Chronic Kidney Disease In Adults Research Articles

Renal Function Is Preserved after Hematopoietic Stem Cell Transplantation for Sickle Cell Disease

Chronic kidney disease (CKD) is a common complication and a significant contributor to morbidity and mortality for patients with sickle cell disease (SCD). Hematopoietic stem cell transplantation (HSCT) is a curative strategy for SCD and potentially life-saving therapy. Though HSCT can reverse the SCD phenotype, acute and chronic kidney dysfunction may be an unintended consequence. The incidence of acute kidney injury (AKI) and the effect of different HSCT regimens on progression or amelioration of CKD in adults with SCD have not previously been reported. This cohort study analyzes prospectively collected data from 106 patients transplanted for SCD at the National Institutes of Health (NIH) Clinical Center, including HLA-matched sibling (N=71) and haploidentical HSCT (N=26) where nonmyeloablative conditioning was given, as well as gene therapy (N=9), where a myeloablative regimen was employed. Patients' renal function was assessed at baseline and annually thereafter for up to 3-years. We sought to define 1) the prevalence of CKD before and after HSCT 2) the incidence of CKD after HSCT 3) estimated glomerular filtration rate (eGFR) trends after HSCT 4) urine albumin to creatinine ratio (UACR) change after HSCT and 5) the incidence of AKI within 100 days of HSCT. We defined and staged AKI according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria (stage 1: 1.5-1.9 times baseline serum creatinine increase or ≥0.3 mg/dl increase; stage 2: 2-2.9 times baseline; stage 3: 3 times baseline, increase in creatinine to ≥4.0 mg/dl, or initiation of renal replacement therapy). The baseline prevalence of CKD was 6% when defined conservatively (eGFR <60 ml/min/1.73m2); this prevalence did not change significantly post-HSCT. When using a more comprehensive definition of CKD (urine albumin to creatinine ratio (UACR) ≥30 mg/g OR eGFR <60 ml/min/1.73m2), 48% had CKD at baseline, 62% at 1 year, 55% at 2 years, and 55% at 3 years (with p=0.02, 0.26, 0.54 for longitudinal model comparing post-HCST prevalence to baseline). The incidence of CKD any time after HSCT was 1% and 11% according to each of these CKD definitions, respectively. 25% of participants had follow-up of ≤2 years, median follow-up was 3 years. The median eGFR remained within the normal range throughout the follow-up period but declined annually: the baseline median eGFR was 139.7 ml/min/1.73m2 and declined by 7.6, 11.6, and 20.9 ml/min/1.73m2 each year post-HSCT (p<0.0001). In an adjusted regression analysis, there was no association of gender, engraftment status, transplant regimen, or conditioning agent- specifically use of pentostatin, total body irradiation, or post-transplant cyclophosphamide- with worsening eGFR (p>0.05 for each variable). This eGFR trend represents an improvement in renal function toward the normal range: there was a statistically significant decrease in hyperfiltration (eGFR ≥150 ml/min/1.73m2), which was present in 34% patients at baseline but steadily declined to 12% by 3 years post-HSCT (p = 0.0006 for adjusted longitudinal model). There was a corresponding increase in patients with normal eGFR (60-149 ml/min/1.73m2) from 60% at baseline to 80% at 3 years post-HSCT. UACR showed an increase in the year following transplant that subsequently dissipated. Median UACR at baseline was 24.3 mg/g with annual follow-up median values of 62.2, 38.9 and 36.2 mg/g (p-values of 0.007, 0.41, and 0.69 for comparison to baseline from regression model of log transformed UACR). In our cohort, 58% of patients experienced AKI in the first 100 days post-HSCT; which is consistent with previous data. 77% of those were mild, stage 1; 13% were moderate, stage 2; and 10% were severe, stage 3 AKI. This study demonstrates that HSCT in patients with SCD is not associated with a significant increase in CKD incidence or prevalence at 2 and 3 years post-HSCT. While there is a substantial decline in eGFR from baseline to each annual follow-up, the proportion of patients whose eGFR was in the normal range increased and the prevalence of hyperfiltration decreased. The stability of UACR after an initial increase at the 1-year time point further suggests that even more mild renal damage may stabilize after transplant. Finally, AKI occurred in over half of the patients in our cohort, though the preponderance developed mild AKI. Disclosures Diamantidis: United Health Group: Membership on an entity's Board of Directors or advisory committees.

Chronic kidney disease in adults aged 18 years and older in Chile: findings from the cross-sectional Chilean National Health Surveys 2009-2010 and 2016-2017.

