95% confidence interval for the incident moderate to severe CKD (adjusted hazard ratio [95% confidence interval]) according to tertile levels of dietary intake of antioxidant vitamins. Subgroup analysis was conducted to evaluate the risk of progression from normal to mildly decreased renal function, and from mildly decreased renal function to moderate to severe CKD. The risk of moderate to severe CKD was not significantly associated with the third tertile of dietary antioxidant vitamin intake including vitamin C (1.02 [0.78-1.34]), E (0.96 [0.73-1.27]), and A (0.98 [0.74-1.29]). Additionally, any tertile groups didn't show the significant association with the risk of moderate to severe CKD. Subgroup analysis also didn't show the decreased risk of progression from normal to mildly decreased renal function, and from mildly decreased renal function to moderate to severe CKD in any tertile groups. Dietary intake of vitamins C, E, and A was not significantly associated with the risk of CKD progression.

Association between Whole Grain Intake and Chronic Kidney Disease

BackgroundThe relationship between whole grain intake and chronic kidney disease (CKD) remains uncertain. ObjectiveThis study aimed to evaluate the association between whole grain intake and risk of CKD in Chinese adults. MethodsThe present cross-sectional study used data from the China Health and Nutrition Survey conducted in 2009. Whole grain intake was measured using 3 consecutive 24-h dietary recalls and a household food inventory. A multivariable logistic regression model was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for risk of CKD. In addition, a restricted cubic spline was used to investigate the dose‒response relationship between whole grain and risk of CKD. ResultsA total of 6747 participants were included, 728 of whom had CKD. Compared with those in the lowest whole grain intake group, those in the higher grain intake group had an inverse association with risk of CKD (Q2: adjusted OR 0.70, 95% CI: 0.54, 0.89; Q3: adjusted OR 0.54, 95% CI: 0.42, 0.69; and Q4: adjusted OR 0.29, 95% CI: 0.21, 0.41). The association between whole grain intake and CKD seems to be stronger for individuals who were male (P for interaction = 0.008) or smokers (P for interaction = 0.013). In addition, the restricted cubic spline suggested an obvious L-shaped correlation. ConclusionsIncreased whole grain intake was associated with a decreased risk of CKD in Chinese adults.

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

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

Association of accelerometer-measured physical activity and its change with progression to chronic kidney disease in adults with type 2 diabetes and overweight/obesity

ObjectiveTo examine the long-term association of objectively measured moderate-to-vigorous physical activity (MVPA) and its longitudinal changes with progression to chronic kidney disease (CKD) in patients with type 2 diabetes (T2D)...

Epidemiology and clinical characteristics of biopsy-confirmed adult-onset IgA vasculitis in southern Sweden

ObjectiveImmunoglobulin A vasculitis (IgAV) is the most prevalent primary childhood vasculitis in Sweden, but is considerably rarer in adults. This study aims to describe the epidemiology, clinical characteristics and renal...

Association between dietary diversity and chronic kidney disease in community-dwelling older adults.

The present study examined whether dietary diversity is associated with chronic kidney disease (CKD) in community-dwelling older Japanese adults. Participants comprised 8,195 older adults (mean age was 74.0 ± 5.6years; 42.7% were men) in this cross-sectional study. In this study, CKD was defined as estimated Glomerular Filtration Rate (eGFR) < 45mL/min/1.73m2. Diet variety was assessed using the Food Frequency Score (FFS) (maximum, 30 points). The FFS assessed the one-week consumption frequency of ten foods (meat, fish/shellfish, eggs, milk, soybean products, green & yellow vegetables, potatoes, fruits, seafood, and fats & oil). Participants with an FFS of 16 or fewer points were defined as having low dietary diversity. The prevalence of CKD was 376 (4.6%), and the low dietary diversity group had higher prevalence (5.6%) compared with the high and low dietary diversity group (4.3%). Multiple logistic regression analysis revealed low dietary diversity was associated with CKD in older adults (OR 1.30, 95%CI 1.01-1.68). Stratified analysis showed that low dietary diversity was independently associated with CKD (OR 1.43, 95% CI 1.07-1.91) in older adults with hypertension, but not in adults without hypertension (OR 0.94, 95% CI 0.54-1.64). This cross-sectional study revealed that low dietary diversity was associated with CKD among older adults. Furthermore, low dietary diversity was associated with CKD among older adults with hypertension.

Association between blood metals mixture and chronic kidney disease in adults: NHANES 2013-2016

BackgroundThe association between single metal exposure and chronic kidney disease (CKD) has been established. However, there is limited research on the effects of multi-metal mixtures and their potential age-specific associations with kidney injury. This study aimed to examine the relationship between metal mixtures and kidney function in adults, while also exploring the modifying effects of age. MethodsWe included a subset (n = 4250) of a nationally representative adult population in the National Health and Nutrition Examination Survey (NHANES) 2013–2016. Kidney function was assessed using the glomerular filtration rate (eGFR) and creatinine albumin ratio (ACR). The individual and combined effects of lead (Pb), cadmium (Cd), mercury, and manganese on kidney injury and the risk of CKD were evaluated. ResultsPb and Cd were found to be positively associated with decreased kidney function. For a one Ln-unit increase in lead and cadmium, the adjusted ORs of CKD were 1.60 (95% CI: 1.35, 1.90) and 1.41 (95% CI:1.12, 1.77), respectively. We also observed an interaction between lead and cadmium for ACR. We also observed the joint effect between Pb and Cd on eGFR, ACR and CKD. Stratified analysis found a higher risk of decreased kidney function among older individuals. The quantile-g calculation model further showed that metal mixture was associated with decreased kidney function and the risk of CKD (OR = 1.53, 95% CI: 1.22, 1.90). And lead and cadmium were the main contributors. And Pb and Cd were the major components that increased the risk of CKD. ConclusionCo-exposure to metal mixture were associated with reduced kidney function in adults, especially in older. Our findings support co-exposure to lead and cadmium as risk factors of CKD in adults.

Serum vitamin C levels and their correlation with chronic kidney disease in adults: a nationwide study

Introduction Inflammation and oxidative stress play significant roles in the development of chronic kidney disease (CKD). Given the recognized antioxidant properties of vitamin C, our study aimed to explore the correlation between CKD and serum vitamin C levels. Methods Data were gathered from the 2017–2018 National Health and Nutrition Examination Survey. Participants below 18 years of age, pregnant individuals, those lacking essential data for CKD diagnosis, or individuals with incomplete serum vitamin C data were excluded. Subgroup and weighted multivariable logistic regression analyses were performed to assess the potential correlation between serum vitamin C and CKD. Results Our study comprised 4969 participants, revealing an overall CKD prevalence of 15.0%. The results indicated that individuals with reduced serum vitamin C levels were more likely to be male, possess lower educational attainment, have a diminished poverty-income ratio, engage in heavy drinking, and be current smokers. Additionally, they exhibited a higher prevalence of obesity and diabetes. Significantly, participants in the third quartile group experienced a 37.0%, 47.0%, and 46.6% decrease in the risk of developing albuminuria, low estimated glomerular filtration rate (eGFR), and CKD, respectively. Subgroup analysis demonstrated that individuals between 65 and 80 years of age showed a statistically reduced risk of developing CKD and low eGFR when their serum vitamin C levels fell in the third and fourth quartile groups. Conclusions Our findings reveal a correlation between elevated serum vitamin C levels and a decreased risk of developing albuminuria, low eGFR, and CKD. Appropriately increasing serum vitamin C levels may hold promise in protecting renal function, particularly among older individuals.