ObjectivesThis study estimates the prevalence of chronic kidney disease (CKD) among Chilean adults and examines its associations with sociodemographic characteristics, health behaviours and comorbidities.DesignAnalysis of cross-sectional data from the two most recent large nationally representative Chilean Health Surveys (Encuesta Nacional de Salud, ENS) 2009–2010 and 2016–2017.ParticipantsAdults aged 18+ years with serum creatine data (ENS 2009–2010: n=4583; ENS 2016–2017: n=5084).Primary and secondary outcome measuresReduced kidney function (CKD stages 3a–5) based on the estimated glomerular filtration rate (eGFR <60 mL/min/1.73 m2) was the primary outcome measure. Using the urine albumin-to-creatinine ratio (ACR ≥30 mg/g), increased albuminuria was ascertained among adults aged 40+ years with diabetes and/or hypertension. Both outcomes were analysed using logistic regression with results summarised using OR. CKD prevalence (stages 1–5) among adults aged 40+ years was estimated including participants with an eGFR of >60 mL/min/1.73 m2 but with increased albuminuria (stages 1–2).ResultsOverall, 3.2% (95% CI: 2.4% to 3.8%) of adults aged 18+ in ENS 2016–2017 had reduced kidney function. After full adjustment, participants with hypertension (OR: 2.37; 95% CI: 1.19 to 4.74) and those with diabetes (OR: 1.66; 95% CI: 1.03 to 2.66) had significantly higher odds of reduced kidney function. In ENS 2016–2017, 15.5% (13.5% to 17.8%) of adults aged 40+ years with diabetes and/or hypertension had increased albuminuria. Being obese versus normal-weight (OR: 1.66; 95% CI: 1.08 to 2.54) and having both diabetes and hypertension versus having diabetes alone (OR: 2.30; 95% CI: 1.34 to 3.95) were significantly associated with higher odds of increased albuminuria in fully-adjusted analyses. At least 15.4% of adults aged 40+ years in ENS 2016–2017 had CKD (stages 1–5), including the 9.6% of adults at CKD stages 1–2.ConclusionsPrevention strategies and Chilean guidelines should consider the high percentage of adults aged 40 years and older at CKD stages 1–2.

Prevalence of chronic kidney disease in adults in England: comparison of nationally representative cross-sectional surveys from 2003 to 2016

ObjectivesTo identify recent trends in chronic kidney disease (CKD) prevalence in England and explore their association with changes in sociodemographic, behavioural and clinical factors.DesignPooled cross-sectional analysis.SettingHealth Survey for England 2003,...

Associations of accelerometer-measured physical activity and sedentary time with chronic kidney disease: The Framingham Heart Study.

BackgroundFew studies examined the individual and conjoint associations of accelerometer-measured physical activity (PA) and sedentary times with the prevalence of chronic kidney disease (CKD) among older adults.MethodsWe evaluated 1,268 Framingham Offspring Study participants (mean age 69.2 years, 53.8% women) between 2011 and 2014. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.732 and/or urine albumin-to-creatinine ratio (UACR) ≥25/35 μg/mg (men/women). We used multivariable logistic regression models to relate time spent being sedentary and active with the odds of CKD. We then performed compositional data analysis to estimate the change in the eGFR and UACR when a fixed proportion of time in one activity behavior (among the following: moderate to vigorous physical activity [MVPA], light intensity physical activity [LIPA], and sedentary) is reallocated to another activity behavior.ResultsOverall, 258 participants had prevalent CKD (20.4%; 120 women). Higher total PA ([MVPA+LIPA], adjusted-odds ratio [OR] per 30 minutes/day increase, 0.86; 95% CI, 0.78–0.96) and higher LIPA (OR per 30 minutes/day increase, 0.87; 95% CI, 0.76–0.99) were associated with lower odds of CKD. Additionally, higher sedentary time (OR per 30 minutes/day increase, 1.16; 95% CI, 1.04–1.29) was associated with higher odds of CKD. Reallocating 5% of the time from LIPA to sedentary was associated with the largest predicted difference in eGFR (-1.06 ml/min/1.73m2). Reallocating 1% of time spent in MVPA to sedentary status predicted the largest difference in UACR (14.37 μg/mg).ConclusionThe findings suggest that increasing LIPA and maintaining MVPA at the expense of sedentary time may be associated with a lower risk of CKD in community-based older adults.

Prevalence and Risk Factors of CKD in South Kivu, Democratic Republic of Congo: A Large-Scale Population Study

BackgroundThe prevalence of chronic kidney disease (CKD) in African American individuals is high but whether this applies to native populations in sub-Saharan Africa is unclear.MethodsIn a cross-sectional study, we assessed the prevalence and risk factors of CKD in rural and urban adults in South Kivu, Democratic Republic of Congo. Glomerular filtration rate (GFR) was estimated using the CKD–Epidemiology Collaboration (CKD-EPI) equations based on serum creatinine (eGFRcr), cystatin C (eGFRcys), or both markers (eGFRcr-cys), without ethnic correction factor. CKD was defined as an eGFR <60 ml/min per 1.73 m2 and/or albuminuria (albumin-to-creatinine ratio ≥30 mg/g).ResultsA total of 1317 participants aged 41.1 ± 17.1 years (730 rural, 587 urban) were enrolled. The prevalence of hypertension (20.2%; 95% confidence interval [CI], 18–22.3), diabetes mellitus (4.3%; 95% CI, 3.2–5.4) and obesity (8.9%; 95% CI, 7.4–10.5) was higher in urban than rural participants (all P < 0.05). HIV infection prevalence was 0.41% (95% CI, 0.05–0.78). The prevalence of eGFRcr <60 ml/min per 1.73 m2 was 5.4% (95% CI, 4.2–6.7). The prevalence of albuminuria was 6.6% (95 % CI, 5.1–8.1). The overall prevalence of CKD was 12.2% (95% CI, 10.2–14.2) according to CKD-EPIcr. Factors independently associated with CKD-EPIcr were older age (adjusted odds ratio [aOR], 1.05 [1.04–1.07]), urban residence (aOR 1.86 [1.18–2.95]), female sex (aOR 1.66 [1.04–2.66]), hypertension (aOR 1.90 [1.15–3.12]), diabetes (aOR 2.03 [1.02–4.06]), and HIV infection (10.21 [2.75–37.85]). The results based on eGFRcys or eGFRcr-cys were largely consistent with the preceding.ConclusionOverall, the burden of CKD is substantial (>11%), predominantly in the urban area, and largely driven by classic risk factors (gender, aging, HIV, hypertension, and diabetes).

P0688GREATER MUSCLE STRENGTH IS ASSOCIATED WITH LOWER RISK OF CHRONIC KIDNEY DISEASE

Abstract Background and Aims Frailty is a known risk factor for chronic disease and mortality. However, the association between frailty assessed by hand grip strength (HGS) and chronic kidney disease (CKD) among adults has not been elucidated. This study evaluated the association between muscle strength and the risk of CKD. Method Data were retrieved from a nationwide cohort study (Korean National Health and Nutrition Examination Surveys VI-VII, 2014-2017) and participants aged 40 to 80 years were included in the study analysis (male=6,660, female=8,195). HGS was measured using digital hand dynamometer and normalized to body mass index (BMI). The association between the risk of CKD (estimated glomerular filtration rate [eGFR] &amp;lt;60 mL/min/1.73 m2 or the presence of proteinuria) and quartile of HGS per BMI was evaluated among male and female subjects. Results The mean age was 58.8 ± 11.6 years and mean eGFR level was 88.2 ± 18.7 mL/min/1.73 m2. The mean levels of HGS per BMI were 1.5 ± 0.3 and 0.9 ± 0.2 in male and female subjects, respectively. Those in higher quartile of HGS per BMI showed lower prevalences of advanced CKD stages than lowest quartile among both male and female subjects. When univariable logistic regression analysis for the risk of CKD was performed, higher quartile of HGS per BMI was significantly associated with lower risk of CKD in both male and female subjects. After adjustment for confounding factors including age, systolic blood pressure, smoking and alcohol intake, education and income levels, history of hypertension, diabetes, or arthritis, physical activity, baseline eGFR, total cholesterol, hemoglobin, and daily protein intake, the higher quartile of HGS per BMI were associated with lower risk of CKD in both male and female subjects (odds ratio [OR], 0.66; 95% confidence interval [CI], 0.49-0.88 in Q4; OR, 0.64; 95% CI 0.49-0.83 in Q3 in male; OR, 0.59; 95% CI, 0.43-0.81 in Q4; OR, 0.61; 95% CI, 0.47-0.80 in Q3; OR, 0.70;95% CI, 0.55-0.90 in Q2 in female, Q1 as reference group). These associations were consistent when the HGS per BMI was treated as continuous variable that 34% and 54% of risk was reduced as 1 m2 increase in male and female subjects. Conclusion Greater muscle strength normalized to BMI is associated with lower risk of CKD in adults. These findings suggest that frailty in adults is an important risk factor for CKD development.

P0857BURDEN OF ANEMIA ASSOCIATED WITH CHRONIC KIDNEY DISEASE IN DIALYSIS AND NON-DIALYSIS-DEPENDENT PATIENTS IN EUROPE: A REVIEW OF PUBLISHED EVIDENCE

Abstract Background and Aims Anaemia is a frequent complication in patients with chronic kidney disease (CKD). The aim of this literature review was to understand the prevalence and burden of anaemia associated with CKD, with a further focus on Europe. Method A targeted literature review was conducted to identify publications on prevalence estimates (search: January 2015 to August 2018), and a systematic literature review was performed to identify publications on humanistic and healthcare resource use (HRU) burden (search: from database inception to July 2018) using MEDLINE®, Embase®, Cochrane Library, and conference proceedings. These were complemented by grey literature searches. Citations were screened per predefined criteria to include observational studies and reviews. Case series/reports and conceptual model studies were excluded. The study population included patients with anaemia associated with CKD, irrespective of CKD stage, dialysis status, or modality. All searches were funded by GSK. Results After applying all inclusion and exclusion criteria, 18 publications were retained that contained prevalence data, of which 9 provided European data. Based on 9 publications, the prevalence of anaemia associated with CKD in European adults was reported to range from 12.8% to 61.5% (Figure). Prevalence was higher in older individuals (aged &amp;gt;60 years) and increased with more advanced CKD stages. However, the methodology used to identify anaemia was not consistent across studies. Anaemia was identified based on varying thresholds of haemoglobin (Hgb) levels per different clinical guidelines (Kidney Disease Improving Global Outcomes [KDIGO], N=4; World Health Organization [WHO], N=2; European Best Practice Guidelines [EBPG], N=3), use of anaemia treatment, or Hgb thresholds without a reference to a specified guideline. Most studies focused on later-stage CKD patients (3 − 5), with only 2 studies reporting rates for stage 1 and 2 patients. A total of 50 publications provided data on humanistic and HRU burden, 6 of which provided European data. The literature on humanistic and HRU burden showed adults with anaemia associated with CKD had significantly poorer health-related quality of life (HRQoL) compared with those without anaemia, with significantly lower Kidney Disease Quality of Life (KDQoL) scores reflecting poorer HRQoL observed in the following domains: symptoms/problems, effect of kidney disease, and burden of kidney disease. This finding was consistent irrespective of instrument used for HRQoL assessment. However, tools used were not specific to anaemia or anaemia associated with CKD, and publications did not mention whether thresholds for clinical meaningfulness had been identified and/or met. Publications on HRU in anaemia associated with CKD in Europe were sparse (N=1): this single published study reported increased HRU in CKD patients with anaemia compared with CKD patients without anaemia. Conclusion Prevalence rates of anaemia associated with CKD reported in Europe vary, with increased prevalence in later stages of CKD. Anaemia negatively impacts patient QoL and leads to increased HRU in patients with CKD. More data are needed to characterise anaemia in earlier stages of CKD and across different populations (e.g. patients with particular comorbidities or undergoing different types of dialysis) in European countries. Due to varied definitions of anaemia, it would be of interest to evaluate the extent of underdiagnosis and its impact on prevalence rates.

No stone unturned: The epidemiology and outcomes of paediatric urolithiasis in Manchester, United Kingdom

The epidemiology and risk factors for paediatric urolithiasis (UL) in developed countries are evolving, with increasing rates of metabolic stone-formers. In the United Kingdom (UK), only a single London cohort has been studied in the past three decades. Regional disease patterns across the UK remain unknown. UL has been associated with an increased risk of chronic kidney disease in adults, but long-term paediatric outcomes remain poorly understood. We assessed the epidemiology of paediatric UL by defining the demographics, incidence, aetiology, recurrence rates and outcomes at tertiary nephro-urology centres in Greater Manchester. Health records of 177 consecutive paediatric urology referrals (0-18 years) for UL between 2002 and 2015 were retrospectively included for observational analysis. Metabolic screening was performed in 105 children. The incidence of paediatric urology referrals for UL was 1.77/100,000 person-years, increasing annually by 13.6%. Mean patient age was 8.2 years and the male:female ratio was 1.3:1. The upper urinary tract was involved in more than 90% of cases and 45% of children presented with multiple calculi. Metabolic abnormalities were identified in 52% of children screened: hypercalciuria (64%), hyperoxaluria (18%) and cystinuria (11%) were the most common. Significant family history was predictive of metabolic abnormalities (OR 4.9:1, 95% CI 1.4-17.0). 30% of children had infective stones, which were more common in children less than 6 years. Ultrasound was found to be 90% sensitive for UL detection. Dimercaptosuccinic acid (DMSA) imaging identified renal scarring in 33 of the 55 children tested (60%). Recurrence was observed in 18% of children over mean 6.4 year follow-up and was more common in metabolic stone-formers. Spontaneous passage was observed in 83% of stones ≤ 5mm, 69% between 5 and 10mm and only one calculi > 10mm. The incidence of paediatric urology referrals for UL is rising in North West England. Metabolic abnormalities were detected in half of the children tested, justifying comprehensive screening. Recurrence is common following paediatric UL, reinforcing the need for stone prevention strategies. The majority of calculi less than 10mm were found to pass spontaneously with supportive measures, which favours an initial observation period over surgical intervention for small calculi. UL was associated with renal scarring in the analysed population and therefore, children with UL require long-term assessment of blood pressure and proteinuria.

Advances of the experimental models of idiopathic membranous nephropathy (Review).

Idiopathic membranous nephropathy (IMN) is one of the main types of chronic kidney disease in adults and one of the most common causes of end-stage renal disease. In recent years, the morbidity of IMN among primary glomerular diseases has markedly increased, while the pathogenesis of the disease remains unclear. To address this, a number of experimental models, including Heymann nephritis, anti-thrombospondin type-1 domain-containing 7A antibody-induced IMN, cationic bovine serum albumin, anti-human podocyte antibodies and zymosan-activated serum-induced C5b-9, have been established. This review comprehensively summarized the available animal and cell models for IMN. The limitations and advantages of the current models were discussed and two improved models were introduced to facilitate the selection of an appropriate model for further studies on IMN.

Association between exposure to the Chinese famine during early life and the risk of chronic kidney disease in adulthood

Background and objectivesFamine exposure in human early life is proven to be associated with urinary protein concentration and renal function but has not been studied with chronic kidney disease. We aimed to explore the association between exposure to the Chinese famine (from 1959 to 1962) in early life and the risk of chronic kidney disease in adulthood.Design, setting, participants, and measurements: We selected 6267 participants from the baseline survey of China Health and Retirement Longitudinal Study (CHARLS) 2011–2012. Based on the birth year, they were divided into fetal exposed, preschool exposed, school-aged exposed, and non-exposed groups. The estimated glomerular filtration rate (eGFR) was calculated according to Japanese coefficient–modified Chronic Kidney Disease Epidemiology Collaboration equation. Chronic kidney disease (CKD) was defined as eGFR less than 60 mL/min per 1.73 m2. ResultsThe prevalence of CKD in fetal exposed, preschool exposed, school-aged exposed and non-exposed groups was 4.27%, 5.41%, 9.65% and 2.42%, respectively. The risk of CKD in fetal exposed, preschool exposed and school-aged exposed groups was significantly higher than the non-exposed group. In addition, after stratification by gender and famine severity, we found that only fetal exposure to the severe famine was associated with the elevated risk of CKD among male adults (OR 4.44, 95%CI 1.10–17.92, P < 0.05), even after adjusting for age, marital status, household per capita income, history of kidney disease, hypertension, diabetes or abnormal glucose tolerance, smoking, drinking, rural/urban residence and highest educational attainment of parents. ConclusionsSevere famine exposure as a fetus might increase the risk of chronic kidney disease in male adults.

Dietary Patterns and Risk of Chronic Kidney Disease Among Tehranian Adults with High Blood Pressure.

BackgroundAlthough high blood pressure is an important risk factor for chronic kidney disease (CKD), it remains unclear whether diet can still influence the risk of CKD in adults with high blood pressure.ObjectivesThis study aimed at investigating the association between major dietary patterns and the incidence of CKD in adults with high blood pressure.MethodsIn this cross-sectional study, we recruited 1,521 subjects aged ≥ 27 years with high blood pressure and with preserved estimated glomerular filtration rate at baseline, who participated in the fourth examination survey of the Tehran Lipid and Glucose Study. The principal component analysis was performed to derive dietary patterns. High blood pressure was defined as systolic blood pressure ≥ 120, diastolic blood pressure ≥ 80, or the current use of antihypertensive drugs. Multiple logistic regression analysis was applied to investigate the association between the dietary pattern scores and CKD risk.ResultsAfter 3.6 years of follow-up, the incidence of CKD was 16.8%. Three dietary patterns were produced by using factor analysis, including the Western, the healthy, and the traditional Iranian dietary patterns. The healthy and the traditional Iranian dietary patterns were not related to the risk of CKD, but scoring on the Western dietary pattern was associated with enhanced odds of CKD, after being adjusted for relevant confounders (odds ratio: 2.12; 95% confidence interval: 1.19 - 3.76).ConclusionsResults of this study provided evidence that a high score on the Western dietary pattern was associated with an increased risk of CKD in adults with high blood pressure.

Dietary Total Antioxidant Capacity and Its Association with Renal Function and Progression of Chronic Kidney Disease in Older Adults: a Report from a Developing Country.

While evidence exists for an association between the dietary total antioxidant capacity (DTAC), mortality, metabolic syndrome, and cardiovascular diseases, data about DTAC and renal function, and progression of chronic kidney disease (CKD) are scarce. This study aimed to determine the associations between DTAC, renal function, and progression of CKD in older adults. The present cross-sectional study consisted of 226 older adults aged ≥ 60 years old from five districts of Tehran, Iran. DTAC was estimated using the oxygen radical absorbance capacity (ORAC) method. Dietary intake, socio-demographic data, medical history, and anthropometric measurements were collected using a validated questionnaire. The estimated glomerular filtration rate (eGFR) was assessed from serum creatinine. Albumin to creatinine ratio (ACR) was calculated by dividing albumin concentration by creatinine concentration and reported as mg/g. The DTAC ranged from 112.8 to 2,553.9. Analyses indicated that DTAC was not associated with eGFR (p = 0.35) and ACR (p = 0.91) even after controlling for confounding variables. Additionally, in logistic regression, no association between eGFR < 60 mL/min/1.73 m2 (p = 0.32) and ACR ≥ 30 mg/g (p = 0.32) with DTAC was observed, which was independent of confounding variables. We observed that more compliance with DTAC is not associated with renal function and CKD progression. Further studies are needed to confirm the findings of the present study in larger samples on different populations.

Chronic interstitial nephritis of nontraditional causes in Salvadoran agricultural communities.

In El Salvador, a form of chronic kidney disease (CKD) of nontraditional causes (CKDnt) affecting farmers is being reported. Its behavior has been epidemic and is responsible for tens of thousands of deaths. This article summarizes the results obtained from a series of studies conducted to identify the epidemiology and clinical behavior of this disease, proposing a case definition and an etiopathogenic hypothesis. Methods included a survey of CKD in agricultural communities studying 2,388 people ≥18 years and 1,755 < 18, a descriptive clinical study followed by histopathological assessment conducted in 46 possible cases of CKDnt ≥18 years, and a national survey to study the prevalence of CKD and associated risk factors in 4,817 participants ≥ 20 years followed by a nested case-control study. In the agricultural communities, the prevalence of CKD in adults was 18% (men: 23.9%, women: 13.9%), 26.8% in agricultural workers (non-agricultural 13.8%), CKDnt accounted for 51.9% of cases. CKD in the population < 18 years was 3.9% (mean estimated glomerular filtration rate > 160 mL/1.73m2). The national CKD prevalence was 12.6% (urban: 11.3%; rural: 14.4%; males: 17.8%, females 8.5%), and CKDnt was only 3.8%; with associations between CKD and exposure to agrochemicals. The clinical study revealed the presence of markers of kidney damage (A3 albuminuria: 80.4%; β2-microglobulin: 78.2%), urine electrolyte anomalies (100% hypermagnesuria, 45.7% hypernatriuria, 43.5% osmotic polyuria), abnormal osteotendinous reflexes (45.7%), sensorineural hearing loss (56.5%), and damage of the tibial arteries by Doppler imaging (66.7%). Biopsies revealed a chronic tubulointerstitial nephropathy. The etiopathogenesis of CKDnt is possibly multifactorial, including environmental contamination by agrochemicals, heat stress, and dehydration.

Prenatal glucocorticoid administration accelerates kidney development in the fetal rats.

The hypothesis of the "development origins of health and diseases" addresses the risk of chronic kidney disease in adulthood. Although prenatal glucocorticoid (GC) therapy has shown to prevent infant respiratory injury in the neonate, the effects of the kidney functions remains unknown. This study aimed to investigate whether prenatal GC administration is associated with fetal kidney maturation.

Clinical Characteristics of and Risk Factors for Chronic Kidney Disease Among Adults and Children

Chronic kidney disease (CKD) is serious and common, yet recognition and public health responses are limited. To describe clinical features of, prevalence of, major risk factors for, and care for CKD among patients treated in 2 large US health care systems. This cohort study collected data from the Center for Kidney Disease Research, Education, and Hope (CURE-CKD) registry, an electronic health record-based registry jointly curated and sponsored by Providence St Joseph Health and the University of California, Los Angeles. Patients were adults and children with CKD (excluding end-stage kidney disease) and adults at risk of CKD (ie, with diabetes, hypertension, or prediabetes) identified by laboratory values, vital signs, prescriptions, and administrative codes. Data were collected from January 2006 through December 2017, with analyses performed from March 2019 through November 2019. Diabetes, hypertension, and prediabetes. Clinical and demographic characteristics, prevalence, and prescribed medications. Of 2 625 963 adults and children in the sample, 606 064 adults (23.1%) with CKD had a median (interquartile range [IQR]) age of 70 (59-81) years, with 338 785 women (55.9%) and 434 474 non-Latino white individuals (71.7%). A total of 12 591 children (0.4%) with CKD had a median (IQR) age of 6 (1-13) years, with 7079 girls (56.2%) and 6653 non-Latino white children (52.8%). Median (IQR) estimated glomerular filtration rate was 53 (41-61) mL/min/1.73 m2 among adults and 70 (50-95) mL/min/1.73 m2 in children. Prevalence rates for CKD in adults were 4.8% overall (606 064 of 12 669 700) with 1.6% (93 644 of 6 011 129) during 2006 to 2009, 5.7% (393 455 of 6 903 084) during 2010 to 2013, and 8.4% (683 574 of 8 179 860) during 2014 to 2017 (P < .001). A total of 226 693 patients (37.4%) had category 3a CKD; 100 239 (16.5%), category 3b CKD; 39 125 (6.5%), category 4 CKD; and 20 328 (3.4%), category 5 CKD. Among adults with CKD, albuminuria and proteinuria assessments were available in 52 551 (8.7%) and 25 035 (4.1%) patients, respectively. A renin-angiotensin system inhibitor was prescribed to 124 575 patients (20.6%), and 204 307 (33.7%) received nonsteroidal anti-inflammatory drugs or proton pump inhibitors. Of 1 973 258 adults (75.1%) at risk, one-quarter had diabetes or prediabetes (512 299 [26.0%]), nearly half had hypertension (955 812 [48.4%]), and one-quarter had both hypertension and diabetes or prediabetes (505 147 [25.6%]). This registry-based cohort study revealed a burgeoning number of patients with CKD and its major risk factors. Rates of identification and use of kidney protective agents were low, while potential nephrotoxin use was widespread, underscoring the pressing need for practice-based improvements in CKD prevention, recognition, and treatment.

Low serum testosterone levels and the incidence of chronic kidney disease among male adults: A prospective population-based study.

Despite existing evidence regarding the role of testosterone as a protective factor for the kidney function in male adults, there are conflicting and inconclusive results on the influence of testosterone deficiency on developing chronic kidney disease (CKD). This study aimed to investigate the incidence and hazard ratio of CKD among male adults with low testosterone levels compared to controls with normal testosterone levels. During a 15-year follow-up study, a total of 1277 eligible male adults aged 20-80year consisting of 605 males with low testosterone levels (< 350ng/dL) and 672 controls with normal levels participating in the Tehran Lipid and Glucose Study were recruited. Cox's proportional hazards models were applied to estimate hazard ratios of CKD between the groups after adjusting for confounders. The total cumulative incidence rate of CKD at the median follow-up time of approximately 11.2years was 21/1000 (95% CI: 18/1000, 25/1000) and 18/1000 (95% CI: 16/1000, 22/1000) in the low and normal testosterone groups, respectively (P=.2). The multivariate Cox model adjusted for age, body mass index, dyslipidemia, hypertension, diabetes, and smoking showed that HR of developing CKD in the male adults with low testosterone levels was significantly higher than those with normal levels (HR=1.38; 95% CI: 1.05, 1.80). This study shows a higher hazard ratio of CKD progression in male adults with hypogonadism compared to those with normal levels in their later life. Therefore, timely diagnosis and treatment of kidney diseases in hypogonadal men can prevent the morbidity and mortality from CKD.

Chronic Kidney Disease Is Under-Screened in SCD and Mild Albuminuria Is Associated with a Drop in Hemoglobin: A Report from the Grndad Sickle Cell Registry

The Globin Research Network for Data and Discovery (GRNDaD) is a combined effort, from 6 US clinical sites (Baltimore, Cleveland, Columbus OH, Milwaukee, Oakland, and The Bronx) that care for people with sickle cell disease (SCD), to improve care through shared data collection and review and quality improvement. Using a single IRB-Reliant protocol, we have assembled harmonized baseline and annual data on 758 adults with sickle cell disease (41.7% male and 58.3% female, mean age 35.5), collected on a REDCap server housed at Johns Hopkins. For this study, we reviewed adherence to the 2014 NHLBI Guidelines on the management of SCD -- which recommends annual screening for chronic kidney disease (CKD) by testing for albuminuria or proteinuria in anyone over the age of 10 with sickle cell disease. To evaluate whether subjects had an annual visit in any given year we used the recording of a well visit hemoglobin. Of the 758 adults in the study 411 had at least one year of follow up data marked as completed. Among these 411 adults there were 826 distinct observations. Of these 826 observations, 137 observations among 85 subjects did not have any hemoglobin lab drawn, suggesting that they did not have a well outpatient visit during that year. Amongst the observation years, where a well hemoglobin was performed, yearly screening for albuminuria occurred in 37.4% (258/689) of annual observations. There was an association between having screening for CKD and site of care (p&lt;.0001), with some sites having adhered to guidelines in 34.2% of observation years and others having adhered 75.9% of years. There was no association between adherence and genotype or sex. Albuminuria was associated with a clinical phenotype. A multi-variable linear mixed effects model controlling for age and gender with a randomly varying intercept based on the subject, excluding chronically transfused subjects, and stratified by sickle cell anemia (HbSS or HbSB0, SCA) or variant genotypes was used. There was a significant association in those with SCA between the presence of albuminuria between 30 and 300, level (A2) and hemoglobin. Hemoglobin levels were, on average, 0.79 g/dL lower in those with albuminuria between 30-300 when compared to those with no albuminuria (A1, P=0.005). For those with SCA and albuminuria greater than 300 (A3), the sample size was small (n=28) and hemoglobin levels were 0.61 g/dl lower compared to those without albuminuria but this was not statistically significant (p=0.12). For those with variant compound heterozygous SCD and A2 albuminuria, hemoglobin levels were not statistically significantly different from those without albuminuria. However, high-grade albuminuria (A3) was associated with hemoglobin levels which were, on average, 1.86 g/dL lower than those in group A1 (P=0.004). Interestingly, the association between reduced hemoglobin and albuminuria was seen in both variant and SCA genotypes in the context of a preserved creatinine (&lt;1.0 mg/dL). Using a multisite registry we demonstrate the need to develop strategies to assist providers and patients with adherence to guideline based recommendations for routine screening for chronic kidney disease in adults with SCD. The early association of albuminuria with worsening anemia, even in the absence of elevated creatinine levels, suggests an added urgency to screening. The causality of the association remains unclear but emphasizes the need for longitudinally followed cohorts that might help us understand the relationship between anemia and the development of CKD. Figure Disclosures Manwani: Novartis: Consultancy; Pfizer: Consultancy; GBT: Consultancy, Research Funding. Desai:Novartis: Research Funding; Pfizer: Membership on an entity's Board of Directors or advisory committees, Research Funding; University of Pittsburgh: Research Funding; Ironwood: Other: Adjudication Board; Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees, Research Funding; Potomac: Speakers Bureau. Field:Ironwood: Consultancy, Research Funding; Rigel: Research Funding; Prolong: Research Funding; Incyte: Research Funding. Neumayr:La Jolla Pharmaceuticals: Research Funding; Pfizer: Consultancy, Research Funding; Bayer: Consultancy; CTD Holdings: Consultancy; CDC: Research Funding; Celgene: Research Funding; Imara: Research Funding; NHLBI: Research Funding; Sangamo: Research Funding; HRSA: Research Funding; GBT: Research Funding; Emmaus: Consultancy; Apopharma: Consultancy; Sancillo: Research Funding; Novartis: Research Funding; Bluebird Bio: Research Funding; Silarus: Research Funding; Terumo: Research Funding; PCORI: Research Funding; Doris Duke Foundation: Research Funding; Seattle Children's Research Grants: Research Funding. Clay:Novartis: Speakers Bureau. Cong:Global Blood Therapeutics: Employment, Equity Ownership. Agodoa:Global Blood Therapeutics: Employment, Equity Ownership. Hoppe:Global Blood Therapeutics: Employment, Equity Ownership. Lanzkron:PCORI: Research Funding; Pfizer: Research Funding; Global Blood Therapeutics: Research Funding; Ironwood: Research Funding; HRSA: Research Funding; NIH: Research Funding. Little:Hemex Health, Inc.: Patents &amp; Royalties; GBT: Research Funding.

Metabolic abnormalities, but not obesity per se, associated with chronic kidney disease in a Taiwanese population

Background and aimsIt is inconclusive whether obesity itself or metabolic abnormalities are linked to chronic kidney disease (CKD). The aim of this study was to examine the association between different subtypes of obesity and metabolic abnormalities with CKD in adults. Methods and resultsThis study enrolled 14,983 eligible subjects stratified into metabolically healthy normal weight (MHNW), metabolically healthy overweight (MHOW), metabolically healthy obesity (MHO), metabolically unhealthy normal weight (MUNW), metabolically unhealthy overweight (MUOW), and metabolically unhealthy obesity (MUO) according to body mass index and metabolic syndrome status (ATP-III criteria). The metabolic healthy phenotype was defined as the absence of both metabolic syndrome and any known diabetes, coronary artery disease, stroke, hypertension or dyslipidemia. Early and advanced CKD were defined as eGFR<60, proteinuria, or structural abnormalities as detected by renal sonography. The prevalence of CKD was 2.5, 3.0, 4.0, 10.6, 9.5, and 10.5% in subjects with MHNW, MHOW, MHO, MUNW, MUOW, and MUO, respectively. In the multivariate analysis, the MUNW (OR:2.22, P < 0.001), MUOW (OR:2.22, P < 0.001), and MUO (OR:2.45, P < 0.001) groups were associated with early CKD. For advanced CKD, the OR was 2.56 (P < 0.001), 2.31 (P < 0.001), and 3.49 (P < 0.001) in the MUNW, MUOW, and MUO groups, respectively. The associated risks of early and advanced CKD were not significant in the MHOW and MHO group. MUOW and MUO were associated with higher risk of CKD compared with MHOW and MHO after adjusting other variables. ConclusionsMetabolic abnormalities, but neither overweight nor obesity, were associated with a higher risk of CKD in adults.

Effects of antihypertensives, lipid-modifying drugs, glycaemic control drugs and sodium bicarbonate on the progression of stages 3 and 4 chronic kidney disease in adults: a systematic review and meta-analysis

ObjectiveTo evaluate the effects of drug interventions that may modify the progression of chronic kidney disease (CKD) in adults with CKD stages 3 and 4.DesignSystematic review and meta-analysis.MethodsSearching MEDLINE, EMBASE,...

Low Birth Weight and Kidney Function in Middle-Aged Men and Women: The Netherlands Epidemiology of Obesity Study

Chronic kidney disease (CKD), defined as estimated glomerular filtration rate (eGFR)<60mL/min/1.73m2, is a risk factor for cardiovascular morbidity and mortality. Little is known about low birth weight and risk for CKD in middle-aged adults in the general population. We estimated the causal association between birth weight and eGFR in a Dutch cohort of middle-aged men and women. Retrospective cohort study. 6,671 participants in the Netherlands Epidemiology of Obesity (NEO) Study. Replication study using data for 133,814 participants studied by the CKDGen consortium. Birth weight was self-reported and also based on an instrumental variable, 59 birth weight-associated genetic variants, derived from an independent data source. eGFR at the age of 45 to 65 years. We assessed the association between self-reported birth weight and eGFR in the NEO Study using multivariable linear regression, adjusted for age, sex, education, smoking, and alcohol use. The effect of the instrument on eGFR was estimated using separate 2-sample Mendelian randomization analyses: one using individual data from the NEO cohort and one using summary data from the CKDGen consortium. At baseline, mean eGFR was 86±12.4 (SD) mL/min/1.73m2. After multivariable adjustment, self-reported birth weight was not associated with kidney function in middle age. Two-sample Mendelian randomization analysis showed that in the NEO cohort, for each 500-g lower birth weight defined using genetic variants, there was a 3.7 (95% CI, 0.5-6.9)-mL/min/1.73m2 lower eGFR at the age of 45 to 65 years. However, using CKDGen summary-level data, there was a smaller nonsignificant relationship between birth weight and eGFR. Birth weight was self-reported. Lower birth weight defined using genetic variants was associated with lower eGFRs in Dutch middle-aged adults. However, this finding was not replicated within the CKDGen consortium.